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Khan L, Derksen T, Redmond D, Storek J, Durand C, Gniadecki R, Korman B, Cohen Tervaert JW, D'Aubeterre A, Osman MS, Willis LM. The cancer-associated glycan polysialic acid is dysregulated in systemic sclerosis and is associated with fibrosis. J Autoimmun 2023; 140:103110. [PMID: 37742510 DOI: 10.1016/j.jaut.2023.103110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/28/2023] [Accepted: 09/03/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is a rare but deadly disease characterized by autoimmunity, vasculopathy, and fibrosis. Fibrotic complications associated with SSc correlate with severe morbidity and mortality. Previous studies in SSc have identified fibroblasts as the primary drivers of fibrosis; however, the mechanism(s) promoting this are not well understood. Aberrant glycosylation, particularly polysialylation (polySia), has been described as a prominent feature of aggressive cancers. Inspired by this observation, we aimed to determine if polySia is dysregulated in various forms of SSc. METHODS All patients with SSc met the 2013 ACR/EULAR. Patients were sub-classified into limited cutaneous (lSSc, N = 5 or 46 patients for polySia quantification in the dermis or serum; respectively), diffuse cutaneous (dSSc, N = 11 or 18 patients for polySia quantification in the dermis or serum; respectively), or patients with dSSc treated with an autologous stem cell transplantation (post-ASCT, N = 4 patients for quantification in the dermis). Dermal polySia levels were measured via immunofluorescence microscopy in 10 μm dermal sections, quantified in each group (healthy volunteers (HC), lSSc, dSSc, and post-ASCT) and correlated with skin fibrosis (via the modified Rodnan skin score (mRSS)). Similarly, serum polySia was quantified in each group, and correlated with the mRSS. RESULTS Dermal polySia levels were highest in patients with dSSc (compared to HC < 0.001), and correlated with the degree of fibrosis in all of the groups (P = 0.008). Serum polySia was higher in all SSc groups (p < 0.001) and correlated with the severity of mRSS (p < 0.0001). CONCLUSION Polysia is more abundant in the skin and sera from patients with SSc and correlates with the degree of skin fibrosis. The aberrant expression of polySia highlights its potential use as a biomarker in patients with progressive forms of SSc. Dysregulated polySia levels in SSc further emphasizes the cancer-like phenotype present in SSc, which may promote fibrosis and immune dysregulation.
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Affiliation(s)
- Lamia Khan
- Faculty of Medicine & Dentistry, Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Tahlia Derksen
- Faculty of Science, Department of Biological Sciences, University of Alberta, Edmonton, AB, Canada
| | - Desiree Redmond
- Faculty of Medicine & Dentistry, Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jan Storek
- University of Calgary, Calgary, AB, Canada
| | | | - Robert Gniadecki
- Faculty of Medicine & Dentistry, Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Benjamin Korman
- Division of Allergy, Immunology and Rheumatology, University of Rochester Medical Center, Rochester, NY, USA
| | - Jan Willem Cohen Tervaert
- Faculty of Medicine & Dentistry, Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Ana D'Aubeterre
- Faculty of Science, Department of Biological Sciences, University of Alberta, Edmonton, AB, Canada
| | - Mohammed S Osman
- Faculty of Medicine & Dentistry, Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
| | - Lisa M Willis
- Faculty of Science, Department of Biological Sciences, University of Alberta, Edmonton, AB, Canada; Faculty of Medicine & Dentistry, Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada.
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Kruzer K, Korman B. Response to Letter to the Editor. J Clin Rheumatol 2023; 29:215. [PMID: 36423349 DOI: 10.1097/rhu.0000000000001928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Karen Kruzer
- Department of Rheumatology University of Rochester Medical Center, Rochester, NY
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Murphy SL, Chen YT, Lee YC, Carns M, Aren K, Korman B, Hinchcliff M, Varga J. Differences in symptom experience among patients with systemic sclerosis: a cluster analytic approach to identifying subgroups. Rheumatology (Oxford) 2023; 62:SI64-SI73. [PMID: 35920770 PMCID: PMC9910572 DOI: 10.1093/rheumatology/keac444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/22/2022] [Accepted: 07/27/2022] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Symptoms of people who have SSc are heterogeneous and difficult to address clinically. Because diverse symptoms often co-occur and may share common underlying mechanisms, identifying symptoms that cluster together may better target treatment approaches. We sought to identify and characterize patient subgroups based on symptom experience. METHODS An exploratory hierarchical agglomerative cluster analysis was conducted to identify subgroups from a large SSc cohort from a single US academic medical centre. Patient-reported symptoms of pain interference, fatigue, sleep disturbance, dyspnoea, depression and anxiety were used for clustering. A multivariate analysis of variance (MANOVA) was used to examine the relative contribution of each variable across subgroups. Analyses of variance were performed to determine participant characteristics based on subgroup assignment. Presence of symptom clusters were tallied within subgroup. RESULTS Participants (n = 587; 84% female, 41% diffuse cutaneous subtype, 59% early disease) divided into three subgroups via cluster analysis based on symptom severity: (i) no/minimal, (ii) mild, and (iii) moderate. Participants in mild and moderate symptoms subgroups had similar disease severity, but different symptom presentation. In the mild symptoms subgroup, pain, fatigue and sleep disturbance was the main symptom cluster. Participants in the moderate symptoms subgroup were characterized by co-occurring pain, fatigue, sleep disturbance, depression and anxiety. CONCLUSION Identification of distinct symptom clusters, particularly among SSc patients who experience mild and moderate symptoms, suggests potential differences in treatment approach and in mechanisms underlying symptom experience that require further study.
