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Barbera M, Lehtisalo J, Perera D, Aspö M, Cross M, De Jager Loots CA, Falaschetti E, Friel N, Luchsinger JA, Gavelin HM, Peltonen M, Price G, Neely AS, Thunborg C, Tuomilehto J, Mangialasche F, Middleton L, Ngandu T, Solomon A, Kivipelto M. A multimodal precision-prevention approach combining lifestyle intervention with metformin repurposing to prevent cognitive impairment and disability: the MET-FINGER randomised controlled trial protocol. Alzheimers Res Ther 2024; 16:23. [PMID: 38297399 PMCID: PMC10829308 DOI: 10.1186/s13195-023-01355-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/17/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Combining multimodal lifestyle interventions and disease-modifying drugs (novel or repurposed) could provide novel precision approaches to prevent cognitive impairment. Metformin is a promising candidate in view of the well-established link between type 2 diabetes (T2D) and Alzheimer's Disease and emerging evidence of its potential neuro-protective effects (e.g. vascular, metabolic, anti-senescence). MET-FINGER aims to test a FINGER 2.0 multimodal intervention, combining an updated FINGER multidomain lifestyle intervention with metformin, where appropriate, in an APOE ε4-enriched population of older adults (60-79 years) at increased risk of dementia. METHODS MET-FINGER is an international randomised, controlled, parallel-group, phase-IIb proof-of-concept clinical trial, where metformin is included through a trial-within-trial design. 600 participants will be recruited at three sites (UK, Finland, Sweden). Participants at increased risk of dementia based on vascular risk factors and cognitive screening, will be first randomised to the FINGER 2.0 intervention (lifestyle + metformin if eligible; active arm) or to receive regular health advice (control arm). Participants allocated to the FINGER 2.0 intervention group at risk indicators of T2D will be additionally randomised to receive metformin (2000 mg/day or 1000 mg/day) or placebo. The study duration is 2 years. The changes in global cognition (primary outcome, using a Neuropsychological Test Battery), memory, executive function, and processing speed cognitive domains; functional status; lifestyle, vascular, metabolic, and other dementia-related risk factors (secondary outcomes), will be compared between the FINGER 2.0 intervention and the control arm. The feasibility, potential interaction (between-groups differences in healthy lifestyle changes), and disease-modifying effects of the lifestyle-metformin combination will be exploratory outcomes. The lifestyle intervention is adapted from the original FINGER trial (diet, physical activity, cognitive training, monitoring of cardiovascular/metabolic risk factors, social interaction) to be consistently delivered in three countries. Metformin is administered as Glucophage®XR/SR 500, (500 mg oral tablets). The metformin/placebo treatment will be double blinded. CONCLUSION MET-FINGER is the first trial combining a multimodal lifestyle intervention with a putative repurposed disease-modifying drug for cognitive impairment prevention. Although preliminary, its findings will provide crucial information for innovative precision prevention strategies and form the basis for a larger phase-III trial design and future research in this field. TRIAL REGISTRATION ClinicalTrials.gov (NCT05109169).
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Affiliation(s)
- Mariagnese Barbera
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Yliopistonranta 1C, 70211, Kuopio, Finland.
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, Charing Cross Hospital, St Dunstan's Road, LondonLondon, W6 8RP, UK.
| | - Jenni Lehtisalo
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Yliopistonranta 1C, 70211, Kuopio, Finland
- Population Health Unit, Finnish Institute for Health and Welfare, Mannerheimintie 166, P.O. Box 30, Helsinki, Finland
| | - Dinithi Perera
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, Charing Cross Hospital, St Dunstan's Road, LondonLondon, W6 8RP, UK
- FINGERS Brain Health Institute, C/O Stockholms Sjukhem, Box 122 30, SE-102 26, Stockholm, Sweden
| | - Malin Aspö
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska Vägen 37A, 171 64, Solna, Sweden
- Theme Inflammation and Aging, Medical Unit Aging, Karolinska University Hospital, Karolinska Vägen 37A, 171 76, Solna, Sweden
| | - Mary Cross
- Imperial Clinical Trials Unit, School of Public Health, Faculty of Medicine, Imperial College London, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
| | - Celeste A De Jager Loots
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, Charing Cross Hospital, St Dunstan's Road, LondonLondon, W6 8RP, UK
| | - Emanuela Falaschetti
- Imperial Clinical Trials Unit, School of Public Health, Faculty of Medicine, Imperial College London, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
| | - Naomi Friel
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, Charing Cross Hospital, St Dunstan's Road, LondonLondon, W6 8RP, UK
| | - José A Luchsinger
- Departments of Medicine and Epidemiology, Columbia University Irving Medical Center, 622 W 168Th St, New York, NY, USA
| | | | - Markku Peltonen
- Population Health Unit, Finnish Institute for Health and Welfare, Mannerheimintie 166, P.O. Box 30, Helsinki, Finland
- FINGERS Brain Health Institute, C/O Stockholms Sjukhem, Box 122 30, SE-102 26, Stockholm, Sweden
| | - Geraint Price
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, Charing Cross Hospital, St Dunstan's Road, LondonLondon, W6 8RP, UK
| | - Anna Stigsdotter Neely
- Department of Social and Psychological Studies, Karlstad University, 651 88, Karlstad, Sweden
- Department of Health, Education and Technology, Luleå University of Technology, 971 87, Luleå, Sweden
| | - Charlotta Thunborg
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska Vägen 37A, 171 64, Solna, Sweden
- Theme Inflammation and Aging, Medical Unit Aging, Karolinska University Hospital, Karolinska Vägen 37A, 171 76, Solna, Sweden
| | - Jaakko Tuomilehto
- Population Health Unit, Finnish Institute for Health and Welfare, Mannerheimintie 166, P.O. Box 30, Helsinki, Finland
- Department of Public Health, University of Helsinki, PO BOX 20, 00014, Helsinki, Finland
- Diabetes Research Group, King Abdulaziz University, 21589, Jeddah, Saudi Arabia
| | - Francesca Mangialasche
- FINGERS Brain Health Institute, C/O Stockholms Sjukhem, Box 122 30, SE-102 26, Stockholm, Sweden
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska Vägen 37A, 171 64, Solna, Sweden
- Theme Inflammation and Aging, Medical Unit Aging, Karolinska University Hospital, Karolinska Vägen 37A, 171 76, Solna, Sweden
| | - Lefkos Middleton
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, Charing Cross Hospital, St Dunstan's Road, LondonLondon, W6 8RP, UK
- Directorate of Public Health, Imperial College NHS Healthcare Trust Hospitals, Praed Street, London, W2 1NY, UK
| | - Tiia Ngandu
- Population Health Unit, Finnish Institute for Health and Welfare, Mannerheimintie 166, P.O. Box 30, Helsinki, Finland
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska Vägen 37A, 171 64, Solna, Sweden
| | - Alina Solomon
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Yliopistonranta 1C, 70211, Kuopio, Finland.
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, Charing Cross Hospital, St Dunstan's Road, LondonLondon, W6 8RP, UK.
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska Vägen 37A, 171 64, Solna, Sweden.
| | - Miia Kivipelto
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, Charing Cross Hospital, St Dunstan's Road, LondonLondon, W6 8RP, UK
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska Vägen 37A, 171 64, Solna, Sweden
- Theme Inflammation and Aging, Medical Unit Aging, Karolinska University Hospital, Karolinska Vägen 37A, 171 76, Solna, Sweden
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Yliopistonranta 1C, 70211, Kuopio, Finland
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Sadlon A, Takousis P, Evangelou E, Prokopenko I, Alexopoulos P, Udeh-Momoh CM, Price G, Middleton L, Perneczky R. Association of Blood MicroRNA Expression and Polymorphisms with Cognitive and Biomarker Changes in Older Adults. J Prev Alzheimers Dis 2024; 11:230-240. [PMID: 38230736 PMCID: PMC10994991 DOI: 10.14283/jpad.2023.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/13/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Identifying individuals before the onset of overt symptoms is key in the prevention of Alzheimer's disease (AD). OBJECTIVES Investigate the use of miRNA as early blood-biomarker of cognitive decline in older adults. DESIGN Cross-sectional. SETTING Two observational cohorts (CHARIOT-PRO, Alzheimer's Disease Neuroimaging Initiative (ADNI)). PARTICIPANTS 830 individuals without overt clinical symptoms from CHARIOT-PRO and 812 individuals from ADNI. MEASUREMENTS qPCR analysis of a prioritised set of 38 miRNAs in the blood of individuals from CHARIOT-PRO, followed by a brain-specific functional enrichment analysis for the significant miRNAs. In ADNI, genetic association analysis for polymorphisms within the significant miRNAs' genes and CSF levels of phosphorylated-tau, total-tau, amyloid-β42, soluble-TREM2 and BACE1 activity using whole genome sequencing data. Post-hoc analysis using multi-omics datasets. RESULTS Six miRNAs (hsa-miR-128-3p, hsa-miR-144-5p, hsa-miR-146a-5p, hsa-miR-26a-5p, hsa-miR-29c-3p and hsa-miR-363-3p) were downregulated in the blood of individuals with low cognitive performance on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The pathway enrichment analysis indicated involvement of apoptosis and inflammation, relevant in early AD stages. Polymorphisms within genes encoding for hsa-miR-29c-3p and hsa-miR-146a-5p were associated with CSF levels of amyloid-β42, soluble-TREM2 and BACE1 activity, and 21 variants were eQTL for hippocampal MIR29C expression. CONCLUSIONS six miRNAs may serve as potential blood biomarker of subclinical cognitive deficits in AD. Polymorphisms within these miRNAs suggest a possible interplay between the amyloid cascade and microglial activation at preclinical stages of AD.
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Affiliation(s)
- A Sadlon
- Prof. Dr. Robert Perneczky, Division of Mental Health of Older Adults, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Nußbaumstr. 7, 80336 Munich, Germany, Tel.: +49 89 4400 55772, Fax: +49 89 4400-55448,
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Malzbender K, Barbarino P, Barkman Ferrell P, Bradshaw A, Brookes AJ, Díaz C, van der Flier WM, Georges J, Hansson O, Hartmanis M, Jönsson L, Krishnan R, MacLeod T, Mangialasche F, Mecocci P, Minguillon C, Middleton L, Pla S, Sardi SP, Schöll M, Suárez-Calvet M, Weidner W, Visser PJ, Zetterberg H, Bose N, Solomon A, Kivipelto M. Validation, Deployment, and Real-World Implementation of a Modular Toolbox for Alzheimer's Disease Detection and Dementia Risk Reduction: The AD-RIDDLE Project. J Prev Alzheimers Dis 2024; 11:329-338. [PMID: 38374739 DOI: 10.14283/jpad.2024.32] [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] [Indexed: 02/21/2024]
Abstract
The Real-World Implementation, Deployment, and Validation of Early Detection Tools and Lifestyle Enhancement (AD-RIDDLE) project, recently launched with the support of the EU Innovative Health Initiative (IHI) public-private partnership and UK Research and Innovation (UKRI), aims to develop, test, and deploy a modular toolbox platform that can reduce existing barriers to the timely detection, and therapeutic approaches in Alzheimer's disease (AD), thus accelerating AD innovation. By focusing on health system and health worker practices, AD-RIDDLE seeks to improve and smooth AD management at and between each key step of the clinical pathway and across the disease continuum, from at-risk asymptomatic stages to early symptomatic ones. This includes innovation and improvement in AD awareness, risk reduction and prevention, detection, diagnosis, and intervention. The 24 partners in the AD-RIDDLE interdisciplinary consortium will develop and test the AD-RIDDLE toolbox platform and its components individually and in combination in six European countries. Expected results from this cross-sectoral research collaboration include tools for earlier detection and accurate diagnosis; validated, novel digital cognitive and blood-based biomarkers; and improved access to individualized preventative interventions (including multimodal interventions and symptomatic/disease-modifying therapies) across diverse populations, within the framework of precision medicine. Overall, AD-RIDDLE toolbox platform will advance management of AD, improving outcomes for patients and their families, and reducing costs.
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Affiliation(s)
- K Malzbender
- Miia Kivipelto, MD, PhD, Center for Alzheimer's Research, Karolinska Universitetssjukhuset, Karolinska Vägen 37 A, QA32, 171 64 Solna, Sweden, , Phone: +46 73 99 409 22
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Zheng B, Su B, Ahmadi-Abhari S, Kapogiannis D, Tzoulaki I, Riboli E, Middleton L. Dementia risk in patients with type 2 diabetes: Comparing metformin with no pharmacological treatment. Alzheimers Dement 2023; 19:5681-5689. [PMID: 37395154 DOI: 10.1002/alz.13349] [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: 01/26/2023] [Revised: 04/26/2023] [Accepted: 05/19/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Metformin has been suggested as a therapeutic agent for dementia, but the relevant evidence has been partial and inconsistent. METHODS We established a national cohort of 210,237 type 2 diabetes patients in the UK Clinical Practice Research Datalink. Risks of incident dementia were compared between metformin initiators and those who were not prescribed any anti-diabetes medication during follow-up. RESULTS Compared with metformin initiators (n = 114,628), patients who received no anti-diabetes medication (n = 95,609) had lower HbA1c and better cardiovascular health at baseline. Both Cox regression and propensity score weighting analysis showed metformin initiators had lower risk of dementia compared to those non-users (adjusted hazard ratio = 0.88 [95% confidence interval: 0.84-0.92] and 0.90 [0.84-0.96]). Patients on long-term metformin treatment had an even lower risk of dementia. DISCUSSION Metformin may act beyond its glycemic effect and reduce dementia risk to an even lower level than that of patients with milder diabetes and better health profiles. HIGHLIGHTS Metformin initiators had a significantly lower risk of dementia compared with patients not receiving anti-diabetes medication. Compared with metformin initiators, diabetes patients not receiving pharmacological treatment had better glycemic profiles at baseline and during follow-up. Patients on long-term metformin treatment had an even lower risk of subsequent dementia incidence. Metformin may act beyond its effect on hyperglycemia and has the potential of being repurposed for dementia prevention.
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Affiliation(s)
- Bang Zheng
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Bowen Su
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Sara Ahmadi-Abhari
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
| | - Dimitrios Kapogiannis
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute on Aging, Baltimore, USA
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Public Health Directorate, Imperial College NHS Healthcare Trust, London, UK
| | - Lefkos Middleton
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
- Public Health Directorate, Imperial College NHS Healthcare Trust, London, UK
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Zhao Y, Walker DI, Lill CM, Bloem BR, Darweesh SKL, Pinto-Pacheco B, McNeil B, Miller GW, Heath AK, Frissen M, Petrova D, Sánchez MJ, Chirlaque MD, Guevara M, Zibetti M, Panico S, Middleton L, Katzke V, Kaaks R, Riboli E, Masala G, Sieri S, Zamora-Ros R, Amiano P, Jenab M, Peters S, Vermeulen R. Lipopolysaccharide-binding protein and future Parkinson's disease risk: a European prospective cohort. J Neuroinflammation 2023; 20:170. [PMID: 37480114 PMCID: PMC10362572 DOI: 10.1186/s12974-023-02846-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/29/2023] [Accepted: 07/02/2023] [Indexed: 07/23/2023] Open
Abstract
INTRODUCTION Lipopolysaccharide (LPS) is the outer membrane component of Gram-negative bacteria. LPS-binding protein (LBP) is an acute-phase reactant that mediates immune responses triggered by LPS and has been used as a blood marker for LPS. LBP has recently been indicated to be associated with Parkinson's disease (PD) in small-scale retrospective case-control studies. We aimed to investigate the association between LBP blood levels with PD risk in a nested case-control study within a large European prospective cohort. METHODS A total of 352 incident PD cases (55% males) were identified and one control per case was selected, matched by age at recruitment, sex and study center. LBP levels in plasma collected at recruitment, which was on average 7.8 years before diagnosis of the cases, were analyzed by enzyme linked immunosorbent assay. Odds ratios (ORs) were estimated for one unit increase of the natural log of LBP levels and PD incidence by conditional logistic regression. RESULTS Plasma LBP levels were higher in prospective PD cases compared to controls (median (interquartile range) 26.9 (18.1-41.0) vs. 24.7 (16.6-38.4) µg/ml). The OR for PD incidence per one unit increase of log LBP was elevated (1.46, 95% CI 0.98-2.19). This association was more pronounced among women (OR 2.68, 95% CI 1.40-5.13) and overweight/obese subjects (OR 1.54, 95% CI 1.09-2.18). CONCLUSION The findings suggest that higher plasma LBP levels may be associated with an increased risk of PD and may thus pinpoint to a potential role of endotoxemia in the pathogenesis of PD, particularly in women and overweight/obese individuals.
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Affiliation(s)
- Yujia Zhao
- Institute for Risk Assessment Sciences, Utrecht University, Nieuw Gildestein, Room 3.53, Yalelaan 2, 3584 CM, Utrecht, The Netherlands
| | - Douglas I Walker
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Christina M Lill
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
- Ageing Epidemiology Research Unit (AGE), School of Public Health, Imperial College London, London, UK
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sirwan K L Darweesh
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Brismar Pinto-Pacheco
- Department of Environmental Medicine and Public Health, Icahn School of Medicine, Mount Sinai, New York, USA
| | - Brooklyn McNeil
- Department of Environmental Medicine and Public Health, Icahn School of Medicine, Mount Sinai, New York, USA
| | - Gary W Miller
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, USA
| | - Alicia K Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Myrthe Frissen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dafina Petrova
- Escuela Andaluza de Salud Pública, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - María-Dolores Chirlaque
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Murcia, Spain
| | - Marcela Guevara
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Instituto de Salud Pública y Laboral de Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Maurizio Zibetti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città Della Salute E Della Scienza, Turin, Italy
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - Lefkos Middleton
- Ageing Epidemiology Research Unit (AGE), School of Public Health, Imperial College London, London, UK
- Public Health Directorate, Imperial College NHS Healthcare Trust, London, UK
| | - Verena Katzke
- Division of Cancer Epidemiology C020, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology C020, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elio Riboli
- Cancer Epidemiology and Prevention Research Unit, School of Public Health, Imperial College London, London, UK
| | - Giovanna Masala
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Raul Zamora-Ros
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pilar Amiano
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Sub Directorate for Public Health and Addictions of Gipuzkoa, Ministry of Health of the Basque Government, San Sebastián, Spain
- Epidemiology of Chronic and Communicable Diseases Group, Biodonostia Health Research Institute, San Sebastián, Spain
| | - Mazda Jenab
- Nutrition and Metabolism (NME) Branch, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Susan Peters
- Institute for Risk Assessment Sciences, Utrecht University, Nieuw Gildestein, Room 3.53, Yalelaan 2, 3584 CM, Utrecht, The Netherlands.
