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Lahti J, Tuominen S, Yang Q, Pergola G, Ahmad S, Amin N, Armstrong NJ, Beiser A, Bey K, Bis JC, Boerwinkle E, Bressler J, Campbell A, Campbell H, Chen Q, Corley J, Cox SR, Davies G, De Jager PL, Derks EM, Faul JD, Fitzpatrick AL, Fohner AE, Ford I, Fornage M, Gerring Z, Grabe HJ, Grodstein F, Gudnason V, Simonsick E, Holliday EG, Joshi PK, Kajantie E, Kaprio J, Karell P, Kleineidam L, Knol MJ, Kochan NA, Kwok JB, Leber M, Lam M, Lee T, Li S, Loukola A, Luck T, Marioni RE, Mather KA, Medland S, Mirza SS, Nalls MA, Nho K, O'Donnell A, Oldmeadow C, Painter J, Pattie A, Reppermund S, Risacher SL, Rose RJ, Sadashivaiah V, Scholz M, Satizabal CL, Schofield PW, Schraut KE, Scott RJ, Simino J, Smith AV, Smith JA, Stott DJ, Surakka I, Teumer A, Thalamuthu A, Trompet S, Turner ST, van der Lee SJ, Villringer A, Völker U, Wilson RS, Wittfeld K, Vuoksimaa E, Xia R, Yaffe K, Yu L, Zare H, Zhao W, Ames D, Attia J, Bennett DA, Brodaty H, Chasman DI, Goldman AL, Hayward C, Ikram MA, Jukema JW, Kardia SLR, Lencz T, Loeffler M, Mattay VS, Palotie A, Psaty BM, Ramirez A, Ridker PM, Riedel-Heller SG, Sachdev PS, Saykin AJ, Scherer M, Schofield PR, Sidney S, Starr JM, Trollor J, Ulrich W, Wagner M, Weir DR, Wilson JF, Wright MJ, Weinberger DR, Debette S, Eriksson JG, Mosley TH, Launer LJ, van Duijn CM, Deary IJ, Seshadri S, Räikkönen K. Genome-wide meta-analyses reveal novel loci for verbal short-term memory and learning. Mol Psychiatry 2022; 27:4419-4431. [PMID: 35974141 PMCID: PMC9734053 DOI: 10.1038/s41380-022-01710-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 12/14/2022]
Abstract
Understanding the genomic basis of memory processes may help in combating neurodegenerative disorders. Hence, we examined the associations of common genetic variants with verbal short-term memory and verbal learning in adults without dementia or stroke (N = 53,637). We identified novel loci in the intronic region of CDH18, and at 13q21 and 3p21.1, as well as an expected signal in the APOE/APOC1/TOMM40 region. These results replicated in an independent sample. Functional and bioinformatic analyses supported many of these loci and further implicated POC1. We showed that polygenic score for verbal learning associated with brain activation in right parieto-occipital region during working memory task. Finally, we showed genetic correlations of these memory traits with several neurocognitive and health outcomes. Our findings suggest a role of several genomic loci in verbal memory processes.
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Affiliation(s)
- Jari Lahti
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.
- Turku Institute of Advanced Studies, University of Turku, Turku, Finland.
| | - Samuli Tuominen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Qiong Yang
- Department of Biostatistics, Boston University, Boston, MA, USA
| | - Giulio Pergola
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Shahzad Ahmad
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Najaf Amin
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Nicola J Armstrong
- Department of Mathematics and Statistics, Murdoch University, Murdoch, WA, Australia
| | - Alexa Beiser
- Department of Biostatistics, Boston University, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
| | - Katharina Bey
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Joshua C Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Eric Boerwinkle
- Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Jan Bressler
- Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Archie Campbell
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Harry Campbell
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Qiang Chen
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA
| | - Janie Corley
- Department of Psychology, Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Simon R Cox
- Department of Psychology, Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Gail Davies
- Department of Psychology, Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Philip L De Jager
- Center for Translational and Computational Neuroimmunology, Columbia University Medical Center, New York, NY, USA
| | - Eske M Derks
- Translational Neurogenomics Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Jessica D Faul
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Annette L Fitzpatrick
- Department of Family Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Alison E Fohner
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Institute of Public Health Genetics, University of Washington, Seattle, WA, USA
| | - Ian Ford
- Robertson Center for Biostatistics, University of Glasgow, Glasgow, UK
| | - Myriam Fornage
- McGovern Medical School, Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Zachary Gerring
- Translational Neurogenomics Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Center for Neurodegenerative Diseases, Greifswald, Germany
| | - Francine Grodstein
- Channing Laboratory, Brigham and Women's Hospital, Boston, MA, USA
- Harvard School of Public Health, Boston, MA, USA
| | - Vilmundur Gudnason
- Icelandic Heart Assocation, Kopavogur, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Eleanor Simonsick
- Translational Gerontology Branch, National Institute on Aging, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | - Elizabeth G Holliday
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Peter K Joshi
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, UK
- Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland
| | - Eero Kajantie
- National Institute for Health and Welfare, Helsinki and Oulu, Oulu, Finland
- Hospital for Children and Adolescents, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jaakko Kaprio
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Pauliina Karell
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Luca Kleineidam
- German Center for Neurodegenerative Diseases, Bonn, Germany
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Bonn, Germany
| | - Maria J Knol
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, NSW, Australia
| | - John B Kwok
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Markus Leber
- Department of Psychiatry, University of Cologne, Cologne, Germany
| | - Max Lam
- Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, USA
| | - Teresa Lee
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Shuo Li
- Department of Biostatistics, Boston University, Boston, MA, USA
| | - Anu Loukola
- Helsinki Biobank, University of Helsinki Central Hospital, Helsinki, Finland
| | - Tobias Luck
- Department of Economic and Social Sciences & Institute of Social Medicine, Rehabilitation Sciences and Healthcare Research, University of Applied Sciences Nordhausen, Nordhausen, Germany
- University of Leipzig, Leipzig, Germany
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig, Germany
| | - Riccardo E Marioni
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Karen A Mather
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Sunnybrook Health Sciences Centre, University of Toronto, Randwick, NSW, Australia
| | - Sarah Medland
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Saira S Mirza
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Mike A Nalls
- Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
- Data Tecnica International, Glen Echo, MD, USA
| | - Kwangsik Nho
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
- Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Adrienne O'Donnell
- Department of Biostatistics, Boston University, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
| | - Christopher Oldmeadow
- Clinical Research Design, IT and Statistical Support Unit, Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Jodie Painter
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Alison Pattie
- Department of Psychology, Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Simone Reppermund
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Shannon L Risacher
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Richard J Rose
- Department of Psychological & Brain Sciences, Indiana University Bloomington, Bloomington, IN, USA
| | - Vijay Sadashivaiah
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA
| | - Markus Scholz
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
- LIFE Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Claudia L Satizabal
- Framingham Heart Study, Framingham, MA, USA
- Department of Neurology, Boston University, Boston, MA, USA
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
| | - Peter W Schofield
- Neuropsychiatry Service, Hunter New England Local Health District, Charlestown, NSW, Australia
| | - Katharina E Schraut
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, UK
- Centre for Cardiovascular Sciences, Queen's Medical Research Institute, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
| | - Rodney J Scott
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Jeannette Simino
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Albert V Smith
- Icelandic Heart Assocation, Kopavogur, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Jennifer A Smith
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
- Institute of Social Research, Survey Research Center, University of Michigan, Ann Arbor, MI, USA
| | - David J Stott
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Ida Surakka
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Anbupalam Thalamuthu
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Stella Trompet
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Stephen T Turner
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Sven J van der Lee
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Arno Villringer
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Day Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Uwe Völker
- Interfaculty Institute for Genetics and Functional Genomics, Department Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Katharina Wittfeld
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Center for Neurodegenerative Diseases, Greifswald, Germany
| | - Eero Vuoksimaa
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Rui Xia
- Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kristine Yaffe
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Habil Zare
- Department of Cell Systems & Anatomy, The University of Texas Health Science Center, San Antonio, TX, USA
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas, San Antonio, TX, USA
- University of Texas Health Sciences Center, Houston, NA, US
| | - Wei Zhao
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - David Ames
- National Ageing Research Institute, Parkville, Melbourne, VIC, Australia
- University of Melbourne, Academic Unit for Psychiatry of Old Age, St George's Hospital, Melbourne, VIC, Australia
| | - John Attia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Clinical Research Design, IT and Statistical Support Unit, Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Dementia Collaborative Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Daniel I Chasman
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Aaron L Goldman
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA
| | - Caroline Hayward
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sharon L R Kardia
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Todd Lencz
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Markus Loeffler
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
- LIFE Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Venkata S Mattay
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA
- Food and Drug Administration, Washington, DC, USA
| | - Aarno Palotie
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- Analytic and Translational Genetics Unit, Department of Medicine, Department of Neurology and Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- The Stanley Center for Psychiatric Research and Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology and Department of Health Services, University of Washington, Seattle, WA, USA
- Kaiser Permanente Washington Heath Research Institute, Seattle, WA, USA
| | - Alfredo Ramirez
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Bonn, Germany
- Department of Psychiatry, University of Cologne, Cologne, Germany
| | - Paul M Ridker
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Andrew J Saykin
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
- Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Martin Scherer
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter R Schofield
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Stephen Sidney
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, USA
| | - John M Starr
- Department of Psychology, Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Julian Trollor
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - William Ulrich
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA
| | - Michael Wagner
- German Center for Neurodegenerative Diseases, Bonn, Germany
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Bonn, Germany
| | - David R Weir
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - James F Wilson
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, UK
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Margaret J Wright
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
- Centre for Advanced Imaging, The University of Queensland, Brisbane, QLD, Australia
| | - Daniel R Weinberger
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephanie Debette
- Inserm, Bordeaux Population Health Research Center, team VINTAGE, UMR 1219, University of Bordeaux, Bordeaux, France
- Bordeaux University Hospital (CHU Bordeaux), Department of Neurology, Bordeaux, France
| | - Johan G Eriksson
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Helsinki, Singapore
| | - Thomas H Mosley
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Public Health, Oxford University, Oxford, UK
| | - Ian J Deary
- Department of Psychology, Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Sudha Seshadri
- Framingham Heart Study, Framingham, MA, USA
- Department of Neurology, Boston University, Boston, MA, USA
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
| | - Katri Räikkönen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
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McGrath ER, Beiser AS, O'Donnell A, Himali JJ, Pase MP, Satizabal CL, Seshadri S. Determining Vascular Risk Factors for Dementia and Dementia Risk Prediction Across Mid- to Later Life: The Framingham Heart Study. Neurology 2022; 99:e142-e153. [PMID: 35584926 PMCID: PMC9280997 DOI: 10.1212/wnl.0000000000200521] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/28/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The association between vascular risk factors and dementia varies with age, making generalizability of dementia risk prediction rules to individuals of different ages challenging. We determined the most important vascular risk factors for inclusion in age-specific dementia risk scores. METHODS Framingham Heart Study Original and Offspring cohort participants with available data on the Framingham Stroke Risk Profile (FSRP) at midlife (age 55; n = 4,899, 57% women), late life (ages 65 or 70), or later life (ages 75 or 80 [n = 2,386, 62% women]) were followed for 10-year incident dementia risk from ages 65, 70, 75, and 80. RESULTS Age- and sex-adjusted midlife risk factors associated with 10-year risk of dementia from age 65 included FSRP (hazard ratio [HR] 1.16, 95% CI 1.06-1.26, per 1 SD increment in log-transformed score), diabetes mellitus (DM; HR 4.31, 95% CI 1.97-9.43), and systolic blood pressure (SBP; HR 1.12, 95% CI 1.02-1.24, per 10 mm Hg increment). Late-life risk factors associated with 10-year incident dementia from ages 65 or 70 included FSRP (age 65 only: HR 1.06, 95% CI 1.02-1.10), antihypertensive use (age 65 reported: HR 1.66, 95% CI 1.12-2.46), DM (age 65 reported: HR 1.96, 95% CI 1.09-3.52), atrial fibrillation (age 65 reported: HR 2.30, 95% CI 1.00-5.27), nonstroke cardiovascular disease (nsCVD; age 65 reported: HR 1.95, 95% CI 1.24-3.07), and stroke (age 70 only: HR 3.61, 95% CI 2.21-5.92). Later-life risk factors associated with 10-year incident dementia from ages 75 or 80 included antihypertensive use (age 80 only: HR 0.74, 95% CI 0.62-0.89), DM (age 80 reported: HR 1.40, 95% CI 1.04-1.89), atrial fibrillation (age 80 reported: HR 1.43, 95% CI 1.07-1.92), and stroke (age 80 reported: HR 1.63, 95% CI 1.13-2.35). In stepwise models, SBP and DM at age 55, nsCVD at age 65, DM and stroke at ages 70 and 75, and DM, stroke, and use of antihypertensives (protective) at age 80 were the most important vascular risk factors for dementia. DISCUSSION Our findings support the use of age-specific dementia risk scores, which should prioritize including, at age 55, SBP and DM; at age 65, nsCVD; at ages 70 and 75, DM and stroke; and at age 80, DM, stroke, and antihypertensive use.
