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Malembaka EB, Bugeme PM, Hutchins C, Xu H, Hulse JD, Demby MN, Gallandat K, Saidi JM, Rumedeka BB, Itongwa M, Tshiwedi-Tsilabia E, Kitoga F, Bodisa-Matamu T, Kavunga-Membo H, Bengehya J, Kulondwa JC, Debes AK, Taty N, Lee EC, Lunguya O, Lessler J, Leung DT, Cumming O, Okitayemba PW, Mukadi-Bamuleka D, Knee J, Azman AS. Effectiveness of one dose of killed oral cholera vaccine in an endemic community in the Democratic Republic of the Congo: a matched case-control study. Lancet Infect Dis 2024; 24:514-522. [PMID: 38246191 PMCID: PMC11043051 DOI: 10.1016/s1473-3099(23)00742-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND A global shortage of cholera vaccines has increased the use of single-dose regimens, rather than the standard two-dose regimen. There is sparse evidence on single-dose protection, particularly in children. In 2020, a mass vaccination campaign was conducted in Uvira, an endemic urban setting in eastern Democratic Republic of the Congo, resulting in largely single-dose coverage. We examined the effectiveness of a single-dose of the oral cholera vaccine Euvichol-Plus in this high-burden setting. METHODS In this matched case-control study, we recruited individuals with medically attended confirmed cholera in the two cholera treatment facilities in the city of Uvira. The control group consisted of age-matched, sex-matched, and neighbourhood-matched community individuals. We recruited across two distinct periods: Oct 14, 2021, to March 10, 2022 (12-17 months after vaccination), and Nov 21, 2022, to Oct 18, 2023 (24-36 months after vaccination). Study staff administered structured questionnaires to all participants to capture demographics, household conditions, potential confounding variables, and vaccination status. The odds of vaccination for the case and control groups were contrasted in conditional logistic regression models to estimate unadjusted and adjusted vaccine effectiveness. FINDINGS We enrolled 658 individuals with confirmed cholera and 2274 matched individuals for the control group. 99 (15·1%) individuals in the case group were younger than 5 years at the time of vaccination. The adjusted single-dose vaccine effectiveness was 52·7% (95% CI 31·4 to 67·4) 12-17 months after vaccination and 44·7% (24·8 to 59·4) 24-36 months after vaccination. Although protection in the first 12-17 months after vaccination was similar for children aged 1-4 years and older individuals, the estimate of protection in children aged 1-4 years appeared to wane during the third year after vaccination (adjusted vaccine effectiveness 32·9%, 95% CI -30·7 to 65·5), with CIs spanning the null. INTERPRETATION A single dose of Euvichol-Plus provided substantial protection against medically attended cholera for at least 36 months after vaccination in this cholera-endemic setting. Although the evidence provides support for similar levels of protection in young children and others in the short term, protection among children younger than 5 years might wane significantly during the third year after vaccination. FUNDING Wellcome Trust and Gavi, the Vaccine Alliance.
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Affiliation(s)
- Espoir Bwenge Malembaka
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Centre for Tropical Diseases and Global Health (CTDGH), Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Patrick Musole Bugeme
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Centre for Tropical Diseases and Global Health (CTDGH), Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Chloe Hutchins
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Hanmeng Xu
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Juan Dent Hulse
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Maya N Demby
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Karin Gallandat
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Jaime Mufitini Saidi
- Ministère de la Santé Publique, Hygiène et Prévention, Zone de Santé d'Uvira, Uvira, Democratic Republic of the Congo
| | | | | | | | - Faida Kitoga
- Rodolphe Merieux INRB-Goma Laboratory, Goma, North Kivu, Democratic Republic of the Congo
| | - Tavia Bodisa-Matamu
- Rodolphe Merieux INRB-Goma Laboratory, Goma, North Kivu, Democratic Republic of the Congo
| | - Hugo Kavunga-Membo
- Rodolphe Merieux INRB-Goma Laboratory, Goma, North Kivu, Democratic Republic of the Congo; Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo
| | - Justin Bengehya
- Ministère de la Santé Publique, Hygiène et Prévention, Division Provinciale de la Sante' Publique du Sud-Kivu, Bukavu, Democratic Republic of the Congo
| | - Jean-Claude Kulondwa
- Ministère de la Santé Publique, Hygiène et Prévention, Division Provinciale de la Sante' Publique du Sud-Kivu, Bukavu, Democratic Republic of the Congo
| | - Amanda K Debes
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Nagède Taty
- PNECHOL-MD, Community IMCI, Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Elizabeth C Lee
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Octavie Lunguya
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; University of North Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel T Leung
- Division of Infectious Diseases and Division of Microbiology and Immunology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Daniel Mukadi-Bamuleka
- Rodolphe Merieux INRB-Goma Laboratory, Goma, North Kivu, Democratic Republic of the Congo; Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jackie Knee
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Geneva Centre for Emerging Viral Diseases and Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland.
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Bugeme PM, Xu H, Hutchins C, Dent J, Saidi JM, Rumedeka BB, Itongwa M, Mashauri JFZ, Masembe Lulela F, Bengehya J, Kulondwa JC, Debes AK, Ciglenecki I, Tshiwedi E, Kitoga F, Bodisa-Matamu T, Nadège T, Kavunga-Membo H, Lunguya O, Welo PO, Knee J, Mukadi-Bamuleka D, Azman AS, Malembaka EB. Cholera Deaths During Outbreaks in Uvira, Eastern Democratic Republic of the Congo, 10-35 Months After Mass Vaccination. Open Forum Infect Dis 2024; 11:ofae058. [PMID: 38500577 PMCID: PMC10946650 DOI: 10.1093/ofid/ofae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/29/2024] [Indexed: 03/20/2024] Open
Abstract
Our understanding of the burden and drivers of cholera mortality is hampered by limited surveillance and confirmation capacity. Leveraging enhanced clinical and laboratory surveillance in the cholera-endemic community of Uvira, eastern Democratic Republic of Congo, we describe cholera deaths across 3 epidemics between September 2021 and September 2023 following mass vaccination.
