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Fairley JL, Hansen D, Proudman S, Sahhar J, Ngian GS, Walker J, Host LV, La Gerche A, Prior D, Burns A, Morrisroe K, Stevens W, Nikpour M, Ross L. Prognostic and functional importance of both overt and subclinical left ventricular systolic dysfunction in systemic sclerosis. Semin Arthritis Rheum 2024; 66:152443. [PMID: 38631275 DOI: 10.1016/j.semarthrit.2024.152443] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 03/13/2024] [Accepted: 03/22/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES To quantify the frequency and clinical implications of systemic sclerosis (SSc)-associated left ventricular function (LV) impairment. METHODS Australian Scleroderma Cohort Study participants meeting ACR/EULAR criteria for SSc with ≥1 echocardiographic LVEF measurement were included. Overt LV dysfunction was indicated by reduced LV ejection fraction (LVEF) and subclinical LV dysfunction was measured using impaired LV global longitudinal strain (LV-GLS>-16 %). Those with secondary causes of LV dysfunction (myocardial ischaemia, valvulopathy and pulmonary arterial hypertension) were excluded. Chi-squared tests, two-sample t-tests or Wilcoxon rank-sum tests were used for between-group comparison as appropriate. Generalised estimating equations(GEE) were used to model longitudinal data. Kaplan-Meier and Cox proportional hazard models were used for survival analyses. RESULTS Of 1141 participants with no co-morbid cardiac disease, 2.4 % ever recorded a LVEF<50 %, while only 0.6 % ever recorded a LVEF≤40 %. LV-GLS data were available for 90 % of participants at one centre (n = 218). Impaired LV-GLS was detected in 21 % despite LVEF≥50 %. Those with a LVEF<50 % were more frequently male (p = 0.01) with dcSSc (p < 0.01), higher inflammatory markers (p < 0.02) and skeletal muscle disease (p < 0.05). In multivariable analyses, recording a LVEF<50 % was associated with increased mortality (HR2.3, 95 %CI1.0-4.8, p = 0.04). Impaired LV-GLS was also associated with poorer survival in univariable analyses (HR3.4, 95 %CI1.0-11.8, p = 0.05). Those with a LVEF<50 % more frequently recorded WHO Class III/IV dyspnoea (OR3.5, 95 %CI1.6-7.7, p < 0.01), with shorter six-minute walk distance (p = 0.01), higher Health Assessment Questionnaire-Disability Index scores (p < 0.01) and lower Short Form-36 Physical Component Summary scores (p = 0.02). Increased dyspnoea (WHO Class III/IV dyspnoea; OR3.6, 95 %CI1.4-9.2, p < 0.01) was also seen in those with impaired LV-GLS. CONCLUSIONS Both overt and subclinical SSc-associated LV dysfunction are associated with worse survival and impaired physical function. The frequency of abnormal LV-GLS in those with consistently normal LVEF suggests an under-appreciated burden of subtle LV systolic dysfunction in SSc that has a significant impact on patient symptomatology.
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Affiliation(s)
- Jessica L Fairley
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; Department of Rheumatology, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
| | - Dylan Hansen
- Department of Rheumatology, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Susanna Proudman
- Department of Medicine, The University of Adelaide, Adelaide, South Australia, Australia; Department of Rheumatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joanne Sahhar
- Department of Rheumatology, Monash Health, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gene-Siew Ngian
- Department of Rheumatology, Monash Health, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jenny Walker
- Department of Rheumatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Lauren V Host
- Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - André La Gerche
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - David Prior
- Department of Cardiology, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Andrew Burns
- Department of Cardiology, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Kathleen Morrisroe
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; Department of Rheumatology, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Wendy Stevens
- Department of Rheumatology, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; Department of Rheumatology, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia; The University of Sydney School of Public Health, Sydney, New South Wales, Australia; Royal Prince Alfred Hospital Sydney, New South Wales, Australia
| | - Laura Ross
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; Department of Rheumatology, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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Garber AI, Garcia de la Filia Molina A, Vea IM, Mongue AJ, Ross L, McCutcheon JP. Retention of an Endosymbiont for the Production of a Single Molecule. Genome Biol Evol 2024; 16:evae075. [PMID: 38577764 PMCID: PMC11032189 DOI: 10.1093/gbe/evae075] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/06/2024] Open
Abstract
Sap-feeding insects often maintain two or more nutritional endosymbionts that act in concert to produce compounds essential for insect survival. Many mealybugs have endosymbionts in a nested configuration: one or two bacterial species reside within the cytoplasm of another bacterium, and together, these bacteria have genomes that encode interdependent sets of genes needed to produce key nutritional molecules. Here, we show that the mealybug Pseudococcus viburni has three endosymbionts, one of which contributes only two unique genes that produce the host nutrition-related molecule chorismate. All three bacterial endosymbionts have tiny genomes, suggesting that they have been coevolving inside their insect host for millions of years.
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Affiliation(s)
- Arkadiy I Garber
- Biodesign Center for Mechanisms of Evolution and School of Life Sciences, Arizona State University, Tempe, AZ, USA
| | | | - Isabelle M Vea
- Institute of Ecology and Evolution, University of Edinburgh, Edinburgh, UK
| | - Andrew J Mongue
- Institute of Ecology and Evolution, University of Edinburgh, Edinburgh, UK
- Department of Entomology and Nematology, University of Florida, Gainesville, FL, USA
| | - Laura Ross
- Institute of Ecology and Evolution, University of Edinburgh, Edinburgh, UK
| | - John P McCutcheon
- Biodesign Center for Mechanisms of Evolution and School of Life Sciences, Arizona State University, Tempe, AZ, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
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Fairley JL, Hansen D, Day J, Proudman S, Sahhar J, Ngian GS, Walker J, Host LV, Morrisroe K, Stevens W, Ross L, Nikpour M. Proximal weakness and creatine kinase elevation in systemic sclerosis: Clinical correlates, prognosis and functional implications. Semin Arthritis Rheum 2024; 65:152363. [PMID: 38316069 DOI: 10.1016/j.semarthrit.2024.152363] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/17/2023] [Accepted: 12/27/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVES To determine the frequency, clinical correlates and implications of clinical evidence of muscle disease in systemic sclerosis (SSc). METHODS Australian Scleroderma Cohort Study participants with ≥1 creatine kinase (CK) and proximal power assessment were subdivided according to presence of proximal weakness (PW: proximal muscle power<5/5) and CK elevation(≥140IU/L). Participants were assigned to one of four groups: concurrent PW&CK elevation, PW alone, CK elevation alone or neither. Between-group comparisons were made with chi-squared, ANOVA or Kruskal-Wallis tests. Survival analysis was performed using time-varying-covariate Cox regression modelling. Longitudinal data were modelled using multinomial logistic and linear regression. RESULTS Of 1786 participants, 4 % had concurrent PW&CK elevation, 15 % PW alone, 24 % CK elevation and 57 % neither. Participants with PW&CK elevation displayed a severe, inflammatory SSc phenotype, with more frequent dcSSc(p < 0.01), tendon friction rubs(p < 0.01), synovitis(p < 0.01) and digital ulceration(p = 0.03). Multimorbidity(p < 0.01) and cardiopulmonary disease, including ischaemic heart disease(p < 0.01) and pulmonary arterial hypertension(p < 0.01), were most common in those with PW, with and without CK elevation. Men with anti-Scl70 positivity most frequently had CK elevation alone, without other significant clinical differences. Multivariable modelling demonstrated 3.6-fold increased mortality in those with PW&CK elevation (95 %CI 1.9-6.6, p < 0.01) and 2.1-fold increased mortality in PW alone (95 %CI 1.4-3.0, p < 0.01) compared to those without PW or CK elevation. CK elevation alone conferred better survival (HR 0.7, 95 %CI 0.4-1.1, p = 0.09) compared to those with no PW or CK elevation. PW regardless of CK elevation was associated with impaired physical function, with reduced six-minute-walk-distance (p < 0.01), higher HAQ-DI scores (p < 0.01) and increased patient-reported dyspnoea (p = 0.04). CONCLUSION Clinical features of myopathy are highly prevalent in SSc, affecting almost half of our study cohort. Detection of PW and elevated CK alone, even without imaging or histopathological identification of SSc-myopathy, identified important clinical associations and are associated with poorer function and overall prognosis.
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Affiliation(s)
- Jessica L Fairley
- The University of Melbourne, Melbourne, Victoria, Australia; St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
| | - Dylan Hansen
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Jessica Day
- The University of Melbourne, Melbourne, Victoria, Australia; The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Susanna Proudman
- University of Adelaide, Adelaide, South Australia, Australia; Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joanne Sahhar
- Monash Health, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
| | - Gene-Siew Ngian
- Monash Health, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
| | - Jenny Walker
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Lauren V Host
- Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Kathleen Morrisroe
- The University of Melbourne, Melbourne, Victoria, Australia; St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Wendy Stevens
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Laura Ross
- The University of Melbourne, Melbourne, Victoria, Australia; St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Mandana Nikpour
- The University of Melbourne, Melbourne, Victoria, Australia; St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia; The University of Sydney School of Public Health, Sydney, New South Wales, Australia; Royal Prince Alfred Hospital Sydney, New South Wales, Australia
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Gregory K, Hansen D, Penglase R, Apostolopoulos D, Ngian GS, Stevens W, Morrisroe K, Ferdowsi N, Ross L, Walker J, Cooley H, Youssef P, Tymms K, Host L, Proudman S, Moore J, Nikpour M, Sahhar J. Outcomes of patients with diffuse systemic sclerosis eligible for autologous stem cell transplantation managed with conventional therapy. Arthritis Rheumatol 2024. [PMID: 38560777 DOI: 10.1002/art.42850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 02/04/2024] [Accepted: 03/15/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To determine the event-free survival of Australian patients with diffuse systemic sclerosis (dcSSc), who meet eligibility criteria for autologous stem cell transplant (ASCT) in previously published randomised controlled trials (RCTs), but were managed without ASCT. METHODS Patients who met inclusion criteria for the ASTIS (Autologous Stem Cell Transplantation International Scleroderma)(1) and SCOT (Scleroderma: Cyclophosphamide Or Transplantation)(2) trials were identified from the multicentre Australian Scleroderma Cohort Study (ASCS). Event-free survival (survival without cardiac, renal or pulmonary failure or death) at four years was assessed. ASCS patients who had already undergone transplantation were excluded from analysis. RESULTS Of the 492 dcSSc patients in ASCS, 56 met ASTIS inclusion criteria for ASCT (56/492, 11.4% of dcSSc) and 30 met SCOT inclusion criteria (30/492, 6.1%). An additional 11 patients met ASTIS or SCOT inclusion criteria, but were excluded due to severe organ manifestations. Event-free survival at four years in ASCS patients meeting ASTIS inclusion criteria was 83.3% and in ASCS patients meeting SCOT inclusion criteria was 81.2%. Event-free survival at four years in ASCS patients who met ASTIS and SCOT inclusion but also exclusion criteria was 46.7% and 45.7% respectively. CONCLUSIONS ASCS patients meeting ASTIS and/or SCOT inclusion criteria who were managed without ASCT have similar event-free survival (EFS) at four years than patients receiving ASCT, and better EFS than those receiving cyclophosphamide in the ASTIS and SCOT trials. This may reflect confounders unable to be controlled for, including survivor bias, but may also reflect improved standard of care for dcSSc over time.
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Affiliation(s)
- Kate Gregory
- Monash University, Melbourne
- Monash Health, Melbourne
| | | | - Ross Penglase
- St Vincent's Hospital, Sydney
- St Vincent's Centre for Applied Medical Research, Sydney
- University of New South, Wales
| | | | | | | | - Kathleen Morrisroe
- St. Vincent's Hospital, Melbourne
- Canberra Hospital
- University of Melbourne
| | | | - Laura Ross
- St. Vincent's Hospital, Melbourne
- University of Melbourne
| | | | | | | | | | | | | | - John Moore
- St Vincent's Hospital, Sydney
- St Vincent's Centre for Applied Medical Research, Sydney
- University of New South, Wales
| | | | - Joanne Sahhar
- Monash University, Melbourne
- Monash Health, Melbourne
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Brown Z, Hansen D, Stevens W, Ferdowsi N, Ross L, Quinlivan A, Sahhar J, Ngian GS, Apostolopoulos D, Walker JG, Proudman S, Teng GG, Low AHL, Morrisroe K, Nikpour M. Evaluation of the European Society of Cardiology Risk Assessment Score in Incident Systemic Sclerosis-Associated Pulmonary Arterial Hypertension. Arthritis Care Res (Hoboken) 2024. [PMID: 38523256 DOI: 10.1002/acr.25328] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/12/2024] [Accepted: 03/21/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE Patients with pulmonary arterial hypertension (PAH) may be stratified as low, intermediate, or high risk of 1-year mortality. In 2022, the European Society of Cardiology (ESC) updated and simplified its risk stratification tool, based on three variables: World Health Organization functional class, serum N-terminal pro-brain type natriuretic peptide and six-minute walk distance, applied at follow-up visits, intended to guide therapy over time. METHODS We applied the 2022 ESC risk assessment tool at baseline and follow-up (within 2 years) to a multinational incident cohort of systemic sclerosis-associated PAH (SSc-PAH). Kaplan-Meier curves, Cox hazards regression, and accelerated failure time models were used to evaluate survival by risk score. RESULTS At baseline (n = 260), the majority of SSc-PAH (72.2%) were graded as intermediate risk of death according to the 2022 tool. At follow-up, according to 2022 tool, half (55.5%) of the cohort were classified as low or intermediate-low risk. The 2022 risk model at follow-up was able to differentiate survival between risk strata. All three individual parameters (World Health Organization functional class, N-terminal pro-brain type natriuretic peptide, six-minute walk distance) were significantly associated with mortality at baseline and/or follow-up. CONCLUSION The 2022 ESC risk assessment strategy applied at baseline and follow-up predicts survival in SSc-PAH. Treatment decisions for SSc-PAH should include risk assessments, aiming to achieve low-risk status according to the 2022 ESC guidelines.
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Affiliation(s)
- Zoe Brown
- The University of Melbourne at St. Vincent's Hospital and St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Dylan Hansen
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Wendy Stevens
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Nava Ferdowsi
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Laura Ross
- The University of Melbourne at St. Vincent's Hospital and St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Alannah Quinlivan
- The University of Melbourne at St. Vincent's Hospital and St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Joanne Sahhar
- Monash Health and Monash University, Clayton, Victoria, Australia
| | - Gene-Siew Ngian
- Monash Health and Monash University, Clayton, Victoria, Australia
| | | | - Jennifer G Walker
- Royal Adelaide Hospital, Adelaide, South Australia, Australia, University of Adelaide, North Adelaide, South Australia, Australia, and Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Susanna Proudman
- Royal Adelaide Hospital, Adelaide, South Australia, Australia, and University of Adelaide, North Adelaide, South Australia, Australia
| | - Gim Gee Teng
- Alexandra Hospital, National University Health System, Singapore, Singapore
| | - Andrea H L Low
- Singapore General Hospital and Duke National University of Singapore
| | - Kathleen Morrisroe
- The University of Melbourne at St. Vincent's Hospital and St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Mandana Nikpour
- The University of Melbourne at St. Vincent's Hospital and St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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Morrisroe K, Hansen D, Stevens W, Ross L, Sahhar J, Ngian GS, Hill C, Host L, Walker J, Proudman S, Nikpour M. Predictors and prognosis of pulmonary hypertension complicating interstitial lung disease in systemic sclerosis. Rheumatology (Oxford) 2024:keae166. [PMID: 38471118 DOI: 10.1093/rheumatology/keae166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/21/2024] [Accepted: 02/12/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE To identify those with concurrent pulmonary hypertension (PH) and interstitial lung disease (ILD) in systemic sclerosis (SSc) and determine their disease severity, therapeutic approach, and survival. METHODS Consecutive SSc patients enrolled in the Australian Scleroderma Cohort Study (ASCS) who were diagnosed on right heart catherisation with pulmonary hypertension were included. Logistic regression was used to determine the associations of ILD with PH hemodynamic parameters and therapeutic approach. Kaplan-Meier survival curves were used to estimate survival. RESULTS Of 1,883 SSc patients, 164 (8.7%) developed incident PH over a median follow up of 4.3 (1.7-7.9) years. Of these, 43.9% had concurrent ILD at PH diagnosis (PH-ILD) and 56.1% had Group 1 PAH. Extensive ILD was present at PH diagnosis in 40.3%. Despite these distinct PH cohorts, a similar frequency of each PH cohort was treated with vasodilatory therapy at PH diagnosis, regardless of the presence or severity of ILD. The majority (87.5%) of those with extensive ILD and PH received upfront vasodilatory therapy at PH diagnosis with no difference in its tolerability or therapy cessation compared with Group 1 PAH. Although vasodilator therapy was not associated with a survival advantage in those with extensive ILD, its use was associated with an improvement in symptoms, physical function, and quality of life (QoL). CONCLUSION Despite vasodilator therapy, survival in SSc-PH is poor, with the presence of concurrent ILD associated with worse survival. Although vasodilator therapy commenced at PH diagnosis does not portray an improved survival in PH with extensive ILD, it appears well tolerated and may improve symptoms, physical function, and QoL.