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Affiliation(s)
- Emer R McGrath
- From the HRB Clinical Research Facility (E.R.M.) and School of Medicine, National University of Ireland Galway; The Framingham Heart Study (E.R.M., A.S.B., A.O., J.J.H., M.P.P., C.L.S., S.S.); Boston University School of Public Health (A.S.B., A.O., J.J.H.); Boston University School of Medicine (A.S.B., J.J.H., S.S.), MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (J.J.H., C.L.S., S.S.), University of Texas Health Sciences Center, San Antonio; The Turner Institute for Brain and Mental Health (M.P.P.), Monash University, Victoria, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA.
| | - Alexa S Beiser
- From the HRB Clinical Research Facility (E.R.M.) and School of Medicine, National University of Ireland Galway; The Framingham Heart Study (E.R.M., A.S.B., A.O., J.J.H., M.P.P., C.L.S., S.S.); Boston University School of Public Health (A.S.B., A.O., J.J.H.); Boston University School of Medicine (A.S.B., J.J.H., S.S.), MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (J.J.H., C.L.S., S.S.), University of Texas Health Sciences Center, San Antonio; The Turner Institute for Brain and Mental Health (M.P.P.), Monash University, Victoria, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA
| | - Adrienne O'Donnell
- From the HRB Clinical Research Facility (E.R.M.) and School of Medicine, National University of Ireland Galway; The Framingham Heart Study (E.R.M., A.S.B., A.O., J.J.H., M.P.P., C.L.S., S.S.); Boston University School of Public Health (A.S.B., A.O., J.J.H.); Boston University School of Medicine (A.S.B., J.J.H., S.S.), MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (J.J.H., C.L.S., S.S.), University of Texas Health Sciences Center, San Antonio; The Turner Institute for Brain and Mental Health (M.P.P.), Monash University, Victoria, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA
| | - Jayandra J Himali
- From the HRB Clinical Research Facility (E.R.M.) and School of Medicine, National University of Ireland Galway; The Framingham Heart Study (E.R.M., A.S.B., A.O., J.J.H., M.P.P., C.L.S., S.S.); Boston University School of Public Health (A.S.B., A.O., J.J.H.); Boston University School of Medicine (A.S.B., J.J.H., S.S.), MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (J.J.H., C.L.S., S.S.), University of Texas Health Sciences Center, San Antonio; The Turner Institute for Brain and Mental Health (M.P.P.), Monash University, Victoria, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA
| | - Matthew P Pase
- From the HRB Clinical Research Facility (E.R.M.) and School of Medicine, National University of Ireland Galway; The Framingham Heart Study (E.R.M., A.S.B., A.O., J.J.H., M.P.P., C.L.S., S.S.); Boston University School of Public Health (A.S.B., A.O., J.J.H.); Boston University School of Medicine (A.S.B., J.J.H., S.S.), MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (J.J.H., C.L.S., S.S.), University of Texas Health Sciences Center, San Antonio; The Turner Institute for Brain and Mental Health (M.P.P.), Monash University, Victoria, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA
| | - Claudia L Satizabal
- From the HRB Clinical Research Facility (E.R.M.) and School of Medicine, National University of Ireland Galway; The Framingham Heart Study (E.R.M., A.S.B., A.O., J.J.H., M.P.P., C.L.S., S.S.); Boston University School of Public Health (A.S.B., A.O., J.J.H.); Boston University School of Medicine (A.S.B., J.J.H., S.S.), MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (J.J.H., C.L.S., S.S.), University of Texas Health Sciences Center, San Antonio; The Turner Institute for Brain and Mental Health (M.P.P.), Monash University, Victoria, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA
| | - Sudha Seshadri
- From the HRB Clinical Research Facility (E.R.M.) and School of Medicine, National University of Ireland Galway; The Framingham Heart Study (E.R.M., A.S.B., A.O., J.J.H., M.P.P., C.L.S., S.S.); Boston University School of Public Health (A.S.B., A.O., J.J.H.); Boston University School of Medicine (A.S.B., J.J.H., S.S.), MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (J.J.H., C.L.S., S.S.), University of Texas Health Sciences Center, San Antonio; The Turner Institute for Brain and Mental Health (M.P.P.), Monash University, Victoria, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA
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Buckley RF, O'Donnell A, McGrath ER, Jacobs HI, Lois C, Satizabal CL, Ghosh S, Rubinstein ZB, Murabito JM, Sperling RA, Johnson KA, Seshadri S, Beiser AS. Menopause Status Moderates Sex Differences in Tau Burden: A Framingham PET Study. Ann Neurol 2022; 92:11-22. [PMID: 35471588 PMCID: PMC9233144 DOI: 10.1002/ana.26382] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Women have a higher lifetime risk of Alzheimer's disease (AD) than men. Among cognitively normal (CN) older adults, women exhibit elevated tau positron emission tomography (PET) signal compared with men. We explored whether menopause exacerbates sex differences in tau deposition in middle-aged adults. METHODS 328 CN participants from the Framingham Study (mean age = 57 years (±10 years), 161 women, of whom, 104 were post-menopausal) underwent tau and β-amyloid (Aβ)-PET neuroimaging. We examined global Aβ-PET, and tau-PET signal in 5 regions identified a priori as demonstrating significant sex differences in older adults (in temporal, inferior parietal, middle frontal, and lateral occipital regions). We examined sex and menopause status-related differences in each region-of-interest, using linear regressions, as well as interactions with Aβ and APOEε4 genotype. RESULTS Women exhibited higher tau-PET signal (p < 0.002), and global Aβ-PET (p = 0.010), than men in inferior parietal, rostral middle frontal, and lateral occipital regions. Compared with age-matched men, post-menopausal women showed significantly higher tau-PET signal in parieto-occipital regions (p < 0.0001). By contrast, no differences in tau-PET signal existed between pre-menopausal women and men. Aβ-PET was not associated with menopausal status or age. Neither Aβ-PET nor APOEε4 status moderated sex or menopause associations with tau-PET. INTERPRETATION Clear divergence in tauopathy between the sexes are apparent approximately 20 years earlier than previously reported. Menopause status moderated sex differences in Aβ and tau-PET burden, with tau first appearing post-menopause. Sex and menopause differences consistently appeared in middle frontal and parieto-occipital regions but were not moderated by Aβ burden or APOEε4, suggesting that menopause-related tau vulnerability may be independent of AD-related pathways. ANN NEUROL 2022;92:11-22.
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Affiliation(s)
- Rachel F. Buckley
- Department of NeurologyMassachusetts General Hospital and Harvard Medical SchoolBostonMAUSA
- Center for Alzheimer Research and Treatment, Department of NeurologyBrigham and Women's HospitalBostonMAUSA
- Melbourne School of Psychological Science and Florey InstitutesUniversity of MelbourneParkvilleVICAustralia
| | - Adrienne O'Donnell
- Department of BiostatisticsBoston University School of Public HealthBostonMAUSA
- Framingham Heart StudyFraminghamMAUSA
| | - Emer R. McGrath
- Framingham Heart StudyFraminghamMAUSA
- HRB Clinical Research FacilityNational University of Ireland GalwayGalwayIreland
| | - Heidi I.L. Jacobs
- Gordon Center for Medical Imaging, Department of RadiologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
- Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Alzheimer Centre LimburgMaastricht UniversityMaastrichtThe Netherlands
| | - Cristina Lois
- Gordon Center for Medical Imaging, Department of RadiologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Claudia L. Satizabal
- Framingham Heart StudyFraminghamMAUSA
- Glen Biggs Institute for Alzheimer's & Neurodegenerative DiseasesUniversity of Texas Health San AntonioSan AntonioTXUSA
- Department of NeurologyBoston University School of MedicineBostonMAUSA
| | | | - Zoe B. Rubinstein
- Gordon Center for Medical Imaging, Department of RadiologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | | | - Reisa A. Sperling
- Department of NeurologyMassachusetts General Hospital and Harvard Medical SchoolBostonMAUSA
- Center for Alzheimer Research and Treatment, Department of NeurologyBrigham and Women's HospitalBostonMAUSA
| | - Keith A. Johnson
- Center for Alzheimer Research and Treatment, Department of NeurologyBrigham and Women's HospitalBostonMAUSA
- Gordon Center for Medical Imaging, Department of RadiologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Sudha Seshadri
- Framingham Heart StudyFraminghamMAUSA
- Glen Biggs Institute for Alzheimer's & Neurodegenerative DiseasesUniversity of Texas Health San AntonioSan AntonioTXUSA
- Department of NeurologyBoston University School of MedicineBostonMAUSA
| | - Alexandra S. Beiser
- Department of BiostatisticsBoston University School of Public HealthBostonMAUSA
- Framingham Heart StudyFraminghamMAUSA
- Department of NeurologyBoston University School of MedicineBostonMAUSA
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4
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Cooper LL, O'Donnell A, Beiser AS, Thibault EG, Sanchez JS, Benjamin EJ, Hamburg NM, Vasan RS, Larson MG, Johnson KA, Mitchell GF, Seshadri S. Association of Aortic Stiffness and Pressure Pulsatility With Global Amyloid-β and Regional Tau Burden Among Framingham Heart Study Participants Without Dementia. JAMA Neurol 2022; 79:710-719. [PMID: 35666520 DOI: 10.1001/jamaneurol.2022.1261] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Aortic stiffness is associated with clinical hallmarks of Alzheimer disease and related dementias and could be a modifiable target for disease prevention. Objective To assess associations of aortic stiffness and pressure pulsatility with global amyloid-β plaques and regional tau burden in the brain of middle-aged and older adults without dementia. Design, Setting, and Participants The sample for this cross-sectional study was drawn from the Framingham Heart Study Third Generation Cohort at examination 3 (N = 3171; 2016-2019), of whom 3092 successfully underwent comprehensive hemodynamic evaluations. In a supplemental visit (2015-2021), a subset of 270 participants without dementia who represented the spectrum of vascular risk also underwent positron emission tomography. Thirteen participants were excluded for missing covariate data. The final sample size was 257 participants. Exposures Three measures of aortic stiffness and pressure pulsatility (carotid-femoral pulse wave velocity, central pulse pressure [CPP], and forward wave amplitude [FWA]) were evaluated using arterial tonometry. Main Outcomes and Measures Global amyloid-β plaques and regional tau were assessed using 11C-Pittsburgh compound B and 18F-flortaucipir positron emission tomography tracers, respectively. Results The mean (SD) age of the 257 participants was 54 (8) years, and 126 were women (49%). All participants were White Western European race. In multivariable models, higher CPP (β per SD = 0.17; 95% CI, 0.00-0.35; P = .045) and FWA (β per SD = 0.16; 95% CI, 0.00-0.31; P = .04) were associated with greater entorhinal tau burden. In similar models, higher CPP (β per SD = 0.19; 95% CI, 0.02-0.36; P = .03) and FWA (β per SD = 0.17; 95% CI, 0.01-0.32; P = .03) were associated with greater rhinal tau burden. Aortic stiffness and pressure pulsatility measures were not associated with amygdala, inferior temporal, precuneus tau burden, or global amyloid-β plaques. Associations for entorhinal and rhinal tau outcomes were more prominent in older participants (≥60 years). For example, higher levels of all aortic stiffness and pressure pulsatility measures (β per SD = 0.40-0.92; P = .001-.02) were associated with higher entorhinal tau burden among older but not younger participants in stratified analyses. Conclusions and Relevance In this cross-sectional study, abnormal central vascular hemodynamics were associated with higher tau burden in specific brain regions. Findings suggest that aortic stiffness, which is potentially modifiable, may be a probable independent target for prevention of tau-related pathologies.
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Affiliation(s)
- Leroy L Cooper
- Biology Department, Vassar College, Poughkeepsie, New York
| | - Adrienne O'Donnell
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.,Boston University and the National Heart, Lung, and Blood Institute (NHLBI) Framingham Heart Study, Framingham, Massachusetts
| | - Alexa S Beiser
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.,Boston University and the National Heart, Lung, and Blood Institute (NHLBI) Framingham Heart Study, Framingham, Massachusetts.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Emma G Thibault
- Gordon Center for Medical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Justin S Sanchez
- Gordon Center for Medical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Emelia J Benjamin
- Boston University and the National Heart, Lung, and Blood Institute (NHLBI) Framingham Heart Study, Framingham, Massachusetts.,Cardiology and Preventive Medicine Sections, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.,Evans Department of Medicine, Boston Medical Center, Boston, Massachusetts.,Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Naomi M Hamburg
- Evans Department of Medicine, Boston Medical Center, Boston, Massachusetts.,Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Ramachandran S Vasan
- Boston University and the National Heart, Lung, and Blood Institute (NHLBI) Framingham Heart Study, Framingham, Massachusetts.,Cardiology and Preventive Medicine Sections, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.,Evans Department of Medicine, Boston Medical Center, Boston, Massachusetts.,Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Martin G Larson
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.,Boston University and the National Heart, Lung, and Blood Institute (NHLBI) Framingham Heart Study, Framingham, Massachusetts
| | - Keith A Johnson
- Gordon Center for Medical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston.,Departments of Radiology and Neurology, Harvard Medical School, Boston, Massachusetts
| | | | - Sudha Seshadri
- Boston University and the National Heart, Lung, and Blood Institute (NHLBI) Framingham Heart Study, Framingham, Massachusetts.,Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, San Antonio, Texas
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5
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Salinas J, Beiser AS, Samra JK, O'Donnell A, DeCarli CS, Gonzales MM, Aparicio HJ, Seshadri S. Association of Loneliness With 10-Year Dementia Risk and Early Markers of Vulnerability for Neurocognitive Decline. Neurology 2022; 98:e1337-e1348. [PMID: 35131906 PMCID: PMC8967424 DOI: 10.1212/wnl.0000000000200039] [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] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 12/27/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Loneliness is common, and its prevalence is rising. The relationship of loneliness with subsequent dementia and the early preclinical course of Alzheimer disease and related dementia (ADRD) remains unclear. Thus, the primary objective of this study was to determine the association of loneliness with 10-year all-cause dementia risk and early cognitive and neuroanatomic imaging markers of ADRD vulnerability. METHODS This was a retrospective analysis of prospectively collected data from the population-based Framingham Study cohorts (September 9, 1948-December 31, 2018). Eligible participants had loneliness assessed and were dementia-free at baseline. Loneliness was recorded with the Center for Epidemiologic Studies Depression Scale, defined conservatively as feeling lonely ≥3 days in the past week. The main outcomes were incident dementia over a 10-year period, cognition, and MRI brain volumes and white matter injury. RESULTS Of 2,308 participants (mean age 73 [SD 9] years, 56% women) who met eligibility in the dementia sample, 14% (329 of 2,308) developed dementia and 6% (144 of 2,308) were lonely. Lonely (versus not lonely) adults had higher 10-year dementia risk (age-, sex-, and education-adjusted hazard ratio 1.54, 95% CI 1.06-2.24). Lonely participants <80 years of age without APOE ε4 alleles had a 3-fold greater risk (adjusted hazard ratio 3.03, 95% CI, 1.63-5.62). Among 1,875 persons without dementia who met eligibility in the cognition sample (mean age 62 [SD 9] years, 54% women), loneliness associated with poorer executive function, lower total cerebral volume, and greater white matter injury. DISCUSSION Over 10 years of close clinical dementia surveillance in this cohort study, loneliness was associated with increased dementia risk; this tripled in adults whose baseline risk would otherwise be relatively low on the basis of age and genetic risk, representing a majority of the US population. Loneliness was also associated with worse neurocognitive markers of ADRD vulnerability, suggesting an early pathogenic role. These findings may have important clinical and public health implications given observed loneliness trends. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that loneliness increases the 10-year risk of developing dementia.