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Affiliation(s)
- Patrick Musole Bugeme
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
- Centre for Tropical Diseases and Global Health (CTDGH), Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Hanmeng Xu
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Chloe Hutchins
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Juan Dent
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jaime Mufitini Saidi
- Zone de Santé d’Uvira, Ministère de la Santé Publique, Hygiène et Prévention, Uvira, Democratic Republic of the Congo
| | - Baron Bashige Rumedeka
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
- Zone de Santé d’Uvira, Ministère de la Santé Publique, Hygiène et Prévention, Uvira, Democratic Republic of the Congo
| | | | | | | | - Justin Bengehya
- Division Provinciale de la Santé Publique du Sud-Kivu, Ministère de la Santé Publique, Hygiène et Prévention, Bukavu, Democratic Republic of the Congo
| | - Jean-Claude Kulondwa
- Division Provinciale de la Santé Publique du Sud-Kivu, Ministère de la Santé Publique, Hygiène et Prévention, Bukavu, Democratic Republic of the Congo
| | - Amanda K Debes
- Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Iza Ciglenecki
- Medical Department, Médecins Sans Frontières, Geneva, Switzerland
| | - Esperance Tshiwedi
- Rodolphe Merieux INRB-Goma Laboratory, Institut National de Recherche Biomédicale (INRB), Goma, Democratic Republic of the Congo
| | - Faida Kitoga
- Rodolphe Merieux INRB-Goma Laboratory, Institut National de Recherche Biomédicale (INRB), Goma, Democratic Republic of the Congo
| | - Tavia Bodisa-Matamu
- Rodolphe Merieux INRB-Goma Laboratory, Institut National de Recherche Biomédicale (INRB), Goma, Democratic Republic of the Congo
| | - Taty Nadège
- Programme National d’Elimination de Choléra et de lutte contre les autres Maladies Diarrhéiques (PNECHOL-MD), Ministère de la Santé Publique, Hygiène et Prévention, Kinshasa, Democratic Republic of the Congo
| | - Hugo Kavunga-Membo
- Rodolphe Merieux INRB-Goma Laboratory, Institut National de Recherche Biomédicale (INRB), Goma, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo
| | - Octavie Lunguya
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo
| | - Placide Okitayemba Welo
- Programme National d’Elimination de Choléra et de lutte contre les autres Maladies Diarrhéiques (PNECHOL-MD), Ministère de la Santé Publique, Hygiène et Prévention, Kinshasa, Democratic Republic of the Congo
| | - Jackie Knee
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Daniel Mukadi-Bamuleka
- Rodolphe Merieux INRB-Goma Laboratory, Institut National de Recherche Biomédicale (INRB), Goma, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo
| | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals (HUG), Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Espoir Bwenge Malembaka
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
- Centre for Tropical Diseases and Global Health (CTDGH), Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
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3
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Hutchins C, Sayavedra L, Diaz M, Gupta P, Tissingh E, Elumogo C, Nolan J, Charles I, Elumogo N, Narbad A. Genomic analysis of a rare recurrent Listeria monocytogenes prosthetic joint infection indicates a protected niche within biofilm on prosthetic materials. Sci Rep 2021; 11:21864. [PMID: 34750463 PMCID: PMC8575960 DOI: 10.1038/s41598-021-01376-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 10/22/2021] [Indexed: 12/13/2022] Open
Abstract
Listeria monocytogenes is a rare cause of prosthetic joint infections (PJI). In this study, we describe a case of recurrent L. monocytogenes infections, 39 months apart, following debridement and retention of a prosthetic hip. Despite numerous studies reporting persistent L. monocytogenes in human infections, the genomic and phenotypic changes that clinically relevant strains undergo in the host are poorly understood. Improved knowledge of how PJI occurs is needed to improve the management of prosthetic infections. We used a combination of long- and short-read sequencing to identify any potential genomic differences between two L. monocytogenes isolates that occurred over 39-month incubation in the host. The isolates, QI0054 and QI0055, showed three single nucleotide polymorphisms and three insertions or deletions, suggesting that the recurrent infection was caused by the same strain. To identify potential differences in the capacity for persistence of these isolates, their biofilm-forming ability and potential to colonize prosthesis-relevant materials was investigated both in microtitre plates and on prosthetic material titanium, stainless steel 316 and ultra-high molecular weight polyethylene. Whilst the L. monocytogenes isolate from the most recent infection (QI0055) was able to form higher biofilm in microtitre plates, this did not lead to an increase in biomass on prosthetic joint materials compared to the initial isolate (QI0054). Both clinical isolates were able to form significantly more biofilm on the two metal prosthetic materials than on the ultra-high molecular weight polyethylene, in contrast to reference strain Scott A. Transcriptomics revealed 41 genes overexpressed in biofilm state and 643 in planktonic state. Moreover, genes with mutations were actively expressed in both isolates. We conclude the isolates are derived from the same strain and hypothesize that L. monocytogenes formed biofilm on the prosthetic joint materials, with minimal exposure to stresses, which permitted their survival and growth.