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Affiliation(s)
- Kathleen Morrisroe
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Rheumatology St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Dylan Hansen
- Department of Rheumatology St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Wendy Stevens
- Department of Rheumatology St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Laura Ross
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Rheumatology St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Joanne Sahhar
- Department of Medicine, Monash University, Clayton and Monash Health, Melbourne, Victoria, Australia
| | - Gene-Siew Ngian
- Department of Medicine, Monash University, Clayton and Monash Health, Melbourne, Victoria, Australia
| | - Catherine Hill
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, SA Australia
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, SA 5011, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Lauren Host
- Department of Rheumatology, Royal Perth Hospital, Perth, Australia
| | - Jennifer Walker
- Rheumatology Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, SA Australia
- Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Rheumatology St Vincent's Hospital, Melbourne, Victoria, Australia
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Schwender E, Hansen D, Stevens W, Ross L, Proudman S, Walker J, Sahhar J, Ngian G, Host L, Major G, Nikpour M, Morrisroe K. Inflammatory Arthritis in Systemic Sclerosis: Its Epidemiology, Associations, and Morbidity. Arthritis Care Res (Hoboken) 2024. [PMID: 38327022 DOI: 10.1002/acr.25311] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 01/04/2024] [Accepted: 02/02/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To describe the epidemiology, associations, and impact of inflammatory arthritis (IA) in systemic sclerosis (SSc). METHODS Patients with SSc prospectively enrolled in the Australian Scleroderma Cohort Study were included. IA was defined clinically as the presence of synovitis on examination. Logistic regression was used to determine the associations of IA with SSc manifestations and serological parameters. Patient-reported outcome measures were used to capture physical function and health-related quality of life (HRQoL). RESULTS IA was a common SSc manifestation affecting one-third (33.3%) of patients over a median follow-up of 4.3 (1.7-8.4) years. Associations of IA included diffuse SSc (odds ratio [OR] 1.33, 95% confidence interval [95% CI] 1.01-1.74, P = 0.042), concurrent musculoskeletal manifestations (joint contractures and tendon friction rubs, OR 1.70, 95% CI 1.34-2.15, P < 0.001); myositis (OR 2.11, 95% CI 1.39-3.20, P < 0.001), and sicca symptoms (OR 1.57, 95% CI 1.14-2.16, P = 0.006), whereas IA was negatively associated with pulmonary arterial hypertension (OR 0.52, 95% CI 0.35-0.78, P = 0.002). Neither the presence of rheumatoid factor nor U1 small nuclear RNP were associated with IA (OR 1.13, 95% CI 0.88-1.44, P = 0.331, OR 1.46, 95% CI 0.89-2.39, P = 0.129 respectively). Positive anticyclic citrullinated protein antibodies, although at low frequency, were more common in those with IA compared with those without IA (7.5% vs 1.5%, P < 0.001). IA was associated with significantly lower HRQoL score (P < 0.001) and more physical disability than in those without IA (P < 0.001). CONCLUSION IA is a common disease manifestation that is more frquently seen in diffuse disease. IA is associated with poor HRQoL and physical disability. Further research is needed into the effective management of IA in SSc.
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Affiliation(s)
| | - Dylan Hansen
- The University of Melbourne at St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Wendy Stevens
- The University of Melbourne at St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Laura Ross
- The University of Melbourne at St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Susanna Proudman
- Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Jenny Walker
- Royal Adelaide Hospital, University of Adelaide, and Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Joanne Sahhar
- Monash University, Clayton and Monash Health, Victoria, Australia
| | - Gene Ngian
- Monash University, Clayton and Monash Health, Victoria, Australia
| | - Lauren Host
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Gabor Major
- Royal Newcastle Centre, New South Wales, Australia
| | - Mandana Nikpour
- The University of Melbourne at St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Kathleen Morrisroe
- The University of Melbourne at St Vincent's Hospital, Melbourne, Victoria, Australia
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Emery A, Moore S, Crowe J, Murray J, Peacock O, Thompson D, Betts F, Rapps S, Ross L, Rothschild-Rodriguez D, Arana Echarri A, Davies R, Lewis R, Augustine DX, Whiteway A, Afzal Z, Heaney J, Drayson MT, Turner JE, Campbell JP. The effects of short-term, progressive exercise training on disease activity in smouldering multiple myeloma and monoclonal gammopathy of undetermined significance: a single-arm pilot study. BMC Cancer 2024; 24:174. [PMID: 38317104 PMCID: PMC10840198 DOI: 10.1186/s12885-024-11817-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/01/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND High levels of physical activity are associated with reduced risk of the blood cancer multiple myeloma (MM). MM is preceded by the asymptomatic stages of monoclonal gammopathy of undetermined significance (MGUS) and smouldering multiple myeloma (SMM) which are clinically managed by watchful waiting. A case study (N = 1) of a former elite athlete aged 44 years previously indicated that a multi-modal exercise programme reversed SMM disease activity. To build from this prior case study, the present pilot study firstly examined if short-term exercise training was feasible and safe for a group of MGUS and SMM patients, and secondly investigated the effects on MGUS/SMM disease activity. METHODS In this single-arm pilot study, N = 20 participants diagnosed with MGUS or SMM were allocated to receive a 16-week progressive exercise programme. Primary outcome measures were feasibility and safety. Secondary outcomes were pre- to post-exercise training changes to blood biomarkers of MGUS and SMM disease activity- monoclonal (M)-protein and free light chains (FLC)- plus cardiorespiratory and functional fitness, body composition, quality of life, blood immunophenotype, and blood biomarkers of inflammation. RESULTS Fifteen (3 MGUS and 12 SMM) participants completed the exercise programme. Adherence was 91 ± 11%. Compliance was 75 ± 25% overall, with a notable decline in compliance at intensities > 70% V̇O2PEAK. There were no serious adverse events. There were no changes to M-protein (0.0 ± 1.0 g/L, P =.903), involved FLC (+ 1.8 ± 16.8 mg/L, P =.839), or FLC difference (+ 0.2 ± 15.6 mg/L, P =.946) from pre- to post-exercise training. There were pre- to post-exercise training improvements to diastolic blood pressure (- 3 ± 5 mmHg, P =.033), sit-to-stand test performance (+ 5 ± 5 repetitions, P =.002), and energy/fatigue scores (+ 10 ± 15%, P =.026). Other secondary outcomes were unchanged. CONCLUSIONS A 16-week progressive exercise programme was feasible and safe, but did not reverse MGUS/SMM disease activity, contrasting a prior case study showing that five years of exercise training reversed SMM in a 44-year-old former athlete. Longer exercise interventions should be explored in a group of MGUS/SMM patients, with measurements of disease biomarkers, along with rates of disease progression (i.e., MGUS/SMM to MM). REGISTRATION https://www.isrctn.com/ISRCTN65527208 (14/05/2018).
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Affiliation(s)
- A Emery
- Department for Health, University of Bath, Bath, UK
| | - S Moore
- Department for Haematology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - J Crowe
- Department for Haematology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - J Murray
- Department for Haematology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - O Peacock
- Department for Health, University of Bath, Bath, UK
| | - D Thompson
- Department for Health, University of Bath, Bath, UK
| | - F Betts
- Department for Health, University of Bath, Bath, UK
| | - S Rapps
- Department for Health, University of Bath, Bath, UK
| | - L Ross
- Department for Health, University of Bath, Bath, UK
| | | | | | - R Davies
- Department for Health, University of Bath, Bath, UK
| | - R Lewis
- Department for Physiotherapy, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - D X Augustine
- Department for Health, University of Bath, Bath, UK
- Department for Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - A Whiteway
- Department for Haematology, North Bristol NHS Trust, Bristol, UK
| | - Z Afzal
- Clinical Immunology Service, Institute of Immunity and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jlj Heaney
- Clinical Immunology Service, Institute of Immunity and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - M T Drayson
- Clinical Immunology Service, Institute of Immunity and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - J E Turner
- Department for Health, University of Bath, Bath, UK
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - J P Campbell
- Department for Health, University of Bath, Bath, UK.
- School of Medical and Health Sciences, Edith Cowan University, WA, Joondalup, Australia.
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9
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Luo Y, Ross L, Zheng J, Bernstein EJ. Are there more acute cardiac hospitalizations in winter in patients with systemic sclerosis? An analysis from the National Inpatient Sample. J Scleroderma Relat Disord 2024; 9:59-66. [PMID: 38333525 PMCID: PMC10848930 DOI: 10.1177/23971983231197268] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/09/2023] [Indexed: 02/10/2024]
Abstract
Objective Cold-induced transient myocardial ischemia has been described in patients with systemic sclerosis. The clinical impact of cold exposure in systemic sclerosis patients with acute cardiac conditions is unknown. We compared the seasonal variation of acute cardiac hospitalizations in patients with and without systemic sclerosis. Methods We performed a retrospective cross-sectional study using the National Inpatient Sample from 2016 to 2019. The primary outcome was acute cardiac hospitalization primarily due to heart failure, acute myocardial infarction, or cardiac arrhythmias. We compared the proportion of acute cardiac hospitalizations in each season in patients with and without systemic sclerosis. We also performed a subgroup analysis by US geographic region (Northeast, Midwest, South, West). Results There were a total of 10,118,002 acute cardiac hospitalizations over the 4-year study period. Compared to those without systemic sclerosis, patients with systemic sclerosis who were hospitalized for acute cardiac care were younger (mean age 67 ± 13 vs 70 ± 14 years, p < 0.01), a greater proportion were female (82% vs 45%, p < 0.01), and a smaller proportion were Caucasian (68% vs 71%, p < 0.01). There was a lesser proportion of traditional cardiovascular risk factors in systemic sclerosis compared to non-systemic sclerosis patients. There was no significant difference in the proportion of winter admissions between systemic sclerosis and non-systemic sclerosis patients for total acute cardiac hospitalizations (26.4% vs 25.9%, p = 0.51), heart failure (27.0% vs 26.5%, p = 0.64), acute myocardial infarction (26.9% vs 25.5%, p = 0.50), or arrhythmias (24.3% vs 25.0%, p = 0.68). The results were consistent across all four US geographic regions. Conclusion Our study did not support that patients with systemic sclerosis had a disproportionally higher risk of acute cardiac hospitalization in winter compared to the general population. We found that systemic sclerosis patients hospitalized for acute cardiac care had a lower burden of traditional cardiovascular risk factors than their non-systemic sclerosis counterparts.
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Affiliation(s)
- Yiming Luo
- Division of Rheumatology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Laura Ross
- Department of Medicine, St Vincent’s Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Department of Rheumatology, St Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
| | - Jiayi Zheng
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA, USA
| | - Elana J Bernstein
- Division of Rheumatology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
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10
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Ross L, Hansen D, Maltez N, Morrisroe K, Kumar K, Walker J, Stevens W, Sahhar J, Ngian GS, Host L, Nikpour M, Proudman S. The effect of calcium channel blockers on digital ulcers in systemic sclerosis: data from a prospective cohort study. Clin Rheumatol 2024; 43:269-276. [PMID: 37921914 PMCID: PMC10774194 DOI: 10.1007/s10067-023-06796-1] [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: 08/15/2023] [Revised: 09/25/2023] [Accepted: 10/14/2023] [Indexed: 11/05/2023]
Abstract
Digital ulcers (DU) are a common, severe vascular manifestation of systemic sclerosis (SSc) with few effective treatment options. Using data from the Australian Scleroderma Cohort Study (ASCS), we sought to evaluate the effect of calcium channel blockers (CCB) on the treatment and prevention of DU.Using data from 1953 participants, with a median of 4.34 years of follow-up, we used generalised estimating equations to evaluate the clinical characteristics associated with CCB use and ascertain the risk factors for the presence of DU at subsequent study visits. A time-dependent Cox-proportional hazard model was applied to evaluate the risk of future occurrence of DU with CCB use.Sixty-six percent of participants received CCB and patients with a history of DU were more likely to be prescribed a CCB (76.76% vs 53.70%, p < 0.01). CCB use was more frequent in patients with severe complications of DU including chronic DU (OR 1.47, p = 0.02), need for hospitalisation for iloprost (OR 1.30, p = 0.01) or antibiotics (OR 1.36, p = 0.04) and digital amputation (OR 1.48, p < 0.01). Use of CCB was more likely in patients who experienced DU at subsequent study visits (OR 1.32, p < 0.01) and was not associated with a decreased risk of the development of a first DU (HR 0.94, p = 0.65).CCB are frequently used in the management of SSc in the ASCS and their use is associated with severe peripheral vascular manifestations of SSc. However, our results suggest that CCB may not be effective in the healing or prevention of DU.
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Affiliation(s)
- Laura Ross
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia.
- Department of Rheumatology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.
| | - Dylan Hansen
- Department of Rheumatology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Nancy Maltez
- Department of Rheumatology, The Ottawa Hospital, Ottawa, Canada
| | - Kathleen Morrisroe
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
- Department of Rheumatology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Kimti Kumar
- Department of Rheumatology, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Jennifer Walker
- Rheumatology Unit, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Joanne Sahhar
- Department of Rheumatology, Monash Health, Clayton, VIC, Australia
- Department of Medicine, Monash University, Clayton, VIC, Australia
| | - Gene-Siew Ngian
- Department of Rheumatology, Monash Health, Clayton, VIC, Australia
- Department of Medicine, Monash University, Clayton, VIC, Australia
| | - Lauren Host
- Department of Rheumatology, Fiona Stanley Hospital, Perth, WA, Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
- Department of Rheumatology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
- School of Public Health, University of Sydney, Sydney, Australia
- Department of Rheumatology, Institute of Rheumatology & Orthopaedics, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Susanna Proudman
- Department of Rheumatology, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Medicine, The University of Adelaide, Adelaide, SA, Australia
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11
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Campochiaro C, Suliman YA, Hughes M, Schoones JW, Giuggioli D, Moinzadeh P, Baron M, Chung L, Ross L, Maltez N, Allanore Y, Denton CP, Distler O, Frech T, Furst DE, Khanna D, Krieg T, Kuwana M, Matucci-Cerinic M, Pope J, Alunno A. Non-surgical local treatments of digital ulcers in systemic sclerosis: a systematic literature review. Semin Arthritis Rheum 2023; 63:152267. [PMID: 37778090 DOI: 10.1016/j.semarthrit.2023.152267] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/03/2023] [Accepted: 08/27/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION Digital ulcers (DUs) are difficult to treat in patients with systemic sclerosis (SSc) and systemic (i.e., pharmacological) therapy is currently considered the 'standard of care'. Our aim was to examine the safety and efficacy of local, non-surgical treatment for SSc-DUs. METHODS A systematic literature review (SLR) of original research articles up to August, 29 2022 was performed according to the PICO framework. References were independently screened by two reviewers and risk of bias was assed using validated tools. Due to study heterogeneity narrative summaries are used to present data. RESULTS Among 899 retrieved references, 14 articles were included (2 randomised trials (RTs), and 12 observational (OBS) studies). The most frequently studied procedure (5 studies) was botulin A toxin (hand or single finger) injection with a reported healing rate (HR) of 71%-100%. Amniotic and hydrocolloid membranes were examined in one study each and associated with a good HR. Tadalafil 2% cream was studied in a single study with a reduction in the number of DUs. Vitamin E gel was associated with a reduction in ulcer healing time. Low-level light therapy, hydrodissection and corticosteroid injection, extracorporeal shock wave (ESW) and photobiomodulation were evaluated in a single study each and showed a positive trend. Dimethyl sulfoxide was associated with significant local toxicity. CONCLUSIONS A range of non-surgical, local treatments for SSc-DUs have been explored and showed efficacy to some extent. We have identified methodological flaws that should be avoided in the design of future studies to explore locally-acting treatments for SSc-DUs.
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Affiliation(s)
- Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University.
| | | | - Michael Hughes
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester
| | - Jan W Schoones
- Directorate of Research Policy (formerly Walaeus Library), Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Murray Baron
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Lorinda Chung
- Stanford University School of Medicine and Palo Alto VA Health Care System, Palo Alto, CA, USA
| | - Laura Ross
- The University of Melbourne, Melbourne, VIC, Australia; St Vincent's Hospital, Melbourne, Australia
| | | | | | | | | | - Tracy Frech
- University of Utah, Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | | | | | - Thomas Krieg
- Department of Dermatology and Venereology, University Hospital of Cologne, Cologne, Germany
| | | | | | - Janet Pope
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Alessia Alunno
- Department of Life, Health & Environmental Sciences, University of L'Aquila and Internal Medicine and Nephrology Unit and Department of Medicine, ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
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12
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Ross L, Maltez N, Hughes M, Schoones JW, Baron M, Chung L, Giuggioli D, Moinzadeh P, Suliman YA, Campochiaro C, Allanore Y, Denton CP, Distler O, Frech T, Furst DE, Khanna D, Krieg T, Kuwana M, Matucci-Cerinic M, Pope J, Alunno A. Systemic pharmacological treatment of digital ulcers in systemic sclerosis: a systematic literature review. Rheumatology (Oxford) 2023; 62:3785-3800. [PMID: 37335850 PMCID: PMC10691932 DOI: 10.1093/rheumatology/kead289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/19/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE To evaluate the evidence concerning systemic pharmacological treatments for SSc digital ulcers (DUs) to inform the development of evidence-based treatment guidelines. METHODS A systematic literature review of seven databases was performed to identify all original research studies of adult patients with SSc DUs. Randomized controlled trials (RCTs) and prospective longitudinal observational studies (OBSs) were eligible for inclusion. Data were extracted, applying the patient, intervention, comparison, outcome framework, and risk of bias (RoB) was assessed. Due to study heterogeneity, narrative summaries were used to present data. RESULTS Forty-seven studies that evaluated the treatment efficacy or safety of pharmacological therapies were identified among 4250 references. Data from 18 RCTs of 1927 patients and 29 OBSs of 661 patients, at various RoB (total 2588 patients) showed that i.v. iloprost, phosphodiesterase-5 inhibitors and atorvastatin are effective for the treatment of active DUs. Bosentan reduced the rate of future DUs in two RCTs (moderate RoB) and eight OBSs at low to high RoB. Two small studies (moderate RoB) indicate that Janus kinase inhibitors may be effective for the treatment of active DUs, otherwise there are no data to support the use of immunosuppression or anti-platelet agents in the management of DUs. CONCLUSION There are several systemic treatments, across four medication classes, that are effective therapies for the management of SSc DUs. However, a lack of robust data means it is not possible to define the optimal treatment regimen for SSc DUs. The relatively low quality of evidence available has highlighted further areas of research need.