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Affiliation(s)
- Joel Salinas
- From the Department of Neurology (J.S.), Center for Cognitive Neurology, New York University Grossman School of Medicine, New York; The Framingham Study (J.S., A.S.B., J.K.S., A.O., H.J.A., S.S.); Department of Biostatistics (A.S.B., J.K.S., A.O.), Boston University School of Public Health; Department of Neurology (A.S.B., H.J.A., S.S.), Boston University School of Medicine, MA; Department of Neurology (C.S.D.), University of California Davis; and Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (M.M.G., S.S.), University of Texas Health Sciences Center, San Antonio.
| | - Alexa S Beiser
- From the Department of Neurology (J.S.), Center for Cognitive Neurology, New York University Grossman School of Medicine, New York; The Framingham Study (J.S., A.S.B., J.K.S., A.O., H.J.A., S.S.); Department of Biostatistics (A.S.B., J.K.S., A.O.), Boston University School of Public Health; Department of Neurology (A.S.B., H.J.A., S.S.), Boston University School of Medicine, MA; Department of Neurology (C.S.D.), University of California Davis; and Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (M.M.G., S.S.), University of Texas Health Sciences Center, San Antonio
| | - Jasmeet K Samra
- From the Department of Neurology (J.S.), Center for Cognitive Neurology, New York University Grossman School of Medicine, New York; The Framingham Study (J.S., A.S.B., J.K.S., A.O., H.J.A., S.S.); Department of Biostatistics (A.S.B., J.K.S., A.O.), Boston University School of Public Health; Department of Neurology (A.S.B., H.J.A., S.S.), Boston University School of Medicine, MA; Department of Neurology (C.S.D.), University of California Davis; and Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (M.M.G., S.S.), University of Texas Health Sciences Center, San Antonio
| | - Adrienne O'Donnell
- From the Department of Neurology (J.S.), Center for Cognitive Neurology, New York University Grossman School of Medicine, New York; The Framingham Study (J.S., A.S.B., J.K.S., A.O., H.J.A., S.S.); Department of Biostatistics (A.S.B., J.K.S., A.O.), Boston University School of Public Health; Department of Neurology (A.S.B., H.J.A., S.S.), Boston University School of Medicine, MA; Department of Neurology (C.S.D.), University of California Davis; and Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (M.M.G., S.S.), University of Texas Health Sciences Center, San Antonio
| | - Charles S DeCarli
- From the Department of Neurology (J.S.), Center for Cognitive Neurology, New York University Grossman School of Medicine, New York; The Framingham Study (J.S., A.S.B., J.K.S., A.O., H.J.A., S.S.); Department of Biostatistics (A.S.B., J.K.S., A.O.), Boston University School of Public Health; Department of Neurology (A.S.B., H.J.A., S.S.), Boston University School of Medicine, MA; Department of Neurology (C.S.D.), University of California Davis; and Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (M.M.G., S.S.), University of Texas Health Sciences Center, San Antonio
| | - Mitzi M Gonzales
- From the Department of Neurology (J.S.), Center for Cognitive Neurology, New York University Grossman School of Medicine, New York; The Framingham Study (J.S., A.S.B., J.K.S., A.O., H.J.A., S.S.); Department of Biostatistics (A.S.B., J.K.S., A.O.), Boston University School of Public Health; Department of Neurology (A.S.B., H.J.A., S.S.), Boston University School of Medicine, MA; Department of Neurology (C.S.D.), University of California Davis; and Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (M.M.G., S.S.), University of Texas Health Sciences Center, San Antonio
| | - Hugo J Aparicio
- From the Department of Neurology (J.S.), Center for Cognitive Neurology, New York University Grossman School of Medicine, New York; The Framingham Study (J.S., A.S.B., J.K.S., A.O., H.J.A., S.S.); Department of Biostatistics (A.S.B., J.K.S., A.O.), Boston University School of Public Health; Department of Neurology (A.S.B., H.J.A., S.S.), Boston University School of Medicine, MA; Department of Neurology (C.S.D.), University of California Davis; and Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (M.M.G., S.S.), University of Texas Health Sciences Center, San Antonio
| | - Sudha Seshadri
- From the Department of Neurology (J.S.), Center for Cognitive Neurology, New York University Grossman School of Medicine, New York; The Framingham Study (J.S., A.S.B., J.K.S., A.O., H.J.A., S.S.); Department of Biostatistics (A.S.B., J.K.S., A.O.), Boston University School of Public Health; Department of Neurology (A.S.B., H.J.A., S.S.), Boston University School of Medicine, MA; Department of Neurology (C.S.D.), University of California Davis; and Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (M.M.G., S.S.), University of Texas Health Sciences Center, San Antonio
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6
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Weinstein G, O'Donnell A, Davis-Plourde K, Zelber-Sagi S, Ghosh S, DeCarli CS, Thibault EG, Sperling RA, Johnson KA, Beiser AS, Seshadri S. Non-Alcoholic Fatty Liver Disease, Liver Fibrosis, and Regional Amyloid-β and Tau Pathology in Middle-Aged Adults: The Framingham Study. J Alzheimers Dis 2022; 86:1371-1383. [PMID: 35213373 DOI: 10.3233/jad-215409] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 12/21/2022]
Abstract
BACKGROUND Liver steatosis and fibrosis are emerging as risk factors for multiple extrahepatic health conditions; however, their relationship with Alzheimer's disease pathology is unclear. OBJECTIVE To examine whether non-alcoholic fatty liver disease (NAFLD) and FIB-4, a non-invasive index of advanced fibrosis, are associated with brain amyloid-β (Aβ) and tau pathology. METHODS The study sample included Framingham Study participants from the Offspring and Third generation cohorts who attended exams 9 (2011-2014) and 2 (2008-2011), respectively. Participants underwent 11C-Pittsburgh Compound-B amyloid and 18F-Flortaucipir tau positron emission tomography (PET) imaging and abdomen computed tomography, or had information on all components of the FIB-4 index. Linear regression models were used to assess the relationship of NAFLD and FIB-4 with regional tau and Aβ, adjusting for potential confounders and multiple comparisons. RESULTS Of the subsample with NAFLD information (N = 169; mean age 52±9 y; 57% males), 57 (34%) had NAFLD. Of the subsample with information on liver fibrosis (N = 177; mean age 50±10 y; 51% males), 34 (19%) had advanced fibrosis (FIB-4 > 1.3). Prevalent NAFLD was not associated with Aβ or tau PET. However, FIB-4 index was significantly associated with increased rhinal tau (β= 1.03±0.33, p = 0.002). Among individuals with prevalent NAFLD, FIB-4 was related to inferior temporal, parahippocampal gyrus, entorhinal and rhinal tau (β= 2.01±0.47, p < 0.001; β= 1.60±0.53, p = 0.007, and β= 1.59±0.47, p = 0.003 and β= 1.60±0.42, p = 0.001, respectively) and to Aβ deposition overall and in the inferior temporal and parahippocampal regions (β= 1.93±0.47, p < 0.001; β= 1.59±0.38, p < 0.001, and β= 1.52±0.54, p = 0.008, respectively). CONCLUSION This study suggests a possible association between liver fibrosis and early Alzheimer's disease pathology, independently of cardio-metabolic risk factors.
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Affiliation(s)
| | - Adrienne O'Donnell
- Department of Biostatistics, BostonUniversity School of Public Health, Boston, MA, USA.,The Framingham Study, Framingham, MA, USA
| | - Kendra Davis-Plourde
- Department of Biostatistics, BostonUniversity School of Public Health, Boston, MA, USA.,The Framingham Study, Framingham, MA, USA
| | - Shira Zelber-Sagi
- School of Public Health, University of Haifa, Haifa, Israel.,Liver Unit, Department of Gastroenterology, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Saptaparni Ghosh
- The Framingham Study, Framingham, MA, USA.,Department of Neurology, Boston University Schoolof Medicine, Boston, MA, USA
| | - Charles S DeCarli
- Department ofNeurology, School of Medicine & Imaging of Dementia and AgingLaboratory, Center for Neuroscience, University of California Davis, Davis, CA, USA
| | - Emma G Thibault
- Department of Radiology, AthinoulaA. Martinos Center for Biomedical Imaging, Massachusetts GeneralHospital, Harvard Medical School, Boston, MA, USA
| | - Reisa A Sperling
- Department of Radiology, AthinoulaA. Martinos Center for Biomedical Imaging, Massachusetts GeneralHospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts GeneralHospital, Harvard Medical School, Boston, MA, USA
| | - Keith A Johnson
- Department of Radiology, AthinoulaA. Martinos Center for Biomedical Imaging, Massachusetts GeneralHospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts GeneralHospital, Harvard Medical School, Boston, MA, USA
| | - Alexa S Beiser
- Department of Biostatistics, BostonUniversity School of Public Health, Boston, MA, USA.,The Framingham Study, Framingham, MA, USA.,Department of Neurology, Boston University Schoolof Medicine, Boston, MA, USA
| | - Sudha Seshadri
- The Framingham Study, Framingham, MA, USA.,Department of Neurology, Boston University Schoolof Medicine, Boston, MA, USA.,Glenn Biggs Institute for Alzheimer's andNeurodegenerative Diseases, University of Texas Health SciencesCenter, San Antonio, TX, USA
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7
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Jacobs HIL, O'Donnell A, Satizabal CL, Lois C, Kojis D, Hanseeuw BJ, Thibault E, Sanchez JS, Buckley RF, Yang Q, DeCarli C, Killiany R, Sargurupremraj M, Sperling RA, Johnson KA, Beiser AS, Seshadri S. Associations Between Brainstem Volume and Alzheimer's Disease Pathology in Middle-Aged Individuals of the Framingham Heart Study. J Alzheimers Dis 2022; 86:1603-1609. [PMID: 35213372 PMCID: PMC9038711 DOI: 10.3233/jad-215372] [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] [Indexed: 11/15/2022]
Abstract
The brainstem is among the first regions to accumulate Alzheimer's disease (AD)-related hyperphosphorylated tau pathology during aging. We aimed to examine associations between brainstem volume and neocortical amyloid-β or tau pathology in 271 middle-aged clinically normal individuals of the Framingham Heart Study who underwent MRI and PET imaging. Lower volume of the medulla, pons, or midbrain was associated with greater neocortical amyloid burden. No associations were detected between brainstem volumes and tau deposition. Our results support the hypothesis that lower brainstem volumes are associated with initial AD-related processes and may signal preclinical AD pathology.
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Affiliation(s)
- Heidi I L Jacobs
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, Netherlands
- Gordon Center for Medical Imaging, Boston, MA, USA
| | - Adrienne O'Donnell
- Boston University School of Public Health, Boston, MA, USA
- The Framingham Heart Study, Framingham, MA, USA
| | - Claudia L Satizabal
- The Framingham Heart Study, Framingham, MA, USA
- Boston University School of Medicine, Boston, MA, USA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
| | - Cristina Lois
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Gordon Center for Medical Imaging, Boston, MA, USA
| | - Daniel Kojis
- Boston University School of Public Health, Boston, MA, USA
- The Framingham Heart Study, Framingham, MA, USA
| | - Bernard J Hanseeuw
- Massachusetts General Hospital, Boston, MA, USA
- Gordon Center for Medical Imaging, Boston, MA, USA
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Emma Thibault
- Massachusetts General Hospital, Boston, MA, USA
- Gordon Center for Medical Imaging, Boston, MA, USA
| | - Justin S Sanchez
- Massachusetts General Hospital, Boston, MA, USA
- Gordon Center for Medical Imaging, Boston, MA, USA
| | - Rachel F Buckley
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Qiong Yang
- Boston University School of Public Health, Boston, MA, USA
| | | | - Ron Killiany
- Boston University School of Medicine, Boston, MA, USA
| | - Muralidharan Sargurupremraj
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
| | - Reisa A Sperling
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Keith A Johnson
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Gordon Center for Medical Imaging, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Alexa S Beiser
- Boston University School of Public Health, Boston, MA, USA
- The Framingham Heart Study, Framingham, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Sudha Seshadri
- The Framingham Heart Study, Framingham, MA, USA
- Boston University School of Medicine, Boston, MA, USA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
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8
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McGrath ER, Beiser AS, O'Donnell A, Yang Q, Ghosh S, Gonzales MM, Himali JJ, Satizabal CL, Johnson KA, Tracy RP, Seshadri S. Blood Phosphorylated Tau 181 as a Biomarker for Amyloid Burden on Brain PET in Cognitively Healthy Adults. J Alzheimers Dis 2022; 87:1517-1526. [PMID: 35491781 DOI: 10.3233/jad-215639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Plasma phosphorylated-tau181 (p-tau181) is a promising biomarker for Alzheimer's disease (AD) and may offer utility for predicting preclinical disease. OBJECTIVE To evaluate the prospective association between plasma p-tau181 and amyloid-β (Aβ) and tau-PET deposition in cognitively unimpaired individuals. METHODS Plasma p-tau181 levels were measured at baseline in 52 [48% women, mean 64.4 (SD 5.5) years] cognitively unimpaired Framingham Offspring cohort participants using samples stored between 2011-2014 who subsequently underwent 11C-Pittsburgh Compound-B (PiB)-PET and/or 18F-Flortaucipir (FTP)-PET scans (n = 18 with tau-PET) a mean of 6.8 (SD 0.6) years later. Our primary outcomes included Aβ-precuneus, Aβ-FLR (frontal, lateral, and retrosplenial cortices) and tau-global composite region PET deposition. Secondary outcomes included individual regional Aβ and tau PET-deposition. P-tau181 was compared with plasma neurofilament light chain (NFL) and glial fibrillary acidic protein (GFAP) in predicting PET outcomes. RESULTS P-tau181 was associated with increased Aβ deposition in the FLR (β±SE, 1.25±0.30, p < 0.0001), precuneus (1.35±0.29, p < 0.001), and other cortical regions. Plasma NFL (1.30±0.49, p = 0.01) and GFAP (1.46±0.39, p < 0.001) were also associated with FLR Aβ deposition. In models including all three biomarkers adjusted for age, sex, APOE E4 allele, AD polygenic risk score and cortical atrophy score, p-tau181 (0.93±0.31, p < 0.01, R2 = 0.18) and GFAP (0.93±0.41, p = 0.03, R2 = 0.11), but not NFL (0.25±0.51, p = 0.62, R2 = 0.01), were associated with FLR-Aβ deposition. Plasma p-tau181 was not associated with tau-PET burden. CONCLUSION In cognitively unimpaired adults, elevated plasma p-tau181 is associated with future increased Aβ deposition across multiple brain regions. Our results highlight the potential utility of p-tau181 as a blood-biomarker to screen for brain-amyloid deposition in cognitively healthy individuals in a community-setting.