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Affiliation(s)
- Chloe Hutchins
- Gut Health and Microbes, Quadram Institute Bioscience, Norwich Research Park, Norwich, UK.
| | - Lizbeth Sayavedra
- Gut Health and Microbes, Quadram Institute Bioscience, Norwich Research Park, Norwich, UK.
| | - Maria Diaz
- Gut Health and Microbes, Quadram Institute Bioscience, Norwich Research Park, Norwich, UK.,Microbes in the Food Chain, Quadram Institute Bioscience, Norwich Research Park, Norwich, UK
| | - Puja Gupta
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Elizabeth Tissingh
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Chiamaka Elumogo
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - John Nolan
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Ian Charles
- Gut Health and Microbes, Quadram Institute Bioscience, Norwich Research Park, Norwich, UK.,University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - Ngozi Elumogo
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Arjan Narbad
- Gut Health and Microbes, Quadram Institute Bioscience, Norwich Research Park, Norwich, UK
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4
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Li T, Garcia-Gutierrez E, Yara DA, Scadden J, Davies J, Hutchins C, Aydin A, O'Grady J, Narbad A, Romano S, Sayavedra L. An optimised protocol for detection of SARS-CoV-2 in stool. BMC Microbiol 2021; 21:242. [PMID: 34488633 PMCID: PMC8419809 DOI: 10.1186/s12866-021-02297-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/18/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND SARS-CoV-2 has been detected in stool samples of COVID-19 patients, with potential implications for faecal-oral transmission. Compared to nasopharyngeal swab samples, the complexity of the stool matrix poses a challenge in the detection of the virus that has not yet been solved. However, robust and reliable methods are needed to estimate the prevalence and persistence of SARS-CoV-2 in the gut and to ensure the safety of microbiome-based procedures such as faecal microbiota transplant (FMT). The aim of this study was to establish a sensitive and reliable method for detecting SARS-CoV-2 in stool samples. RESULTS Stool samples from individuals free of SARS-CoV-2 were homogenised in saline buffer and spiked with a known titre of inactivated virus ranging from 50 to 750 viral particles per 100 mg stool. Viral particles were concentrated by ultrafiltration, RNA was extracted, and SARS-CoV-2 was detected via real-time reverse-transcription polymerase chain reaction (RT-qPCR) using the CDC primers and probes. The RNA extraction procedure we used allowed for the detection of SARS-CoV-2 via RT-qPCR in most of the stool samples tested. We could detect as few as 50 viral particles per 100 mg of stool. However, high variability was observed across samples at low viral titres. The primer set targeting the N1 region provided more reliable and precise results and for this primer set our method had a limit of detection of 1 viral particle per mg of stool. CONCLUSIONS Here we describe a sensitive method for detecting SARS-CoV-2 in stool samples. This method can be used to establish the persistence of SARS-CoV-2 in stool and ensure the safety of clinical practices such as FMT.
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Affiliation(s)
- Tianqi Li
- Gut Health and Microbes, Quadram Institute Bioscience, Norwich Research Park, Norwich, UK
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi, China
| | | | - Daniel A Yara
- Gut Health and Microbes, Quadram Institute Bioscience, Norwich Research Park, Norwich, UK
| | - Jacob Scadden
- Gut Health and Microbes, Quadram Institute Bioscience, Norwich Research Park, Norwich, UK
| | - Jade Davies
- Gut Health and Microbes, Quadram Institute Bioscience, Norwich Research Park, Norwich, UK
| | - Chloe Hutchins
- Gut Health and Microbes, Quadram Institute Bioscience, Norwich Research Park, Norwich, UK
| | - Alp Aydin
- Microbes in the Food Chain, Quadram Institute Bioscience, Norwich Research Park, Norwich, UK
| | - Justin O'Grady
- Microbes in the Food Chain, Quadram Institute Bioscience, Norwich Research Park, Norwich, UK
| | - Arjan Narbad
- Gut Health and Microbes, Quadram Institute Bioscience, Norwich Research Park, Norwich, UK
| | - Stefano Romano
- Gut Health and Microbes, Quadram Institute Bioscience, Norwich Research Park, Norwich, UK.
| | - Lizbeth Sayavedra
- Gut Health and Microbes, Quadram Institute Bioscience, Norwich Research Park, Norwich, UK.
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5
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Hutchins C, Henderson A, Henden A, Barnes E, Abaca-Cleopas M, Acworth M, McEnroe B, Mudie K, Dropulic B, Schneider D, Kennedy G, Tey S. Place-of-care manufacturing of car19-t cells using an automated closed-system device. Cytotherapy 2021. [DOI: 10.1016/s1465324921006125] [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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6
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Ekwe A, Au R, McEnroe B, Tan M, Saldan A, Henden A, Zhang P, Hutchins C, Henderson A, Mudie K, Western R, Fuery M, Kennedy G, Hill G, Tey S. Clinical scale facs-sorting and expansion of regulatory t cells (TREGS) for phase i clinical trial. Cytotherapy 2021. [DOI: 10.1016/s1465324921006150] [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: 10/21/2022]
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7
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Gilhooly M, Hutchins C, Lichtenberg P. LOSS OF VOCATIONAL CAPACITY IN SENIOR PROFESSIONALS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2577] [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: 11/13/2022] Open
Affiliation(s)
- M.L. Gilhooly
- Brunel University London, Uxbridge, England, United Kingdom
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8
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Romo E, Field J, Ross S, Pidgeon H, Hutchins C, Christian E, Bailitz J. 324 Self-Directed Learning Through Ultrasound Simulator: A Feasibility Study. Ann Emerg Med 2016. [DOI: 10.1016/j.annemergmed.2016.08.340] [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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9
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Durrant S, Stylian S, Western R, Morton J, Butler J, Hutchins C, Hill G, Kennedy G. 57: Outcomes for allogeneic transplantation in imatinib-refractory chronic myeloid leukaemia (CML) are equivalent to outcomes in imatinib-responsive/imatinib-naive CML and can be predicted by the EBMT risk score. Biol Blood Marrow Transplant 2007. [DOI: 10.1016/j.bbmt.2006.12.060] [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: 11/30/2022]
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10
