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Hoare JI, Hockings H, Saxena J, Silva VL, Haughey MJ, Wood GE, Nicolini F, Mirza H, McNeish IA, Huang W, Maniati E, Graham TA, Lockley M. A novel cell line panel reveals non-genetic mediators of platinum resistance and phenotypic diversity in high grade serous ovarian cancer. Gynecol Oncol 2022; 167:96-106. [PMID: 35918200 DOI: 10.1016/j.ygyno.2022.07.027] [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: 04/28/2022] [Revised: 07/18/2022] [Accepted: 07/23/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Resistance to cancer therapy is an enduring challenge and accurate and reliable preclinical models are lacking. We interrogated this unmet need using high grade serous ovarian cancer (HGSC) as a disease model. METHODS We created five in vitro and two in vivo platinum-resistant HGSC models and characterised the entire cell panel via whole genome sequencing, RNASeq and creation of intraperitoneal models. RESULTS Mutational signature analysis indicated that platinum-resistant cell lines evolved from a pre-existing ancestral clone but a unifying mutational cause for drug resistance was not identified. However, cisplatin-resistant and carboplatin-resistant cells evolved recurrent changes in gene expression that significantly overlapped with independent samples obtained from multiple patients with relapsed HGSC. Gene Ontology Biological Pathways (GOBP) related to the tumour microenvironment, particularly the extracellular matrix, were repeatedly enriched in cisplatin-resistant cells, carboplatin-resistant cells and also in human resistant/refractory samples. The majority of significantly over-represented GOBP however, evolved uniquely in either cisplatin- or carboplatin-resistant cell lines resulting in diverse intraperitoneal behaviours that reflect different clinical manifestations of relapsed human HGSC. CONCLUSIONS Our clinically relevant and usable models reveal a key role for non-genetic factors in the evolution of chemotherapy resistance. Biological pathways relevant to the extracellular matrix were repeatedly expressed by resistant cancer cells in multiple settings. This suggests that recurrent gene expression changes provide a fitness advantage during platinum therapy and also that cancer cell-intrinsic mechanisms influence the tumour microenvironment during the evolution of drug resistance. Candidate genes and pathways identified here could reveal therapeutic opportunities in platinum-resistant HGSC.
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Affiliation(s)
- J I Hoare
- Centre for Cancer Cell and Molecular Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - H Hockings
- Centre for Cancer Cell and Molecular Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - J Saxena
- Centre for Cancer Cell and Molecular Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - V L Silva
- Centre for Cancer Cell and Molecular Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - M J Haughey
- School of Mathematical Sciences, Queen Mary University of London, London, UK
| | - G E Wood
- Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - F Nicolini
- Centre for Cancer Cell and Molecular Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - H Mirza
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - I A McNeish
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - W Huang
- School of Mathematical Sciences, Queen Mary University of London, London, UK
| | - E Maniati
- Bioinformatics Core Service, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - T A Graham
- Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - M Lockley
- Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, UK; Department of Gynaecological Oncology, Cancer Services, University College London Hospital, London, London, UK.
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Karnik M, Kumar A, Shabir Khaki A, Mirza H. First molecular detection of
Babesia gibsoni
in a horse. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13555] [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: 11/28/2022]
Affiliation(s)
- M. Karnik
- Department of Veterinary Pathology Veterinary College Bangalore India
| | - A. Kumar
- Department of Veterinary Pathology Veterinary College Bangalore India
- VetLesions Veterinary Diagnostic Laboratory Bengaluru India
| | | | - H. Mirza
- Aspital Equine Clinic Bengaluru India
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King ALO, Mirza FN, Mirza H, Yumeen N, Lee V, Yumeen S. Factors associated with the American Academy of Dermatology abstract publication: A multivariate analysis. J Am Acad Dermatol 2021; 86:1416-1419. [PMID: 34139294 DOI: 10.1016/j.jaad.2021.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/20/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Amber Loren O King
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Fatima N Mirza
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Humza Mirza
- University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Victor Lee
- Department of Radiation Oncology, Yale School of Medicine, New Haven, Connecticut
| | - Sara Yumeen
- Department of Internal Medicine, Hartford Healthcare St. Vincent's Medical Center, Bridgeport, Connecticut.