- Institute for Risk Assessment Sciences, Utrecht University, Nieuw Gildestein, Room 3.59, Yalelaan 2, 3584 CM, Utrecht, The Netherlands.
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Nieuw Gildestein, Room 3.53, Yalelaan 2, 3584 CM, Utrecht, The Netherlands.
- University Medical Centre Utrecht, Utrecht, The Netherlands.
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Lai HTM, Chang K, Sharabiani MTA, Valabhji J, Gregg EW, Middleton L, Majeed A, Pearson-Stuttard J, Millett C, Bottle A, Vamos EP. Twenty-year trajectories of cardio-metabolic factors among people with type 2 diabetes by dementia status in England: a retrospective cohort study. Eur J Epidemiol 2023; 38:733-744. [PMID: 36869989 PMCID: PMC10276060 DOI: 10.1007/s10654-023-00977-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 02/17/2023] [Indexed: 03/05/2023]
Abstract
To assess 20-year retrospective trajectories of cardio-metabolic factors preceding dementia diagnosis among people with type 2 diabetes (T2D). We identified 227,145 people with T2D aged > 42 years between 1999 and 2018. Annual mean levels of eight routinely measured cardio-metabolic factors were extracted from the Clinical Practice Research Datalink. Multivariable multilevel piecewise and non-piecewise growth curve models assessed retrospective trajectories of cardio-metabolic factors by dementia status from up to 19 years preceding dementia diagnosis (dementia) or last contact with healthcare (no dementia). 23,546 patients developed dementia; mean (SD) follow-up was 10.0 (5.8) years. In the dementia group, mean systolic blood pressure increased 16-19 years before dementia diagnosis compared with patients without dementia, but declined more steeply from 16 years before diagnosis, while diastolic blood pressure generally declined at similar rates. Mean body mass index followed a steeper non-linear decline from 11 years before diagnosis in the dementia group. Mean blood lipid levels (total cholesterol, LDL, HDL) and glycaemic measures (fasting plasma glucose and HbA1c) were generally higher in the dementia group compared with those without dementia and followed similar patterns of change. However, absolute group differences were small. Differences in levels of cardio-metabolic factors were observed up to two decades prior to dementia diagnosis. Our findings suggest that a long follow-up is crucial to minimise reverse causation arising from changes in cardio-metabolic factors during preclinical dementia. Future investigations which address associations between cardiometabolic factors and dementia should account for potential non-linear relationships and consider the timeframe when measurements are taken.
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Affiliation(s)
- Heidi T M Lai
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, St Dunstan's Road, London, W6 8RP, UK.
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
| | - Kiara Chang
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, St Dunstan's Road, London, W6 8RP, UK
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Mansour T A Sharabiani
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Jonathan Valabhji
- NHS England, London, UK
- Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Division of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Edward W Gregg
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Lefkos Middleton
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Jonathan Pearson-Stuttard
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Health Analytics, Lane Clark & Peacock LLP, London, UK
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, St Dunstan's Road, London, W6 8RP, UK
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
- Public Health Research Centre, Comprehensive Health Research Center, NOVA National School of Public Health, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Alex Bottle
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Eszter P Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, St Dunstan's Road, London, W6 8RP, UK
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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7
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Barbera M, Perera D, Matton A, Mangialasche F, Rosenberg A, Middleton L, Ngandu T, Solomon A, Kivipelto M. Multimodal Precision Prevention - A New Direction in Alzheimer's Disease. J Prev Alzheimers Dis 2023; 10:718-728. [PMID: 37874092 DOI: 10.14283/jpad.2023.114] [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] [Indexed: 10/25/2023]
Abstract
At least 40% of all dementia has been linked to modifiable risk factors suggesting a clear potential for preventative approaches targeting these factors. Despite the recent promising findings from anti-amyloid monoclonal antibodies, a limited proportion of patients are expected to be eligible for these novel AD treatments. Given the heterogeneous nature of AD and the complex multi-level pathological processes leading to dementia (involving, e.g., shared risk factors, interaction of different pathology mechanisms, and their putative synergistic effects on cognition), targeting a single pathology may not be sufficient to halt or significantly impact disease progression. With exponentially increasing numbers of patients world-wide, in parallel to the unprecedented population ageing, new multimodal therapy approaches targeting several modifiable risk factors and disease mechanisms simultaneously are urgently required. Developing the next generation of combination therapies with lifestyle intervention and pharmacological treatments, implementing the right interventions for the right people at the right time, and defining accessible and sustainable strategies worldwide are crucial. Here, we summarize the state-of-the-art multimodal lifestyle-based approaches, especially findings and lessons learned from the FINGER trial, for prevention and risk reduction of cognitive impairment and dementia. We also discuss some emerging underlying biological mechanisms and the current development of precision prevention approaches. We present an example of a novel trial design combining healthy lifestyle changes with a repurposed putative disease-modifying drug and place this study in the context of the World-Wide FINGERS, the first interdisciplinary network of multimodal trials dedicated to the prevention and risk reduction of cognitive impairment and dementia.
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Affiliation(s)
- M Barbera
- Miia Kivipelto, Address: Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska Vägen 37A, 171 64 Solna, Sweden, , Phone: +46 73-994-0922
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8
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Charpignon ML, Vakulenko-Lagun B, Zheng B, Magdamo C, Su B, Evans K, Rodriguez S, Sokolov A, Boswell S, Sheu YH, Somai M, Middleton L, Hyman BT, Betensky RA, Finkelstein SN, Welsch RE, Tzoulaki I, Blacker D, Das S, Albers MW. Causal inference in medical records and complementary systems pharmacology for metformin drug repurposing towards dementia. Nat Commun 2022; 13:7652. [PMID: 36496454 PMCID: PMC9741618 DOI: 10.1038/s41467-022-35157-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
Metformin, a diabetes drug with anti-aging cellular responses, has complex actions that may alter dementia onset. Mixed results are emerging from prior observational studies. To address this complexity, we deploy a causal inference approach accounting for the competing risk of death in emulated clinical trials using two distinct electronic health record systems. In intention-to-treat analyses, metformin use associates with lower hazard of all-cause mortality and lower cause-specific hazard of dementia onset, after accounting for prolonged survival, relative to sulfonylureas. In parallel systems pharmacology studies, the expression of two AD-related proteins, APOE and SPP1, was suppressed by pharmacologic concentrations of metformin in differentiated human neural cells, relative to a sulfonylurea. Together, our findings suggest that metformin might reduce the risk of dementia in diabetes patients through mechanisms beyond glycemic control, and that SPP1 is a candidate biomarker for metformin's action in the brain.
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Affiliation(s)
- Marie-Laure Charpignon
- Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Bang Zheng
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
| | - Colin Magdamo
- Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Bowen Su
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Kyle Evans
- Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
- Laboratory of Systems Pharmacology, Harvard Program in Therapeutic Science, Harvard Medical School, Boston, MA, USA
| | - Steve Rodriguez
- Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
- Laboratory of Systems Pharmacology, Harvard Program in Therapeutic Science, Harvard Medical School, Boston, MA, USA
| | - Artem Sokolov
- Laboratory of Systems Pharmacology, Harvard Program in Therapeutic Science, Harvard Medical School, Boston, MA, USA
| | - Sarah Boswell
- Laboratory of Systems Pharmacology, Harvard Program in Therapeutic Science, Harvard Medical School, Boston, MA, USA
| | - Yi-Han Sheu
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Melek Somai
- Inception Labs, Collaborative for Health Delivery Sciences, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Lefkos Middleton
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
- Public Health Directorate, Imperial College London NHS Healthcare Trust, London, UK
| | - Bradley T Hyman
- Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Rebecca A Betensky
- Department of Biostatistics, School of Global Public Health, New York University, New York, NY, USA
| | - Stan N Finkelstein
- Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Roy E Welsch
- Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge, MA, USA
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
- Dementia Research Institute, Imperial College London, London, UK.
- Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, Greece.
| | - Deborah Blacker
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Sudeshna Das
- Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
| | - Mark W Albers
- Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
- Laboratory of Systems Pharmacology, Harvard Program in Therapeutic Science, Harvard Medical School, Boston, MA, USA.
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9
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Dobricic V, Schilling M, Farkas I, Gveric DO, Ohlei O, Schulz J, Middleton L, Gentleman SM, Parkkinen L, Bertram L, Lill CM. Common signatures of differential microRNA expression in Parkinson's and Alzheimer's disease brains. Brain Commun 2022; 4:fcac274. [PMID: 36382223 PMCID: PMC9645562 DOI: 10.1093/braincomms/fcac274] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/22/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
Abstract
Dysregulation of microRNA gene expression has been implicated in many neurodegenerative diseases, including Parkinson's disease. However, the individual dysregulated microRNAs remain largely unknown. Previous meta-analyses have highlighted several microRNAs being differentially expressed in post-mortem Parkinson's disease and Alzheimer's disease brains versus controls, but they were based on small sample sizes. In this study, we quantified the expression of the most compelling Parkinson's and Alzheimer's disease microRNAs from these meta-analyses ('candidate miRNAs') in one of the largest Parkinson's/Alzheimer's disease case-control post-mortem brain collections available (n = 451), thereby quadruplicating previously investigated sample sizes. Parkinson's disease candidate microRNA hsa-miR-132-3p was differentially expressed in our Parkinson's (P = 4.89E-06) and Alzheimer's disease samples (P = 3.20E-24) compared with controls. Alzheimer's disease candidate microRNAs hsa-miR-132-5p (P = 4.52E-06) and hsa-miR-129-5p (P = 0.0379) were differentially expressed in our Parkinson's disease samples. Combining these novel data with previously published data substantially improved the statistical support (α = 3.85E-03) of the corresponding meta-analyses, clearly implicating these microRNAs in both Parkinson's and Alzheimer's disease. Furthermore, hsa-miR-132-3p/-5p (but not hsa-miR-129-5p) showed association with α-synuclein neuropathological Braak staging (P = 3.51E-03/P = 0.0117), suggesting that hsa-miR-132-3p/-5p play a role in α-synuclein aggregation beyond the early disease phase. Our study represents the largest independent assessment of recently highlighted candidate microRNAs in Parkinson's and Alzheimer's disease brains, to date. Our results implicate hsa-miR-132-3p/-5p and hsa-miR-129-5p to be differentially expressed in both Parkinson's and Alzheimer's disease, pinpointing shared pathogenic mechanisms across these neurodegenerative diseases. Intriguingly, based on publicly available high-throughput sequencing of RNA isolated by cross-linking immunoprecipitation data, hsa-miR-132 may interact with SNCA messenger RNA in the human brain, possibly pinpointing novel therapeutic approaches in fighting Parkinson's disease.
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Affiliation(s)
- Valerija Dobricic
- Correspondence to: Prof Dr Christina M. Lill, MD, MSc Ageing Epidemiology Unit, School of Public Health Imperial College London, London, UK E-mail: ; Dr. Valerija Dobricic, Lübeck Interdisciplinary Platform for Genome Analytics, University of Lübeck, Lübeck, Germany, E-mail:
| | - Marcel Schilling
- Lübeck Interdisciplinary Platform for Genome Analytics (LIGA), University of Lübeck, 23562 Lübeck, Germany
| | - Ildiko Farkas
- Multiple Sclerosis and Parkinson’s Tissue Bank, Imperial College London, London W12 0NN, UK
| | - Djordje O Gveric
- Multiple Sclerosis and Parkinson’s Tissue Bank, Imperial College London, London W12 0NN, UK
| | - Olena Ohlei
- Lübeck Interdisciplinary Platform for Genome Analytics (LIGA), University of Lübeck, 23562 Lübeck, Germany
| | - Jessica Schulz
- Lübeck Interdisciplinary Platform for Genome Analytics (LIGA), University of Lübeck, 23562 Lübeck, Germany
| | - Lefkos Middleton
- Ageing and Epidemiology Unit (AGE), School of Public Health, Imperial College London, London W6 8RF, UK,Public Health Directorate, Imperial College NHS Healthcare Trust, London W6 8RF, UK
| | - Steve M Gentleman
- Department of Brain Sciences, Hammersmith Hospital campus, Imperial College London, London W12 0HS, UK
| | - Laura Parkkinen
- Nuffield Department of Clinical Neurosciences, Oxford Parkinson’s Disease Centre, University of Oxford, Oxford OX3 9DU, UK
| | - Lars Bertram
- Lübeck Interdisciplinary Platform for Genome Analytics (LIGA), University of Lübeck, 23562 Lübeck, Germany,Department of Psychology, University of Oslo, 0373 Oslo, Norway
| | - Christina M Lill
- Correspondence to: Prof Dr Christina M. Lill, MD, MSc Ageing Epidemiology Unit, School of Public Health Imperial College London, London, UK E-mail: ; Dr. Valerija Dobricic, Lübeck Interdisciplinary Platform for Genome Analytics, University of Lübeck, Lübeck, Germany, E-mail:
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10
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Koblinsky ND, Anderson ND, Ajwani F, Parrott MD, Dawson D, Marzolini S, Oh P, MacIntosh B, Middleton L, Ferland G, Greenwood CE. Feasibility and preliminary efficacy of the LEAD trial: a cluster randomized controlled lifestyle intervention to improve hippocampal volume in older adults at-risk for dementia. Pilot Feasibility Stud 2022; 8:37. [PMID: 35139918 PMCID: PMC8826667 DOI: 10.1186/s40814-022-00977-6] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 01/11/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Healthy diet and exercise are associated with reduced risk of dementia in older adults. The impact of diet and exercise interventions on brain health is less consistent, especially with dietary interventions which rely on varying approaches. Our objective was to evaluate the feasibility and preliminary efficacy of a 6-month intervention combining exercise with a novel dietary counseling approach to improve hippocampal volume among older adults at-risk for dementia. METHODS Participants with vascular risk factors and subjective cognitive decline or early mild cognitive impairment were cluster randomized in groups of 3-4 to the diet intervention (DIET) or control education (ED) group. All participants engaged in 1 h of supervised exercise per week and additional exercise at home. DIET involved 1 h per week of group-based dietary counseling comprising education, goal setting, and strategy training. ED involved 1 h per week of group-based brain health education classes. Our primary outcome was change in hippocampal volume from baseline to 6 months. Secondary outcomes included changes in cognitive function, blood biomarkers, diet, and fitness. Recruitment challenges and early discontinuation of the trial due to COVID-19 necessitated a revised focus on feasibility and preliminary efficacy. RESULTS Of 190 older adults contacted, 14 (7%) were eligible and enrolled, constituting 21% of our recruitment target. All participants completed the intervention and attended 90% of exercise and DIET/ED sessions on average. All 6-month assessments prior to COVID-19 were completed but disruptions to in-person testing resulted in incomplete data collection. No serious adverse events occurred and all participants expressed positive feedback about the study. Preliminary findings did not identify any significant changes in hippocampal volume; however, substantial improvements in diet and HbA1c were observed with DIET compared to ED (d = 1.75 and 1.07, respectively). CONCLUSIONS High adherence and retention rates were observed among participants and preliminary findings illustrate improvements in diet quality and HbA1c. These results indicate that a larger trial is feasible if difficulties surrounding recruitment can be mitigated. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03056508 .
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Affiliation(s)
- N D Koblinsky
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Canada
| | - N D Anderson
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Canada.