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Affiliation(s)
- Susan L Murphy
- Correspondence to: Susan L. Murphy, Department of Physical Medicine and Rehabilitation, University of Michigan, ScD OTR/L, 24 Frank Lloyd Wright Drive, Lobby M Suite 3100, Ann Arbor, MI 48105, USA. E-mail:
| | - Yen T Chen
- Department of Physical Medicine and Rehabilitation
- Michigan Medicine Scleroderma Program, University of Michigan, Ann Arbor, MI
| | | | - Mary Carns
- Division of Rheumatology
- Divisions of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kathleen Aren
- Division of Rheumatology
- Divisions of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Benjamin Korman
- Division of Allergy-Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, NY
| | - Monique Hinchcliff
- Section of Rheumatology, Allergy and Immunology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - John Varga
- Division of Rheumatology
- Michigan Medicine Scleroderma Program, University of Michigan, Ann Arbor, MI
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Kruzer K, Marangoni RG, Heckler I, Elhage A, Varga J, Hinchcliff M, Carns M, Aren K, Wielgosz A, Nuzzo M, Venkataraman I, Korman B. Clinical and Autoantibody Associations in Antinuclear Antibody-Positive Systemic Sclerosis Lacking Prototypic Autoantibodies. J Clin Rheumatol 2023; 29:47-51. [PMID: 35767831 PMCID: PMC10241190 DOI: 10.1097/rhu.0000000000001881] [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: 12/24/2022]
Abstract
Background/Objectives: The subset of ANA-positive patients with systemic sclerosis (SSc) who lack prototypic SSc-specific autoantibodies (centromere, topoisomerase, RNA polymerase III, “triple negative SSc”) is poorly characterized. We assessed clinical features and prevalence of additional autoantibodies in these patients. Methods: In this case series patients with ANA+ and triple negative SSc antibodies were identified from two independent SSc cohorts (n=280) and demographic and clinical data were obtained over two years. Sera were screened for ANA and autoantibodies were examined by immunoblots. Significance was assessed through Fisher’s exact test and Student’s T-test. Results: Forty ANA+ triple negative SSc patients (14% of the two SSc cohorts) were identified. Mean age was 53 ± 14.5 years, 53% had limited disease, average disease duration was 9 ± 9.7 years, and MRSS was 7.6 ± 6.8. 47.5% of the patients had digital ulcers, 60% had interstitial lung disease and 15% had pulmonary hypertension. The most common immunofluorescence patterns were speckled and mixed speckled/nucleolar. Of 29 autoantibodies tested, the most prevalent were Ro-52 (50%), Th/To (40%), MDA5 (35%), SAE1 (28%). Ro-52 was associated with ILD (RR 2.67, p<0.001) and elevated CK (RR 2.64, p<0.05), and PM-75 was associated with digital ulcers (RR 2.18, p<0.05). Conclusions: ANA+ triple negative SSc patients represent an understudied and heterogeneous population of patients with a high prevalence of Ro-52 antibodies, an enrichment for myositis specific antibodies, and increased risk of interstitial lung disease. These patients are seen relatively frequently and should be regularly assessed for evidence of myopathy and lung involvement.