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Affiliation(s)
- Emer R McGrath
- HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
- The Framingham Heart Study, Framingham, MA, USA
| | - Alexa S Beiser
- The Framingham Heart Study, Framingham, MA, USA
- Boston University School of Public Health, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Adrienne O'Donnell
- The Framingham Heart Study, Framingham, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - Qiong Yang
- The Framingham Heart Study, Framingham, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - Saptaparni Ghosh
- The Framingham Heart Study, Framingham, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Mitzi M Gonzales
- The Framingham Heart Study, Framingham, MA, USA
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
| | - Jayandra J Himali
- The Framingham Heart Study, Framingham, MA, USA
- Boston University School of Public Health, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
| | - Claudia L Satizabal
- The Framingham Heart Study, Framingham, MA, USA
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
| | - Keith A Johnson
- Department of Radiology, Massachusetts General Hospital, the Gordon Center for Medical Imaging and the Athinoula A. Martinos Center for Biomedical Imaging, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Russell P Tracy
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Biochemistry, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Sudha Seshadri
- The Framingham Heart Study, Framingham, MA, USA
- Boston University School of Medicine, Boston, MA, USA
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
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9
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Melo van Lent D, O'Donnell A, Beiser AS, Vasan RS, DeCarli CS, Scarmeas N, Wagner M, Jacques PF, Seshadri S, Himali JJ, Pase MP. Mind Diet Adherence and Cognitive Performance in the Framingham Heart Study. J Alzheimers Dis 2021; 82:827-839. [PMID: 34092629 DOI: 10.3233/jad-201238] [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] [Indexed: 01/21/2023]
Abstract
BACKGROUND Adherence to the Mediterranean-DASH for Neurodegenerative Delay (MIND) diet has previously been associated with cognitive decline and dementia. To our knowledge, no prior study has investigated the association between the MIND diet and measures of brain volume, silent brain infarcts (SBIs), or brain atrophy. OBJECTIVE We evaluated whether adherence to the MIND diet associated with superior cognitive function, larger brain volumes, fewer SBIs, and less cognitive decline in the community-based Framingham Heart Study. METHODS 2,092 participants (mean±SD, age 61±9) completed Food Frequency Questionnaires, averaged across a maximum of 3-time points (examination cycles 5, 6, and 7), cognitive testing at examination cycle 7 (present study baseline: 1998-2001) and after a mean±SD of 6.6±1.1 years from baseline (n = 1,584). A subset of participants also completed brain magnetic resonance imaging (MRI) at examination cycle 7 (n = 1,904). In addition, participants with dementia, stroke, and other relevant neurological diseases such as significant head trauma, subdural hematoma, or multiple sclerosis were excluded from the analyses. RESULTS Higher MIND diet scores were associated with better global cognitive function (β±SE,+0.03SD±0.01; p = 0.004), verbal memory, visual memory, processing speed, verbal comprehension/reasoning, and with larger total brain volume (TBV) following adjustments for clinical, lifestyle and demographic covariates, but not with other brain MRI measures (i.e., hippocampal volume, lateral ventricular volume, white matter hyperintensity volume, and SBIs) or cognitive decline. CONCLUSION Higher MIND diet scores associated with better cognitive performance and larger TBV at baseline, but not with cognitive decline. Clinical trials are needed to ascertain whether adopting the MIND diet affects trajectories of cognitive decline.
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Affiliation(s)
- Debora Melo van Lent
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, USA.,The Framingham Heart Study, Framingham, MA, USA.,German Center for Neurodegenerative Diseases DZNE, Bonn, Germany
| | - Adrienne O'Donnell
- The Framingham Heart Study, Framingham, MA, USA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Alexa S Beiser
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA.,The Framingham Heart Study, Framingham, MA, USA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Ramachandran S Vasan
- The Framingham Heart Study, Framingham, MA, USA.,Sections of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Charles S DeCarli
- Department of Neurology, School of Medicine & Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Davis, CA, USA
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.,Taub Institute for Research in Alzheimer's Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY, USA
| | - Michael Wagner
- German Center for Neurodegenerative Diseases DZNE, Bonn, Germany.,Department of Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Bonn, Germany
| | - Paul F Jacques
- The Framingham Heart Study, Framingham, MA, USA.,Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, USA.,The Framingham Heart Study, Framingham, MA, USA
| | - Jayandra J Himali
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, USA.,The Framingham Heart Study, Framingham, MA, USA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Matthew P Pase
- The Framingham Heart Study, Framingham, MA, USA.,The Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
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10
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Sanchez JS, Becker JA, Jacobs HIL, Hanseeuw BJ, Jiang S, Schultz AP, Properzi MJ, Katz SR, Beiser A, Satizabal CL, O'Donnell A, DeCarli C, Killiany R, El Fakhri G, Normandin MD, Gómez-Isla T, Quiroz YT, Rentz DM, Sperling RA, Seshadri S, Augustinack J, Price JC, Johnson KA. The cortical origin and initial spread of medial temporal tauopathy in Alzheimer's disease assessed with positron emission tomography. Sci Transl Med 2021; 13:eabc0655. [PMID: 33472953 PMCID: PMC7978042 DOI: 10.1126/scitranslmed.abc0655] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [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: 04/14/2020] [Accepted: 09/10/2020] [Indexed: 12/15/2022]
Abstract
Advances in molecular positron emission tomography (PET) have enabled anatomic tracking of brain pathology in longitudinal studies of normal aging and dementia, including assessment of the central model of Alzheimer's disease (AD) pathogenesis, according to which TAU pathology begins focally but expands catastrophically under the influence of amyloid-β (Aβ) pathology to mediate neurodegeneration and cognitive decline. Initial TAU deposition occurs many years before Aβ in a specific area of the medial temporal lobe. Building on recent work that enabled focus of molecular PET measurements on specific TAU-vulnerable convolutional temporal lobe anatomy, we applied an automated anatomic sampling method to quantify TAU PET signal in 443 adult participants from several observational studies of aging and AD, spanning a wide range of ages, Aβ burdens, and degrees of clinical impairment. We detected initial cortical emergence of tauopathy near the rhinal sulcus in clinically normal people and, in a subset with longitudinal 2-year follow-up data (n = 104), tracked Aβ-associated spread of TAU from this site first to nearby neocortex of the temporal lobe and then to extratemporal regions. Greater rate of TAU spread was associated with baseline measures of both global Aβ burden and medial temporal lobe TAU. These findings are consistent with clinicopathological correlation studies of Alzheimer's tauopathy and enable precise tracking of AD-related TAU progression for natural history studies and prevention therapeutic trials.
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Affiliation(s)
- Justin S Sanchez
- Massachusetts General Hospital, Boston, MA 02114, USA.
- Harvard Medical School, Boston, MA 02115, USA
- Gordon Center for Medical Imaging, Boston, MA, 02114, USA
| | - J Alex Becker
- Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
- Gordon Center for Medical Imaging, Boston, MA, 02114, USA
| | - Heidi I L Jacobs
- Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
- Gordon Center for Medical Imaging, Boston, MA, 02114, USA
- School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, 6211 LK, Netherlands
| | - Bernard J Hanseeuw
- Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
- Gordon Center for Medical Imaging, Boston, MA, 02114, USA
- Université Catholique de Louvain, Brussels B-1348, Belgium
| | - Shu Jiang
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Aaron P Schultz
- Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Michael J Properzi
- Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Samantha R Katz
- Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
- Gordon Center for Medical Imaging, Boston, MA, 02114, USA
| | - Alexa Beiser
- Boston University School of Medicine, Boston, MA 02118, USA
- Boston University School of Public Health, Boston, MA 02118, USA
- Framingham Heart Study, Framingham, MA 01702, USA
| | - Claudia L Satizabal
- Boston University School of Medicine, Boston, MA 02118, USA
- Framingham Heart Study, Framingham, MA 01702, USA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX 78229, USA
| | - Adrienne O'Donnell
- Boston University School of Public Health, Boston, MA 02118, USA
- Framingham Heart Study, Framingham, MA 01702, USA
| | | | - Ron Killiany
- Boston University School of Medicine, Boston, MA 02118, USA
- Boston University School of Public Health, Boston, MA 02118, USA
| | - Georges El Fakhri
- Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
- Gordon Center for Medical Imaging, Boston, MA, 02114, USA
| | - Marc D Normandin
- Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
- Gordon Center for Medical Imaging, Boston, MA, 02114, USA
| | - Teresa Gómez-Isla
- Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Yakeel T Quiroz
- Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
- Grupo de Neurociencias, Universidad de Antioquia, Antioquia 050010, Colombia
| | - Dorene M Rentz
- Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
- Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Reisa A Sperling
- Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
- Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Sudha Seshadri
- Boston University School of Medicine, Boston, MA 02118, USA
- Framingham Heart Study, Framingham, MA 01702, USA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX 78229, USA
| | - Jean Augustinack
- Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Julie C Price
- Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Keith A Johnson
- Massachusetts General Hospital, Boston, MA 02114, USA.
- Harvard Medical School, Boston, MA 02115, USA
- Gordon Center for Medical Imaging, Boston, MA, 02114, USA
- Brigham and Women's Hospital, Boston, MA 02115, USA
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11
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Petrea RE, O'Donnell A, Beiser AS, Habes M, Aparicio H, DeCarli C, Seshadri S, Romero JR. Mid to Late Life Hypertension Trends and Cerebral Small Vessel Disease in the Framingham Heart Study. Hypertension 2020; 76:707-714. [PMID: 32755403 DOI: 10.1161/hypertensionaha.120.15073] [Citation(s) in RCA: 24] [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] [Indexed: 01/14/2023]
Abstract
The duration and lifetime pattern of hypertension is related to risk of stroke and dementia. In turn, cerebral small vessel disease (CSVD) is the most frequent form of cerebrovascular disease underlying dementia and stroke. Thus, study of the relation of mid to late life hypertension trends with CSVD late in life will help understand hypertension's role and inform preventive efforts of CSVD consequences. We studied 1686 Framingham Heart Study Offspring cohort participants free of stroke and dementia, who were examined in mid and late life, and had available brain magnetic resonance imaging during late life. We related hypertension trends between mid and late life (normotension-normotension N-N, normotension-hypertension N-H, hypertension-hypertension H-H) to cerebral microbleeds and covert brain infarcts (CBI), overall and stratified by brain topography. We used multivariable logistic regression analyses to calculate odds ratio and 95% CIs for CSVD measures. The prevalence of CSVD in late life was 8% for cerebral microbleeds and 13% for covert brain infarcts and increased with longer hypertension exposure across all brain regions. Compared with the trend pattern of N-N, both N-H and H-H trends had higher odds of mixed cerebral microbleeds (2.71 [1.08-6.80], and 3.44 [1.39-8.60], respectively); H-H also had higher odds of any cerebral microbleeds or covert brain infarcts (1.54 [1.12-2.20]), and any covert brain infarcts (1.55 [1.08-2.20]). The burden of CSVD also increased with longer hypertension exposure. Our results highlight hypertension having a major role in subclinical CSVD, across subtypes and brain regions, and call attention to improve recognition and treatment of hypertension early in life.
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Affiliation(s)
- Rodica Elena Petrea
- From the Department of Neurology, Boston University School of Medicine, MA (R.E.P., A.S.B., H.A., S.S., J.R.R.).,NHLBI's Framingham Heart Study, MA (R.E.P., A.O., A.S.B., H.A., S.S., J.R.R.)
| | - Adrienne O'Donnell
- NHLBI's Framingham Heart Study, MA (R.E.P., A.O., A.S.B., H.A., S.S., J.R.R.).,Department of Biostatistics, Boston University School of Public Health, MA (A.O., A.S.B.)
| | - Alexa S Beiser
- From the Department of Neurology, Boston University School of Medicine, MA (R.E.P., A.S.B., H.A., S.S., J.R.R.).,NHLBI's Framingham Heart Study, MA (R.E.P., A.O., A.S.B., H.A., S.S., J.R.R.).,Department of Biostatistics, Boston University School of Public Health, MA (A.O., A.S.B.)
| | - Mohammad Habes
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX (M.H., S.S.)
| | - Hugo Aparicio
- From the Department of Neurology, Boston University School of Medicine, MA (R.E.P., A.S.B., H.A., S.S., J.R.R.).,NHLBI's Framingham Heart Study, MA (R.E.P., A.O., A.S.B., H.A., S.S., J.R.R.)
| | - Charles DeCarli
- Department of Neurology, University of California-Davis (C.D.)
| | - Sudha Seshadri
- From the Department of Neurology, Boston University School of Medicine, MA (R.E.P., A.S.B., H.A., S.S., J.R.R.).,NHLBI's Framingham Heart Study, MA (R.E.P., A.O., A.S.B., H.A., S.S., J.R.R.).,Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX (M.H., S.S.)
| | - Jose Rafael Romero
- From the Department of Neurology, Boston University School of Medicine, MA (R.E.P., A.S.B., H.A., S.S., J.R.R.).,NHLBI's Framingham Heart Study, MA (R.E.P., A.O., A.S.B., H.A., S.S., J.R.R.)
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12
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Horvath L, Desai J, Sandhu S, O'Donnell A, Hill A, Deva S, Markman B, Jameson M, Chen Z, Tan X, Hou J, Lim A. Preliminary results from a subset of patients (pts) with advanced head and neck squamous carcinoma (HNSCC) in a dose-escalation and dose-expansion study of BGB-A317, an anti-PD-1 monoclonal antibody (mAb). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx367.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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13
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O'Donnell A, Bilton D, Serisier D, Wanner A, Froehlich J, Bruinenberg P, Gonda I. A Phase 3 Study Design of Pulmaquin® in Non-Cystic Fibrosis Bronchiectasis (NCFBE) Patients Chronically Colonized with Pseudomonas aeruginosa (PA). Pneumologie 2016. [DOI: 10.1055/s-0036-1592235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Manning L, Cutts J, Stanisic DI, Laman M, Carmagnac A, Allen S, O'Donnell A, Karunajeewa H, Rosanas-Urgell A, Siba P, Davis TME, Michon P, Schofield L, Rockett K, Kwiatkowski D, Mueller I. A Toll-like receptor-1 variant and its characteristic cellular phenotype is associated with severe malaria in Papua New Guinean children. Genes Immun 2015; 17:52-9. [PMID: 26633000 DOI: 10.1038/gene.2015.50] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 08/18/2015] [Accepted: 08/20/2015] [Indexed: 01/13/2023]
Abstract
Genetic factors are likely to contribute to low severe malaria case fatality rates in Melanesian populations, but association studies can be underpowered and may not provide plausible mechanistic explanations if significant associations are detected. In preparation for a genome-wide association study, 29 candidate single-nucleotide polymorphisms (SNPs) with minor allele frequencies >5% were examined in a case-control study of 504 Papua New Guinean children with severe malaria. In parallel, an immunological substudy was performed on convalescent peripheral blood mononuclear cells (PBMCs) from cases and controls. Following stimulation with a Toll-like receptor (TLR) 1/2 agonist, effector cytokines and chemokines were assayed. The only significant genetic association observed involved a nonsynonymous SNP (TLR1rs4833095) in the TLR1 gene. A recessive (TT) genotype was associated with reduced odds of severe malaria of 0.52 (95% confidence interval (0.29-0.90), P=0.006). Concentrations of pro-inflammatory cytokines interleukin-1β and tumour necrosis factor α were significantly higher in severe malaria cases compared with healthy controls, but lower in children with the protective recessive (TT) genotype. A genetic variant in TLR1 may contribute to the low severe malaria case fatality rates in this region through a reduced pro-inflammatory cellular phenotype.
