1
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Fisher BT, Blumenstock J, Boge CLK, Shuster S, Seif AE, Green M, Michaels MG, Alexander JL, Ardura MI, Miller TP, Hijano DR, Muller WJ, Schuster JE, Green AM, Dulek DE, Kajon AE, Danziger-Isakov L. Approach for defining human adenovirus infection and disease for central review adjudication in clinical studies. Pediatr Transplant 2024; 28:e14750. [PMID: 38623880 PMCID: PMC11031616 DOI: 10.1111/petr.14750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 02/14/2024] [Accepted: 03/22/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Pediatric allogeneic hematopoietic cell transplant (allo-HCT) recipients are at risk for morbidity and mortality from human adenovirus (HAdV). HAdV can be detected in an asymptomatic state, referred to as infection or with signs or symptoms of illness, referred to as disease. Standardized case definitions are needed to distinguish infection from disease and allow for consistent reporting in both observational cohort studies and therapeutic clinical trials. METHODS A working group of experts in virology, transplant infectious disease, and HCT was assembled to develop HAdV infection and disease definitions with the degree of certainty (i.e., possible, probable, and proven). Definitions were further refined through an iterative process and independently applied by two central review committees (CRCs) to 20 pediatric allo-HCT recipients with at least one HAdV-positive PCR. RESULTS Initial HAdV infection and disease definitions were developed and updated through an iterative process after reviewing clinical and virological details for 81 subjects with at least one positive HAdV PCR detected in a clinical specimen. Independent application of final definitions to 20 HAdV positive allo-HCT recipients by two CRCs yielded similar number of HAdV infection or disease events but with variation of degree of certainty for some events. CONCLUSIONS Application of definitions by a CRC for a study of HAdV infection and disease is feasible and can provide consistency in the assignment of outcomes. Definitions need further refinement to improve reproducibility and to provide guidance on determining clinical improvement or worsening after initial diagnosis of HAdV infection or disease.
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Affiliation(s)
- Brian T. Fisher
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA
| | - Jesse Blumenstock
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Craig L. K. Boge
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sydney Shuster
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alix E. Seif
- Section of of Cellular Therapy and Transplantation in the Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael Green
- Division of Infectious Diseases, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Marian G. Michaels
- Division of Infectious Diseases, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Jessie L. Alexander
- Division of Pediatric Stem Cell Transplantation and Cellular Therapies, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Monica I. Ardura
- Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University, Columbus, OH, USA
| | - Tamara P. Miller
- Children’s Healthcare of Atlanta, Atlanta, GA, USA
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - William J. Muller
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Abby M. Green
- Washington University School of Medicine, St. Louis, MO, USA
| | - Daniel E. Dulek
- Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Adriana E. Kajon
- Infectious Disease Program, Lovelace Biomedical Research Institute, Albuquerque, NM, USA
| | - Lara Danziger-Isakov
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati, Cincinnati, OH, USA
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Ahmed A, Munoz FM, Muller WJ, Agwu A, Kimberlin DW, Galli L, Deville JG, Sue PK, Mendez-Echevarria A, Humeniuk R, Guo S, Rodriguez L, Han D, Hedskog C, Maxwell H, Palaparthy R, Kersey K, Rojo P. Remdesivir for COVID-19 in Hospitalized Children: A Phase 2/3 Study. Pediatrics 2024; 153:e2023063775. [PMID: 38332740 DOI: 10.1542/peds.2023-063775] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES Remdesivir decreases the risk of SARS-CoV-2 infection progressing to severe disease in adults. This study evaluated remdesivir safety and pharmacokinetics in infants and children. METHODS This was a phase 2/3, open-label trial in children aged 28 days to 17 years hospitalized for polymerase chain reaction-confirmed SARS-CoV-2 infection. Participants received for ≤10 days once-daily intravenous remdesivir doses defined using physiologically based pharmacokinetic modeling (for ≥40 kg, 200 mg day 1, then 100 mg/day; for age ≥28 days and ≥3 to <40 kg, 5 mg/kg day 1, then 2.5 mg/kg/day). Sparse pharmacokinetic samples were analyzed using population-pharmacokinetic approaches for remdesivir and metabolites GS-704277 and GS-441524. RESULTS Among 53 participants, at enrollment the median (Q1, Q3) number of days of COVID-19 symptoms was 5 (3, 7) and hospitalization was 1 (1, 3). Underlying conditions included obesity in 19 (37%), asthma in 11 (21%), and cardiac disorders in 11 (21%). Median duration of remdesivir treatment was 5 days (range, 1-10). Remdesivir treatment had no new apparent safety trends. Two participants discontinued treatment because of adverse events including elevated transaminases; both had elevated transaminases at baseline. Three deaths occurred during treatment (and 1 after). When compared with phase 3 adult data, estimated mean pediatric parameters (area under the concentration-time curve over 1 dosing interval, AUCτ, Cmax, and Cτ) were largely overlapping but modestly increased (remdesivir, 33%-129%; GS-704277, 37%-124%; GS-441524, 0%-60%). Recovery occurred for 62% of participants on day 10 and 83% at last assessment. CONCLUSIONS In infants and children with COVID-19, the doses of remdesivir evaluated provided drug exposure similar to adult dosing. In this study with a small sample size, no new safety concerns were observed.
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Affiliation(s)
- Amina Ahmed
- Department of Pediatrics, Levine Children's Hospital at Atrium Health, Charlotte, North Carolina
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Flor M Munoz
- Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
- Texas Children's Hospital, Houston, Texas
| | - William J Muller
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Allison Agwu
- Division of Infectious Diseases, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Luisa Galli
- Department of Health Sciences, University of Florence; Pediatric Infectious Diseases Unit, Meyer Children's University Hospital, IRCCS, Florence, Italy
| | - Jaime G Deville
- Division of Infectious Diseases, Department of Pediatrics, University of California, Los Angeles, California
| | - Paul K Sue
- Division of Infectious Diseases, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ana Mendez-Echevarria
- Servicio de Pediatría, Enfermedades Infecciosas y Tropicales, Hospital Universitario La Paz, Madrid, Spain
- Centro de Investigación en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Susan Guo
- Gilead Sciences, Inc., Foster City, California
| | | | - Dong Han
- Gilead Sciences, Inc., Foster City, California
| | | | | | | | | | - Pablo Rojo
- Hospital Universitario12 de Octubre, Madrid, Spain
- Instituto de Investigación 12 de Octubre, Madrid, Spain
- Universidad Complutense, Madrid, Spain
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3
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Dagan R, Hammitt LL, Seoane Nuñez B, Baca Cots M, Bosheva M, Madhi SA, Muller WJ, Zar HJ, Chang Y, Currie A, Grenham A, Shroff M, Takas T, Mankad VS, Leach A, Villafana T. Infants Receiving a Single Dose of Nirsevimab to Prevent RSV Do Not Have Evidence of Enhanced Disease in Their Second RSV Season. J Pediatric Infect Dis Soc 2024; 13:144-147. [PMID: 38219024 PMCID: PMC10896255 DOI: 10.1093/jpids/piad113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/08/2024] [Indexed: 01/15/2024]
Abstract
To characterize nirsevimab in the prevention of RSV, children from the Phase 3 MELODY trial were followed through their second RSV season. No increase in medically attended RSV lower respiratory tract infections or evidence of antibody-dependent enhancement of infection or disease severity was found for nirsevimab vs placebo recipients. Clinical Trial Registration: Clinicaltrials.gov, NCT03979313, https://clinicaltrials.gov/ct2/show/NCT03979313.
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Affiliation(s)
- Ron Dagan
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences at the Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Laura L Hammitt
- Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Beatriz Seoane Nuñez
- Biometrics, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Madrid, Spain
| | | | - Miroslava Bosheva
- Paediatrics, University Multiprofile, Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - William J Muller
- Infectious Diseases, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
- Stanley Manne Children’s Research Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross Children’s Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Yue Chang
- Clinical Development, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Alexander Currie
- Clinical Development, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Amy Grenham
- Clinical Development, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Manish Shroff
- Patient Safety, Chief Medical Office, R&D, AstraZeneca, Waltham, Massachusetts, USA
| | - Therese Takas
- Clinical Development, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Vaishali S Mankad
- Clinical Development, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Durham, North Carolina, USA
| | - Amanda Leach
- Clinical Development, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Tonya Villafana
- Clinical Development, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
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4
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Moss JE, Muller WJ. BK virus-associated hemorrhagic cystitis in pediatric stem cell transplantation: a case report and scoping review. Front Pediatr 2024; 11:1267678. [PMID: 38406625 PMCID: PMC10884191 DOI: 10.3389/fped.2023.1267678] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/29/2023] [Indexed: 02/27/2024] Open
Abstract
Introduction BK virus-associated hemorrhagic cystitis (BK-HC) is a debilitating and poorly understood complication of hematopoietic stem cell transplantation (SCT). Hematuria, dysuria, and other symptoms associated with BK-HC are common in the immediate post-SCT period, making BK-HC difficult to distinguish from other conditions presenting with these symptoms. Despite published criteria for diagnosis, the degree to which these criteria are consistently applied to either clinical diagnosis or to studies informing BK-HC management is unclear. We present a case of BK-HC in a pediatric SCT recipient, and discuss the challenges associated with treatment in the absence of rigorous data to inform clinical management. Methods We reviewed all cases of BK viruria at our center in patients undergoing SCT between January 2015 and December 2019. We then performed a scoping review of publications in PubMed addressing BK-HC, specifically focusing on how BK-HC was defined. Publications using the keywords "BK polyomavirus" and "hemorrhagic cystitis" were included if they involved a clinical study of SCT recipients and a full-text article was available in English. Case reports were excluded. Analysis focused on whether BK-HC was explicitly defined and whether the definition incorporated elements of diagnostic criteria published by European Conference on Infections in Leukemia (ECIL). Results A total of 30 studies published between January 2018 and 30 June 2021 met criteria for review, including 4 clinical trials, 7 prospective observational studies, and 19 retrospective observational studies. Fifteen of these studies included pediatric patients (7 pediatric only, 8 combined adult and pediatric). Of the 30 publications, 19 included a definition of either BK-HC or BK cystitis, with only five using ECIL criteria, all of which were observational studies. Multiple interventions are described for treatment of BK-HC, including cidofovir, leflunomide, quinolones, hyperbaric oxygen, keratinocyte growth factor, and BK-specific cytotoxic T lymphocytes. However, evidence to support efficacy for any of these interventions is lacking. Discussion Although BK-HC is a well-known complication of SCT, evidence to support available treatment options is limited. Well-controlled studies that incorporate clear diagnostic criteria are needed to better define the risk factors, natural history, and ideal interventions.
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Affiliation(s)
- Julia E. Moss
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - William J. Muller
- Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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5
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Dankner M, Maritan SM, Priego N, Kruck G, Nkili-Meyong A, Nadaf J, Zhuang R, Annis MG, Zuo D, Nowakowski A, Biondini M, Kiepas A, Mourcos C, Le P, Charron F, Inglebert Y, Savage P, Théret L, Guiot MC, McKinney RA, Muller WJ, Park M, Valiente M, Petrecca K, Siegel PM. Invasive growth of brain metastases is linked to CHI3L1 release from pSTAT3-positive astrocytes. Neuro Oncol 2024:noae013. [PMID: 38271182 DOI: 10.1093/neuonc/noae013] [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: 04/19/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Compared to minimally invasive brain metastases (MI BrM), highly invasive (HI) lesions form abundant contacts with cells in the peritumoral brain parenchyma and are associated with poor prognosis. Reactive astrocytes (RAs) labeled by phosphorylated STAT3 (pSTAT3) have recently emerged as a promising therapeutic target for BrM. Here, we explore whether BrM invasion pattern is influenced by pSTAT3+ RAs and may serve as a predictive biomarker for STAT3 inhibition. METHODS We used immunohistochemistry to identify pSTAT3+ RAs in HI and MI human and patient-derived xenograft (PDX) BrM. Using PDX, syngeneic, and transgenic mouse models of HI and MI BrM, we assessed how pharmacological STAT3 inhibition or RA-specific STAT3 genetic ablation affected BrM growth in vivo. Cancer cell invasion was modeled in vitro using a brain slice-tumor co-culture assay. We performed single-cell RNA sequencing of human BrM and adjacent brain tissue. RESULTS RAs expressing pSTAT3 are situated at the brain-tumor interface and drive BrM invasive growth. HI BrM invasion pattern was associated with delayed growth in the context of STAT3 inhibition or genetic ablation. We demonstrate that pSTAT3+ RAs secrete Chitinase 3-like-1 (CHI3L1), which is a known STAT3 transcriptional target. Furthermore, single-cell RNA sequencing identified CHI3L1-expressing RAs in human HI BrM. STAT3 activation, or recombinant CHI3L1 alone, induced cancer cell invasion into the brain parenchyma using a brain slice-tumor plug co-culture assay. CONCLUSIONS Together, these data reveal that pSTAT3+ RA-derived CHI3L1 is associated with BrM invasion, implicating STAT3 and CHI3L1 as clinically relevant therapeutic targets for the treatment of HI BrM.
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Affiliation(s)
- Matthew Dankner
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montreal, QC, Canada
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, QC, Canada
| | - Sarah M Maritan
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montreal, QC, Canada
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, QC, Canada
| | - Neibla Priego
- Brain Metastasis Group, Spanish National Cancer Research Center (CNIO), Madrid, Spain
| | - Georgia Kruck
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montreal, QC, Canada
| | - Andriniaina Nkili-Meyong
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Montreal Neurological Institute-Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Javad Nadaf
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Montreal Neurological Institute-Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Rebecca Zhuang
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Matthew G Annis
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montreal, QC, Canada
| | - Dongmei Zuo
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montreal, QC, Canada
| | - Alexander Nowakowski
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montreal, QC, Canada
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, QC, Canada
| | - Marco Biondini
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montreal, QC, Canada
| | - Alexander Kiepas
- Cell Biology Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - Caitlyn Mourcos
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montreal, QC, Canada
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, QC, Canada
| | - Phuong Le
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Montreal Neurological Institute-Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Francois Charron
- Department of Pharmacology, McGill University, Montreal, QC, Canada
| | - Yanis Inglebert
- Department of Neurosciences, University of Montreal, Montreal, QC, Canada
| | - Paul Savage
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Louis Théret
- Research Institute of the University of Montreal (IRIC), Montreal, QC, Canada
| | - Marie-Christine Guiot
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Montreal Neurological Institute-Hospital, McGill University Health Centre, Montreal, QC, Canada
- Department of Pathology, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - R Anne McKinney
- Department of Pharmacology, McGill University, Montreal, QC, Canada
| | - William J Muller
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montreal, QC, Canada
- Department of Biochemistry, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Morag Park
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montreal, QC, Canada
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, QC, Canada
- Department of Pathology, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Department of Biochemistry, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Manuel Valiente
- Brain Metastasis Group, Spanish National Cancer Research Center (CNIO), Madrid, Spain
| | - Kevin Petrecca
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Montreal Neurological Institute-Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Peter M Siegel
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montreal, QC, Canada
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, QC, Canada
- Department of Biochemistry, Faculty of Medicine, McGill University, Montreal, QC, Canada
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6
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Kuang X, Salinger A, Benavides F, Muller WJ, Dent SYR, Koutelou E. USP22 overexpression fails to augment tumor formation in MMTV-ERBB2 mice but loss of function impacts MMTV promoter activity. PLoS One 2024; 19:e0290837. [PMID: 38236941 PMCID: PMC10796002 DOI: 10.1371/journal.pone.0290837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/15/2023] [Indexed: 01/22/2024] Open
Abstract
The Ubiquitin Specific Peptidase 22 (USP22), a component of the Spt-Ada-Gcn5 Acetyltransferase (SAGA) histone modifying complex, is overexpressed in multiple human cancers, but how USP22 impacts tumorigenesis is not clear. We reported previously that Usp22 loss in mice impacts execution of several signaling pathways driven by growth factor receptors such as erythroblastic oncogene B b2 (ERBB2). To determine whether changes in USP22 expression affects ERBB2-driven tumorigenesis, we introduced conditional overexpression or deletion alleles of Usp22 into mice bearing the Mouse mammary tumor virus-Neu-Ires-Cre (MMTV-NIC) transgene, which drives both rat ERBB2/NEU expression and Cre recombinase activity from the MMTV promoter resulting in mammary tumor formation. We found that USP22 overexpression in mammary glands did not further enhance primary tumorigenesis in MMTV-NIC female mice, but increased lung metastases were observed. However, deletion of Usp22 significantly decreased tumor burden and increased survival of MMTV-NIC mice. These effects were associated with markedly decreased levels of both Erbb2 mRNA and protein, indicating Usp22 loss impacts MMTV promoter activity. Usp22 loss had no impact on ERBB2 expression in other settings, including MCF10A cells bearing a Cytomegalovirus (CMV)-driven ERBB2 transgene or in human epidermal growth factor receptor 2 (HER2)+ human SKBR3 and HCC1953 cells. Decreased activity of the MMTV promoter in MMTV-NIC mice correlated with decreased expression of known regulatory factors, including the glucocorticoid receptor (GR), the progesterone receptor (PR), and the chromatin remodeling factor Brahma-related gene-1 (BRG1). Together our findings indicate that increased expression of USP22 does not augment the activity of an activated ERBB2/NEU transgene but impacts of Usp22 loss on tumorigenesis cannot be assessed in this model due to unexpected effects on MMTV-driven Erbb2/Neu expression.
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Affiliation(s)
- Xianghong Kuang
- Department of Epigenetics and Molecular Carcinogenesis, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
- Center for Cancer Epigenetics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Andrew Salinger
- Department of Epigenetics and Molecular Carcinogenesis, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
- Center for Cancer Epigenetics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Fernando Benavides
- Department of Epigenetics and Molecular Carcinogenesis, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
- Center for Cancer Epigenetics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - William J. Muller
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montreal, Canada
- Department of Biochemistry, McGill University, Montreal, Canada
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Sharon Y. R. Dent
- Department of Epigenetics and Molecular Carcinogenesis, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
- Center for Cancer Epigenetics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
- The University of Texas MD Anderson Cancer Center/UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX, United States of America
| | - Evangelia Koutelou
- Department of Epigenetics and Molecular Carcinogenesis, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
- Center for Cancer Epigenetics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
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7
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Goyette MA, Duhamel S, Aubert L, Pelletier A, Savage P, Thibault MP, Johnson RM, Carmeliet P, Basik M, Gaboury L, Muller WJ, Park M, Roux PP, Gratton JP, Côté JF. The Receptor Tyrosine Kinase AXL Is Required at Multiple Steps of the Metastatic Cascade during HER2-Positive Breast Cancer Progression. Cell Rep 2023; 42:113604. [PMID: 38100352 DOI: 10.1016/j.celrep.2023.113604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
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8
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Muller WJ, Jhaveri R, Heald-Sargent T, Macy ML, Heard-Garris N, Shah S, Paquette E. A pilot recruitment strategy to enhance ethical and equitable access to Covid-19 pediatric vaccine trials. Clin Trials 2023:17407745231217299. [PMID: 38140914 DOI: 10.1177/17407745231217299] [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: 12/24/2023]
Abstract
BACKGROUND/AIMS The SARS-CoV-2 pandemic disproportionately impacted communities with lower access to health care in the United States, particularly before vaccines were widely available. These same communities are often underrepresented in clinical trials. Efforts to ensure equitable enrollment of participants in trials related to treatment and prevention of Covid-19 can raise concerns about exploitation if communities with lower access to health care are targeted for recruitment. METHODS To enhance equity while avoiding exploitation, our site developed and implemented a three-part recruitment strategy for pediatric Covid-19 vaccine studies. First, we publicized a registry for potentially interested participants. Next, we applied public health community and social vulnerability indices to categorize the residence of families who had signed up for the registry into three levels to reflect the relative impact of the pandemic on their community: high, medium, and low. Finally, we preferentially offered study participation to interested families living in areas categorized by these indices as having high impact of the Covid-19 pandemic on their community. RESULTS This approach allowed us to meet goals for study recruitment based on public health metrics related to disease burden, which contributed to a racially diverse study population that mirrored the surrounding community demographics. While this three-part recruitment strategy improved representation of minoritized groups from areas heavily impacted by the Covid-19 pandemic, important limitations were identified that would benefit from further study. CONCLUSION Future use of this approach to enhance equitable access to research while avoiding exploitation should test different methods to build trust and communicate with underserved communities more effectively.