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Affiliation(s)
- Karen Kruzer
- Department of Internal Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Ilana Heckler
- Scientific Affairs, EUROIMMUN US, Mountain Lakes, New Jersey, USA
| | - Aya Elhage
- Scientific Affairs, EUROIMMUN US, Mountain Lakes, New Jersey, USA
| | - John Varga
- Department of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Monique Hinchcliff
- Department of Internal Medicine, Section of Rheumatology, Allergy & Immunology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mary Carns
- Department of Rheumatology, Northwestern University, Chicago, Illinois, USA
| | - Kathleen Aren
- Department of Rheumatology, Northwestern University, Chicago, Illinois, USA
| | - Amy Wielgosz
- Department of Rheumatology, University of Rochester Medical Center, Rochester, New York, USA
| | - Marc Nuzzo
- Department of Rheumatology, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Benjamin Korman
- Department of Rheumatology, University of Rochester Medical Center, Rochester, New York, USA
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Ocon A, Lokineni S, Korman B. Understanding and Therapeutically Targeting the Scleroderma Myofibroblast. Curr Treat Options in Rheum 2022. [DOI: 10.1007/s40674-021-00189-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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6
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Shi B, Wang W, Korman B, Kai L, Wang Q, Wei J, Bale S, Marangoni RG, Bhattacharyya S, Miller S, Xu D, Akbarpour M, Cheresh P, Proccissi D, Gursel D, Espindola-Netto JM, Chini CCS, de Oliveira GC, Gudjonsson JE, Chini EN, Varga J. Targeting CD38-dependent NAD + metabolism to mitigate multiple organ fibrosis. iScience 2020; 24:101902. [PMID: 33385109 PMCID: PMC7770554 DOI: 10.1016/j.isci.2020.101902] [Citation(s) in RCA: 32] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/20/2020] [Accepted: 12/03/2020] [Indexed: 11/26/2022] Open
Abstract
The processes underlying synchronous multiple organ fibrosis in systemic sclerosis (SSc) remain poorly understood. Age-related pathologies are associated with organismal decline in nicotinamide adenine dinucleotide (NAD+) that is due to dysregulation of NAD+ homeostasis and involves the NADase CD38. We now show that CD38 is upregulated in patients with diffuse cutaneous SSc, and CD38 levels in the skin associate with molecular fibrosis signatures, as well as clinical fibrosis scores, while expression of key NAD+-synthesizing enzymes is unaltered. Boosting NAD+ via genetic or pharmacological CD38 targeting or NAD+ precursor supplementation protected mice from skin, lung, and peritoneal fibrosis. In mechanistic experiments, CD38 was found to reduce NAD+ levels and sirtuin activity to augment cellular fibrotic responses, while inhibiting CD38 had the opposite effect. Thus, we identify CD38 upregulation and resulting disrupted NAD+ homeostasis as a fundamental mechanism driving fibrosis in SSc, suggesting that CD38 might represent a novel therapeutic target. CD38 shows elevated expression in skin biopsies of patients with systemic sclerosis Elevated CD38 is associated with reduced NAD+ and augmented fibrotic responses Genetic loss of CD38 is associated with increased NAD+ levels and attenuated fibrosis NAD+ boosting via CD38 inhibition or NR supplementation prevents multi-organ fibrosis
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Affiliation(s)
- Bo Shi
- Northwestern Scleroderma Program, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Wenxia Wang
- Northwestern Scleroderma Program, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Benjamin Korman
- Northwestern Scleroderma Program, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Li Kai
- Northwestern Scleroderma Program, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Qianqian Wang
- Northwestern Scleroderma Program, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Jun Wei
- Northwestern Scleroderma Program, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Swarna Bale
- Northwestern Scleroderma Program, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Roberta Goncalves Marangoni
- Northwestern Scleroderma Program, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Swati Bhattacharyya
- Northwestern Scleroderma Program, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Stephen Miller
- Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Dan Xu
- Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Mahzad Akbarpour
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Paul Cheresh
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Daniele Proccissi
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Demirkan Gursel
- Pathology Core Facility, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | | | - Claudia C S Chini
- Department of Anesthesiology and Kogod Center on Aging, Mayo Clinic, Rochester 55905 MN, USA
| | - Guilherme C de Oliveira
- Department of Anesthesiology and Kogod Center on Aging, Mayo Clinic, Rochester 55905 MN, USA
| | | | - Eduardo N Chini
- Department of Anesthesiology and Kogod Center on Aging, Mayo Clinic, Rochester 55905 MN, USA
| | - John Varga
- Northwestern Scleroderma Program, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
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7
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Lemay M, Korman B, Hammert W, White RJ, Lachant D. Combination of treprostinil with sympathectomy and vascular reconstruction to treat recurrent digital ulcer disease. Clin Exp Rheumatol 2020; 38 Suppl 125:176-177. [PMID: 32301422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/10/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Marie Lemay
- Department of Medicine, University of Rochester Medical Centre, Rochester, USA
| | - Benjamin Korman
- Division of Rheumatology, University of Rochester Medical Centre, Rochester, USA
| | - Warren Hammert
- Department of Orthopaedic Surgery, University of Rochester Medical Centre, Rochester, USA
| | - R James White
- Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Centre, Rochester, USA
| | - Daniel Lachant
- Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Centre, Rochester, USA.