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Affiliation(s)
- L Manning
- School of Medicine and Pharmacology, University of Western Australia, Harry Perkins Institute, Fiona Stanley Hospital, Bull Creek, Western Australia, Australia
| | - J Cutts
- Infection and Immunity Division, Walter & Eliza Hall Institute, Parkville, Melbourne, Australia.,Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia
| | - D I Stanisic
- Infection and Immunity Division, Walter & Eliza Hall Institute, Parkville, Melbourne, Australia.,Institute for Glycomics, Griffith University, Southport, Queensland, Australia
| | - M Laman
- School of Medicine and Pharmacology, University of Western Australia, Harry Perkins Institute, Fiona Stanley Hospital, Bull Creek, Western Australia, Australia.,Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - A Carmagnac
- Infection and Immunity Division, Walter & Eliza Hall Institute, Parkville, Melbourne, Australia
| | - S Allen
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - A O'Donnell
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - H Karunajeewa
- Infection and Immunity Division, Walter & Eliza Hall Institute, Parkville, Melbourne, Australia
| | - A Rosanas-Urgell
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.,Institute of Tropical Medicine, Antwerp, Belgium
| | - P Siba
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - T M E Davis
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - P Michon
- Infection and Immunity Division, Walter & Eliza Hall Institute, Parkville, Melbourne, Australia.,Faculty of Health Sciences, Divine Word University, Madang, Papua New Guinea
| | - L Schofield
- Infection and Immunity Division, Walter & Eliza Hall Institute, Parkville, Melbourne, Australia
| | - K Rockett
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK and Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - D Kwiatkowski
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK and Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - I Mueller
- Infection and Immunity Division, Walter & Eliza Hall Institute, Parkville, Melbourne, Australia.,Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.,Barcelona Center for International Health Research (CRESIB), Barcelona, Spain
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15
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Schmidt CS, Schulte B, Seo H, Kuhn S, O'Donnell A, Kriston L, Verthein U, Reimer J. Meta-analysis on the Effectiveness of Alcohol Screening and Brief Interventions for Patients in Emergency Care Settings. Suchttherapie 2015. [DOI: 10.1055/s-0035-1557664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Milekic MH, Xin Y, O'Donnell A, Kumar KK, Bradley-Moore M, Malaspina D, Moore H, Brunner D, Ge Y, Edwards J, Paul S, Haghighi FG, Gingrich JA. Age-related sperm DNA methylation changes are transmitted to offspring and associated with abnormal behavior and dysregulated gene expression. Mol Psychiatry 2015; 20:995-1001. [PMID: 25092244 DOI: 10.1038/mp.2014.84] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 05/14/2014] [Accepted: 06/17/2014] [Indexed: 12/15/2022]
Abstract
Advanced paternal age (APA) has been shown to be a significant risk factor in the offspring for neurodevelopmental psychiatric disorders, such as schizophrenia and autism spectrum disorders. During aging, de novo mutations accumulate in the male germline and are frequently transmitted to the offspring with deleterious effects. In addition, DNA methylation during spermatogenesis is an active process, which is susceptible to errors that can be propagated to subsequent generations. Here we test the hypothesis that the integrity of germline DNA methylation is compromised during the aging process. A genome-wide DNA methylation screen comparing sperm from young and old mice revealed a significant loss of methylation in the older mice in regions associated with transcriptional regulation. The offspring of older fathers had reduced exploratory and startle behaviors and exhibited similar brain DNA methylation abnormalities as observed in the paternal sperm. Offspring from old fathers also had transcriptional dysregulation of developmental genes implicated in autism and schizophrenia. Our findings demonstrate that DNA methylation abnormalities arising in the sperm of old fathers are a plausible mechanism to explain some of the risks that APA poses to resulting offspring.
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Affiliation(s)
- M H Milekic
- Department of Psychiatry, Columbia University and The New York State Psychiatric Institute, New York, NY, USA
| | - Y Xin
- Department of Psychiatry, Columbia University and The New York State Psychiatric Institute, New York, NY, USA
| | - A O'Donnell
- Department of Genetics and Development, Columbia University, New York, NY, USA
| | - K K Kumar
- Department of Psychiatry, Columbia University and The New York State Psychiatric Institute, New York, NY, USA
| | - M Bradley-Moore
- Department of Psychiatry, Columbia University and The New York State Psychiatric Institute, New York, NY, USA
| | - D Malaspina
- 1] Department of Psychiatry, New York University, New York, NY, USA [2] Department of Psychiatry, New York University, and The NY OMH Creedmoor Psychiatric Center, New York, NY, USA
| | - H Moore
- Department of Psychiatry, Columbia University and The New York State Psychiatric Institute, New York, NY, USA
| | - D Brunner
- 1] Department of Psychiatry, Columbia University and The New York State Psychiatric Institute, New York, NY, USA [2] PsychoGenics, New York, NY, USA
| | - Y Ge
- Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA
| | - J Edwards
- Center for Pharmacogenomics, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - S Paul
- Helen & Robert Appel Institute for Alzheimer's Research, Mind and Brain Institute, Weill Cornell Medical School, New York, NY, USA
| | - F G Haghighi
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J A Gingrich
- Department of Psychiatry, Columbia University and The New York State Psychiatric Institute, New York, NY, USA
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17
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Biddle STB, O'Donnell A, Houghton E, Creaser CS. Metabolism of norethisterone in the greyhound. Rapid Commun Mass Spectrom 2013; 27:2229-2238. [PMID: 24019188 DOI: 10.1002/rcm.6689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 07/17/2013] [Accepted: 07/17/2013] [Indexed: 06/02/2023]
Abstract
RATIONALE Norethisterone has been used as a successful oral contraceptive in humans for many years. It was recently permitted for use as an oestrus suppressant in racing greyhounds. To monitor the use of norethisterone as part of a routine drug surveillance programme, knowledge of its metabolism was required to enable detection. METHODS Gas chromatography/mass spectrometry and selective derivatisation techniques have been used to identify urinary metabolites of norethisterone following oral administration to the greyhound. Metabolites were extracted using solid-phase and liquid-liquid extraction techniques. RESULTS Several metabolites were identified, including reduced, mono-, di- and trihydroxylated steroids. The major metabolites observed were 17α-ethynyl-5β-estrane-3α,17β-diol, 17α-ethynyl-5α-estrane-3β,17β-diol, three 17α-ethynylestranetriol stereoisomers and two 17α-ethynylestranetetrol stereoisomers. The major metabolites were predominantly excreted as glucuronic acid conjugates and detection of the administration of norethisterone was possible for up to 8 days post-dose using the methods described. The nandrolone metabolites, 19-norepiandrosterone, estranediol and 19-noretiocholanolone, were also identified in the post-administration samples collected up to 8 h after dosing the treated animals. CONCLUSIONS The urinary metabolites identified in this study have further increased the knowledge of steroid metabolism in the greyhound, providing information to support routine drug testing programmes for greyhound racing.
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Affiliation(s)
- S T B Biddle
- HFL Sport Science, Quotient Bioresearch, Newmarket Road, Fordham, CB7 5WW, UK
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18
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Silveira-Moriyama L, Schwingenschuh P, O'Donnell A, Schneider SA, Mir P, Carrillo F, Terranova C, Petrie A, Grosset DG, Quinn NP, Bhatia KP, Lees AJ. Olfaction in patients with suspected parkinsonism and scans without evidence of dopaminergic deficit (SWEDDs). J Neurol Neurosurg Psychiatry 2009; 80:744-8. [PMID: 19276101 DOI: 10.1136/jnnp.2009.172825] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [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: 11/03/2022]
Abstract
BACKGROUND Positron emission tomography and single photon emission computed tomography scanning have 87-94% sensitivity and 80-100% specificity to differentiate patients with Parkinson's disease (PD) from control subjects and patients with essential (ET) or atypical tremor. More than 10% of patients diagnosed as early PD can have scans without evidence of dopaminergic deficiency (SWEDDs). This study investigated whether smell tests can help identify possible cases with SWEDDs. METHODS The 40 item University of Pennsylvania Smell Test (UPSIT) was used to evaluate the sense of smell in 21 SWEDDs patients. Twenty-six ET patients, 16 patients with a diagnosis of idiopathic adult onset dystonia (D), 191 non-demented PD patients and 136 control subjects were also tested. Multiple regression analyses were used to compare the mean UPSIT score in the SWEDDs group with the other four groups (ET, D, PD and controls) after adjusting for the effects of relevant covariates. RESULTS The mean UPSIT score for the SWEDDs group was greater than in the PD group (p<0.001) and not different from the mean UPSIT in the control (p = 0.7), ET (p = 0.4) or D (p = 0.9) groups. Smell tests indicated a high probability of PD in only 23.8% of SWEDDs as opposed to 85.3% of PD patients. CONCLUSIONS In a patient with suspected PD, a high PD probability on smell testing favours the diagnosis of PD, and a low PD probability strengthens the indication for dopamine transporter imaging.
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Affiliation(s)
- L Silveira-Moriyama
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London WC1N 1PJ, UK
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19
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Abstract
Gas chromatography/mass spectrometry and selective derivatisation techniques have been used to identify urinary metabolites of methyltestosterone following oral administration to the greyhound. Several metabolites were identified including reduced, mono-, di- and trihydroxylated steroids. The major metabolites observed were 17alpha-methyl-5beta-androstane-3alpha-17beta-diol, 17alpha-methyl-5beta-androstane-3alpha,16alpha,17beta-triol, and a further compound tentatively identified as 17alpha-methyl-5z-androstane-6z,17beta-triol. The most abundant of these was the 17alpha-methyl-5beta-androstane-3alpha,16alpha,17beta-triol. This metabolite was identified by comparison with a reference standard synthesised using a Grignard procedure and characterised using trimethylsilyl (TMS) and acetonide-TMS derivatisation techniques. There did not appear to be any evidence for 16beta-hydroxylation as a phase I metabolic transformation in the greyhound. However, significant quantities of 16alpha-hydroxy metabolites were detected. Selective enzymatic hydrolysis procedures indicated that the major metabolites identified were excreted as glucuronic acid conjugates. Metabolic transformations observed in the greyhound have been compared with those of other mammalian species and are discussed here.
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Affiliation(s)
- S T B Biddle
- HFL Sport Science, Quotient Bioresearch, Newmarket Road, Fordham, Ely CB7 5WW, UK.
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20
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Hargrove M, O'Donnell A, Aherne T. Differences in displayed pump flow compared to measured flow under varying conditions during simulated cardiopulmonary bypass. Perfusion 2009; 23:227-30. [PMID: 19181755 DOI: 10.1177/0267659108100458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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
Errors in blood flow delivery due to shunting have been reported to reduce flow by, potentially, up to 40-83% during cardiopulmonary bypass. The standard roller-pump measures revolutions per minute and a calibration factor for different tubing sizes calculates and displays flow accordingly. We compared displayed roller-pump flow with ultrasonically measured flow to ascertain if measured flow correlated with the heart-lung pump flow reading. Comparison of flows was measured under varying conditions of pump run duration, temperature, viscosity, varying arterial/venous loops, occlusiveness, outlet pressure, use of silicone or polyvinyl chloride (PVC) in the roller race, different tubing diameters, and use of a venous vacuum-drainage device.
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Affiliation(s)
- M Hargrove
- Cardiothoracic Surgery Unit, Cork University Hospital, Wilton, Cork, Ireland.
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21
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Healy DG, Hargrove M, Doddakulla K, Hinchion J, O'Donnell A, Aherne T. Impact of pacing modality and biventricular pacing on cardiac output and coronary conduit flow in the post-cardiotomy patient. Interact Cardiovasc Thorac Surg 2008; 7:805-8. [DOI: 10.1510/icvts.2008.180497] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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22
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O'Donnell A. Essays on the First Hundred Years of Anaesthesia. West J Med 2008. [DOI: 10.1136/bmj.a794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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23
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Benson C, White J, Bono JD, O'Donnell A, Raynaud F, Cruickshank C, McGrath H, Walton M, Workman P, Kaye S, Cassidy J, Gianella-Borradori A, Judson I, Twelves C. A phase I trial of the selective oral cyclin-dependent kinase inhibitor seliciclib (CYC202; R-Roscovitine), administered twice daily for 7 days every 21 days. Br J Cancer 2006; 96:29-37. [PMID: 17179992 PMCID: PMC2360206 DOI: 10.1038/sj.bjc.6603509] [Citation(s) in RCA: 199] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Seliciclib (CYC202; R-roscovitine) is the first selective, orally bioavailable inhibitor of cyclin-dependent kinases 1, 2, 7 and 9 to enter clinical trial. Preclinical studies showed antitumour activity in a broad range of human tumour xenografts. A phase I trial was performed with a 7-day b.i.d. p.o. schedule. Twenty-one patients (median age 62 years, range: 39-73 years) were treated with doses of 100, 200 and 800 b.i.d. Dose-limiting toxicities were seen at 800 mg b.i.d.; grade 3 fatigue, grade 3 skin rash, grade 3 hyponatraemia and grade 4 hypokalaemia. Other toxicities included reversible raised creatinine (grade 2), reversible grade 3 abnormal liver function and grade 2 emesis. An 800 mg portion was investigated further in 12 patients, three of whom had MAG3 renograms. One patient with a rapid increase in creatinine on day 3 had a reversible fall in renal perfusion, with full recovery by day 14, and no changes suggestive of renal tubular damage. Further dose escalation was precluded by hypokalaemia. Seliciclib reached peak plasma concentrations between 1 and 4 h and elimination half-life was 2-5 h. Inhibition of retinoblastoma protein phosphorylation was not demonstrated in peripheral blood mononuclear cells. No objective tumour responses were noted, but disease stabilisation was recorded in eight patients; this lasted for a total of six courses (18 weeks) in a patient with ovarian cancer.
