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Borowitz MJ, Wood BL, Keeney M, Hedley BD. Measurable Residual Disease Detection in B-Acute Lymphoblastic Leukemia: The Children's Oncology Group (COG) Method. Curr Protoc 2022; 2:e383. [PMID: 35263042 DOI: 10.1002/cpz1.383] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Measurable (minimal) residual disease (MRD) in B-acute lymphoblastic leukemia (B-ALL), as assessed by flow cytometry, is an established prognostic factor used to adjust treatment in most pediatric therapeutic protocols. MRD in B-ALL has been standardized by the Children's Oncology Group in North America and more recently in a multicenter Foundation for the National Institutes of Health-funded study. This article outlines the reagents, instrument setup, and analysis protocols required for the reproducible detection of residual leukemic cells in patients following induction therapy for B-ALL. © 2022 Wiley Periodicals LLC. Basic Protocol 1: Staining and flow cytometry for B-acute lymphoblastic leukemia (B-ALL) measurable residual disease detection Support Protocol: Specimen collection, handling, storage, and shipping Basic Protocol 2: Analysis and interpretation of data for B-ALL measurable residual disease detection Basic Protocol 3: Analysis of samples lacking sufficient CD19+ events.
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Affiliation(s)
- Michael J Borowitz
- Pathology and Oncology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Brent L Wood
- Pathology and Laboratory Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California
| | - Michael Keeney
- Department of Pathology and Laboratory Medicine, London Health Sciences Center, London, Ontario
| | - Benjamin D Hedley
- Department of Pathology and Laboratory Medicine, London Health Sciences Center, London, Ontario
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2
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Hupp MM, Bashleben C, Cardinali JL, Dorfman DM, Karlon W, Keeney M, Leith C, Long T, Murphy CE, Pillai V, Rosado FN, Seegmiller AC, Linden MA. Participation in the College of American Pathologists Laboratory Accreditation Program Decreases Variability in B-Lymphoblastic Leukemia and Plasma Cell Myeloma Flow Cytometric Minimal Residual Disease Testing: A Follow-up Survey. Arch Pathol Lab Med 2021; 145:336-342. [PMID: 32886757 DOI: 10.5858/arpa.2019-0493-cp] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Minimal residual disease (MRD) testing by flow cytometry is ubiquitous in hematolymphoid neoplasm monitoring, especially B-lymphoblastic leukemia (B-ALL), for which it provides predictive information and guides management. Major heterogeneity was identified in 2014. Subsequently, new Flow Cytometry Checklist items required documentation of the sensitivity determination method and required lower level of detection (LLOD) inclusion in final reports. This study assesses Laboratory Accreditation Program (LAP) participation and new checklist items' impact on flow cytometry MRD testing. OBJECTIVES.— To survey flow cytometry laboratories about MRD testing for B-ALL and plasma cell myeloma. In particular, enumerate the laboratories performing MRD testing, the proportion performing assays with very low LLODs, and implementation of new checklist items. DESIGN.— Supplemental questions were distributed in the 2017-A mailing to 548 flow cytometry laboratories subscribed to the College of American Pathologists FL3 Proficiency Testing Survey (Flow Cytometry-Immunophenotypic Characterization of Leukemia/Lymphoma). RESULTS.— The percentage of laboratories performing MRD studies has significantly decreased since 2014. Wide ranges of LLOD and collection event numbers were reported for B-ALL and plasma cell myeloma. Most laboratories determine LLOD by using dilutional studies and include it in final reports; a higher proportion of LAP participants used these practices than nonparticipants. CONCLUSIONS.— Several MRD testing aspects vary among laboratories receiving FL3 Proficiency Testing materials. After the survey in 2014, new checklist items were implemented. As compared to 2014, fewer laboratories are performing MRD studies. While LLOD remains heterogeneous, a high proportion of LAP subscribers follow the new checklist requirements and, overall, target LLOD recommendations from disease-specific working groups are met.