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Abad-Zapatero C, Lubben T, Severin J, Hebert E, Ahmed T, Johnson R, Stewart K, Hutchins C, Oie T, Smith R. Structural, kinetic and biochemical characterization of the oxidation states of human protein tyrosine phosphatase 1B: implications for redox regulation of phosphatase activity. Acta Crystallogr A 2002. [DOI: 10.1107/s0108767302096277] [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: 11/10/2022] Open
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11
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Lea RA, Curtain RP, Hutchins C, Brimage PJ, Griffiths LR. Investigation of the CACNA1A gene as a candidate for typical migraine susceptibility. Am J Med Genet 2001; 105:707-12. [PMID: 11803518 DOI: 10.1002/ajmg.1609] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Typical migraine is a complex neurological disorder comprised of two main subtypes: migraine with (MA) and without aura (MO). The disease etiology is still unclear, but family studies provide strong evidence that defective genes play an important role. Familial hemiplegic migraine (FHM) is a very rare and severe subtype of MA. It has been proposed that FHM and MA may have a similar genetic etiology. Therefore, genetic studies on FHM provide a useful model for investigating the more prevalent types of typical migraine. FHM in some families has been shown to be caused by mutations in a brain-specific P/Q-type calcium channel alpha1 subunit gene (CACNA1A) on chromosome 19p13. There has also been a report of a CACNA1A mutation being associated with MA in a patient from a family with predominant FHM. We have previously demonstrated suggestive linkage of typical migraine in a large Australian family to the FHM region on chromosome 19p13. These findings suggest that CACNA1A may also be implicated in the etiology of typical migraine in this pedigree. To investigate this possibility, we sequenced two patients carrying the critical susceptibility haplotype surrounding CACNA1A. No disease-causing mutations or polymorphisms were revealed in any of the 47 exons screened. To determine whether the CACNA1A gene was implicated in typical migraine susceptibility in the general Caucasian population, we also analyzed 82 independent pedigrees and a large case control group. We did not detect any linkage or association in these groups and conclude that if CACNA1A plays a role in typical migraine, it does not confer a major effect on the disease.
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Affiliation(s)
- R A Lea
- Genomics Research Centre, School of Health Science, Griffith University, Gold Coast, Queensland, Australia
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12
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Morton J, Hutchins C, Durrant S. Granulocyte-colony-stimulating factor (G-CSF)-primed allogeneic bone marrow: significantly less graft-versus-host disease and comparable engraftment to G-CSF-mobilized peripheral blood stem cells. Blood 2001; 98:3186-91. [PMID: 11719353 DOI: 10.1182/blood.v98.12.3186] [Citation(s) in RCA: 149] [Impact Index Per Article: 6.5] [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: 02/07/2023] Open
Abstract
Prospective studies have shown rapid engraftment using granulocyte-colony-stimulating factor-mobilized peripheral blood stem cells (G-PBSCs) for allogeneic transplantation, though the risks for graft-versus-host disease (GVHD) may be increased. It was hypothesized that the use of G-CSF to prime bone marrow (G-BM) would allow rapid engraftment without increased risk for GVHD compared with G-PBSC. Patients were randomized to receive G-BM or G-PBSCs for allogeneic stem cell transplantation. The study was designed (beta <.8) to detect a difference in the incidence of chronic GVHD of 33% (alpha <.05). The plan was to recruit 100 patients and to conduct an interim analysis when the 6-month follow-up point was reached for the first 50 patients. Fifty-seven consecutive patients were recruited (G-BM, n = 28; G-PBSC, n = 29). Patients in the G-PBSC group received 3-fold more CD34(+) and 9-fold more CD3(+) cells. Median times to neutrophil (G-BM, 16 days; G-PBSC, 14 days; P <.1) and platelet engraftment (G-BM, 14 days; G-PBSC, 12 days; P <.1) were similar. The use of G-PBSC was associated with steroid refractory acute GVHD (G-BM, 0%; G-PBSC, 32%; P <.001), chronic GVHD (G-BM, 22%; G-PBSC, 80%; P <.02), and prolonged requirement for immunosuppressive therapy (G-BM, 173 days; G-PBSC, 680 days; P <.009). Survival was similar for the 2 groups. Compared with G-PBSC, the use of G-BM resulted in comparable engraftment, reduced severity of acute GVHD, and less subsequent chronic GVHD.
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MESH Headings
- Acute Disease
- Adolescent
- Adult
- Antigens, CD34/analysis
- Blood Platelets/physiology
- Bone Marrow Cells
- CD3 Complex/analysis
- Cell Count
- Chronic Disease
- Graft Survival
- Graft vs Host Disease/prevention & control
- Granulocyte Colony-Stimulating Factor/administration & dosage
- Hematopoietic Stem Cell Transplantation
- Hematopoietic Stem Cells/immunology
- Humans
- Immunosuppressive Agents/administration & dosage
- Immunosuppressive Agents/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/therapy
- Middle Aged
- Neutrophils/physiology
- Recurrence
- Survival Rate
- Transplantation, Homologous
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Affiliation(s)
- J Morton
- Bone Marrow Transplant Unit, Royal Brisbane Hospital, Herston, Australia.
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13
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Chern B, McCarthy N, Hutchins C, Durrant ST. Analgesic infiltration at the site of bone marrow harvest significantly reduces donor morbidity. Bone Marrow Transplant 1999; 23:947-9. [PMID: 10338052 DOI: 10.1038/sj.bmt.1701751] [Citation(s) in RCA: 13] [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: 11/09/2022]
Abstract
Little information has been published concerning the severity of pain experienced by bone marrow donors or the use of local analgesia following bone marrow harvesting procedures. The aims of this study were to assess duration and severity of pain experienced by bone marrow donors and the effectiveness of bupivacaine as a local analgesic agent following bone marrow harvest. During a single blinded randomised study of 24 bone marrow donors, 10 ml of 0.5% bupivacaine was infiltrated either into the right or left posterior iliac crest of the donor immediately following bone marrow harvest. Donors were requested to record the level of pain experienced at the right and left harvest sites on a pain rating score sheet (0-10) at time intervals of 4, 8, 12, 24, 48 and 72 h following harvest. A significant reduction in pain was experienced at the harvest site infiltrated with bupivacaine when compared with the control site during the first 3 days post-harvest. It is recommended that bupivacaine be infiltrated routinely into the harvest sites of all bone marrow donors to reduce the pain experienced in the 3 days following harvest.