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Affiliation(s)
- William J Muller
- Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ravi Jhaveri
- Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Taylor Heald-Sargent
- Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michelle L Macy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Nia Heard-Garris
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Advanced General Pediatrics & Primary Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center, Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - Seema Shah
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Advanced General Pediatrics & Primary Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center, Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - Erin Paquette
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Pediatric Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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9
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Taifour T, Attalla SS, Zuo D, Gu Y, Sanguin-Gendreau V, Proud H, Solymoss E, Bui T, Kuasne H, Papavasiliou V, Lee CG, Kamle S, Siegel PM, Elias JA, Park M, Muller WJ. The tumor-derived cytokine Chi3l1 induces neutrophil extracellular traps that promote T cell exclusion in triple-negative breast cancer. Immunity 2023; 56:2755-2772.e8. [PMID: 38039967 DOI: 10.1016/j.immuni.2023.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/22/2023] [Accepted: 11/05/2023] [Indexed: 12/03/2023]
Abstract
In triple-negative breast cancer (TNBC), stromal restriction of CD8+ T cells associates with poor clinical outcomes and lack of responsiveness to immune-checkpoint blockade (ICB). To identify mediators of T cell stromal restriction, we profiled murine breast tumors lacking the transcription factor Stat3, which is commonly hyperactive in breast cancers and promotes an immunosuppressive tumor microenvironment. Expression of the cytokine Chi3l1 was decreased in Stat3-/- tumors. CHI3L1 expression was elevated in human TNBCs and other solid tumors exhibiting T cell stromal restriction. Chi3l1 ablation in the polyoma virus middle T (PyMT) breast cancer model generated an anti-tumor immune response and delayed mammary tumor onset. These effects were associated with increased T cell tumor infiltration and improved response to ICB. Mechanistically, Chi3l1 promoted neutrophil recruitment and neutrophil extracellular trap formation, which blocked T cell infiltration. Our findings provide insight into the mechanism underlying stromal restriction of CD8+ T cells and suggest that targeting Chi3l1 may promote anti-tumor immunity in various tumor types.
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Affiliation(s)
- Tarek Taifour
- McGill University, Division of Experimental Medicine, Department of Medicine, Faculty of Medicine, Montreal, QC H4A 3J1, Canada; Goodman Cancer Institute, Montreal, QC H3A 1A3, Canada
| | - Sherif Samer Attalla
- Goodman Cancer Institute, Montreal, QC H3A 1A3, Canada; McGill University, Department of Biochemistry, Faculty of Medicine, Montreal, QC H3A 1A3, Canada
| | - Dongmei Zuo
- Goodman Cancer Institute, Montreal, QC H3A 1A3, Canada
| | - Yu Gu
- Goodman Cancer Institute, Montreal, QC H3A 1A3, Canada; McGill University, Department of Biochemistry, Faculty of Medicine, Montreal, QC H3A 1A3, Canada
| | | | - Hailey Proud
- Goodman Cancer Institute, Montreal, QC H3A 1A3, Canada; McGill University, Department of Biochemistry, Faculty of Medicine, Montreal, QC H3A 1A3, Canada
| | - Emilie Solymoss
- McGill University, Division of Experimental Medicine, Department of Medicine, Faculty of Medicine, Montreal, QC H4A 3J1, Canada; Goodman Cancer Institute, Montreal, QC H3A 1A3, Canada
| | - Tung Bui
- Goodman Cancer Institute, Montreal, QC H3A 1A3, Canada
| | - Hellen Kuasne
- Goodman Cancer Institute, Montreal, QC H3A 1A3, Canada
| | | | - Chun Geun Lee
- Brown University, Molecular Biology and Immunology, Faculty of Medicine, Providence, RI 02903, USA
| | - Suchitra Kamle
- Brown University, Molecular Biology and Immunology, Faculty of Medicine, Providence, RI 02903, USA
| | - Peter M Siegel
- McGill University, Division of Experimental Medicine, Department of Medicine, Faculty of Medicine, Montreal, QC H4A 3J1, Canada; Goodman Cancer Institute, Montreal, QC H3A 1A3, Canada; McGill University, Department of Biochemistry, Faculty of Medicine, Montreal, QC H3A 1A3, Canada
| | - Jack A Elias
- Brown University, Molecular Biology and Immunology, Faculty of Medicine, Providence, RI 02903, USA
| | - Morag Park
- McGill University, Division of Experimental Medicine, Department of Medicine, Faculty of Medicine, Montreal, QC H4A 3J1, Canada; Goodman Cancer Institute, Montreal, QC H3A 1A3, Canada; McGill University, Department of Biochemistry, Faculty of Medicine, Montreal, QC H3A 1A3, Canada
| | - William J Muller
- McGill University, Division of Experimental Medicine, Department of Medicine, Faculty of Medicine, Montreal, QC H4A 3J1, Canada; Goodman Cancer Institute, Montreal, QC H3A 1A3, Canada; McGill University, Department of Biochemistry, Faculty of Medicine, Montreal, QC H3A 1A3, Canada.
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10
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Alisoltani A, Simons LM, Agnes MFR, Heald-Sargent TA, Muller WJ, Kociolek LK, Hultquist JF, Lorenzo-Redondo R, Ozer EA. Resurgence of SARS-CoV-2 Delta after Omicron variant superinfection in an immunocompromised pediatric patient. Virol J 2023; 20:246. [PMID: 37891657 PMCID: PMC10604949 DOI: 10.1186/s12985-023-02186-w] [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] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/18/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Persistent SARS-CoV-2 infection in immunocompromised hosts is thought to contribute to viral evolution by facilitating long-term natural selection and viral recombination in cases of viral co-infection or superinfection. However, there are limited data on the longitudinal intra-host population dynamics of SARS-CoV-2 co-infection/superinfection, especially in pediatric populations. Here, we report a case of Delta-Omicron superinfection in a hospitalized, immunocompromised pediatric patient. METHODS We conducted Illumina whole genome sequencing (WGS) for longitudinal specimens to investigate intra-host dynamics of SARS-CoV-2 strains. Topoisomerase PCR cloning of Spike open-reading frame and Sanger sequencing of samples was performed for four specimens to validate the findings. Analysis of publicly available SARS-CoV-2 sequence data was performed to investigate the co-circulation and persistence of SARS-CoV-2 variants. RESULTS Results of WGS indicate the patient was initially infected with the SARS-CoV-2 Delta variant before developing a SARS-CoV-2 Omicron variant superinfection, which became predominant. Shortly thereafter, viral loads decreased below the level of detection before resurgence of the original Delta variant with no residual trace of Omicron. After 54 days of persistent infection, the patient tested negative for SARS-CoV-2 but ultimately succumbed to a COVID-19-related death. Despite protracted treatment with remdesivir, no antiviral resistance mutations emerged. These results indicate a unique case of persistent SARS-CoV-2 infection with the Delta variant interposed by a transient superinfection with the Omicron variant. Analysis of publicly available sequence data suggests the persistence and ongoing evolution of Delta subvariants despite the global predominance of Omicron, potentially indicative of continued transmission in an unknown population or niche. CONCLUSION A better understanding of SARS-CoV-2 intra-host population dynamics, persistence, and evolution during co-infections and/or superinfections will be required to continue optimizing patient care and to better predict the emergence of new variants of concern.
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Affiliation(s)
- Arghavan Alisoltani
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL, 60611, USA
| | - Lacy M Simons
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL, 60611, USA
| | - Maria Francesca Reyes Agnes
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL, 60611, USA
| | | | - William J Muller
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA
| | - Larry K Kociolek
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA
| | - Judd F Hultquist
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL, 60611, USA
| | - Ramon Lorenzo-Redondo
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL, 60611, USA
| | - Egon A Ozer
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL, 60611, USA.
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11
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Wattier RL, Bucayu RFT, Boge CLK, Ross RK, Yildirim I, Zaoutis TE, Palazzi DL, Vora SB, Castagnola E, Avilés-Robles M, Danziger-Isakov L, Tribble AC, Sharma TS, Arrieta AC, Maron G, Berman DM, Yin DE, Sung L, Green M, Roilides E, Belani K, Romero J, Soler-Palacin P, López-Medina E, Nolt D, Bin Hussain IZ, Muller WJ, Hauger SB, Halasa N, Dulek D, Pong A, Gonzalez BE, Abzug MJ, Carlesse F, Huppler AR, Rajan S, Aftandilian C, Ardura MI, Chakrabarti A, Hanisch B, Salvatore CM, Klingspor L, Knackstedt ED, Lutsar I, Santolaya ME, Shuster S, Johnson SK, Steinbach WJ, Fisher BT. Adjunctive Diagnostic Studies Completed Following Detection of Candidemia in Children: Secondary Analysis of Observed Practice From a Multicenter Cohort Study Conducted by the Pediatric Fungal Network. J Pediatric Infect Dis Soc 2023; 12:487-495. [PMID: 37589394 PMCID: PMC10533205 DOI: 10.1093/jpids/piad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/11/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Adjunctive diagnostic studies (aDS) are recommended to identify occult dissemination in patients with candidemia. Patterns of evaluation with aDS across pediatric settings are unknown. METHODS Candidemia episodes were included in a secondary analysis of a multicenter comparative effectiveness study that prospectively enrolled participants age 120 days to 17 years with invasive candidiasis (predominantly candidemia) from 2014 to 2017. Ophthalmologic examination (OE), abdominal imaging (AbdImg), echocardiogram, neuroimaging, and lumbar puncture (LP) were performed per clinician discretion. Adjunctive diagnostic studies performance and positive results were determined per episode, within 30 days from candidemia onset. Associations of aDS performance with episode characteristics were evaluated via mixed-effects logistic regression. RESULTS In 662 pediatric candidemia episodes, 490 (74%) underwent AbdImg, 450 (68%) OE, 426 (64%) echocardiogram, 160 (24%) neuroimaging, and 76 (11%) LP; performance of each aDS per episode varied across sites up to 16-fold. Longer durations of candidemia were associated with undergoing OE, AbdImg, and echocardiogram. Immunocompromised status (58% of episodes) was associated with undergoing AbdImg (adjusted odds ratio [aOR] 2.38; 95% confidence intervals [95% CI] 1.51-3.74). Intensive care at candidemia onset (30% of episodes) was associated with undergoing echocardiogram (aOR 2.42; 95% CI 1.51-3.88). Among evaluated episodes, positive OE was reported in 15 (3%), AbdImg in 30 (6%), echocardiogram in 14 (3%), neuroimaging in 9 (6%), and LP in 3 (4%). CONCLUSIONS Our findings show heterogeneity in practice, with some clinicians performing aDS selectively, potentially influenced by clinical factors. The low frequency of positive results suggests that targeted application of aDS is warranted.
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Affiliation(s)
- Rachel L Wattier
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Robert F T Bucayu
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Craig L K Boge
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Rachael K Ross
- Department of Epidemiology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Inci Yildirim
- Department of Pediatrics, Yale University School of Medicine, Connecticut, USA
- Yale Institute for Global Health, Yale University, New Haven, Connecticut, USA
- Yale Center for Infection and Immunity, New Haven, Connecticut, USA
- Department of Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Theoklis E Zaoutis
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Debra L Palazzi
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas, USA
| | - Surabhi B Vora
- Department of Pediatrics, University of Washington, Division of Infectious Diseases, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Elio Castagnola
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Martha Avilés-Robles
- Department of Infectious Diseases, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Lara Danziger-Isakov
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alison C Tribble
- Division of Infectious Diseases, Department of Pediatrics, University of Michigan and C.S. Mott Children’s Hospital, Ann Arbor, Michigan, USA
| | - Tanvi S Sharma
- Division of Infectious Diseases, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Antonio C Arrieta
- Department of Infectious Diseases, Children’s Hospital of Orange County, Orange, California, USA
- Department of Pediatrics, University of California Irvine, Irvine, California, USA
| | - Gabriela Maron
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - David M Berman
- Division of Pediatric Infectious Diseases, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida, USA
| | - Dwight E Yin
- Department of Pediatrics, Children’s Mercy and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Michael Green
- Department of Pediatrics, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Pediatrics, Aristotle University and Hippokration Hospital, Thessaloniki, Greece
| | - Kiran Belani
- Pediatric Infectious Diseases, Children’s Minnesota, Minneapolis, Minnesota, USA
| | - José Romero
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pere Soler-Palacin
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Barcelona, Catalonia, Spain
| | - Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica, Clínica Imbanaco Grupo Quirónsalud and Universidad del Valle, Cali, Colombia
| | - Dawn Nolt
- Department of Pediatrics, Oregon Health and Science University and Doernbecher Children’s Hospital, Portland, Oregon, USA
| | - Ibrahim Zaid Bin Hussain
- Pediatric Infectious Diseases, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - William J Muller
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarmistha B Hauger
- Department of Pediatrics, University of Texas at Austin and Dell Children’s Medical Center, Austin, Texas, USA
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center and Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Daniel Dulek
- Department of Pediatrics, Vanderbilt University Medical Center and Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Alice Pong
- Department of Pediatrics, University of California San Diego and Rady Children’s Hospital San Diego, San Diego, California, USA
| | - Blanca E Gonzalez
- Center for Pediatric Infectious Diseases, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mark J Abzug
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Fabianne Carlesse
- Instituto de Oncologia Pediatrica–IOP/GRAACC-UNIFESP, São Paulo, Brazil
| | - Anna R Huppler
- Department of Pediatrics, Medical College of Wisconsin and Children’s Wisconsin, Milwaukee, Wisconsin, USA
| | - Sujatha Rajan
- Division of Pediatric Infectious Diseases, Cohen Children’s Medical Center, New Hyde Park, New York, USA
| | - Catherine Aftandilian
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Monica I Ardura
- Division of Infectious Diseases and Host Defense Program, Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University, Columbus, Ohio, USA
| | | | - Benjamin Hanisch
- Pediatric Infectious Diseases, Children’s National Health System, Washington, District of Columbia, USA
| | - Christine M Salvatore
- Division of Pediatric Infectious Diseases, Weill Cornell Medicine and Komansky Children’s Hospital, New York, New York, USA
| | - Lena Klingspor
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | | | - Irja Lutsar
- Department of Microbiology, University of Tartu, Tartu, Estonia
| | - Maria E Santolaya
- Hospital Dr. Luis Calvo Mackenna, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Sydney Shuster
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sarah K Johnson
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - William J Steinbach
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Brian T Fisher
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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12
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Attalla SS, Boucher J, Proud H, Taifour T, Zuo D, Sanguin-Gendreau V, Ling C, Johnson G, Li V, Luo RB, Kuasne H, Papavasiliou V, Walsh LA, Barok M, Joensuu H, Park M, Roux PP, Muller WJ. HER2Δ16 Engages ENPP1 to Promote an Immune-Cold Microenvironment in Breast Cancer. Cancer Immunol Res 2023; 11:1184-1202. [PMID: 37311021 DOI: 10.1158/2326-6066.cir-22-0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/07/2023] [Accepted: 06/09/2023] [Indexed: 06/15/2023]
Abstract
The tumor-immune microenvironment (TIME) is a critical determinant of therapeutic response. However, the mechanisms regulating its modulation are not fully understood. HER2Δ16, an oncogenic splice variant of the HER2, has been implicated in breast cancer and other tumor types as a driver of tumorigenesis and metastasis. Nevertheless, the underlying mechanisms of HER2Δ16-mediated oncogenicity remain poorly understood. Here, we show that HER2∆16 expression is not exclusive to the clinically HER2+ subtype and associates with a poor clinical outcome in breast cancer. To understand how HER2 variants modulated the tumor microenvironment, we generated transgenic mouse models expressing either proto-oncogenic HER2 or HER2Δ16 in the mammary epithelium. We found that HER2∆16 tumors were immune cold, characterized by low immune infiltrate and an altered cytokine profile. Using an epithelial cell surface proteomic approach, we identified ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) as a functional regulator of the immune cold microenvironment. We generated a knock-in model of HER2Δ16 under the endogenous promoter to understand the role of Enpp1 in aggressive HER2+ breast cancer. Knockdown of Enpp1 in HER2Δ16-derived tumor cells resulted in decreased tumor growth, which correlated with increased T-cell infiltration. These findings suggest that HER2Δ16-dependent Enpp1 activation associates with aggressive HER2+ breast cancer through its immune modulatory function. Our study provides a better understanding of the mechanisms underlying HER2Δ16-mediated oncogenicity and highlights ENPP1 as a potential therapeutic target in aggressive HER2+ breast cancer.
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Affiliation(s)
- Sherif Samer Attalla
- Department of Biochemistry, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Goodman Cancer Institute, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Jonathan Boucher
- Institute for Research in Immunology and Cancer, Université de Montréal, Montreal, Canada
| | - Hailey Proud
- Department of Biochemistry, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Goodman Cancer Institute, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Tarek Taifour
- Goodman Cancer Institute, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Department of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Dongmei Zuo
- Goodman Cancer Institute, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Virginie Sanguin-Gendreau
- Goodman Cancer Institute, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Chen Ling
- Goodman Cancer Institute, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Gabriella Johnson
- Department of Biochemistry, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Goodman Cancer Institute, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Vincent Li
- Department of Biochemistry, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Goodman Cancer Institute, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Robin B Luo
- Goodman Cancer Institute, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Department of Human Genetics, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Hellen Kuasne
- Goodman Cancer Institute, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Vasilios Papavasiliou
- Goodman Cancer Institute, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Logan A Walsh
- Goodman Cancer Institute, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Department of Human Genetics, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Mark Barok
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Heikki Joensuu
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Morag Park
- Department of Biochemistry, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Goodman Cancer Institute, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Department of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Philippe P Roux
- Institute for Research in Immunology and Cancer, Université de Montréal, Montreal, Canada
- Department of Pathology and Cell Biology, Université de Montréal, Montreal, Canada
| | - William J Muller
- Department of Biochemistry, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Goodman Cancer Institute, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Department of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
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13
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He Y, Goyette MA, Chapelle J, Boufaied N, Al Rahbani J, Schonewolff M, Danek EI, Muller WJ, Labbé DP, Côté JF, Lamarche-Vane N. CdGAP is a talin-binding protein and a target of TGF-β signaling that promotes HER2-positive breast cancer growth and metastasis. Cell Rep 2023; 42:112936. [PMID: 37552602 DOI: 10.1016/j.celrep.2023.112936] [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] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/10/2023] [Accepted: 07/20/2023] [Indexed: 08/10/2023] Open
Abstract
Epithelial-to-mesenchymal transition (EMT) plays a crucial role in metastasis, which is the leading cause of death in breast cancer patients. Here, we show that Cdc42 GTPase-activating protein (CdGAP) promotes tumor formation and metastasis to lungs in the HER2-positive (HER2+) murine breast cancer model. CdGAP facilitates intravasation, extravasation, and growth at metastatic sites. CdGAP depletion in HER2+ murine primary tumors mediates crosstalk with a Dlc1-RhoA pathway and is associated with a transforming growth factor β (TGF-β)-induced EMT transcriptional signature. CdGAP is positively regulated by TGF-β signaling during EMT and interacts with the adaptor talin to modulate focal adhesion dynamics and integrin activation. Moreover, HER2+ breast cancer patients with high CdGAP mRNA expression combined with a high TGF-β-EMT signature are more likely to present lymph node invasion. Our results suggest CdGAP as a candidate therapeutic target for HER2+ metastatic breast cancer by inhibiting TGF-β and integrin/talin signaling pathways.
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Affiliation(s)
- Yi He
- Cancer Research Program, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3J1, Canada; Department of Anatomy and Cell Biology, McGill University, Montréal, QC H3A 0C7, Canada
| | - Marie-Anne Goyette
- Institut de Recherches Cliniques de Montréal, Université de Montréal, Montréal, QC H2W 1R7, Canada
| | - Jennifer Chapelle
- Cancer Research Program, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3J1, Canada; Department of Anatomy and Cell Biology, McGill University, Montréal, QC H3A 0C7, Canada
| | - Nadia Boufaied
- Cancer Research Program, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - Jalal Al Rahbani
- Cancer Research Program, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3J1, Canada; Department of Anatomy and Cell Biology, McGill University, Montréal, QC H3A 0C7, Canada
| | - Maribel Schonewolff
- Cancer Research Program, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3J1, Canada; Department of Anatomy and Cell Biology, McGill University, Montréal, QC H3A 0C7, Canada
| | - Eric I Danek
- Cancer Research Program, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3J1, Canada; Department of Anatomy and Cell Biology, McGill University, Montréal, QC H3A 0C7, Canada
| | - William J Muller
- Rosalind and Morris Goodman Cancer Research Centre, McGill University, Montréal, QC H3A 1A3, Canada
| | - David P Labbé
- Cancer Research Program, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3J1, Canada; Department of Anatomy and Cell Biology, McGill University, Montréal, QC H3A 0C7, Canada; Division of Urology, Department of Surgery, McGill University, Montréal, QC H4A 3J1, Canada
| | - Jean-François Côté
- Department of Anatomy and Cell Biology, McGill University, Montréal, QC H3A 0C7, Canada; Institut de Recherches Cliniques de Montréal, Université de Montréal, Montréal, QC H2W 1R7, Canada
| | - Nathalie Lamarche-Vane
- Cancer Research Program, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3J1, Canada; Department of Anatomy and Cell Biology, McGill University, Montréal, QC H3A 0C7, Canada.