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8
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Mitchell DC, Agnihothri R, Scott GA, Korman B, Richardson CT. A case of concurrent systemic sclerosis and scleredema. JAAD Case Rep 2019; 5:940-942. [PMID: 31687459 PMCID: PMC6820239 DOI: 10.1016/j.jdcr.2019.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Drew C Mitchell
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Ritesh Agnihothri
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York
| | - Glynis A Scott
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York.,Department of Pathology, University of Rochester Medical Center, Rochester, New York
| | - Benjamin Korman
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, New York
| | - Christopher T Richardson
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York.,Department of Medicine, Division of Allergy, Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, New York
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Abstract
Systemic sclerosis (SSc, scleroderma) is a complex multisystem disease characterized by autoimmunity, vasculopathy, and most notably, fibrosis. Multiple lines of evidence demonstrate a variety of emerging cellular and molecular pathways which are relevant to fibrosis in SSc. The myofibroblast remains the key effector cell in SSc. Understanding the development, differentiation, and function of the myofibroblast is therefore crucial to understanding the fibrotic phenotype of SSc. Studies now show that (1) multiple cell types give rise to myofibroblasts, (2) fibroblasts and myofibroblasts are heterogeneous, and (3) that a large number of (primarily immune) cells have important influences on the transition of fibroblasts to an activated myofibroblasts. In SSc, this differentiation process involves multiple pathways, including well known signaling cascades such as TGF-β and Wnt/β-Catenin signaling, as well as epigenetic reprogramming and a number of more recently defined cellular pathways. After reviewing the major and emerging cellular and molecular mechanisms underlying SSc, this article looks to identify clinical applications where this new molecular knowledge may allow for targeted treatment and personalized medicine approaches.
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Affiliation(s)
- Benjamin Korman
- Division of Allergy/Immunology & Rheumatology, University of Rochester Medical Center, Rochester, New York.
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10
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Shi B, Wang W, Wei J, Bhattacharyya S, Korman B, Marangoni R, Xu D, Miller S, Akbarpour M, Bharat A, Kamp D, Cheresh P, Procissi D, de Olivera G, Chini E, Varga J. 700 Targeting SIRT/CD38/NAD+ homeostasis to mitigate fibrosis in scleroderma. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.776] [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: 11/26/2022]
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Gourh P, Remmers EF, Boyden SE, Alexander T, Morgan ND, Shah AA, Mayes MD, Doumatey A, Bentley AR, Shriner D, Domsic RT, Medsger TA, Steen VD, Ramos PS, Silver RM, Korman B, Varga J, Schiopu E, Khanna D, Hsu V, Gordon JK, Saketkoo LA, Gladue H, Kron B, Criswell LA, Derk CT, Bridges SL, Shanmugam VK, Kolstad KD, Chung L, Jan R, Bernstein EJ, Goldberg A, Trojanowski M, Kafaja S, Maksimowicz-McKinnon KM, Mullikin JC, Adeyemo A, Rotimi C, Boin F, Kastner DL, Wigley FM. Brief Report: Whole-Exome Sequencing to Identify Rare Variants and Gene Networks That Increase Susceptibility to Scleroderma in African Americans. Arthritis Rheumatol 2018; 70:1654-1660. [PMID: 29732714 DOI: 10.1002/art.40541] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/26/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Whole-exome sequencing (WES) studies in systemic sclerosis (SSc) patients of European American (EA) ancestry have identified variants in the ATP8B4 gene and enrichment of variants in genes in the extracellular matrix (ECM)-related pathway that increase SSc susceptibility. This study was undertaken to evaluate the association of the ATP8B4 gene and the ECM-related pathway with SSc in a cohort of African American (AA) patients. METHODS SSc patients of AA ancestry were enrolled from 23 academic centers across the US under the Genome Research in African American Scleroderma Patients consortium. Unrelated AA individuals without serologic evidence of autoimmunity who were enrolled in the Howard University Family Study were used as unaffected controls. Functional variants in genes reported in the 2 WES studies in EA patients with SSc were selected for gene association testing using the optimized sequence kernel association test (SKAT-O) and pathway analysis by Ingenuity Pathway Analysis in 379 patients and 411 controls. RESULTS Principal components analysis demonstrated that the patients and controls had similar ancestral backgrounds, with roughly equal proportions of mean European admixture. Using SKAT-O, we examined the association of individual genes that were previously reported in EA patients and none remained significant, including ATP8B4 (P = 0.98). However, we confirmed the previously reported association of the ECM-related pathway with enrichment of variants within the COL13A1, COL18A1, COL22A1, COL4A3, COL4A4, COL5A2, PROK1, and SERPINE1 genes (corrected P = 1.95 × 10-4 ). CONCLUSION In the largest genetic study in AA patients with SSc to date, our findings corroborate the role of functional variants that aggregate in a fibrotic pathway and increase SSc susceptibility.