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Affiliation(s)
- B Chern
- Bone Marrow Transplant Unit, Royal Brisbane Hospital, Queensland, Australia
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14
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Morton J, Mollee P, Taylor K, Grigg A, Durrant S, Moore D, Rodwell R, Eliadis P, Hutchins C, Williams B, Seeley G, Wright S, Kelly C, Rentoul A, Iland H, Atkinson K, Januszewicz H, Bunce I, Bashford J, Stewart C, Taylor D. Safe mobilization of normal progenitors in advanced chronic myeloid leukemia with intensive chemotherapy and granulocyte-colony stimulating factor. Leuk Res 1999; 23:177-83. [PMID: 10071133 DOI: 10.1016/s0145-2126(98)00143-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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Twenty-one patients with advanced chronic myeloid leukemia (late chronic phase (n = 8), accelerated phase (n = 11) and blast crisis (n = 2)) were treated with idarubicin, cytarabine, and etoposide followed by G-CSF and subsequent collection of peripheral blood progenitor cells in the early recovery phase. Treatment was reasonably well tolerated with no deaths or intensive care admissions. Despite the advanced phase of disease and heavy pretreatment with cytotoxics and interferon-alfa, 11 of 21 patients (52%) achieved a cytogenetic response. Of the nine major cytogenetic responses (complete (n = 3) and partial (n = 6)), seven achieved adequate progenitor collections for consideration for autologous transplantation. The only predictor of response was disease duration (P = 0.02). With a median follow-up of 1171 days from treatment it appears unlikely that G-CSF contributed to disease progression. Survival post-IcE was predicted by disease stage (P = 0.0001). Intensive chemotherapy followed by G-CSF allowed adequate yields of predominantly Philadelphia chromosome negative progenitor cells to be obtained from one-third of patients with advanced CML.
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Affiliation(s)
- J Morton
- Mater Hospital, South Brisbane, Australia
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15
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Lessard IA, Pratt SD, McCafferty DG, Bussiere DE, Hutchins C, Wanner BL, Katz L, Walsh CT. Homologs of the vancomycin resistance D-Ala-D-Ala dipeptidase VanX in Streptomyces toyocaensis, Escherichia coli and Synechocystis: attributes of catalytic efficiency, stereoselectivity and regulation with implications for function. Chem Biol 1998; 5:489-504. [PMID: 9751644 DOI: 10.1016/s1074-5521(98)90005-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.4] [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
BACKGROUND Vancomycin-resistant enterococci are pathogenic bacteria that have altered cell-wall peptidoglycan termini (D-alanyl-D-lactate [D-Ala-D-lactate] instead of D-alanyl-D-alanine [D-Ala-D-Ala]), which results in a 1000-fold decreased affinity for binding vancomycin. The metallodipeptidase VanX (EntVanX) is key enzyme in antibiotic resistance as it reduces the cellular pool of the D-Ala-D-Ala dipeptide. RESULTS A bacterial genome search revealed vanX homologs in Streptomyces toyocaensis (StoVanX), Escherichia coli (EcoVanX), and Synechocystis sp. strain PCC6803 (SynVanX). Here, the D,D-dipeptidase catalytic activity of all three VanX homologs is validated, and the catalytic efficiencies and diastereoselectivity ratios for dipeptide cleavage are reported. The ecovanX gene is shown to have an RpoS (sigma(s))-dependent promoter typical of genes turned on in stationary phase. Expression of ecovanX and an associated cluster of dipeptide permease genes permitted growth of E. coli using D-Ala-D-Ala as the sole carbon source. CONCLUSIONS The key residues of the EntVanX active site are strongly conserved in the VanX homologs, suggesting their active-site topologies are similar. StoVanX is a highly efficient D-Ala-D-Ala dipeptidase; its gene is located in a vanHAX operon, consistent with a vancomycin-immunity function. StoVanX is a potential source for the VanX found in gram-positive enterococci. The catalytic efficiencies of D-Ala-D-Ala hydrolysis for EcoVanX and SynVanX are 25-fold lower than for EntVanX, suggesting they have a role in cell-wall turnover. Clustered with the ecovanX gene is a putative dipeptide permease system that imports D-Ala-D-Ala into the cell. The combined action of EcoVanX and the permease could permit the use of D-Ala-D-Ala as a bacterial energy source under starvation conditions.
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Affiliation(s)
- I A Lessard
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA
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16
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Steinman DH, Curtin ML, Garland RB, Davidsen SK, Heyman HR, Holms JH, Albert DH, Magoc TJ, Nagy IB, Marcotte PA, Li J, Morgan DW, Hutchins C, Summers JB. The design, synthesis, and structure-activity relationships of a series of macrocyclic MMP inhibitors. Bioorg Med Chem Lett 1998; 8:2087-92. [PMID: 9873491 DOI: 10.1016/s0960-894x(98)00396-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [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: 10/27/2022]
Abstract
A series of succinate-derived hydroxamic acids incorporating a macrocyclic ring were designed, synthesized, and evaluated as inhibitors of matrix metalloproteinases. The inhibitors were designed based on the published X-ray crystal structure of batimastat (1) complexed with human neutrophil collagenase (MMP-8). The synthesized compounds were shown to inhibit selected MMPs in vitro with low nanomolar potency.