- Departments of Psychology and Psychiatry, University of Toronto, Toronto, Canada.
| | - F Ajwani
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Canada
- KITE, Toronto Rehabilitation Institute - the University Health Network, Toronto, Canada
| | - M D Parrott
- PERFORM Centre, Concordia University, Montreal, Canada
| | - D Dawson
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Canada
- Department of Occupational Sciences and Occupational Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - S Marzolini
- KITE, Toronto Rehabilitation Institute - the University Health Network, Toronto, Canada
| | - P Oh
- KITE, Toronto Rehabilitation Institute - the University Health Network, Toronto, Canada
| | - B MacIntosh
- Hurvitz Brain Sciences, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | | | - G Ferland
- Montreal Heart Institute Research Centre, Montreal, Canada
- Department of Nutrition, Université de Montréal, Montreal, Canada
| | - C E Greenwood
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
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11
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Udeh-Momoh C, Zheng B, Sandebring-Matton A, Novak G, Kivipelto M, Jönsson L, Middleton L. Blood Derived Amyloid Biomarkers for Alzheimer's Disease Prevention. J Prev Alzheimers Dis 2022; 9:12-21. [PMID: 35098969 DOI: 10.14283/jpad.2021.70] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Reliable, widely accessible and affordable biomarkers for predicting Alzheimer's disease (AD) brain pathology status are a necessity to aid development of prevention strategies in cognitively healthy at-risk older adults, at the right timepoint. Measurements of the key neuropathological hallmark beta-amyloid (Aβ) by PET neuroimaging or cerebrospinal fluid measures reflect its accumulation in the brain, yet recent methodological advancements now enable blood-based measures reflecting cerebral amyloid burden. OBJECTIVES The current study validated the capacity of plasma Aβ42/Aβ40 measured using six different assays to predict amyloid positivity in a subgroup of cognitively unimpaired (CU) participants in the ADNI study and assessed its ability to discriminate CU from AD cases. We also explored economic viability of using two different plasma amyloid assays for pre-screening in AD prevention trials and as routine clinical diagnostic tool, versus amyloid PET alone. DESIGN A cross-sectional analysis of plasma and brain amyloid data, including comparative cost analysis of the plasma biomarkers in relation to brain amyloid PET. SETTING Alzheimer's Disease Neuroimaging Initiative (ADNI). PARTICIPANTS ADNI participants consisting of 115 CU, mild cognitive impairment and AD cases who had plasma Aβ42/Aβ40 measured with six platforms. MEASUREMENTS Plasma Aβ42/Aβ40 was measured via six different platforms: three immunoassays (Roche, Quanterix and ADx Neurosciences) and three mass spectrometry (MS) based assays (WashU, Shimadzu and Gothenburg). Aβ-PET imaging was conducted within three months of plasma sampling using [18F]florbetapir. RESULTS There was a weak to moderate correlation of plasma Aβ42/Aβ40 ratio between platforms. The MS-based WashU test had the highest capacity to discriminate between CU and AD (area under the curve, AUC = 0.734, 95% CI: 0.613-0.854; P = 0.008). Within the CU group, the WashU plasma amyloid test had the best discriminative capacity to distinguish Aβ+ from Aβ- (AUC = 0.753, 95% CI: 0.601-0.905; P = 0.003) closely followed by the immunoassay from Roche (AUC = 0.737, 95% CI: 0.597-0.877; P = 0.006). The exploratory economic analyses showed that the use of Roche or WashU plasma amyloid assay as a pre-screening tool prior to Aβ-PET scans for clinical trial recruitment significantly reduced total screening cost (saving up to $5882 per recruited patient) expected in an AD prevention trial. CONCLUSIONS With few available treatment strategies, dementia prevention is a global priority. CU individuals at risk for AD are the target population for dementia prevention but have been poorly studied. Our findings confirming diagnostic value of ultrasensitive immunoassays and high-performance immunoprecipitation coupled with MS for measurement of plasma Aβ42/Aβ40 to detect PET amyloid positivity in CU participants allude to potential clinical utility of this biomarker. Plasma Aβ42/Aβ40 could be optimal for pre-selecting at-risk candidates for more invasive and expensive investigations across AD prevention clinical trials and clinical care for a rapidly ageing population.
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Affiliation(s)
- C Udeh-Momoh
- Prof. Lefkos Middleton, Ageing Epidemiology Research Unit, School of Public Health, Faculty of Medicine, Imperial College London, London W6 8RP, UK. E-mail: ; Tel: +44 20 3311 0216; Fax: +44 20 3311 0216
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12
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Abbott KA, Posma JM, Garcia-Perez I, Udeh-Momoh C, Ahmadi-Abhari S, Middleton L, Frost G. Evidence-Based Tools for Dietary Assessments in Nutrition Epidemiology Studies for Dementia Prevention. J Prev Alzheimers Dis 2022; 9:49-53. [PMID: 35098973 DOI: 10.14283/jpad.2022.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Increasing evidence proposes diet as a notable modifiable factor and viable target for the reduction of Alzheimer's Disease risk and age-related cognitive decline. However, assessment of dietary exposures is challenged by dietary capture methods that are prone to misreporting and measurement errors. The utility of -omics technologies for the evaluation of dietary exposures has the potential to improve reliability and offer new insights to pre-disease indicators and preventive targets in cognitive aging and dementia. In this review, we present a focused overview of metabolomics as a validation tool and framework for investigating the immediate or cumulative effects of diet on cognitive health.
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Affiliation(s)
- K A Abbott
- Prof Gary Frost, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London Hammersmith Campus, Commonwealth Building, Du Cane Road, London W12 ONN, United Kingdom, Tel: +44 (0)20 7594 0959. Fax: +44 (0208383 8320, Email :
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13
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Hemming K, Martin J, Gallos I, Coomarasamy A, Middleton L. Interim data monitoring in cluster randomised trials: Practical issues and a case study. Clin Trials 2021; 18:552-561. [PMID: 34154426 PMCID: PMC8479148 DOI: 10.1177/17407745211024751] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is an abundance of guidance for the interim monitoring of individually randomised trials. While methodological literature exists on how to extend these methods to cluster randomised trials, there is little guidance on practical implementation. Cluster trials have many features which make their monitoring needs different. We outline the methodological and practical challenges of interim monitoring of cluster trials; and apply these considerations to a case study. CASE STUDY The E-MOTIVE study is an 80-cluster randomised trial of a bundle of interventions to treat postpartum haemorrhage. The proposed data monitoring plan includes (1) monitor sample size assumptions, (2) monitor for evidence of selection bias, and (3) an interim assessment of the primary outcome, as well as monitoring data completeness. The timing of the sample size monitoring is chosen with both consideration of statistical precision and to allow time to recruit more clusters. Monitoring for selection bias involves comparing individual-level characteristics and numbers recruited between study arms to identify any post-randomisation participant identification bias. An interim analysis of outcomes presented with 99.9% confidence intervals using the Haybittle-Peto approach should mitigate any concern regarding the inflation of type-I error. The pragmatic nature of the trial means monitoring for adherence is not relevant, as it is built into a process evaluation. CONCLUSIONS The interim analyses of cluster trials have a number of important differences to monitoring individually randomised trials. In cluster trials, there will often be a greater need to monitor nuisance parameters, yet there will often be considerable uncertainty in their estimation. This means the utility of sample size re-estimation can be questionable particularly when there are practical or funding difficulties associated with making any changes to planned sample sizes. Perhaps most importantly interim monitoring has the potential to identify selection bias, particularly in trials with post-randomisation identification or recruitment. Finally, the pragmatic nature of cluster trials might mean that the utility of methods to allow for interim monitoring of outcomes based on statistical testing, or monitoring for adherence to study interventions, are less relevant. Our intention is to facilitate the planning of future cluster randomised trials and to promote discussion and debate to improve monitoring of these studies.
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Affiliation(s)
- K Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - J Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - I Gallos
- University of Birmingham, Birmingham, UK
| | - A Coomarasamy
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - L Middleton
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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14
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Zheng B, Su B, Price G, Tzoulaki I, Ahmadi-Abhari S, Middleton L. Glycemic Control, Diabetic Complications, and Risk of Dementia in Patients With Diabetes: Results From a Large U.K. Cohort Study. Diabetes Care 2021; 44:1556-1563. [PMID: 34035076 DOI: 10.2337/dc20-2850] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 04/23/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 2 diabetes is an established risk factor for dementia. However, the roles of glycemic control and diabetic complications in the development of dementia have been less well substantiated. This large-scale cohort study aims to examine associations of longitudinal HbA1c levels and diabetic complications with the risk of dementia incidence among patients with type 2 diabetes. RESEARCH DESIGN AND METHODS Data of eligible patients with diabetes, aged ≥50 years in the U.K. Clinical Practice Research Datalink from 1987 to 2018, were analyzed. Time-varying Cox regressions were used to estimate adjusted hazard ratios (HRs) and 95% CIs for dementia risk. RESULTS Among 457,902 patients with diabetes, 28,627 (6.3%) incident dementia cases were observed during a median of 6 years' follow-up. Patients with recorded hypoglycemic events or microvascular complications were at higher risk of dementia incidence compared with those without such complications (HR 1.30 [95% CI 1.22-1.39] and 1.10 [1.06-1.14], respectively). The HbA1c level, modeled as a time-varying exposure, was associated with increased dementia risk (HR 1.08 [95% CI 1.07-1.09] per 1% HbA1c increment) among 372,287 patients with diabetes with postdiagnosis HbA1c records. Similarly, a higher coefficient of variation of HbA1c during the initial 3 years of follow-up was associated with higher subsequent dementia risk (HR 1.03 [95% CI 1.01-1.04] per 1-SD increment). CONCLUSIONS Higher or unstable HbA1c levels and the presence of diabetic complications in patients with type 2 diabetes are associated with increased dementia risk. Effective management of glycemia might have a significant role in maintaining cognitive health among older adults with diabetes.
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Affiliation(s)
- Bang Zheng
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, U.K
| | - Bowen Su
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, U.K
| | - Geraint Price
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, U.K
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, U.K
| | - Sara Ahmadi-Abhari
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, U.K
| | - Lefkos Middleton
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, U.K. .,Public Health Directorate, Imperial College Healthcare NHS Trust, London, U.K
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15
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Udeh-Momoh CT, Watermeyer T, Price G, de Jager Loots CA, Reglinska-Matveyev N, Ropacki M, Ketter N, Fogle M, Raghavan N, Arrighi M, Brashear R, Di J, Baker S, Giannakopoulou P, Robb C, Bassil D, Cohn M, McLellan-Young H, Crispin J, Lakey K, Lisa C, Chowdary Seemulamoodi Y, Kafetsouli D, Perera D, Car J, Majeed A, Ward H, Ritchie K, Perneczky R, Kivipelto M, Scott D, Bracoud L, Saad Z, Novak G, Ritchie CW, Middleton L. Protocol of the Cognitive Health in Ageing Register: Investigational, Observational and Trial Studies in Dementia Research (CHARIOT): Prospective Readiness cOhort (PRO) SubStudy. BMJ Open 2021; 11:e043114. [PMID: 34168021 PMCID: PMC8230926 DOI: 10.1136/bmjopen-2020-043114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The Cognitive Health in Ageing Register: Investigational, Observational and Trial Studies in Dementia Research (CHARIOT): Prospective Readiness cOhort (PRO) SubStudy (CPSS), sponsored by Janssen Pharmaceutical Research & Development LLC, is an Alzheimer's disease (AD) biomarker enriched observational study that began 3 July 2015 CPSS aims to identify and validate determinants of AD, alongside cognitive, functional and biological changes in older adults with or without detectable evidence of AD pathology at baseline. METHODS AND ANALYSIS CPSS is a dual-site longitudinal cohort (3.5 years) assessed quarterly. Cognitively normal participants (60-85 years) were recruited across Greater London and Edinburgh. Participants are classified as high, medium (amnestic or non-amnestic) or low risk for developing mild cognitive impairment-Alzheimer's disease based on their Repeatable Battery for the Assessment of Neuropsychological Status performance at screening. Additional AD-related assessments include: a novel cognitive composite, the Global Preclinical Alzheimer's Cognitive Composite, brain MRI and positron emission tomography and cerebrospinal fluid analysis. Lifestyle, other cognitive and functional data, as well as biosamples (blood, urine, and saliva) are collected. Primarily, study analyses will evaluate longitudinal change in cognitive and functional outcomes. Annual interim analyses for descriptive data occur throughout the course of the study, although inferential statistics are conducted as required. ETHICS AND DISSEMINATION CPSS received ethical approvals from the London-Central Research Ethics Committee (15/LO/0711) and the Administration of Radioactive Substances Advisory Committee (RPC 630/3764/33110) The study is at the forefront of global AD prevention efforts, with frequent and robust sampling of the well-characterised cohort, allowing for detection of incipient pathophysiological, cognitive and functional changes that could inform therapeutic strategies to prevent and/or delay cognitive impairment and dementia. Dissemination of results will target the scientific community, research participants, volunteer community, public, industry, regulatory authorities and policymakers. On study completion, and following a predetermined embargo period, CPSS data are planned to be made accessible for analysis to facilitate further research into the determinants of AD pathology, onset of symptomatology and progression. TRIAL REGISTRATION NUMBER The CHARIOT:PRO SubStudy is registered with clinicaltrials.gov (NCT02114372). Notices of protocol modifications will be made available through this trial registry.
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Affiliation(s)
- Chinedu T Udeh-Momoh
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tamlyn Watermeyer
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Geraint Price
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
| | | | - Natalia Reglinska-Matveyev
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | | | - Nzeera Ketter
- Janssen Alzheimer Immunotherapy Research and Development LLC, South San Francisco, California, USA
| | - Michael Fogle
- Janssen Research and Development LLC, Titusville, New Jersey, USA
| | - Nandini Raghavan
- Janssen Research and Development LLC, Titusville, New Jersey, USA
| | | | - Robert Brashear
- Janssen Alzheimer Immunotherapy Research and Development LLC, South San Francisco, California, USA
| | - Jianing Di
- Department of Biostatistics, Janssen Research and Development Shanghai, Shanghai, China
| | - Susan Baker
- Janssen Research and Development LLC, Titusville, New Jersey, USA
| | | | - Catherine Robb
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
| | - Darina Bassil
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
| | - Martin Cohn
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
| | - Heather McLellan-Young
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
| | - Jennifier Crispin
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
| | - Kristina Lakey
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
| | - Curry Lisa
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
| | | | - Dimitra Kafetsouli
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
| | - Dinithi Perera
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
| | - Josip Car
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public, Imperial College London, London, UK
| | - Heather Ward
- Department of Epidemiology and Biostatistics, School of Public, Imperial College London, London, UK
| | - Karen Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM, University of Montpellier, Montpellier, France
| | - Robert Perneczky
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilians University Munich, Munchen, Germany
| | - Miia Kivipelto
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - David Scott
- BioClinica Inc Newark California Office, Newark, California, USA
| | | | - Ziad Saad
- Janssen Research and Development, Fremont, California, USA
| | - Gerald Novak
- Janssen Research and Development LLC, Titusville, New Jersey, USA
| | - Craig W Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Lefkos Middleton
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
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16
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Peters S, Broberg K, Gallo V, Levi M, Kippler M, Vineis P, Veldink J, van den Berg L, Middleton L, Travis RC, Bergmann MM, Palli D, Grioni S, Tumino R, Elbaz A, Vlaar T, Mancini F, Kühn T, Katzke V, Agudo A, Goñi F, Gómez J, Rodríguez‐Barranco M, Merino S, Barricarte A, Trichopoulou A, Jenab M, Weiderpass E, Vermeulen R. Blood Metal Levels and Amyotrophic Lateral Sclerosis Risk: A Prospective Cohort. Ann Neurol 2021; 89:125-133. [PMID: 33068316 PMCID: PMC7756568 DOI: 10.1002/ana.25932] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Metals have been suggested as a risk factor for amyotrophic lateral sclerosis (ALS), but only retrospective studies are available to date. We compared metal levels in prospectively collected blood samples from ALS patients and controls, to explore whether metals are associated with ALS mortality. METHODS A nested ALS case-control study was conducted within the prospective EPIC (European Prospective Investigation into Cancer and Nutrition) cohort. Cases were identified through death certificates. We analyzed metal levels in erythrocyte samples obtained at recruitment, as a biomarker for metal exposure from any source. Arsenic, cadmium, copper, lead, manganese, mercury, selenium, and zinc concentrations were measured by inductively coupled plasma-mass spectrometry. To estimate ALS risk, we applied conditional logistic regression models. RESULTS The study population comprised 107 cases (65% female) and 319 controls matched for age, sex, and study center. Median time between blood collection and ALS death was 8 years (range = 1-15). Comparing the highest with the lowest tertile, cadmium (odds ratio [OR] = 2.04, 95% confidence interval [CI] = 1.08-3.87) and lead (OR = 1.89, 95% CI = 0.97-3.67) concentrations suggest associations with increased ALS risk. Zinc was associated with a decreased risk (OR = 0.50, 95% CI = 0.27-0.94). Associations for cadmium and lead remained when limiting analyses to noncurrent smokers. INTERPRETATION This is the first study to compare metal levels before disease onset, minimizing reverse causation. The observed associations suggest that cadmium, lead, and zinc may play a role in ALS etiology. Cadmium and lead possibly act as intermediates on the pathway from smoking to ALS. ANN NEUROL 20209999:n/a-n/a.