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Mirza F, Mirza H, Yumeen S. 13779 Epidemiology of cutaneous mucoepidermoid carcinoma: A United States population-based cohort analysis using the Surveillance, Epidemiology, and End Results database. J Am Acad Dermatol 2020. [DOI: 10.1016/j.jaad.2020.06.579] [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: 10/22/2022]
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Al-Maashani M, Al-Balushi N, Al-Alawi M, Mirza H, Al-Huseini S, Al-Balushi M, Obeid Y, Jose S, Al-Sibani N, Al-Adawi S. Prevalence and Correlates of Depressive Symptoms among Medical Students: a Cross-sectional Single-centre Study. East Asian Arch Psychiatry 2020; 30:28-31. [PMID: 32229644 DOI: 10.12809/eaap1882] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Depressive symptoms are common among medical students. The aim of the present study was to determine the prevalence and risk factors of depressive symptoms among medical students in Sultan Qaboos University in Oman. METHOD A cross-sectional study was conducted among a random sample selected from 1041 medical students at Sultan Qaboos University, Oman. The Patient Health Questionnaire-9 (PHQ-9) was used to screen for depressive symptoms. A logistic regression model was used to determine risk factors for depressive symptoms. RESULTS Of 197 medical students selected, 189 (61 men and 128 women) responded. The PHQ-9 results showed that the prevalence of depressive symptoms was 41.3%. In multivariate analysis, female students were more likely than male students to develop depression (adjusted odds ratio = 2.866, p = 0.004). Medical students with a family history of depression were more likely to develop depression than those without a family history of depression (adjusted odds ratio = 4.150, p = 0.014). CONCLUSIONS Depressive symptoms are common among medical students in Sultan Qaboos University. Risk factors for depressive symptoms are female sex and family history of depression.
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Affiliation(s)
- M Al-Maashani
- Psychiatry Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| | - N Al-Balushi
- Psychiatry Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| | - M Al-Alawi
- Psychiatry Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - H Mirza
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - S Al-Huseini
- Psychiatry Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| | - M Al-Balushi
- Psychiatry Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| | - Y Obeid
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - S Jose
- Research and Statistics, Oman Medical Specialty Board, Muscat, Oman
| | - N Al-Sibani
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - S Al-Adawi
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
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Quist J, Mirza H, Weekes D, Nowinski S, Cheang M, Lord C, Tutt A, Grigoriadis A. PO-228 Comprehensive molecular characterisation of TNBCs expressing HORMAD1, a driver of homologous recombination deficiency. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.745] [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: 11/04/2022] Open
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Lim Y, Lu Y, Mirza H, Zhou J, Hu R, Choate K. 832 Mechanisms of spontaneous genetic reversion in ichthyosis with confetti. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.842] [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: 10/17/2022]
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Grigoriadis A, Quist J, Mirza H, Cheang MC, Ring BZ, Hout DR, Bailey DB, Seitz RS, Tutt AN. Abstract P1-07-03: Mesenchymal subtype negatively associates with the presence of immune infiltrates within a triple negative breast cancer classifier. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-07-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Lehmann and colleagues (Lehmann et al., 2011) devised a gene expression classification system for triple negative breast cancer (TNBC) consisting of seven subtypes—IM, BL1, BL2, LAR, M, MSL, and UNS (unselected). We (Ring et al., 2016) recently modified this original algorithm of 2188 gene subtyping into a 101-gene algorithm. In addition to a reduction of genes, the 101-gene algorithm has two methodological differences: first, the immunomodulatory (IM) signature was treated not as a subtype but rather as a binary feature of one of the other subtypes (e.g. BL1/IM+, LAR/IM-); second, when tumors—by a predefined correlation coefficient—showed traits of more than one subtype, both subtypes were reported as “dual subtypes.”
Aim: Our aim was to apply the 101-gene algorithm for TNBC subtyping and to establish the relation of TNBC subtypes with their IM-status across several independent data sets.
Methods: 951 patients from four independent TNBC cohorts with available gene expression data were analyzed by the 101-gene algorithm. Of these 848 were classified with at least one subtype.