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Affiliation(s)
- Laura Ross
- Department of Medicine and Rheumatology, University of Melbourne at St Vincent’s Hospital, Melbourne, Victoria, Australia
| | - Nancy Maltez
- Department of Medicine, Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael Hughes
- Department of Rheumatology, Northern Care Alliance NHS Foundation Trust, Salford Care Organisation, Salford, UK
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, UK
| | - Jan W Schoones
- Directorate of Research Policy (formerly Walaeus Library), Leiden University Medical Center, Leiden, The Netherlands
| | - Murray Baron
- Division of Rheumatology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Lorinda Chung
- Department of Rheumatology, Stanford University School of Medicine and Palo Alto VA Health Care System, Palo Alto, CA, USA
| | - Dilia Giuggioli
- Department of Rheumatology, Division of Rheumatology, University of Modena and Reggio Emilia, Policlinico of Modena, Modena, Italy
| | - Pia Moinzadeh
- Department of Dermatology and Venereology, University Hospital Cologne, Cologne, Germany
| | - Yossra A Suliman
- Department of Rheumatology and Rehabilitation, Assiut University Hospital, Assiut, Egypt
| | - Corrado Campochiaro
- Department of Immunology, Rheumatology, Allergy and Rare Diseases, Raffaele Hospital, Vita-Salute San Raffaele Università, Milan, Italy
| | - Yannick Allanore
- Department of Rheumatology, Cochin Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Christopher P Denton
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital, London, UK
- UCL Division of Medicine, University College London, London, UK
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tracy Frech
- Department of Medicine, Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Veterans Affairs Medical Center, Nashville, TN, USA
| | - Daniel E Furst
- Department of Rheumatology and Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Dinesh Khanna
- Department of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - Thomas Krieg
- Department of Rheumatology, Division of Rheumatology, University of Modena and Reggio Emilia, Policlinico of Modena, Modena, Italy
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School, Tokyo, Japan
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, Careggi University Hospital, University of Florence, Florence, Italy
| | - Janet Pope
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Alessia Alunno
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
- Internal Medicine and Nephrology Division, ASL1 Avezzano-Sulmona-L'Aquila, L'Aquila, Italy
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13
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Suliman YA, Campochiaro C, Hughes M, Schoones JW, Giuggioli D, Moinzadeh P, Baron M, Chung L, Ross L, Maltez N, Allanore Y, Denton CP, Distler O, Frech T, Furst DE, Khanna D, Krieg T, Kuwana M, Matucci-Cerinic M, Pope J, Alunno A. Surgical management of digital ulcers in systemic sclerosis: A systematic literature review. Semin Arthritis Rheum 2023; 63:152266. [PMID: 37826898 DOI: 10.1016/j.semarthrit.2023.152266] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 09/02/2023] [Accepted: 09/23/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND There is a strong rationale to develop locally-acting surgical treatments for digital ulcers (DUs) in patients with systemic sclerosis (SSc). Our aim was to examine the safety and efficacy of local surgical management for SSc-DU. METHODS A systematic literature review was carried out until to August 2022 using 7 different databases. Original research studies concerning adult patients with SSc-DUs, and local surgical treatments were analysed using the PICO framework. We included randomized controlled trials, prospective/retrospective studies, and case series (minimum of 3 patients) References were independently screened by two reviewers including assessment of the risk of bias using validated tools. RESULTS Out of 899, 13eligible articles were included. Autologous fat (adipose tissue AT) grafting was the surgical modality most identified (7 studies, 1 randomized controlled double blinded trial and 6 prospective open-label single arm studies). The healing rate (HR) with autologous fat grafting (4 studies) was 66-100 %. Three studies reported autologous adipose-derived stromal vascular fraction grafting: HR of 32-60 %. Bone marrow derived cell transplantation in a single study showed 100 % healing rate over 4-24 weeks. Surgical sympathectomy was examined in 3 studies, prospective without comparator with a median healing rate of 81 %. Two surgical studies (of direct microsurgical revascularisation and microsurgical arteriolysis) showed 100 % healing of ulcers, with no complications. CONCLUSION Several surgical approaches for SSc-DUs have demonstrated some degree of safety and effectiveness for DU healing. However, there are significant methodological issues. Future studies are warranted to rigorously investigate surgical interventions for SSc-DUs.
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Affiliation(s)
- Yossra A Suliman
- Rheumatology and Rehabilitation Dept, Assiut University Hospital, Assiut, Egypt.
| | - Corrado Campochiaro
- IRCCS San Raffaele Hospital, Vita-Salute San Raffaele Università, Milan, Italy
| | - Michael Hughes
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Northern Care Alliance NHS Foundation Trust, Salford Care alliance, Manchester Academic Health Science Centre, Manchester, UK
| | - Jan W Schoones
- Directorate of Research Policy (formerly Walaeus Library), Leiden University Medical Center, Leiden, the Netherlands
| | | | - Pia Moinzadeh
- Department of Dermatology and Venereology, University Hospital of Cologne, Germany
| | - Murray Baron
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Lorinda Chung
- Stanford University School of Medicine and Palo Alto VA Health Care System, Palo Alto, CA, USA
| | - Laura Ross
- The University of Melbourne, Melbourne, VIC, Australia; St Vincent's Hospital, Melbourne, Australia
| | | | | | | | | | - Tracy Frech
- University of Utah, Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Daniel E Furst
- University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Thomas Krieg
- Department of Dermatology and Venereology, University Hospital of Cologne, Cologne, Germany
| | | | | | - Janet Pope
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Alessia Alunno
- Department of Life, Health & Environmental Sciences, University of L'Aquila and Internal Medicine and Nephrology Unit and Department of Medicine, ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
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14
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Ross L, Nikpour M. Composite measures to assess disease damage, disease severity and treatment response in systemic sclerosis clinical trials. Curr Opin Rheumatol 2023; 35:334-340. [PMID: 37650689 DOI: 10.1097/bor.0000000000000971] [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: 09/01/2023]
Abstract
PURPOSE OF REVIEW The aim of this study was to summarize the composite outcome measures available to assess disease damage, severity and treatment response in systemic sclerosis (SSc). RECENT FINDINGS There have been many recent efforts to rigorously develop and validate composite outcome measures to assess the totality of the impact of SSc on patients. All initiatives have used both consensus and data-driven methods. Recently developed are a SSc-specific damage index, a patient-reported disease impact questionnaire (ScleroID) and a treatment response index (ACR-CRISS). SUMMARY Multiorgan, composite measures are being increasingly applied to assess treatment efficacy in clinical trials. Although a fully validated, disease-specific composite measure is not yet available, there has been significant recent progress towards developing measures of treatment response, damage and overall impact of SSc for application in randomized controlled trials.
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Affiliation(s)
- Laura Ross
- Department of Medicine at St Vincent's Hospital, University of Melbourne
- Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Mandana Nikpour
- Department of Medicine at St Vincent's Hospital, University of Melbourne
- Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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15
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Fairley JL, Ross L, Quinlivan A, Hansen D, Paratz E, Stevens W, Kistler PM, McLellan A, La Gerche A, Nikpour M. Sudden cardiac death, arrhythmias and abnormal electrocardiography in systemic sclerosis: A systematic review and meta-analysis. Semin Arthritis Rheum 2023; 62:152229. [PMID: 37354723 DOI: 10.1016/j.semarthrit.2023.152229] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE To calculate the frequency of sudden cardiac death(SCD), arrhythmia and conduction defects in SSc. METHODS MEDLINE/EMBASE were searched to January 2023. English-language studies reporting the incidence/frequency of SCD, arrhythmia and electrocardiography(ECG) abnormalities in SSc were included. Odds ratios(OR), estimations of annual incidence or pooled frequencies were calculated. RESULTS Seventy-nine studies(n = 13,609 participants with SSc) were included in the meta-analysis. Methodology and outcomes were heterogeneous. Ten studies included cohorts with known/suspected SSc-associated heart involvement(SHI), generally defined as clinically-manifest cardiac disease/abnormal cardiac investigations. The incidence of SCD in SHI was estimated to be 3.3% annually(n = 4 studies, 301PY follow-up). On ambulatory ECG, 18% of SHI cohorts had non-sustained ventricular tachycardia(NSVT; n = 4, 95%CI3.2-39.3%), 70% frequent premature ventricular complexes (PVCs; n = 1, 95%CI34.8-93.3%), and 8% atrial fibrillation (AF; n = 1, 95%CI4.2-13.6%). Nineteen studies included participants without SHI, defined as normal cardiac investigations/absence of cardiac disease. The estimated incidence of SCD was approximately 2.9% annually (n = 1, 67.5PY). Compared to healthy controls, individuals without SHI demonstrated NSVT 13.3-times more frequently (n = 2, 95%CI2-102), and paroxysmal supraventricular tachycardia 7-times more frequently (n = 4, 95%CI3-15). Other ambulatory ECG abnormalities included NSVT in 9% (n = 7, 95%CI6-14%), >1000 PVCs/24 h in 6% (n = 2, 95%CI1-13%), and AF in 7% (n = 5, 0-21%). Fifty studies included general SSc cohorts unselected for cardiac disease. The incidence of SCD was estimated to be 2.0% annually(n = 4 studies, 1646PY). Unselected SSc cohorts were 10.5-times more likely to demonstrate frequent PVCs (n = 2, 95%CI 2-59) and 2.5-times more likely to have an abnormal electrocardiography (n = 2, 95%CI1-4). CONCLUSIONS The incidence of SCD in SSc is estimated to be 1.0-3.3% annually, at least 10-fold higher than general population estimates. Arrhythmias including NSVT and frequent PVCs appear common, including amongst those without known/suspected SHI.
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Affiliation(s)
- Jessica L Fairley
- The University of Melbourne, Melbourne, Victoria, Australia; St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Laura Ross
- The University of Melbourne, Melbourne, Victoria, Australia; St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Alannah Quinlivan
- The University of Melbourne, Melbourne, Victoria, Australia; St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Dylan Hansen
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth Paratz
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Wendy Stevens
- The University of Melbourne, Melbourne, Victoria, Australia; St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Peter M Kistler
- The University of Melbourne, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Australia
| | - Alex McLellan
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Andre La Gerche
- The University of Melbourne, Melbourne, Victoria, Australia; St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Mandana Nikpour
- The University of Melbourne, Melbourne, Victoria, Australia; St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
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16
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Fairley JL, Ross L, Burns A, Prior D, Conron M, Rouse H, McDonald J, MacIsaac A, La Gerche A, Morrisroe K, Ferdowsi N, Quinlivan A, Brown Z, Stevens W, Nikpour M. Multidisciplinary team discussion: the emerging gold standard for management of cardiopulmonary complications of connective tissue disease. Intern Med J 2023; 53:1919-1924. [PMID: 37772776 PMCID: PMC10947227 DOI: 10.1111/imj.16233] [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: 07/04/2023] [Accepted: 08/28/2023] [Indexed: 09/30/2023]
Abstract
Cardiopulmonary complications of connective tissue diseases (CTDs), particularly pulmonary arterial hypertension (PAH) and interstitial lung disease (ILD), are major determinants of morbidity and mortality. Multidisciplinary meetings may improve diagnostic accuracy and optimise treatment. We review the literature regarding multidisciplinary meetings in CTD-ILD and PAH and describe our tertiary centre experience of the role of the multidisciplinary meeting in managing CTD-PAH.
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Affiliation(s)
- Jessica L. Fairley
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Laura Ross
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Andrew Burns
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of CardiologySt Vincent's Hospital MelbourneMelbourneAustralia
| | - David Prior
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of CardiologySt Vincent's Hospital MelbourneMelbourneAustralia
| | - Matthew Conron
- Department of Respiratory MedicineSt Vincent's Hospital MelbourneMelbourneAustralia
| | - Hannah Rouse
- Department of RadiologySt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Julie McDonald
- Department of Respiratory MedicineSt Vincent's Hospital MelbourneMelbourneAustralia
| | - Andrew MacIsaac
- Department of CardiologySt Vincent's Hospital MelbourneMelbourneAustralia
| | - André La Gerche
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Baker Heart and Diabetes InstituteVictoriaAustralia
| | - Kathleen Morrisroe
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Nava Ferdowsi
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Alannah Quinlivan
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Zoe Brown
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Wendy Stevens
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Mandana Nikpour
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
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Morrisroe K, Hansen D, Stevens W, Ross L, Sahhar J, Ngian GS, Hill CL, Host L, Walker J, Proudman S, Nikpour M. Progressive pulmonary fibrosis and its impact on survival in systemic sclerosis related interstitial lung disease. Rheumatology (Oxford) 2023:kead491. [PMID: 37725359 DOI: 10.1093/rheumatology/kead491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVE To describe the frequency of progressive pulmonary fibrosis (PPF) in an incident cohort of systemic sclerosis (SSc) related interstitial lung disease (ILD) and its impact on survival. METHODS Incident ILD was defined as the new development of characteristic fibrotic changes on chest HRCT scan. PPF was defined as per the 2022 American Thoracic Society. Determinants of PPF were identified using generalised estimating equations. Impact on survival was analysed using accelerated failure time regression modelling. RESULTS Of our incident SSc-ILD cases, 38.8% (n = 180) experienced PPF within a 12-month period after ILD diagnosis. Determinants of PPF included older age (OR 1.02, 95%CI 1.00-1.03, p= 0.011), dcSSc (OR 1.54, 95% CI 1.06-2.25, p= 0.024) and SSc specific antibodies (anticentomere antibody OR 0.51, 95%CI 0.29-0.91, p= 0.021 and anti-Scl-70 antibody OR 1.46, 95%CI 1.01-2.09, p= 0.043). Raised CRP was numerically associated with PPF but did not reach statistical significance (OR 1.29, 95%CI 0.99-1.68, p= 0.064) nor did GORD or dysphagia (OR 1.18, 95%CI 0.57-2.42, p= 0.658 and OR 1.17, 95%CI 0.57-2.40, p= 0.664 respectively). The presence of PPF significantly impacted survival in SSc-ILD (hazard ratio 2.66, 95%CI 1.59-4.41, p< 0.001). CONCLUSIONS PPF occurred in a third of our incident SSc-ILD cohort; however, its occurrence was significantly associated with mortality indicating an at-risk group who may be suitable for earlier introduction of immunosuppressive and/or antifibrotic therapy.
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Affiliation(s)
- Kathleen Morrisroe
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Dylan Hansen
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Laura Ross
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Joanne Sahhar
- Department of Medicine, Monash University, Clayton and Monash Health, Clayton, Victoria, Australia
| | - Gene-Siew Ngian
- Department of Medicine, Monash University, Clayton and Monash Health, Clayton, Victoria, Australia
| | - Catherine L Hill
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, SA, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Lauren Host
- Department of Rheumatology, Fiona Stanley Hospital, Perth, Australia
| | - Jennifer Walker
- Rheumatology Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Victoria, Australia
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18
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Herbette M, Ross L. Paternal genome elimination: patterns and mechanisms of drive and silencing. Curr Opin Genet Dev 2023; 81:102065. [PMID: 37413739 DOI: 10.1016/j.gde.2023.102065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 07/08/2023]
Abstract
In thousands of arthropod species, males inherit, but subsequently eliminate the entire haploid genome of their father. However, why this peculiar reproductive strategy evolved repeatedly across diverse species and what mechanisms are involved in paternal genome elimination (PGE) remains largely unknown. In this review, we summarize what we know about the patterns of paternal chromosome elimination during various stages of development in the diverse taxa that have been studied. We also discuss some other unusual features often associated with PGE, such as the transcriptional silencing of paternally derived chromosomes in males and sex determination through the early embryonic elimination of X chromosomes. Little is known about the molecular mechanisms underlying the parent-of-origin-dependent chromosome elimination and silencing under PGE, but we discuss the insight of several studies that are pioneering this work and highlight directions for future research.
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Affiliation(s)
- Marion Herbette
- School of Biological Sciences, Institute of Evolutionary Biology, The University of Edinburgh, Edinburgh EH9 3FL, UK
| | - Laura Ross
- School of Biological Sciences, Institute of Evolutionary Biology, The University of Edinburgh, Edinburgh EH9 3FL, UK.