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Affiliation(s)
- Susan Peters
- Institute for Risk Assessment SciencesUtrecht UniversityUtrechtthe Netherlands
- Department of NeurologyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Karin Broberg
- Institute of Environmental MedicineKarolinska InstituteSolnaSweden
| | - Valentina Gallo
- Centre for Primary Care and Public HealthQueen Mary University of LondonLondonUK
| | - Michael Levi
- Institute of Environmental MedicineKarolinska InstituteSolnaSweden
| | - Maria Kippler
- Institute of Environmental MedicineKarolinska InstituteSolnaSweden
| | - Paolo Vineis
- School of Public HealthImperial College LondonLondonUK
| | - Jan Veldink
- Department of NeurologyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | | | | | - Ruth C. Travis
- Cancer Epidemiology UnitNuffield Department of Population Health, University of OxfordOxfordUK
| | | | - Domenico Palli
- Cancer Risk Factors and Life‐Style Epidemiology UnitInstitute for Cancer Research, Prevention and Clinical NetworkFlorenceItaly
| | - Sara Grioni
- Epidemiology and Prevention UnitIRCCS National Cancer Institute FoundationMilanItaly
| | - Rosario Tumino
- Cancer Registry and Histopathology DepartmentProvincial Health CompanyRagusaItaly
| | - Alexis Elbaz
- Public Health FranceSaint‐MauriceFrance
- Paris‐Sud UniversityUVSQ, CESP, INSERM, Paris‐Saclay UniversityVillejuifFrance
| | - Tim Vlaar
- Public Health FranceSaint‐MauriceFrance
- Paris‐Sud UniversityUVSQ, CESP, INSERM, Paris‐Saclay UniversityVillejuifFrance
| | - Francesca Mancini
- Faculty of Medicine, CESP, Paris‐Sud University, UVSQ, INSERMParis‐Saclay UniversityVillejuifFrance
- Gustave Roussy InstituteVillejuifFrance
| | - Tilman Kühn
- German Cancer Research CenterHeidelbergGermany
| | | | - Antonio Agudo
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Group of Research on Nutrition and CancerBellvitge Biomedical Research Institute, L'Hospitalet de LlobregatBarcelonaSpain
| | - Fernando Goñi
- Networked Biomedical Research Center of Epidemiology and Public HealthMadridSpain
- Biodonostia Health Research Institute; Public Health Laboratory in GipuzkoaBasque GovernmentSan SebastianSpain
| | - Jesús‐Humberto Gómez
- Networked Biomedical Research Center of Epidemiology and Public HealthMadridSpain
- Department of EpidemiologyRegional Health Council, IMIB‐ArrixacaMurciaSpain
| | - Miguel Rodríguez‐Barranco
- Networked Biomedical Research Center of Epidemiology and Public HealthMadridSpain
- Andalusian School of Public HealthGranadaSpain
- Grenada Institute of Biosanitary ResearchGranadaSpain
| | | | - Aurelio Barricarte
- Networked Biomedical Research Center of Epidemiology and Public HealthMadridSpain
- Navarra Public Health InstitutePamplonaSpain
- Navarra Institute for Health ResearchPamplonaSpain
| | | | - Mazda Jenab
- International Agency for Research on CancerLyonFrance
| | | | - Roel Vermeulen
- Institute for Risk Assessment SciencesUtrecht UniversityUtrechtthe Netherlands
- School of Public HealthImperial College LondonLondonUK
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
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17
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Ford J, Zheng B, Hurtado B, de Jager CA, Udeh-Momoh C, Middleton L, Price G. Strategy or symptom: Semantic clustering and risk of Alzheimer's disease-related impairment. J Clin Exp Neuropsychol 2020; 42:849-856. [PMID: 32933358 DOI: 10.1080/13803395.2020.1819964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Alzheimer's disease (AD) is the most common form of dementia, impacting global cognitive performance, including episodic memory. Semantic clustering is a learning strategy involving grouping words of similar meaning and can improve episodic memory performance, e.g., list learning. As the APOE ε4 allele is the most validated genetic risk factor for AD, we predicted that its presence would be associated with poorer list learning performance, and we hypothesized that semantic clustering moderates or mediates this association. The sample comprised 699 healthy older adults participating in the CHARIOT PRO Main Study, 169 of whom were APOE ε4 carriers. Participants' ability to form groups of related stimuli (assessed via a categorization task, CAT), and their use of semantic clustering during list learning, were investigated using the Neuropsychological Assessment Battery (NAB). CAT scores predicted the use of semantic clustering in, and performance on, the list learning task. CAT scores were not significantly lower in APOE ε4 carriers, suggesting that the ability to categorize was preserved. However, APOE ε4 carriers made less use of semantic clustering in list learning. Semantic clustering use partially mediated the relationship between CAT scores and list learning performance, and, in women only, moderated the impact of APOE ε4 on list learning performance. The results suggest that better categorization ability is associated with greater use of mnemonic strategies and better performance on memory tasks regardless of genetic risk, but that APOE ε4 carriers make less use of such strategies. Furthermore, female APOE ε4 carriers may benefit more than their non-carriers from using semantic clustering to aid list learning. Thus, semantic clustering may be a contributing factor of their "cognitive reserve", compensating for potential deficits in episodic memory.
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Affiliation(s)
- Jamie Ford
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London , London, UK
| | - Bang Zheng
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London , London, UK
| | - Barbara Hurtado
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London , London, UK
| | - Celeste A de Jager
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London , London, UK
| | - Chi Udeh-Momoh
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London , London, UK
| | - Lefkos Middleton
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London , London, UK.,Directorate of Public Health, Imperial College Healthcare NHS Trust , London, UK
| | - Geraint Price
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London , London, UK
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18
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Udeh-Momoh C, Price G, Ropacki MT, Ketter N, Andrews T, Arrighi HM, Brashear HR, Robb C, Bassil DT, Cohn M, Curry LK, Su B, Perera D, Giannakopoulou P, Car J, Ward HA, Perneczky R, Novak G, Middleton L. Prospective Evaluation of Cognitive Health and Related Factors in Elderly at Risk for Developing Alzheimer's Dementia: A Longitudinal Cohort Study. J Prev Alzheimers Dis 2020; 6:256-266. [PMID: 31686098 DOI: 10.14283/jpad.2019.31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The CHARIOT PRO Main study is a prospective, non-interventional study evaluating cognitive trajectories in participants at the preclinical stage of Alzheimer's disease (AD) classified by risk levels for developing mild cognitive impairment due to AD (MCI-AD). OBJECTIVES The study aimed to characterize factors and markers influencing cognitive and functional progression among individuals at-risk for developing MCI-AD, and examine data for more precise predictors of cognitive change, particularly in relation to APOE ε4 subgroup. DESIGN This single-site study was conducted at the Imperial College London (ICL) in the United Kingdom. Participants 60 to 85 years of age were classified as high, medium (amnestic or non-amnestic) or low risk for developing MCI-AD based on RBANS z-scores. A series of clinical outcome assessments (COAs) on factors influencing baseline cognitive changes were collected in each of the instrument categories of cognition, lifestyle exposure, mood, and sleep. Data collection was planned to occur every 6 months for 48 months, however the median follow-up time was 18.1 months due to early termination of study by the sponsor. RESULTS 987 participants were screened, among them 690 participants were actively followed-up post baseline, of whom 165 (23.9%) were APOE ε4 carriers; with at least one copy of the allele. The mean age was 68.73 years, 94.6% were white, 57.4% were female, and 34.8% had a Family History of Dementia with a somewhat larger percentage in the APOE ε4 carrier group (42.4%) compared to the non-carrier group (32.4%). Over half of the participants were married and 53% had a Bachelor's or higher degree. Most frequently, safety events typical for this population consisted of upper respiratory tract infection (10.4%), falls (5.2%), hypertension (3.5%) and back pain (3.0%). Conclusion (clinical relevance): AD-related measures collected during the CHARIOT PRO Main study will allow identification and evaluation of AD risk factors and markers associated with cognitive performance from the pre-clinical stage. Evaluating the psycho-biological characteristics of these pre-symptomatic individuals in relation to their natural neurocognitive trajectories will enhance current understanding on determinants of the initial signs of cognitive changes linked to AD.
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Affiliation(s)
- C Udeh-Momoh
- Gerald Novak, MD, Janssen Research and Development, LLC, 1125 Trenton-Harbourton Rd., Titusville, NJ 08560, USA, Tel.:+1 609 730 4416, Fax: +1 908 730 2069,
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19
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Kivipelto M, Mangialasche F, Snyder HM, Allegri R, Andrieu S, Arai H, Baker L, Belleville S, Brodaty H, Brucki SM, Calandri I, Caramelli P, Chen C, Chertkow H, Chew E, Choi SH, Chowdhary N, Crivelli L, Torre RDL, Du Y, Dua T, Espeland M, Feldman HH, Hartmanis M, Hartmann T, Heffernan M, Henry CJ, Hong CH, Håkansson K, Iwatsubo T, Jeong JH, Jimenez-Maggiora G, Koo EH, Launer LJ, Lehtisalo J, Lopera F, Martínez-Lage P, Martins R, Middleton L, Molinuevo JL, Montero-Odasso M, Moon SY, Morales-Pérez K, Nitrini R, Nygaard HB, Park YK, Peltonen M, Qiu C, Quiroz YT, Raman R, Rao N, Ravindranath V, Rosenberg A, Sakurai T, Salinas RM, Scheltens P, Sevlever G, Soininen H, Sosa AL, Suemoto CK, Tainta-Cuezva M, Velilla L, Wang Y, Whitmer R, Xu X, Bain LJ, Solomon A, Ngandu T, Carrillo MC. World-Wide FINGERS Network: A global approach to risk reduction and prevention of dementia. Alzheimers Dement 2020; 16:1078-1094. [PMID: 32627328 PMCID: PMC9527644 DOI: 10.1002/alz.12123] [Citation(s) in RCA: 237] [Impact Index Per Article: 59.3] [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: 08/23/2019] [Revised: 03/11/2020] [Accepted: 04/30/2020] [Indexed: 12/14/2022]
Abstract
Reducing the risk of dementia can halt the worldwide increase of affected people. The multifactorial and heterogeneous nature of late-onset dementia, including Alzheimer’s disease (AD), indicates a potential impact of multidomain lifestyle interventions on risk reduction. The positive results of the landmark multidomain Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) support such an approach. The World-Wide FINGERS (WW-FINGERS), launched in 2017 and including over 25 countries, is the first global network of multidomain lifestyle intervention trials for dementia risk reduction and prevention. WW-FINGERS aims to adapt, test, and optimize the FINGER model to reduce risk across the spectrum of cognitive decline—from at-risk asymptomatic states to early symptomatic stages—in different geographical, cultural, and economic settings. WW-FINGERS aims to harmonize and adapt multidomain interventions across various countries and settings, to facilitate data sharing and analysis across studies, and to promote international joint initiatives to identify globally implementable and effective preventive strategies.
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Affiliation(s)
- Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden.,Stockholms Sjukhem, Research & Development Unit, Stockholm, Sweden.,The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Francesca Mangialasche
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Aging Research Center, Center for Alzheimer Research, Department of Neurobiology Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Heather M Snyder
- Division of Medical and Scientific Relations, Alzheimer's Association, Chicago, Illinois, USA
| | - Ricardo Allegri
- Department of Cognitive Neurology, FLENI, Buenos Aires, Argentina
| | - Sandrine Andrieu
- INSERM, University of Toulouse UMR1027, Toulouse, France.,Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Laura Baker
- Department of Internal Medicine - Geriatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Sylvie Belleville
- Institute Universitaire de Geriatrie de Montreal, Universite de Montreal, Montreal, Canada
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, Sydney, Australia
| | - Sonia M Brucki
- Department of Neurology, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Ismael Calandri
- Department of Cognitive Neurology, FLENI, Buenos Aires, Argentina
| | - Paulo Caramelli
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Christopher Chen
- Memory Aging and Cognition Centre, National University of Singapore, Singapore, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Howard Chertkow
- Division of Medicine/Neurology, University of Toronto, Toronto, Canada.,Division of Cognitive Neurology and Innovation, Baycrest Health Sciences and Rotman Research Institute, Toronto, Canada
| | - Effie Chew
- Division of Neurology, University Medicine Cluster, National University Hospital, Singapore, Singapore
| | - Seong H Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Korea
| | - Neerja Chowdhary
- Brain Health Unit, Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Lucía Crivelli
- Department of Cognitive Neurology, FLENI, Buenos Aires, Argentina
| | - Rafael De La Torre
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Yifeng Du
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Tarun Dua
- Brain Health Unit, Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Mark Espeland
- Department of Internal Medicine - Geriatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Howard H Feldman
- Department of Neurosciences, Alzheimer Disease Cooperative Study, University of California, San Diego, California, La Jolla, USA.,Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maris Hartmanis
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,FINGERS Brain Health Institute, Stockholm, Sweden
| | - Tobias Hartmann
- German Institute for Dementia Prevention (DIDP), Medical Faculty, and Department of Experimental Neurology, Saarland University, Homburg, Germany
| | - Megan Heffernan
- Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, Sydney, Australia
| | - Christiani J Henry
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chang H Hong
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Korea
| | - Krister Håkansson
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Takeshi Iwatsubo
- Unit for Early and Exploratory Clinical Development, The University of Tokyo Hospital, Tokyo, Japan.,Department of Neuropathology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Jee H Jeong
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Gustavo Jimenez-Maggiora
- Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, California, San Diego, USA
| | - Edward H Koo
- Departments of Medicine and Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, Maryland, USA
| | - Jenni Lehtisalo
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Francisco Lopera
- Neuroscience Group of Antioquia (GNA), Faculty of Medicine of the University of Antioquia, Medellín, Antioquia, Colombia
| | - Pablo Martínez-Lage
- Department of Neurology, Center for Research and Advanced Therapies, CITA-Alzheimer Foundation, San Sebastian, Spain
| | - Ralph Martins
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,Department of Biomedical Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Lefkos Middleton
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom.,Neurology, Public Health Directorate, Imperial College Healthcare NHS Trust, London, UK
| | - José L Molinuevo
- BarcelonaBeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
| | - Manuel Montero-Odasso
- Department of Medicine and Biostatistics Western University, London, Ontario, Canada
| | - So Y Moon
- Department of Neurology, Ajou University School of Medicine, Suwon, Korea
| | - Kristal Morales-Pérez
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,FINGERS Brain Health Institute, Stockholm, Sweden
| | - Ricardo Nitrini
- Department of Neurology, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Haakon B Nygaard
- Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yoo K Park
- Department of Medical nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Suwon, Korea
| | - Markku Peltonen
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Chengxuan Qiu
- Aging Research Center, Center for Alzheimer Research, Department of Neurobiology Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Department of Neurology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Yakeel T Quiroz
- Neuroscience Group of Antioquia (GNA), Faculty of Medicine of the University of Antioquia, Medellín, Antioquia, Colombia.,Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rema Raman
- Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, California, San Diego, USA
| | - Naren Rao
- Department of psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Anna Rosenberg
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | | | - Rosa M Salinas
- Laboratory of Dementias, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Gustavo Sevlever
- Department of Cognitive Neurology, FLENI, Buenos Aires, Argentina
| | - Hilkka Soininen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ana L Sosa
- Laboratory of Dementias, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Claudia K Suemoto
- Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
| | - Mikel Tainta-Cuezva
- Department of Neurology, Center for Research and Advanced Therapies, CITA-Alzheimer Foundation, San Sebastian, Spain.,Organización Sanitaria Integrada Goierri Alto Urola, Basque Country, Spain
| | - Lina Velilla
- Neuroscience Group of Antioquia (GNA), Faculty of Medicine of the University of Antioquia, Medellín, Antioquia, Colombia
| | - Yongxiang Wang
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Rachel Whitmer
- Division of Epidemiology, University of California, Davis, Davis, California, USA
| | - Xin Xu
- Memory Aging and Cognition Centre, National University of Singapore, Singapore, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lisa J Bain
- Independent Science Writer, Philadelphia, Pennsylvania, USA
| | - Alina Solomon
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tiia Ngandu
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Maria C Carrillo
- Division of Medical and Scientific Relations, Alzheimer's Association, Chicago, Illinois, USA
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20
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Bauermeister S, Orton C, Thompson S, Barker RA, Bauermeister JR, Ben-Shlomo Y, Brayne C, Burn D, Campbell A, Calvin C, Chandran S, Chaturvedi N, Chêne G, Chessell IP, Corbett A, Davis DHJ, Denis M, Dufouil C, Elliott P, Fox N, Hill D, Hofer SM, Hu MT, Jindra C, Kee F, Kim CH, Kim C, Kivimaki M, Koychev I, Lawson RA, Linden GJ, Lyons RA, Mackay C, Matthews PM, McGuiness B, Middleton L, Moody C, Moore K, Na DL, O'Brien JT, Ourselin S, Paranjothy S, Park KS, Porteous DJ, Richards M, Ritchie CW, Rohrer JD, Rossor MN, Rowe JB, Scahill R, Schnier C, Schott JM, Seo SW, South M, Steptoe M, Tabrizi SJ, Tales A, Tillin T, Timpson NJ, Toga AW, Visser PJ, Wade-Martins R, Wilkinson T, Williams J, Wong A, Gallacher JEJ. The Dementias Platform UK (DPUK) Data Portal. Eur J Epidemiol 2020; 35:601-611. [PMID: 32328990 PMCID: PMC7320955 DOI: 10.1007/s10654-020-00633-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/10/2020] [Indexed: 11/18/2022]
Abstract
The Dementias Platform UK Data Portal is a data repository facilitating access to data for 3 370 929 individuals in 42 cohorts. The Data Portal is an end-to-end data management solution providing a secure, fully auditable, remote access environment for the analysis of cohort data. All projects utilising the data are by default collaborations with the cohort research teams generating the data. The Data Portal uses UK Secure eResearch Platform infrastructure to provide three core utilities: data discovery, access, and analysis. These are delivered using a 7 layered architecture comprising: data ingestion, data curation, platform interoperability, data discovery, access brokerage, data analysis and knowledge preservation. Automated, streamlined, and standardised procedures reduce the administrative burden for all stakeholders, particularly for requests involving multiple independent datasets, where a single request may be forwarded to multiple data controllers. Researchers are provided with their own secure 'lab' using VMware which is accessed using two factor authentication. Over the last 2 years, 160 project proposals involving 579 individual cohort data access requests were received. These were received from 268 applicants spanning 72 institutions (56 academic, 13 commercial, 3 government) in 16 countries with 84 requests involving multiple cohorts. Projects are varied including multi-modal, machine learning, and Mendelian randomisation analyses. Data access is usually free at point of use although a small number of cohorts require a data access fee.