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Affiliation(s)
- D H Steinman
- Pharmaceutical Products Division, Abbott Laboratories, Abbott Park, IL 60064, USA
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17
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Curtin ML, Garland RB, Davidsen SK, Marcotte PA, Albert DH, Magoc TJ, Hutchins C. Broad spectrum matrix metalloproteinase inhibitors: an examination of succinamide hydroxamate inhibitors with P1 C alpha gem-disubstitution. Bioorg Med Chem Lett 1998; 8:1443-8. [PMID: 9873367 DOI: 10.1016/s0960-894x(98)00255-8] [Citation(s) in RCA: 10] [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: 10/17/2022]
Abstract
A series of P1 C alpha gem-disubstituted succinamide hydroxamate matrix metalloproteinase inhibitors were prepared stereoselectively and evaluated in vitro for their ability to inhibit MMP-1, MMP-2, and MMP-3. It was found that while methyl/allyl substitution as in 2 and 18 provided compounds that were broad spectrum inhibitors and nearly equipotent with parent inhibitor 1, a larger group such as bis-allyl as in 13 or gem-cyclopentyl as in 14 significantly reduced enzyme inhibition.
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Affiliation(s)
- M L Curtin
- Pharmaceutical Products Division, Abbott Laboratories, Abbott Park, IL 60064-3500, USA
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18
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Abad-Zapatero C, Goldman R, Muchmore SW, Hutchins C, Oie T, Stewart K, Cutfield SM, Cutfield JF, Foundling SI, Ray TL. Structure of secreted aspartic proteinases from Candida. Implications for the design of antifungal agents. Adv Exp Med Biol 1998; 436:297-313. [PMID: 9561233 DOI: 10.1007/978-1-4615-5373-1_41] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pathogens of the genus Candida can cause life threatening infections in immuno-compromised patients. The three-dimensional structures of two closely related secreted aspartic proteinases from C. albicans complexed with a potent (Ki = 0.17 nM) inhibitor, and an analogous enzyme from C. tropicalis reveal variations on the classical aspartic proteinase theme that dramatically alter the specificity of this class of enzymes. The novel fungal proteases present: i) an 8 residue insertion near the first disulfide (Cys45-Cys50, pepsin numbering) that results in a broad flap extending towards the active site; ii) a seven residue deletion replacing helix hN2 (Ser110-Tyr114), which enlarges the S3 pocket; iii) a short polar connection between the two rigid body domains that alters their relative orientation and provides certain specificity; and i.v.) an ordered 12 residue addition at the carboxy terminus. The same inhibitor (A-70450) binds in an extended conformation in the two variants of C. albicans protease, and presents a branched structure at the P3 position. However, the conformation of the terminal methylpiperazine ring is different in the two crystals structures. The implications of these findings for the design of potent antifungal agents are discussed.
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Affiliation(s)
- C Abad-Zapatero
- Laboratory of Protein Crystallography, Abbott Laboratories, Abbott Park, Illinois 60064-3500, USA. ,
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19
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Abstract
A simulated annealing method for finding important ligand fragments is described. At a given temperature, ligand fragments are randomly selected and randomly placed within the given receptor cavity, often replacing or forming bonds with existing ligand fragments. For each new ligand fragment combination, the bonded, nonbonded, polarization and solvation energies of the new ligand-receptor system are compared to the previous configuration. Acceptance or rejection of the new system is decided using the Boltzmann distribution e-E/kT, where E is the energy difference between the old and new systems, k is the Boltzmann constant and T is the temperature. Thus, energetically unfavorable fragment switches are sometimes accepted, sacrificing immediate energy gains in the interest of findings a system with minimum energy. By lowering the temperature, the rate of unfavorable switches decreases and energetically favorable combinations become more difficult to change. The process is terminated when the frequency of switches becomes too small. As a test, the method predicted positions and types of important ligand fragments for neuraminidase that were in accord with the known ligand, sialic acid.
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Affiliation(s)
- S Burt
- National Cancer Institute, Frederick, MD 21702, USA
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20
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Morton J, Morton A, Bird R, Hutchins C, Durrant S. Predictors for optimal mobilization and subsequent engraftment of peripheral blood progenitor cells following intermediate dose cyclophosphamide and G-CSF. Leuk Res 1997; 21:21-7. [PMID: 9029182 DOI: 10.1016/s0145-2126(96)00059-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Fifty consecutive patients undergoing cyclophosphamide/G-CSF mobilization were studied for indicators predictive for adequate harvest (CD34+ cells > 2 x 10(6)/kg, CFU-GM > 1 x 10(5)/kg). Target yields following a single leukopheresis were achieved for 66% of patients (89% with no previous alkylation chemotherapy or radiotherapy). Previous alkylation therapy, radiotherapy and low collection day platelet count were predictive of poor collection yields. Following reinfusion, the median time to platelets > 20 x 10(9)/l (PLT > 20) was 10 days and to neutrophils > 500 x 10(6)/l (ANC > 500) was 13 days. Total CD34+ cells infused was predictive of early platelet engraftment. Previous radiotherapy was inversely predictive of neutrophil engraftment. For the majority of patients not exposed to alkylation therapy or radiotherapy, adequate progenitor cells can be collected following a single leukopheresis. In patients suitable for future autologous bone marrow transplantation it would seem appropriate to avoid or minimize radiotherapy and alkylation therapy exposure in the pre-collection period.