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19
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Jaron KS, Berg MP, Ellers J, Hodson CN, Ross L. The genome sequence of the springtail Allacma fusca (Linnaeus, 1758). Wellcome Open Res 2023; 8:319. [PMID: 37593568 PMCID: PMC10427803 DOI: 10.12688/wellcomeopenres.19690.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/19/2023] Open
Abstract
We present a genome assembly from an individual male Allacma fusca (the springtail; Arthropoda; Collembola; Symphypleona; Sminthuridae). The genome sequence is 392.8 megabases in span. Most of the assembly is scaffolded into 6 chromosomal pseudomolecules, including the X 1 and X 2 sex chromosomes. The mitochondrial genome has also been assembled and is 14.94 kilobases in length.
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Affiliation(s)
- Kamil S. Jaron
- Tree of Life, Wellcome Sanger Institute, Hinxton, England, UK
- School of Biological Sciences, Institute of Ecology and Evolution, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Matty P. Berg
- Amsterdam Institute for Life and Environment, Section Ecology & Evolution, Vrije Universiteit Amsterdam, Amsterdam, North Holland, The Netherlands
| | - Jacintha Ellers
- Amsterdam Institute for Life and Environment, Section Ecology & Evolution, Vrije Universiteit Amsterdam, Amsterdam, North Holland, The Netherlands
| | - Christina N. Hodson
- Biodiversity Research Centre, Department of Zoology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura Ross
- School of Biological Sciences, Institute of Ecology and Evolution, The University of Edinburgh, Edinburgh, Scotland, UK
| | - University of Oxford and Wytham Woods Genome Acquisition Lab
- Tree of Life, Wellcome Sanger Institute, Hinxton, England, UK
- School of Biological Sciences, Institute of Ecology and Evolution, The University of Edinburgh, Edinburgh, Scotland, UK
- Amsterdam Institute for Life and Environment, Section Ecology & Evolution, Vrije Universiteit Amsterdam, Amsterdam, North Holland, The Netherlands
- Biodiversity Research Centre, Department of Zoology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Wellcome Sanger Institute Tree of Life programme
- Tree of Life, Wellcome Sanger Institute, Hinxton, England, UK
- School of Biological Sciences, Institute of Ecology and Evolution, The University of Edinburgh, Edinburgh, Scotland, UK
- Amsterdam Institute for Life and Environment, Section Ecology & Evolution, Vrije Universiteit Amsterdam, Amsterdam, North Holland, The Netherlands
- Biodiversity Research Centre, Department of Zoology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Wellcome Sanger Institute Scientific Operations: DNA Pipelines collective
- Tree of Life, Wellcome Sanger Institute, Hinxton, England, UK
- School of Biological Sciences, Institute of Ecology and Evolution, The University of Edinburgh, Edinburgh, Scotland, UK
- Amsterdam Institute for Life and Environment, Section Ecology & Evolution, Vrije Universiteit Amsterdam, Amsterdam, North Holland, The Netherlands
- Biodiversity Research Centre, Department of Zoology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Tree of Life Core Informatics collective
- Tree of Life, Wellcome Sanger Institute, Hinxton, England, UK
- School of Biological Sciences, Institute of Ecology and Evolution, The University of Edinburgh, Edinburgh, Scotland, UK
- Amsterdam Institute for Life and Environment, Section Ecology & Evolution, Vrije Universiteit Amsterdam, Amsterdam, North Holland, The Netherlands
- Biodiversity Research Centre, Department of Zoology, The University of British Columbia, Vancouver, British Columbia, Canada
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20
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Baird RB, Urban JM, Mongue AJ, Jaron KS, Hodson CN, Grewoldt M, Martin SH, Ross L. Recent evolution of a maternally-acting sex-determining supergene in a fly with single-sex broods. Mol Biol Evol 2023:msad148. [PMID: 37352554 DOI: 10.1093/molbev/msad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/30/2023] [Accepted: 06/15/2023] [Indexed: 06/25/2023] Open
Abstract
Sex determination is a key developmental process, yet it is remarkably variable across the tree of life. The dipteran family Sciaridae exhibits one of the most unusual sex determination systems in which mothers control offspring sex through selective elimination of paternal X chromosomes. Whereas in some members of the family females produce mixed-sex broods, others such as the dark-winged fungus gnat Bradysia coprophila are monogenic, with females producing single-sex broods. Female-producing females were previously found to be heterozygous for a large X-linked paracentric inversion (X´), which is maternally inherited and absent from male-producing females. Here we assembled and characterized the X´ sequence. As close sequence homology between the X and X´ made identification of the inversion challenging, we developed a k-mer-based approach to bin genomic reads before assembly. We confirmed that the inversion spans most of the X´ chromosome (approximately 55Mb) and encodes around 3500 genes. Analysis of the divergence between the inversion and the homologous region of the X revealed that it originated very recently (<0.5 mya). Surprisingly, we found that the X´ is more complex than previously thought and is likely to have undergone multiple rearrangements that have produced regions of varying ages, resembling a supergene composed of evolutionary strata. We found functional degradation of around 7.3% of genes within the region of recombination suppression, but no evidence of accumulation of repetitive elements. Our findings provide an indication that sex-linked inversions are driving turnover of the strange sex determination system in this family of flies.
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Affiliation(s)
- Robert B Baird
- Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, EH9 3JT, UK
| | - John M Urban
- Department of Embryology, Carnegie Institution for Science, Howard Hughes Medical Institute Research Laboratories, Baltimore, Maryland 21218. United States of America
| | - Andrew J Mongue
- Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, EH9 3JT, UK
| | - Kamil S Jaron
- Tree of Life Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Christina N Hodson
- Department of Zoology, University of British Columbia, Vancouver, V6T 1Z4, Canada
| | - Malte Grewoldt
- Department of Molecular Biology and Genetics, Aarhus University, 8000 Aarhus, Denmark
| | - Simon H Martin
- Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, EH9 3JT, UK
| | - Laura Ross
- Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, EH9 3JT, UK
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21
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Baird RB, Mongue AJ, Ross L. Why put all your eggs in one basket? Evolutionary perspectives on the origins of monogenic reproduction. Heredity (Edinb) 2023:10.1038/s41437-023-00632-7. [PMID: 37328587 PMCID: PMC10382564 DOI: 10.1038/s41437-023-00632-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/18/2023] Open
Abstract
Sexual reproduction is ubiquitous in eukaryotes, but the mechanisms by which sex is determined are diverse and undergo rapid turnovers in short evolutionary timescales. Usually, an embryo's sex is fated at the moment of fertilisation, but in rare instances it is the maternal genotype that determines the offspring's sex. These systems are often characterised by mothers producing single-sex broods, a phenomenon known as monogeny. Monogenic reproduction is well documented in Hymenoptera (ants, bees and wasps), where it is associated with a eusocial lifestyle. However, it is also known to occur in three families in Diptera (true flies): Sciaridae, Cecidomyiidae and Calliphoridae. Here we review current knowledge of monogenic reproduction in these dipteran clades. We discuss how this strange reproductive strategy might evolve, and we consider the potential contributions of inbreeding, sex ratio distorters, and polygenic control of the sex ratio. Finally, we provide suggestions on future work to elucidate the origins of this unusual reproductive strategy. We propose that studying these systems will contribute to our understanding of the evolution and turnover of sex determination systems.
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Affiliation(s)
- Robert B Baird
- Institute of Ecology and Evolution, University of Edinburgh, Edinburgh, EH9 3JT, UK.
| | - Andrew J Mongue
- Department of Entomology and Nematology, University of Florida, Gainesville, Florida, 32611, USA
| | - Laura Ross
- Institute of Ecology and Evolution, University of Edinburgh, Edinburgh, EH9 3JT, UK
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22
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Janitz AE, Neil JM, Bray LA, Jervis LL, Ross L, Campbell JE, Doescher MP, Spicer PG, Williams ML, Lopez AK, Uribe-Frias CA, Chen S, James JA, VanWagoner TM. CATCH-UP vaccines: protocol for a randomized controlled trial using the multiphase optimization strategy (MOST) framework to evaluate education interventions to increase COVID-19 vaccine uptake in Oklahoma. BMC Public Health 2023; 23:1146. [PMID: 37316843 PMCID: PMC10265558 DOI: 10.1186/s12889-023-16077-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/08/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Oklahoma's cumulative COVID-19 incidence is higher in rural than urban counties and higher than the overall US incidence. Furthermore, fewer Oklahomans have received at least one COVID-19 vaccine compared to the US average. Our goal is to conduct a randomized controlled trial using the multiphase optimization strategy (MOST) to test multiple educational interventions to improve uptake of COVID-19 vaccination among underserved populations in Oklahoma. METHODS Our study uses the preparation and optimization phases of the MOST framework. We conduct focus groups among community partners and community members previously involved in hosting COVID-19 testing events to inform intervention design (preparation). In a randomized clinical trial, we test three interventions to improve vaccination uptake: (1) process improvement (text messages); (2) barrier elicitation and reduction (electronic survey with tailored questions/prompts); and (2) teachable moment messaging (motivational interviewing) in a three-factor fully crossed factorial design (optimization). DISCUSSION Because of Oklahoma's higher COVID-19 impact and lower vaccine uptake, identifying community-driven interventions is critical to address vaccine hesitancy. The MOST framework provides an innovative and timely opportunity to efficiently evaluate multiple educational interventions in a single study. TRIAL REGISTRATION ClinicalTrials.gov: NCT05236270, First Posted: February 11, 2022, Last Update Posted: August 31, 2022.
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Affiliation(s)
- Amanda E Janitz
- University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 309, Oklahoma City, OK, 73104, USA.
| | - Jordan M Neil
- University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 309, Oklahoma City, OK, 73104, USA
| | - Laura A Bray
- University of Oklahoma Norman Campus, 5 Partners Place, 201 Stephenson Parkway, Suite 4100, Norman, OK, 73072, USA
| | - Lori L Jervis
- University of Oklahoma Norman Campus, 5 Partners Place, 201 Stephenson Parkway, Suite 4100, Norman, OK, 73072, USA
| | - Laura Ross
- Public Health Institute of Oklahoma, P.O. Box 60926, Oklahoma City, OK, 73146, USA
| | - Janis E Campbell
- University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 309, Oklahoma City, OK, 73104, USA
| | - Mark P Doescher
- University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 309, Oklahoma City, OK, 73104, USA
| | - Paul G Spicer
- University of Oklahoma Norman Campus, 5 Partners Place, 201 Stephenson Parkway, Suite 4100, Norman, OK, 73072, USA
| | - Mary L Williams
- University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 309, Oklahoma City, OK, 73104, USA
| | - April K Lopez
- University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 309, Oklahoma City, OK, 73104, USA
| | - Conce A Uribe-Frias
- University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 309, Oklahoma City, OK, 73104, USA
| | - Sixia Chen
- University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 309, Oklahoma City, OK, 73104, USA
| | - Judith A James
- Oklahoma Medical Research Foundation, 825 NE 13th Street, Oklahoma City, OK, 73104, USA
| | - Timothy M VanWagoner
- University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 309, Oklahoma City, OK, 73104, USA
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23
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Hodson CN, Toon A, Cook L, Ross L. Are asymmetric inheritance systems an evolutionary trap? Transitions in the mechanism of paternal genome loss in the scale insect family Eriococcidae. Genetics 2023:7161927. [PMID: 37183508 DOI: 10.1093/genetics/iyad090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/21/2023] [Accepted: 05/12/2023] [Indexed: 05/16/2023] Open
Abstract
Haplodiploidy and paternal genome elimination (PGE) are examples of asymmetric inheritance, where males transmit only maternally inherited chromosomes to their offspring. Under haplodiploidy this results from males being haploid, whereas under PGE males inherit but subsequently exclude paternally inherited chromosomes from sperm. Their evolution involves changes in the mechanisms of meiosis and sex determination, and sometimes also dosage compensation. As a result, these systems are thought to be an evolutionary trap, meaning that once asymmetric chromosome transmission evolves, it is difficult to transition back to typical Mendelian transmission. We assess whether there is evidence for this idea in the scale insect family Eriococcidae, a lineage with PGE and the only clade with a suggestion that asymmetric inheritance has transitioned back to Mendelian inheritance. We conduct a cytological survey of 13 eriococcid species, and a cytological, genetic, and gene expression analysis of species in the genus Cystococcus, to investigate whether there is evidence for species in this family evolving Mendelian chromosome transmission. Although we find that all species we examined exhibit PGE, the mechanism is extremely variable within Eriococcidae. Within Cystococcus, in fact, we uncover a previously undiscovered type of PGE in scale insects that acts exclusively in meiosis, where paternally inherited chromosomes in males are present, uncondensed, and expressed in somatic cells, but eliminated prior to meiosis. Broadly, we fail to find evidence for a reversion from PGE to Mendelian inheritance in Eriococcidae, supporting the idea that asymmetric inheritance systems such as PGE may be an evolutionary trap.
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Affiliation(s)
- Christina N Hodson
- Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, EH9 3JT, UK
- Biodiversity Research Centre, Department of Zoology, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Alicia Toon
- School of Biological Sciences, University of Queensland, Brisbane, QLD, 4072, Australia
| | - Lyn Cook
- School of Biological Sciences, University of Queensland, Brisbane, QLD, 4072, Australia
| | - Laura Ross
- Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, EH9 3JT, UK
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24
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Fairley JL, Hansen D, Ross L, Proudman S, Sahhar J, Ngian GS, Walker J, Host LV, Morrisroe K, Apostolopoulous D, Ferdowsi N, Wilson M, Tabesh M, Stevens W, Nikpour M. Clinical characteristics and survival of pulmonary arterial hypertension with or without interstitial lung disease in systemic sclerosis. Arthritis Res Ther 2023; 25:77. [PMID: 37173780 PMCID: PMC10176744 DOI: 10.1186/s13075-023-03059-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] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVES To describe the clinical phenotype and prognosis of people in the Australian Scleroderma (SSc) Cohort Study with pulmonary arterial hypertension (PAH) with or without interstitial lung disease (ILD). METHODS Participants meeting ACR/EULAR criteria for SSc were divided into four mutually exclusive groups: those meeting criteria for PAH (PAH-only), ILD (ILD-only), concurrent PAH and ILD (PAH-ILD) or neither PAH nor ILD (SSc-only). Logistic or linear regression analyses were used for associations between clinical features, health-related quality of life (HRQoL) and physical function. Survival analysis was performed using Kaplan-Meier estimates and Cox-regression modelling. RESULTS Of 1561 participants, 7% fulfilled criteria for PAH-only, 24% ILD-only, 7% PAH-ILD and 62% SSc-only. People with PAH-ILD were more frequently male, with diffuse skin involvement, higher inflammatory markers, older age of SSc onset and higher frequency of extensive ILD than the cohort overall (p < 0.001). People of Asian race more frequently developed PAH-ILD (p < 0.001). People with PAH-ILD or PAH-only had worse WHO functional class and 6-min-walk-distance than ILD-only (p < 0.001). HRQoL scores were worst in those with PAH-ILD (p < 0.001). Survival was reduced in the PAH-only and PAH-ILD groups (p < 0.01). Multivariable hazard modelling demonstrated the worst prognosis in extensive ILD and PAH (HR = 5.65 95% CI 3.50-9.12 p < 0.01), followed by PAH-only (HR = 4.21 95% CI 2.89-6.13 p < 0.01) and PAH with limited ILD (HR = 2.46 95% CI 1.52-3.99 p < 0.01). CONCLUSIONS The prevalence of concurrent PAH-ILD in the ASCS is 7%, with poorer survival in those patients with PAH-ILD compared to ILD or SSc alone. The presence of PAH confers a poorer overall prognosis than even extensive ILD; however, further data are required to better understand the clinical outcomes of this high-risk patient group.
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Affiliation(s)
- Jessica L Fairley
- The University of Melbourne at St. Vincent's Hospital, 41 Victoria Parade Fitzroy, Melbourne, VIC, 3065, Australia
- St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Dylan Hansen
- St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Laura Ross
- The University of Melbourne at St. Vincent's Hospital, 41 Victoria Parade Fitzroy, Melbourne, VIC, 3065, Australia
- St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Susanna Proudman
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joanne Sahhar
- Monash Health, Melbourne, VIC, Australia
- Monash University, Melbourne, VIC, Australia
| | - Gene-Siew Ngian
- Monash Health, Melbourne, VIC, Australia
- Monash University, Melbourne, VIC, Australia
| | - Jennifer Walker
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Kathleen Morrisroe
- The University of Melbourne at St. Vincent's Hospital, 41 Victoria Parade Fitzroy, Melbourne, VIC, 3065, Australia
- St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Diane Apostolopoulous
- Monash Health, Melbourne, VIC, Australia
- Monash University, Melbourne, VIC, Australia
| | - Nava Ferdowsi
- St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Michelle Wilson
- St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Monash University, Melbourne, VIC, Australia
| | - Maryam Tabesh
- St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Wendy Stevens
- St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Mandana Nikpour
- The University of Melbourne at St. Vincent's Hospital, 41 Victoria Parade Fitzroy, Melbourne, VIC, 3065, Australia.
- St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia.