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14
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Liu L, Xiao B, Hirukawa A, Smith HW, Zuo D, Sanguin-Gendreau V, McCaffrey L, Nam AJ, Muller WJ. Ezh2 promotes mammary tumor initiation through epigenetic regulation of the Wnt and mTORC1 signaling pathways. Proc Natl Acad Sci U S A 2023; 120:e2303010120. [PMID: 37549258 PMCID: PMC10438390 DOI: 10.1073/pnas.2303010120] [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] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/22/2023] [Indexed: 08/09/2023] Open
Abstract
The regulation of gene expression through histone posttranslational modifications plays a crucial role in breast cancer progression. However, the molecular mechanisms underlying the contribution of histone modification to tumor initiation remain unclear. To gain a deeper understanding of the role of the histone modifier Enhancer of Zeste homology 2 (Ezh2) in the early stages of mammary tumor progression, we employed an inducible mammary organoid system bearing conditional Ezh2 alleles that faithfully recapitulates key events of luminal B breast cancer initiation. We showed that the loss of Ezh2 severely impairs oncogene-induced organoid growth, with Ezh2-deficient organoids maintaining a polarized epithelial phenotype. Transcriptomic profiling showed that Ezh2-deficient mammary epithelial cells up-regulated the expression of negative regulators of Wnt signaling and down-regulated genes involved in mTORC1 (mechanistic target of rapamycin complex 1) signaling. We identified Sfrp1, a Wnt signaling suppressor, as an Ezh2 target gene that is derepressed and expressed in Ezh2-deficient epithelium. Furthermore, an analysis of breast cancer data revealed that Sfrp1 expression was associated with favorable clinical outcomes in luminal B breast cancer patients. Finally, we confirmed that targeting Ezh2 impairs mTORC1 activity through an indirect mechanism that up-regulates the expression of the tumor suppressor Pten. These findings indicate that Ezh2 integrates the mTORC1 and Wnt signaling pathways during early mammary tumor progression, arguing that inhibiting Ezh2 or therapeutically targeting Ezh2-dependent programs could be beneficial for the treatment of early-stage luminal B breast cancer.
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Affiliation(s)
- Linshan Liu
- Rosalind and Morris Goodman Cancer Research Institute, McGill University, Montreal, QCH3A 1A3, Canada
- Department of Biochemistry, McGill University, Montreal, QCH3A 1A3, Canada
| | - Bin Xiao
- Rosalind and Morris Goodman Cancer Research Institute, McGill University, Montreal, QCH3A 1A3, Canada
- Department of Biochemistry, McGill University, Montreal, QCH3A 1A3, Canada
| | - Alison Hirukawa
- Rosalind and Morris Goodman Cancer Research Institute, McGill University, Montreal, QCH3A 1A3, Canada
- Department of Biochemistry, McGill University, Montreal, QCH3A 1A3, Canada
| | - Harvey W. Smith
- Rosalind and Morris Goodman Cancer Research Institute, McGill University, Montreal, QCH3A 1A3, Canada
| | - Dongmei Zuo
- Rosalind and Morris Goodman Cancer Research Institute, McGill University, Montreal, QCH3A 1A3, Canada
- Department of Biochemistry, McGill University, Montreal, QCH3A 1A3, Canada
| | - Virginie Sanguin-Gendreau
- Rosalind and Morris Goodman Cancer Research Institute, McGill University, Montreal, QCH3A 1A3, Canada
| | - Luke McCaffrey
- Department of Biochemistry, McGill University, Montreal, QCH3A 1A3, Canada
- Department of Medicine, McGill University, Montreal, QCH3A 1A3, Canada
- Department of Oncology, McGill University, Montreal, QCH3A0G4, Canada
| | - Alice Jisoo Nam
- Rosalind and Morris Goodman Cancer Research Institute, McGill University, Montreal, QCH3A 1A3, Canada
- Department of Biochemistry, McGill University, Montreal, QCH3A 1A3, Canada
| | - William J. Muller
- Rosalind and Morris Goodman Cancer Research Institute, McGill University, Montreal, QCH3A 1A3, Canada
- Department of Biochemistry, McGill University, Montreal, QCH3A 1A3, Canada
- Department of Medicine, McGill University, Montreal, QCH3A 1A3, Canada
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15
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Upadhyaya HP, Chien JY, Long AJ, Bohm MS, Kallewaard NL, Macpherson LF, Patel DR, Hufford MM, Krull CJ, Ang JY, Chen P, Muller WJ, Potts JA, Quinn T, Williams M. Pharmacokinetics, Efficacy, and Safety of a SARS-CoV-2 Antibody Treatment in Pediatric Participants: An Open-Label Addendum of a Placebo-Controlled, Randomized Phase 2/3 Trial. Infect Dis Ther 2023:10.1007/s40121-023-00832-y. [PMID: 37329415 PMCID: PMC10390421 DOI: 10.1007/s40121-023-00832-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/30/2023] [Indexed: 06/19/2023] Open
Abstract
INTRODUCTION Bamlanivimab and etesevimab (BAM + ETE) are monoclonal antibodies (mAbs) effective in reducing COVID-19-related hospitalizations and all-cause mortality in adult participants at increased risk for severe disease. We present pharmacokinetic (PK), efficacy, and safety results from pediatric participants (< 18 years of age) with COVID-19 who were treated with BAM + ETE. METHODS In an addendum to the phase 2/3 BLAZE-1 clinical trial (NCT04427501), pediatric participants received open-label weight-based dosing (WBD, n = 94) based on exposure-matching to the authorized dose of BAM + ETE in adult participants. For efficacy and safety assessments, placebo (n = 14) and BAM + ETE (n = 20)-treated adolescent participants (> 12 to < 18 years of age) from the BLAZE-1 trial were included in the overall pediatric population (N = 128). All participants had mild to moderate COVID-19 upon enrollment and ≥ 1 risk factor for severe COVID-19. The primary objective was to characterize the PK of BAM and ETE in the WBD population. RESULTS The median age of the participants was 11.2 years, 46.1% were female, 57.9% were Black/African American, and 19.7% were Hispanic/Latino. The area under the curve for BAM and ETE in the WBD population was similar to that previously observed in adults. There were no COVID-19-related hospitalizations or deaths. All adverse events (AE) except one were mild or moderate, with one participant reporting a serious AE. CONCLUSION WBD in pediatric participants achieved similar drug exposures compared to adult participants that received the authorized BAM + ETE dose. The pediatric efficacy and safety data were consistent with adults receiving mAbs for COVID-19. TRIAL REGISTRATION NUMBER NCT04427501.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jocelyn Y Ang
- Children's Hospital of Michigan, Detroit, MI, USA
- Central Michigan University, Mt Pleasant, MI, USA
| | - Peter Chen
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - William J Muller
- Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Timothy Quinn
- Sky Clinical Research Network Group, Ridgeland, MS, USA
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16
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Muller WJ, Madhi SA, Seoane Nuñez B, Baca Cots M, Bosheva M, Dagan R, Hammitt LL, Llapur CJ, Novoa JM, Saez Llorens X, Grenham A, Kelly EJ, Mankad VS, Shroff M, Takas T, Leach A, Villafana T. Nirsevimab for Prevention of RSV in Term and Late-Preterm Infants. N Engl J Med 2023; 388:1533-1534. [PMID: 37018470 DOI: 10.1056/nejmc2214773] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Affiliation(s)
| | - Shabir A Madhi
- University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | - Ron Dagan
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
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17
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Ciccolini E, Sabourin V, Patten D, Im YK, Hébert S, Muller WJ, Kleinman C, St-Pierre J, Ursini-Siegel J. Abstract 1279: Investigating the impact of PGC-1α-coupled metabolic reprogramming on breast cancer metastasis. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-1279] [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: 04/07/2023]
Abstract
Abstract
Peroxisome proliferator-activated receptor γ coactivator 1 α (PGC-1α) is a transcriptional coactivator known to play a role in regulating cellular metabolism, contributing to pathways such as mitochondrial respiration, glutaminolysis, and lipogenesis. PGC-1α has been shown to promote cancer metastasis in mouse models of breast cancer while increasing both the global bioenergetic capacity and metabolic flexibility of breast cancer cells. However, the molecular mechanisms through which PGC-1α contributes to metabolic reprogramming to support breast cancer metastasis remain unknown. To address this, we have generated the first transgenic mouse model of breast cancer lacking PGC-1α expression specifically in the mammary epithelium (PGC-1α null), allowing us to examine how PGC-1α loss impacts breast cancer initiation, progression, and metastasis. While no significant differences were observed in tumour onset or growth between wild-type and PGC-1α null mice, lung metastatic burden was decreased in PGC-1α null mice. Ion pairing liquid chromatography-mass spectrometry was employed to measure steady state metabolite levels in mammary tumours collected from wild-type and PGC-1α null mice. By integrating our metabolomics data with RNA sequencing data from wild-type and PGC-1α null tumours, we identified potential deficits in glycolysis and aspartate metabolism in the context of mammary epithelial PGC-1α loss. Interestingly, RNA sequencing further revealed the downregulation of several genes involved in extracellular matrix remodelling in PGC-1α null tumours. Through immunohistochemistry, we further observed lower levels of α smooth muscle actin, a marker of cancer-associated fibroblasts, in PGC-1α null tumours compared with wild-type tumours. Overall, PGC-1α knockout impedes metastasis to the lung in mouse models of breast cancer. Moreover, our transgenic mouse model suggests possible cell intrinsic and extrinsic roles for PGC-1α expression, influencing breast cancer cell metabolism as well as fibroblast activation and extracellular matrix remodelling in the tumour microenvironment. By developing cell lines modeling PGC-1α overexpression or knockdown in luminal B, HER2+, and triple negative breast cancer, we will validate the findings from our transgenic mouse model and further elucidate how PGC-1α reprograms metabolism in breast cancer, how PGC-1α expression influences the tumour microenvironment, and how these mechanisms contribute to cancer cell invasion, anoikis-resistance, and metastasis.
Citation Format: Emma Ciccolini, Valérie Sabourin, David Patten, Young K. Im, Steven Hébert, William J. Muller, Claudia Kleinman, Julie St-Pierre, Josie Ursini-Siegel. Investigating the impact of PGC-1α-coupled metabolic reprogramming on breast cancer metastasis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1279.
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Affiliation(s)
| | - Valérie Sabourin
- 2Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | | | - Young K. Im
- 2Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Steven Hébert
- 2Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - William J. Muller
- 4Rosalind and Morris Goodman Cancer Institute, Montreal, Quebec, Canada
| | - Claudia Kleinman
- 2Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
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18
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Simões EAF, Madhi SA, Muller WJ, Atanasova V, Bosheva M, Cabañas F, Baca Cots M, Domachowske JB, Garcia-Garcia ML, Grantina I, Nguyen KA, Zar HJ, Berglind A, Cummings C, Griffin MP, Takas T, Yuan Y, Wählby Hamrén U, Leach A, Villafana T. Efficacy of nirsevimab against respiratory syncytial virus lower respiratory tract infections in preterm and term infants, and pharmacokinetic extrapolation to infants with congenital heart disease and chronic lung disease: a pooled analysis of randomised controlled trials. The Lancet Child & Adolescent Health 2023; 7:180-189. [PMID: 36634694 PMCID: PMC9940918 DOI: 10.1016/s2352-4642(22)00321-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND In a phase 2b trial and the phase 3 MELODY trial, nirsevimab, an extended half-life, monoclonal antibody against respiratory syncytial virus (RSV), protected healthy infants born preterm or at full term against medically attended RSV lower respiratory tract infection (LRTI). In the MEDLEY phase 2-3 trial in infants at higher risk for severe RSV infection, nirsevimab showed a similar safety profile to that of palivizumab. The aim of the current analysis was to assess the efficacy of nirsevimab using a weight-banded dosing regimen in infants born between 29 weeks gestational age and full term. METHODS Infants enrolled in the phase 2b and MELODY trials were randomised (2:1) to receive a single intramuscular injection of nirsevimab (infants weighing <5 kg received 50 mg; those weighing ≥5 kg received 100 mg) or placebo before the RSV season. Infants in MEDLEY were randomised (2:1) to receive one dose of nirsevimab (infants weighing <5 kg received 50 mg; those weighing ≥5 kg received 100 mg) followed by four monthly placebo doses, or five once-a-month intramuscular doses of palivizumab. We report a prespecified pooled efficacy analysis assessing the weight-banded dosing regimen proposed on the basis of the phase 2b and MELODY trials, in addition to extrapolated efficacy in infants with chronic lung disease, congenital heart disease, or extreme preterm birth (<29 weeks' gestational age) based on pharmacokinetic data from the phase 2-3 MEDLEY safety trial. For the pooled efficacy analysis, the primary endpoint was incidence of medically attended RSV LRTI through 150 days post-dose. The secondary efficacy endpoint was number of admissions to hospital for medically attended RSV LRTI. The incidence of very severe RSV LRTI was an exploratory endpoint, defined as cases of hospital admission for medically attended RSV LRTI that required supplemental oxygen or intravenous fluids. We also did a prespecified exploratory analysis of medically attended LRTI of any cause (in the investigator's judgement) and hospital admission for respiratory illness of any cause (defined as any upper respiratory tract infection or LRTI leading to hospital admission). Post hoc exploratory analyses of outpatient visits and antibiotic use were also done. Nirsevimab serum concentrations in MEDLEY were assessed using population pharmacokinetic methods and the pooled data from the phase 2b and MELODY trials. An exposure target was defined on the basis of an exposure-response analysis. To successfully demonstrate extrapolation, more than 80% of infants in MEDLEY had to achieve serum nirsevimab exposures at or above the predicted efficacious target. FINDINGS Overall, 2350 infants (1564 in the nirsevimab group and 786 in the placebo group) in the phase 2b and MELODY trials were included in the pooled analysis. Nirsevimab showed efficacy versus placebo with respect to the primary endpoint of medically attended RSV LRTI (19 [1%] nirsevimab recipients vs 51 [6%] placebo recipients; relative risk reduction [RRR] 79·5% [95% CI 65·9-87·7]). Consistent efficacy was shown for additional endpoints of RSV LRTI hospital admission (nine [1%] nirsevimab recipients vs 21 [3%] placebo recipients; 77·3% [50·3-89·7]) and very severe RSV (five [<1%] vs 18 [2%]; 86·0% [62·5-94·8]). Nirsevimab recipients had fewer hospital admissions for any-cause respiratory illness (RRR 43·8% [18·8-61·1]), any-cause medically attended LRTI (35·4% [21·5-46·9]), LRTI outpatient visits (41·9% [25·7-54·6]), and antibiotic prescriptions (23·6% [3·8-39·3]). Among infants with chronic lung disease, congenital heart disease, or extreme preterm birth in MEDLEY, nirsevimab serum exposures were similar to those found in the pooled data; exposures were above the target in more than 80% of the overall MEDLEY trial population (94%), including infants with chronic lung disease (94%) or congenital heart disease (80%) and those born extremely preterm (94%). INTERPRETATION A single dose of nirsevimab protected healthy infants born at term or preterm from medically attended RSV LRTI, associated hospital admission, and severe RSV. Pharmacokinetic data support efficacy extrapolation to infants with chronic lung disease, congenital heart disease, or extreme prematurity. Together, these data suggest that nirsevimab has the potential to change the landscape of infant RSV disease by reducing a major cause of infant morbidity and the consequent burden on caregivers, clinicians, and health-care providers. FUNDING AstraZeneca and Sanofi.
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Affiliation(s)
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - William J Muller
- Ann & Robert H Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Miroslava Bosheva
- University Multiprofile Hospital for Active Treatment Sv Georgi Medical University, Plovdiv, Bulgaria
| | | | | | | | | | | | - Kim A Nguyen
- Hospices Civils de Lyon, Neonatal Intensive Care Units and CIC 1407, Lyon, France
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross Children's Hospital, Cape Town, South Africa; SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Anna Berglind
- Biometrics, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Celeste Cummings
- Clinical Development, Vaccines & Immune Therapies, Biopharmaceuticals R&D, AstraZeneca, Durham, NC, USA
| | - M Pamela Griffin
- Clinical Development, Vaccines & Immune Therapies, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Therese Takas
- Clinical Development, Vaccines & Immune Therapies, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Yuan Yuan
- Biometrics, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Ulrika Wählby Hamrén
- Clinical Pharmacology and Quantitative Pharmacology, R&D, AstraZeneca, Gothenburg, Sweden
| | - Amanda Leach
- Clinical Development, Vaccines & Immune Therapies, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Tonya Villafana
- Clinical Development, Vaccines & Immune Therapies, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA.
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19
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Nandi I, Smith HW, Sanguin-Gendreau V, Ji L, Pacis A, Papavasiliou V, Zuo D, Nam S, Attalla SS, Kim SH, Lusson S, Kuasne H, Fortier AM, Savage P, Martinez Ramirez C, Park M, Katzenellenbogen JA, Katzenellenbogen BS, Muller WJ. Coordinated activation of c-Src and FOXM1 drives tumor cell proliferation and breast cancer progression. J Clin Invest 2023; 133:162324. [PMID: 36795481 PMCID: PMC10065076 DOI: 10.1172/jci162324] [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: 06/22/2022] [Accepted: 02/14/2023] [Indexed: 02/17/2023] Open
Abstract
Activation of the tyrosine kinase c-Src promotes breast cancer progression and poor outcomes, yet the underlying mechanisms are incompletely understood. Here, we show that deleting c-Src abrogates the activity of Forkhead Box M1 (FOXM1), a master transcriptional regulator of the cell cycle, in a genetically engineered model mimicking the Luminal B molecular subtype of breast cancer. By phosphorylating it on two tyrosine residues, c-Src stimulates the nuclear localization of FOXM1 and the expression of its target genes, including key regulators of G2-M cell cycle progression as well as c-Src itself. This positive feedback loop drives proliferation in genetically engineered and patient-derived models of Luminal B-like breast cancer. Targeting this mechanism, including through novel compounds that destabilize the FOXM1 protein, induces G2-M cell cycle arrest and apoptosis, blocking tumor progression and impairing metastasis. We identify a positive correlation between FOXM1 and c-Src expression in human breast cancer and show that the expression of FOXM1 target genes predicts poor outcomes and associates with the Luminal B subtype, which responds poorly to approved therapies. These findings indicate that a regulatory network centered on c-Src and FOXM1 is a targetable vulnerability in aggressive luminal breast cancers.
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Affiliation(s)
- Ipshita Nandi
- Goodman Cancer Institute, McGill University, Montreal, Canada
| | - Harvey W Smith
- Goodman Cancer Institute, McGill University, Montreal, Canada
| | | | - Linjia Ji
- Goodman Cancer Institute, McGill University, Montreal, Canada
| | - Alain Pacis
- Goodman Cancer Institute, McGill University, Montreal, Canada
| | | | - Dongmei Zuo
- Goodman Cancer Institute, McGill University, Montreal, Canada
| | - Stella Nam
- Goodman Cancer Institute, McGill University, Montreal, Canada
| | | | - Sung Hoon Kim
- Department of Chemistry, University of Illinois Urbana-Champaign, Urbana, United States of America
| | - Sierra Lusson
- Goodman Cancer Institute, McGill University, Montreal, Canada
| | - Hellen Kuasne
- Goodman Cancer Institute, McGill University, Montreal, Canada
| | | | - Paul Savage
- Goodman Cancer Institute, McGill University, Montreal, Canada
| | | | - Morag Park
- Goodman Cancer Institute, McGill University, Montreal, Canada
| | - John A Katzenellenbogen
- Department of Chemistry, University of Illinois Urbana-Champaign, Urbana, United States of America
| | - Benita S Katzenellenbogen
- Department of Molecular and Integrative Physiology, University of Illinois Urbana-Champaign, Urbana, United States of America
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Pardasani S, Dallas RH, Ross HS, Ferrolino JA, Fisher BT, Danziger-Isakov LA, Muller WJ, Maron G, Kitt E. 2162. Risk Factors Associated with Hospitalization among 0 to 21 Years Old Patients with Active Asthma/Active Airway Disease: Preliminary Findings from Multi-Center Study Across United States. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1782] [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: 12/23/2022] Open
Abstract
Abstract
Background
More data are needed to understand the risk for COVID-19 severity among pediatric asthma patients. We present findings from a national registry characterizing COVID-19 hospitalizations among pediatric asthma patients.
Methods
Data were obtained from the Pediatric COVID-19 US Registry, which included medical records of COVID-19 cases < 21 years old between March 2020 and May 2021. Those with asthma were eligible while immunocompromised and transplant cases were excluded. Descriptive statistics and chi-square tests were performed.
Results
Of the 1089 eligible asthma cases, half were 12 to 17 years old [Figure 1], the majority were male [Figure 2], a third Black African American [Figure 3], and most were Non-Hispanic/Latino 825 (76%). 242 (22%) reported a history of smoking.
A fourth of cases (257 (23.6%) were hospitalized for COVID-19. More than half (54%) reported asthma as their only pre-existing condition. The majority (n=71, 28%) were taking regular inhaled corticosteroids. Almost half (n=120, 47%) had abnormal chest radiographic findings, 20 (7.8%) had abnormal CT findings, and 24 (9%) progressed to lower respiratory infection. About 10% (n=25) needed mechanical ventilation. A third (n=88, 34%) required ICU care with 33% of those receiving inhaled corticosteroids. A quarter needed mechanical ventilation [Figure 5].
Compared to asthma patients not hospitalized for COVID-19, those hospitalized were significantly (P< 0.05) more likely to be non-Hispanic, havemultiple pre-existing conditions, and be obese [Figure 6]. Compared to those not admitted to ICU, ICU cases were significantly more likely to be obeseand be diagnosed with MIS-C [Figure 7].
Demographics
The majority of cases (N=479, 44%) were between 12 and 17 years old, Male (N=610,56%) and Black or African American (N=410, 38%).