Results: The distribution of the 5 TNBC subtypes in both single and dual subtypes was 47%,10%,15%,18%,11%, for BL1, BL2, LAR, M, and MSL respectively. The majority of cases gave only one subtype (572, 67%) with M (Mesenchymal) being 9% (n=54) of these. Given this frequency of 9% of M as a baseline, in the remaining 276 (33%) cases with dual subtypes, the expectation that M would be one of the two is 11% (64 subtype calls). However, M is one of the two of the dual subtypes at a much higher frequency of 40% (222 subtype calls, Chi-Squared, P<0.0001). IM+ is a common feature across these cohorts (n=310 or 37%). When examining the IM feature within the patients exhibiting the M subtype as either a single subtype or one of the two dual subtypes (n=276, 33%), IM positive tumors are never of the M phenotype (Chi-Squared, p<0.0001).
Conclusions: We further have confirmed with the 101-gene algorithm that the IM signature inversely associates with the M subtype as it has been observed with the 2188 gene algorithm (Lehmann et al., 2016). Moreover, the M signature is occasionally a confounder of other subtypes however still identifies those tumors negative for immune infiltrates. This raises important opportunities to understand the relationships between intrinsic tumor biology reflected in TNBC subtypes and their interaction with variable immune cell stroma which are the subject of ongoing analyses.
Citation Format: Grigoriadis A, Quist J, Mirza H, Cheang MC, Ring BZ, Hout DR, Bailey DB, Seitz RS, Tutt AN. Mesenchymal subtype negatively associates with the presence of immune infiltrates within a triple negative breast cancer classifier [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-07-03.
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Affiliation(s)
- A Grigoriadis
- Cancer Bioinformatics, King's College, London, United Kingdom; Breast Cancer Now, King's College, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom; Insight Genetics, Inc., Nashville, TN; Breast Cancer Now, The Institute of Cancer Research, London, United Kingdom
| | - J Quist
- Cancer Bioinformatics, King's College, London, United Kingdom; Breast Cancer Now, King's College, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom; Insight Genetics, Inc., Nashville, TN; Breast Cancer Now, The Institute of Cancer Research, London, United Kingdom
| | - H Mirza
- Cancer Bioinformatics, King's College, London, United Kingdom; Breast Cancer Now, King's College, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom; Insight Genetics, Inc., Nashville, TN; Breast Cancer Now, The Institute of Cancer Research, London, United Kingdom
| | - MC Cheang
- Cancer Bioinformatics, King's College, London, United Kingdom; Breast Cancer Now, King's College, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom; Insight Genetics, Inc., Nashville, TN; Breast Cancer Now, The Institute of Cancer Research, London, United Kingdom
| | - BZ Ring
- Cancer Bioinformatics, King's College, London, United Kingdom; Breast Cancer Now, King's College, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom; Insight Genetics, Inc., Nashville, TN; Breast Cancer Now, The Institute of Cancer Research, London, United Kingdom
| | - DR Hout
- Cancer Bioinformatics, King's College, London, United Kingdom; Breast Cancer Now, King's College, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom; Insight Genetics, Inc., Nashville, TN; Breast Cancer Now, The Institute of Cancer Research, London, United Kingdom
| | - DB Bailey
- Cancer Bioinformatics, King's College, London, United Kingdom; Breast Cancer Now, King's College, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom; Insight Genetics, Inc., Nashville, TN; Breast Cancer Now, The Institute of Cancer Research, London, United Kingdom
| | - RS Seitz
- Cancer Bioinformatics, King's College, London, United Kingdom; Breast Cancer Now, King's College, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom; Insight Genetics, Inc., Nashville, TN; Breast Cancer Now, The Institute of Cancer Research, London, United Kingdom
| | - AN Tutt
- Cancer Bioinformatics, King's College, London, United Kingdom; Breast Cancer Now, King's College, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom; Insight Genetics, Inc., Nashville, TN; Breast Cancer Now, The Institute of Cancer Research, London, United Kingdom
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Mohd Noor A, Maguire S, Watkins J, Quist J, Mirza H, Tutt A, Gillett C, Natrajan R, Grigoriadis A. Abstract P1-05-14: Copy number aberration-induced gene breakage analysis identifies recurrent FOXP1 fusions in breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-05-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Genomic instability is a critical feature of breast cancers, which manifests in genome-wide copy number aberrations (CNA), often causing “gene breakage” and the generation of fusion genes. We aimed to identify aborted transcripts with underlying CNAs and to investigate the molecular landscape of breast cancers harbouring such events.