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Affiliation(s)
- C Benson
- Cancer Research UK Centre for Cancer Therapeutics, The Institute of Cancer Research, Sutton, Surrey, UK
- Section of Medicine, The Institute of Cancer Research and Royal Marsden Hospital, Sutton, Surrey, UK
| | - J White
- Department of Medical Oncology and Beatson Oncology Centre, University of Glasgow, Glasgow, UK
| | - J De Bono
- Cancer Research UK Centre for Cancer Therapeutics, The Institute of Cancer Research, Sutton, Surrey, UK
- Section of Medicine, The Institute of Cancer Research and Royal Marsden Hospital, Sutton, Surrey, UK
| | - A O'Donnell
- Cancer Research UK Centre for Cancer Therapeutics, The Institute of Cancer Research, Sutton, Surrey, UK
| | - F Raynaud
- Cancer Research UK Centre for Cancer Therapeutics, The Institute of Cancer Research, Sutton, Surrey, UK
| | - C Cruickshank
- Cancer Research UK Drug Development Office, London, UK
| | | | - M Walton
- Cancer Research UK Centre for Cancer Therapeutics, The Institute of Cancer Research, Sutton, Surrey, UK
| | - P Workman
- Cancer Research UK Centre for Cancer Therapeutics, The Institute of Cancer Research, Sutton, Surrey, UK
| | - S Kaye
- Section of Medicine, The Institute of Cancer Research and Royal Marsden Hospital, Sutton, Surrey, UK
| | - J Cassidy
- Department of Medical Oncology and Beatson Oncology Centre, University of Glasgow, Glasgow, UK
| | | | - I Judson
- Cancer Research UK Centre for Cancer Therapeutics, The Institute of Cancer Research, Sutton, Surrey, UK
- Cancer Research UK Centre for Cancer Therapeutics, The Institute of Cancer Research, Sutton, Surrey, UK. E-mail:
| | - C Twelves
- Beatson Oncology Centre, Glasgow, UK
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24
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Woodrow P, May V, Buras-Rees S, Higgs D, Hendrick J, Lewis T, Whitney S, Cummings C, Boorman P, O'Donnell A, Harris P, McHenry M. Comparing no-touch and tympanic thermometer temperature recordings. ACTA ACUST UNITED AC 2006; 15:1012-6. [PMID: 17077774 DOI: 10.12968/bjon.2006.15.18.22028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Temperature is a vital sign which can be measured using various types of clinical thermometers. Pulmonary artery temperature is considered the 'gold standard', but this measurement is not usually clinically practical. There is currently no consensus for optimal alternative site or equipment. This research compares 178 simultaneous measurements from 5 clinical areas, using two types of thermometers: tympanic and no-touch temporal. No-touch thermometers were all set to oral equivalent. Tympanic thermometers were adjusted to either oral (n=105) or core (n=73) equivalent. Maximum acceptable difference was identified as 1oC. Two data sets (oral/core; oral/oral) were analysed using Bland-Altman method on Excel programmes, comparing all thermometers and separating oral and core-equivalent tympanics. The two thermometers were found not to be equivalent. As a simple comparison between two thermometers, this research cannot identify which thermometer is more accurate.
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Affiliation(s)
- P Woodrow
- East Kent Hospitals NHS Trust, Canterbury
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25
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Abstract
The effect of maternal alpha+ -thalassaemia on pregnancy was assessed in the north coastal region of Papua New Guinea (PNG), where malaria is hyperendemic and alpha+ -thalassaemia is extremely common. In a prospective study of 987 singleton hospital deliveries, we correlated maternal alpha-globin genotype with markers of reproductive fitness (age in primigravidae, gravidity, pregnancy interval and the number of miscarriages and stillbirths), Plasmodium falciparum(P. falciparum) infection of the mother and placenta, maternal haemoglobin, preterm delivery and birthweight. The frequency of the -alpha genotype in mothers was 0.61. Markers of reproductive fitness were similar in women with and without alpha+ -thalassaemia. Median haemoglobin concentration during pregnancy and after delivery was about 1.0 g/dl lower in homozygous alpha+ -thalassaemia than in women with a normal alpha- globin genotype (P < or = 0.001). The frequency of placental P. falciparum infection and systemic malaria infection after delivery showed no consistent relationship to alpha-globin genotype. The frequency of preterm delivery and low birthweight did not vary significantly according to maternal alpha-globin genotype. Maternal alpha+ -thalassaemia does not affect reproductive fitness or susceptibility to malaria during pregnancy. Although median haemoglobin concentration was significantly lower in mothers homozygous for alpha+ -thalassaemia than those with a normal alpha-globin genotype, this did not result in an adverse outcome of pregnancy.
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Affiliation(s)
- A O'Donnell
- Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Headington, Oxford, UK.
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26
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O'Donnell A, Weatherall DJ, Taylor AM, Reeder JC, Allen SJ. Muscle cell injury, haemolysis and dark urine in children with falciparum malaria in Papua New Guinea. Trans R Soc Trop Med Hyg 2006; 100:817-25. [PMID: 16527319 DOI: 10.1016/j.trstmh.2005.11.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Revised: 11/21/2005] [Accepted: 11/21/2005] [Indexed: 11/17/2022] Open
Abstract
During a prospective study of red cell variants and severe malaria in children, a surprising observation was the occurrence of dark urine. Children were grouped according to urine findings: 22 had dark urine that contained a haem protein (Group I), 93 had urine of normal colour that contained a haem protein (Group II) and 236 had normal urine (Group III). To investigate the cause of dark urine, haemolysis and muscle cell injury were assessed. Intravascular haemolysis was greater in Group I than in Groups II and III. However, anaemia was more severe in Group III and is likely to have resulted mainly from extravascular haemolysis. Median plasma myoglobin concentrations were greater in Groups I and II than Group III (P = 0.00060). Plasma myoglobin was greater in children with cerebral malaria, hyperlactataemia and those who died but was not associated with acidosis. Urine myoglobin was greater in Group I than Groups II and III (P = 0.00054). It is likely that both haemoglobin and myoglobin contributed to dark urine. The association between muscle cell injury and coma suggests sequestration of parasitized red cells as a common underlying pathology. In malaria, hyperlactataemia may result directly from breakdown of muscle protein as well as tissue hypoxia.
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Affiliation(s)
- A O'Donnell
- Weatherall Institute of Molecular Medicine, University of Oxford, The John Radcliffe Hospital, Headington, Oxford OX3 9DS, UK.
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27
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O'Donnell A, Padhani A, Hayes C, Kakkar AJ, Leach M, Trigo JM, Scurr M, Raynaud F, Phillips S, Aherne W, Hardcastle A, Workman P, Hannah A, Judson I. A Phase I study of the angiogenesis inhibitor SU5416 (semaxanib) in solid tumours, incorporating dynamic contrast MR pharmacodynamic end points. Br J Cancer 2005; 93:876-83. [PMID: 16222321 PMCID: PMC2361651 DOI: 10.1038/sj.bjc.6602797] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
SU5416 (Z-3-[(2,4-dimethylpyrrol-5-yl)methylidenyl]-2-indolinone; semaxanib) is a small molecule inhibitor of the vascular endothelial growth factor receptor (VEGFR2). A Phase I dose escalation study was performed. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) was used as a pharmacodynamic assessment tool. In all, 27 patients were recruited. SU5416 was administered twice weekly by fixed rate intravenous infusion. Patients were treated in sequential cohorts of three patients at 48, 65, 85 110 and 145 mg m-2. A further dose level of 190 mg m-2 after a 2-week lead in period at a lower dose was completed; thereafter, the cohort at 145 mg m-2 was expanded. SU5416 showed linear pharmacokinetics to 145 mg m-2 with a large volume of distribution and rapid clearance. A significant degree of interpatient variability was seen. SU5416 was well tolerated, by definition a maximum-tolerated dose was not defined. No reproducible changes were seen in DCE-MRI end points. Serial assessments of VEGF in a cohort of patients treated at 145 mg m-2 did not show a statistically significant treatment-related change. Parallel assessments of the impact of SU5416 on coagulation profiles in six patients showed a transient effect within the fibrinolytic pathway. Clinical experience showed that patients who had breaks of therapy longer than a week could not have treatment reinitiated at a dose of 190 mg m-2 without unacceptable toxicity. The 145 mg m-2 dose level is thus the recommended dose for future study.
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Affiliation(s)
- A O'Donnell
- Institute of Cancer Research, and Royal Marsden Hospital, Sutton SM2 5PT, UK. anne.o'
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28
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Sibartie V, Quigley EMM, O'Donnell A, O'Halloran D, Thompson C. Gastric electrical stimulation: a report of two cases. Ir Med J 2005; 98:245-6. [PMID: 16445145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Gastroparesis refractory to prokinetic agents poses a major challenge to the physician and patient, alike. In the past 5 years, electrical methods to treat gastroparesis have emerged from animal and human experiments to a potentially valuable tool in clinical gastroenterology. One of these methods, known as gastric electrical stimulation (GES), is being increasingly used in specialized centres worldwide, but had never been tried in Ireland. We describe here our experience with the first two implantations of gastric neurostimulators performed in Ireland and the outcome with these 2 patients. Our results at 6 months show reduction in symptoms and improvement in quality of life, which is encouraging and should prompt further evaluation of GES for patients with gastroparesis refractory to medical therapy.
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Affiliation(s)
- V Sibartie
- Alimentary Pharmabiotic Centre, Department of Medicine, Cork University Hospital, Wilton.
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29
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Premawardhena A, Fisher CA, Olivieri NF, de Silva S, Arambepola M, Perera W, O'Donnell A, Peto TEA, Viprakasit V, Merson L, Muraca G, Weatherall DJ. Haemoglobin E beta thalassaemia in Sri Lanka. Lancet 2005; 366:1467-70. [PMID: 16243092 DOI: 10.1016/s0140-6736(05)67396-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Haemoglobin E beta thalassaemia is the commonest form of severe thalassaemia in many Asian countries, but little is known about its natural history, the reasons for clinical diversity, or its management. We studied 109 Sri Lankan patients with the disorder over 5 years. 25 patients were not receiving transfusion; transfusion was stopped with no deleterious effect in a further 37. We identified several genetic and environmental factors that might contribute to the phenotypic diversity of the disorder, including modifiers of haemoglobin F production, malaria, and age-related changes in adaptive function. Our findings suggest that haemoglobin E beta thalassaemia can be managed without transfusion in many patients, even with low haemoglobin levels. Age-related changes in the pattern of adaptation to anaemia suggest that different and more cost-effective approaches to management should be explored.
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Affiliation(s)
- A Premawardhena
- National Thalassaemia Centre, General Hospital, Kurunegala, Sri Lanka
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30
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Crosby TF, O'Donnell A, O'Doherty JV, Quinn PJ, Evans ACO. Effects of exogenous progesterone on gestation length, foetal survival and colostrum yield in ewes. Theriogenology 2005; 64:1121-9. [PMID: 16125556 DOI: 10.1016/j.theriogenology.2005.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2004] [Revised: 01/24/2005] [Accepted: 01/26/2005] [Indexed: 11/28/2022]
Abstract
Twin bearing mature ewes (n=40) were treated with exogenous progesterone (100mg daily in oil) or vehicle (oil control) from Day 143 of gestation until lambing to investigate the effects on gestation length, foetal survival and colostrum yield and composition. Compared to control ewes, progesterone treated ewes had increased (P<0.05) serum progesterone concentrations (by 4.3 ng/ml) before lambing and in the first day post-partum (by 10 ng/ml). Progesterone treatment increased gestation length (150.4+/-0.6 days versus 147.8+/-0.6 days, P<0.05) and colostrum yield at 1h after lambing (P<0.05) but the colostrum had a lower concentration of IgG (P=0.02). In the first 24h after lambing, total colostrum and IgG yields were not different between groups. Four (20%) of the progesterone treated ewes produced either one or two dead lambs, while one ewe died on day 155 without initiating the birth process. We conclude that the daily administration of 100mg progesterone resulted in extended gestation length and reduced lamb survival but did not lower colostrum yield.
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Affiliation(s)
- T F Crosby
- Department of Animal Science, University College Dublin, Faculty of Agri-food and the Environment, Belfield, Dublin 4, Ireland.
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31
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Harmon D, Eustace N, Ghori K, Butler M, O'Callaghan S, O'Donnell A, Moore-Groarke GM, Shorten G. Plasma concentrations of nitric oxide products and cognitive dysfunction following coronary artery bypass surgery. Eur J Anaesthesiol 2005; 22:269-76. [PMID: 15892404 DOI: 10.1017/s0265021505000451] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Prospective longitudinal studies now indicate that cognitive dysfunction following coronary artery bypass surgery (CABG) is both common and persistent. This dysfunction is due in part to the inflammatory response and cerebral ischaemia-reperfusion, with nitric oxide (NO) as an important mediator of both. We hypothesized that a clinically significant association exists between plasma concentrations of nitrate/nitrite (NO3-/NO2-) and cognitive dysfunction after CABG. METHODS Cognitive assessment was performed on 36 adult patients the day before CABG, on the fourth postoperative day and 3 months postoperatively. Patient spouses (n = 10) were also studied. RESULTS A new cognitive deficit was present in 22/36 (62%) 4 days postoperatively and in 16/35 (49%) of patients, 3 months postoperatively. Patients who had cognitive dysfunction 3 months postoperatively were more likely to have cognitive dysfunction and increased plasma NO3-/NO2- concentrations compared to the non-deficit group preoperatively (22.6 (9.2) vs. 27.6 (8.4)) (P = 0.002). Plasma NOx (NO3- plus NO2-) concentrations were greater in patients with cognitive dysfunction 3 months postoperatively, 2 h (24.2 (6.3) vs. 19.1 (5.2)) (P = 0.002), and 12 h postoperatively (24.8 (7.6) vs. 18.8 (5.6)) (P = 0.001). There was, however, a time course similarity in NOx elevations for both deficit and non-deficit groups. CONCLUSIONS Perioperative plasma NOx concentrations do not serve as an effective biomarker of cognitive deficit after CABG.
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Affiliation(s)
- D Harmon
- Walton Centre for Neurology and Neurosurgery, Liverpool, UK.
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Abstract
Veillonella species is a rare cause of endocarditis. We report a case of a 49-year-old man with Veillonella parvula prosthetic valve endocarditis who presented with acute cardiac failure due to valvular dehiscence. His clinical course was complicated by cortical blindness and limb paresis as a result of cerebral embolism. The endocarditis was successfully treated with urgent valve replacement surgery and a prolonged course of metronidazole.
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Affiliation(s)
- T W Boo
- Department of Microbiology, University Hospital, Wilton Road, Cork, Ireland.