Clinical Characteristics
Risk factors assessment
Conclusion
This is one of the first national studies examining COVID-19 among pediatric cases with asthma. Our data suggest that children with asthma who have multiple pre-existing conditions and/or are obese have a higher risk for hospitalization. These early data may aid clinicians in developing future prospective studies to understand COVID-19 risk among this vulnerable population.
Disclosures
Lara A. Danziger-Isakov, MD, Ansun BioPharma: Contracted clinical research|Astellas: Contracted clinical research|GSK: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Contracted clinical research|Pfizer: Contracted clinical research|Takeda: Grant/Research Support|Takeda: Contracted clinical research|Viracor: Grant/Research Support.
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Affiliation(s)
| | | | | | | | - Brian T Fisher
- Children's Hospital of Philadelphia , Philadelphia, Pennsylvania
| | | | - William J Muller
- Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | | | - Eimear Kitt
- Children's Hospital of Philadelphia , Philadelphia, Pennsylvania
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21
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Soneji M, Newman AM, Toia J, Muller WJ. Metronidazole for treatment of norovirus in pediatric transplant recipients. Pediatr Transplant 2022; 26:e14390. [PMID: 36087286 DOI: 10.1111/petr.14390] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/29/2022] [Accepted: 08/24/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Norovirus is a common cause of gastroenteritis in both immunocompetent and immunocompromised hosts. In transplant recipients, it can lead to prolonged shedding and chronic diarrhea. Treatment with nitazoxanide, oral immunoglobulin, or mammalian target of rapamycin inhibitors has shown varying degrees of benefit in case reports and case series. Prior studies have shown that the commensal gastrointestinal bacterial flora may influence the pathogenesis of norovirus infection. Metronidazole is often used to modulate gastrointestinal flora and was trialed in our hospital for norovirus in some immunocompromised patients after observing an association with anecdotal improvement. METHODS We retrospectively reviewed episodes of norovirus in the stool of 38 patients with a history of solid organ or stem cell transplantation between July 2014 and March 2019. RESULTS There were 85 positive norovirus tests among the 38 patients. In 25 of the 85 positive norovirus tests, nitazoxanide was given, with clinical improvement in 15 of these episodes (60%). Eight positive tests were treated with metronidazole alone, in all cases after a course of nitazoxanide had been used. Improvement was observed for 6 of these episodes (75%). CONCLUSION Further investigation of the use of metronidazole for norovirus gastroenteritis in transplant recipients is warranted.
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Affiliation(s)
- Maulin Soneji
- Loma Linda University School of Medicine, Loma Linda, California, USA
| | | | - Jacquie Toia
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - William J Muller
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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22
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Anderson EJ, Creech CB, Berthaud V, Piramzadian A, Johnson KA, Zervos M, Garner F, Griffin C, Palanpurwala K, Turner M, Gerber J, Bennett RL, Ali K, Ampajwala M, Berman G, Nayak J, Chronis C, Rizzardi B, Muller WJ, Smith CA, Fuchs G, Hsia D, Tomassini JE, DeLucia D, Reuter C, Kuter B, Zhao X, Deng W, Zhou H, Ramirez Schrempp D, Hautzinger K, Girard B, Slobod K, McPhee R, Pajon R, Aunins A, Das R, Miller JM, Schnyder Ghamloush S. Evaluation of mRNA-1273 Vaccine in Children 6 Months to 5 Years of Age. N Engl J Med 2022; 387:1673-1687. [PMID: 36260859 PMCID: PMC9634866 DOI: 10.1056/nejmoa2209367] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The safety, reactogenicity, immunogenicity, and efficacy of the mRNA-1273 coronavirus disease 2019 (Covid-19) vaccine in young children are unknown. METHODS Part 1 of this ongoing phase 2-3 trial was open label for dose selection; part 2 was an observer-blinded, placebo-controlled evaluation of the selected dose. In part 2, we randomly assigned young children (6 months to 5 years of age) in a 3:1 ratio to receive two 25-μg injections of mRNA-1273 or placebo, administered 28 days apart. The primary objectives were to evaluate the safety and reactogenicity of the vaccine and to determine whether the immune response in these children was noninferior to that in young adults (18 to 25 years of age) in a related phase 3 trial. Secondary objectives were to determine the incidences of Covid-19 and severe acute respiratory syndrome coronavirus 2 infection after administration of mRNA-1273 or placebo. RESULTS On the basis of safety and immunogenicity results in part 1 of the trial, the 25-μg dose was evaluated in part 2. In part 2, 3040 children 2 to 5 years of age and 1762 children 6 to 23 months of age were randomly assigned to receive two 25-μg injections of mRNA-1273; 1008 children 2 to 5 years of age and 593 children 6 to 23 months of age were randomly assigned to receive placebo. The median duration of follow-up after the second injection was 71 days in the 2-to-5-year-old cohort and 68 days in the 6-to-23-month-old cohort. Adverse events were mainly low-grade and transient, and no new safety concerns were identified. At day 57, neutralizing antibody geometric mean concentrations were 1410 (95% confidence interval [CI], 1272 to 1563) among 2-to-5-year-olds and 1781 (95% CI, 1616 to 1962) among 6-to-23-month-olds, as compared with 1391 (95% CI, 1263 to 1531) among young adults, who had received 100-μg injections of mRNA-1273, findings that met the noninferiority criteria for immune responses for both age cohorts. The estimated vaccine efficacy against Covid-19 was 36.8% (95% CI, 12.5 to 54.0) among 2-to-5-year-olds and 50.6% (95% CI, 21.4 to 68.6) among 6-to-23-month-olds, at a time when B.1.1.529 (omicron) was the predominant circulating variant. CONCLUSIONS Two 25-μg doses of the mRNA-1273 vaccine were found to be safe in children 6 months to 5 years of age and elicited immune responses that were noninferior to those in young adults. (Funded by the Biomedical Advanced Research and Development Authority and National Institute of Allergy and Infectious Diseases; KidCOVE ClinicalTrials.gov number, NCT04796896.).
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Affiliation(s)
- Evan J Anderson
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - C Buddy Creech
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Vladimir Berthaud
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Arin Piramzadian
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Kimball A Johnson
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Marcus Zervos
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Fredric Garner
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Carl Griffin
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Khozema Palanpurwala
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Mark Turner
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Jeffrey Gerber
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Richard L Bennett
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Kashif Ali
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Madhavi Ampajwala
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Gary Berman
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Jennifer Nayak
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Carey Chronis
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Barbara Rizzardi
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - William J Muller
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Christopher A Smith
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - George Fuchs
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Daniel Hsia
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Joanne E Tomassini
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Dianne DeLucia
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Caroline Reuter
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Barbara Kuter
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Xiaoping Zhao
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Weiping Deng
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Honghong Zhou
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Daniela Ramirez Schrempp
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Kelly Hautzinger
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Bethany Girard
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Karen Slobod
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Roderick McPhee
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Rolando Pajon
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Anne Aunins
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Rituparna Das
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Jacqueline M Miller
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
| | - Sabine Schnyder Ghamloush
- From the Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, and the Department of Pediatrics, Emory University School of Medicine, Atlanta (E.J.A.), and IResearch Atlanta, Decatur (K.A.J.) - all in Georgia; the Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center (C.B.C.), and Meharry Medical College (V.B.) - both in Nashville; OnSite Clinical Solutions, Charlotte, NC (A.P.); the Henry Ford Health System, Detroit (M.Z.); Pi-Coor Clinical Research, Burke, VA (F.G.); the Lynn Health Science Institute, Oklahoma City (C.G.); the Cyfair Clinical Research Center (K.P.) and the Texas Center for Drug Development (K.A.), Houston, and ACRC Trials, Frisco (M.A.) - all in Texas; Velocity Clinical Research, Meridian, ID (M.T.); Children's Hospital of Philadelphia Clinical Research Partners, Philadelphia (J.G.); Clinical Research Partners, Richmond, VA (R.L.B.); Clinical Research Institute, Minneapolis (G.B.); the University of Rochester Medical Center, Rochester (J.N.), and Certified Research Associates, Cortland (C.A.S.) - both in New York; Pediatric, Infant, and Adolescent Medicine, Ventura, CA (C.C.); Velocity Clinical Research, West Jordan, UT (B.R.); Ann and Robert H. Lurie Children's Hospital, Chicago (W.J.M.); the University of Kentucky, Lexington (G.F.); the Pennington Biomedical Research Center, Baton Rouge, LA (D.H.); and Moderna, Cambridge, MA (J.E.T., D.D., C.R., B.K., X.Z., W.D., H.Z., D.R.S., K.H., B.G., K.S., R.M., R.P., A.A., R.D., J.M.M., S.S.G.)
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23
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Edward PR, Lorenzo-Redondo R, Reyna ME, Simons LM, Hultquist JF, Patel AB, Ozer EA, Muller WJ, Heald-Sargent T, McHugh M, Dean T, Dalal RM, John J, Manz SC, Kociolek LK. Severity of Illness Caused by Severe Acute Respiratory Syndrome Coronavirus 2 Variants of Concern in Children: A Single-Center Retrospective Cohort Study. J Pediatric Infect Dis Soc 2022; 11:440-447. [PMID: 35924454 PMCID: PMC9384683 DOI: 10.1093/jpids/piac068] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/29/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Recent COVID-19 surges are attributed to emergence of more transmissible SARS-CoV-2 variants of concern (VOCs). The relative severity of VOCs in children is unknown. METHODS We performed a single-center retrospective cohort study of children ≤18 years old diagnosed with COVID-19 from October 2020-February 2022 and whose SARS-CoV-2 isolate underwent Illumina sequencing. We measured the frequency of five markers of COVID-19 severity. Logistic regression models were fitted to estimate the odds of each severity marker with each VOC. RESULTS Among 714 children, 471 (66.0%) were infected with a VOC: 96 (13.4%) alpha, 38 (5.3%) gamma, 119 (16.7%) delta, and 215 (30.1%) omicron. High-risk medical conditions and increasing age were independently associated with COVID-19 severity. After adjusting for age, race, ethnicity, high-risk medical conditions, and COVID-19 community incidence, neither alpha, delta, nor omicron was associated with severe COVID-19. Gamma was independently associated with hospitalization (OR 6.7, 95% CI 2.0-22.1); pharmacologic treatment (OR 5.7, 95% CI 1.2-26.8); respiratory support (OR 11.9, 95% CI 2.7-62.4); and severe disease per the WHO Clinical Progression Scale (OR 11.7, 95% CI 2.1-90.5). Upon subgroup analyses, omicron was independently associated with ICU admission and severe disease per the WHO Clinical Progression Scale in children without SARS-CoV-2 immunization or prior COVID-19 infection. CONCLUSIONS Compared to non-VOC COVID-19, the gamma VOC was independently associated with increased COVID-19 severity, as was omicron in children without SARS-CoV-2 immunization or prior COVID-19 infection. SARS-CoV-2 vaccination and prior COVID-19 prevented severe outcomes during the omicron surge.
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Affiliation(s)
- Priya R Edward
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Ramon Lorenzo-Redondo
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Institute for Global Health, Chicago, IL, USA
| | - Megan E Reyna
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Lacy M Simons
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Institute for Global Health, Chicago, IL, USA
| | - Judd F Hultquist
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Institute for Global Health, Chicago, IL, USA
| | - Ami B Patel
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Egon A Ozer
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Institute for Global Health, Chicago, IL, USA
| | - William J Muller
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Taylor Heald-Sargent
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Matthew McHugh
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Taylor Dean
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Institute for Global Health, Chicago, IL, USA
| | - Raj M Dalal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jordan John
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Shannon C Manz
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Larry K Kociolek
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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24
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Bhimraj A, Morgan RL, Shumaker AH, Baden L, Cheng VCC, Edwards KM, Gallagher JC, Gandhi RT, Muller WJ, Nakamura MM, O’Horo JC, Shafer RW, Shoham S, Murad MH, Mustafa RA, Sultan S, Falck-Ytter Y. Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19. Clin Infect Dis 2022:ciac724. [PMID: 36063397 PMCID: PMC9494372 DOI: 10.1093/cid/ciac724] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There are many pharmacologic therapies that are being used or considered for treatment of coronavirus disease 2019 (COVID-19), with rapidly changing efficacy and safety evidence from trials. OBJECTIVE Develop evidence-based, rapid, living guidelines intended to support patients, clinicians, and other healthcare professionals in their decisions about treatment and management of patients with COVID-19. METHODS In March 2020, the Infectious Diseases Society of America (IDSA) formed a multidisciplinary guideline panel of infectious disease clinicians, pharmacists, and methodologists with varied areas of expertise to regularly review the evidence and make recommendations about the treatment and management of persons with COVID-19. The process used a living guideline approach and followed a rapid recommendation development checklist. The panel prioritized questions and outcomes. A systematic review of the peer-reviewed and grey literature was conducted at regular intervals. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations. RESULTS Based on the most recent search conducted on May 31, 2022, the IDSA guideline panel has made 30 recommendations for the treatment and management of the following groups/populations: pre- and post-exposure prophylaxis, ambulatory with mild-to-moderate disease, hospitalized with mild-to-moderate, severe but not critical, and critical disease. As these are living guidelines, the most recent recommendations can be found online at: https://idsociety.org/COVID19guidelines. CONCLUSIONS At the inception of its work, the panel has expressed the overarching goal that patients be recruited into ongoing trials. Since then, many trials were done which provided much needed evidence for COVID-19 therapies. There still remain many unanswered questions as the pandemic evolved which we hope future trials can answer.
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Affiliation(s)
- Adarsh Bhimraj
- Division of Infectious Diseases, Houston Methodist Hospital, Houston, Texas
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, Ohio
| | - Amy Hirsch Shumaker
- Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, Ohio
- VA Northeast Ohio Healthcare System, Cleveland, Ohio
| | | | - Vincent Chi Chung Cheng
- Queen Mary Hospital, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kathryn M Edwards
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center,Nashville, Tennessee
| | - Jason C Gallagher
- Department of Pharmacy Practice, Temple University, Philadelphia, Pennsylvania
| | - Rajesh T Gandhi
- Infectious Diseases Division, Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | - William J Muller
- Division of Pediatric Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University, Chicago, Illinois
| | - Mari M Nakamura
- Antimicrobial Stewardship Program and Division of Infectious Diseases, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - John C O’Horo
- Division of Infectious Diseases, Joint Appointment Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Robert W Shafer
- Division of Infectious Diseases, Department of Medicine, Stanford University, Palo Alto, California
| | - Shmuel Shoham
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - M Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Healthcare System, Minneapolis, Minnesota
| | - Yngve Falck-Ytter
- Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, Ohio
- VA Northeast Ohio Healthcare System, Cleveland, Ohio
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25
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Dankner M, Maritan SM, Priego N, Nadaf J, Nkili A, Zhuang R, Kruck G, Zuo D, Nowakowski A, Inglebert Y, Savage P, Park M, Guiot MC, McKinney A, Muller WJ, Valiente M, Petrecca K, Siegel PM. Abstract 1569: pSTAT3+ stromal cells drive the invasive growth of brain metastases. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-1569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Brain metastases (BrM) with highly invasive (HI) growth patterns are associated with shortened local recurrence free- and overall survival compared to minimally invasive (MI) lesions (Dankner et al. 2021). Compared to MI lesions, HI BrM form abundant contacts with cells in the peritumoral brain, particularly GFAP+ reactive astrocytes (RAs). RAs expressing phosphorylated STAT3 (pSTAT3+ GFAP+ cells) have been shown to be required for BrM colonization and outgrowth (Priego et al. 2018). Here, we investigate the role of pSTAT3+ cells in the brain microenvironment in promoting invasive growth.
Methods: We performed immunohistochemistry to identify pSTAT3+ GFAP+ cells in HI and MI human and patient-derived xenograft BrM. We assessed how pharmacological inhibition or genetic ablation of STAT3 affected HI and MI BrM growth in vivo with patient-derived xenograft and syngeneic models of BrM. The secretome of STAT3+ RAs was interrogated to identify STAT3 target genes that could drive invasive cancer growth. scRNA-Seq from patients with highly invasive brain metastases was used to examine the expression of candidate invasion factors in distinct cell types within the brain. Finally, cancer cell invasion was modeled in vitro using a brain slice-tumor co-culture assay.
Results: HI BrM displayed increased pSTAT3+GFAP+ cells compared to MI lesions. Pharmacological STAT3i with Legasil (Silibinin) or genetic ablation of STAT3 specifically in RAs decreased in vivo growth of HI, but not MI, BrM. Brain slice cultures treated with STAT3-activating cytokines induced cancer cell invasion, a response that was ablated with STAT3i. Chi3L1 was identified as a STAT3 target gene expressed abundantly by stromal cells in the BrM microenvironment. Cancer cells treated with recombinant Chi3L1 showed enhanced invasion into brain slice cultures compared to control-treated cells.
Conclusions: pSTAT3+GFAP+ cells are over-represented in HI BrM, rendering HI BrM preferentially sensitive to STAT3i. pSTAT3+ stromal cells functionally contribute to BrM invasion within the brain, in part through Chi3L1. This work nominates HI histopathological growth pattern as a predictive biomarker of response to STAT3i, and highlights Chi3L1 as a novel therapeutic target for the management of HI BrM.
Citation Format: Matthew Dankner, Sarah M. Maritan, Neibla Priego, Javad Nadaf, Andy Nkili, Rebecca Zhuang, Georgia Kruck, Dongmei Zuo, Alexander Nowakowski, Yanis Inglebert, Paul Savage, Morag Park, Marie-Christine Guiot, Anne McKinney, William J. Muller, Manuel Valiente, Kevin Petrecca, Peter M. Siegel. pSTAT3+ stromal cells drive the invasive growth of brain metastases [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1569.
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Affiliation(s)
- Matthew Dankner
- 1Rosalind and Morris Goodman Cancer Institute, Montreal, Quebec, Canada
| | - Sarah M. Maritan
- 1Rosalind and Morris Goodman Cancer Institute, Montreal, Quebec, Canada
| | - Neibla Priego
- 2Spanish National Cancer Research Center, Madrid, Spain
| | - Javad Nadaf
- 3Montreal Neurological Institute-Hospital, Montreal, Quebec, Canada
| | - Andy Nkili
- 3Montreal Neurological Institute-Hospital, Montreal, Quebec, Canada
| | - Rebecca Zhuang
- 1Rosalind and Morris Goodman Cancer Institute, Montreal, Quebec, Canada
| | - Georgia Kruck
- 1Rosalind and Morris Goodman Cancer Institute, Montreal, Quebec, Canada
| | - Dongmei Zuo
- 1Rosalind and Morris Goodman Cancer Institute, Montreal, Quebec, Canada
| | | | - Yanis Inglebert
- 4Bellini McGill Life Sciences Complex, Montreal, Quebec, Canada
| | - Paul Savage
- 1Rosalind and Morris Goodman Cancer Institute, Montreal, Quebec, Canada
| | - Morag Park
- 1Rosalind and Morris Goodman Cancer Institute, Montreal, Quebec, Canada
| | | | - Anne McKinney
- 4Bellini McGill Life Sciences Complex, Montreal, Quebec, Canada
| | - William J. Muller
- 1Rosalind and Morris Goodman Cancer Institute, Montreal, Quebec, Canada
| | | | - Kevin Petrecca
- 3Montreal Neurological Institute-Hospital, Montreal, Quebec, Canada
| | - Peter M. Siegel
- 1Rosalind and Morris Goodman Cancer Institute, Montreal, Quebec, Canada
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Gerhart JG, Carreño FO, Ford JL, Edginton A, Perrin EM, Watt KM, Muller WJ, Atz AM, Al‐Uzri A, Delmore P, Gonzalez D, Benjamin DK, Hornik C, Zimmerman K, Kennel P, Beci R, Dang Hornik C, Kearns GL, Laughon M, Paul IM, Sullivan J, Wade K, Delmore P, Taylor‐Zapata P, Lee J, Anand R, Sharma G, Simone G, Kaneshige K, Taylor L, Al‐Uzri A, Hornik C, Sokol G, Speicher D, Sullivan J, Mourani P, Mendley S, Meyer M, Atkins R, Flynn J, Vaughns J, Sherwin C, Delmore P, Goldstein S, Rathore M, Melloni C, Muller W, Delmore P, Tremoulet A, James L, Mendley S, Blackford M, Atz A, Adu‐Darko M, Mourani P, Watt K, Hornik C, Al‐Uzri A, Sullivan J, Laughon M, Brian Smith P, Watt K, Cheifetz I, Atz A, Bhatt‐Mehta V, Fernandez A, Lowry J. Use of
physiologically‐based
pharmacokinetic modeling to inform dosing of the opioid analgesics fentanyl and methadone in children with obesity. CPT Pharmacometrics Syst Pharmacol 2022; 11:778-791. [PMID: 35491971 PMCID: PMC9197535 DOI: 10.1002/psp4.12793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 11/12/2022] Open
Abstract
Obesity is an increasingly alarming public health threat, with nearly 20% of children classified as obese in the United States today. Children with obesity are commonly prescribed the opioids fentanyl and methadone, and accurate dosing is critical to reducing the risk of serious adverse events associated with overexposure. However, pharmacokinetic studies in children with obesity are challenging to conduct, so there is limited information to guide fentanyl and methadone dosing in these children. To address this clinical knowledge gap, physiologically‐based pharmacokinetic models of fentanyl and methadone were developed in adults and scaled to children with and without obesity to explore the interplay of obesity, age, and pharmacogenomics. These models included key obesity‐induced changes in physiology and pharmacogenomic effects. Model predictions captured observed concentrations in children with obesity well, with an overall average fold error of 0.72 and 1.08 for fentanyl and methadone, respectively. Model simulations support a reduced fentanyl dose (1 vs. 2 μg/kg/h) starting at an earlier age (6 years) in virtual children with obesity, highlighting the importance of considering both age and obesity status when selecting an infusion rate most likely to achieve steady‐state concentrations within the target range. Methadone dosing simulations highlight the importance of considering genotype in addition to obesity status when possible, as cytochrome P450 (CYP)2B6*6/*6 virtual children with obesity required half the dose to match the exposure of wildtype children without obesity. This physiologically‐based pharmacokinetic modeling approach can be applied to explore dosing of other critical drugs in children with obesity.