Methods: A walking student's t-test algorithm was applied to Affymetrix Exon 1.0ST array data of 123 breast cancers to identify regions of aborted transcription and overlaid with DNA breakpoints derived from matched Affymetrix SNP6 ASCAT-segmented copy number. Aborted transcripts were investigated as potential fusion gene partners through RNA-seq analysis of 151 breast cancer samples (TCGA) and 51 breast cancer cell lines (BCCL) using ChimeraScan. Clinical correlates were established for clinicopathological features, genomic instability measures, and gene expression-based molecular classifiers including PAM50, TNBCtype, IntClust subtypes and immune signatures.
Results: One hundred and six genes with recurrent CNA-induced aborted transcription were identified. Aborted transcription showed hormone receptor subtype-specificity for 7 genes (nTNBC=1, nNon-TNBC=6) and was less prevalent in samples of IntClust 2 and IntClust 4 subtypes (p: 0.0043, 0.0011). Aborted transcripts were more frequently observed in samples with greater copy-neutral loss of heterozygosity (p=0.012), while aborted transcription of 54/106 genes significantly affected enrichment of 27 tumor-infiltrating lymphocyte subpopulations.14 aborted transcripts were found as a fusion gene with one partner in RNA-seq of TCGA and BCCL, while 19 were involved in multiple fusion events (range=1-6, median=2). Nine of 106 genes displayed gene breakage and fusion events exclusively in samples with an enriched tandem duplication phenotype. Notably, FOXP1, localised to a tumour suppressor locus at 3p14.1, reported the highest number of fusion configurations (n=6) with concurrent aborted transcription across all RNA-seq datasets (nPRADA=9, nTCGA=38, nBCCL=6).
Conclusion: CNA-induced gene breakage affects the molecular landscape of breast cancers and is linked with many genomic configurations of interest including copy-neutral loss of heterozygosity and tandem duplications. In particular, the role of recurrent gene fusions of the tumour suppressor, FOXP1, in tumourigenesis warrants further investigation.
Citation Format: Mohd Noor A, Maguire S, Watkins J, Quist J, Mirza H, Tutt A, Gillett C, Natrajan R, Grigoriadis A. Copy number aberration-induced gene breakage analysis identifies recurrent FOXP1 fusions in breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-05-14.
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Affiliation(s)
- A Mohd Noor
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - S Maguire
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - J Watkins
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - J Quist
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - H Mirza
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - A Tutt
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - C Gillett
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - R Natrajan
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - A Grigoriadis
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
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Noor AM, Maguire S, Watkins J, Quist J, Mirza H, Ougham K, Tutt A, Gillett C, Natrajan R, Grigoriadis A. The characterisation of potential fusion genes in breast cancer. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61097-3] [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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Mirza H, Tan K. P249 Comparison, optimization and validation of high throughput in-vitro drug susceptibility microassays for the emerging protozoan pathogen Blastocystis. Int J Antimicrob Agents 2009. [DOI: 10.1016/s0924-8579(09)70468-6] [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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Abstract
OBJECTIVES To determine the safety and efficacy of intermittent midazolam and fentanyl conscious sedation for electrophysiology procedures (EP). BACKGROUND Intermittent midazolam and fentanyl conscious sedation was administered in 700 consecutive cases (175 radiofrequency ablations, 163 EP studies, 261 pacemakers, and 101 implantable cardioverter-defibrillators) for 471 patients (239 males, 51%) mean age 65 +/- 15 years. The mean dose of midazolam was 0.063 mg/kg/hr and fentanyl was 0.591 microgram/kg/hr. METHODS Cardiac rate and rhythm were monitored continuously, while blood pressure and arterial oxygen saturation were noninvasively assessed every 5 minutes. Drugs were administered in aliquots of 0.5 to 2.0 mg of midazolam and 6.25 to 25 micrograms of fentanyl as determined by clinical condition every 15 to 30 minutes. RESULTS There were no deaths. In no case was endotracheal intubation required. Mild hypoxemia (SaO2 > 80%, but < 90%) occurred in 17 cases (2.4%) and was easily reversed with verbal stimulation and oropharyngeal repositioning (12 cases, 1.7%), increased F1O2 (3 cases, 0.4%), or intravenous naloxone (2 cases, 0.3%). Reversible hypotension (systolic blood pressure < 90, but > 60 mmHg) occurred in 14 patients (2.0%) and was corrected with intravenous crystalloid bolus or flumazenil (10 cases, 1.4%) or inotrope infusion (4 cases, 0.6%). No patient stay was prolonged due to sedation. Only five patients (0.7%) had any recollection of the procedure, while two (0.3%) were aware of pain. All hypoxemic episodes occurred during the first hour, whereas 43% (6/14) of hypotensive episodes occurred after the first hour. CONCLUSION Conscious sedation with intermittent midazolam and fentanyl is safe and efficacious for a broad range of EP procedures.