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Affiliation(s)
- Pravitt Gourh
- NIAMS and National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Elaine F Remmers
- National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Steven E Boyden
- National Human Genome Research Institute, NIH, Bethesda, Maryland
| | | | - Nadia D Morgan
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ami A Shah
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Ayo Doumatey
- National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Amy R Bentley
- National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Daniel Shriner
- National Human Genome Research Institute, NIH, Bethesda, Maryland
| | | | | | | | | | | | - Benjamin Korman
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - John Varga
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Vivien Hsu
- Robert Wood Johnson University, New Brunswick, New Jersey
| | | | | | - Heather Gladue
- Arthritis and Osteoporosis Consultants of the Carolinas, Charlotte, North Carolina
| | | | | | | | | | | | | | - Lorinda Chung
- Stanford University School of Medicine, Stanford, California, and Palo Alto VA Health Care System, Palo Alto, California
| | - Reem Jan
- University of Chicago, Pritzker School of Medicine, Chicago, Illinois
| | - Elana J Bernstein
- New York Presbyterian Hospital, Columbia University, New York, New York
| | - Avram Goldberg
- New York University Langone Medical Center, New York, New York
| | | | - Suzanne Kafaja
- David Geffen School of Medicine, University of California, Los Angeles
| | | | - James C Mullikin
- National Human Genome Research Institute, NIH Intramural Sequencing Center, Rockville, Maryland
| | | | - Charles Rotimi
- National Human Genome Research Institute, NIH, Bethesda, Maryland
| | | | - Daniel L Kastner
- National Human Genome Research Institute, NIH, Bethesda, Maryland
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Korman B, Marangoni RG, Lord G, Olefsky J, Tourtellotte W, Varga J. Adipocyte-specific Repression of PPAR-gamma by NCoR Contributes to Scleroderma Skin Fibrosis. Arthritis Res Ther 2018; 20:145. [PMID: 29996896 PMCID: PMC6042240 DOI: 10.1186/s13075-018-1630-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/22/2018] [Indexed: 12/29/2022] Open
Abstract
Background A pivotal role for adipose tissue homeostasis in systemic sclerosis (SSc) skin fibrosis is increasingly recognized. The nuclear receptor PPAR-γ is the master regulator of adipogenesis. Peroxisome proliferator activated receptor-γ (PPAR-γ) has antifibrotic effects by blocking transforming growth factor-β (TGF-β) and is dysregulated in SSc. To unravel the impact of dysregulated PPAR-γ in SSc, we focused on nuclear corepressor (NCoR), which negatively regulates PPAR-γ activity and suppresses adipogenesis. Methods An NCoR-regulated gene signature was measured in the SSc skin transcriptome. Experimental skin fibrosis was examined in mice with adipocyte-specific NCoR ablation. Results SSc skin biopsies demonstrated deregulated NCoR signaling. A 43-gene NCoR gene signature showed strong positive correlation with PPAR-γ signaling (R = 0.919, p < 0.0001), whereas negative correlations with TGF-β signaling (R = − 0.796, p < 0.0001) and the modified Rodnan skin score (R = − 0.49, p = 0.004) were found. Mice with adipocyte-specific NCoR ablation demonstrated significant protection from experimental skin fibrosis and inflammation. The protective effects were mediated primarily through endogenous PPAR-γ. Conclusions Our results implicate, for the first time, to our knowledge, deregulated NCoR/PPAR-γ pathways in SSc, and they support a role of adipocyte modulation of skin fibrosis. Pharmacologic restoration of NCoR/PPAR-γ signaling may represent a novel strategy to control skin fibrosis in SSc.
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Affiliation(s)
- Benjamin Korman
- Northwestern Scleroderma Program, Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Division of Allergy, Immunology and Rheumatology, University of Rochester Medical Center, Rochester, NY, USA.
| | - Roberta Goncalves Marangoni
- Northwestern Scleroderma Program, Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gabriel Lord
- Northwestern Scleroderma Program, Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jerrold Olefsky
- Division of Endocrinology, University of California, San Diego, La Jolla, CA, USA
| | | | - John Varga
- Northwestern Scleroderma Program, Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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13
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Korman B, Alejo R, Sudhakar D, Hinchcliff M, Agrawal R, Varga J, Marangoni RG. The novel adipokine C1q-TNF related protein 9 (CTRP9) is elevated in systemic sclerosis-associated interstitial lung disease. Clin Exp Rheumatol 2018; 36 Suppl 113:184-185. [PMID: 30183591 PMCID: PMC7389309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/30/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Benjamin Korman
- Northwestern Scleroderma Program, Departments of Medicine and Dermatology, Division of Rheumatology, Northwestern University, Chicago, IL, USA
| | - Rafael Alejo
- Northwestern Scleroderma Program, Departments of Medicine and Dermatology, Division of Rheumatology, Northwestern University, Chicago, IL, USA
| | - Deepshika Sudhakar
- Northwestern Scleroderma Program,Departments of Medicine and Dermatology, Division of Rheumatology, Northwestern University, Chicago, IL, USA
| | - Monique Hinchcliff
- Northwestern Scleroderma Program, Departments of Medicine and Dermatology, Division of Rheumatology, and Institute for Public Health and Medicine, Northwestern University, Chicago, IL, USA
| | - Rishi Agrawal
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - John Varga
- Northwestern Scleroderma Program, Departments of Medicine and Dermatology, Division of Rheumatology, Northwestern University, Chicago, IL, USA
| | - Roberta G Marangoni
- Northwestern Scleroderma Program, Departments of Medicine and Dermatology, Division of Rheumatology, Northwestern University, Chicago, IL, USA.