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Shuhaibar MN, Hargrove M, Millat MH, O'Donnell A, Aherne T. How much heparin do we really need to go on pump? A rethink of current practices. Eur J Cardiothorac Surg 2004; 26:947-50. [PMID: 15519187 DOI: 10.1016/j.ejcts.2004.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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] [Received: 08/26/2003] [Revised: 06/01/2004] [Accepted: 07/01/2004] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Patients undergoing myocardial revascularisation using extracorporeal circulation require heparin anticoagulation. We aimed to evaluate the effect of reducing heparin dosage on target activated clotting time (ACT) and postoperative blood loss. METHODS In a prospective randomised trial, 195 patients undergoing isolated primary CABG were randomised into four groups A, B, C, and D receiving an initial heparin dosage of 100, 200, 250 and 300 iu/kg, respectively. Extra incremental heparin (50 iu/kg) was added if required to achieve a target ACT of 480 s before initiating cardiopulmonary bypass. Postoperative blood loss was measured from the time of heparin reversal to drain removal 24h later. RESULTS Target ACT was achieved in 0, 63, 68.3 and 82.4% of patients in groups A, B, C and D, respectively, after the initial dose of heparin. In group B, of those not achieving target act a single increment of heparin was sufficient to achieve target ACT in further 18.6%. The mean ACT after the initial dose in groups B, C and D was 482.9, 519 and 588 s, respectively (P<0.05). Postoperative blood loss in millilitre per kilogram was directly proportional to preoperative heparin dose. CONCLUSIONS Patients receiving lower dose of heparin has lower postoperative blood loss. Of those achieving the target ACT, group B was significantly the closest to the target ACT. A starting dose of 200 iu/kg of heparin and if necessary one 50 iu/kg increment achieved target ACT in 81.5% of patients. The added benefit of significant drop in postoperative blood loss is evident.
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Harries M, O'Donnell A, Scurr M, Reade S, Cole C, Judson I, Greystoke A, Twelves C, Kaye S. Phase I/II study of DHA-paclitaxel in combination with carboplatin in patients with advanced malignant solid tumours. Br J Cancer 2004; 91:1651-5. [PMID: 15494716 PMCID: PMC2410023 DOI: 10.1038/sj.bjc.6602196] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
DHA-paclitaxel is a conjugate of paclitaxel and the fatty acid, docosahexaenoic acid. Preclinical studies have demonstrated increased activity, relative to paclitaxel, with the potential for an improved therapeutic ratio. We conducted a phase I study to determine the maximum tolerated doses of DHA-paclitaxel and carboplatin when administered in combination. Two cohorts of patients were treated: carboplatin AUC 5 with DHA-paclitaxel 660 mg m(-2) and carboplatin AUC 5 with DHA-paclitaxel 880 mg m(-2). Both drugs were given on day 1 every 21 days. A total of 15 patients were enrolled with a median age of 59 years (range 33-71). All patients had advanced cancer refractory to standard treatment, performance status 0-2 and were without major organ dysfunction. A total of 54 cycles of treatment were delivered. No dose-limiting toxicity (DLT) was seen in the first cohort of three patients. In an expanded second cohort, neutropenia was the main DLT, occurring in the first cycle of treatment in five of 12 patients: three of these patients and one additional patient also experienced dose-limiting grade 3 transient rises in liver transaminases. No alopecia was seen and one patient developed clinically significant neuropathy. One partial response was seen in a patient with advanced adenocarcinoma of the oesophago-gastric junction and 12 patients had stable disease with a median time to progression of 184 days (range 60-506 days). The recommended phase II dose in pretreated patients is Carboplatin AUC 5 and DHA-paclitaxel 660 mg m(-2) given every 21 days. Further studies with Carboplatin AUC 5 and DHA-paclitaxel 880 mg m(-2), given every 28 days, are warranted in chemo-naive patients.
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Affiliation(s)
- M Harries
- The CRUK Department of Medical Oncology, Royal Marsden Hospital Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - A O'Donnell
- The CRUK Department of Medical Oncology, Royal Marsden Hospital Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - M Scurr
- The CRUK Department of Medical Oncology, Royal Marsden Hospital Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - S Reade
- The CRUK Department of Medical Oncology, Royal Marsden Hospital Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - C Cole
- The CRUK Department of Medical Oncology, Royal Marsden Hospital Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - I Judson
- The CRUK Department of Medical Oncology, Royal Marsden Hospital Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - A Greystoke
- The CRUK Department of Medical Oncology, Royal Marsden Hospital Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - C Twelves
- The Beatson Oncology Centre, Glasgow, UK
| | - S Kaye
- The CRUK Department of Medical Oncology, Royal Marsden Hospital Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
- CRUK Department of Medical Oncology, Royal Marsden Hospital Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK. E-mail:
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Pacey S, Rea D, Steven N, Brock C, Knowlton N, Shand N, Hazell K, Zoellner U, O'Donnell A, Judson I. Results of a phase 1 clinical trial investigating a combination of the oral mTOR-inhibitor Everolimus (E, RAD001) and Gemcitabine (GEM) in patients (pts) with advanced cancers. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. Pacey
- Royal Marsden Hospital NHS Trust, Sutton, United Kingdom; University Birmingham Cancer Research Trials Unit, Birmingham, United Kingdom; Novartis Pharma AG, Basel, Switzerland
| | - D. Rea
- Royal Marsden Hospital NHS Trust, Sutton, United Kingdom; University Birmingham Cancer Research Trials Unit, Birmingham, United Kingdom; Novartis Pharma AG, Basel, Switzerland
| | - N. Steven
- Royal Marsden Hospital NHS Trust, Sutton, United Kingdom; University Birmingham Cancer Research Trials Unit, Birmingham, United Kingdom; Novartis Pharma AG, Basel, Switzerland
| | - C. Brock
- Royal Marsden Hospital NHS Trust, Sutton, United Kingdom; University Birmingham Cancer Research Trials Unit, Birmingham, United Kingdom; Novartis Pharma AG, Basel, Switzerland
| | - N. Knowlton
- Royal Marsden Hospital NHS Trust, Sutton, United Kingdom; University Birmingham Cancer Research Trials Unit, Birmingham, United Kingdom; Novartis Pharma AG, Basel, Switzerland
| | - N. Shand
- Royal Marsden Hospital NHS Trust, Sutton, United Kingdom; University Birmingham Cancer Research Trials Unit, Birmingham, United Kingdom; Novartis Pharma AG, Basel, Switzerland
| | - K. Hazell
- Royal Marsden Hospital NHS Trust, Sutton, United Kingdom; University Birmingham Cancer Research Trials Unit, Birmingham, United Kingdom; Novartis Pharma AG, Basel, Switzerland
| | - U. Zoellner
- Royal Marsden Hospital NHS Trust, Sutton, United Kingdom; University Birmingham Cancer Research Trials Unit, Birmingham, United Kingdom; Novartis Pharma AG, Basel, Switzerland
| | - A. O'Donnell
- Royal Marsden Hospital NHS Trust, Sutton, United Kingdom; University Birmingham Cancer Research Trials Unit, Birmingham, United Kingdom; Novartis Pharma AG, Basel, Switzerland
| | - I. Judson
- Royal Marsden Hospital NHS Trust, Sutton, United Kingdom; University Birmingham Cancer Research Trials Unit, Birmingham, United Kingdom; Novartis Pharma AG, Basel, Switzerland
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Rowinsky EK, Pacey S, Patnaik A, O'Donnell A, Mita MM, Atadja P, Peng B, Dugan M, Scott JW, De Bono JS. A phase I, pharmacokinetic (PK) and pharmacodynamic (PD) study of a novel histone deacetylase (HDAC) inhibitor LAQ824 in patients with advanced solid tumors. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- E. K. Rowinsky
- Cancer Therapy & Research Center, San Antonio, TX; Royal Marsden Hospital, London, United Kingdom; Novartis Pharmaceutics Corporation, East Hanover, NJ
| | - S. Pacey
- Cancer Therapy & Research Center, San Antonio, TX; Royal Marsden Hospital, London, United Kingdom; Novartis Pharmaceutics Corporation, East Hanover, NJ
| | - A. Patnaik
- Cancer Therapy & Research Center, San Antonio, TX; Royal Marsden Hospital, London, United Kingdom; Novartis Pharmaceutics Corporation, East Hanover, NJ
| | - A. O'Donnell
- Cancer Therapy & Research Center, San Antonio, TX; Royal Marsden Hospital, London, United Kingdom; Novartis Pharmaceutics Corporation, East Hanover, NJ
| | - M. M. Mita
- Cancer Therapy & Research Center, San Antonio, TX; Royal Marsden Hospital, London, United Kingdom; Novartis Pharmaceutics Corporation, East Hanover, NJ
| | - P. Atadja
- Cancer Therapy & Research Center, San Antonio, TX; Royal Marsden Hospital, London, United Kingdom; Novartis Pharmaceutics Corporation, East Hanover, NJ
| | - B. Peng
- Cancer Therapy & Research Center, San Antonio, TX; Royal Marsden Hospital, London, United Kingdom; Novartis Pharmaceutics Corporation, East Hanover, NJ
| | - M. Dugan
- Cancer Therapy & Research Center, San Antonio, TX; Royal Marsden Hospital, London, United Kingdom; Novartis Pharmaceutics Corporation, East Hanover, NJ
| | - J. W. Scott
- Cancer Therapy & Research Center, San Antonio, TX; Royal Marsden Hospital, London, United Kingdom; Novartis Pharmaceutics Corporation, East Hanover, NJ
| | - J. S. De Bono
- Cancer Therapy & Research Center, San Antonio, TX; Royal Marsden Hospital, London, United Kingdom; Novartis Pharmaceutics Corporation, East Hanover, NJ
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37
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Scurr M, Judson I, Brock C, O'Donnell A, Tan S, Partridge EA, D'Souza RA, Roberts DW. Assessment of metabolism, excretion and pharmacokinetics of a single dose of [ 14C]-ZD6126 in patients with solid malignant tumors. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. Scurr
- Cancer Research UK, Sutton, United Kingdom; AstraZeneca, Macclesfield, United Kingdom
| | - I. Judson
- Cancer Research UK, Sutton, United Kingdom; AstraZeneca, Macclesfield, United Kingdom
| | - C. Brock
- Cancer Research UK, Sutton, United Kingdom; AstraZeneca, Macclesfield, United Kingdom
| | - A. O'Donnell
- Cancer Research UK, Sutton, United Kingdom; AstraZeneca, Macclesfield, United Kingdom
| | - S. Tan
- Cancer Research UK, Sutton, United Kingdom; AstraZeneca, Macclesfield, United Kingdom
| | - E. A. Partridge
- Cancer Research UK, Sutton, United Kingdom; AstraZeneca, Macclesfield, United Kingdom
| | - R. A. D'Souza
- Cancer Research UK, Sutton, United Kingdom; AstraZeneca, Macclesfield, United Kingdom
| | - D. W. Roberts
- Cancer Research UK, Sutton, United Kingdom; AstraZeneca, Macclesfield, United Kingdom
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O'Donnell A, Judson I, Dowsett M, Raynaud F, Dearnaley D, Mason M, Harland S, Robbins A, Halbert G, Nutley B, Jarman M. Hormonal impact of the 17alpha-hydroxylase/C(17,20)-lyase inhibitor abiraterone acetate (CB7630) in patients with prostate cancer. Br J Cancer 2004; 90:2317-25. [PMID: 15150570 PMCID: PMC2409523 DOI: 10.1038/sj.bjc.6601879] [Citation(s) in RCA: 319] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A series of three dose escalating studies were conducted to investigate the ability of the 17α-hydroxylase/C17,20-lyase inhibitor abiraterone acetate, to cause maximum suppression of testosterone synthesis when delivered to castrate and noncastrate males with prostate cancer. Study A was a single dose study in castrate males. Study B was a single dose study in noncastrate males and study C was a multiple dose study in noncastrate males. The drug was given orally in a once-daily dose and blood samples taken to assess pharmacokinetic (PK) parameters and hormone levels in all patients. The study drug was well tolerated with some variability in PKs. Suppression of testosterone levels to <0.14 nmol l−1 was seen in four out of six castrate males treated with a single dose of 500 mg. At 800 mg given days 1–12 in noncastrate males, target suppression was achieved in three out of three patients, but a two- to three-fold increase of Luteinising Hormone (LH) levels in two out of three patients overcame suppression within 3 days. All patients in the multiple dose study developed an abnormal response to a short Synacthen test by day 11, although baseline cortisol levels remained normal. This is the first report of the use of a specific 17α-hydroxylase/17,20-lyase inhibitor in humans. Repeated treatment of men with intact gonadal function with abiraterone acetate at a dose of 800 mg can successfully suppress testosterone levels to the castrate range. However, this level of suppression may not be sustained in all patients due to compensatory hypersecretion of LH. The enhanced testosterone suppression achieved in castrate men merits further clinical study as a second-line hormonal treatment for prostate cancer. Adrenocortical suppression may necessitate concomitant administration of replacement glucocorticoid.
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Affiliation(s)
- A O'Donnell
- Royal Marsden NHS Trust, Sutton, Surrey SM2 5PT, UK
- CR UK Centre for Cancer Therapeutics, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
| | - I Judson
- Royal Marsden NHS Trust, Sutton, Surrey SM2 5PT, UK
- CR UK Centre for Cancer Therapeutics, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
- Clinical Pharmacology, Institute of Cancer Research, E-Block, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK. E-Mail:
| | - M Dowsett
- Academic Department of Biochemistry, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
| | - F Raynaud
- CR UK Centre for Cancer Therapeutics, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
| | - D Dearnaley
- Royal Marsden NHS Trust, Sutton, Surrey SM2 5PT, UK
- Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
| | - M Mason
- Department of Clinical Oncology, Velindre Hospital, Whitchurch, Cardiff CF4 7XL, UK
| | - S Harland
- Department of Oncology, University College of London, The Middlesex Hospital Mortimer St, London W1N 8AA, UK
| | - A Robbins
- Drug Development Office, Cancer Research UK, PO Box 123, London WC2A 3PX, UK
| | - G Halbert
- Cancer Research UK Formulation Unit, University of Strathclyde, Glasgow G1 1XW, UK
| | - B Nutley
- CR UK Centre for Cancer Therapeutics, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
| | - M Jarman
- CR UK Centre for Cancer Therapeutics, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
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40
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Yim CT, O'Donnell A, Yach K, Morin FG, Reven L. Deuterium NMR Study of the Dynamics of Self-Assembled Hexadecanoate Monolayers on Zirconium Oxide. J Phys Chem B 2003. [DOI: 10.1021/jp0347623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C. T. Yim
- Department of Chemistry, Dawson College, 3040 Sherbrooke Street West, Westmount, Québec, Canada H3Z 1A4
| | - A. O'Donnell
- Department of Chemistry, McGill University, 801 Sherbrooke Street West, Montréal, Québec, Canada H3A 2K6
| | - K. Yach
- Department of Chemistry, McGill University, 801 Sherbrooke Street West, Montréal, Québec, Canada H3A 2K6
| | - F. G. Morin
- Department of Chemistry, McGill University, 801 Sherbrooke Street West, Montréal, Québec, Canada H3A 2K6
| | - L. Reven
- Department of Chemistry, McGill University, 801 Sherbrooke Street West, Montréal, Québec, Canada H3A 2K6
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Abstract
Insertion of a chest drain can be associated with serious complications. It is recommended that the drain is inserted with blunt dissection through the chest wall but there is no specific instrument to aid this task. We describe a new reusable forceps that has been designed specifically to facilitate the insertion of chest drains.A feasibility study of its use in patients who required a chest drain as part of elective cardiothoracic operations was undertaken. The primary end-point was successful and accurate placement of the drain. The operators also completed a questionnaire rating defined aspects of the procedure. The new instrument was used to insert the chest drain in 30 patients (19 male, 11 female; median age 61.5 years (range 16-81 years)). The drain was inserted successfully without the trocar in all cases and there were no complications. Use of the instrument rated as significantly easier relative to experience of previous techniques in all specified aspects. The new device can be used to insert intercostal chest drains safely and efficiently without using the trocar or any other instrument.