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Affiliation(s)
- R T Pachulski
- Department of Medicine, Division of Cardiology, Health Sciences Center at Stony Brook, State University of New York, Stony Brook, New York 11794-8171, USA.
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Abstract
We present a case of complex regional pain syndrome (CRPS) Type 1 in a 12-year-old girl. The patient did not respond to the usual therapeutic modalities used to treat CRPS, including physical therapy, lumbar sympathetic block, epidural local anesthetic block, intravenous lidocaine infusion, or other oral medications. Of note is the fact that, during epidural block, the patient demonstrated a resistance to local anesthetic neural blockade in the area of the body involved with the pain problem. The mechanism of this resistance could be related to the changes in the dorsal horn cells of the spinal cord, secondary to activation of N-methyl-D-aspartate receptors, which may play a role in the pathophysiology of this pain syndrome.
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Affiliation(s)
- F R Maneksha
- Department of Anesthesiology, Health Sciences Center, State University of New York at Stony Brook, NY 11794-8480, USA
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al-Naquib N, Frankenburg WK, Mirza H, Yazdi AW, al-Noori S. The standardization of the Denver Developmental Screening Test on Arab children from the Middle East and north Africa. J Med Liban 1999; 47:95-106. [PMID: 10410469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
A total of 936 children of Arab ethnic origin and culture were tested for the purpose of the standardization of the Denver Developmental Screening Test (DDST) on children from the Middle East and North Africa. There were 457 males and 479 females included in the study, with a race distribution of 216 white, 96 black, and 624 of mixed racial origin. The sample was divided into three age groups, with the age-range all-inclusive being from birth to six years. Five social classes were included. Accordingly, a new DDST screening form was designed and presented for the population studied. Age norms of developmental milestones on the personal-social, fine motor-adaptive, language, and gross motor skills are presented here.
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Affiliation(s)
- N al-Naquib
- Wake Forest University Baptist Medical Center, Winston-Salem, NC 27157, USA.
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Steinberg ES, Adsumelli RS, Saunders TA, Mirza H. Successful epidural anesthesia for cesarean section for sextuplets. Anesth Analg 1998; 86:1236-8. [PMID: 9620511 DOI: 10.1097/00000539-199806000-00019] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- E S Steinberg
- Department of Anesthesiology, University Medical Center at Stony Brook, New York 11794-8480, USA
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Zucker S, Mirza H, Conner CE, Lorenz AF, Drews MH, Bahou WF, Jesty J. Vascular endothelial growth factor induces tissue factor and matrix metalloproteinase production in endothelial cells: conversion of prothrombin to thrombin results in progelatinase A activation and cell proliferation. Int J Cancer 1998; 75:780-6. [PMID: 9495249 DOI: 10.1002/(sici)1097-0215(19980302)75:5<780::aid-ijc19>3.0.co;2-a] [Citation(s) in RCA: 221] [Impact Index Per Article: 8.5] [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: 02/06/2023]
Abstract
Production of vascular endothelial growth factor (VEGF) by cancer cells at invasive and metastatic sites is an important aspect of tumor angiogenesis. Although known primarily as a mitogen and a vascular permeability factor (VPF) for endothelial cells, VEGF/VPF has been proposed to induce the expression of procoagulant factors in endothelial cells. In this study, we have explored the ramifications of VEGF induction of tissue factor (TF) in human umbilical vein endothelial cells (HUVECs) and subsequent activation of progelatinase A. Within 3 hr of incubation with VEGF/VPF, endothelial cells accelerate TF generation as measured using chromogenic substrate assays for coagulation factors Xa and thrombin. Incubation of VEGF/VPF-pre-treated cells with prothrombin and factors X, Va, and VIIa at 37 degrees C and subsequent generation of thrombin resulted in activation of secreted endothelial progelatinase A as demonstrated by gelatin zymography. Anti-thrombin III or antibodies to TF inhibited thrombin generation and progelatinase A activation. VEGF/VPF also directly increased HUVEC secretion of interstitial collagenase, tissue inhibitor of metalloproteinases (TIMP-1) and, to a lesser extent, gelatinase A. The effect of thrombin on endothelial proliferation in serum-free media was examined. Thrombin was a growth factor for HUVECs at a lower dose than that required for progelatinase A activation. Whereas TIMP-2 abrogated thrombin-induced progelatinase A activation, it had no significant effect on thrombin-induced endothelial cell growth. We propose that an early step in tumor angiogenesis involves VEGF-induced thrombin generation and increased MMP production with subsequent activation of endothelial progelatinase A and degradation of the underlying basement membrane.