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14
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Wei J, Zhu H, Lord G, Bhattachayya M, Jones BM, Allaway G, Biswal SS, Korman B, Marangoni RG, Tourtellotte WG, Varga J. Nrf2 exerts cell-autonomous antifibrotic effects: compromised function in systemic sclerosis and therapeutic rescue with a novel heterocyclic chalcone derivative. Transl Res 2017; 183:71-86.e1. [PMID: 28027929 PMCID: PMC7205471 DOI: 10.1016/j.trsl.2016.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 11/26/2016] [Accepted: 12/02/2016] [Indexed: 12/21/2022]
Abstract
The transcription factor nuclear factor erythroid 2-related factor 2 (Nrf2) governs antioxidant, innate immune and cytoprotective responses and its deregulation is prominent in chronic inflammatory conditions. To examine the hypothesis that Nrf2 might be implicated in systemic sclerosis (SSc), we investigated its expression, activity, and mechanism of action in SSc patient samples and mouse models of fibrosis and evaluated the effects of a novel pharmacologic Nrf2 agonist. We found that both expression and activity of Nrf2 were significantly reduced in SSc patient skin biopsies and showed negative correlation with inflammatory gene expression. In skin fibroblasts, Nrf2 mitigated fibrotic responses by blocking canonical transforming growth factor-β (TGF-β)-Smad signaling, whereas silencing Nrf2 resulted in constitutively elevated collagen synthesis, spontaneous myofibroblast differentiation, and enhanced TGF-ß responses. Bleomycin treatment of Nrf2-null mice resulted in exaggerated fibrosis. In wild-type mice, treatment with a novel pharmacologic Nrf2 agonist 2-trifluoromethyl-2'-methoxychalcone prevented dermal fibrosis induced by TGF-β. These findings are the first to identify Nrf2 as a cell-intrinsic antifibrotic factor with key roles in maintaining extracellular matrix homeostasis and a pathogenic role in SSc. Pharmacologic reactivation of Nrf2, therefore, represents a novel therapeutic strategy toward effective treatment of fibrosis in SSc.
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Affiliation(s)
- Jun Wei
- Northwestern Scleroderma Program, Feinberg School of Medicine, Chicago, Ill.
| | - Hongyan Zhu
- Northwestern Scleroderma Program, Feinberg School of Medicine, Chicago, Ill
| | - Gabriel Lord
- Northwestern Scleroderma Program, Feinberg School of Medicine, Chicago, Ill
| | - Mitra Bhattachayya
- Northwestern Scleroderma Program, Feinberg School of Medicine, Chicago, Ill
| | | | | | - Shyam S Biswal
- Department of Environmental Health Sciences, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Md
| | - Benjamin Korman
- Northwestern Scleroderma Program, Feinberg School of Medicine, Chicago, Ill
| | | | - Warren G Tourtellotte
- Department of Pathology, Feinberg School of Medicine, Chicago, Ill; Department of Neurology, Feinberg School of Medicine, Chicago, Ill
| | - John Varga
- Northwestern Scleroderma Program, Feinberg School of Medicine, Chicago, Ill.