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Affiliation(s)
- Emmet Andrews
- Department of Surgery, Cork University Hospital, Wilton, Cork, Ireland.
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Hargrove M, Ramish BC, O'Donnell A, Aherne T. Electrical failure during cardiopulmonary bypass: an evaluation of incidence, causes, management and guidelines for preventative measures. Perfusion 2003; 17:369-72. [PMID: 12243442 DOI: 10.1191/0267659102pf592oa] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The incidence of electrical failure during cardiopulmonary bypass (CPB) has been reported to occur in approximately 1 per 1000 cases. While the resultant morbidity and mortality is low, electrical failure is a life-threatening scenario. We report three major electrical failures during CPB in a patient population of 3500 over a 15-year period. These cases involved mains failure and generator shut down, mains failure and generator power surge, and failure of the uninterruptable power supply (UPS), which caused protected sockets to shut down. Protocols for preventative maintenance, necessary equipment, battery backup and guidelines for the successful management of such accidents during CPB are discussed.
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Affiliation(s)
- M Hargrove
- Cardiothoracic Surgery Unit, Cork University Hospital, Wilton, Ireland.
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43
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Nölke L, Haque A, Kumar K, O'Donnell A. A needle aspirated into the thyroid vein! Ir Med J 2003; 96:151. [PMID: 12846280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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Beale P, Judson I, O'Donnell A, Trigo J, Rees C, Raynaud F, Turner A, Simmons L, Etterley L. A Phase I clinical and pharmacological study of cis-diamminedichloro(2-methylpyridine) platinum II (AMD473). Br J Cancer 2003; 88:1128-34. [PMID: 12671715 PMCID: PMC2376375 DOI: 10.1038/sj.bjc.6600854] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AMD473 is a novel sterically hindered platinum cytotoxic with demonstrated ability to overcome acquired resistance to cisplatin in vitro and in human tumour xenografts. A single-agent dose escalating Phase I study was performed. AMD473 was initially administered intravenously as a 1 h infusion every 21 days to patients with advanced solid tumours. In total, 42 patients received a total of 147 cycles (median 3, range 1-8) of treatment at doses of 12, 24, 48, 96, 110, 120, 130, and 150 mg m(-2). Dosing intervals of 21 and 28 days were explored at the recommended dose. Neutropenia and thrombocytopenia proved dose limiting. Other toxicities included moderate nausea, vomiting, anorexia, and a transient metallic taste. There was no significant alopecia. The maximum tolerated dose was 150 mg m(-2). Plasma pharmacokinetics were linear. Two patients with heavily pretreated ovarian cancer showed partial response. Five patients (mesothelioma, ovary, nonsmall cell lung, and melanoma) showed prolonged stable disease. AMD473 demonstrates encouraging activity in patients, including those with prior platinum exposure. Toxicity is predictable with linear pharmacokinetics, as was predicted by preclinical studies. A dose of 120 mg m(-2) every 21 days is recommended for Phase II evaluation although there is evidence that chemo-naive patients and those of good performance status may tolerate a higher dose.
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Affiliation(s)
- P Beale
- Sydney Cancer Centre, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, New South Wales, Australia
| | - I Judson
- The Cancer Research UK Centre for Cancer Therapeutics, Institute of Cancer Research, 15 Cotswold Rd Belmont Sutton, Surrey SM2 5NG, UK
- The Cancer Research UK Centre for Cancer Therapeutics, Institute of Cancer Research, 15 Cotswold Rd Belmont Sutton, Surrey SM2 5NG, UK. E-mail:
| | - A O'Donnell
- The Cancer Research UK Centre for Cancer Therapeutics, Institute of Cancer Research, 15 Cotswold Rd Belmont Sutton, Surrey SM2 5NG, UK
| | - J Trigo
- Hospital Universitari de la Vall d'Hebron, Passeig de la Vall d'Hebron, Barcelona, Spain
| | - C Rees
- The Cancer Research UK Centre for Cancer Therapeutics, Institute of Cancer Research, 15 Cotswold Rd Belmont Sutton, Surrey SM2 5NG, UK
| | - F Raynaud
- The Cancer Research UK Centre for Cancer Therapeutics, Institute of Cancer Research, 15 Cotswold Rd Belmont Sutton, Surrey SM2 5NG, UK
| | - A Turner
- Cancer Research UK, PO Box 123, Lincoln's Inn Fields, London WC2A 3PX, UK
| | - L Simmons
- The Cancer Research UK Centre for Cancer Therapeutics, Institute of Cancer Research, 15 Cotswold Rd Belmont Sutton, Surrey SM2 5NG, UK
| | - L Etterley
- The Cancer Research UK Centre for Cancer Therapeutics, Institute of Cancer Research, 15 Cotswold Rd Belmont Sutton, Surrey SM2 5NG, UK
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O'Connor PA, Nölke L, O'Donnell A, Lingham KM. Retrosternal dislocation of the clavicle associated with a traumatic pneumothorax. Interact Cardiovasc Thorac Surg 2003; 2:9-11. [PMID: 17669976 DOI: 10.1016/s1569-9293(02)00066-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Retrosternal dislocation of the clavicle is a rare injury that is easily overlooked. Significant complications can occur both immediately following the initial injury and in the long term. We report a case of a young male in which the medial aspect of the clavicle was dislocated deep into the pleura abutting the aortic arch. Knowledge of these injuries allows for early detection and intervention, avoiding long-term sequelae.
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Affiliation(s)
- P A O'Connor
- Department of Orthopaedic Surgery, Cork University Hospital, Wilton, Cork, Ireland.
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Abstract
Aspergillus fumigatus is one of the most ubiquitous of the airborne saprophytic fungi. Allergic bronchopulmonary aspergillosis (ABPA) is a syndrome seen in patients with asthma and cystic fibrosis, and is characterized by hypersensitivity to chronic colonization of the airways with A. fumigatus. We report the case of a patient with ABPA presenting with pleural effusion. A 27-year-old male was referred with recurrent right pleural effusion. Past medical history was remarkable for asthma, allergic sinusitis, and recurrent pleurisy. Investigations revealed peripheral eosinophilia with elevated serum immunoglobulin E and bilateral pleural effusions with bilateral upper lobe proximal bronchiectasis. Precipitating serum antibodies to A. fumigatus were positive and the A. fumigatus immediate skin test yielded a positive reaction. A diagnosis of ABPA associated with bilateral pleural effusions was made and the patient was commenced on prednisolone. At review, the patient's symptoms had considerably improved and his pleural effusions had resolved. ABPA may present with diverse atypical syndromes, including paratracheal and hilar adenopathy, obstructive lung collapse, pneumothorax and bronchopleural fistula, and allergic sinusitis. Allergic bronchopulmonary aspergillosis is a rare cause of pleural effusion and must be considered in the differential diagnosis of patients presenting with a pleural effusion, in particular those with a history of asthma.
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Affiliation(s)
- T M O'Connor
- Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork, Ireland.
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MacLeod C, O'Donnell A, Tattersall MH, Dalrymple C, Firth I. Locally advanced cervix cancer: chemotherapy prior to definitive surgery or radiotherapy. A single institutional experience. Australas Radiol 2001; 45:491-5. [PMID: 11903183 DOI: 10.1046/j.1440-1673.2001.00961.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Primary or neoadjuvant chemotherapy prior to definitive local therapy has potential advantages for locally advanced cervix cancer. It can downstage a cancer and allow definitive local therapy to be technically possible (surgery), or potentially more effective (radiotherapy). It can also eradicate subclinical systemic metastases. This report reviews a single institution's experience of neoadjuvant chemotherapy prior to definitive local therapy for cervix cancer over a 13-year period. One hundred and six patients were treated with this intent. The patients were analysed for their response to chemotherapy, treatment received, survival, relapse and toxicity. The chemotherapy was feasible and the majority of patients had a complete or partial response (58.5%). Eight patients did not proceed to local treatment. Forty-six patients had definitive surgery and 52 had definitive radiotherapy. The 5-year overall survival was 27% and the majority of patients died with disease. The first site of relapse was usually in the pelvis (46.2%). Late complications that required ongoing medical therapy (n=6) or surgical intervention (n=2) were recorded in eight patients (7.5%). On univariate analysis stage (P=0.04), tumour size (P=0.01), lymph node status (P=0.003), response to chemotherapy (P=0.045) and treatment (P=0.003) were all significant predictors of survival. On multivariate analysis, tumour size (P < 0.0001) and nodal status (P=0.02) were significant predictors of survival. Despite the impressive responses to chemotherapy of advanced cervix cancer, there is evidence from randomized trials that it does not improve or compromise survival prior to radiotherapy. As its role prior to surgery remains unclear, it should not be used in this setting outside a prospective randomized trial.
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Affiliation(s)
- C MacLeod
- Department of Radiation Oncology, Murray Valley Cancer Centre, Wodonga, Victoria, Australia.
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48
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Halpenny M, Lakshmi S, O'Donnell A, O'Callaghan-Enright S, Shorten GD. Fenoldopam: renal and splanchnic effects in patients undergoing coronary artery bypass grafting. Anaesthesia 2001. [DOI: 10.1111/j.1365-2044.2001.02220.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Halpenny M, Lakshmi S, O'Donnell A, O'Callaghan-Enright S, Shorten GD. Fenoldopam: renal and splanchnic effects in patients undergoing coronary artery bypass grafting. Anaesthesia 2001; 56:953-60. [PMID: 11576097 DOI: 10.1046/j.1365-2044.2001.02220.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Impairment of renal and splanchnic perfusion during and after cardiopulmonary bypass may be responsible for acute renal failure and endotoxin-mediated systemic inflammation, respectively. We hypothesised that fenoldopam, a selective dopamine receptor agonist, would preserve renal function after cardiopulmonary bypass through its selective renal vasodilatory and natriuretic effects, and increase gastrointestinal mucosal perfusion by selective splanchnic vasodilation. We examined the effects of fenoldopam on haemodynamic parameters, creatinine clearance, fractional excretion of sodium, urine output, free water clearance and gastric mucosal pH in 31 patients undergoing elective coronary revascularisation. Patients were randomly assigned to receive continuous infusions of fenoldopam 0.1 microg x kg(-1) x min(-1) (n = 16) or placebo (n = 15). Renal parameters were measured: during a 24-h period before hospital admission, during cardiopulmonary bypass, from completion of cardiopulmonary bypass until 4 h later, from 4 to 8 h after cardiopulmonary bypass, and from 8 to 14 h after cardiopulmonary bypass. Gastric intramucosal pH was measured using a gastric tonometer before, during and after cardiopulmonary bypass. In the placebo group, but not the fenoldopam group, mean (SD) creatinine clearance decreased after separation from cardiopulmonary bypass, from 107 (36) to 71 (22) ml x min(-1) (p < 0.01) and from 107 (36) to 79 (26) ml x min(-1) (p < 0.01) for the 0-4 h and 4-8 h intervals after cardiopulmonary bypass, respectively. Changes in intramucosal pH were similar in both groups. The findings are consistent with the hypothesis that fenoldopam possesses a renoprotective effect in patients undergoing cardiopulmonary bypass.
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Affiliation(s)
- M Halpenny
- Department of Anaesthesia and Intensive Care Medicine, Mercy Hospital and University College Cork, Ireland.
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Coleman ET, Hargrove M, Mahony CO, O'Donnell A, Shorten G, Aherne T. The effects of venous cannulation technique and cardioplegia type on plasma potassium concentration and arterial blood pressure during cardiopulmonary bypass. J Extra Corpor Technol 2001; 33:148-52. [PMID: 11680727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
The cannulation method and cardioplegia solution used during cardiopulmonary bypass (CPB) may both influence plasma potassium concentrations ([K+]) and mean arterial blood pressure (MAP). Bi-caval or right atrial cannulation methods are routinely used in conjunction with crystalloid or blood cardioplegia. We investigated the influence of cannulation method and cardioplegia solutions on plasma [K+] and MAP during cardiopulmonary bypass. Sixty consecutive patients undergoing elective coronary artery bypass grafting (CABG) using CPB were studied. They were randomly divided into three groups of 20 patients. Patients in Group A underwent bi-caval venous cannulation and received crystalloid cardioplegia. Group B patients underwent right atrial cannulation and received crystalloid cardioplegia. Group C patients underwent right atrial cannulation and received blood cardioplegia. In each case. cardioplegia was administered antegrade via the aortic root. Plasma [K+], MAP. and hemoglobin concentration (Hb) were measured over an 8-min period following cardioplegia administration (pilot studies indicated pressure changes occuring post cardioplegia administration up to this time). The combination of bi-caval cannulation and crystalloid cardioplegia (Group A) was associated with the least increase in plasma [K+] and no decrease in MAP. The maximum [K+] for this Group was 4.2 mmol/L (4.6% increase). The minimum mean pressure was 57 mmHg (13.6% increase). Both right atrial cannulation groups (B and C) showed a large rise in plasma [K+] and a decrease in MAP. Group B maximum [K+] was 5.2 mmol/L (27.5% increase). Group C was also 5.2 mmol/L (26.0% increase). Group C showed the largest pressure decrease, the minimum mean pressure was 45 mmHg (21.3% decrease). The Group B minimum mean pressure was 45 mmHg (8.7% decrease). Our results show that patients undergoing CPB operations who are deemed to be at increased risk of suffering adverse effects from hypotensive episodes may benefit from bicaval cannulation and caval snaring, in preference to right atrial cannulation. Crystalloid cardioplegia may be preferable to blood cardioplegia in these cases to maintain the MAP.
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Affiliation(s)
- E T Coleman
- Cardiothoracic Theatre, Cork University Hospital, Ireland.
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