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Affiliation(s)
- Meghan M Hupp
- From the Division of Hematopathology, Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis (Hupp, Linden)
| | | | - Jolene L Cardinali
- Special Hematology, Hartford Hospital, Hartford, Connecticut (Cardinali)
| | - David M Dorfman
- The Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dorfman)
| | - William Karlon
- The Departments of Pathology and Laboratory Medicine, University of California, San Francisco (Karlon)
| | - Michael Keeney
- London Health Sciences Centre, Lawson Health Research Institute, London, Ontario, Canada (Keeney)
| | - Catherine Leith
- The Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, Madison (Leith)
| | - Thomas Long
- College of American Pathologists, Northfield, Illinois (Bashleben, Long)
| | | | - Vinodh Pillai
- the Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Pillai)
| | - Flavia N Rosado
- The Department of Pathology and Laboratory Services, University of Texas Southwestern Medical Center, Dallas (Rosado)
| | - Adam C Seegmiller
- The Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Seegmiller)
| | - Michael A Linden
- From the Division of Hematopathology, Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis (Hupp, Linden)
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Hedley BD, Cheng G, Keeney M, Kern W, Padurean A, Luider J, Chin‐Yee I, Lowes LE, Rohrbach J, Ortega R, Smit A, Lo K, Magari R, Tejidor L. A multicenter study evaluation of the ClearLLab 10C panels. Cytometry B Clin Cytom 2021; 100:225-234. [PMID: 32667744 PMCID: PMC8048967 DOI: 10.1002/cyto.b.21935] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/20/2020] [Accepted: 06/16/2020] [Indexed: 11/26/2022]
Abstract
Multiparameter flow cytometry plays an important role in the diagnosis, staging, and monitoring of patients with a suspected hematological malignancy. The ClearLLab 10C Panels consist of four reagent panels (B-Lineage Tube, T-Lineage Tube, and 2 Myeloid Lineage Tubes), each consisting of 10 color/10 antibody conjugates utilizing Beckman Coulters proprietary dry format optimized for investigating patients with suspected leukemia or lymphoma. A multicenter study was conducted to evaluate the performance of the ClearLLab 10C Panels for qualitative assessment of normal versus abnormal phenotype in peripheral blood, bone marrow, and lymph node samples with suspected hematological malignancies. ClearLLab 10C was compared to laboratory developed tests (LDTs) and final clinical diagnosis. Four clinical sites were used to enroll patient's spent specimens (n = 453); three laboratories in North America and one in Europe. Of the 453 specimens, 198 had no malignancy and 255 contained an abnormal population. The diagnostic accuracy of the ClearLLab 10C Panels was achieved with sensitivity of 96% and specificity of 95% with respect to patient final clinical diagnosis. The agreement of phenotyping between ClearLLab10C Panels and LDTs was 98%. Any differences noted between ClearLLab 10C and LDT were due to either the presence of populations below the level of detection, the lack of clinical information provided to the evaluators, or marker(s) not present in these panels. Overall, the ClearLLab 10C demonstrated excellent agreement to LDTs and diagnosis. These four reagent panels can be adopted by individual laboratories to assess the presence or absence of malignancy.
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Affiliation(s)
- Benjamin D. Hedley
- Department of Pathology and Laboratory MedicineLondon Health Sciences CenterLondonOntarioCanada
| | - Guoyan Cheng
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
| | - Michael Keeney
- Department of Pathology and Laboratory MedicineLondon Health Sciences CenterLondonOntarioCanada
| | - Wolfgang Kern
- MLL Munich Leukemia LaboratoryDepartment of ImmunophenotypingMunichGermany
| | - Adrian Padurean
- Neogenomics Laboratory, Inc.Department of Flow CytometryFort MyersFloridaUSA
| | - Joanne Luider
- Calgary Laboratory ServicesFlow Cytometry CalgaryAlbertaCanada
| | - Ian Chin‐Yee
- Department of Pathology and Laboratory MedicineLondon Health Sciences CenterLondonOntarioCanada
| | - Lori E. Lowes
- Department of Pathology and Laboratory MedicineLondon Health Sciences CenterLondonOntarioCanada
| | - Justin Rohrbach
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
| | - Robert Ortega
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
| | - Astrid Smit
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
| | - Ka‐Wai Lo
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
| | - Robert Magari
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
| | - Liliana Tejidor
- Department of Clinical Research, Beckman Coulter, Inc.MiamiFloridaUSA