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25
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Marshall H, Nicholas MT, van Zweden JS, Wäckers F, Ross L, Wenseleers T, Mallon EB. DNA methylation is associated with codon degeneracy in a species of bumblebee. Heredity (Edinb) 2023; 130:188-195. [PMID: 36658299 PMCID: PMC10076500 DOI: 10.1038/s41437-023-00591-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/21/2023] Open
Abstract
Social insects display extreme phenotypic differences between sexes and castes even though the underlying genome can be almost identical. Epigenetic processes have been proposed as a possible mechanism for mediating these phenotypic differences. Using whole genome bisulfite sequencing of queens, males, and reproductive female workers we have characterised the sex- and caste-specific methylome of the bumblebee Bombus terrestris. We have identified a potential role for DNA methylation in histone modification processes which may influence sex and caste phenotypic differences. We also find differentially methylated genes generally show low levels of DNA methylation which may suggest a separate function for lowly methylated genes in mediating transcriptional plasticity, unlike highly methylated genes which are usually involved in housekeeping functions. We also examined the relationship between the underlying genome and the methylome using whole genome re-sequencing of the same queens and males. We find DNA methylation is enriched at zero-fold degenerate sites. We suggest DNA methylation may be acting as a targeted mutagen at these sites, providing substrate for selection via non-synonymous changes in the underlying genome. However, we did not see any relationship between DNA methylation and rates of positive selection in our samples. In order to fully assess a possible role for DNA methylation in adaptive processes a specifically designed study using natural population data is needed.
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Affiliation(s)
- H Marshall
- Department of Genetics and Genome Biology, The University of Leicester, Leicester, UK.
| | - M T Nicholas
- Department of Genetics and Genome Biology, The University of Leicester, Leicester, UK
| | - J S van Zweden
- Laboratory of Socioecology and Social Evolution, Department of Biology, KU Leuven, Leuven, Belgium
| | - F Wäckers
- Biobest Belgium N.V., Westerlo, Belgium
- The Lancaster Environmental Centre, University of Lancaster, Lancaster, UK
| | - L Ross
- The Institute for Evolutionary Biology, University of Edinburgh, Edinburgh, UK
| | - T Wenseleers
- Laboratory of Socioecology and Social Evolution, Department of Biology, KU Leuven, Leuven, Belgium
| | - E B Mallon
- Department of Genetics and Genome Biology, The University of Leicester, Leicester, UK.
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Yu X, Marshall H, Liu Y, Xiong Y, Zeng X, Yu H, Chen W, Zhou G, Zhu B, Ross L, Lu Z. Sex-specific transcription and DNA methylation landscapes of the Asian citrus psyllid, a vector of huanglongbing pathogens. Evolution 2023; 77:1203-1215. [PMID: 36869727 DOI: 10.1093/evolut/qpad036] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 02/02/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023]
Abstract
The relationship of DNA methylation and sex-biased gene expression is of high interest, it allows research into mechanisms of sexual dimorphism and the development of potential novel strategies for insect pest control. The Asian citrus psyllid, Diaphorina citri Kuwayama, is a major vector for the causative agents of Huanglongbing (HLB), which presents an unparalleled challenge to citrus production worldwide. Here, we identify the X chromosome of D. citri and investigate differences in the transcription and DNA methylation landscapes between adult virgin males and females. We find a large number of male-biased genes on the autosomes and a depletion of such on the X chromosome. We have also characterised the methylome of D. citri, finding low genome-wide levels, which is unusual for an hemipteran species, as well as evidence for both promoter and TE methylation. Overall, DNA methylation profiles are similar between the sexes but with a small number of differentially methylated genes found to be involved in sex differentiation. There also appears to be no direct relationship between differential DNA methylation and differential gene expression. Our findings lay the groundwork for the development of novel epigenetic-based pest control methods, and given the similarity of theD. citri methylome to some other insect species, these methods could be applicable across agricultural insect pests.
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Affiliation(s)
- Xiudao Yu
- Ganzhou Key Laboratory of Nanling Insect Biology/Ganzhou Key Laboratory of Greenhouse Vegetables/National Navel Orange Engineering Research Center, College of Life Sciences, Gannan Normal University, Jiangxi, China
| | - Hollie Marshall
- The Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom.,The Institute of Evolutionary Biology, University of Edinburgh, United Kingdom
| | - Yan Liu
- Ganzhou Key Laboratory of Nanling Insect Biology/Ganzhou Key Laboratory of Greenhouse Vegetables/National Navel Orange Engineering Research Center, College of Life Sciences, Gannan Normal University, Jiangxi, China
| | - Yu Xiong
- Ganzhou Key Laboratory of Nanling Insect Biology/Ganzhou Key Laboratory of Greenhouse Vegetables/National Navel Orange Engineering Research Center, College of Life Sciences, Gannan Normal University, Jiangxi, China
| | - Xiangdong Zeng
- Ganzhou Key Laboratory of Nanling Insect Biology/Ganzhou Key Laboratory of Greenhouse Vegetables/National Navel Orange Engineering Research Center, College of Life Sciences, Gannan Normal University, Jiangxi, China
| | - Haizhong Yu
- Ganzhou Key Laboratory of Nanling Insect Biology/Ganzhou Key Laboratory of Greenhouse Vegetables/National Navel Orange Engineering Research Center, College of Life Sciences, Gannan Normal University, Jiangxi, China
| | - Wei Chen
- Ganzhou Key Laboratory of Nanling Insect Biology/Ganzhou Key Laboratory of Greenhouse Vegetables/National Navel Orange Engineering Research Center, College of Life Sciences, Gannan Normal University, Jiangxi, China
| | - Guchun Zhou
- Ganzhou Key Laboratory of Nanling Insect Biology/Ganzhou Key Laboratory of Greenhouse Vegetables/National Navel Orange Engineering Research Center, College of Life Sciences, Gannan Normal University, Jiangxi, China
| | - Bo Zhu
- Ganzhou Key Laboratory of Nanling Insect Biology/Ganzhou Key Laboratory of Greenhouse Vegetables/National Navel Orange Engineering Research Center, College of Life Sciences, Gannan Normal University, Jiangxi, China
| | - Laura Ross
- The Institute of Evolutionary Biology, University of Edinburgh, United Kingdom
| | - Zhanjun Lu
- Ganzhou Key Laboratory of Nanling Insect Biology/Ganzhou Key Laboratory of Greenhouse Vegetables/National Navel Orange Engineering Research Center, College of Life Sciences, Gannan Normal University, Jiangxi, China
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Ross L, Costello B, Lindqvist A, Hansen D, Brown Z, Stevens W, Burns A, Prior D, Pianta M, Perera W, La Gerche A, Nikpour M. Disease specific determinants of cardiopulmonary fitness in systemic sclerosis. Semin Arthritis Rheum 2023; 58:152137. [PMID: 36434894 DOI: 10.1016/j.semarthrit.2022.152137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We aimed to quantify the burden of exercise intolerance in systemic sclerosis (SSc) and explore the disease features that contribute to impaired exercise capacity (measured as peak oxygen uptake, peak VO2) to provide novel mechanistic insights into the causes of physical disability in SSc. METHODS Thirty-three SSc patients with no history of cardiac disease and no active myositis underwent cardiac and skeletal muscle MRI, transthoracic echocardiography, pulmonary function tests and cardiopulmonary exercise testing (CPET). CPET results were compared to an age-, sex-, and weight-matched controls with no overt cardiopulmonary disease. Native T1 and T2-mapping sequences were used to quantify diffuse fibroinflammatory myocardial disease and qualitative assessment of skeletal muscle oedema was performed. The associations between parameters of cardiorespiratory function and skeletal muscle abnormalities and peak VO2 were evaluated with linear regression analysis. RESULTS Exercise capacity was markedly impaired in SSc and significantly reduced when compared to control subjects (percent predicted peak VO2: 70% vs 98%, p < 0⋅01). Diffuse myocardial fibroinflammatory disease (p < 0⋅01) and skeletal muscle oedema (p = 0⋅01) were significantly associated with reduced exercise capacity. There was no association between impaired exercise capacity and left ventricular ejection fraction. CONCLUSION SSc is associated with marked functional impairment that is not explained by commonly used parameters of cardiac function such as left ventricular ejection fraction. Rather, only more sensitive measures of organ involvement are associated with impaired exercise tolerance. Our results show diffuse interstitial changes of the myocardium and skeletal muscle affect oxygen uptake and are important contributors to functional limitation in SSc.
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Affiliation(s)
- Laura Ross
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia; Department of Rheumatology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.
| | - Benedict Costello
- Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; Department of Cardiology, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia
| | - Anniina Lindqvist
- Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Dylan Hansen
- Department of Rheumatology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Zoe Brown
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia; Department of Rheumatology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Andrew Burns
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia; Department of Cardiology, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia
| | - David Prior
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia; Department of Cardiology, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia
| | - Marcus Pianta
- Department of Medical Imaging, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia
| | - Warren Perera
- Department of Medical Imaging, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia
| | - André La Gerche
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia; Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; Department of Cardiology, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia; Department of Rheumatology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
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Ross L, McKelvie P, Reardon K, Wong H, Wicks I, Day J. Muscle biopsy practices in the evaluation of neuromuscular disease: A systematic literature review. Neuropathol Appl Neurobiol 2023; 49:e12888. [PMID: 36734037 PMCID: PMC10946625 DOI: 10.1111/nan.12888] [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: 09/23/2022] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023]
Abstract
AIMS Muscle biopsy techniques range from needle muscle biopsy (NMB) and conchotome biopsy to open surgical biopsy. It is unknown whether specific biopsy techniques offer superior diagnostic yield or differ in procedural complication rates. Therefore, we aimed to compare the diagnostic utility of NMB, conchotome and open muscle biopsies in the assessment of neuromuscular disorders. METHODS A systematic literature review of the EMBASE and Medline (Ovid) databases was performed to identify original, full-length research articles that described the muscle biopsy technique used to diagnose neuromuscular disease in both adult and paediatric patient populations. Studies of any design, excluding case reports, were eligible for inclusion. Data pertaining to biopsy technique, biopsy yield and procedural complications were extracted. RESULTS Sixty-four studies reporting the yield of a specific muscle biopsy technique and, or procedural complications were identified. Open surgical biopsies provided a larger tissue sample than any type of percutaneous muscle biopsy. Where anaesthetic details were reported, general anaesthesia was required in 60% of studies that reported open surgical biopsies. Percutaneous biopsies were most commonly performed under local anaesthesia and despite the smaller tissue yield, moderate- to large-gauge needle and conchotome muscle biopsies had an equivalent diagnostic utility to that of open surgical muscle biopsy. All types of muscle biopsy procedures were well tolerated with few adverse events and no scarring complications were reported with percutaneous sampling. CONCLUSIONS When a histological diagnosis of myopathy is required, moderate- to large-gauge NMB and the conchotome technique appear to have an equivalent diagnostic yield to that of an open surgical biopsy.
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Affiliation(s)
- Laura Ross
- Department of RheumatologySt Vincent's Hospital MelbourneFitzroyVictoriaAustralia
- Department of MedicineThe University of Melbourne at St Vincent's HospitalFitzroyVictoriaAustralia
| | - Penny McKelvie
- Department of Anatomical PathologySt Vincent's Hospital MelbourneFitzroyVictoriaAustralia
| | - Katrina Reardon
- Department of NeurologySt Vincent's Hospital MelbourneFitzroyVictoriaAustralia
| | - Huon Wong
- Inflammation DivisionWalter and Eliza Hall Institute of Medical ResearchParkvilleVictoriaAustralia
| | - Ian Wicks
- Inflammation DivisionWalter and Eliza Hall Institute of Medical ResearchParkvilleVictoriaAustralia
- Department of RheumatologyRoyal Melbourne HospitalParkvilleVictoriaAustralia
- Department of Medical BiologyUniversity of MelbourneParkvilleVictoriaAustralia
| | - Jessica Day
- Inflammation DivisionWalter and Eliza Hall Institute of Medical ResearchParkvilleVictoriaAustralia
- Department of RheumatologyRoyal Melbourne HospitalParkvilleVictoriaAustralia
- Department of Medical BiologyUniversity of MelbourneParkvilleVictoriaAustralia
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Ross L, Proudman S, Walker J, Stevens W, Ferdowsi N, Quinlivan A, Morrisroe K, Baron M, Nikpour M. Evaluation of patient and physician assessments of gastrointestinal disease activity in systemic sclerosis. J Rheumatol 2022; 50:519-525. [PMID: 36379565 DOI: 10.3899/jrheum.220832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
ObjectiveTo assess whether patient and physician global assessment of gastrointestinal disease in systemic sclerosis (SSc) are associated with a meaningful change in disease status.MethodsOne hundred and forty-three participants from the Australian Scleroderma Cohort Study were recruited to this study. Using logistic regression analysis, we evaluated the relationship between patient and physician assessed gastrointestinal disease status and symptoms, measures of health-related quality of life (Medical Short Form 36 (SF-36)) and gastrointestinal disease severity, measured by the Scleroderma Clinical Trials Consortium (SCTC) UCLA Gastrointestinal Tract 2.0 Score (GIT 2.0).ResultsPatient-reported worsening of gastrointestinal symptoms in the month preceding assessment was significantly associated with more severe gastrointestinal disease (OR 6.14, p<0.01) and progressive worsening gastrointestinal disease severity as measured by the GIT 2.0 score (OR 45.98, p<0.01). The new onset of reflux was the only specific symptom associated with patient reported gastrointestinal disease activity (OR 2.98, p=0.04). Physician assessed gastrointestinal disease activity was not significantly associated with higher GIT 2.0 scores or increasing severity of disease. Patient and physician assessed gastrointestinal activity was not associated with SF-36 scores.ConclusionIn the absence of objective measures of gastrointestinal disease activity in SSc, patient-reported symptoms of gastrointestinal disease could be used to indicate disease activity and merit consideration for inclusion in a multi-system disease activity index.
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Ross L, Nikpour M, D'Aoust J, Khanna D, Merkel PA, Pauling JD, Baron M. Patient and Physician Global Assessments of Disease Status in Systemic Sclerosis. Arthritis Care Res (Hoboken) 2022. [PMID: 36342397 DOI: 10.1002/acr.25056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/11/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
Global assessments of disease by both patients and physicians are widely used in clinical studies of systemic sclerosis (SSc). They are commonly secondary end points in randomized controlled trials (RCTs) and are considered important items in composite measures of treatment response. A comprehensive literature review was conducted of the formats, wording, and clinimetric properties of the patient global assessment of disease status (PtGA) and physician global assessment of disease status (PhGA) used in RCTs of SSc. Marked heterogeneity was found in the wording and measurement scales of the global assessments applied in RCTs. These instruments were not developed using rigorous methodology and have not been fully validated. There is a pressing need for standardization and validation of patient and physician global assessment tools in SSc to enable universal application of these measures across RCTs in SSc.
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Affiliation(s)
- Laura Ross
- The University of Melbourne at St Vincent's Hospital and St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Mandana Nikpour
- The University of Melbourne at St Vincent's Hospital and St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Julie D'Aoust
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | | | - Murray Baron
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Ross L, Patel S, Stevens W, Burns A, Prior D, La Gerche A, Nikpour M. The clinical implications of left ventricular diastolic dysfunction in systemic sclerosis. Clin Exp Rheumatol 2022; 40:1986-1992. [PMID: 36259603 DOI: 10.55563/clinexprheumatol/irc0ih] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES We sought to quantify the burden of left ventricular diastolic dysfunction (LVDD) and heart failure with preserved ejection fraction (HFpEF) in systemic sclerosis (SSc) and assess the progression of LVDD over time and its prognostic importance. METHODS Two-hundred and twenty-five participants enrolled in the Australian Scleroderma Cohort Study were included and LVDD was assessed according to 2016 ASE/EACVI Guidelines. Logistic regression analyses and generalised estimating equations were performed to evaluate the relationship between LVDD and SSc disease characteristics and symptoms and signs of heart failure, respectively. The relationship between LVDD and mortality was assessed using Kaplan-Meier survival estimates. RESULTS Thirty-four (15%) participants were diagnosed with LVDD. A further 89 (40%) participants had indeterminate diastolic function. Older age (p<0.01), hypertension (p=0.02), impaired systolic function (p=0.03) and interstitial lung disease (p=0.01) were all associated with the presence of LVDD. There was no association between the presence of LVDD and clinical signs of heart failure, however, LVDD was associated with more breathlessness and worse functional class (p=0.03). LVDD was observed to progress over time, with significant worsening of parameters of left ventricular filling pressure. There was no significant relationship between LVDD and mortality (p=0.23). CONCLUSIONS Abnormal diastolic function is a common finding in SSc, progresses over time and is associated with more severe dyspnoea. Whilst patients with LVDD are more breathless, LVDD is not clearly associated with clinical findings of heart failure demonstrating that LVDD may be of importance in explaining symptoms even in the absence of HFpEF in SSc.