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Affiliation(s)
- J Morton
- Bone Marrow Transplantation Unit, Royal Brisbane Hospital, Herston, Australia
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21
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Abad-Zapatero C, Goldman R, Muchmore SW, Hutchins C, Stewart K, Navaza J, Payne CD, Ray TL. Structure of a secreted aspartic protease from C. albicans complexed with a potent inhibitor: implications for the design of antifungal agents. Protein Sci 1996; 5:640-52. [PMID: 8845753 PMCID: PMC2143388 DOI: 10.1002/pro.5560050408] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.1] [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] [Indexed: 02/02/2023]
Abstract
The three-dimensional structure of a secreted aspartic protease from Candida albicans complexed with a potent inhibitor reveals variations on the classical aspartic protease theme that dramatically alter the specificity of this class of enzymes. The structure presents: (1) an 8-residue insertion near the first disulfide (Cys 45-Cys 50, pepsin numbering) that results in a broad flap extending toward the active site; (2) a 7-residue deletion replacing helix hN2 (Ser 110-Tyr 114), which enlarges the S3 pocket; (3) a short polar connection between the two rigid body domains that alters their relative orientation and provides certain specificity; and (4) an ordered 11-residue addition at the carboxy terminus. The inhibitor binds in an extended conformation and presents a branched structure at the P3 position. The implications of these findings for the design of potent antifungal agents are discussed.
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Affiliation(s)
- C Abad-Zapatero
- Laboratory of Protein Crystallography, Abbott Laboratories, Abbott Park, Illinois 60064-3500, USA
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22
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Szer J, Bardy P, Grigg A, Durrant S, Hutchins C, Herrmann R, Atkinson K. Allogeneic peripheral blood progenitor cell transplantation--the Australian experience. Bone Marrow Transplant 1996; 17 Suppl 2:S51-3. [PMID: 8722336] [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] [Indexed: 02/01/2023]
Affiliation(s)
- J Szer
- Royal Melbourne Hospital, Australia
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23
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von Geldern TW, Hutchins C, Kester JA, Wu-Wong JR, Chiou W, Dixon DB, Opgenorth TJ. Azole endothelin antagonists. 1. A receptor model explains an unusual structure-activity profile. J Med Chem 1996; 39:957-67. [PMID: 8632419 DOI: 10.1021/jm950591h] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [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: 02/01/2023]
Abstract
The pseudotetrapeptide FR-139317 is a potent and highly selective antagonist of the endothelin-A (ET(A)) receptor; however, its peptidic nature leads to poor oral absorption characteristics which make it an unlikely drug candidate. In an attempt to improve these properties, we have replaced a portion of the amide bond framework of FR-139317 with a heterocyclic surrogate. The resultant analogs are also ET(A)-selective antagonists, but show a structure-activity profile substantially different from that of the peptidic series, particularly with regard to the requirements for the side chain group that has been incorporated into the heterocycle. The nature of the heterocycle itself also has profound effects on the activity of the compounds. Both of these surprising results can be rationalized through examination of a 3D model of ET ligand--receptor binding that has previously been developed in our laboratories.
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Affiliation(s)
- T W von Geldern
- Aging and Degenerative Diseases Research Department, Abbott Laboratories, Abbott Park, Illinois 60064, USA
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24
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Michelson JD, Hutchins C. Mechanoreceptors in human ankle ligaments. J Bone Joint Surg Br 1995; 77:219-24. [PMID: 7706334] [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: 01/26/2023]
Abstract
Chronic ankle instability after ligamentous injuries has been attributed to loss of proprioception, but there has been no previous study of the mechanoreceptors in human ligaments at this joint. We have examined the ligaments from five cadaver ankles for mechanoreceptors and classified them into the four types described by Wyke and Freeman in their study of feline ligaments. Type-II receptors, thought to provide the sensation of the beginning of joint motion, and type-III receptors, thought to be activated at the extremes of movement, were the most common. Our findings provide some neuroanatomical data to validate further research into the use of proprioceptive training after ligamentous injuries about the ankle.
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25
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Abstract
Chronic ankle instability after ligamentous injuries has been attributed to loss of proprioception, but there has been no previous study of the mechanoreceptors in human ligaments at this joint. We have examined the ligaments from five cadaver ankles for mechanoreceptors and classified them into the four types described by Wyke and Freeman in their study of feline ligaments. Type-II receptors, thought to provide the sensation of the beginning of joint motion, and type-III receptors, thought to be activated at the extremes of movement, were the most common. Our findings provide some neuroanatomical data to validate further research into the use of proprioceptive training after ligamentous injuries about the ankle.
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26
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Casey G, Rudzki Z, Roberts M, Hutchins C, Juttner C. N-ras mutation in acute myeloid leukemia: incidence, prognostic significance and value as a marker of minimal residual disease. Pathology 1993; 25:57-62. [PMID: 8316501 DOI: 10.3109/00313029309068903] [Citation(s) in RCA: 11] [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: 01/29/2023]
Abstract
The polymerase chain reaction (PCR) and allele specific oligonucleotide (ASO) hybridization have been used to investigate the incidence of N-ras mutation in acute myeloid leukemia (AML). The prognostic significance of these mutations and their value as markers of minimal residual disease have also been assessed. Mutated N-ras alleles were detected in 9 of 69 AML patients (13%). No significant difference in survival or remission duration was found between those patients with an N-ras mutation and those without. Four patients with N-ras mutations at presentation were followed through disease progression. The results showed no consistent pattern of association between the presence of an N-ras mutation and disease state.
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Affiliation(s)
- G Casey
- Department of Haematology, Institute of Medical and Veterinary Science, Adelaide, South Australia
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27
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Rodney WM, Huff M, Euans D, Hutchins C, Clement K, McCall JW. Colposcopy in family practice: pilot studies of pain prophylaxis and patient volume. Fam Pract Res J 1992; 12:91-8. [PMID: 1312759] [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: 12/26/2022]
Abstract
In a family practice office with volume representative of an average one-person practice, the implementation of colposcopy services was studied. During six months, 257 patients received Papanicolaou (PAP) smears. These patients represented 16.2% of the total 1,585 female patient visits for ages greater than 16. Of the 257 cytology specimens, 10.1% (26) revealed dysplasia or evidence of Human Papilloma Virus (HPV), indicating the need for colposcopic examination. Pathology reports of all biopsied cases confirmed the presence of dysplasia or HPV. These results suggest that the average family physician might reasonably anticipate about 100 colposcopy sessions per year, assuming each patient receives a diagnostic and a therapeutic colposcopic evaluation. In the course of colposcopy services in a family practice, 46 patients underwent 67 colposcopic examinations with cervical biopsy and/or cryotherapy in the office. Some patients received nonsteroidal anti-inflammatory medication 30-60 minutes before the procedure, with selection according to physician preference. All patients rated the pain experienced during the procedure on a 10-point visual-analog scale. Pain scores were significantly lower in those who received medication. Overall, patients tolerated the procedure well and there were no reported complications. Because of the possibility of such factors as the placebo effect influencing these results, a randomized, placebo-controlled, double-blind study will be needed to verify the findings.