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Affiliation(s)
- Jacqueline G. Gerhart
- Division of Pharmacotherapy and Experimental Therapeutics, The University of North Carolina Eshelman School of Pharmacy The University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Fernando O. Carreño
- Division of Pharmacotherapy and Experimental Therapeutics, The University of North Carolina Eshelman School of Pharmacy The University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Jennifer L. Ford
- Division of Pharmacotherapy and Experimental Therapeutics, The University of North Carolina Eshelman School of Pharmacy The University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | | | - Eliana M. Perrin
- Department of Pediatrics, School of Medicine and School of Nursing Johns Hopkins University Baltimore Maryland USA
| | - Kevin M. Watt
- Division of Pediatric Clinical Pharmacology, School of Medicine University of Utah Salt Lake City Utah USA
| | - William J. Muller
- Ann and Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
| | - Andrew M. Atz
- Medical University of South Carolina Children's Hospital Charleston South Carolina USA
| | - Amira Al‐Uzri
- Oregon Health and Science University Portland Oregon USA
| | | | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, The University of North Carolina Eshelman School of Pharmacy The University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
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27
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Simond AM, Bui T, Zuo D, Sanguin-Gendreau V, Rao T, Phillips WA, Cardiff RD, Muller WJ. Physiological expression of PI3K H1047R mutation reveals its anti-metastatic potential in ErbB2-driven breast cancer. Oncogene 2022; 41:3445-3451. [PMID: 35538223 DOI: 10.1038/s41388-022-02323-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 03/11/2022] [Accepted: 04/12/2022] [Indexed: 12/24/2022]
Abstract
p110α is a catalytic subunit of phosphoinositide 3-kinase (PI3K), a major downstream effector of receptor tyrosine kinase ErbB2, that is amplified and overexpressed in 20-30% of breast cancers, 40% of which have an activating mutation in p110α. Despite the high frequency of PIK3CA gain-of-function mutations, their prognostic value is controversial. Here, we employ a knock-in transgenic strategy to restrict the expression of an activated form of ErbB2 and p110α kinase domain mutation (p110αHR) in the mammary epithelium. Physiological levels of transgene expression under the control of their endogenous promoters did not result in a major synergistic effect. However, tumors arising in ErbB2/p110αHR bi-genic strain metastasized to the lung with significantly reduced capacity compared to tumors expressing ErbB2 alone. The reduced metastasis was further associated with retention of the myoepithelial layer reminiscent of ductal carcinoma in situ (DCIS), a non-invasive stage of human breast cancer. Molecular and biochemical analyses revealed that these poorly metastatic tumors exhibited a significant decrease in phospho-myosin light chain 2 (MLC2) associated with cellular contractility and migration. Examination of human samples for MLC2 activity revealed a progressive increase in cellular contractility between non-invasive DCIS and invasive ductal carcinoma. Collectively, these data argue that p110αHR mutation attenuates metastatic behavior in the context of ErbB2-driven breast cancer.
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Affiliation(s)
- Alexandra M Simond
- Rosalind and Morris Goodman Cancer Research Institute, McGill University, Montreal, QC, Canada.,Department of Biochemistry, McGill University, Montreal, QC, Canada
| | - Tung Bui
- Rosalind and Morris Goodman Cancer Research Institute, McGill University, Montreal, QC, Canada.,Department of Biochemistry, McGill University, Montreal, QC, Canada
| | - Dongmei Zuo
- Rosalind and Morris Goodman Cancer Research Institute, McGill University, Montreal, QC, Canada
| | | | - Trisha Rao
- Rosalind and Morris Goodman Cancer Research Institute, McGill University, Montreal, QC, Canada
| | - Wayne A Phillips
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Robert D Cardiff
- Center for Comparative Medicine, University of California, Davis, CA, USA
| | - William J Muller
- Rosalind and Morris Goodman Cancer Research Institute, McGill University, Montreal, QC, Canada. .,Department of Biochemistry, McGill University, Montreal, QC, Canada. .,Faculty of Medicine, McGill University, Montreal, QC, Canada.
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28
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Bhimraj A, Morgan RL, Shumaker AH, Baden L, Chi-Chung Cheng V, Edwards KM, Gandhi RT, Gallagher JC, Muller WJ, O’Horo JC, Shoham S, Wollins DS, Falck-Ytter Y. Lessons Learned from Coronavirus Disease 2019 (COVID-19) Therapies: Critical Perspectives From the Infectious Diseases Society of America (IDSA) COVID-19 Treatment Guideline Panel. Clin Infect Dis 2022; 74:1691-1695. [PMID: 34668008 PMCID: PMC8574532 DOI: 10.1093/cid/ciab882] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Indexed: 11/13/2022] Open
Abstract
Despite the challenges of the pandemic, there has been substantial progress with coronavirus disease 2019 (COVID-19) therapies. Pivotal COVID-19 trials like SOLIDARITY, RECOVERY, and ACCT-1 were rapidly conducted and data disseminated to support effective therapies. However, critical shortcomings remain on trial conduct, dissemination and interpretation of study results, and regulatory guidance in pandemic settings. The lessons that we learned have implications for both the current pandemic and future emerging infectious diseases. There is a need for establishing and standardizing clinical meaningful outcomes in therapeutic trials and for targeting defined populations and phenotypes that will most benefit from specific therapies. Standardized processes should be established for rapid and critical data review and dissemination to ensure scientific integrity. Clarity around the evidence standards needed for issuance of both emergency use authorization (EUA) and biologic license application (BLA) should be established and an infrastructure for executing rapid trials in epidemic settings maintained.
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Affiliation(s)
- Adarsh Bhimraj
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Amy Hirsch Shumaker
- VA Northeast Ohio Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Lindsey Baden
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Vincent Chi-Chung Cheng
- Department of Microbiology, Queen Mary Hospital, and Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kathryn M Edwards
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rajesh T Gandhi
- Infectious Diseases Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jason C Gallagher
- Department of Pharmacy Practice, Temple University, Philadelphia, Pennsylvania, USA
| | - William J Muller
- Division of Pediatric Infectious Diseases, Northwestern University, Chicago, Illinois, USA
| | - John C O’Horo
- Division of Infectious Diseases, Joint Appointment Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Shmuel Shoham
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Yngve Falck-Ytter
- VA Northeast Ohio Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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29
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Abstract
Breast cancer recurrence and metastasis from activated dormant tumors remain the leading causes in disease morbidity. Estrogen receptor positive breast cancer that accounts for nearly 80% of all cases face a life-long risk of relapse after initial treatment. The biology of dormant tumors and dormant cancer cells that give rise to recurrent disease and metastasis remain to be understood for us to overcome the clinical challenges that they bring. The selection and optimization of pre-clinical models to recapitulate dormancy and recurrence in patients is critical for studying the underlying cellular and environmental factors. Here, we provide a brief review of studies that utilize mouse models to dissect the mechanisms of dormancy and therapeutic strategies to avert recurrence. This review specifically accentuates the versatility and benefits of immunocompetent transgenic mouse models that can be manipulated to recapitulate primary dormancy, metastatic dormancy, and post-therapy dormancy.
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Affiliation(s)
- Yu Gu
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montreal, Canada
- Department of Biochemistry, McGill University, Montreal, Canada
| | - Tung Bui
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montreal, Canada
- Department of Biochemistry, McGill University, Montreal, Canada
| | - William J Muller
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montreal, Canada
- Department of Biochemistry, McGill University, Montreal, Canada
- Faculty of Medicine, McGill University, Montreal, Canada
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30
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Li Z, McGinn O, Wu Y, Bahreini A, Priedigkeit NM, Ding K, Onkar S, Lampenfeld C, Sartorius CA, Miller L, Rosenzweig M, Cohen O, Wagle N, Richer JK, Muller WJ, Buluwela L, Ali S, Bruno TC, Vignali DAA, Fang Y, Zhu L, Tseng GC, Gertz J, Atkinson JM, Lee AV, Oesterreich S. ESR1 mutant breast cancers show elevated basal cytokeratins and immune activation. Nat Commun 2022; 13:2011. [PMID: 35440136 PMCID: PMC9019037 DOI: 10.1038/s41467-022-29498-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/15/2022] [Indexed: 12/26/2022] Open
Abstract
Estrogen receptor alpha (ER/ESR1) is frequently mutated in endocrine resistant ER-positive (ER+) breast cancer and linked to ligand-independent growth and metastasis. Despite the distinct clinical features of ESR1 mutations, their role in intrinsic subtype switching remains largely unknown. Here we find that ESR1 mutant cells and clinical samples show a significant enrichment of basal subtype markers, and six basal cytokeratins (BCKs) are the most enriched genes. Induction of BCKs is independent of ER binding and instead associated with chromatin reprogramming centered around a progesterone receptor-orchestrated insulated neighborhood. BCK-high ER+ primary breast tumors exhibit a number of enriched immune pathways, shared with ESR1 mutant tumors. S100A8 and S100A9 are among the most induced immune mediators and involve in tumor-stroma paracrine crosstalk inferred by single-cell RNA-seq from metastatic tumors. Collectively, these observations demonstrate that ESR1 mutant tumors gain basal features associated with increased immune activation, encouraging additional studies of immune therapeutic vulnerabilities.
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Affiliation(s)
- Zheqi Li
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
- Womens Cancer Research Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Olivia McGinn
- Womens Cancer Research Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Yang Wu
- Womens Cancer Research Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
- School of Medicine, Tsinghua University, Beijing, China
| | - Amir Bahreini
- Womens Cancer Research Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nolan M Priedigkeit
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
- Womens Cancer Research Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Kai Ding
- Womens Cancer Research Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Sayali Onkar
- Womens Cancer Research Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
- Cancer Immunology and Immunotherapy Program, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Tumor Microenvironment Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Caleb Lampenfeld
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
- Cancer Immunology and Immunotherapy Program, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Tumor Microenvironment Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Carol A Sartorius
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lori Miller
- Womens Cancer Research Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | | | - Ofir Cohen
- Department of Medical Oncology and Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Nikhil Wagle
- Department of Medical Oncology and Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jennifer K Richer
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - William J Muller
- Goodman Cancer Centre and Departments of Biochemistry and Medicine, McGill University, Montreal, QC, Canada
| | - Laki Buluwela
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Simak Ali
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Tullia C Bruno
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
- Cancer Immunology and Immunotherapy Program, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Tumor Microenvironment Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Dario A A Vignali
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
- Cancer Immunology and Immunotherapy Program, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Tumor Microenvironment Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Yusi Fang
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Li Zhu
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - George C Tseng
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jason Gertz
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Jennifer M Atkinson
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
- Womens Cancer Research Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Adrian V Lee
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
- Womens Cancer Research Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steffi Oesterreich
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA.
- Womens Cancer Research Center, UPMC Hillman Cancer Center, Pittsburgh, PA, USA.
- Magee-Womens Research Institute, Pittsburgh, PA, USA.
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA.
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31
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Karatza E, Ganguly S, Hornik CD, Muller WJ, Al-Uzri A, James L, Balevic SJ, Gonzalez D. External Evaluation of Risperidone Population Pharmacokinetic Models Using Opportunistic Pediatric Data. Front Pharmacol 2022; 13:817276. [PMID: 35370711 PMCID: PMC8969425 DOI: 10.3389/fphar.2022.817276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/31/2022] [Indexed: 11/23/2022] Open
Abstract
Risperidone is approved to treat schizophrenia in adolescents and autistic disorder and bipolar mania in children and adolescents. It is also used off-label in younger children for various psychiatric disorders. Several population pharmacokinetic models of risperidone and 9-OH-risperidone have been published. The objectives of this study were to assess whether opportunistically collected pediatric data can be used to evaluate risperidone population pharmacokinetic models externally and to identify a robust model for precision dosing in children. A total of 103 concentrations of risperidone and 112 concentrations of 9-OH-risperidone, collected from 62 pediatric patients (0.16–16.8 years of age), were used in the present study. The predictive performance of five published population pharmacokinetic models (four joint parent-metabolite models and one parent only) was assessed for accuracy and precision of the predictions using statistical criteria, goodness of fit plots, prediction-corrected visual predictive checks (pcVPCs), and normalized prediction distribution errors (NPDEs). The tested models produced similarly precise predictions (Root Mean Square Error [RMSE]) ranging from 0.021 to 0.027 nmol/ml for risperidone and 0.053–0.065 nmol/ml for 9-OH-risperidone). However, one of the models (a one-compartment mixture model with clearance estimated for three subpopulations) developed with a rich dataset presented fewer biases (Mean Percent Error [MPE, %] of 1.0% vs. 101.4, 146.9, 260.4, and 292.4%) for risperidone. In contrast, a model developed with fewer data and a more similar population to the one used for the external evaluation presented fewer biases for 9-OH-risperidone (MPE: 17% vs. 69.9, 47.8, and 82.9%). None of the models evaluated seemed to be generalizable to the population used in this analysis. All the models had a modest predictive performance, potentially suggesting that sources of inter-individual variability were not entirely captured and that opportunistic data from a highly heterogeneous population are likely not the most appropriate data to evaluate risperidone models externally.
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Affiliation(s)
- Eleni Karatza
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Samit Ganguly
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Regeneron Pharmaceuticals, Inc., Tarrytown, NY, United States
| | - Chi D Hornik
- Duke Clinical Research Institute, Durham, NC, United States
| | - William J Muller
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Amira Al-Uzri
- Oregon Health and Science University, Portland, OR, United States
| | - Laura James
- Arkansas Children's Hospital Research Institute and the University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | | | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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32
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Newman AM, Posch LC, Gianchetti L, Rand EB, Mohammad S, Downes KJ, Muller WJ. Live virus vaccination following pediatric liver transplantation: Outcomes from two academic children's hospitals. Am J Transplant 2022; 22:1201-1212. [PMID: 34967134 DOI: 10.1111/ajt.16937] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 01/25/2023]
Abstract
Pediatric liver transplant (LT) recipients are often transplanted at a young age, precluding them from receiving live virus vaccinations (LVV) such as varicella (VZV) vaccine and measles, mumps and rubella. This places them at profound risk for vaccine preventable illness. We sought to detail safety of vaccination. This was a retrospective cohort study of pediatric LT recipients at two children's hospitals. Among 204 LT recipients included in the study, 97 received at least one LVV after LT. Six patients who did not receive LVV after transplant had evidence of vaccine-preventable infection following vaccination (one disseminated VZV disease, five VZV-related rash), while one patient who received LVV after transplant developed a diffuse VZV-related rash. Rejection rates were the same between those that did and did not receive a live virus vaccine post-transplant. There were no serious adverse events caused by vaccination post-transplant. LVV following LT was safe at our two institutions, although there exist limitations in our study due to its retrospective study design. Larger scale studies should be performed to evaluate the effectiveness of LVV in relation to immunosuppression.
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Affiliation(s)
- Alexander M Newman
- Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Leila C Posch
- Division of Infectious Diseases, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Lauren Gianchetti
- Center for Pediatric Clinical Effectiveness (CPCE), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Elizabeth B Rand
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Saeed Mohammad
- Division of Gastroenterology, Hepatology, and Nutrition, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kevin J Downes
- Center for Pediatric Clinical Effectiveness (CPCE), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - William J Muller
- Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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33
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Hammitt LL, Dagan R, Yuan Y, Baca Cots M, Bosheva M, Madhi SA, Muller WJ, Zar HJ, Brooks D, Grenham A, Wählby Hamrén U, Mankad VS, Ren P, Takas T, Abram ME, Leach A, Griffin MP, Villafana T. Nirsevimab for Prevention of RSV in Healthy Late-Preterm and Term Infants. N Engl J Med 2022; 386:837-846. [PMID: 35235726 DOI: 10.1056/nejmoa2110275] [Citation(s) in RCA: 289] [Impact Index Per Article: 144.5] [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: 12/13/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infection and hospitalization in infants. Nirsevimab is a monoclonal antibody to the RSV fusion protein that has an extended half-life. The efficacy and safety of nirsevimab in healthy late-preterm and term infants are uncertain. METHODS We randomly assigned, in a 2:1 ratio, infants who had been born at a gestational age of at least 35 weeks to receive a single intramuscular injection of nirsevimab or placebo before the start of an RSV season. The primary efficacy end point was medically attended RSV-associated lower respiratory tract infection through 150 days after the injection. The secondary efficacy end point was hospitalization for RSV-associated lower respiratory tract infection through 150 days after the injection. RESULTS A total of 1490 infants underwent randomization: 994 were assigned to the nirsevimab group and 496 to the placebo group. Medically attended RSV-associated lower respiratory tract infection occurred in 12 infants (1.2%) in the nirsevimab group and in 25 infants (5.0%) in the placebo group; these findings correspond to an efficacy of 74.5% (95% confidence interval [CI], 49.6 to 87.1; P<0.001) for nirsevimab. Hospitalization for RSV-associated lower respiratory tract infection occurred in 6 infants (0.6%) in the nirsevimab group and in 8 infants (1.6%) in the placebo group (efficacy, 62.1%; 95% CI, -8.6 to 86.8; P = 0.07). Among infants with data available to day 361, antidrug antibodies after baseline were detected in 58 of 951 (6.1%) in the nirsevimab group and in 5 of 473 (1.1%) in the placebo group. Serious adverse events were reported in 67 of 987 infants (6.8%) who received nirsevimab and in 36 of 491 infants (7.3%) who received placebo. CONCLUSIONS A single injection of nirsevimab administered before the RSV season protected healthy late-preterm and term infants from medically attended RSV-associated lower respiratory tract infection. (Funded by MedImmune/AstraZeneca and Sanofi; MELODY ClinicalTrials.gov number, NCT03979313.).
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MESH Headings
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antiviral Agents/administration & dosage
- Antiviral Agents/adverse effects
- Antiviral Agents/therapeutic use
- Drug Administration Schedule
- Female
- Humans
- Infant
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/prevention & control
- Injections, Intramuscular
- Kaplan-Meier Estimate
- Male
- Respiratory Syncytial Virus Infections/prevention & control
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Affiliation(s)
- Laura L Hammitt
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Ron Dagan
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Yuan Yuan
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Manuel Baca Cots
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Miroslava Bosheva
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Shabir A Madhi
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - William J Muller
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Heather J Zar
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Dennis Brooks
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Amy Grenham
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Ulrika Wählby Hamrén
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Vaishali S Mankad
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Pin Ren
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Therese Takas
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Michael E Abram
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Amanda Leach
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - M Pamela Griffin
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
| | - Tonya Villafana
- From the Department of International Health, Johns Hopkins University, Baltimore (L.L.H.), and AstraZeneca, Gaithersburg (Y.Y., D.B., A.G., P.R., T.T., M.E.A., A.L., M.P.G., T.V.) - both in Maryland; the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (R.D.); Quirónsalud Málaga Hospital, Malaga, Spain (M.B.C.); University Multiprofile Hospital for Active Treatment, St. George Medical University, Plovdiv, Bulgaria (M.B.); the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit and African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and the Department of Paediatrics and Child Health, Red Cross Children's Hospital, and the Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town (H.J.Z.) - all in South Africa; Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago (W.J.M.); AstraZeneca, Gothenburg, Sweden (U.W.H.); and AstraZeneca, Durham, NC (V.S.M.)