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Affiliation(s)
| | | | - Simon Thompson
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Roger A Barker
- Cambridge University Department of Clinical Neurosciences and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Carol Brayne
- Department of Public Health, University of Cambridge, Cambridge, UK
| | - David Burn
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Archie Campbell
- Department of Medical Genetics, University of Edinburgh, Edinburgh, UK
| | | | | | | | - Geneviève Chêne
- Bordeaux Population Health, Université Bordeaux, Bordeaux, France
| | | | - Anne Corbett
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Mike Denis
- Oxford Academic Health Science Network, University of Oxford, Oxford, UK
| | - Carole Dufouil
- Bordeaux Population Health, Université Bordeaux, Bordeaux, France
| | - Paul Elliott
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Imperial College NIHR Biomedical Research Centre, Imperial College London, London, UK
- Health Data Research UK London at Imperial College London, London, UK
| | - Nick Fox
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | | | - Scott M Hofer
- Department of Psychology, University of Victoria, Victoria, Canada
| | - Michele T Hu
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | | | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Chi-Hun Kim
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Changsoo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Mika Kivimaki
- Institute of Epidemiology and Health, University College London, London, UK
| | - Ivan Koychev
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Rachael A Lawson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gerry J Linden
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Ronan A Lyons
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Clare Mackay
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Paul M Matthews
- Division of Brain Sciences and UK Dementia Research Institute, Imperial College London, London, UK
| | | | - Lefkos Middleton
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | | | - Katrina Moore
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | | | - Ki-Soo Park
- Institute of Health Science, Gyeongsang National University, Jinju-si, South Korea
| | - David J Porteous
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | | | - Craig W Ritchie
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jonathan D Rohrer
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Martin N Rossor
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - James B Rowe
- Cambridge University Department of Clinical Neurosciences and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Rachael Scahill
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Christian Schnier
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Jonathan M Schott
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Sang W Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Matthew South
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Matthew Steptoe
- Department of Behavioural Science and Health, UCL, London, UK
| | - Sarah J Tabrizi
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Andrea Tales
- Centre for Innovative Ageing, Swansea University, Swansea, UK
| | | | | | | | - Pieter-Jelle Visser
- VU University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Richard Wade-Martins
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Tim Wilkinson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Julie Williams
- Institute of Psychological Medicine and Clinical Neurosciences, and UK Dementia Research Institute, Cardiff University, Cardiff, UK
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing, UCL, London, UK
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21
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Schulz J, Takousis P, Wohlers I, Itua IOG, Dobricic V, Rücker G, Binder H, Middleton L, Ioannidis JPA, Perneczky R, Bertram L, Lill CM. Meta-analyses identify differentially expressed micrornas in Parkinson's disease. Ann Neurol 2020; 85:835-851. [PMID: 30990912 DOI: 10.1002/ana.25490] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 04/14/2019] [Accepted: 04/15/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE MicroRNA (miRNA)-mediated (dys)regulation of gene expression has been implicated in Parkinson's disease (PD), although results of miRNA expression studies remain inconclusive. We aimed to identify miRNAs that show consistent differential expression across all published expression studies in PD. METHODS We performed a systematic literature search on miRNA expression studies in PD and extracted data from eligible publications. After stratification for brain, blood, and cerebrospinal fluid (CSF)-derived specimen, we performed meta-analyses across miRNAs assessed in three or more independent data sets. Meta-analyses were performed using effect-size- and p-value-based methods, as applicable. RESULTS After screening 599 publications, we identified 47 data sets eligible for meta-analysis. On these, we performed 160 meta-analyses on miRNAs quantified in brain (n = 125), blood (n = 31), or CSF (n = 4). Twenty-one meta-analyses were performed using effect sizes. We identified 13 significantly (Bonferroni-adjusted α = 3.13 × 10-4 ) differentially expressed miRNAs in brain (n = 3) and blood (n = 10) with consistent effect directions across studies. The most compelling findings were with hsa-miR-132-3p (p = 6.37 × 10-5 ), hsa-miR-497-5p (p = 1.35 × 10-4 ), and hsa-miR-133b (p = 1.90 × 10-4 ) in brain and with hsa-miR-221-3p (p = 4.49 × 10-35 ), hsa-miR-214-3p (p = 2.00 × 10-34 ), and hsa-miR-29c-3p (p = 3.00 × 10-12 ) in blood. No significant signals were found in CSF. Analyses of genome-wide association study data for target genes of brain miRNAs showed significant association (α = 9.40 × 10-5 ) of genetic variants in nine loci. INTERPRETATION We identified several miRNAs that showed highly significant differential expression in PD. Future studies may assess the possible role of the identified brain miRNAs in pathogenesis and disease progression as well as the potential of the top blood miRNAs as biomarkers for diagnosis, progression, or prediction of PD. ANN NEUROL 2019;85:835-851.
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Affiliation(s)
- Jessica Schulz
- Genetic and Molecular Epidemiology Group, Lübeck Interdisciplinary Platform for Genome Analytics, Institutes of Neurogenetics & Cardiogenetics, University of Lübeck, Lübeck, Germany
| | - Petros Takousis
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College, London, United Kingdom
| | - Inken Wohlers
- Lübeck Interdisciplinary Platform for Genome Analytics (LIGA), Institutes of Neurogenetics & Cardiogenetics, University of Lübeck, Lübeck, Germany
| | - Ivie O G Itua
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College, London, United Kingdom
| | - Valerija Dobricic
- Lübeck Interdisciplinary Platform for Genome Analytics (LIGA), Institutes of Neurogenetics & Cardiogenetics, University of Lübeck, Lübeck, Germany
| | - Gerta Rücker
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center-University of Freiburg, Freiburg, Germany
| | - Harald Binder
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center-University of Freiburg, Freiburg, Germany
| | - Lefkos Middleton
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College, London, United Kingdom
| | - John P A Ioannidis
- Departments of Medicine, Health Research and Policy, Biomedical Data Science, and Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, CA
| | - Robert Perneczky
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College, London, United Kingdom.,Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany.,West London Mental Health NHS Trust, London, United Kingdom
| | - Lars Bertram
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College, London, United Kingdom.,Lübeck Interdisciplinary Platform for Genome Analytics (LIGA), Institutes of Neurogenetics & Cardiogenetics, University of Lübeck, Lübeck, Germany
| | - Christina M Lill
- Genetic and Molecular Epidemiology Group, Lübeck Interdisciplinary Platform for Genome Analytics, Institutes of Neurogenetics & Cardiogenetics, University of Lübeck, Lübeck, Germany.,Ageing Epidemiology Research Unit, School of Public Health, Imperial College, London, United Kingdom
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22
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Robb CE, de Jager CA, Ahmadi-Abhari S, Giannakopoulou P, Udeh-Momoh C, McKeand J, Price G, Car J, Majeed A, Ward H, Middleton L. Associations of Social Isolation with Anxiety and Depression During the Early COVID-19 Pandemic: A Survey of Older Adults in London, UK. Front Psychiatry 2020; 11:591120. [PMID: 33132942 PMCID: PMC7566017 DOI: 10.3389/fpsyt.2020.591120] [Citation(s) in RCA: 188] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/31/2020] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic is imposing a profound negative impact on the health and wellbeing of societies and individuals, worldwide. One concern is the effect of social isolation as a result of social distancing on the mental health of vulnerable populations, including older people. Within six weeks of lockdown, we initiated the CHARIOT COVID-19 Rapid Response Study, a bespoke survey of cognitively healthy older people living in London, to investigate the impact of COVID-19 and associated social isolation on mental and physical wellbeing. The sample was drawn from CHARIOT, a register of people over 50 who have consented to be contacted for aging related research. A total of 7,127 men and women (mean age=70.7 [SD=7.4]) participated in the baseline survey, May-July 2020. Participants were asked about changes to the 14 components of the Hospital Anxiety Depression scale (HADS) after lockdown was introduced in the UK, on 23rd March. A total of 12.8% of participants reported feeling worse on the depression components of HADS (7.8% men and 17.3% women) and 12.3% reported feeling worse on the anxiety components (7.8% men and 16.5% women). Fewer participants reported feeling improved (1.5% for depression and 4.9% for anxiety). Women, younger participants, those single/widowed/divorced, reporting poor sleep, feelings of loneliness and who reported living alone were more likely to indicate feeling worse on both the depression and/or anxiety components of the HADS. There was a significant negative association between subjective loneliness and worsened components of both depression (OR 17.24, 95% CI 13.20, 22.50) and anxiety (OR 10.85, 95% CI 8.39, 14.03). Results may inform targeted interventions and help guide policy recommendations in reducing the effects of social isolation related to the pandemic, and beyond, on the mental health of older people.
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Affiliation(s)
- Catherine E Robb
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Celeste A de Jager
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Sara Ahmadi-Abhari
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Parthenia Giannakopoulou
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Chinedu Udeh-Momoh
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - James McKeand
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Geraint Price
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Josip Car
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom.,Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom.,Imperial College Healthcare NHS Trust, Faculty of Medicine, Imperial College London, Public Health Directorate, London, United Kingdom
| | - Helen Ward
- Imperial College Healthcare NHS Trust, Faculty of Medicine, Imperial College London, Public Health Directorate, London, United Kingdom.,Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | - Lefkos Middleton
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom.,Imperial College Healthcare NHS Trust, Faculty of Medicine, Imperial College London, Public Health Directorate, London, United Kingdom
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23
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Takousis P, Sadlon A, Schulz J, Wohlers I, Dobricic V, Middleton L, Lill CM, Perneczky R, Bertram L. Differential expression of microRNAs in Alzheimer's disease brain, blood, and cerebrospinal fluid. Alzheimers Dement 2019; 15:1468-1477. [PMID: 31495604 DOI: 10.1016/j.jalz.2019.06.4952] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [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: 03/01/2019] [Revised: 06/13/2019] [Accepted: 06/23/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Several microRNAs (miRNAs) have been implicated in Alzheimer's disease pathogenesis, but the evidence from individual case-control studies remains inconclusive. METHODS A systematic literature review was performed, followed by standardized multistage data extraction, quality control, and meta-analyses on eligible data for brain, blood, and cerebrospinal fluid specimens. Results were compared with miRNAs reported in the abstracts of eligible studies or recent qualitative reviews to assess novelty. RESULTS Data from 147 independent data sets across 107 publications were quantitatively assessed in 461 meta-analyses. Twenty-five, five, and 32 miRNAs showed studywide significant differential expression (α < 1·08 × 10-4) in brain, cerebrospinal fluid, and blood-derived specimens, respectively, with 5 miRNAs showing differential expression in both brain and blood. Of these 57 miRNAs, 13 had not been reported in the abstracts of previous original or review articles. DISCUSSION Our systematic assessment of differential miRNA expression is the first of its kind in Alzheimer's disease and highlights several miRNAs of potential relevance.
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Affiliation(s)
- Petros Takousis
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK
| | - Angélique Sadlon
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK
| | - Jessica Schulz
- Genetic and Molecular Epidemiology Group, Lübeck Interdisciplinary Platform for Genome Analytics (LIGA), Institutes of Neurogenetics & Cardiogenetics, University of Lübeck, Lübeck, Germany
| | - Inken Wohlers
- Lübeck Interdisciplinary Platform for Genome Analytics (LIGA), Institutes of Neurogenetics & Cardiogenetics, University of Lübeck, Lübeck, Germany
| | - Valerija Dobricic
- Lübeck Interdisciplinary Platform for Genome Analytics (LIGA), Institutes of Neurogenetics & Cardiogenetics, University of Lübeck, Lübeck, Germany
| | - Lefkos Middleton
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK
| | - Christina M Lill
- Genetic and Molecular Epidemiology Group, Lübeck Interdisciplinary Platform for Genome Analytics (LIGA), Institutes of Neurogenetics & Cardiogenetics, University of Lübeck, Lübeck, Germany
| | - Robert Perneczky
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK; Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
| | - Lars Bertram
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK; Lübeck Interdisciplinary Platform for Genome Analytics (LIGA), Institutes of Neurogenetics & Cardiogenetics, University of Lübeck, Lübeck, Germany; Department of Psychology, University of Oslo, Oslo, Norway.
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24
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Ward HA, McLellan H, Udeh-Momoh C, Giannakopoulou P, Robb C, Wark PA, Middleton L. Use of Online Dietary Recalls among Older UK Adults: A Feasibility Study of an Online Dietary Assessment Tool. Nutrients 2019; 11:nu11071451. [PMID: 31252526 PMCID: PMC6682978 DOI: 10.3390/nu11071451] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 12/11/2022] Open
Abstract
This study examined the feasibility of including myfood24, an online 24-hour dietary recall tool, in a cohort studies of older adults. Participants (n = 319) were recruited during follow-up visits for the CHARIOT-Pro Sub-study, a prospective study of cognitively healthy adults aged 60–85 years at baseline. Email invitations were sent over three consecutive months, with weekly reminders. Multivariable regression models were applied to examine the number of recalls completed in relation to technology readiness (TR) scores and demographic characteristics. Ninety-four percent of people agreed to participate. Among participants, 67% completed at least one recall, and 48% completed two or more. Participants who completed multiple recalls reported higher self-confidence with technology and received a higher TR score than those who did not complete any recalls. A one-point higher TR score was associated with higher odds of completing three recalls compared to zero recalls (OR 1.70, 95% CI 0.96–3.01); this association was further attenuated after adjustment for demographic and other TR-related covariates (OR 1.35, 95% CI 0.63–2.88). This study demonstrates reasonable participation rates for a single myfood24 recall among older adults participating in a cohort study but suggests that further support may be required to obtain multiple recalls in this population.
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Affiliation(s)
- Heather A Ward
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK.
| | - Heather McLellan
- Department of Neuroepidemiology and Ageing, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Chi Udeh-Momoh
- Department of Neuroepidemiology and Ageing, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Parthenia Giannakopoulou
- Department of Neuroepidemiology and Ageing, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Catherine Robb
- Department of Neuroepidemiology and Ageing, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Petra A Wark
- Faculty of Health and Life Sciences, Coventry University, Coventry CV1 5FB, UK
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Lefkos Middleton
- Department of Neuroepidemiology and Ageing, School of Public Health, Imperial College London, London W6 8RP, UK
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25
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Gallo V, Vineis P, Cancellieri M, Chiodini P, Barker RA, Brayne C, Pearce N, Vermeulen R, Panico S, Bueno-de-Mesquita B, Vanacore N, Forsgren L, Ramat S, Ardanaz E, Arriola L, Peterson J, Hansson O, Gavrila D, Sacerdote C, Sieri S, Kühn T, Katzke VA, van der Schouw YT, Kyrozis A, Masala G, Mattiello A, Perneczky R, Middleton L, Saracci R, Riboli E. Exploring causality of the association between smoking and Parkinson's disease. Int J Epidemiol 2019; 48:912-925. [PMID: 30462234 PMCID: PMC6659366 DOI: 10.1093/ije/dyy230] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The aim of this paper is to investigate the causality of the inverse association between cigarette smoking and Parkinson's disease (PD). The main suggested alternatives include a delaying effect of smoking, reverse causality or an unmeasured confounding related to a low-risk-taking personality trait. METHODS A total of 715 incident PD cases were ascertained in a cohort of 220 494 individuals from NeuroEPIC4PD, a prospective European population-based cohort study including 13 centres in eight countries. Smoking habits were recorded at recruitment. We analysed smoking status, duration, and intensity and exposure to passive smoking in relation to PD onset. RESULTS Former smokers had a 20% decreased risk and current smokers a halved risk of developing PD compared with never smokers. Strong dose-response relationships with smoking intensity and duration were found. Hazard ratios (HRs) for smoking <20 years were 0.84 [95% confidence interval (CI) 0.67-1.07], 20-29 years 0.73 (95% CI 0.56-0.96) and >30 years 0.54 (95% CI 0.43-0.36) compared with never smokers. The proportional hazard assumption was verified, showing no change of risk over time, arguing against a delaying effect. Reverse causality was disproved by the consistency of dose-response relationships among former and current smokers. The inverse association between passive smoking and PD, HR 0.70 (95% CI 0.49-0.99) ruled out the effect of unmeasured confounding. CONCLUSIONS These results are highly suggestive of a true causal link between smoking and PD, although it is not clear which is the chemical compound in cigarette smoking responsible for the biological effect.
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Affiliation(s)
- Valentina Gallo
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
- School of Public Health, Imperial College London, London, UK
- Epidemiology and Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, UK
| | - Paolo Vineis
- School of Public Health, Imperial College London, London, UK
| | - Mariagrazia Cancellieri
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
- School of Hygiene and Preventive Medicine, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
- Hygiene and Public Health Unit, Department of Public Health, AUSL Imola, Bologna, Italy
| | - Paolo Chiodini
- Medical Statistics Unit, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Roger A Barker
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Neil Pearce
- Epidemiology and Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, UK
| | - Roel Vermeulen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Division of Epidemiology, Institute for Risk Assessment Science, Utrecht University, Utrecht, The Netherlands
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - Bas Bueno-de-Mesquita
- School of Public Health, Imperial College London, London, UK
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nicola Vanacore
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Lars Forsgren
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Silvia Ramat
- Department of Neuroscience, Psychology, Drug Research, and Child Health, University of Florence, Careggi Hospital-University, Florence, Italy
| | - Eva Ardanaz
- Navarra Public Health Institute, IdiSNA, Pamplona, Spain
- CIBER Epidemiology and Public Health, CIBERESP, Madrid, Spain
| | - Larraitz Arriola
- CIBER Epidemiology and Public Health, CIBERESP, Madrid, Spain
- Public Health Department of Gipuzkoa, Basque Government, Vitoria-Gasteiz, Spain
- Biodonostia Research Institute, Neurosciences Area, Hospital Universitario Donostia, Donostia, Spain
| | | | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Diana Gavrila
- CIBER Epidemiology and Public Health, CIBERESP, Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Centre for Cancer Prevention (CPO-Piemonte), Turin, Italy
- Human Genetic Foundation (HuGeF), Turin, Italy
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Verena A Katzke
- Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andreas Kyrozis
- Hellenic Health Foundation, Athens, Greece
- First Department of Neurology, University of Athens, Athens, Greece
| | - Giovanna Masala
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention, and Clinical Network (ISPRO), Florence, Italy
| | - Amalia Mattiello
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - Robert Perneczky
- School of Public Health, Imperial College London, London, UK
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany
- German Centre for Neurodegenerative Disorders (DZNE), Munich, Germany
- Munich Cluster for System Neurology (SyNergy), Munich, Germany
| | | | - Rodolfo Saracci
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Elio Riboli
- School of Public Health, Imperial College London, London, UK
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Cardoso F, Bartlett JMS, Slaets L, van Deurzen CHM, van Leeuwen-Stok E, Porter P, Linderholm B, Hedenfalk I, Schröder C, Martens J, Bayani J, van Asperen C, Murray M, Hudis C, Middleton L, Vermeij J, Punie K, Fraser J, Nowaczyk M, Rubio IT, Aebi S, Kelly C, Ruddy KJ, Winer E, Nilsson C, Lago LD, Korde L, Benstead K, Bogler O, Goulioti T, Peric A, Litière S, Aalders KC, Poncet C, Tryfonidis K, Giordano SH. Characterization of male breast cancer: results of the EORTC 10085/TBCRC/BIG/NABCG International Male Breast Cancer Program. Ann Oncol 2019; 29:405-417. [PMID: 29092024 DOI: 10.1093/annonc/mdx651] [Citation(s) in RCA: 202] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Male breast cancer (BC) is rare, managed by extrapolation from female BC. The International Male BC Program aims to better characterize and manage this disease. We report the results of part I, a retrospective joint analysis of cases diagnosed during a 20-year period. Methods Patients with follow-up and tumor samples, treated between 1990 and 2010, in 93 centers/9 countries. Samples were centrally analyzed in three laboratories (the United Kingdom, the Netherlands and the United States). Results Of 1822 patients enrolled, 1483 were analyzed; 63.5% were diagnosed between 2001 and 2010, 57 (5.1%) had metastatic disease (M1). Median age at diagnosis: 68.4 years. Of 1054 M0 cases, 56.2% were node-negative (N0) and 48.5% had T1 tumors; 4% had breast conserving surgery (BCS), 18% sentinel lymph-node biopsy; half received adjuvant radiotherapy; 29.8% (neo)adjuvant chemotherapy and 76.8% adjuvant endocrine therapy (ET), mostly tamoxifen (88.4%). Per central pathology, for M0 tumors: 84.8% ductal invasive carcinomas, 51.5% grade 2; 99.3% estrogen receptor (ER)-positive; 81.9% progesterone receptor (PR)-positive; 96.9% androgen receptor (AR)-positive [ER, PR or AR Allred score ≥3]; 61.1% Ki67 expression low (<14% positive cells); using immunohistochemistry (IHC) surrogates, 41.9% were Luminal-A-like, 48.6% Luminal-B-like/HER-2-negative, 8.7% HER-2-positive, 0.3% triple negative. Median follow-up: 8.2 years (0.0-23.8) for all, 7.2 years (0.0-23.2), for M0, 2.6 years (0.0-12.7) for M1 patients. A significant improvement over time was observed in age-corrected BC mortality. BC-specific-mortality was higher for men younger than 50 years. Better overall (OS) and recurrence-free survival (RFS) were observed for highly ER+ (P = 0.001), highly PR+ (P = 0.002), highly AR+ disease (P = 0.019). There was no association between OS/RFS and HER-2 status, Ki67, IHC subtypes nor grade. Conclusions Male BC is usually ER, PR and AR-positive, Luminal B-like/HER2-negative. Of note, 56% patients had T1 tumors but only 4% had BCS. ER was highly positive in >90% of cases but only 77% received adjuvant ET. ER, PR and AR were associated with OS and RFS, whereas grade, Ki67 and IHC surrogates were not. Significant improvement in survival over time was observed.