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Affiliation(s)
- S Zucker
- Department of Research, Veterans Affairs Medical Center, Northport, NY 11768, USA.
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Mirza H, Schmidt VA, Derian CK, Jesty J, Bahou WF. Mitogenic responses mediated through the proteinase-activated receptor-2 are induced by expressed forms of mast cell alpha- or beta-tryptases. Blood 1997; 90:3914-22. [PMID: 9354658] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The proteinase-activated receptor-2 (PAR-2) is the second member of a putative larger class of proteolytically activated receptors that mediate cell activation events by receptor cleavage or synthetic peptidomimetics corresponding to the newly generated N-terminus. To further study the previously identified mitogenic effects of PAR-2, we used the interleukin-3 (IL-3)-dependent murine lymphoid cell line, BaF3, for generation of stable cell lines expressing PAR-2 (BaF3/PAR-2) or the noncleavable PAR-2 mutant PAR-2(Arg36 --> Ala36). Only BaF3 cells expressing either wild-type or mutated receptor exhibited mitogenic responses when grown in IL-3-deficient media supplemented with PAR-2 activating peptide (SLIGRL, PAR39-44). This effect was dose dependent with an EC50 of approximately 80 micromol/L, sustained at 24, 48, and 72 hours, and was also demonstrable using thrombin receptor peptide TR42-47. Because tryptase shares approximately 70% homology with trypsin (previously shown to activate PAR-2), we studied recombinantly expressed forms of alpha- and beta-tryptases as candidate protease agonists for PAR-2. Hydrolytic activity of the chromogenic substrate tosyl-glycyl-prolyl-argly-4-nitroanilide acetate was present as a sharp peak at Mr approximately 130, confirming the presence of secretable and functionally active homotetrameric alpha- and beta-tryptases in transfected COS-1 cells. Dose-dependent proliferative responses were evident using either secreted form of tryptase with maximal responses seen at approximately 3 pmol/L (0.1 U/L). Receptor proteolysis was necessary and sufficient for mitogenesis because active site-blocked tryptase failed to induce this response, and proliferative responses were abrogated in BaF3 cells expressing PAR-2(Arg36 --> Ala36). These results specifically identify both forms of mast cell tryptases as serine protease agonists for PAR-2 and have implications for elucidating molecular mechanisms regulating cellular activation events mediated by proteases generated during inflammatory, fibrinolytic, or hemostatic-regulated pathways.
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Affiliation(s)
- H Mirza
- Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY 11794-8151, USA
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Mirza H, Yatsula V, Bahou WF. The proteinase activated receptor-2 (PAR-2) mediates mitogenic responses in human vascular endothelial cells. J Clin Invest 1996; 97:1705-14. [PMID: 8601636 PMCID: PMC507235 DOI: 10.1172/jci118597] [Citation(s) in RCA: 149] [Impact Index Per Article: 5.3] [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: 01/31/2023] Open
Abstract
Proteolytically cleaved receptors, typified by the functional thrombin receptor (TR), represent a novel class of receptors that mediate signaling events by functional coupling to G proteins. Northern blot analysis completed with a human proteinase activated receptor-2 (PAR-2) cDNA as probe demonstrated the approximately 3.5kb PAR-2 transcript in total cellular RNA from human umbilical vein endothelial cells (HUVEC). Microspectrofluorimetry using Fura2-loaded HUVEC demonstrated a dose-dependent elevation in intracellular calcium transients ([Ca2+]i) to murine PAR39-44 (SLIGRL, putative neoligand after cleavage), with an approximate EC50 of 30 microM, and evidence for homologous desensitization with complete recovery at 45 min. Xenopus oocytes microinjected with TR cRNA failed to respond to 200 microM PAR39-44, and TR-targeted antisense oligonucleotides specifically abrogated thrombin-induced but not PAR39-44-mediated [Ca2+]i, excluding the possibility that TR/PAR-2 cell-surface coexpression was structurally linked. HUVEC incubated with PAR39-44 demonstrated a dose- and time-dependent mitogenic response similar to that seen with thrombin or TR42-47 (TR-activating peptide, SFLLRN). Preactivation of HUVEC with either PAR39-44 or thrombin resulted in heterologous desensitization to the corresponding agonist, an effect that was mediated primarily by TR internalization as evaluated by immunofluorescence and quantitative ELISA. These results ascribe a previously unrecognized function to the PAR-2 receptor, imply that a natural enzyme agonist may circulate in plasma, and suggest the presence of an additional regulatory mechanism controlling receptor activation events in vascular endothelial cells.