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Fink EL, Robertson CL, Wainwright MS, Roa JD, Lovett ME, Stulce C, Yacoub M, Potera RM, Zivick E, Holloway A, Nagpal A, Wellnitz K, Czech T, Even KM, Brunow de Carvalho W, Rodriguez IS, Schwartz SP, Walker TC, Campos-Miño S, Dervan LA, Geneslaw AS, Sewell TB, Pryce P, Silver WG, Lin JE, Vargas WS, Topjian A, Alcamo AM, McGuire JL, Domínguez Rojas JA, Muñoz JT, Hong SJ, Muller WJ, Doerfler M, Williams CN, Drury K, Bhagat D, Nelson A, Price D, Dapul H, Santos L, Kahoud R, Francoeur C, Appavu B, Guilliams KP, Agner SC, Walson KH, Rasmussen L, Janas A, Ferrazzano P, Farias-Moeller R, Snooks KC, Chang CCH, Yun J, Schober ME. Prevalence and Risk Factors of Neurologic Manifestations in Hospitalized Children Diagnosed with Acute SARS-CoV-2 or MIS-C. Pediatr Neurol 2022; 128:33-44. [PMID: 35066369 PMCID: PMC8713420 DOI: 10.1016/j.pediatrneurol.2021.12.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Our objective was to characterize the frequency, early impact, and risk factors for neurological manifestations in hospitalized children with acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or multisystem inflammatory syndrome in children (MIS-C). METHODS Multicenter, cross-sectional study of neurological manifestations in children aged <18 years hospitalized with positive SARS-CoV-2 test or clinical diagnosis of a SARS-CoV-2-related condition between January 2020 and April 2021. Multivariable logistic regression to identify risk factors for neurological manifestations was performed. RESULTS Of 1493 children, 1278 (86%) were diagnosed with acute SARS-CoV-2 and 215 (14%) with MIS-C. Overall, 44% of the cohort (40% acute SARS-CoV-2 and 66% MIS-C) had at least one neurological manifestation. The most common neurological findings in children with acute SARS-CoV-2 and MIS-C diagnosis were headache (16% and 47%) and acute encephalopathy (15% and 22%), both P < 0.05. Children with neurological manifestations were more likely to require intensive care unit (ICU) care (51% vs 22%), P < 0.001. In multivariable logistic regression, children with neurological manifestations were older (odds ratio [OR] 1.1 and 95% confidence interval [CI] 1.07 to 1.13) and more likely to have MIS-C versus acute SARS-CoV-2 (OR 2.16, 95% CI 1.45 to 3.24), pre-existing neurological and metabolic conditions (OR 3.48, 95% CI 2.37 to 5.15; and OR 1.65, 95% CI 1.04 to 2.66, respectively), and pharyngeal (OR 1.74, 95% CI 1.16 to 2.64) or abdominal pain (OR 1.43, 95% CI 1.03 to 2.00); all P < 0.05. CONCLUSIONS In this multicenter study, 44% of children hospitalized with SARS-CoV-2-related conditions experienced neurological manifestations, which were associated with ICU admission and pre-existing neurological condition. Posthospital assessment for, and support of, functional impairment and neuroprotective strategies are vitally needed.
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Affiliation(s)
- Ericka L Fink
- Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, Pittsburgh, Pennsylvania; Safar Center for Resuscitation Research, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Courtney L Robertson
- Departments of Anesthesiology and Critical Care Medicine, and Pediatrics of The Johns Hopkins University SOM, Baltimore, Maryland
| | - Mark S Wainwright
- Division of Pediatric Neurology, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Juan D Roa
- Department of Pediatrics, Universidad Nacional de Colombia and Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
| | - Marlina E Lovett
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Casey Stulce
- Department of Pediatrics, University of Chicago, Chicago, Illinois
| | - Mais Yacoub
- Division of Critical Care, Department of Pediatrics, UMC Children's Hospital, Las Vegas, Nevada
| | - Renee M Potera
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elizabeth Zivick
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Adrian Holloway
- Division of Critical Care, Department of Pediatrics, University of Maryland Medical Center, Baltimore, Maryland
| | - Ashish Nagpal
- Department of Pediatrics, Section of Critical Care Medicine, Oklahoma Children's Hospital at OU health, Oklahoma University College of Medicine, Oklahoma City, Oklahoma
| | - Kari Wellnitz
- Division of Pediatric Critical Care, Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Theresa Czech
- Division of Pediatric Neurology, Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Katelyn M Even
- Division of Pediatric Critical Care Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | | | | | - Stephanie P Schwartz
- Department of Pediatrics, University of North Carolina at Chapel Hill Hospitals, Chapel Hill, North Carolina
| | - Tracie C Walker
- Department of Pediatrics, University of North Carolina at Chapel Hill Hospitals, Chapel Hill, North Carolina
| | | | - Leslie A Dervan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Andrew S Geneslaw
- Division of Pediatric Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Taylor B Sewell
- Division of Pediatric Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Patrice Pryce
- Division of Pediatric Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, Morgan Stanley Children's Hospital New York-Presbyterian Hospital, New York, New York
| | - Wendy G Silver
- Division of Child Neurology, Department of Neurology, Columbia University Irving Medical Center, New York, New York
| | - Jieru Egeria Lin
- Division of Child Neurology, Department of Neurology, Columbia University Irving Medical Center, New York, New York
| | - Wendy S Vargas
- Division of Child Neurology, Department of Neurology, Columbia University Irving Medical Center, New York, New York
| | - Alexis Topjian
- Division of Critical Care Medicine at The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Departments of Anesthesiology and Critical Care Medicine and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Alicia M Alcamo
- Division of Critical Care Medicine at The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Departments of Anesthesiology and Critical Care Medicine and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jennifer L McGuire
- Division of Neurology at The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jesus Angel Domínguez Rojas
- Division of Pediatric Critical Care, Department of Pediatrics, Hospital de Emergencia Villa El Salvador, Lima, Peru
| | - Jaime Tasayco Muñoz
- Division of Pediatric Critical Care, Department of Pediatrics, Hospital de Emergencia Villa El Salvador, Lima, Peru
| | - Sue J Hong
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William J Muller
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew Doerfler
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Cydni N Williams
- Division of Pediatric Critical Care, Department of Pediatrics Pediatric Critical Care and Neurotrauma Recovery Program Portland, Oregon Health & Science University, Oregon
| | - Kurt Drury
- Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
| | - Dhristie Bhagat
- Department of Neurology, NYU Langone Health, New York, New York
| | - Aaron Nelson
- Department of Neurology, NYU Langone Health, New York, New York
| | - Dana Price
- Department of Neurology, NYU Langone Health, New York, New York
| | - Heda Dapul
- Division of Pediatric Critical Care, Department of Pediatrics, Hassenfeld Children's Hospital at NYU Langone Health, New York, New York
| | - Laura Santos
- Division of Pediatric Critical Care, Department of Pediatrics, Hassenfeld Children's Hospital at NYU Langone Health, New York, New York
| | - Robert Kahoud
- Division of Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Conall Francoeur
- Department of Pediatrics, CHU de Québec - Université Laval Research Center, Quebec City, Quebec, Canada
| | - Brian Appavu
- Division of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, University of Arizona, College of Medicine, Phoenix, Arizona
| | - Kristin P Guilliams
- Departments of Neurology, Pediatrics, and Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Shannon C Agner
- Departments of Neurology, Pediatrics, and Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Karen H Walson
- Department of Pediatric Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Lindsey Rasmussen
- Pediatric Critical Care Medicine, Lucile Packard Children's Hospital, Stanford University, Stanford, California
| | - Anna Janas
- Pediatric Critical Care Medicine, Lucile Packard Children's Hospital, Stanford University, Stanford, California
| | - Peter Ferrazzano
- Department of Pediatrics, University of Wisconsin, Madison, Wisconsin
| | - Raquel Farias-Moeller
- Division Child Neurology, Department of Neurology, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, Wisconsin
| | - Kellie C Snooks
- Department of Pediatrics, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, Wisconsin
| | - Chung-Chou H Chang
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James Yun
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michelle E Schober
- Division of Critical Care of the University of Utah, Department of Pediatrics, Salt Lake City, Utah
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Downes KJ, Statler VA, Orscheln RC, Cousino MK, Green M, Michaels MG, Muller WJ, Sharma TS, Danziger-Isakov LA, Ardura MI. Return to School and COVID-19 Vaccination for Pediatric Solid Organ Transplant Recipients in the United States: Expert Opinion for 2021-2022. J Pediatric Infect Dis Soc 2022; 11:43-54. [PMID: 34734268 PMCID: PMC8689907 DOI: 10.1093/jpids/piab098] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/24/2021] [Indexed: 01/07/2023]
Abstract
The COVID-19 pandemic continues to generate challenges for pediatric solid organ transplant (SOT) recipients and their families. As rates of COVID-19 fluctuate, new SARS-CoV-2 variants emerge, and adherence to and implementation of mitigation strategies vary from community to community, questions remain about the best and safest practices to prevent COVID-19 in vulnerable patients. Notably, decisions about returning to school remain difficult. We assembled a team of specialists in pediatric infectious diseases, transplant infectious diseases, public health, transplant psychology, and infection prevention and control to re-address concerns about school re-entry, as well as COVID-19 vaccines, for pediatric SOT recipients in the United States in 2021. Based on available literature and guidance from national organizations, we generated expert statements specific to pediatric SOT recipients focused on school attendance in 2021.
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Affiliation(s)
- Kevin J Downes
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Victoria A Statler
- Division of Infectious Diseases, Norton Children’s Hospital, Louisville, Kentucky, USA
- Department of Pediatrics, University of Louisville, Louisville, Kentucky, USA
| | - Rachel C Orscheln
- Division of Pediatric Infectious Diseases, St. Louis Children’s Hospital, St. Louis, Missouri, USA
- Department of Pediatrics, Washington University, St. Louis, Missouri, USA
| | - Melissa K Cousino
- Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA
- University of Michigan Transplant Center, Ann Arbor, Michigan, USA
| | - Michael Green
- Division of Pediatric Infectious Diseases, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Departments of Pediatrics and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marian G Michaels
- Division of Pediatric Infectious Diseases, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Departments of Pediatrics and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - William J Muller
- Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tanvi S Sharma
- Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Lara A Danziger-Isakov
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Monica I Ardura
- Division of Infectious Diseases and Host Defense, Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
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Tsao LC, Crosby EJ, Trotter TN, Wei J, Wang T, Yang X, Summers AN, Lei G, Rabiola CA, Chodosh LA, Muller WJ, Lyerly HK, Hartman ZC. Trastuzumab/Pertuzumab combination therapy stimulates anti-tumor responses through complement-dependent cytotoxicity and phagocytosis. JCI Insight 2022; 7:155636. [PMID: 35167491 PMCID: PMC8986081 DOI: 10.1172/jci.insight.155636] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/07/2021] [Accepted: 02/09/2022] [Indexed: 11/17/2022] Open
Abstract
Standard-of-care treatment for advanced HER2+ breast cancers (BC) is comprised of two HER2-specific monoclonal antibodies (mAb), Trastuzumab (T) and Pertuzumab (P) with chemotherapy. While this combination (T+P) is highly effective, its synergistic mechanism of action (MOA) is not completely known. Initial studies had demonstrated that Pertuzumab suppressed HER2 hetero-dimerization as the potential therapeutic MOA, thus the improved outcome associated with the T+P combination MOA compared to Trastuzumab alone has been widely reported as being due to Pertuzumab-mediated suppression of HER2 signaling in combination with Trastuzumab-mediated induction of anti-tumor immunity. Unraveling this MOA may be critical to extend this combination strategy to other antigens or other cancers, as well as improving this current treatment modality. Using novel murine and human versions of Pertuzumab, we found it induced both Antibody-Dependent-Cellular-Phagocytosis (ADCP) by tumor-associated macrophages and suppression of HER2 oncogenic signaling. Most significantly, we identified that only T+P combination therapy, but not when either antibody used in isolation, allows for the activation of the classical complement pathway, resulting in both direct complement-dependent cytotoxicity (CDC) as well as complement-dependent cellular phagocytosis (CDCP) of HER2+ BC cells. Notably, we show that tumor expression of C1q was positively associated with survival outcome in HER2+ BC patients, whereas expression of complement regulators CD55 and CD59 were inversely correlated, suggesting the importance of complement activity in clinical outcomes. Accordingly, inhibition of C1 activity in mice abolished the synergistic therapeutic activity of T+P therapy, whereas knockdown of CD55 and CD59 expression enhanced T+P efficacy. In summary, our study identifies classical complement activation as a significant anti-tumor MOA for T+P therapy that may be functionally enhanced to augment therapeutic efficacy in the clinic.
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Affiliation(s)
- Li-Chung Tsao
- Department of Surgery, Duke University, Durham, United States of America
| | - Erika J Crosby
- Department of Surgery, Duke University, Durham, United States of America
| | - Timothy N Trotter
- Department of Surgery, Duke University, Durham, United States of America
| | - Junping Wei
- Department of Surgery, Duke University, Durham, United States of America
| | - Tao Wang
- Department of Surgery, Duke University, Durham, United States of America
| | - Xiao Yang
- Department of Surgery, Duke University, Durham, United States of America
| | - Amanda N Summers
- Department of Surgery, Duke University, Durham, United States of America
| | - Gangjun Lei
- Department of Surgery, Duke University, Durham, United States of America
| | | | - Lewis A Chodosh
- Department of Cancer Biology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, United States of America
| | | | - Herbert Kim Lyerly
- Department of Surgery, Duke University, Durham, United States of America
| | - Zachary C Hartman
- Department of Surgery, Duke University, Durham, United States of America
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Li Z, Wu Y, Mcginn O, Bahreini A, Priedigkeit NM, Ding K, Onkar S, Sartorius CA, Miller L, Rosenzweig M, Wagle N, Richer JK, Muller WJ, Buluwela L, Ali S, Vignali DA, Fang Y, Zhu L, Tseng GC, Gertz J, Atkinson JM, Lee AV, Oesterreich S. Abstract PD1-08: Esr1 mutant breast cancers show elevated basal cytokeratins and immune activation. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-pd1-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Estrogen receptor alpha (ER/ESR1) is mutated in 30-40% of endocrine resistant ER-positive (ER+) breast cancer. ESR1 mutations cause ligand-independent growth and increased metastasis in vivo and in vitro. Despite the distinct clinical features and changes in therapeutic response associated with ESR1 mutations, there are no data about their potential role in intrinsic subtype switching.Applying five different luminal and basal gene set pairs derived from cell lines and tumors, ESR1 mutant cell models and clinical samples showed a significant enrichment of basal subtype markers. Among them, the six basal cytokeratins (BCKs) were the most enriched genes (KRT5/6A/6B/14/16/17) uniquely in ESR1 mutant cells but not other endocrine resistant cell models. BCKs were observed to heterogeneously express in a minor cell subpopulation in ESR1 mutant cell models and clinical specimens. ER ChIP-seq showed the mutant-specific induction of BCKs was independent of ER binding and instead selectively expressed in clones with low ER expression. In contrast, BCKs are associated with chromatin reprogramming centered around a progesterone receptor-orchestrated 154 kb insulated neighborhood at the KRT14/16/17 genomic region. Stronger CTCF binding was detected at the bases of chromatin loop in ESR1 mutant cells. Knockdown of progesterone receptor but not glucocorticoid receptor drastically blocked the induction of KRT14/16/17 in ESR1 mutant cells. Unexpectedly, high BCK expression in ER+ primary breast cancer is associated with good prognosis, and these tumors show enriched activation of a number of immune pathways, a distinctive feature shared with ESR1 mutant tumors. While the BCK-associated immune activation is not related to tumor mutation burdens, S100A8 and S100A9 were identified as the most highly induced immune mediators shared between high-BCKs ER+ and ESR1 mutant tumors, which was further validated in the plasma samples of a cohort of 18 patients with ER+ metastases (11 WT vs 7 mutant). Finally, single-cell RNA-seq analysis in an ER+ bone metastasis case inferred the involvement of S100A8 and S100A9 in paracrine crosstalk between epithelial and stromal cells, particularly macrophages and fibroblasts through TLR4 signaling. Collectively, these observations demonstrate that ESR1 mutant tumors gain basal features with induction of basal cytokeratins via epigenetic mechanisms in rare subpopulation of cells. This is associated with increased immune activation, encouraging additional studies of immune therapeutic vulnerabilities in ESR1 mutant tumors.
Citation Format: Zheqi Li, Yang Wu, Olivia Mcginn, Amir Bahreini, Nolan M. Priedigkeit, Kai Ding, Sayali Onkar, Carol A. Sartorius, Lori Miller, Margaret Rosenzweig, Nikhil Wagle, Jennifer K. Richer, William J. Muller, Laki Buluwela, Simak Ali, Dario A.A. Vignali, Yusi Fang, Li Zhu, George C. Tseng, Jason Gertz, Jennifer M. Atkinson, Adrian V. Lee, Steffi Oesterreich. Esr1 mutant breast cancers show elevated basal cytokeratins and immune activation [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD1-08.
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Affiliation(s)
- Zheqi Li
- University of Pittsburgh, Pittsburgh, PA
| | - Yang Wu
- University of Pittsburgh, Pittsburgh, PA
| | | | | | | | - Kai Ding
- University of Pittsburgh, Pittsburgh, PA
| | | | | | | | | | | | | | | | | | - Simak Ali
- Imperial College London, London, United Kingdom
| | | | - Yusi Fang
- University of Pittsburgh, Pittsburgh, PA
| | - Li Zhu
- University of Pittsburgh, Pittsburgh, PA
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Fisher BT, Boge CLK, Xiao R, Shuster S, Chin-Quee D, Allen J, Shaheen S, Hayden R, Suganda S, Zaoutis TE, Chang YC, Yin DE, Huppler AR, Danziger-Isakov L, Muller WJ, Roilides E, Romero J, Sue PK, Berman D, Wattier RL, Halasa N, Pong A, Maron G, Soler-Palacin P, Hutto SC, Gonzalez BE, Salvatore CM, Rajan S, Green M, Doby Knackstedt E, Hauger SB, Steinbach WJ. Multicenter Prospective Study of Biomarkers for Diagnosis of Invasive Candidiasis in Children and Adolescents. Clin Infect Dis 2022; 75:248-259. [PMID: 35134165 PMCID: PMC9890499 DOI: 10.1093/cid/ciab928] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Diagnosis of invasive candidiasis (IC) relies on insensitive cultures; the relative utility of fungal biomarkers in children is unclear. METHODS This multinational observational cohort study enrolled patients aged >120 days and <18 years with concern for IC from 1 January 2015 to 26 September 2019 at 25 centers. Blood collected at onset of symptoms was tested using T2Candida, Fungitell (1→3)-β-D-glucan, Platelia Candida Antigen (Ag) Plus, and Platelia Candida Antibody (Ab) Plus assays. Operating characteristics were determined for each biomarker, and assays meeting a defined threshold considered in combination. Sterile site cultures were the reference standard. RESULTS Five hundred participants were enrolled at 22 centers in 3 countries, and IC was diagnosed in 13 (2.6%). Thirteen additional blood specimens were collected and successfully spiked with Candida species, to achieve a 5.0% event rate. Valid T2Candida, Fungitell, Platelia Candida Ag Plus, and Platelia Candida Ab Plus assay results were available for 438, 467, 473, and 473 specimens, respectively. Operating characteristics for T2Candida were most optimal for detecting IC due to any Candida species, with results as follows: sensitivity, 80.0% (95% confidence interval, 59.3%-93.2%), specificity 97.1% (95.0%-98.5%), positive predictive value, 62.5% (43.7%-78.9%), and negative predictive value, 98.8% (97.2%-99.6%). Only T2Candida and Platelia Candida Ag Plus assays met the threshold for combination testing. Positive result for either yielded the following results: sensitivity, 86.4% (95% confidence interval, 65.1%- 97.1%); specificity, 94.7% (92.0%-96.7%); positive predictive value, 47.5% (31.5%-63.9%); and negative predictive value, 99.2% (97.7%-99.8%). CONCLUSIONS T2Candida alone or in combination with Platelia Candida Ag Plus may be beneficial for rapid detection of Candida species in children with concern for IC. CLINICAL TRIALS REGISTRATION NCT02220790.
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Affiliation(s)
- Brian T Fisher
- Correspondence: B. T. Fisher, Division of Infectious Diseases, Children’s Hospital of Philadelphia, Roberts Pediatric Research Center, 2716 South St, Room 10-362, Philadelphia, PA 19146 ()
| | - Craig L K Boge
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Rui Xiao
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sydney Shuster
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - John Allen
- Duke University, Durham, North Carolina, USA
| | | | - Randall Hayden
- Department of Pathology, St Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Sri Suganda
- Department of Pathology, St Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Theoklis E Zaoutis
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Dwight E Yin
- Children’s Mercy and University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Anna R Huppler
- Medical College of Wisconsin and Children’s Wisconsin, Milwaukee, Wisconsin, USA
| | | | - William J Muller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Emmanuel Roilides
- Infectious Disease Unit, 3rd Department of Pediatrics, School of Medicine, Aristotle University and Hippokration Hospital, Thessaloniki, Greece
| | - José Romero
- Arkansas Children’s Hospital Research Institute, Little Rock, Arkansas, USA
| | - Paul K Sue
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David Berman
- John Hopkins All Children’s Hospital, St Petersburg, Florida, USA
| | - Rachel L Wattier
- University of California–San Francisco, San Francisco, California, USA
| | - Natasha Halasa
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alice Pong
- University of California San Diego, San Diego, California, USA
| | - Gabriela Maron
- St Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | | | - Susan C Hutto
- University of Alabama, Birmingham, Birmingham, Alabama, USA
| | | | | | - Sujatha Rajan
- Cohen Children’s Medical Center of New York, New Hyde Park, New York, USA
| | - Michael Green
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Handel AS, Muller WJ, Planet PJ. Metagenomic Next-Generation Sequencing (mNGS): SARS-CoV-2 as an Example of the Technology's Potential Pediatric Infectious Disease Applications. J Pediatric Infect Dis Soc 2021; 10:S69-S70. [PMID: 34951468 PMCID: PMC8755271 DOI: 10.1093/jpids/piab108] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Metagenomic next-generation sequencing (mNGS) has emerged as a potentially powerful tool in clinical diagnosis, hospital epidemiology, microbial evolutionary biology, and studies of host-pathogen interaction. The SARS-CoV-2 pandemic provides a framework for demonstrating the applications of this technology in each of these areas. In this Supplement, we review applications of mNGS within the discipline of pediatric infectious diseases.