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Affiliation(s)
- F Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal; European Organisation for Research and Treatment of Cancer-Breast Cancer Group, Toronto, Canada.
| | - J M S Bartlett
- Transformative Pathology, Ontario Institute for Cancer Research, Toronto, Canada; University of Edinburgh, Edinburgh, UK
| | - L Slaets
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - C H M van Deurzen
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands; Dutch Breast Cancer Research Group (BOOG), The Netherlands
| | | | - P Porter
- Divisions of Human Biology and Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, USA; Department of Pathology, University of Washington, Seattle, USA
| | - B Linderholm
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden; Swedish Association of Breast Oncologists (SABO), Lund University, Lund, Sweden
| | - I Hedenfalk
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - C Schröder
- Dutch Breast Cancer Research Group (BOOG), The Netherlands; Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - J Martens
- Dutch Breast Cancer Research Group (BOOG), The Netherlands; Breast Cancer Genomics and Proteomics Lab, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J Bayani
- Transformative Pathology, Ontario Institute for Cancer Research, Toronto, Canada
| | - C van Asperen
- Dutch Breast Cancer Research Group (BOOG), The Netherlands; Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - M Murray
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York
| | - C Hudis
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York; Weill Cornell Medical College, New York
| | - L Middleton
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - J Vermeij
- Department of Medical Oncology, Hospital Network Antwerp (ZNA), Antwerp, Belgium
| | - K Punie
- Department of General Medical Oncology, UZ Leuven, Leuven, Belgium
| | - J Fraser
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - M Nowaczyk
- Specialist Hospital, St. Wojciech, Gdansk, Poland
| | - I T Rubio
- Breast Surgical Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - S Aebi
- Swiss Group for Clinical Cancer Research (SAKK), Switzerland
| | - C Kelly
- All Ireland Cooperative Oncology Research Group (ICORG), Ireland
| | - K J Ruddy
- Department of Oncology, Mayo Clinic, Rochester, USA
| | - E Winer
- Dana-Farber Cancer Institute, Boston, USA
| | - C Nilsson
- Department of Oncology, Västmanlands Hospital, Västerås, Sweden; Swedish Association of Breast Oncologists (SABO), Sweden
| | - L Dal Lago
- Department of Medical Oncology, Jules Bordet Institute, Brussels, Belgium
| | - L Korde
- University of Washington, Seattle, USA
| | - K Benstead
- Department of Oncology, Cheltenham General Hospital, UK
| | - O Bogler
- Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, USA
| | - T Goulioti
- Breast International Group, Brussels, Belgium
| | - A Peric
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - S Litière
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - K C Aalders
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - C Poncet
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - K Tryfonidis
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - S H Giordano
- Departments of Health Services Research and Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
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27
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Bayani J, Poncet C, Yao CQ, Crozier C, Anouk N, Piper T, Cunningham C, Sobol M, Aebi S, Benstead K, Bogler O, Dal Lago L, Fraser J, Hilbers FH, Hedenfalk I, Korde L, Linderholm B, Martens J, Middleton L, Murray M, Kelly C, Nilsson C, Nowaczyk M, Peeters S, Peric A, Porter P, Schröder C, Rubio IT, Ruddy KJ, van Asperen C, Van Den Weyngaert D, van Deurzen C, van Leeuwen-Stok E, Vermeij J, Winer E, Boutros PC, Giordano SH, Cardoso F, Bartlett JM. Abstract P6-19-01: Evaluation of multiple transcriptomic gene risk signatures in male breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-19-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Male breast cancer (MBC) is a rare disease accounting for less than 1% of all breast cancers (BC) and 1% of all cancers in males. The clinical management is largely extrapolated from female BC. Several multigene assays are increasingly used to guide clinical treatment decisions in female BC, however there is little data on the utility of these tests in MBC.
Methods: Here we present the gene expression results of 380 M0, ER+ve, HER2-ve MBCs enrolled in the Part 1 (retrospective joint analysis) International Male Breast Cancer Program of 1483 patients diagnosed between 1990-2010 (Cardoso et al. Annals of Oncology, 2018). Using a custom Nanostring™ panel comprised of the genes from the commercial risk tests Prosigna®, OncotypeDx® and Mammaprint®, risk scores and intrinsic subtyping data were generated to recapitulate the commercial tests as described by Bayani and Yao et al (npjBreast Cancer, 2017). Survival outcomes by risk classification were analyzed using Cox models with time-dependent covariates when the proportional hazard assumption was not met and adjusted for clinical and treatment variables.
Results: Prosigna-like risk scores identified 99 (26.1%) as low-risk, 159 (41.8%) as intermediate-risk, and 122 (32.1%) as high-risk. Using the TAILORx cut-off (25) for OncotypeDx-like risk of recurrence scoring, 158 (41.6%) were identified as low-risk, while 222 (58.4%) were identified as high-risk. MammaPrint-like results identified 175 (46.1%) as low-risk and 205 (53.9%) as high-risk. Overall, patients classified as high-risk had higher grade, more nodal involvement, larger tumors, and more frequently treated with chemotherapy than low-risk patients. Survival analyses demonstrated clear clinical utility for each test, showing patients at high-risk with poor relapse-free survival (RFS) as compared to patients classified as low-risk: Prosigna-like RFS at 3-years (HR=2.20, 95% CI, 1.28-3.80); Oncotype-like RFS at 3-years (HR=1.92, 95% CI, 1.17-3.17); MammaPrint-like RFS (HR=1.51, 95% CI, 1.00-2.27); with similar findings for distant relapse-free survival (DRFS) and overall survival (OS). Across outcomes and all gene signatures, patients with concordant Low/Low risk classification had better prognosis than those with concordant High/High risk classification. PAM50 intrinsic subtyping identified 147 (38.7%) as Luminal A, 57 (15.0%) as Luminal B, 80 (21.1%) as Her2-enriched and 96 (25.3%) as Basal-like; showing overall 34.5% concordance to clinic-pathological subtyping by central pathology (95% CI, 29.7%-39.5%). Comparison between the tests in the MBC cohort and a comparable cohort of female BC from the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial processed in the same way will be presented.
Conclusion: Common transcriptomic assays designed to assess residual risk, validated in female BC, provide similar information in male BC patients. Not surprisingly, disagreement between test results at the individual patient level was observed. To our knowledge, this is the largest study of MBC assayed to generate risk scores of the current commercial BC tests to demonstrate their clinical utility and their differences and similarity to female BC.
This work has been funded by the Breast Cancer Research Foundation (BCRF).
Citation Format: Bayani J, Poncet C, Yao CQ, Crozier C, Anouk N, Piper T, Cunningham C, Sobol M, Aebi S, Benstead K, Bogler O, Dal Lago L, Fraser J, Hilbers FH, Hedenfalk I, Korde L, Linderholm B, Martens J, Middleton L, Murray M, Kelly C, Nilsson C, Nowaczyk M, Peeters S, Peric A, Porter P, Schröder C, Rubio IT, Ruddy KJ, van Asperen C, Van Den Weyngaert D, van Deurzen C, van Leeuwen-Stok E, Vermeij J, Winer E, Boutros PC, Giordano SH, Cardoso F, Bartlett JM. Evaluation of multiple transcriptomic gene risk signatures in male breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-19-01.
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Affiliation(s)
- J Bayani
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - C Poncet
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - CQ Yao
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - C Crozier
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - N Anouk
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - T Piper
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - C Cunningham
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - M Sobol
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - S Aebi
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - K Benstead
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - O Bogler
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - L Dal Lago
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - J Fraser
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - FH Hilbers
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - I Hedenfalk
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - L Korde
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - B Linderholm
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - J Martens
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - L Middleton
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - M Murray
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - C Kelly
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - C Nilsson
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - M Nowaczyk
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - S Peeters
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - A Peric
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - P Porter
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - C Schröder
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - IT Rubio
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - KJ Ruddy
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - C van Asperen
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - D Van Den Weyngaert
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - C van Deurzen
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - E van Leeuwen-Stok
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - J Vermeij
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - E Winer
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - PC Boutros
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - SH Giordano
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - F Cardoso
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - JM Bartlett
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
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Montero Odasso M, Almeida Q, Camicioli R, Li K, Liu-Ambrose T, Middleton L, Bherer L. PRELIMINARY RESULTS FROM THE SYNERGIC TRIAL: A MULTIMODAL INTERVENTION FOR MILD COGNITIVE IMPAIRMENT. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cruise RS, Wentworth L, Williams J, Allcutt A, Middleton L, Steward H, Palin A. 118A JOINT WYTHENSHAWE HOSPITAL AND RED CROSS INNOVATION REDUCES REATTENDANCES AND READMISSIONS. Age Ageing 2018. [DOI: 10.1093/ageing/afy126.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R S Cruise
- Wythenshawe Hospital, Manchester University NHS Trust
| | - L Wentworth
- Wythenshawe Hospital, Manchester University NHS Trust
| | - J Williams
- Wythenshawe Hospital, Manchester University NHS Trust
| | - A Allcutt
- Wythenshawe Hospital, Manchester University NHS Trust
| | - L Middleton
- Wythenshawe Hospital, Manchester University NHS Trust
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Martens JWM, Sieuwerts A, Ponchet C, Smid M, de Weerd V, Slaets L, Piper T, van Deurzen CHM, Schroder CP, Stangle C, Kloosterman W, van Leeuwen-Stok E, Nilsson C, Vermeij J, Peeters S, Goulioti T, Nowaczyk M, Aebi S, Rubio IT, Kelly C, Bayani J, Porter P, Murray M, Hudis C, Middleton L, Korde L, Ruddy K, Winer E, Bogler O, van den Weyngaert D, dal Lago L, Fraser J, Benstead K, van Asperen C, Linderholm B, Hedenfalk I, Tryfonidis K, Giordano S, Bartlett J, Cardoso F. Abstract PD7-12: Molecular subtyping of male breast cancer by the International male breast cancer program (IMBC): EORTC 10085/TBCRC 0-29/BIG 2-07/NABCG/BOOG 2009-04. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd7-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction. Male breast cancer (male BC) is a rare disease for which disease management is extrapolated from females. IMBC, an international consortium, which previously reported on clinico-pathological aspects, now reports on molecular subgroups revealed by RNA sequencing and their relation to patient outcome.
Methods. Tumor samples from the retrospective MALE BC registry diagnosed between 1990-2010 and with pathology and outcome data (relapse-free- (RFS) and overall survival (OS)) were included (n=699). To allow the discovery of prognostic features, we selected, stratified for known risk factors (TN stage, grade, age at diagnose and adjuvant endocrine treatment), from the cohort 152 cases with poor (RFS <= 4 yrs) and good outcome (RFS > 7yrs) evenly distributed. Here, we report RNA sequencing results of the first 73 cases, 38 with poor and 35 with good outcome. RNA sequencing reads were used to generate gene expression values and to report transcripts carrying driver mutations. Unsupervised clustering identified subgroups and within subgroups differentially expressed genes were identified. The reported prognostic male BC subgroups M1 and M2 (Johansson BCR 2012(14):R31) were also annotated. All identified subgroups were related to outcome using logistic regression (p-value using Wald test).
Results. Unsupervised clustering revealed 2 main subgroups of which group 1 was enriched for expression of ER target genes, WNT3 and genes from amplicons known for female BC, e.g. 19p13 (CCNE1), 8q24 (MYC), and 11q13 (CCND1). The biology of the smaller group 2 was less defined but TGFβ2 expression was high as were various kallikreins (KLK) including interestingly KLK3 (prostate specific antigen). Other known amplified regions [(8p11 (FGFR1), 20q13 (ZNF217) and 12q15 (MDM2)] and mutated transcripts [PIK3CA (H1047R/L/Q; E542K, E545K, N345K; 16% of cases), TP53 and SF3B1 (K700E) (2% of cases)] were identified. Profound tumor infiltrate gene expression was present in 5% of cases and one third of cases expressed proliferation markers. Except for TP53, none of these latter characteristics were unevenly distributed among the 2 main subgroups. ER and AR were highly correlated, particularly in group 1. The two main groups could be further subdivided. Group 1 comprised 3 subgroups of which subgroup 1a expressed TFF1/3 and NAT1, well-known ER targets, while subgroups 1b and 1c expressed other ER targets,respectively BEX1 and PITX1. HOXC cluster expression differentiated subgroup 1b from 1a and 1c. None of these intrinsic subgroups were, however, related to RFS. The previously reported M2 subgroup, which largely segregated with subclusters 1a and 1b, was associated with a better RFS than the M1 subgroup (OR=2.9; 95%CI 1.1-7.5; p-value=0.03).
Conclusions. 1) Intrinsic subtypes of male BC were revealed and their subgrouping is defined by ER associated subsets of genes. 2) The association of the reported M2 subgroup of male BC with longer RFS was validated; 3) Currently identified biological characteristics of male BC may improve future treatments. The full report on 152 cases including a comparison to female BC will be presented at the conference.
This research was funded by Breast Cancer Research Foundation
Citation Format: Martens JWM, Sieuwerts A, Ponchet C, Smid M, de Weerd V, Slaets L, Piper T, van Deurzen CHM, Schroder CP, Stangle C, Kloosterman W, van Leeuwen-Stok E, Nilsson C, Vermeij J, Peeters S, Goulioti T, Nowaczyk M, Aebi S, Rubio IT, Kelly C, Bayani J, Porter P, Murray M, Hudis C, Middleton L, Korde L, Ruddy K, Winer E, Bogler O, van den Weyngaert D, dal Lago L, Fraser J, Benstead K, van Asperen C, Linderholm B, Hedenfalk I, Tryfonidis K, Giordano S, Bartlett J, Cardoso F. Molecular subtyping of male breast cancer by the International male breast cancer program (IMBC): EORTC 10085/TBCRC 0-29/BIG 2-07/NABCG/BOOG 2009-04 [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD7-12.
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Affiliation(s)
- JWM Martens
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - A Sieuwerts
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - C Ponchet
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - M Smid
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - V de Weerd
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - L Slaets
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - T Piper
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - CHM van Deurzen
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - CP Schroder
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - C Stangle
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - W Kloosterman
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - E van Leeuwen-Stok
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - C Nilsson
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - J Vermeij
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - S Peeters
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - T Goulioti
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - M Nowaczyk
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - S Aebi
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - IT Rubio
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - C Kelly
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - J Bayani
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - P Porter
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - M Murray
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - C Hudis
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - L Middleton
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - L Korde
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - K Ruddy
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - E Winer
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - O Bogler
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - D van den Weyngaert
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - L dal Lago
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - J Fraser
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - K Benstead
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - C van Asperen
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - B Linderholm
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - I Hedenfalk
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - K Tryfonidis
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - S Giordano
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - J Bartlett
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - F Cardoso
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
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31
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Middleton L. PUTTING ALL TOGETHER: THE SYNERGIC TRIAL. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L. Middleton
- University of Waterloo, Waterloo, Ontario, Canada
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Ikram MA, Bersano A, Manso-Calderón R, Jia JP, Schmidt H, Middleton L, Nacmias B, Siddiqi S, Adams HHH. Genetics of vascular dementia - review from the ICVD working group. BMC Med 2017; 15:48. [PMID: 28260527 PMCID: PMC5338082 DOI: 10.1186/s12916-017-0813-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 02/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vascular dementia is a common disorder resulting in considerable morbidity and mortality. Determining the extent to which genes play a role in disease susceptibility and their pathophysiological mechanisms could improve our understanding of vascular dementia, leading to a potential translation of this knowledge to clinical practice. DISCUSSION In this review, we discuss what is currently known about the genetics of vascular dementia. The identification of causal genes remains limited to monogenic forms of the disease, with findings for sporadic vascular dementia being less robust. However, progress in genetic research on associated phenotypes, such as cerebral small vessel disease, Alzheimer's disease, and stroke, have the potential to inform on the genetics of vascular dementia. We conclude by providing an overview of future developments in the field and how such work could impact patients and clinicians. CONCLUSION The genetic background of vascular dementia is well established for monogenic disorders, but remains relatively obscure for the sporadic form. More work is needed for providing robust findings that might eventually lead to clinical translation.