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Affiliation(s)
- Laura Ross
- Department of Rheumatology, St Vincent's Hospital, Melbourne, and Department of Medicine at St Vincent's Hospital, The University of Melbourne, Australia.
| | - Shreeya Patel
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Andrew Burns
- Department of Medicine at St. Vincent's Hospital, The University of Melbourne, and Department of Cardiology, St. Vincent's Hospital, Melbourne, Australia
| | - David Prior
- Department of Medicine at St. Vincent's Hospital, The University of Melbourne, and Department of Cardiology, St. Vincent's Hospital, Melbourne, Australia
| | - Andre La Gerche
- Department of Medicine at St. Vincent's Hospital, The University of Melbourne, Department of Cardiology, St. Vincent's Hospital, and Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Mandana Nikpour
- Department of Rheumatology, St Vincent's Hospital, Melbourne, and Department of Medicine at St Vincent's Hospital, The University of Melbourne, Australia
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Geyer C, Garber J, Gelber R, Yothers G, Taboada M, Ross L, Rastogi P, Cui K, Arahmani A, Aktan G, Armstrong A, Arnedos M, Balmaña J, Bergh J, Bliss J, Delaloge S, Domchek S, Eisen A, Elsafy F, Fein L, Fielding A, Ford J, Friedman S, Gelmon K, Gianni L, Gnant M, Hollingsworth S, Im SA, Jager A, Jóhannsson Ó, Lakhani S, Janni W, Linderholm B, Liu TW, Loman N, Korde L, Loibl S, Lucas P, Marmé F, Martinez de Dueñas E, McConnell R, Phillips KA, Piccart M, Rossi G, Schmutzler R, Senkus E, Shao Z, Sharma P, Singer C, Španić T, Stickeler E, Toi M, Traina T, Viale G, Zoppoli G, Park Y, Yerushalmi R, Yang H, Pang D, Jung K, Mailliez A, Fan Z, Tennevet I, Zhang J, Nagy T, Sonke G, Sun Q, Parton M, Colleoni M, Schmidt M, Brufsky A, Razaq W, Kaufman B, Cameron D, Campbell C, Tutt A. Overall survival in the OlympiA phase III trial of adjuvant olaparib in patients with germline pathogenic variants in BRCA1/2 and high risk, early breast cancer. Ann Oncol 2022; 33:1250-1268. [PMID: 36228963 DOI: 10.1016/j.annonc.2022.09.159] [Citation(s) in RCA: 115] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The randomized, double-blind OlympiA trial compared 1 year of the oral poly(adenosine diphosphate-ribose) polymerase inhibitor, olaparib, to matching placebo as adjuvant therapy for patients with pathogenic or likely pathogenic variants in germline BRCA1 or BRCA2 (gBRCA1/2pv) and high-risk, human epidermal growth factor receptor 2-negative, early breast cancer (EBC). The first pre-specified interim analysis (IA) previously demonstrated statistically significant improvement in invasive disease-free survival (IDFS) and distant disease-free survival (DDFS). The olaparib group had fewer deaths than the placebo group, but the difference did not reach statistical significance for overall survival (OS). We now report the pre-specified second IA of OS with updates of IDFS, DDFS, and safety. PATIENTS AND METHODS One thousand eight hundred and thirty-six patients were randomly assigned to olaparib or placebo following (neo)adjuvant chemotherapy, surgery, and radiation therapy if indicated. Endocrine therapy was given concurrently with study medication for hormone receptor-positive cancers. Statistical significance for OS at this IA required P < 0.015. RESULTS With a median follow-up of 3.5 years, the second IA of OS demonstrated significant improvement in the olaparib group relative to the placebo group [hazard ratio 0.68; 98.5% confidence interval (CI) 0.47-0.97; P = 0.009]. Four-year OS was 89.8% in the olaparib group and 86.4% in the placebo group (Δ 3.4%, 95% CI -0.1% to 6.8%). Four-year IDFS for the olaparib group versus placebo group was 82.7% versus 75.4% (Δ 7.3%, 95% CI 3.0% to 11.5%) and 4-year DDFS was 86.5% versus 79.1% (Δ 7.4%, 95% CI 3.6% to 11.3%), respectively. Subset analyses for OS, IDFS, and DDFS demonstrated benefit across major subgroups. No new safety signals were identified including no new cases of acute myeloid leukemia or myelodysplastic syndrome. CONCLUSION With 3.5 years of median follow-up, OlympiA demonstrates statistically significant improvement in OS with adjuvant olaparib compared with placebo for gBRCA1/2pv-associated EBC and maintained improvements in the previously reported, statistically significant endpoints of IDFS and DDFS with no new safety signals.
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Jaron KS, Hodson CN, Ellers J, Baird SJE, Ross L. Genomic evidence of paternal genome elimination in the globular springtail Allacma fusca. Genetics 2022; 222:6659513. [PMID: 35946560 DOI: 10.1093/genetics/iyac117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/16/2022] [Indexed: 11/13/2022] Open
Abstract
Paternal genome elimination (PGE) - a type of reproduction in which males inherit but fail to pass on their father's genome - evolved independently in six to eight arthropod clades. Thousands of species, including several important for agriculture, reproduce via this mode of reproduction. While PGE is well established in some of the clades, the evidence in globular springtails (Symphypleona) remains elusive, even though they represent the oldest and most species rich clade putatively reproducing via PGE. We sequenced genomic DNA from whole bodies of Allacma fusca males with high fractions (>27.5%) of sperm to conclusively confirm that all the sperm carry one parental haplotype only. Although it is suggestive that the single haplotype present in sperm is maternally inherited, definitive genetic proof of the parent of origin is still needed. The genomic approach we developed allows for detection of genotypic differences between germline and soma in all species with sufficiently high fraction of germline in their bodies. This opens new opportunities for scans of reproductive modes in small organisms.
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Affiliation(s)
- Kamil S Jaron
- Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, EH9 3JT, UK
| | - Christina N Hodson
- Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, EH9 3JT, UK
| | - Jacintha Ellers
- Department of Ecological Science, Vrije Universiteit Amsterdam, Faculty of Science, Amsterdam, 1081 HV, NL
| | - Stuart J E Baird
- Institute of Vertebrate Biology, Czech Academy of Sciences, Studenec 122 675 02 Koněšín, CZ
| | - Laura Ross
- Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, EH9 3JT, UK
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Campochiaro C, Suliman YA, Hughes M, Schoones J, Giuggioli D, Moinzadeh P, Maltez N, Ross L, Baron M, Chung L, Allanore Y, Denton CP, Distler O, Frech T, Furst D, Khanna D, Krieg T, Kuwana M, Matucci-Cerinic M, Pope J, Alunno A. POS0888 NON-SURGICAL LOCAL TREATMENTS FOR DIGITAL ULCERS IN SYSTEMIC SCLEROSIS: A SYSTEMATIC LITERATURE REVIEW. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundDigital ulcers(DUs) in systemic sclerosis(SSc) represent a major clinical challenge. There are no recommendations for the local management of SSc-DUs. Systemic therapy is considered the standard of care. However, there is a strong rationale for local approaches to DU by avoiding side effects from systemic therapies. The World Scleroderma Foundation DU Working Group intends to develop evidence-based recommendations for DU management including local, non-surgical treatment(ln-sT).ObjectivesTo summarise the literature on the safety and efficacy of ln-sT for SSc-DUs.MethodsA systematic literature review(SLR) of papers describing the use of ln-sT for DU in SSc was performed up to May 2021 according to the PICO framework. References were independently screened by two reviewers who independently assessed the full text of eligible articles and extracted data.ResultsAmong 790 retrieved references, 12 were included. Median(range) number of patients per study was 9(7–84), mean age ranging from 37 to 62.5 years. In 5(41%) studies a control group was included. Background systemic therapies are summarized in Table 1. The most studied treatment was botulin toxin A(BTA). It was used as hand injection in 3 studies (median dose ranging from 90 to 150 U) and as 50 U single finger injection in 1 study. Healing rate after a median time of 8-49 weeks ranged from 71% to 100%. In 2 studies a reduction in VAS pain was observed from 20% to 100%. Transient muscle weakness was the most common side effect in 10% of patients. Amniotic(Am) and hydrocolloid membranes(HyM) were used in 1 study each. They were associated with a good healing rate, statistically significant for the HyM. Tadalafil 2% cream was studied in 1 study and was associated with a reduction in the median DU number from 1.6 to 1 per patient after a median time of 4 weeks and a reduction by 1.4 point in the 10-mm VAS scale. Vitamin E gel was shown to be associated with a statistically significant reduction in the healing time compared to SoC alone in 1 RCT(13.2 ± 2.7 versus 20.9 ± 3.6 weeks, P=<0.001). Low-level light therapy, hydrodissection and corticosteroid injection and extracorporeal shock wave(ESW) were evaluated in 1 study each. They were all associated with positive outcomes which was statistically significant only for the ESW. The only negative trial examined dimethyl sulfoxide and was associated with local toxicity.Table 1.Characteristics of the studies.TreatmentType of studyPatientsBaseline DUBackground therapy (%) ETA CCB APA PG ARB ACE-I PDE-5i ISFollow-up (weeks)Healing rate(%)*Pain Reduction (VAS/10)ComparatorHydrodissection and corticosteroid injectionP1202334.4Rheumatoid ArthritisTadalafil 2% Vitamin E gelRRCT15131.6(1)3.5±2.30462700130704 241(1)Reduced time to heal**1.4SoCAmHyMRP67310001002800002817033143810090**SoCBTAMedian 90 U per handHigh-concentration hand100 U non-dominant handSingle finger 50 URRPP772010314571140718558551008514201001414718 4981277717510020%100%Untreated CHLow-level light therapyP8102537025378100ESWP9493355661144441**1.31Dimethyl sulfoxideDBRCT84No change, skin toxicity with 70% formulation*Unless otherwise stated. **Statistically significant. ARB= angiotensin receptor antagonist. ACEi= ACE inhibitors. APA= anti-platelet agents. CCB= calcium channel blockers. CH= contralateral hand. DBRCT= double blind randomized-controlled trial. ETA = endothelin antagonist. IS= immunosuppression. PG= prostaglandins. PDE-5i= Phosphodiesterase type-5 inhibitors. P = prospective. R = retrospective. SoC= standard of care (as per local protocol).ConclusionOur SLR supports interest to develop ln-sTs for SSc-DUs. The number of studies is limited and mainly case reports and small single studies are present. Treatments were well tolerated and there was evidence of efficacy for BTA, vitamin E, ESW and HyM in refractory DUs. The evidence is not robust and confounding factors (vasodilators background therapies) could impact on the findings. Future research is indicated to conduct larger, well-designed studies.Disclosure of InterestsCorrado Campochiaro: None declared, Yossra A. Suliman: None declared, Michael Hughes Speakers bureau: Actelion pharmaceuticals, Eli Lilly, and Pfizer, outside of the submitted work., Jan Schoones: None declared, Dilia Giuggioli: None declared, Pia Moinzadeh Speakers bureau: speaking fees from Actelion pharmaceuticals and Boehringer Ingelheim, Nancy Maltez: None declared, Laura Ross: None declared, Murray Baron: None declared, Lorinda Chung: None declared, Yannick Allanore: None declared, Christopher P Denton: None declared, Oliver Distler Speakers bureau: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Medscape, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur, Tracy Frech: None declared, Daniel Furst: None declared, Dinesh Khanna Speakers bureau: Janssen and Eicos Sciences, Inc., Thomas Krieg: None declared, Masataka Kuwana Speakers bureau: Speakers fees from AbbVie, Asahi Kasei Pharma, Astellas, Boehringer Ingelheim, Chugai, Eisai, GlaxoSmithKline, Janssen, Nippon Shinyaku, Ono Pharmaceuticals, Tanabe-Mitsubishi, and Consultant fees from AstraZeneca, Boehringer Ingelheim, Corbus, Kissei, Mochida, outside of the submitted work., Marco Matucci-Cerinic: None declared, Janet Pope: None declared, Alessia Alunno: None declared
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Suliman YA, Campochiaro C, Hughes M, Schoones J, Giuggioli D, Maltez N, Moinzadeh P, Ross L, Chung L, Allanore Y, Baron M, Denton CP, Distler O, Frech T, Furst D, Khanna D, Krieg T, Kuwana M, Matucci-Cerinic M, Pope J, Alunno A. POS0898 SURGICAL MANAGEMENT OF DIGITAL ULCERS IN SYSTEMIC SCLEROSIS: A SYSTEMATIC LITERATURE REVIEW. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundManagement of digital ulcers (DUs) in systemic sclerosis (SSc) is a major clinical challenge. To date, systemic therapy is generally considered as the ‘standard of care’ for significant SSc-DUs. However, there is a strong rationale to develop local approaches to DUs, to avoid side effects from systemic therapies. World Scleroderma Foundation DU Working Group intends to develop practical, evidence-based recommendations for DU management including local, Surgical Treatment (L-ST).ObjectivesTo summarize the literature on the safety and efficacy of L-ST for SSc-DUs.MethodsA systematic literature review (SLR) was conducted up to May 2021. According to the PICO framework, eligibility criteria were defined and original research articles about surgical treatment of SSc DUs in adult patients were included. References were independently screened by 2 reviewers who assessed the full text of eligible articles and extracted data.ResultsThirteen eligible articles out of 790 total publications were identified (Table 1). Due to the paucity of randomized controlled trials of surgical treatments for SSc-DU, we included retrospective studies and case series with at least 4 patients. Autologous fat (adipose tissue AT) grafting was the surgical modality mostly identified (7 studies of which 1 RCT and 6 prospective open label single arm). The healing rate (HR) with autologous fat grafting (4 studies) ranged from 66-100 %. In the RCT, two age and sex matched groups were included, adipose tissue (AT)group (n=25 pts) and sham procedure (SP) group (n=13), DU healing was reported in 23/25 in AT group versus 1/13 in the SP group in 8 wks, (p<0.0001), 12 pts in the SP group, received rescue AT injection, all of them healed after 8 wks. Three studies reported autologous adipose-derived stromal vascular fraction(SVF) grafting and the HR ranged from 32-60%, followed up to 12 months. Transient edema and paresthesia were reported in 2 studies, and amputation in 2 ulcers in 1 study, and no complications were reported in other studies. Surgical sympathectomy was reported in 3 studies, with a median healing rate of 81%. Bone marrow derived cell transplantation in a single study showed 87% healing rate over (4-24 wks). Two surgical studies (of direct microsurgical revascularization N=4, and microsurgical arteriolysis, N=6), showed 100% healing of ulcers, no complications reported.Table 1.Characteristics of the extracted studies.StudydesignPatients (n)Baseline DU (n)Background therapy (%)Follow-upOutcomeHealed ulcers(%) Adipose tissue graftAutologous fat graftp9.15PG, CCB—100ETA 26PDE-5i 138-12 wks66Adipose tissue graftingRCT25 case13- Ctr25-case13- CtrPG- 100CCB 1008 wks92-case7-CtrAdipose tissue implantp1515no therapy7 wks100Adipose tissue graftp129PG,CCB-100ETA6 month88adipose derived SVFp1215PDE-5i, ccb, PG allowed22m6Adipose derived SVFp1215CCB 50ETA166 m63 Adipose derived SVFp1819CCB 50PG 27ETA 5IS 7124 wks32SympathectomySympathectomyR611CCB-10020 m81SympathectomyR1335PGCCBAPA35Sympathectomy, vascular bypass (+vein graftR1726Ccb 35APA 47PDE-i5 589 m100Bone marrow derived cells transplantation)p88PG-6236 m87Direct microsurgical revascularizationR44m100Limited microsurgical arteriolysisR61712 m100SVF =stromal vascular fraction P = prospective. R = retrospective. RCT= double blind randomized-controlled trial. ETA = endothelin antagonist. CCB= calcium channel blockers. APA= anti-platelet agents. PG= prostaglandins. ARB= angiotensin receptor antagonist. ACEi= ACE inhibitors. PDE-5i= PDE-5 inhibitors. IS= immunosuppression. M=median. SoC= standard of care. HR= healing rateConclusionOur SLR has identified several surgical modalities for SSc-DUs. L-STseemed generally effective and safe for DU healing, thus Significant methodological issues emerged including small numbers of pts, lack of comparator, failure to report confounders such as background therapies and variable follow up. Future research is warranted to rigorously investigate surgical interventions for Dus.Disclosure of InterestsYossra A. Suliman: None declared, Corrado Campochiaro: None declared, Michael Hughes Speakers bureau: speaking fees from Actelion pharmaceuticals, Eli Lilly, and Pfizer, outside of the submitted work, Jan Schoones: None declared, Dilia Giuggioli: None declared, Nancy Maltez: None declared, Pia Moinzadeh Speakers bureau:: speaking fees from Actelion pharmaceuticals and Boehringer Ingelheim, Laura Ross: None declared, Lorinda Chung: None declared, Yannick Allanore: None declared, Murray Baron: None declared, Christopher P Denton: None declared, Oliver Distler Shareholder of: Consultancy relationship with and/or has received research funding from and/or has served as a speaker for the following companies in the area of potential treatments for systemic sclerosis and its complications in the last three calendar years: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Medscape, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Speakers bureau: Consultancy relationship with and/or has received research funding from and/or has served as a speaker for the following companies in the area of potential treatments for systemic sclerosis and its complications in the last three calendar years: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Medscape, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Consultant of: Consultancy relationship with and/or has received research funding from and/or has served as a speaker for the following companies in the area of potential treatments for systemic sclerosis and its complications in the last three calendar years: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Medscape, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Grant/research support from: Consultancy relationship with and/or has received research funding from and/or has served as a speaker for the following companies in the area of potential treatments for systemic sclerosis and its complications in the last three calendar years: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Medscape, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Tracy Frech: None declared, Daniel Furst: None declared, Dinesh Khanna Speakers bureau: Janssen and Eicos Sciences, Inc., Paid instructor for: Janssen and Eicos Sciences, Inc., Consultant of: Janssen and Eicos Sciences, Inc., Thomas Krieg: None declared, Masataka KUWANA Speakers bureau: Speakers fees from AbbVie, Asahi Kasei Pharma, Astellas, Boehringer Ingelheim, Chugai, Eisai, GlaxoSmithKline, Janssen, Nippon Shinyaku, Ono Pharmaceuticals, Tanabe-Mitsubishi, and Consultant fees from AstraZeneca, Boehringer Ingelheim, Corbus, Kissei, Mochida, outside of the submitted work., Paid instructor for: Speakers fees from AbbVie, Asahi Kasei Pharma, Astellas, Boehringer Ingelheim, Chugai, Eisai, GlaxoSmithKline, Janssen, Nippon Shinyaku, Ono Pharmaceuticals, Tanabe-Mitsubishi, and Consultant fees from AstraZeneca, Boehringer Ingelheim, Corbus, Kissei, Mochida, outside of the submitted work., Consultant of: Speakers fees from AbbVie, Asahi Kasei Pharma, Astellas, Boehringer Ingelheim, Chugai, Eisai, GlaxoSmithKline, Janssen, Nippon Shinyaku, Ono Pharmaceuticals, Tanabe-Mitsubishi, and Consultant fees from AstraZeneca, Boehringer Ingelheim, Corbus, Kissei, Mochida, outside of the submitted work., Marco Matucci-Cerinic: None declared, Janet Pope: None declared, Alessia Alunno: None declared