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15
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Korman B, Krsek P, Duchowny M, Maton B, Pacheco-Jacome E, Rey G. Early seizure onset and dysplastic lesion extent independently disrupt cognitive networks. Neurology 2013; 81:745-51. [DOI: 10.1212/wnl.0b013e3182a1aa2a] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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16
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Krsek P, Maton B, Jayakar P, Dean P, Korman B, Rey G, Dunoyer C, Pacheco-Jacome E, Morrison G, Ragheb J, Vinters HV, Resnick T, Duchowny M. Incomplete resection of focal cortical dysplasia is the main predictor of poor postsurgical outcome. Neurology 2008; 72:217-23. [PMID: 19005171 DOI: 10.1212/01.wnl.0000334365.22854.d3] [Citation(s) in RCA: 223] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Focal cortical dysplasia (FCD) is recognized as the major cause of focal intractable epilepsy in childhood. Various factors influencing postsurgical seizure outcome in pediatric patients with FCD have been reported. OBJECTIVE To analyze different variables in relation to seizure outcome in order to identify prognostic factors for selection of pediatric patients with FCD for epilepsy surgery. METHODS A cohort of 149 patients with histologically confirmed mild malformations of cortical development or FCD with at least 2 years of postoperative follow-up was retrospectively studied; 113 subjects had at least 5 years of postoperative follow-up. Twenty-eight clinical, EEG, MRI, neuropsychological, surgical, and histopathologic parameters were evaluated. RESULTS The only significant predictor of surgical success was completeness of surgical resection, defined as complete removal of the structural MRI lesion (if present) and the cortical region exhibiting prominent ictal and interictal abnormalities on intracranial EEG. Unfavorable surgical outcomes are mostly caused by overlap of dysplastic and eloquent cortical regions. There were nonsignificant trends toward better outcomes in patients with normal intelligence, after hemispherectomy and with FCD type II. Other factors such as age at seizure onset, duration of epilepsy, seizure frequency, associated pathologies including hippocampal sclerosis, extent of EEG and MRI abnormalities, as well as extent and localization of resections did not influence outcome. Twenty-five percent of patients changed Engel's class of seizure outcome after the second postoperative year. CONCLUSIONS The ability to define and fully excise the entire region of dysplastic cortex is the most powerful variable influencing outcome in pediatric patients with focal cortical dysplasia.
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Affiliation(s)
- P Krsek
- Department of Pediatric Neurology, Charles University, Second Medical School, Motol University Hospital, V Uvalu 84, CZ 15006 Prague 5, Czech Republic.
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17
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Mapleson WW, Korman B. The Second Gas Effect Is a Valid Concept. Anesth Analg 1999. [DOI: 10.1213/00000539-199911000-00050] [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: 11/05/2022]
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18
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Mapleson WW, Korman B. The second gas effect is a valid concept. Anesth Analg 1999; 89:1326. [PMID: 10553863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Korman B, Jennings LS. Rapid attainment of steady-state plasma drug concentrations within precise limits in multicompartment mammillary systems. J Pharmacokinet Biopharm 1999; 27:325-8. [PMID: 10728493 DOI: 10.1023/a:1020951230947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We have previously described a method of rapidly obtaining a specified steady-state plasma concentration of an intravenous drug within precise limits. However the method is limited to drugs whose disposition may be characterized by an open two-compartment system. In this paper, we illustrate how the method can be extended to drugs whose disposition may be characterized by a mammillary model with any number of compartments. Refinements of our previous technique are also described.
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Affiliation(s)
- B Korman
- Department of Anaesthesia, Royal Perth Hospital, Australia
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20
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Abstract
The water analogue provides a visual model of the process of anaesthetic exchange. In the standard version, a single pipe connects the mouth container to the lung container and the conductance of this mouth-lung pipe is proportional to alveolar ventilation. This implies that inspired and expired ventilations are equal. In fact, with high inspired concentrations of nitrous oxide, early rapid uptake of gas by solution leads to a substantial difference between inspired and expired ventilation which in turn leads to concentration and second-gas effects. It is shown that by representing inspired and expired ventilations separately, and keeping one of them constant while varying the other to compensate for rapid uptake, concentration and second-gas effects are reproduced in the water analogue. Other means of reproducing the effects are reported but we believe that the first method is the most realistic and the most appropriate for teaching.
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Affiliation(s)
- W W Mapleson
- Department of Anaesthetics and Intensive Care Medicine, University of Wales College of Medicine, Cardiff
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21
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Korman B, Jennings LS, Rigg JR. Rapid attainment of steady state plasma drug concentrations within precise limits. J Pharmacokinet Biopharm 1998; 26:319-28. [PMID: 10098102 DOI: 10.1023/a:1023285426388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We describe a method of rapidly obtaining a specified steady state plasma concentration of an intravenous drug within precise limits. The technique requires an initial bolus to raise the plasma concentration to the upper limit followed by a series of constant-rate infusions each of which is associated with a minimum plasma concentration equal to the lower limit. The infusion rate is stepped down when the plasma concentration returns to the upper limit. Computer simulation, based on the method, is used to generate plasma concentration-time curves with fluctuations of up to 10% about selected steady state concentrations of amrinone, esmolol, lidocaine, midazolam, propofol, and theophylline. The utility of this general approach to intravenous dosing and potential limitations of the method are discussed.