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Affiliation(s)
- M Arfan Ikram
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands. .,Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands. .,Department of Neurology, Erasmus MC, Rotterdam, The Netherlands. .,Department of Epidemiology, Erasmus MC University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
| | - Anna Bersano
- Cerebrovascular Unit IRCCS Foundation Neurological Institute C. Besta, Milan, Italy
| | - Raquel Manso-Calderón
- Department of Neurology, University Hospital of Salamanca, Salamanca, Spain.,Institute of Biomedical Research of Salamanca (IBSAL), University of Salamanca-CSIC-SACYL, Salamanca, Spain
| | - Jian-Ping Jia
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Helena Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Lefkos Middleton
- Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, UK
| | - Benedetta Nacmias
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | | | - Hieab H H Adams
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
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33
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Latthe P, Middleton L, Rachaneni S, McCooty S, Daniels J, Coomarasamy A, Balogun M, Duckett J, Thakar R, Goranitis I, Roberts T, Deeks J. Ultrasound bladder wall thickness and detrusor overactivity: a multicentre test accuracy study. BJOG 2017; 124:1422-1429. [DOI: 10.1111/1471-0528.14503] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2016] [Indexed: 11/29/2022]
Affiliation(s)
- P Latthe
- Institute of Metabolism and Systems Biology; University of Birmingham; Edgbaston Birmingham UK
- Birmingham Women's NHS Foundation Trust; Birmingham UK
| | - L Middleton
- Birmingham Clinical Trials Unit; University of Birmingham; Birmingham UK
| | - S Rachaneni
- Institute of Metabolism and Systems Biology; University of Birmingham; Edgbaston Birmingham UK
| | - S McCooty
- Birmingham Women's NHS Foundation Trust; Birmingham UK
| | - J Daniels
- Birmingham Clinical Trials Unit; University of Birmingham; Birmingham UK
| | - A Coomarasamy
- Institute of Metabolism and Systems Biology; University of Birmingham; Edgbaston Birmingham UK
- Birmingham Women's NHS Foundation Trust; Birmingham UK
| | - M Balogun
- Birmingham Women's NHS Foundation Trust; Birmingham UK
| | - J Duckett
- Medway NHS Foundation Trust; Medway Maritime Hospital; Gillingham UK
| | - R Thakar
- Croydon Health Services NHS Trust; Croydon University Hospital; Croydon UK
| | - I Goranitis
- Health Economics Unit; University of Birmingham; Edgbaston Birmingham UK
| | - T Roberts
- Health Economics Unit; University of Birmingham; Edgbaston Birmingham UK
| | - J Deeks
- Birmingham Clinical Trials Unit; University of Birmingham; Birmingham UK
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34
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Lindqvist D, Prokopenko I, Londos E, Middleton L, Hansson O. Associations between TOMM40 Poly-T Repeat Variants and Dementia in Cases with Parkinsonism. J Parkinsons Dis 2017; 6:99-108. [PMID: 26756745 DOI: 10.3233/jpd-150693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mitochondrial dysfunction has been implicated in the pathophysiology of Parkinson's disease (PD)-related pathologies. OBJECTIVE To investigate the role of the Translocase of the Outer Mitochondrial Membrane 40 homolog (TOMM40) variants in PD without dementia (PDND), PD with dementia (PDD) and in Dementia with Lewy bodies (DLB). METHODS 248 individuals, including 92 PDND, 55 PDD, and 101 DLB, were included. The rs10524523 locus in the TOMM40 gene (TOMM40 poly-T repeat) is characterized by a variable number of T residues that were classified into three groups based on length; short (S), long (L), and very long (VL). We tested log-additive genetic model of association with dementia and adjusted for age, sex, and APOEɛ4 carrier status. We analyzed cerebrospinal fluid (CSF) levels of Aβ42 and Tau, biomarkers related to Alzheimer's disease (AD). RESULTS PDD/DBL status and abnormal CSF AD biomarkers (Aβ42 and Aβ42/Tau ratio) were both associated with the APOEɛ4 allele (p < 0.014) and the L allele of TOMM40 poly-T repeat (p < 0.008). The VL allele was less frequently observed in the PDD/DLB group (p = 0.013). In APOE-ɛ4 adjusted analyses, the relationships between the L and VL alleles and dementia status as well as CSF AD biomarkers were not significant. When adjusting for APOE-ɛ4, however, there were associations between S carrier status and PDD/DLB (p = 0.019) and abnormal CSF levels of Aβ42/Tau ratio (p = 0.037) although these were not significant after adjustment for multiple comparisons. CONCLUSION Our results do not support the notion that TOMM40 poly-T repeat variants have independent effects on PDD and DLB pathology. This relationship seems to be driven by APOE-ɛ4.
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Affiliation(s)
- Daniel Lindqvist
- Division of Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden.,Psychiatry Skåne, Lund, Sweden
| | - Inga Prokopenko
- Neuroepidemiology and Ageing Research, School of Public Health, Imperial College London, UK
| | - Elisabet Londos
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.,Memory Clinic, Skåne University Hospital, Lund, Sweden
| | - Lefkos Middleton
- Neuroepidemiology and Ageing Research, School of Public Health, Imperial College London, UK
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.,Memory Clinic, Skåne University Hospital, Lund, Sweden
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35
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Gallo V, Vanacore N, Bueno-de-Mesquita HB, Vermeulen R, Brayne C, Pearce N, Wark PA, Ward HA, Ferrari P, Jenab M, Andersen PM, Wennberg P, Wareham N, Katzke V, Kaaks R, Weiderpass E, Peeters PH, Mattiello A, Pala V, Barricante A, Chirlaque MD, Travier N, Travis RC, Sanchez MJ, Pessah-Rasmussen H, Petersson J, Tjønneland A, Tumino R, Quiros JR, Trichopoulou A, Kyrozis A, Oikonomidou D, Masala G, Sacerdote C, Arriola L, Boeing H, Vigl M, Claver-Chapelon F, Middleton L, Riboli E, Vineis P. Physical activity and risk of Amyotrophic Lateral Sclerosis in a prospective cohort study. Eur J Epidemiol 2016; 31:255-66. [PMID: 26968841 PMCID: PMC4820490 DOI: 10.1007/s10654-016-0119-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 01/12/2016] [Indexed: 12/12/2022]
Abstract
Previous case-control studies have suggested a possible increased risk of Amyotrophic Lateral Sclerosis (ALS) with physical activity (PA), but this association has never been studied in prospective cohort studies. We therefore assessed the association between PA and risk of death from ALS in the European Prospective Investigation into Cancer and Nutrition. A total of 472,100 individuals were included in the analysis, yielding 219 ALS deaths. At recruitment, information on PA was collected thorough standardised questionnaires. Total PA was expressed by the Cambridge Physical Activity Index (CPAI) and analysed in relation to ALS mortality, using Cox hazard models. Interactions with age, sex, and anthropometric measures were assessed. Total PA was weakly inversely associated with ALS mortality with a borderline statistically significant trend across categories (p = 0.042), with those physically active being 33% less likely to die from ALS compared to those inactive: HR = 0.67 (95% CI 0.42-1.06). Anthropometric measures, sex, and age did not modify the association with CPAI. The present study shows a slightly decreased-not increased like in case-control studies-risk of dying from ALS in those with high levels of total PA at enrolment. This association does not appear confounded by age, gender, anthropometry, smoking, and education. Ours was the first prospective cohort study on ALS and physical activity.
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Affiliation(s)
- Valentina Gallo
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus - Norfolk Place, W2 1PG, London, UK.
- Barts and the London School of Medicine, Centre for Primary Care and Public Health, Queen Mary, University of London, London, UK.
| | | | - H Bas Bueno-de-Mesquita
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus - Norfolk Place, W2 1PG, London, UK
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands
| | - Roel Vermeulen
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Carol Brayne
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Neil Pearce
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Petra A Wark
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus - Norfolk Place, W2 1PG, London, UK
| | - Heather A Ward
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus - Norfolk Place, W2 1PG, London, UK
| | - Pietro Ferrari
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Mazda Jenab
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Peter M Andersen
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Nicholas Wareham
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, The Artic University of Norway, Tromsö, Norway
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Folkhälsan Research Center, University of Helsinki, Helsinki, Finland
| | - Petra H Peeters
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus - Norfolk Place, W2 1PG, London, UK
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Amalia Mattiello
- Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
| | - Valeria Pala
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Aurelio Barricante
- Navarre Public Health Institute, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Madrid, Spain
| | - Maria-Dolores Chirlaque
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Madrid, Spain
- Epidemiology Department, Murcia Regional Health Council, Murcia, Spain
| | - Noémie Travier
- Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ruth C Travis
- Cancer Epidemiological Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Maria-Jose Sanchez
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Madrid, Spain
- Andalusian School of Public Health, Granada, Spain
| | | | - Jesper Petersson
- Department of Neurology, Skåne University Hospital, Lund University, Malmö, Sweden
| | | | - Rosario Tumino
- Ragusa Cancer Registry, Azienda Ospedaliera "Civile MP Arezzo", Ragusa, Italy
| | | | | | - Andreas Kyrozis
- Hellenic Health Foundation, Athens, Greece
- First Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Giovanna Masala
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy
| | - Carlotta Sacerdote
- Centre for Cancer Prevention (CPO-Piemonte), Turin, Italy
- Human Genetic Foundation (HuGeF), Turin, Italy
| | - Larraitz Arriola
- Public Health Division of Gipuzkoa, Donostia-San Sebastian, Spain
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam, Germany
| | - Matthaeus Vigl
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam, Germany
| | - Francoise Claver-Chapelon
- Inserm, Centre for Research in Epidemiology and Population Health, Institut Gustave-Roussy, Villejuif, France
| | - Lefkos Middleton
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus - Norfolk Place, W2 1PG, London, UK
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus - Norfolk Place, W2 1PG, London, UK
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus - Norfolk Place, W2 1PG, London, UK
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36
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Gallo V, Brayne C, Forsgren L, Barker RA, Petersson J, Hansson O, Lindqvist D, Ruffmann C, Ishihara L, Luben R, Arriola L, Bergareche A, Gavrila D, Erro ME, Vanacore N, Sacerdote C, Bueno-de-Mesquita B, Vermeulen R, Seelen M, Sieri S, Masala G, Ramat S, Kyrozis A, Thricopolou A, Panico S, Mattiello A, Kaaks R, Teucher B, Katzke V, Kloss M, Curry L, Calboli F, Riboli E, Vineis P, Middleton L. Parkinson's Disease Case Ascertainment in the EPIC Cohort: The NeuroEPIC4PD Study. NEURODEGENER DIS 2015; 15:331-8. [PMID: 26375921 DOI: 10.1159/000381857] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 03/19/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Large epidemiological prospective studies represent an important opportunity for investigating risk factors for rare diseases such as Parkinson's disease (PD). Here we describe the procedures we used for ascertaining PD cases in the EPIC (European Prospective Investigation into Cancer and Nutrition) study. METHODS The following three-phase procedure was used: (1) elaboration of a NeuroEPIC4PD template for clinical data collection, (2) identification of all potential PD cases via record linkage and (3) validation of the diagnosis through clinical record revision, in a population of 220,494 subjects recruited in 7 European countries. All cases were labelled with the NeuroEPIC4PD diagnoses of 'definite', 'very likely', 'probable', or 'possible' PD. RESULTS A total of 881 PD cases were identified, with over 2,741,780 person-years of follow-up (199 definite, 275 very likely, 146 probable, and 261 possible). Of these, 734 were incident cases. The mean age at diagnosis was 67.9 years (SD 9.2) and 458 patients (52.0%) were men. Bradykinesia was the most frequent presenting motor sign (76.5%). Tremor-dominant and akinetic rigid forms of PD were the most common types of PD. A total of 289 patients (32.8%) were dead at the time of the last follow-up. CONCLUSIONS This exercise proved that it is feasible to ascertain PD in large population-based cohort studies and offers a potential framework to be replicated in similar studies.
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Affiliation(s)
- Valentina Gallo
- School of Public Health, Imperial College London, London, UK
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37
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Ropacki MT, Arrighi M, Middleton L, Perneczky R. P1‐320: Cognitive health in ageing register: Investigational, observational, and trial studies in dementia research (CHARIOT)—prospective readiness cohort study (PRO). Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.06.535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Michael T. Ropacki
- Loma Linda University School of MedicineLoma LindaCAUSA
- Janssen R&DFremontCAUSA
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38
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Diwakar L, Roberts TE, Cooper NAM, Middleton L, Jowett S, Daniels J, Smith P, Clark TJ. An economic evaluation of outpatient versus inpatient polyp treatment for abnormal uterine bleeding. BJOG 2015; 123:625-31. [DOI: 10.1111/1471-0528.13434] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2015] [Indexed: 12/01/2022]
Affiliation(s)
- L Diwakar
- Health Economics Unit; School of Health and Population Science; University of Birmingham; Birmingham UK
| | - TE Roberts
- Health Economics Unit; School of Health and Population Science; University of Birmingham; Birmingham UK
| | - NAM Cooper
- Women's Health Research Unit; Queen Mary University of London; London UK
| | - L Middleton
- Birmingham Clinical Trials Unit; University of Birmingham; Birmingham UK
| | - S Jowett
- Health Economics Unit; School of Health and Population Science; University of Birmingham; Birmingham UK
| | - J Daniels
- Birmingham Clinical Trials Unit; University of Birmingham; Birmingham UK
| | - P Smith
- Birmingham Women's NHS Foundation Trust; Birmingham UK
| | - TJ Clark
- Birmingham Women's NHS Foundation Trust; Birmingham UK
- School of Clinical and Experimental Medicine; University of Birmingham; Birmingham UK
- University of Birmingham; Birmingham UK
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Maier R, Moser G, Chen GB, Ripke S, Coryell W, Potash JB, Scheftner WA, Shi J, Weissman MM, Hultman CM, Landén M, Levinson DF, Kendler KS, Smoller JW, Wray NR, Lee SH, Absher D, Agartz I, Akil H, Amin F, Andreassen O, Anjorin A, Anney R, Arking D, Asherson P, Azevedo M, Backlund L, Badner J, Bailey A, Banaschewski T, Barchas J, Barnes M, Barrett T, Bass N, Battaglia A, Bauer M, Bayés M, Bellivier F, Bergen S, Berrettini W, Betancur C, Bettecken T, Biederman J, Binder E, Black D, Blackwood D, Bloss C, Boehnke M, Boomsma D, Breen G, Breuer R, Bruggeman R, Buccola N, Buitelaar J, Bunney W, Buxbaum J, Byerley W, Caesar S, Cahn W, Cantor R, Casas M, Chakravarti A, Chambert K, Choudhury K, Cichon S, Cloninger C, Collier D, Cook E, Coon H, Cormand B, Cormican P, Corvin A, Coryell W, Craddock N, Craig D, Craig I, Crosbie J, Cuccaro M, Curtis D, Czamara D, Daly M, Datta S, Dawson G, Day R, De Geus E, Degenhardt F, Devlin B, Djurovic S, Donohoe G, Doyle A, Duan J, Dudbridge F, Duketis E, Ebstein R, Edenberg H, Elia J, Ennis S, Etain B, Fanous A, Faraone S, Farmer A, Ferrier I, Flickinger M, Fombonne E, Foroud T, Frank J, Franke B, Fraser C, Freedman R, Freimer N, Freitag C, Friedl M, Frisén L, Gallagher L, Gejman P, Georgieva L, Gershon E, Geschwind D, Giegling I, Gill M, Gordon S, Gordon-Smith K, Green E, Greenwood T, Grice D, Gross M, Grozeva D, Guan W, Gurling H, De Haan L, Haines J, Hakonarson H, Hallmayer J, Hamilton S, Hamshere M, Hansen T, Hartmann A, Hautzinger M, Heath A, Henders A, Herms S, Hickie I, Hipolito M, Hoefels S, Holmans P, Holsboer F, Hoogendijk W, Hottenga JJ, Hultman C, Hus V, Ingason A, Ising M, Jamain S, Jones I, Jones L, Kähler A, Kahn R, Kandaswamy R, Keller M, Kelsoe J, Kendler K, Kennedy J, Kenny E, Kent L, Kim Y, Kirov G, Klauck S, Klei L, Knowles J, Kohli M, Koller D, Konte B, Korszun A, Krabbendam L, Krasucki R, Kuntsi J, Kwan P, Landén M, Långström N, Lathrop M, Lawrence J, Lawson W, Leboyer M, Ledbetter D, Lee P, Lencz T, Lesch KP, Levinson D, Lewis C, Li J, Lichtenstein P, Lieberman J, Lin DY, Linszen D, Liu C, Lohoff F, Loo S, Lord C, Lowe J, Lucae S, MacIntyre D, Madden P, Maestrini E, Magnusson P, Mahon P, Maier W, Malhotra A, Mane S, Martin C, Martin N, Mattheisen M, Matthews K, Mattingsdal M, McCarroll S, McGhee K, McGough J, McGrath P, McGuffin P, McInnis M, McIntosh A, McKinney R, McLean A, McMahon F, McMahon W, McQuillin A, Medeiros H, Medland S, Meier S, Melle I, Meng F, Meyer J, Middeldorp C, Middleton L, Milanova V, Miranda A, Monaco A, Montgomery G, Moran J, Moreno-De-Luca D, Morken G, Morris D, Morrow E, Moskvina V, Mowry B, Muglia P, Mühleisen T, Müller-Myhsok B, Murtha M, Myers R, Myin-Germeys I, Neale B, Nelson S, Nievergelt C, Nikolov I, Nimgaonkar V, Nolen W, Nöthen M, Nurnberger J, Nwulia E, Nyholt D, O’Donovan M, O’Dushlaine C, Oades R, Olincy A, Oliveira G, Olsen L, Ophoff R, Osby U, Owen M, Palotie A, Parr J, Paterson A, Pato C, Pato M, Penninx B, Pergadia M, Pericak-Vance M, Perlis R, Pickard B, Pimm J, Piven J, Posthuma D, Potash J, Poustka F, Propping P, Purcell S, Puri V, Quested D, Quinn E, Ramos-Quiroga J, Rasmussen H, Raychaudhuri S, Rehnström K, Reif A, Ribasés M, Rice J, Rietschel M, Ripke S, Roeder K, Roeyers H, Rossin L, Rothenberger A, Rouleau G, Ruderfer D, Rujescu D, Sanders A, Sanders S, Santangelo S, Schachar R, Schalling M, Schatzberg A, Scheftner W, Schellenberg G, Scherer S, Schork N, Schulze T, Schumacher J, Schwarz M, Scolnick E, Scott L, Sergeant J, Shi J, Shilling P, Shyn S, Silverman J, Sklar P, Slager S, Smalley S, Smit J, Smith E, Smoller J, Sonuga-Barke E, St Clair D, State M, Steffens M, Steinhausen HC, Strauss J, Strohmaier J, Stroup T, Sullivan P, Sutcliffe J, Szatmari P, Szelinger S, Thapar A, Thirumalai S, Thompson R, Todorov A, Tozzi F, Treutlein J, Tzeng JY, Uhr M, van den Oord E, Van Grootheest G, Van Os J, Vicente A, Vieland V, Vincent J, Visscher P, Walsh C, Wassink T, Watson S, Weiss L, Weissman M, Werge T, Wienker T, Wiersma D, Wijsman E, Willemsen G, Williams N, Willsey A, Witt S, Wray N, Xu W, Young A, Yu T, Zammit S, Zandi P, Zhang P, Zitman F, Zöllner S. Joint analysis of psychiatric disorders increases accuracy of risk prediction for schizophrenia, bipolar disorder, and major depressive disorder. Am J Hum Genet 2015; 96:283-94. [PMID: 25640677 PMCID: PMC4320268 DOI: 10.1016/j.ajhg.2014.12.006] [Citation(s) in RCA: 163] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 12/08/2014] [Indexed: 12/11/2022] Open
Abstract
Genetic risk prediction has several potential applications in medical research and clinical practice and could be used, for example, to stratify a heterogeneous population of patients by their predicted genetic risk. However, for polygenic traits, such as psychiatric disorders, the accuracy of risk prediction is low. Here we use a multivariate linear mixed model and apply multi-trait genomic best linear unbiased prediction for genetic risk prediction. This method exploits correlations between disorders and simultaneously evaluates individual risk for each disorder. We show that the multivariate approach significantly increases the prediction accuracy for schizophrenia, bipolar disorder, and major depressive disorder in the discovery as well as in independent validation datasets. By grouping SNPs based on genome annotation and fitting multiple random effects, we show that the prediction accuracy could be further improved. The gain in prediction accuracy of the multivariate approach is equivalent to an increase in sample size of 34% for schizophrenia, 68% for bipolar disorder, and 76% for major depressive disorders using single trait models. Because our approach can be readily applied to any number of GWAS datasets of correlated traits, it is a flexible and powerful tool to maximize prediction accuracy. With current sample size, risk predictors are not useful in a clinical setting but already are a valuable research tool, for example in experimental designs comparing cases with high and low polygenic risk.