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Affiliation(s)
- Andrew S Handel
- Department of Pediatrics, Division of Infectious Diseases, Stony Brook Children’s Hospital, Stony Brook, New York, USA,Corresponding Author:> Andrew S. Handel, MD, Department of Pediatrics, Division of Infectious Diseases, Stony Brook Children’s Hospital, 101 Nicolls Road, HSC-T11, Stony Brook, NY 11794, USA. E-mail:
| | - William J Muller
- Department of Pediatrics, Northwestern University, Chicago, Illinois, USA,Division of Pediatric Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | - Paul J Planet
- Division of Pediatric Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Department of Pediatrics, Perelman College of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA, and ,Sackler Institute for Comparative Genomics, American Museum of Natural History, New York, New York, USA
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Hammitt L, Hammitt L, Dagan R, Yuan Y, Cots MB, Bosheva M, Mahdi SA, Muller WJ, Muller WJ, Zar HJ, Brooks D, Grenham A, Hamrén UW, Mankad VS, Ren P, Takas T, Heinrichs J, Leach A, Griffin MP, Villafana TL. LB13. The Efficacy and Impact in Heathy Infants of Nirsevimab on Medically Attended RSV Lower Respiratory Tract Infection. Open Forum Infect Dis 2021. [PMCID: PMC8644820 DOI: 10.1093/ofid/ofab466.1649] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infection (LRTI) in infants. Nirsevimab is a single-dose monoclonal antibody with extended half-life that was shown to protect preterm infants 29 to < 35 weeks gestation against RSV LRTI. However, most medically attended (MA) cases occur in otherwise healthy, term infants for whom there is currently no effective RSV prevention strategy. We report the primary analysis of efficacy and safety, along with the impact of nirsevimab in late preterm and term infants (≥ 35 weeks gestation) in the phase 3 MELODY study (NCT03979313).
Methods
Infants were randomized 2:1 to receive one intramuscular injection of nirsevimab (50 mg if < 5 kg; 100 mg if ≥ 5 kg at dosing) or placebo entering their first RSV season. The primary endpoint was the incidence of MA RSV LRTI over 150 days postdose. Cases met predefined clinical criteria of disease severity and were confirmed by real-time reverse-transcriptase PCR. Safety was evaluated through 360 days postdose. Enrollment started on 23 July 2019 and was suspended following the declaration of the COVID-19 pandemic by the WHO on 11 March 2020.
Results
Overall, 1490 infants were randomized and included in the intent-to-treat population; 1465 (98%) completed the 150-day efficacy follow-up, and 1367 (92%) completed the 360-day safety follow-up. The incidence of MA RSV LRTI was 1.2% (n=12/994) in the nirsevimab group and 5.0% (n=25/496) in the placebo group, giving nirsevimab an efficacy of 74.5% (95% confidence interval [CI]: 49.6, 87.1; p< 0.0001). Nirsevimab averted 93.6 (95% CI 63.0, 124.0) MA LRTIs per 1000 infants dosed. Nirsevimab was well tolerated, with similar rates of adverse events (87.4% nirsevimab; 86.8% placebo) and serious adverse events (6.8% nirsevimab; 7.3% placebo) between groups.
Conclusion
In this phase 3 study, a single dose of nirsevimab protected late preterm and term infants against MA RSV LRTI over an RSV season with a favorable safety profile. Approximately 11 infants need to be immunized to prevent 1 case of LRTI; nirsevimab has the potential to be an important intervention to reduce the burden of RSV LRTI in healthy infants.
Disclosures
Laura Hammitt, MD, MedImmune (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support)Merck & Co., Inc. (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support)Novavax (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support)Pfizer (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support) Laura Hammitt, MD, MedImmune (Individual(s) Involved: Self): Grant/Research Support, Research grant to my institution; Merck (Individual(s) Involved: Self): Grant/Research Support, Research grant to my institution; Pfizer (Individual(s) Involved: Self): Grant/Research Support, Research grant to my institution Ron Dagan, MD, Medimmune/AstraZeneca (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support)MSD (Consultant, Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Research Grant or Support, Speaker’s Bureau)Pfizer (Consultant, Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Research Grant or Support, Speaker’s Bureau) Yuan Yuan, PhD, AstraZeneca (Employee, Shareholder) Shabhir A. Mahdi, PhD, BMGF (Research Grant or Support)EDCTP (Research Grant or Support)GlaxoSmithKline (Research Grant or Support)Melody (Research Grant or Support)Minervax (Research Grant or Support)Novavax (Research Grant or Support)SAMRC (Research Grant or Support) William J. Muller, MD, PhD, Ansun (Scientific Research Study Investigator)Astellas (Scientific Research Study Investigator)AstraZeneca (Scientific Research Study Investigator)Genentech (Scientific Research Study Investigator)Gilead (Scientific Research Study Investigator)Janssen (Scientific Research Study Investigator)Karius (Scientific Research Study Investigator)Melinta (Scientific Research Study Investigator)Merck (Scientific Research Study Investigator)Nabriva (Scientific Research Study Investigator)Seqirus (Scientific Research Study Investigator)Tetraphase (Scientific Research Study Investigator) William J. Muller, MD, PhD, Ansun (Individual(s) Involved: Self): Grant/Research Support; Astellas (Individual(s) Involved: Self): Research Grant or Support; AstraZeneca (Individual(s) Involved: Self): Grant/Research Support; BD (Individual(s) Involved: Self): Research Grant or Support; Eli Lilly (Individual(s) Involved: Self): Grant/Research Support; Gilead (Individual(s) Involved: Self): Grant/Research Support; Karius, Inc. (Individual(s) Involved: Self): Grant/Research Support, Scientific Research Study Investigator; Melinta (Individual(s) Involved: Self): Grant/Research Support; Merck (Individual(s) Involved: Self): Grant/Research Support; Moderna (Individual(s) Involved: Self): Grant/Research Support; Nabriva (Individual(s) Involved: Self): Grant/Research Support; Seqirus (Individual(s) Involved: Self): Consultant; Tetraphase (Individual(s) Involved: Self): Grant/Research Support Heather J. Zar, PhD, AstraZeneca (Grant/Research Support)Novavax (Grant/Research Support)Pfizer (Grant/Research Support, Advisor or Review Panel member) Dennis Brooks, MD, AstraZeneca (Employee) Amy Grenham, MSc, AstraZeneca (Employee, Shareholder) Ulrika Wählby Hamrén, PhD, AstraZeneca R&D (Employee, Shareholder) Vaishali S. Mankad, MD, AstraZeneca (Employee) Therese Takas, BSc, AstraZeneca (Employee, Other Financial or Material Support, Own stock in AstraZeneca) Jon Heinrichs, PhD, AstraZeneca (Shareholder)Bristol Myers Squibb (Shareholder)J&J (Shareholder)Merck (Shareholder)Organon (Shareholder)Procter & Gamble (Shareholder)Sanofi (Shareholder)Sanofi Pasteur (Employee) Amanda Leach, MRCPCH, AstraZeneca (Employee, Shareholder) M. Pamela Griffin, MD, AstraZeneca (Employee) Tonya L. Villafana, PhD, AstraZeneca (Employee)
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Affiliation(s)
- Laura Hammitt
- Johns Hopkins School of Public Health, Baltimore, MD
| | - Laura Hammitt
- Johns Hopkins School of Public Health, Baltimore, MD
| | - Ron Dagan
- Ben-Gurion University of the Negev, Beer Sheva, HaDarom, Israel
| | - Yuan Yuan
- AstraZeneca, Gaithersburg, MD, USA, Gaithersburg, Maryland
| | - Manuel Baca Cots
- Quirónsalud Málaga Hospital, Málaga, Spain, Málaga, Andalucia, Spain
| | - Miroslava Bosheva
- University Multiprofile Hospital for Active Treatment Sv. Georgi Medical University, Plovdiv, Bulgaria, Plovdiv, Plovdiv, Bulgaria
| | - Shabhir A Mahdi
- University of the Witwatersrand, Johannesburg, South Africa, Johannesburg, Gauteng, South Africa
| | | | | | - Heather J Zar
- Red Cross Children’s Hospital and SA-MRC Unit on Child & Adolescent Health, University of Cape Town, South Africa, Cape Town, Western Cape, South Africa
| | - Dennis Brooks
- AstraZeneca, Gaithersburg, MD, USA, Gaithersburg, Maryland
| | - Amy Grenham
- AstraZeneca, Gaithersburg, MD, USA, Gaithersburg, Maryland
| | | | | | - Pin Ren
- AstraZeneca, Gaithersburg, Maryland
| | - Therese Takas
- AstraZeneca, Gaithersburg, MD, USA, Gaithersburg, Maryland
| | - Jon Heinrichs
- Sanofi Pasteur, Swiftwater, PA, USA, Swiftwater, Pennsylvania
| | - Amanda Leach
- AstraZeneca, Gaithersburg, MD, USA, Gaithersburg, Maryland
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Edward PR, Reyna ME, Daly MK, Hultquist JF, Muller WJ, Ozer EA, Lorenzo-Redondo R, Seed PC, Simons LM, Sheehan K, Staples J, Kociolek L. Screening Students and Staff for Asymptomatic Coronavirus Disease 2019 in Chicago Schools. J Pediatr 2021; 239:74-80.e1. [PMID: 34416262 PMCID: PMC8372436 DOI: 10.1016/j.jpeds.2021.08.017] [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: 06/28/2021] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess rates of asymptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) positivity in K-8 schools with risk mitigation procedures in place, and to evaluate SARS-CoV-2 transmission in school and household contacts of these positive individuals. STUDY DESIGN In this prospective observational study, screening testing for SARS-CoV-2 was performed by oropharyngeal swabbing and polymerase chain reaction (PCR) analysis in students and staff at K-8 private schools in high-risk Chicago ZIP codes. New coronavirus disease 2019 (COVID-19) diagnoses or symptoms among participants, household contacts, and nonparticipants in each school were queried. RESULTS Among 11 K-8 private schools across 8 Chicago ZIP codes, 468 participants (346 students, 122 staff members) underwent screening testing. At the first school, 17 participants (36%) tested positive, but epidemiologic investigation suggested against in-school transmission. Only 5 participants in the subsequent 10 schools tested positive for an overall 4.7% positivity rate (1.2% excluding school 1). All but 1 positive test among in-person students had high PCR cycle threshold values, suggesting very low SARS-CoV-2 viral loads. In all schools, no additional students, staff, or household contacts reported new diagnoses or symptoms of COVID-19 during the 2 weeks following screening testing. CONCLUSIONS We identified infrequent asymptomatic COVID-19 in schools in high-risk Chicago communities and did not identify transmission among school staff, students, or their household contacts. These data suggest that COVID-19 mitigation procedures, including masking and physical distancing, are effective in preventing transmission of COVID-19 in schools. These results may inform future strategies for screening testing in K-8 schools.
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Affiliation(s)
- Priya R. Edward
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL,Reprint requests: Priya R. Edward, MD, 225 E Chicago Ave, Box 220, Chicago, IL 60611
| | - Megan E. Reyna
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Mary Kate Daly
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Judd F. Hultquist
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL,Center for Pathogen Genomics and Microbial Evolution, Northwestern University Institute for Global Health, Chicago, IL
| | - William J. Muller
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL,Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Egon A. Ozer
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL,Center for Pathogen Genomics and Microbial Evolution, Northwestern University Institute for Global Health, Chicago, IL
| | - Ramon Lorenzo-Redondo
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL,Center for Pathogen Genomics and Microbial Evolution, Northwestern University Institute for Global Health, Chicago, IL
| | - Patrick C. Seed
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL,Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lacy M. Simons
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL,Center for Pathogen Genomics and Microbial Evolution, Northwestern University Institute for Global Health, Chicago, IL
| | - Karen Sheehan
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL,Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jacinta Staples
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Larry Kociolek
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL,Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Bui T, Gu Y, Ancot F, Sanguin-Gendreau V, Zuo D, Muller WJ. Emergence of β1 integrin-deficient breast tumours from dormancy involves both inactivation of p53 and generation of a permissive tumour microenvironment. Oncogene 2021; 41:527-537. [PMID: 34782719 PMCID: PMC8782722 DOI: 10.1038/s41388-021-02107-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 01/11/2023]
Abstract
The molecular and cellular mechanisms underlying mammary tumour dormancy and cancer recurrence are unclear and remain to be elucidated. Here, we report that mammary epithelial-specific disruption of β1 integrin in a murine model of Luminal B human breast cancer drastically impairs tumour growth with proliferation block, apoptosis induction and cellular senescence. β1 integrin-deficient dormant lesions show activation of the tumour suppressor p53, and tumours that circumvent dormancy possess p53 mutation analogous to those in human disease. We further demonstrate that mammary epithelial deletion of p53 in β1 integrin-deficient mice fully rescues tumour dormancy and bypasses cellular senescence. Additionally, recurrent β1 integrin-deficient tumours exhibit fibrosis with increased cancer-associated fibroblast infiltration and extracellular matrix deposition, absent in fast-growing β1 integrin/p53-deficient lesions. Taken together, these observations argue that β1 integrin modulates p53-dependent cellular senescence resulting in tumour dormancy and that pro-tumourigenic stromal cues and intrinsic genetic mutation are required for dormancy exit.
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Affiliation(s)
- Tung Bui
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montreal, H3A 1A3, Canada.,Department of Biochemistry, McGill University, Montreal, H3G 1Y6, Canada
| | - Yu Gu
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montreal, H3A 1A3, Canada.,Department of Biochemistry, McGill University, Montreal, H3G 1Y6, Canada
| | - Frédéric Ancot
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montreal, H3A 1A3, Canada
| | | | - Dongmei Zuo
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montreal, H3A 1A3, Canada
| | - William J Muller
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montreal, H3A 1A3, Canada. .,Department of Biochemistry, McGill University, Montreal, H3G 1Y6, Canada. .,Faculty of Medicine, McGill University, Montreal, H3G 2M1, Canada.
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Koch CM, Prigge AD, Anekalla KR, Shukla A, Do Umehara HC, Setar L, Chavez J, Abdala-Valencia H, Politanska Y, Markov NS, Hahn GR, Heald-Sargent T, Sanchez-Pinto LN, Muller WJ, Singer BD, Misharin AV, Ridge KM, Coates BM. Age-related Differences in the Nasal Mucosal Immune Response to SARS-CoV-2. Am J Respir Cell Mol Biol 2021; 66:206-222. [PMID: 34731594 PMCID: PMC8845137 DOI: 10.1165/rcmb.2021-0292oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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] [Indexed: 11/24/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected more than 180 million people since the onset of the pandemic. Despite similar viral load and infectivity rates between children and adults, children rarely develop severe illness. Differences in the host response to the virus at the primary infection site are among the mechanisms proposed to account for this disparity. Our objective was to investigate the host response to SARS-CoV-2 in the nasal mucosa in children and adults and compare it with the host response to respiratory syncytial virus (RSV) and influenza virus. We analyzed clinical outcomes and gene expression in the nasal mucosa of 36 children with SARS-CoV-2, 24 children with RSV, 9 children with influenza virus, 16 adults with SARS-CoV-2, and 7 healthy pediatric and 13 healthy adult controls. In both children and adults, infection with SARS-CoV-2 led to an IFN response in the nasal mucosa. The magnitude of the IFN response correlated with the abundance of viral reads, not the severity of illness, and was comparable between children and adults infected with SARS-CoV-2 and children with severe RSV infection. Expression of ACE2 and TMPRSS2 did not correlate with age or presence of viral infection. SARS-CoV-2–infected adults had increased expression of genes involved in neutrophil activation and T-cell receptor signaling pathways compared with SARS-CoV-2–infected children, despite similar severity of illness and viral reads. Age-related differences in the immune response to SARS-CoV-2 may place adults at increased risk of developing severe illness.
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Affiliation(s)
- Clarissa M Koch
- Northwestern University, Medicine , Chicago, Illinois, United States
| | - Andrew D Prigge
- Ann and Robert H Lurie Children's Hospital of Chicago, 2429, Pediatrics, Chicago, Illinois, United States
| | - Kishore R Anekalla
- Northwestern University Feinberg School of Medicine, Division of Pulmonary and Critical Care Medicine, Chicago, Illinois, United States
| | - Avani Shukla
- Ann and Robert H Lurie Children's Hospital of Chicago, 2429, Chicago, Illinois, United States
| | | | - Leah Setar
- Ann and Robert H Lurie Children's Hospital of Chicago, 2429, Pediatrics, Chicago, Illinois, United States
| | - Jairo Chavez
- Ann and Robert H Lurie Children's Hospital of Chicago, 2429, Chicago, Illinois, United States
| | - Hiam Abdala-Valencia
- Northwestern University Feinberg School of Medicine, Division of Pulmonary and Critical Care Medicine, Chicago, Illinois, United States
| | - Yuliya Politanska
- Northwestern University, Medicine , Chicago, Illinois, United States
| | - Nikolay S Markov
- Northwestern University, Medicine , Chicago, Illinois, United States
| | - Grant R Hahn
- Ann and Robert H Lurie Children's Hospital of Chicago, 2429, Pediatrics, Chicago, Illinois, United States
| | - Taylor Heald-Sargent
- Ann and Robert H Lurie Children's Hospital of Chicago, 2429, Pediatrics, Chicago, Illinois, United States
| | - L Nelson Sanchez-Pinto
- Ann and Robert H Lurie Children's Hospital of Chicago, 2429, Critical Care Medicine, Chicago, Illinois, United States.,Northwestern University Feinberg School of Medicine, 12244, Pediatrics, Chicago, Illinois, United States
| | - William J Muller
- Ann and Robert H Lurie Children's Hospital of Chicago, 2429, Pediatrics, Chicago, Illinois, United States
| | - Benjamin D Singer
- Northwestern University Feinberg School of Medicine, 12244, Medicine and Biochemistry & Molecular Genetics, Chicago, Illinois, United States
| | - Alexander V Misharin
- Northwestern University, Rheumatology/Medicine, Chicago, Illinois, United States
| | - Karen M Ridge
- Northwestern University, Pulmonary and Critical Care, Chicago, Illinois, United States
| | - Bria M Coates
- Northwestern University, Division of Pulmonary and Critical Care Medicine, Chicago, Illinois, United States;
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44
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Edward PR, Lorenzo-Redondo R, Reyna ME, Simons LM, Hultquist JF, Patel AB, Ozer EA, Muller WJ, Heald-Sargent T, McHugh M, Dean TJ, Dalal RM, John J, Manz SC, Kociolek LK. Severity of Illness Caused by Severe Acute Respiratory Syndrome Coronavirus 2 Variants of Concern in Children: A Single-Center Retrospective Cohort Study. medRxiv 2021:2021.10.23.21265402. [PMID: 34729568 PMCID: PMC8562552 DOI: 10.1101/2021.10.23.21265402] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Recent surges in coronavirus 2019 disease (COVID-19) is attributed to the emergence of more transmissible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs). However, the relative severity of SARS-CoV-2 VOCs in children is unknown. METHODS This retrospective single-center cohort study was performed at the Ann & Robert H. Lurie Children's Hospital of Chicago, academic free-standing children's hospital. We included all children ≤ 18 years-old diagnosed with COVID-19 between October 15 th , 2020 and August 31 st , 2021 and whose SARS-CoV-2 isolate was sequenced using the Illumina platform. For each patient sample, we identified the SARS-CoV-2 lineage, which was assigned to one of the following groups: Non-VOC, alpha VOC, beta VOC, gamma VOC, or delta VOC. We measured frequency of 5 markers of COVID-19 severity: hospitalization; COVID-19 pharmacologic treatment; respiratory support; intensive care unit admission; and severe disease as classified by the COVID-19 World Health Organization (WHO) Clinical Progression Scale (severe disease; score ≥ 6). A series of logistic regression models were fitted to estimate odds of each severity marker with each VOC (in comparison to non-VOCs), adjusting for COVID-19 community incidence and demographic and clinical co-variates. RESULTS During the study period, 2,025 patients tested positive for SARS-CoV-2; 1,422 (70.2%) had sufficient viral load to permit sequencing. Among the 499 (35.1%) patients whose isolate was sequenced, median (inter-quartile range) age was 7 (1,12) years; 256 (51.3%) isolates were a VOC: 96 (37.5%) alpha, 38 (14.8%) gamma, and 119 (46.5%) delta. After adjusting for age, Black race, Hispanic ethnicity, high-risk medical conditions, and COVID-19 community incidence, neither alpha nor delta was associated with severe COVID-19. Gamma was independently associated with hospitalization (OR 5.9, 95% CI 1.6-21.5, p =0.007), respiratory support (OR 8.3, 95% CI 1.5-56.3, p =0.02), and severe disease as classified by the WHO Clinical Progression Scale (OR 7.7, 95% CI 1.0-78.1, p =0.05). CONCLUSIONS Compared to non-VOC COVID-19 infections, the gamma VOC, but not the alpha or delta VOCs, was associated with increased severity. These data suggest that recent increased in pediatric COVID-19 hospitalizations are related to increased delta COVID-19 incidence rather than increased delta virulence in children.