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Maltez N, Ross L, Hughes M, Schoones J, Baron M, Chung L, Campochiaro C, Suliman YA, Giuggioli D, Moinzadeh P, Allanore Y, Denton CP, Distler O, Frech T, Furst D, Khanna D, Krieg T, Kuwana M, Matucci-Cerinic M, Pope J, Alunno A. POS0900 SYSTEMIC PHARMACOLOGICAL TREATMENT OF DIGITAL ULCERS IN SYSTEMIC SCLEROSIS: A SYSTEMATIC LITERATURE REVIEW. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundDigital ulcers (DU) are common in systemic sclerosis (SSc) and associated with reduced survival, high morbidity and poor quality of life. Recommendations have previously been proposed for DU management yet there remains significant unmet patient need. Therefore the World Scleroderma Foundation DU Working Group intends to develop practical evidence based recommendations for DU management.ObjectivesTo summarise data on efficacy and safety of systemic treatments for SSc DU.MethodsA systematic literature review to May 2021 was performed. PubMed, MEDLINE, Embase, Web of Science, Cochrane Library, Emcare (OVID) and Academic Search Premier databases were searched for original studies on adult patients with SSc DU treated with systemic pharmacological treatment. Based on the PICO framework, eligibility criteria were defined and references were independently screened by two reviewers. Reviewers independently assessed the full text of eligible articles. Owing to interstudy heterogeneity narrative summaries were used to present data.ResultsThe search strategy identified 1271 references of which 45 eligible articles were included. Seventeen studies were randomised placebo controlled trials (RCT) pertaining to PDE5 antagonists (PDE5i) (n=3), endothelin receptor antagonists (ERA) (n=3), prostanoids (n=7), antiplatelet agents (n=1) and other (n=3) (Table 1). No head to head RCT was retrieved. All other studies were observational studies (OBS). Studies were highly heterogeneous with application of differing definition of DU, variable study eligibility criteria, clinical endpoints and follow up periods. This limited the calculation of effect size and comparison across studies.Table 1.Characteristics of placebo controlled randomised controlled trialsAuthor YearInterventionnFollow upOutcomeFavours interventionHachulla 2016Sildenafil8312 weeksTime to DU healing-Andrigueti 2017Sildenafil4112 weeksDU healing+Shenoy 2010Tadalafil246 weeksNew DU+Khanna 2016Macitentan55416 weeksNew DU-Matucci-Cerinic 2011Bosentan18832 weeksNew DU Time to healing of DU+-Korn 2004Bosentan12212 weeksNew DU+Kawald 2008IV iloprost5012 monthsDU healing-Wigley 1992IV iloprost3510 weeksDU healing+Wigley 1994IV iloprost739 weeks50% reduction in DU score-Seibold 2017Treprostinil14820 weeksNet DU burden-Vayssairat 1999Beraprost10725 weeks% patients with new DU-Denton 2017Selexipag7412 weeksNumber of new DU DU healing-Lau 1993Cicaprost334 weeksNumber of DU-Abou-Raya 2008Atorvastatin844 monthsNumber of DU+Au 2010Cyclophosphamide15812 monthsNumber of patients with DU-Beckett 1984Dipyridamole / aspirin412 yearsChange in general SSc-Nagaraja 2019Riociguat1732 weeksNet DU burden-+ significantly superior to comparator- non significantly different from comparatorDU: digital ulcers IV: intravenous SSc: systemic sclerosisSeveral RCT found improved DU healing with treatment: two with PDE5i, one with iloprost and one showed improved DU healing and prevention with atorvastatin. Two RCT demonstrated effective prevention of new DU with bosentan. OBS studies with a total of 621 patients showed variable improvements in the healing of DU with CCB, PDE5i, ERA, statins, N-acetylcysteine, prostanoids and ketanserin and prevention of new DU with ERA.Regarding safety, all treatments were generally tolerated with few serious adverse events. Treatment was ceased in 6.25-17.5% of patients in RCT due to treatment related side effects.ConclusionDespite several studies assessing the efficacy and safety of systemic pharmacological treatment of SSc DU, it is not possible to draw solid conclusions due to study heterogeneity. Small RCT have shown treatment benefit with PDE5i, iloprost and atorvastatin. Large studies demonstrated effective prevention of new DU with bosentan. Our results highlight the urgent need for improved clinical trial design to generate more robust evidence and novel therapies to guide the management SSc DU.AcknowledgementsThis work was supported by the World Scleroderma Foundation.Disclosure of InterestsNancy Maltez: None declared, Laura Ross: None declared, Michael Hughes Speakers bureau: Actelion Pharmaceuticals, Eli Lilly and Pfizer outside of the submitted work., Jan Schoones: None declared, Murray Baron: None declared, Lorinda Chung Consultant of: Eicos, Corrado Campochiaro: None declared, Yossra A. Suliman: None declared, Dilia Giuggioli: None declared, Pia Moinzadeh Speakers bureau: Actelion Pharmaceuticals, Boehringer Ingelheim, Yannick Allanore: None declared, Christopher P Denton: None declared, Oliver Distler Speakers bureau: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Medscape, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur., Consultant of: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Medscape, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur., Grant/research support from: Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143), Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Medscape, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur., Tracy Frech: None declared, Daniel Furst: None declared, Dinesh Khanna Consultant of: Eicos Sciences Inc, Janssen, Thomas Krieg: None declared, Masataka Kuwana Speakers bureau: Speaker fees from AbbVie, Asahi Kasei Pharma, Astellas, Boehringer Ingelheim, Chugai, Eisai, GlaxoSmithKline, Janssen, Nippon Shinyaku, Ono Pharmaceuticals, Tanabe-Mitsubishi, and consultancy fees from AstraZeneca, Boehringer Ingelheim, Corbus, Kissei, Mochida outside of the submitted work., Marco Matucci-Cerinic: None declared, Janet Pope: None declared, Alessia Alunno: None declared
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Ross L, Lindqvist A, Costello B, Hansen D, Brown Z, Day JA, Stevens W, Burns A, Perera W, Pianta M, La Gerche A, Nikpour M. Using magnetic resonance imaging to map the hidden burden of muscle involvement in systemic sclerosis. Arthritis Res Ther 2022; 24:84. [PMID: 35410246 PMCID: PMC8996589 DOI: 10.1186/s13075-022-02768-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Skeletal muscle can be directly affected by systemic sclerosis (SSc); however, a significant burden of SSc-associated myopathy is undetected because clinical parameters such as weakness and creatine kinase (CK) are unreliable biomarkers of muscle involvement. This study presents qualitative and quantitative magnetic resonance imaging (MRI) findings that quantify the prevalence of myopathy and evaluate any association between skeletal and cardiac muscle involvement in SSc. METHODS Thirty-two patients with SSc who fulfilled the 2013 American College of Rheumatology/European League Against Rheumatism classification criteria underwent skeletal muscle MRI in addition to cardiac MRI. Skeletal muscles were independently assessed by two musculoskeletal radiologists for evidence of oedema, fatty infiltration and atrophy. Skeletal muscle T2 mapping times and percentage fat fraction were calculated. Linear regression analysis was used to evaluate the clinical and myocardial associations with skeletal muscle oedema and fatty infiltration. Cardiac MRI was performed using post gadolinium contrast imaging and parametric mapping techniques to assess focal and diffuse myocardial fibrosis. RESULTS Thirteen participants (40.6%) had MRI evidence of skeletal muscle oedema. Five (15.6%) participants had fatty infiltration. There was no association between skeletal muscle oedema and muscle strength, creatine kinase, inflammatory markers or fibroinflammatory myocardial disease. Patients with skeletal muscle oedema had higher T2-mapping times; there was a significant association between subjective assessments of muscle oedema and T2-mapping time (coef 2.46, p = 0.02) and percentage fat fraction (coef 3.41, p = 0.02). Diffuse myocardial fibrosis was a near-universal finding, and one third of patients had focal myocardial fibrosis. There was no association between skeletal myopathy detected by MRI and burden of myocardial disease. CONCLUSIONS MRI is a sensitive measure of muscle oedema and systematic assessment of SSc patients using MRI shows that myopathy is highly prevalent, even in patients without symptoms or other signs of muscle involvement. Similarly, cardiac fibrosis is highly prevalent but occurs independently of skeletal muscle changes. These results indicate that novel quantitative MRI techniques may be useful for assessing sub-clinical skeletal muscle disease in SSc.
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Affiliation(s)
- Laura Ross
- Department of Medicine, The University of Melbourne at St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia.,Department of Rheumatology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Anniina Lindqvist
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Benedict Costello
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Department of Cardiology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Dylan Hansen
- Department of Rheumatology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Zoe Brown
- Department of Medicine, The University of Melbourne at St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia.,Department of Rheumatology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Jessica A Day
- Inflammation Division, Walter and Eliza Hall Institute, Parkville, VIC, Australia
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Andrew Burns
- Department of Medicine, The University of Melbourne at St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia.,Department of Cardiology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Warren Perera
- Department of Radiology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Marcus Pianta
- Department of Radiology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - André La Gerche
- Department of Medicine, The University of Melbourne at St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia.,Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Department of Cardiology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia. .,Department of Rheumatology, St Vincent's Hospital, Fitzroy, VIC, Australia.
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Whitmore E, Silburn K, Chalmers G, Chan W, Ross L, Cheung H, Elmas K, Hickling D. The Impact of Malnutrition and Body Mass Index on Heart Transplant Outcomes. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Paratz ED, Ross L, Zentner D, Morgan N, Bouwer H, Lynch M, Parsons S, La Gerche A. Intracoronary IgG4-related disease as an unusual cause of sudden cardiac arrest: a case series. Eur Heart J Case Rep 2022; 6:ytac050. [PMID: 35187393 PMCID: PMC8851923 DOI: 10.1093/ehjcr/ytac050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/30/2021] [Accepted: 01/19/2022] [Indexed: 01/14/2023]
Abstract
Background IgG4-related disease (IgG4-RD) is a fibro-inflammatory condition classically causing retroperitoneal fibrosis, aortitis, thyroiditis, or pancreatitis. Diagnosis includes the presence of lymphoplasmacytic infiltrate (with >40% ratio IgG4+:IgG plasma cells) and fibrosis. Cardiac involvement may include aortic, pericardial, or coronary disease. Coronary manifestations encompass obstructive intra-luminal lesions, external encasing pseudo-tumour on imaging, or lymphoplasmacytic arteritis. Case summary Case 1: A fit and healthy 50-year-old man was found deceased. His only known medical condition was treated Hashimoto’s thyroiditis. Post-mortem examination demonstrated an isolated severe stenosis of the left anterior descending (LAD) coronary artery without histopathological evidence of acute myocardial infarction. Coronary plaque histopathology showed florid IgG4-positive plasma cell infiltrate throughout all layers of the artery with dense fibrous tissue connective tissue stroma, all features consistent with coronary artery IgG4-RD. Case 2: A 48-year-old man collapsed at work. Computed tomography scan 1 week prior reported an ill-defined para-aortic retroperitoneal soft tissue density. No cardiac symptoms were reported in life. Post-mortem examination showed coronary arteritis and peri-arteritis with sclerosing peri-aortitis in the LAD. There was myocardial fibrosis of the anterior left ventricle and focal myocarditis of the right ventricle. Discussion IgG4-related disease presenting as sudden cardiac death without any preceding symptoms is very rare (six prior cases identified on literature review). Reported targeted successful interventions for intracoronary IgG4-RD diagnosed in life have included steroid therapy and B cell depleting therapy (i.e. rituximab). If cardiac symptoms are present in a patient with known IgG4-RD, cardiac investigations should be promptly arranged.
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Affiliation(s)
- Elizabeth D Paratz
- Department of Cardiology, Baker Heart and Diabetes Institute, 75 Commercial Road, Prahran, VIC 3181, Australia
- Department of Cardiology, Alfred Hospital, 55 Commercial Road, Prahran, VIC 3181, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, 41 Victoria Pde, Fitzroy. VIC 3065, Australia
| | - Laura Ross
- Department of Cardiology, St Vincent’s Hospital Melbourne, 41 Victoria Pde, Fitzroy. VIC 3065, Australia
- Department of Rheumatology, St Vincent’s Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC 3065, Australia
- Department of Medicine, The University of Melbourne at St Vincent’s, 41 Victoria Pde, Fitzroy, VIC 3065, Australia
| | - Dominica Zentner
- Department of Cardiology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3050, Australia
- Department of Cardiology, Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Natalie Morgan
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC 3006, Australia
| | - Heinrich Bouwer
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC 3006, Australia
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC 3006, Australia
| | - Matthew Lynch
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC 3006, Australia
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC 3006, Australia
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC 3006, Australia
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC 3006, Australia
| | - Andre La Gerche
- Department of Cardiology, Baker Heart and Diabetes Institute, 75 Commercial Road, Prahran, VIC 3181, Australia
- Department of Cardiology, Alfred Hospital, 55 Commercial Road, Prahran, VIC 3181, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, 41 Victoria Pde, Fitzroy. VIC 3065, Australia
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Ross L, Costello B, Brown Z, Hansen D, Lindqvist A, Stevens W, Burns A, Prior D, Nikpour M, La Gerche A. OUP accepted manuscript. Rheumatology (Oxford) 2022; 61:4497-4502. [PMID: 35136975 PMCID: PMC9629381 DOI: 10.1093/rheumatology/keac065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/07/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives Cardiac complications of SSc are a leading cause of SSc-associated death. Cardiac imaging for identifying substrate abnormality may be useful in predicting risk of cardiac arrhythmias or future cardiac failure. The aim of this study was to quantify the burden of asymptomatic fibro-inflammatory myocardial disease using cardiac magnetic resonance imaging (CMR) and assess the relationship between asymptomatic myocardial fibrosis and cardiac arrhythmias in SSc. Methods Thirty-two patients with SSc with no documented history of pulmonary vascular or heart disease underwent CMR with gadolinium and 24-h ambulatory ECG. Focal myocardial fibrosis was assessed using post-gadolinium imaging and diffuse fibro-inflammatory myocardial disease quantified using T1- and T2-mapping. CMR results were compared with an age- and sex-matched control group. Results Post-gadolinium focal fibrosis was prevalent in SSc but not controls (30% vs 0%, p < 0.01).. T1-mapping values (as a marker of diffuse fibrosis) were greater in SSc than controls [saturated recovery single-shot acquisition (SASHA): 1584 ms vs 1515 ms, P < 0.001; shortened Modified look locker sequence (ShMOLLI): 1218 ms vs 1138 ms, p < 0.001]. More than one-fifth (22.6%) of the participants had ventricular arrhythmias on ambulatory ECG, but no associations between focal or diffuse myocardial fibrosis and arrhythmias were evident. Conclusion In SSc patients without evidence of overt cardiac disease, a high burden of myocardial fibrosis and arrhythmias was identified. However, there was no clear association between focal or diffuse myocardial fibrosis and arrhythmias, suggesting CMR may have limited use as a screening tool to identify SSc patients at risk of future significant arrhythmias.