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Lowes LE, Hedley BD, Sutherland DR, Keeney M. Evaluation of Versalyse as an alternative red blood cell lysing agent in the evaluation of CD34 stem and progenitor cells with the ISHAGE guidelines. Cytometry B Clin Cytom 2020; 100:402-405. [PMID: 33009886 DOI: 10.1002/cyto.b.21960] [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] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/31/2020] [Accepted: 09/15/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Lori E Lowes
- Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Benjamin D Hedley
- Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - D Robert Sutherland
- Laboratory Medicine Program, The University Health Network, Toronto, Ontario, Canada
| | - Michael Keeney
- Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
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5
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Cherian S, Hedley BD, Keeney M. Common flow cytometry pitfalls in diagnostic hematopathology. Cytometry 2019; 96:449-463. [DOI: 10.1002/cyto.b.21854] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/16/2019] [Accepted: 10/22/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Sindhu Cherian
- Department of Laboratory MedicineUniversity of Washington Seattle Washington
| | - Ben D. Hedley
- Department of Pathology and Laboratory Medicine, London Health Sciences Center, London, Ontario Canada
| | - Michael Keeney
- Department of Pathology and Laboratory Medicine, London Health Sciences Center, London, Ontario Canada
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6
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Russell SA, Sholzberg M, Mangel J, Keeney M, Hedley B, Bode M, Gob A, Lam S, Phua C, Hsia CC. Gaucher disease screening at a general adult hematology tertiary care centre: A prospective study. Int J Lab Hematol 2018; 41:e66-e69. [DOI: 10.1111/ijlh.12960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/05/2018] [Accepted: 11/12/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Steven A. Russell
- Department of Internal Medicine Western University London Ontario Canada
| | - Michelle Sholzberg
- Department of Medicine and Laboratory Medicine & Pathobiology St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto London Ontario Canada
| | - Joy Mangel
- Division of Hematology, Department of Medicine Western University London Ontario Canada
| | - Michael Keeney
- MLT London Laboratory Services Group London Ontario Canada
| | - Ben Hedley
- MLT London Laboratory Services Group London Ontario Canada
| | - Margo Bode
- MLT London Laboratory Services Group London Ontario Canada
| | - Alan Gob
- Division of Hematology, Department of Medicine Western University London Ontario Canada
| | - Selay Lam
- Division of Hematology, Department of Medicine Western University London Ontario Canada
| | - Chai Phua
- Division of Hematology, Department of Medicine Western University London Ontario Canada
| | - Cyrus C. Hsia
- Division of Hematology, Department of Medicine Western University London Ontario Canada
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7
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Hilden J, Sullivan M, Polizzi M, Wade J, Greer J, Keeney M. Power consumption during oscillatory mixing of pharmaceutical powders. POWDER TECHNOL 2018. [DOI: 10.1016/j.powtec.2018.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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8
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Kovacs MJ, Wong A, MacKinnon K, Weir K, Keeney M, Boyle E, Cruickshank M. Assessment of the Validity of the INR System for Patients with Liver Impairment. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1642513] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThe INR system was developed to standardize PT reporting in patients on oral anticoagulants. We prospectively collected blood samples from 29 patients with liver impairment (INR 1.5-3.5). Control patients were on warfarin (n = 31). PT’s were measured on an ACL-300 with three thromboplastin reagents. INR’s were calculated using instrument specific ISI’s. Other tests performed were FDP’s, fibrinogen, aPTT, factors II, V, VII and X. The INR’s for each patient in the study population using the three thromboplastin reagents were significantly different (p = 0.0001). Those for the control population were not (p = 0.0658). Fibrinogen, factors V, II and X were different at the 5% level of significance between the populations. FDP’s were detected in 17 study subjects. The INR system is not valid for comparison of patients with liver impairment because different reagents do not give the same INR for the same sample. It is, however, no less valid than the use of PT with different thromboplastin reagents. Further study is recommended.