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Geoghegan J, Middleton L, Moore P, Subseson G, Khan K, Daniels J. Routine cell salvage during elective caesarean section: a pilot randomised trial. Int J Obstet Anesth 2015; 24:86-7. [DOI: 10.1016/j.ijoa.2014.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 08/05/2014] [Accepted: 08/19/2014] [Indexed: 11/26/2022]
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Hayward C, Patel H, Manohar S, Waton J, Middleton L, Lyon A, Sutton R, Rosen S. 39 * Short time window analysis of heart rate variability during tilt table testing provides insights in to the timing of changes in the autonomic nervous system. Europace 2014. [DOI: 10.1093/europace/euu239.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Middleton L, Smith J, Chabela A, Howard A, Murrman M, El-Sadr W. Fostering the nursing/midwifery workforce in sub-Saharan Africa. Ann Glob Health 2014. [DOI: 10.1016/j.aogh.2014.08.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Hung CF, Rivera M, Craddock N, Owen MJ, Gill M, Korszun A, Maier W, Mors O, Preisig M, Rice JP, Rietschel M, Jones L, Middleton L, Aitchison KJ, Davis OSP, Breen G, Lewis C, Farmer A, McGuffin P. Relationship between obesity and the risk of clinically significant depression: Mendelian randomisation study. Br J Psychiatry 2014; 205:24-8. [PMID: 24809401 PMCID: PMC4076654 DOI: 10.1192/bjp.bp.113.130419] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Obesity has been shown to be associated with depression and it has been suggested that higher body mass index (BMI) increases the risk of depression and other common mental disorders. However, the causal relationship remains unclear and Mendelian randomisation, a form of instrumental variable analysis, has recently been employed to attempt to resolve this issue. AIMS To investigate whether higher BMI increases the risk of major depression. METHOD Two instrumental variable analyses were conducted to test the causal relationship between obesity and major depression in RADIANT, a large case-control study of major depression. We used a single nucleotide polymorphism (SNP) in FTO and a genetic risk score (GRS) based on 32 SNPs with well-established associations with BMI. RESULTS Linear regression analysis, as expected, showed that individuals carrying more risk alleles of FTO or having higher score of GRS had a higher BMI. Probit regression suggested that higher BMI is associated with increased risk of major depression. However, our two instrumental variable analyses did not support a causal relationship between higher BMI and major depression (FTO genotype: coefficient -0.03, 95% CI -0.18 to 0.13, P = 0.73; GRS: coefficient -0.02, 95% CI -0.11 to 0.07, P = 0.62). CONCLUSIONS Our instrumental variable analyses did not support a causal relationship between higher BMI and major depression. The positive associations of higher BMI with major depression in probit regression analyses might be explained by reverse causality and/or residual confounding.
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Steffen A, Sørensen TIA, Knüppel S, Travier N, Sánchez MJ, Huerta JM, Quirós JR, Ardanaz E, Dorronsoro M, Teucher B, Li K, Bueno-de-Mesquita HB, van der A D, Mattiello A, Palli D, Tumino R, Krogh V, Vineis P, Trichopoulou A, Orfanos P, Trichopoulos D, Hedblad B, Wallström P, Overvad K, Halkjær J, Tjønneland A, Fagherazzi G, Dartois L, Crowe F, Khaw KT, Wareham N, Middleton L, May AM, Peeters PHM, Boeing H. Development and validation of a risk score predicting substantial weight gain over 5 years in middle-aged European men and women. PLoS One 2013; 8:e67429. [PMID: 23874419 PMCID: PMC3713004 DOI: 10.1371/journal.pone.0067429] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [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: 09/28/2012] [Accepted: 05/21/2013] [Indexed: 12/15/2022] Open
Abstract
Background Identifying individuals at high risk of excess weight gain may help targeting prevention efforts at those at risk of various metabolic diseases associated with weight gain. Our aim was to develop a risk score to identify these individuals and validate it in an external population. Methods We used lifestyle and nutritional data from 53°758 individuals followed for a median of 5.4 years from six centers of the European Prospective Investigation into Cancer and Nutrition (EPIC) to develop a risk score to predict substantial weight gain (SWG) for the next 5 years (derivation sample). Assuming linear weight gain, SWG was defined as gaining ≥10% of baseline weight during follow-up. Proportional hazards models were used to identify significant predictors of SWG separately by EPIC center. Regression coefficients of predictors were pooled using random-effects meta-analysis. Pooled coefficients were used to assign weights to each predictor. The risk score was calculated as a linear combination of the predictors. External validity of the score was evaluated in nine other centers of the EPIC study (validation sample). Results Our final model included age, sex, baseline weight, level of education, baseline smoking, sports activity, alcohol use, and intake of six food groups. The model's discriminatory ability measured by the area under a receiver operating characteristic curve was 0.64 (95% CI = 0.63–0.65) in the derivation sample and 0.57 (95% CI = 0.56–0.58) in the validation sample, with variation between centers. Positive and negative predictive values for the optimal cut-off value of ≥200 points were 9% and 96%, respectively. Conclusion The present risk score confidently excluded a large proportion of individuals from being at any appreciable risk to develop SWG within the next 5 years. Future studies, however, may attempt to further refine the positive prediction of the score.
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Affiliation(s)
- Annika Steffen
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany.
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Chan KY, Wang W, Wu JJ, Liu L, Theodoratou E, Car J, Middleton L, Russ TC, Deary IJ, Campbell H, Wang W, Rudan I. Epidemiology of Alzheimer's disease and other forms of dementia in China, 1990-2010: a systematic review and analysis. Lancet 2013; 381:2016-23. [PMID: 23746902 DOI: 10.1016/s0140-6736(13)60221-4] [Citation(s) in RCA: 474] [Impact Index Per Article: 43.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND China is increasingly facing the challenge of control of the growing burden of non-communicable diseases. We assessed the epidemiology of Alzheimer's disease and other forms of dementia in China between 1990, and 2010, to improve estimates of the burden of disease, analyse time trends, and inform health policy decisions relevant to China's rapidly ageing population. METHODS In our systematic review we searched for reports of Alzheimer's disease or dementia in China, published in Chinese and English between 1990 and 2010. We searched China National Knowledge Infrastructure, Wanfang, and PubMed databases. Two investigators independently assessed case definitions of Alzheimer's disease and dementia: we excluded studies that did not use internationally accepted case definitions. We also excluded reviews and viewpoints, studies with no numerical estimates, and studies not done in mainland China. We used Poisson regression and UN demographic data to estimate the prevalence (in nine age groups), incidence, and standardised mortality ratio of dementia and its subtypes in China in 1990, 2000, and 2010. FINDINGS Our search returned 12,642 reports, of which 89 met the inclusion criteria (75 assessed prevalence, 13 incidence, and nine mortality). In total, the included studies had 340,247 participants, in which 6357 cases of Alzheimer's disease were recorded. 254,367 people were assessed for other forms of dementia, of whom 3543 had vascular dementia, frontotemporal dementia, or Lewy body dementia. In 1990 the prevalence of all forms of dementia was 1·8% (95% CI 0·0-44·4) at 65-69 years, and 42·1% (0·0-88·9) at age 95-99 years. In 2010 prevalence was 2·6% (0·0-28·2) at age 65-69 years and 60·5% (39·7-81·3) at age 95-99 years. The number of people with dementia in China was 3·68 million (95% CI 2·22-5·14) in 1990, 5·62 million (4·42-6·82) in 2000, and 9·19 million (5·92-12·48) in 2010. In the same period, the number of people with Alzheimer's disease was 1·93 million (1·15-2·71) in 1990, 3·71 million (2·84-4·58) people in 2000, and 5·69 million (3·85-7·53) in 2010. The incidence of dementia was 9·87 cases per 1000 person-years, that of Alzheimer's disease was 6·25 cases per 1000 person-years, that of vascular dementia was 2·42 cases per 1000 person-years, and that of other rare forms of dementia was 0·46 cases per 1000 person-years. We retrieved mortality data for 1032 people with dementia and 20,157 healthy controls, who were followed up for 3-7 years. The median standardised mortality ratio was 1·94:1 (IQR 1·74-2·45). INTERPRETATION Our analysis suggests that previous estimates of dementia burden, based on smaller datasets, might have underestimated the burden of dementia in China. The burden of dementia seems to be increasing faster than is generally assumed by the international health community. Rapid and effective government responses are needed to tackle dementia in low-income and middle-income countries. FUNDING Nossal Institute of Global Health (University of Melbourne, Australia), the National 12th Five-Year Major Projects of China, National Health and Medical Research Council Australia-China Exchange Fellowship, Importation and Development of High-Calibre Talents Project of Beijing Municipal Institutions, and the Bill & Melinda Gates Foundation.
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Affiliation(s)
- Kit Yee Chan
- Nossal Institute for Global Health, University of Melbourne, Australia
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Gallo V, Wark PA, Jenab M, Pearce N, Brayne C, Vermeulen R, Andersen PM, Hallmans G, Kyrozis A, Vanacore N, Vahdaninia M, Grote V, Kaaks R, Mattiello A, Bueno-de-Mesquita HB, Peeters PH, Travis RC, Petersson J, Hansson O, Arriola L, Jimenez-Martin JM, Tjønneland A, Halkjær J, Agnoli C, Sacerdote C, Bonet C, Trichopoulou A, Gavrila D, Overvad K, Weiderpass E, Palli D, Quirós JR, Tumino R, Khaw KT, Wareham N, Barricante-Gurrea A, Fedirko V, Ferrari P, Clavel-Chapelon F, Boutron-Ruault MC, Boeing H, Vigl M, Middleton L, Riboli E, Vineis P. Prediagnostic body fat and risk of death from amyotrophic lateral sclerosis: the EPIC cohort. Neurology 2013; 80:829-38. [PMID: 23390184 DOI: 10.1212/wnl.0b013e3182840689] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate for the first time the association between body fat and risk of amyotrophic lateral sclerosis (ALS) with an appropriate prospective study design. METHODS The EPIC (European Prospective Investigation into Cancer and Nutrition) study included 518,108 individuals recruited from the general population across 10 Western European countries. At recruitment, information on lifestyle was collected and anthropometric characteristics were measured. Cox hazard models were fitted to investigate the associations between anthropometric measures and ALS mortality. RESULTS Two hundred twenty-two ALS deaths (79 men and 143 women) occurred during the follow-up period (mean follow-up = 13 years). There was a statistically significant interaction between categories of body mass index and sex regarding ALS risk (p = 0.009): in men, a significant linear decrease of risk per unit of body mass index was observed (hazard ratio = 0.93, 95% confidence interval 0.86-0.99 per kg/m(2)); among women, the risk was more than 3-fold increased for underweight compared with normal-weight women. Among women, a significant risk reduction increasing the waist/hip ratio was also evident: women in the top quartile had less than half the risk of ALS compared with those in the bottom quartile (hazard ratio = 0.48, 95% confidence interval 0.25-0.93) with a borderline significant p value for trend across quartiles (p = 0.056). CONCLUSION Increased prediagnostic body fat is associated with a decreased risk of ALS mortality.
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Affiliation(s)
- Valentina Gallo
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK.
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Davies L, Saing CW, Power S, Middleton L, Yoganathan K. . West J Med 2011; 343:d7004-d7004. [DOI: 10.1136/bmj.d7004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Breen G, Webb BT, Butler AW, van den Oord EJCG, Tozzi F, Craddock N, Gill M, Korszun A, Maier W, Middleton L, Mors O, Owen MJ, Cohen-Woods S, Perry J, Galwey NW, Upmanyu R, Craig I, Lewis CM, Ng M, Brewster S, Preisig M, Rietschel M, Jones L, Knight J, Rice J, Muglia P, Farmer AE, McGuffin P. A genome-wide significant linkage for severe depression on chromosome 3: the depression network study. Am J Psychiatry 2011; 168:840-7. [PMID: 21572164 DOI: 10.1176/appi.ajp.2011.10091342] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The purpose of this study was to find loci for major depression via linkage analysis of a large sibling pair sample. METHOD The authors conducted a genome-wide linkage analysis of 839 families consisting of 971 affected sibling pairs with severe recurrent major depression, comprising waves I and II of the Depression Network Study cohort. In addition to examining affected status, linkage analyses in the full data set were performed using diagnoses restricted by impairment severity, and association mapping of hits in a large case-control data set was attempted. RESULTS The authors identified genome-wide significant linkage to chromosome 3p25-26 when the diagnoses were restricted by severity, which was a maximum LOD score of 4.0 centered at the linkage marker D3S1515. The linkage signal identified was genome-wide significant after correction for the multiple phenotypes tested, although subsequent association mapping of the region in a genome-wide association study of a U.K. depression sample did not provide significant results. CONCLUSIONS The authors report a genome-wide significant locus for depression that implicates genes that are highly plausible for involvement in the etiology of recurrent depression. Despite the fact that association mapping in the region was negative, the linkage finding was replicated by another group who found genome-wide-significant linkage for depression in the same region. This suggests that 3p25-26 is a new locus for severe recurrent depression. This represents the first report of a genome-wide significant locus for depression that also has an independent genome-wide significant replication.
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Affiliation(s)
- Gerome Breen
- Medical Research Council Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London
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Daniels JP, Middleton L, Xiong T, Champaneria R, Johnson NP, Lichten EM, Sutton C, Vercellini P, Gray R, Hills RK, Jones KD, Aimi G, Khan KS. Individual patient data meta-analysis of randomized evidence to assess the effectiveness of laparoscopic uterosacral nerve ablation in chronic pelvic pain. Hum Reprod Update 2010; 16:568-76. [PMID: 20634210 DOI: 10.1093/humupd/dmq031] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND There have been conflicting results in randomized trials of the effects of laparoscopic uterosacral nerve ablation (LUNA) in chronic pelvic pain. Our objective was to perform a meta-analysis using individual patient data (IPD) to provide the most comprehensive and reliable assessment of the effectiveness of LUNA. METHODS Electronic searches were conducted in the Medline, Embase, PsycInfo and Cochrane Library databases from database inception to August 2009. The reference lists of known relevant papers were searched for any further articles. Randomized trials comparing LUNA with no additional intervention were selected and authors contacted for IPD. Raw data were available from 862 women randomized into five trials. Pain scores were calibrated to a 10-point scale and were analysed using a multilevel model allowing for repeated measures. RESULTS There was no significant difference between LUNA and No LUNA for the worst pain recorded over a 12 month time period (mean difference 0.25 points in favour of No LUNA on a 0-10 point scale, 95% confidence interval: -0.08 to 0.58; P = 0.1). CONCLUSIONS LUNA does not result in improved chronic pelvic pain.
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Affiliation(s)
- J P Daniels
- University of Birmingham, Birmingham Women's Hospital, Edgbaston, Birmingham B15 2TG, UK.
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