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MESH Headings
- Animals
- Base Sequence
- Calcium
- Cells, Cultured
- DNA Primers/genetics
- DNA, Complementary/genetics
- Endothelium, Vascular/cytology
- Endothelium, Vascular/metabolism
- Humans
- In Vitro Techniques
- Mice
- Mitosis
- Molecular Sequence Data
- Oligonucleotides, Antisense/genetics
- Oocytes/metabolism
- Polymerase Chain Reaction
- Receptor, PAR-2
- Receptors, Cell Surface/genetics
- Receptors, Cell Surface/metabolism
- Receptors, Thrombin/genetics
- Receptors, Thrombin/metabolism
- Xenopus laevis
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Affiliation(s)
- H Mirza
- Department of Medicine, State University of New York at Stony Brook, 11794-8151, USA
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Abstract
OBJECTIVES The aims of this study were to determine the number and rate of accumulation of new long-stay hospital patients in one of Ireland's eight health board areas, to describe their demographic and clinical features, and to assess their needs in relation to possible community placement. METHODS Demographic and clinical information was obtained on all patients over age 17 who had been continuously hospitalized in area hospitals for more than one year and less than six years on the census day of March 1, 1992. The Community Placement Questionnaire was used to rate the patients' social functioning, problem behavior, physical disability, social contact, and needs for accommodation and day care. RESULTS The survey identified 175 new long-stay patients, mainly middle aged to elderly. Schizophrenia was the most common psychiatric diagnosis. The bed occupancy rate for these patients was 14 per 100,000 population, and the annual accumulation rate was 2.3 per 100,000 population. CONCLUSIONS New long-stay patients were chronically ill with significant psychiatric and social disabilities. Involuntary patients were overrepresented in the group. Two-thirds could be placed in the community if facilities were available and had sufficiently high staffing levels.
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Bahou WF, Potter CL, Mirza H. The VLA-2 (alpha 2 beta 1) I domain functions as a ligand-specific recognition sequence for endothelial cell attachment and spreading: molecular and functional characterization. Blood 1994; 84:3734-41. [PMID: 7949129] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The integrin VLA-2 (alpha 2 beta 1), generally considered to represent the specific collagen receptor on human endothelial cells, contains an alpha 2-subunit inserted I domain with structural similarity to the type A domains found within the recently described superfamily of receptor-ligand recognition proteins. This region of the cDNA has now been isolated and used for molecular and functional characterization of this heterodimeric receptor complex. Comparative sequence analysis with the porcine homologue revealed 93% amino acid sequence identity, suggestive of a developmentally conserved function. To complete structure/function studies, this region of the human cDNA was expressed as a chimeric protein in Escherichia coli, and a rabbit polyclonal antibody (anti-I domain) was used to study determinants of endothelial cell attachment and spreading in vitro. Quantifiable and visual disruption of endothelial cell attachment to gelatin, type I collagen, and laminin was evident using the specific anti-I domain antibody, with minimal inhibitory effects demonstrable using fibronectin or fibrinogen matrices. Therefore, these data would suggest that the alpha 2 beta 1 I domain confers ligand-binding specificity for both known alpha 2 beta 1 substrates (laminin and collagen), and that this region subserves a regulatory function in the molecular processes controlling endothelial cell attachment and spreading in vitro.
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Affiliation(s)
- W F Bahou
- Department of Medicine, State University of New York at Stony Brook 11794-8151
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