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Affiliation(s)
- M J Kovacs
- The Department of Hematology/Blood Bank, Victoria Hospital, University of Western Ontario, London, Ontario, Canada
- The Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - A Wong
- The Department of Hematology/Blood Bank, Victoria Hospital, University of Western Ontario, London, Ontario, Canada
- The Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - K MacKinnon
- The Department of Hematology/Blood Bank, Victoria Hospital, University of Western Ontario, London, Ontario, Canada
| | - K Weir
- The Department of Hematology/Blood Bank, Victoria Hospital, University of Western Ontario, London, Ontario, Canada
| | - M Keeney
- The Department of Hematology/Blood Bank, Victoria Hospital, University of Western Ontario, London, Ontario, Canada
| | - E Boyle
- The Departments of Biostatistics and Epidemiology, University of Western Ontario, London, Ontario, Canada
| | - M Cruickshank
- The Department of Hematology, University Hospital, London, Ontario, Canada
- The Department of Medicine, University of Western Ontario, London, Ontario, Canada
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9
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Sutherland DR, Illingworth A, Marinov I, Ortiz F, Andreasen J, Payne D, Wallace PK, Keeney M. ICCS/ESCCA Consensus Guidelines to detect GPI-deficient cells in Paroxysmal Nocturnal Hemoglobinuria (PNH) and related Disorders Part 2 - Reagent Selection and Assay Optimization for High-Sensitivity Testing. Cytometry 2018; 94:23-48. [DOI: 10.1002/cyto.b.21610] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/07/2017] [Accepted: 12/11/2017] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Iuri Marinov
- Institute of Hematology and Blood Transfusion; Prague Czech Republic
| | - Fernando Ortiz
- University Health Network, Toronto General Hospital; Ontario M5G2C4 Canada
| | - John Andreasen
- Immunologic Flow Cytometry; ARUP Laboratories, Inc; Salt Lake City Utah
| | - Dan Payne
- HMDL and Immunology Flow Cytometry Service; Leicester Royal Infirmary UHL NHS Trust; Leicester United Kingdom
| | - Paul K. Wallace
- Department of Flow and Image Cytometry; Roswell Park Cancer Institute; Buffalo New York
| | - Michael Keeney
- Department of Hematology/Flow Cytometry London Health Sciences Centre; London Ontario Canada
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Kovacs MJ, Levine MN, Keeney M, Mackinnon KM, Lee AY. Anti-Xa effect of a low molecular weight heparin (dalteparin) does not accumulate in extended duration therapy for venous thromboembolism in cancer patients. Thromb Haemost 2017; 93:1185-8. [PMID: 15968406 DOI: 10.1160/th05-01-0052] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryMany patients with venous thromboembolism are being treated with low molecular weight heparin for extended periods of time. It is not certain if it is necessary to assess anti-Xa levels for extended treatment periods. This study is a prospective assessment of anti-Xa levels in patients on long-term therapy for acute venous thromboembolism who have active cancer. Consecutive consenting patients from one center in a multicenter trial that compared 6 months of low molecular weight heparin with oral anticoagulant therapy were treated with therapeutic doses of dalteparin (200 IU per kilogram) subcutaneously daily. Anti-Xa levels were assessed at the end of weeks 1 and 4, 4–6 hours after injection of dalteparin. Patients were followed for bleeding and recurrent venous thromboembolism. There were 24 patients who had anti-Xa levels measured at weeks 1 and 4. Two other patients had week 1 measurements performed but died before the week 4 sample was collected due to their underlying cancer. The mean anti-Xa levels at weeks 1 and 4 were 1.11 and 1.03 anti-Xa units/ml respectively (P=0.13). These results suggest that for patients with active cancer receiving extended duration therapy with low molecular weight heparin (dalteparin) there is no accumulation of anti-Xa effect over the first month of therapy. Monitoring of anti-Xa levels in this situation is usually not required.
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Affiliation(s)
- Michael J Kovacs
- London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, N6A 4G5, Canada.
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11
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Hedley B, Cheng G, Luider J, Kern W, Lozanski G, Chin-Yee I, Lowes L, Keeney M, Careaga D, Magari R, Tejidor L. Initial flow cytometric evaluation of the Clearllab lymphoid screen. Cytometry 2017; 94:707-713. [DOI: 10.1002/cyto.b.21603] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 11/16/2017] [Accepted: 11/22/2017] [Indexed: 12/13/2022]
Affiliation(s)
- B.D. Hedley
- Pathology and Laboratory Medicine, London Health Sciences Center; London Ontario, N6A 5W9 Canada
| | - G. Cheng
- Clinical Research, Beckman Coulter, Inc.; Miami 33196 Florida
| | - J. Luider
- Calgary Laboratory Services; Calgary T2N 2T9 Alberta Canada
| | - W. Kern
- MLL Munich Leukemia Laboratory; Munich 81377 Bavaria Germany
| | - G. Lozanski
- The Ohio State University; Columbus 43210 Ohio
| | - I. Chin-Yee
- Department of Medicine; Schulich School of Medicine Western University of Ontario; London N6K 5W9 Ontario Canada
| | - L.E. Lowes
- Pathology and Laboratory Medicine, London Health Sciences Center; London Ontario, N6A 5W9 Canada
| | - M. Keeney
- Pathology and Laboratory Medicine, London Health Sciences Center; London Ontario, N6A 5W9 Canada
| | - D. Careaga
- Clinical Research, Beckman Coulter, Inc.; Miami 33196 Florida
| | - R. Magari
- Clinical Research, Beckman Coulter, Inc.; Miami 33196 Florida
| | - L. Tejidor
- Clinical Research, Beckman Coulter, Inc.; Miami 33196 Florida
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12
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Kuruvilla J, Wells P, Morrow B, MacKinnon K, Keeney M, Kovacs M. Prospective assessment of the natural history of positive D-dimer results in persons with acute venous thromboembolism (DVT or PE). Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613444] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryThe natural history of initially positive D-dimers for venous thromboembolism is not known. If it returns to negative in the majority of patients, it would be potentially helpful to diagnose a recurrence. In this study, we prospectively measured D-dimer levels in outpatients with a diagnosis of venous thrombo-embolism. There were a total of 152 patients with an average age of 57. D-dimer results were performed at baseline and repeated at one week, one month and three months.At baseline 120 of 152 (79%) had a positive D-dimer result. Of those with an initially positive result, 80% were still positive at one week and 39% were still positive at one month. Finally at three months, 13% remained positive. Seven patients had recurrent events and all had persistently elevated D-dimers at one month. This study suggests that a persistently positive D-dimer result after one month of treatment may indicate a higher risk of recurrent venous thromboembolism. D-dimer testing for the diagnosis of recurrence of venous thromboembolism deserves further study.