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Affiliation(s)
- W M Rodney
- Baptist Department of Family Medicine, University of Tennessee, Memphis
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28
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Abstract
Renin, the first enzyme in the renin-angiotensin system, is critically important for the maintenance of blood pressure, and, therefore, as a target for antihypertensive therapy. The three-dimensional structure of renin would be an invaluable aid in understanding the functional properties of renin as well as in the design of novel, potent inhibitors. Three-dimensional models of renin have been developed by a number of different groups based on comparative homology modeling from the other known aspartic proteinase structures. These models have been used widely in the drug design process to suggest targets for synthesis and to rationalize the structure-activity relationships of compounds. This review describes the different published renin models and compares them to the extent possible. Applications of these model renin and renin-inhibitor complex structures to biological function and inhibitor design are summarized.
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Affiliation(s)
- C Hutchins
- Pharmaceutical Products Division, Abbott Laboratories, Abbott Park, Illinois
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29
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Abstract
The adrenal stress hormones glucocorticoids (GCs) impair the ability of hippocampal neurons to survive neurological insults, including hypoxia-ischemia and seizure. These insults are thought to be toxic via a cascade of excessive synaptic concentrations of excitatory neurotransmitters (e.g. glutamate), activation of the NMDA receptor, and pathologic mobilization of cytosolic calcium post-synaptically. We tested whether GCs exacerbate these insults by exacerbating this 'NMDA cascade'. We sought a toxin which damaged independently of the NMDA cascade, and whose toxicity was enhanced by GCs. After testing a number of neurotoxins, we found that the antimetabolite 3-acetylpyridine (3AP) fit this requirement. We then tested if blockade of the NMDA receptor blocks the ability of GCs to enhance 3AP toxicity. Hippocampi were microinfused with 160 micrograms of 3AP. Elevating circulating GC concentrations to the range seen during major stressors for a week before and after microinfusion caused a significant increase in 3AP-induced damage (when compared to adrenalectomized rats kept GC-free for the same period). Infusing the NMDA receptor blocker APV with 3AP did not alter the toxicity in adrenalectomized rats. However, APV reduced 3AP-induced damage in GC-treated rats to levels seen in adrenalectomized rats. This suggests that GCs endanger hippocampal neurons by enhancing glutamatergic signals and/or enhancing vulnerability to such signals. As a possible explanation for this observation, GCs inhibit glucose uptake into hippocampal neurons, and numerous steps in the NMDA cascade are exacerbated when neuronal energy stores are diminished.
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Affiliation(s)
- M P Armanini
- Department of Biological Sciences, Stanford University, CA 94305
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30
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Hutchins C, Casey G, White D, Moore S, Rudzki Z, Kimber R. Detection of rearrangement within the breakpoint cluster region of chromosome 22 in the diagnosis of chronic myeloid leukemia. Aust N Z J Med 1989; 19:443-8. [PMID: 2590093 DOI: 10.1111/j.1445-5994.1989.tb00302.x] [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: 01/01/2023]
Abstract
Chronic myeloid leukemia (CML) is characterised by the presence of a Philadelphia (Ph) chromosome in approximately 95% of patients. Molecular analysis has shown that the Ph chromosome translocation breakpoints are clustered within 5.8 kb on chromosome 22 (breakpoint cluster region or bcr). This has facilitated the diagnosis of CML by nucleic acid hybridisation using probes specific for the bcr to detect DNA rearrangement in this region. Forty patients diagnosed with CML, including four with variant Ph chromosome translocations and three with normal karyotypes were analysed for rearrangement within the bcr. All except one patient with Ph negative CML had rearrangement within the bcr. In contrast, none of the patients diagnosed with other hematological disorders such as the myelodysplastic or myeloproliferative syndromes (16 patients), acute myeloid leukemia (AML) (six patients), acute lymphoblastic leukemia (ALL) (five patients), including Ph positive ALL (two patients), showed rearrangement within the bcr. Analysis for rearrangement within the bcr is useful in the diagnosis of CML, especially when cytogenetic analysis is unsuccessful or in patients with normal karyotypes or variant Ph chromosome translocations.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Child
- Chromosome Fragility
- Chromosomes, Human, Pair 22
- Diagnosis, Differential
- Female
- Gene Rearrangement/genetics
- Humans
- Karyotyping
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Male
- Middle Aged
- Myelodysplastic Syndromes/diagnosis
- Myelodysplastic Syndromes/genetics
- Myeloproliferative Disorders/diagnosis
- Myeloproliferative Disorders/genetics
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Translocation, Genetic/genetics
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Affiliation(s)
- C Hutchins
- Division of Hematology, Institute of Medical and Veterinary Science, Adelaide, SA, Australia
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31
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Hutchins C, Cleveland R. For staff nurses and patients-the 7-70 plan. Am J Nurs 1978; 78:230-3. [PMID: 246681] [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: 12/14/2022]
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32
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Novin D, Hutchins C, Mundy P. Effects of intravenous injections of water on the consummatory behavior of rats. J Comp Physiol Psychol 1966; 61:473-4. [PMID: 5938142 DOI: 10.1037/h0023259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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