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Affiliation(s)
- Laura Ross
- Correspondence to: Laura Ross, Department of Rheumatology, St Vincent’s Hospital, Melbourne, 41 Victoria Parade, Fitzroy VIC 3065, Australia. E-mail:
| | - Benedict Costello
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne
- Department of Cardiology, St Vincent’s Hospital, Fitzroy, VIC, Australia
| | - Zoe Brown
- Department of Medicine, The University of Melbourne at St Vincent’s Hospital
- Department of Rheumatology, St Vincent’s Hospital, Fitzroy
| | - Dylan Hansen
- Department of Rheumatology, St Vincent’s Hospital, Fitzroy
| | - Anniina Lindqvist
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne
| | - Wendy Stevens
- Department of Rheumatology, St Vincent’s Hospital, Fitzroy
| | - Andrew Burns
- Department of Medicine, The University of Melbourne at St Vincent’s Hospital
- Department of Cardiology, St Vincent’s Hospital, Fitzroy, VIC, Australia
| | - David Prior
- Department of Medicine, The University of Melbourne at St Vincent’s Hospital
- Department of Cardiology, St Vincent’s Hospital, Fitzroy, VIC, Australia
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Abstract
Females and males may face different selection pressures, such that alleles conferring a benefit in one sex may be deleterious in the other. Such sexual antagonism has received a great deal of theoretical and empirical attention, almost all of which has focused on diploids. However, a sizeable minority of animals display an alternative haplodiploid mode of inheritance, encompassing both arrhenotoky, whereby males develop from unfertilized eggs, and paternal genome elimination (PGE), whereby males receive but do not transmit a paternal genome. Alongside unusual genetics, haplodiploids often exhibit social ecologies that modulate the relative value of females and males. Here we develop a series of evolutionary-genetic models of sexual antagonism for haplodiploids, incorporating details of their molecular biology and social ecology. We find that: 1) PGE promotes female-beneficial alleles more than arrhenotoky, and to an extent determined by the timing of elimination - and degree of silencing of - the paternal genome; 2) sib-mating relatively promotes female-beneficial alleles, as do other forms of inbreeding, including limited male-dispersal, oedipal-mating, and the pseudo-hermaphroditism of Icerya purchasi; 3) resource competition between related females inhibits the invasion of female-beneficial alleles; and 4) sexual antagonism foments conflicts between parents and offspring, endosymbionts and hosts, and maternal-origin and paternal-origin genes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Andy Gardner
- School of Biology, University of St Andrews, St Andrews, UK
| | - Laura Ross
- School of Biological Sciences, Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, UK
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Abstract
In some eukaryotes, germline soma differentiation involves elimination of parts of the genome from somatic cells. The portions of the genome restricted to the germline often contain genes that play a role in development and function of the germline. Lineages with germline-restricted DNA are taxonomically diverse, and the size of the germline-restricted genome varies substantially. Unfortunately, few of these lineages have been studied in detail. As a result, we understand little about the general evolutionary forces that drive the origin and maintenance of germline-restricted DNA. One of the taxonomic groups where germline-restricted DNA has been poorly studied are the flies (Diptera). In three Dipteran families, Chironomidae, Cecidomyiidae, and Sciaridae, entire chromosomes are eliminated from somatic cells early in embryonic development. Germline-restricted chromosomes are thought to have evolved independently in the Dipteran families and their size, number, and transmission patterns vary between families. Although there is a wealth of cytological studies on these chromosomes in flies, almost no genomic studies have been undertaken. As a result, very little is known about how and why they evolved and what genes they encode. This review summarizes the literature on germline-restricted chromosomes in Diptera, discusses hypotheses for their origin and function, and compares germline-restricted DNA in Diptera to other eukaryotes. Finally, we discuss why Dipteran lineages represent a promising system for the study of germline-restricted chromosomes and propose future avenues of research on this topic.
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Affiliation(s)
- Christina N Hodson
- Institute of Evolutionary Biology, University of Edinburgh, United Kingdom
| | - Laura Ross
- Institute of Evolutionary Biology, University of Edinburgh, United Kingdom
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43
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Abstract
Genetic conflict is considered a key driver in the evolution of reproductive systems with non-Mendelian inheritance, where parents do not contribute equally to the genetic makeup of their offspring. One of the most extraordinary examples of non-Mendelian inheritance is paternal genome elimination (PGE), a form of haplodiploidy which has evolved repeatedly across arthropods. Under PGE, males are diploid but only transmit maternally inherited chromosomes, while the paternally inherited homologues are excluded from sperm. This asymmetric inheritance is thought to have evolved through an evolutionary arms race between the paternal and maternal genomes over transmission to future generations. In several PGE clades, such as the mealybugs (Hemiptera: Pseudococcidae), paternal chromosomes are not only eliminated from sperm, but also heterochromatinized early in development and thought to remain inactive, which could result from genetic conflict between parental genomes. Here, we present a parent-of-origin allele-specific transcriptome analysis in male mealybugs showing that expression is globally biased toward the maternal genome. However, up to 70% of somatically expressed genes are to some degree paternally expressed, while paternal genome expression is much more restricted in the male reproductive tract, with only 20% of genes showing paternal contribution. We also show that parent-of-origin-specific gene expression patterns are remarkably similar across genotypes, and that genes with completely biparental expression show elevated rates of molecular evolution. Our results provide the clearest example yet of genome-wide genomic imprinting in insects and enhance our understanding of PGE, which will aid future empirical tests of evolutionary theory regarding the origin of this unusual reproductive strategy.
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Affiliation(s)
- Andrés G de la Filia
- School of Biological Sciences, Institute of Evolutionary Biology, The University of Edinburgh, Edinburgh, United Kingdom
| | - Andrew J Mongue
- School of Biological Sciences, Institute of Evolutionary Biology, The University of Edinburgh, Edinburgh, United Kingdom
| | - Jennifer Dorrens
- School of Biological Sciences, Institute of Evolutionary Biology, The University of Edinburgh, Edinburgh, United Kingdom
| | - Hannah Lemon
- School of Biological Sciences, Institute of Evolutionary Biology, The University of Edinburgh, Edinburgh, United Kingdom
| | - Dominik R Laetsch
- School of Biological Sciences, Institute of Evolutionary Biology, The University of Edinburgh, Edinburgh, United Kingdom
| | - Laura Ross
- School of Biological Sciences, Institute of Evolutionary Biology, The University of Edinburgh, Edinburgh, United Kingdom
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44
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Mongue AJ, Michaelides S, Coombe O, Tena A, Kim DS, Normark BB, Gardner A, Hoddle MS, Ross L. Sex, males, and hermaphrodites in the scale insect Icerya purchasi. Evolution 2021; 75:2972-2983. [PMID: 33844310 DOI: 10.1111/evo.14233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 11/30/2022]
Abstract
Androdioecy (the coexistence of males and hermaphrodites) is a rare mating system for which the evolutionary dynamics are poorly understood. Here, we investigate the cottony cushion scale, Icerya purchasi, one of only three reported cases of androdioecy in insects. In this species, female-like hermaphrodites have been shown to produce sperm and self-fertilize. However, males are ocassionally observed as well. In a large genetic analysis, we show for the first time that, although self-fertilization appears to be the primary mode of reproduction, rare outbreeding events do occur in natural populations, supporting the hypothesis that hermaphrodites mate with males and hence androdioecy is the mating system of I. purchasi. Thus, this globally invasive pest insect appears to enjoy the colonization advantages of a selfing organism while also benefitting from periodic reintroduction of genetic variation through outbreeding with males.
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Affiliation(s)
- Andrew J Mongue
- Institute of Evolutionary Biology, School of Biological Sciences, University of Edinburgh, Edinburgh, EH9 3JT, United Kingdom
| | - Sozos Michaelides
- Department of Zoology, University of Oxford, Oxford, OX1 3PS, United Kingdom.,Department of Biology, Concordia University, Montreal, Quebec, H4B 1R6, Canada
| | - Oliver Coombe
- Department of Zoology, University of Oxford, Oxford, OX1 3PS, United Kingdom
| | - Alejandro Tena
- Institut Valencià d'Investigacions Agràries (IVIA), Centre de Protecció Vegetal i Biotecnologia, Unitat d'Entomologia, Moncada, 46113, Spain
| | - Dong-Soon Kim
- Majors in Plant Resource Sciences and Environment, College of Applied Life Science, SARI, Jeju National University, Jeju, 63243, Republic of Korea
| | - Benjamin B Normark
- Department of Biology and Graduate Program in Organismic and Evolutionary Biology, University of Massachusetts, Amherst, Massachusetts, 01003
| | - Andy Gardner
- Department of Zoology, University of Oxford, Oxford, OX1 3PS, United Kingdom.,School of Biology, University of St Andrews, Fife, KY16 9TH, United Kingdom
| | - Mark S Hoddle
- Department of Entomology, University of California, Riverside, California, 92521
| | - Laura Ross
- Institute of Evolutionary Biology, School of Biological Sciences, University of Edinburgh, Edinburgh, EH9 3JT, United Kingdom.,Department of Zoology, University of Oxford, Oxford, OX1 3PS, United Kingdom.,Department of Biology and Graduate Program in Organismic and Evolutionary Biology, University of Massachusetts, Amherst, Massachusetts, 01003
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45
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Bain SA, Marshall H, de la Filia AG, Laetsch DR, Husnik F, Ross L. Sex-specific expression and DNA methylation in a species with extreme sexual dimorphism and paternal genome elimination. Mol Ecol 2021; 30:5687-5703. [PMID: 33629415 DOI: 10.1111/mec.15842] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/27/2020] [Accepted: 02/09/2021] [Indexed: 12/16/2022]
Abstract
Phenotypic differences between sexes are often mediated by differential expression and alternative splicing of genes. However, the mechanisms that regulate these expression and splicing patterns remain poorly understood. The mealybug, Planococcus citri, displays extreme sexual dimorphism and exhibits an unusual instance of sex-specific genomic imprinting, paternal genome elimination (PGE), in which the paternal chromosomes in males are highly condensed and eliminated from the sperm. Planococcus citri has no sex chromosomes and both sexual dimorphism and PGE are predicted to be under epigenetic control. We recently showed that P. citri females display a highly unusual DNA methylation profile for an insect species, with the presence of promoter methylation associated with lower levels of gene expression. Here, we therefore decided to explore genome-wide differences in DNA methylation between male and female P. citri using whole-genome bisulphite sequencing. We identified extreme differences in genome-wide levels and patterns between the sexes. Males display overall higher levels of DNA methylation which manifest as more uniform low levels across the genome. Whereas females display more targeted high levels of methylation. We suggest these unique sex-specific differences are due to chromosomal differences caused by PGE and may be linked to possible ploidy compensation. Using RNA-Seq, we identify extensive sex-specific gene expression and alternative splicing, but we find no correlation with cis-acting DNA methylation.
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Affiliation(s)
- Stevie A Bain
- Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, UK
| | - Hollie Marshall
- Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, UK
| | | | - Dominik R Laetsch
- Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, UK
| | - Filip Husnik
- Evolution, Cell Biology, and Symbiosis Unit, Okinawa Institute of Science and Technology, Kunigami-gun, Japan
| | - Laura Ross
- Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, UK
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Costello B, Ross L, Lindqvist A, Brown Z, Hansen D, Stevens W, Burns A, Prior D, Nikpour M, La Gerche A. Significant and Early Cardiac Involvement in Systemic Sclerosis Detected by Cardiac Magnetic Resonance. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.243] [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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47
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Paratz E, Ross L, van Heusden A, Zentner D, Thompson T, James P, Smith K, Ball J, Pflaumer A, Stub D, La Gerche A, Morgan N, Bouwer H, Lynch M, Parsons S. Unrecognised Intracoronary IgG4-Related Disease: A Rare Cause of Two Sudden Cardiac Deaths. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.117] [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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48
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Ross L, Lindqvist A, Hansen D, Brown Z, Costello B, Burns A, Prior D, Stevens W, Nikpour M, La Gerche A. Characterising Breathlessness in Systemic Sclerosis: Peak Exercise Performance is Linked to Workload-Indexed Blood Pressure Response. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.057] [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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49
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Ross L, Moxey J, Nikpour M. Are troponin and B-type natriuretic peptides useful biomarkers for the diagnosis of systemic sclerosis heart involvement? A systematic literature review. Semin Arthritis Rheum 2020; 51:299-309. [PMID: 33434765 DOI: 10.1016/j.semarthrit.2020.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/30/2020] [Accepted: 10/23/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Systemic sclerosis (SSc) heart involvement (SHI) is a leading cause of SSc-associated mortality and once clinically overt, carries a very poor prognosis. There remain no established diagnostic criteria for SHI. This study aimed to systematically review the literature regarding the role of cardiac troponin (cTn) and B-type natriuretic peptide (BNP) or N-terminal B-type natriuretic peptide (NT-proBNP) in the diagnosis of SHI. METHODS A comprehensive search of the MEDLINE (Ovid), EMBASE and Pubmed databases was performed to identify adult human studies of at least 10 SSc patients with a primary focus of SHI that included data on cTn and BNP or NT-proBNP results. Only cohort studies and case-controlled studies were identified and the quality of the evidence presented in each study was assessed according to the Newcastle-Ottawa Quality Assessment Scale. RESULTS Of the 2742 studies identified by the database search, 12 articles fulfilled the study inclusion criteria. Three out of four studies evaluating SHI using cardiac magnetic resonance imaging found no association between cardiac biomarkers and imaging changes. By comparison echocardiographic abnormalities, cardiac arrhythmias and congestive cardiac failure were more likely to be associated with elevated cardiac biomarkers. Comparison of results between studies was limited by the highly heterogenous definitions of SHI and inclusion criteria employed across studies. CONCLUSION There are insufficient data to draw definitive conclusions about the role of cTn and BNP / NT-proBNP in the diagnosis of SHI. Currently available literature suggests that cardiac biomarkers may have some role, in conjunction with other diagnostic modalities, in identifying SHI; however, this remains a much-needed area of clinical research.
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Affiliation(s)
- Laura Ross
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, 41 Victoria Parade, Fitzroy, VIC 3065 Australia; Department of Rheumatology, St Vincent's Hospital, Melbourne 41 Victoria Parade, Fitzroy, VIC 3065 Australia
| | - Jayne Moxey
- Department of Rheumatology, St Vincent's Hospital, Melbourne 41 Victoria Parade, Fitzroy, VIC 3065 Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, 41 Victoria Parade, Fitzroy, VIC 3065 Australia; Department of Rheumatology, St Vincent's Hospital, Melbourne 41 Victoria Parade, Fitzroy, VIC 3065 Australia.
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50
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Ross L, Stevens W, Wilson M, Strickland G, Walker J, Sahhar J, Ngian GS, Roddy J, Major G, Proudman S, Baron M, Nikpour M. Can Patient-Reported Symptoms Be Used to Measure Disease Activity in Systemic Sclerosis? Arthritis Care Res (Hoboken) 2020; 72:1459-1465. [PMID: 31421031 DOI: 10.1002/acr.24053] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/13/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To evaluate the association between patient-reported symptoms and changes in disease activity over time in systemic sclerosis (SSc). METHODS Using data from 1,636 patients enrolled in the Australian Scleroderma Cohort Study, we used generalized estimating equations to determine the relationship between patient-reported worsening of Raynaud's phenomenon (RP), skin involvement, and breathlessness in the month preceding each study visit and features of disease activity in the corresponding organ systems. The associations between the following parameters were analyzed: patient-reported worsening RP and the presence of new-onset digital pitting and digital ulcers; patient-reported worsening skin involvement and increasing modified Rodnan skin thickness score (MRSS); new areas of skin involvement and new-onset joint contractures; patient-reported worsening breathlessness and deteriorating respiratory functions test (RFT) results, indicated by a 10% decrease in forced vital capacity (FVC) and a 15% decrease in diffusing capacity for carbon monoxide (DLco), new-onset interstitial lung disease (ILD), and new-onset pulmonary arterial hypertension (PAH). RESULTS We found a significant association between patient-reported worsening RP and the presence of digital ulcers (odds ratio [OR] 1.53 [95% confidence interval (95% CI) 0.60-0.93]), patient-reported worsening skin involvement and increasing MRSS (OR 2.10 [95% CI 1.54-2.86]), and worsening patient breathlessness and deteriorating RFTs (FVC OR 2.12 [95% CI 1.70-2.65]; DLco OR 1.97 [95% CI 1.34-2.02]), new-onset ILD (OR 1.91 [95% CI 1.40-2.61]), and new-onset PAH (OR 5.08 [95% CI 3.59-7.19]). CONCLUSION These results demonstrate that patient-reported symptoms are associated with clinically meaningful changes in disease activity in patients with SSc. This suggests that when objective measures of change in disease status are unavailable, patient-reported symptoms could be used to indicate a change in SSc disease activity.
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Affiliation(s)
- Laura Ross
- St. Vincent's Hospital Melbourne and the University of Melbourne, Fitzroy, Victoria, Australia
| | - Wendy Stevens
- St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Michelle Wilson
- St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | | | - Jennifer Walker
- Flinders Medical Centre, Bedford Park, South Australia, Australia, and Royal Adelaide Hospital and Flinders University, Adelaide, South Australia, Australia
| | - Joanne Sahhar
- Monash Health and Monash University, Clayton, Victoria, Australia
| | - Gene-Siew Ngian
- Monash Health and Monash University, Clayton, Victoria, Australia
| | - Janet Roddy
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Gabor Major
- Royal Newcastle Centre, New Lambton Heights, New South Wales, Australia
| | - Susanna Proudman
- Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Murray Baron
- Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
| | - Mandana Nikpour
- St. Vincent's Hospital Melbourne and the University of Melbourne, Fitzroy, Victoria, Australia
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