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Affiliation(s)
- B Korman
- Department of Anaesthesia, Royal Perth Hospital, Perth, Australia
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22
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Affiliation(s)
- B Korman
- Department of Anesthesia, Royal Perth Hospital, Perth WA, Australia
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23
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Abstract
During induction with high inspired concentrations of nitrous oxide, net uptake of gas produces a contraction in volume and a concentrating effect. In turn, this results in concentration and second gas effects. Most explanations of these effects are based on the common "rectangle" diagram devised by Stoelting and Eger and contain several inconsistencies which are explored here in order to produce a more accurate description. It is shown that in the standard diagram gas uptake is incomplete, there is ambiguity over functional residual capacity (FRC), equilibration with blood is inadequately represented and there is no representation of recirculation of anaesthetic. Compensation for loss of volume may be by means of an increased inspired ventilation, decreased expired ventilation or reduction in lung volume. Numerous accounts in the literature (including those based on the standard diagram) focus on the former mechanism at constant FRC. This has produced an unbalanced picture in which it is often implied that extra gas is routinely drawn into the lungs to replace that taken up. Significant compensation by this means cannot occur, for example when a constant volume ventilator is used. In discussing concentration and second gas effects, it is necessary to give a balanced view of the alternative mechanisms of compensation or to revert, as above, to a simple statement of the principle of conservation of volume.
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Affiliation(s)
- B Korman
- Department of Anaesthesia, Royal Perth Hospital, Western Australia
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24
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Abstract
The postoperative analgesic requirements of a group of patients receiving high doses of corticosteroids for 48 hours postoperatively were studied. It was found that the opioid requirement of the group was significantly less than that of a control group undergoing similar surgery but not receiving steroids (p less than 0.001). The steroid group required approximately half the opioid dose of the control group. Possible explanations of the effect include the anti-inflammatory action of steroids and competitive inhibition of a common metabolic pathway in the liver.
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Abstract
The authors obtained boiling point-composition data and vapor pressure-composition data for the halothane-enflurane system at 20 degrees C and 25 degrees C. This was used to demonstrate the existence of an azeotropic mixture of halothane and enflurane and to predict the output of an enflurane vaporizer contaminated with different amounts of halothane and a halothane vaporizer contaminated with different amounts of enflurane. The study was undertaken because the information allows a comprehensive description of the behavior of a contaminated vaporizer and the required data were not previously available. It was shown that an enflurane vaporizer contaminated with halothane delivers potentially dangerous mixtures of the two agents, whereas an enflurane-contaminated halothane vaporizer does not pose a serious problem. It was concluded that when halothane and enflurane vaporizers are mounted in series, the halothane should be downstream. It is explained why the halothane-enflurane azeotrope is unlikely to be useful clinically.
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Abstract
The authors determined the densities of liquid halothane, methoxyflurane, and enflurane over the temperature range of 0 to 35 degrees C. The measurements were undertaken because detailed information of this type is useful in, for example, the preparations of chromatography standards, and no previous comparable study has been published. The densities of the liquid agents at different temperatures were described by regression equations. Calculated values using these equations compared favorably with isolated values reported in the literature.
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Korman B, Ritchie IM. The vapour pressure-composition diagram for halothane-methoxyflurane and its relevance to cross-contamination. Aust J Chem 1982. [DOI: 10.1071/ch9821769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A cross-contaminated
anaesthetic agent forms a binary liquid mixture with its contaminant. Since it
was thought possible that the behaviour of contaminated vaporizers could be
predicted from a knowledge of the vapour pressure-composition diagram for the binary
liquid mixture, the diagram for a typical system was determined. The technique
used was to allow a suitable mixture of agents to equilibrate, measure their
combined vapour pressure, and determine the liquid and vapour compositions by
infrared analysis. A vacuum line suitable for the vapour pressure measurements
is described. The vapour pressure-composition diagram for
halothane-methoxyflurane was found to be ideal both at 20 and 25�C. This
finding is used to account for some results reported in the literature
concerning cross-contamination between halothane and methoxyflurane.
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28
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Abstract
The Dalkon shield was withdrawn from the market in the United States of America last year because of the reports of 11 maternal deaths and 209 cases of septic midtrimester abortions associated with the device in situ. Four cases of late midtrimester septic abortions resulting in neonatal deaths are presented. In one of these, the mother developed septicaemic shock and almost died. The true pregnancy rate with the Dalkon shield is much higher than was initially claimed, particularly if it is inserted in the puerperium. Surveys on the outcome of the pregnancy indicate that 50% end in spontaneous abortion and one in 20 pregnancies are ectopic. A high percentage of the abortions are septic. The Dalkon shield, therefore, has no advantages over other intrauterine contraceptive devices and it remains to be seen whether the recent modification of the device has overcome the disadvantages of the earlier version. If pregnancy is diagnosed with the device in situ, it should be removed if the string is visible. If pregnancy continues with the shield in place, the patient should be observed closely. Should septic abortion occur, active management is indicated and early evacuation of the uterus is recommended.
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