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Affiliation(s)
- Priya R Edward
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Ramon Lorenzo-Redondo
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Institute for Global Health, Chicago, IL 60611, USA
| | - Megan E Reyna
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Lacy M Simons
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Institute for Global Health, Chicago, IL 60611, USA
| | - Judd F Hultquist
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Institute for Global Health, Chicago, IL 60611, USA
| | - Ami B Patel
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Egon A Ozer
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Institute for Global Health, Chicago, IL 60611, USA
| | - William J Muller
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Taylor Heald-Sargent
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Matthew McHugh
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Taylor J Dean
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Institute for Global Health, Chicago, IL 60611, USA
| | - Raj M Dalal
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Jordan John
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Shannon C Manz
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Larry K Kociolek
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Bhimraj A, Morgan RL, Shumaker AH, Lavergne V, Baden L, Cheng VCC, Edwards KM, Gandhi RT, Gallagher JC, Muller WJ, O'Horo JC, Shoham S, Wollins DS, Falck-Ytter Y. Therapeutic Emergency Use Authorizations (EUAs) During Pandemics: Double-Edged Swords. Clin Infect Dis 2021; 74:1686-1690. [PMID: 34668010 PMCID: PMC8574541 DOI: 10.1093/cid/ciab880] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Indexed: 11/16/2022] Open
Abstract
Given the urgent need for treatments during the coronavirus disease 2019 pandemic, the US Food and Drug Administration issued emergency use authorizations (EUAs) for multiple therapies. In several instances, however, these EUAs were issued before sufficient evidence of a given therapy’s efficacy and safety were available, potentially promoting ineffective or even harmful therapies and undermining the generation of definitive evidence. We describe the strengths and weaknesses of the different therapeutic EUAs issued during this pandemic. We also contrast them to the vaccine EUAs and suggest a framework and criteria for an evidence-based, trustworthy, and publicly transparent therapeutic EUA process for future pandemics.
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Affiliation(s)
- Adarsh Bhimraj
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Amy Hirsch Shumaker
- VA Northeast Ohio Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Valery Lavergne
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Lindsey Baden
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Vincent Chi-Chung Cheng
- Department of Microbiology, Queen Mary Hospital, and Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kathryn M Edwards
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rajesh T Gandhi
- Infectious Diseases Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jason C Gallagher
- Department of Pharmacy Practice, Temple University, Philadelphia, Pennsylvania
| | - William J Muller
- Division of Pediatric Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - John C O'Horo
- Division of Infectious Diseases, Joint Appointment Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Shmuel Shoham
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Yngve Falck-Ytter
- VA Northeast Ohio Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Maharaj AR, Wu H, Zimmerman KO, Muller WJ, Sullivan JE, Sherwin CMT, Autmizguine J, Rathore MH, Hornik CD, Al-Uzri A, Payne EH, Benjamin DK, Hornik CP. Pharmacokinetics of Ceftazidime in Children and Adolescents with Obesity. Paediatr Drugs 2021; 23:499-513. [PMID: 34302290 PMCID: PMC9706343 DOI: 10.1007/s40272-021-00460-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study was to evaluate ceftazidime pharmacokinetics (PK) in a cohort that includes a predominate number of children and adolescents with obesity and assess the efficacy of competing dosing strategies. METHODS A population PK model was developed using opportunistically collected plasma samples. For each dosing strategy, model-based probability of target attainment (PTA) estimates were computed for study participants using empirical Bayes estimates. In addition, the effects of body size and renal function on PTA were evaluated using stochastic model simulations with virtually generated subjects. RESULTS Twenty-nine participants, 24 of whom were obese, contributed data towards the analysis. The median (range) age, body weight, and body mass index of participants were 12.2 years (2.3-20.6), 59.2 kg (8.4-121), and 25.2 kg/m2 (13.8-42.9), respectively. Administration of 50 mg/kg intravenously (IV) every 8 hours (q8h; max 6 g/day) or 40 mg/kg IV q6h (max 6 g/day) resulted in PTA values of ≥ 90% (minimum inhibitory concentration 8 mg/L) for the subset of obese participants with estimated glomerular filtration rates (GFR) ≥ ~ 80 mL/min/1.73 m2. However, for both regimens, stochastic model simulations denoted lower PTA values (< 90%) with increasing body weight for virtual subjects with GFR ≥ 120 mL/min/1.73 m2. Alternatively, permitting for a maximum daily dose of 8 g/day using a 40 mg/kg IV q6h regimen provided PTA values that were near or above target (90%) for virtual subjects between 10 to 120 kg with GFR ≥ 80 mL/min/1.73 m2. CONCLUSION Our analysis suggests administration of 40 mg/kg IV q6h (max 8 g/day) maximizes PTA in children and adolescents with obesity and GFR ≥ 80 mL/min/1.73 m2. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT01431326.
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Affiliation(s)
- Anil R Maharaj
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
- Duke Clinical Research Institute, Duke University School of Medicine, 300 West Morgan Street, Box 3850, Durham, NC, 27701, USA
| | - Huali Wu
- Duke Clinical Research Institute, Duke University School of Medicine, 300 West Morgan Street, Box 3850, Durham, NC, 27701, USA
| | - Kanecia O Zimmerman
- Duke Clinical Research Institute, Duke University School of Medicine, 300 West Morgan Street, Box 3850, Durham, NC, 27701, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - William J Muller
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University, Chicago, IL, USA
| | - Janice E Sullivan
- Department of Pediatrics, University of Louisville and Norton Children's Hospital, Louisville, KY, USA
| | - Catherine M T Sherwin
- Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton Children's Hospital, Dayton, OH, USA
| | - Julie Autmizguine
- Department of Pharmacology and Pediatrics, Research Center, CHU Sainte-Justine, Montreal, QC, Canada
| | - Mobeen H Rathore
- Division of Pediatric Infectious Diseases and Immunology, University of Florida Center for HIV/AIDS Research, Education, and Service, Wolfson Children's Hospital, Jacksonville, FL, USA
| | - Chi D Hornik
- Duke Clinical Research Institute, Duke University School of Medicine, 300 West Morgan Street, Box 3850, Durham, NC, 27701, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Amira Al-Uzri
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | | | - Daniel K Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, 300 West Morgan Street, Box 3850, Durham, NC, 27701, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Christoph P Hornik
- Duke Clinical Research Institute, Duke University School of Medicine, 300 West Morgan Street, Box 3850, Durham, NC, 27701, USA.
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.
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Scardina T, Oikonomopoulou Z, Sun S, Muller WJ, Patel SJ. Opportunities for Antimicrobial Stewardship Among Pediatric Patients Prescribed Combination Antifungal Therapy. J Pediatr Pharmacol Ther 2021; 26:624-631. [PMID: 34421413 DOI: 10.5863/1551-6776-26.6.624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/13/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Combination antifungal therapy (CAF) may be prescribed to treat invasive fungal infections (IFIs). Data on the incidence of CAF among the pediatric population are limited. Antimicrobial stewardship for CAF includes therapeutic drug monitoring (TDM) and monitoring for adverse events. Primary outcome was to determine the incidence of CAF prescribed for documented proven, probable, and possible IFI. Secondary outcomes were to determine initial dose of antifungal therapy, determine incidence of adverse events, and evaluate our practice of TDM. METHODS Medical charts of patients who received CAF for proven, probable, or possible IFI within 6 years were reviewed. Patients age ≤18 years, prescribed CAF (defined as a second antifungal therapy started ≤72 hours of initial antifungal therapy) for at least 72 hours, and with normal liver function test results were included. RESULTS 57 patients received CAF for 72 separate episodes: 35 episodes were proven IFI, 11 were probable IFI, and 26 were possible IFI. Initial dose of antifungal therapy varied, and 29.1% received a loading dose. A total of 10 patients experienced 14 adverse events that were related to antifungal therapy. In 63.8% of CAF episodes, TDM was conducted. Target antifungal concentrations were documented for 10 CAF episodes. Reason for discontinued of CAF was documented for 35 episodes. Of these episodes, 74% were discontinued after therapeutic antifungal concentrations were achieved. CONCLUSIONS There are opportunities for antimicrobial stewardship interventions in the method of TDM and monitoring for adverse events that could aid in management of CAF.
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Fisher BT, Zaoutis TE, Xiao R, Wattier RL, Castagnola E, Pana ZD, Fullenkamp A, Boge CLK, Ross RK, Yildirim I, Palazzi DL, Danziger-Isakov L, Vora SB, Arrieta A, Yin DE, Avilés-Robles M, Sharma T, Tribble AC, Maron G, Berman D, Green M, Sung L, Romero J, Hauger SB, Roilides E, Belani K, Nolt D, Soler-Palacin P, López-Medina E, Muller WJ, Halasa N, Dulek D, Hussain IZB, Pong A, Hoffman J, Rajan S, Gonzalez BE, Hanisch B, Aftandilian C, Carlesse F, Abzug MJ, Huppler AR, Salvatore CM, Ardura MI, Chakrabarti A, Santolaya ME, Localio AR, Steinbach WJ. Comparative Effectiveness of Echinocandins vs Triazoles or Amphotericin B Formulations as Initial Directed Therapy for Invasive Candidiasis in Children and Adolescents. J Pediatric Infect Dis Soc 2021:piab024. [PMID: 34374424 DOI: 10.1093/jpids/piab024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 08/09/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Invasive candidiasis is the most common invasive fungal disease in children and adolescents, but there are limited pediatric-specific antifungal effectiveness data. We compared the effectiveness of echinocandins to triazoles or amphotericin B formulations (triazole/amphotericin B) as initial directed therapy for invasive candidiasis. METHODS This multinational observational cohort study enrolled patients aged >120 days and <18 years with proven invasive candidiasis from January 1, 2014, to November 28, 2017, at 43 International Pediatric Fungal Network sites. Primary exposure was initial directed therapy administered at the time qualifying culture became positive for yeast. Exposure groups were categorized by receipt of an echinocandin vs receipt of triazole/amphotericin B. Primary outcome was global response at 14 days following invasive candidiasis onset, adjudicated by a centralized data review committee. Stratified Mantel-Haenszel analyses estimated risk difference between exposure groups. RESULTS Seven-hundred and fifty invasive candidiasis episodes were identified. After exclusions, 541 participants (235 in the echinocandin group and 306 in the triazole/amphotericin B group) remained. Crude failure rates at 14 days for echinocandin and triazole/amphotericin B groups were 9.8% (95% confidence intervals [CI]: 6.0% to 13.6%) and 13.1% (95% CI: 9.3% to 16.8%), respectively. The adjusted 14-day risk difference between echinocandin and triazole/amphotericin B groups was -7.1% points (95% CI: -13.1% to -2.4%), favoring echinocandins. The risk difference was -0.4% (95% CI: -7.5% to 6.7%) at 30 days. CONCLUSIONS In children with invasive candidiasis, initial directed therapy with an echinocandin was associated with reduced failure rate at 14 days but not 30 days. These results may support echinocandins as initial directed therapy for invasive candidiasis in children and adolescents. CLINICAL TRIALS REGISTRATION NCT01869829.
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Affiliation(s)
- Brian T Fisher
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia Pennsylvania, USA
| | - Theoklis E Zaoutis
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia Pennsylvania, USA
| | - Rui Xiao
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia Pennsylvania, USA
| | - Rachel L Wattier
- Department of Pediatrics, Division of Infectious Diseases and Global Health, University of California-San Francisco, San Francisco, California, USA
| | - Elio Castagnola
- Infectious Diseases Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Zoi Dorothea Pana
- Infectious Disease Unit, 3rd Department of Pediatrics, Aristotle University and Hippokration Hospital, Thessaloniki, Greece
| | - Allison Fullenkamp
- Division of Pediatric Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Craig L K Boge
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Rachael K Ross
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Inci Yildirim
- Division of Infectious Diseases, Department of Pediatrics Emory University, Atlanta, Georgia, USA
| | - Debra L Palazzi
- Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Lara Danziger-Isakov
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Surabhi B Vora
- Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Antonio Arrieta
- Division of Pediatric Infectious Diseases, Children's Hospital - Orange County, Orange, California, US
| | - Dwight E Yin
- Division of Infectious Diseases, Department of Pediatrics, Children's Mercy and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Martha Avilés-Robles
- Infectious Diseases Department, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Tanvi Sharma
- Division of Infectious Diseases Children's Hospital Boston, Boston, Massachusetts, USA
| | - Alison C Tribble
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Infectious Diseases, Department of Pediatrics, University of Michigan and CS Mott Children's Hospital, Ann Arbor, Michigan, USA
| | - Gabriela Maron
- Department of Infectious Diseases St. Jude Children's Hospital, Memphis, Tennessee, USA
| | - David Berman
- Division of Pediatric Infectious Diseases, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Michael Green
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Lillian Sung
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - José Romero
- Division of Pediatric Infectious Diseases, Arkansas Children's Hospital Research Institute, Little Rock, Arkansas, USA
| | - Sarmistha B Hauger
- Pediatric Infectious Diseases, Dell Children's Medical Center, Austin, Texas, USA
| | - Emmanuel Roilides
- Infectious Disease Unit, 3rd Department of Pediatrics, Aristotle University and Hippokration Hospital, Thessaloniki, Greece
| | - Kiran Belani
- Pediatric Infectious Diseases, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Dawn Nolt
- Division of Pediatric Infectious Diseases, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, USA
| | - Pere Soler-Palacin
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica and Universidad del Valle, Cali Colombia
| | - William J Muller
- Division of Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, US
| | - Daniel Dulek
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, US
| | - Ibrahim Zaid Bin Hussain
- Pediatric Infectious Diseases King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Alice Pong
- Department of Pediatrics, University of California San Diego, San Diego, California, USA
| | - Jill Hoffman
- Pediatric Infectious Diseases, University of California Los Angeles, Los Angeles, California, USA
| | - Sujatha Rajan
- Division of Pediatric Infectious Diseases, Cohen Children's Medical Center, New Hyde Park, New York, USA
| | - Blanca E Gonzalez
- Center for Pediatric Infectious Diseases, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Benjamin Hanisch
- Pediatric Infectious Diseases, Children's National Health System, Washington, DC, USA
| | - Catherine Aftandilian
- Pediatric Hematology/Oncology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Fabianne Carlesse
- Instituto de Oncologia Pediatrica-IOP/GRAACC-UNIFESP, Sao Paulo, Brazil
| | - Mark J Abzug
- Division of Pediatric Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Anna R Huppler
- Department of Pediatrics, Division of Infectious Diseases, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christine M Salvatore
- Department of Pediatrics, Division of Pediatric Infectious Diseases Weill Cornell Medicine, New York, New York, USA
| | - Monica I Ardura
- Pediatric Infectious Diseases and Host Defense, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Maria E Santolaya
- Hospital Dr. Luis Calvo Mackenna, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - A Russell Localio
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia Pennsylvania, USA
| | - William J Steinbach
- Division of Pediatric Infectious Diseases, Duke University, Durham, North Carolina, USA
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Monk JM, Liddle DM, Hutchinson AL, Burns JL, Wellings H, Cartwright NM, Muller WJ, Power KA, Robinson LE, Ma DWL. Fish oil supplementation increases expression of mammary tumor apoptosis mediators and reduces inflammation in an obesity-associated HER-2 breast cancer model. J Nutr Biochem 2021; 95:108763. [PMID: 33965532 DOI: 10.1016/j.jnutbio.2021.108763] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 03/10/2021] [Accepted: 04/16/2021] [Indexed: 12/12/2022]
Abstract
Obesity is associated with inflammation and has been shown to increase breast cancer severity. The objective of this study was to examine the effect of fish oil (FO) supplementation in obesity-associated mammary tumorigenesis in the MMTV-neu(ndl)-YD5 mouse model of human epidermal growth factor receptor-2 positive BC. Female mice were fed one of three diets for 16 weeks: i) high fat diet [HF, % kacl: 41.2% lard, 18.7% corn oil (CO)], ii) an isocaloric HF plus menhaden FO diet (HF+FO, % kcal: 41.2 lard, 13.4% CO, 5.3% FO), iii) low fat diet (LF, % kcal: 4.7% lard, 6% CO). HF mice had increased body weight, visceral adipose weight and serum hormone concentrations (increased leptin and resistin; decreased adiponectin) versus LF, which was attenuated in the HF+FO group versus HF (P<.05). Compared to HF, tumor onset was delayed in HF+FO and LF mice (P<0.05). Compared to HF, HF+FO reduced mammary tumor multiplicity (-27%), tumor weight (-46%) and total tumor volume (-50%) (P<0.05). Additionally, HF+FO reduced mammary tumor multiplicity (-33%), tumor weight (-39%) and total tumor volume (-60%) versus LF. HF+FO improved mammary tumor apoptosis status with increased expression of pro-apoptotic Bad and decreased expression of anti-apoptotic Bcl-xLmediators versus HF (P<0.05). Additionally, HF+FO decreased tumor protein expression of activated Akt, NFκB p65 and STAT3, versus HF (P<0.05). Tumor mRNA expression of inflammatory mediators TNFα, IL-6 and leptin were reduced in HF+FO, whereas IL-10 expression was increased compared to HF (P<0.05). Collectively these results demonstrate the efficacy of FO supplementation for improving obesity-associated breast cancer outcomes.
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Affiliation(s)
- Jennifer M Monk
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph ON, Canada, N1G 2W1.
| | - Danyelle M Liddle
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph ON, Canada, N1G 2W1
| | - Amber L Hutchinson
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph ON, Canada, N1G 2W1
| | - Jessie L Burns
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph ON, Canada, N1G 2W1
| | - Hannah Wellings
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph ON, Canada, N1G 2W1
| | - Nadia M Cartwright
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph ON, Canada, N1G 2W1
| | - William J Muller
- Department of Biochemistry, McGill University, Rosalind and Morris Goodman Cancer Research, Montreal, QC, Canada
| | - Krista A Power
- School of Nutrition Sciences, University of Ottawa, Ottawa ON, Canada, K1H 8L1
| | - Lindsay E Robinson
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph ON, Canada, N1G 2W1
| | - David W L Ma
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph ON, Canada, N1G 2W1.
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50
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Xiao B, Zuo D, Hirukawa A, Cardiff RD, Lamb R, Sonenberg N, Muller WJ. Rheb1-Independent Activation of mTORC1 in Mammary Tumors Occurs through Activating Mutations in mTOR. Cell Rep 2021; 31:107571. [PMID: 32348753 DOI: 10.1016/j.celrep.2020.107571] [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: 06/07/2019] [Revised: 12/06/2019] [Accepted: 04/02/2020] [Indexed: 11/25/2022] Open
Abstract
Mechanistic target of rapamycin complex 1 (mTORC1) is a master modulator of cellular growth, and its aberrant regulation is recurrently documented within breast cancer. While the small GTPase Rheb1 is the canonical activator of mTORC1, Rheb1-independent mechanisms of mTORC1 activation have also been reported but have not been fully understood. Employing multiple transgenic mouse models of breast cancer, we report that ablation of Rheb1 significantly impedes mammary tumorigenesis. In the absence of Rheb1, a block in tumor initiation can be overcome by multiple independent mutations in Mtor to allow Rheb1-independent reactivation of mTORC1. We further demonstrate that the mTOR kinase is indispensable for tumor initiation as the genetic ablation of mTOR abolishes mammary tumorigenesis. Collectively, our findings demonstrate that mTORC1 activation is indispensable for mammary tumor initiation and that tumors acquire alternative mechanisms of mTORC1 activation.
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Affiliation(s)
- Bin Xiao
- Department of Biochemistry, McGill University, Montreal, QC H3A 1A3, Canada; Rosalind & Morris Goodman Cancer Centre, McGill University, Montreal, QC H3A 1A3, Canada
| | - Dongmei Zuo
- Department of Biochemistry, McGill University, Montreal, QC H3A 1A3, Canada; Rosalind & Morris Goodman Cancer Centre, McGill University, Montreal, QC H3A 1A3, Canada
| | - Alison Hirukawa
- Department of Biochemistry, McGill University, Montreal, QC H3A 1A3, Canada; Rosalind & Morris Goodman Cancer Centre, McGill University, Montreal, QC H3A 1A3, Canada
| | - Robert D Cardiff
- Center for Comparative Medicine, University of California, Davis, Davis, CA 95616, USA
| | | | - Nahum Sonenberg
- Department of Biochemistry, McGill University, Montreal, QC H3A 1A3, Canada; Faculty of Medicine, McGill University, Montreal, QC H3A 1A3, Canada; Rosalind & Morris Goodman Cancer Centre, McGill University, Montreal, QC H3A 1A3, Canada
| | - William J Muller
- Department of Biochemistry, McGill University, Montreal, QC H3A 1A3, Canada; Faculty of Medicine, McGill University, Montreal, QC H3A 1A3, Canada; Rosalind & Morris Goodman Cancer Centre, McGill University, Montreal, QC H3A 1A3, Canada.
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