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13
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Miller M, Salinas E, Sharma D, Keeney M, McDonald M, Newtson A, Goodheart M, Gonzalez-Bosquet J, Devor E. NOTCH2 Expression is Significantly Associated with FIGO Stage at Diagnosis in Endometrioid Endometrial Cancer. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.07.100] [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: 11/28/2022]
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14
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Newtson A, Salinas E, McDonald M, Miller M, Keeney M, Devor E, Gonzalez-Bosquet J. Identification of Clinical-Molecular Characteristics Associated with Recurrent Endometrial Cancer. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Miller M, Salinas E, Sharma D, Keeney M, McDonald M, Newtson A, Devor E, Goodheart M, Gonzalez-Bosquet J. A Clinical Prediction Model Stratifies Patients by Risk and Helps with Surgical Staging Decisions in Endometrioid Endometrial Cancer. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.07.098] [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: 12/01/2022]
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16
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Keeney M, Hedley BD, Chin-Yee IH. Flow cytometry-Recognizing unusual populations in leukemia and lymphoma diagnosis. Int J Lab Hematol 2017; 39 Suppl 1:86-92. [PMID: 28447408 DOI: 10.1111/ijlh.12666] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/24/2017] [Indexed: 12/16/2022]
Abstract
Flow cytometry is an invaluable technology in the examination of blood, bone marrow, tissue and body fluids for the presence or absence of hematological disease. It is used in both diagnostic and follow-up testing, with an increasingly important role in the detection of very small residual disease populations (Minimal Residual Disease, MRD) However, flow cytometry immunophenotyping of leukemia and lymphoma is highly dependent on interpretation of results and with the increased complexity of 8-10 color instruments routinely used in clinical laboratories, knowledge of disease-defining populations is increasingly important as is recognizing normal and reactive patterns. This manuscript presents case studies with flow cytometric patterns encountered in routine screening of samples sent for leukemia and lymphoma immunophenotyping, focusing mainly on B-cell disorders which may be missed or incorrectly interpreted by the laboratory (including a hematopathologist) performing the test. Case studies are used to illustrate our laboratory's standardized approach to the interpretation of flow cytometric data. In addition to a standardized approach, these cases emphasize the importance of interpretative skills of technologist and hematopathologists in recognizing abnormal patterns in detecting hematological malignancies.
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Affiliation(s)
- M Keeney
- Pathology and Laboratory Medicine, Department of Hematology, London Health Sciences Centre, Victoria Hospital, London, ON, Canada
| | - B D Hedley
- Pathology and Laboratory Medicine, Department of Hematology, London Health Sciences Centre, Victoria Hospital, London, ON, Canada
| | - I H Chin-Yee
- Pathology and Laboratory Medicine, Department of Hematology, London Health Sciences Centre, Victoria Hospital, London, ON, Canada.,Department of Medicine, Schulich School of Medicine Western University, London, ON, Canada
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17
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Keeney M, Wood BL, Hedley BD, DiGiuseppe JA, Stetler-Stevenson M, Paietta E, Lozanski G, Seegmiller AC, Greig BW, Shaver AC, Mukundan L, Higley HR, Sigman CC, Kelloff G, Jessup JM, Borowitz MJ. A QA Program for MRD Testing Demonstrates That Systematic Education Can Reduce Discordance Among Experienced Interpreters. Cytometry B Clin Cytom 2017; 94:239-249. [PMID: 28475275 DOI: 10.1002/cyto.b.21528] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/30/2017] [Accepted: 04/10/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Minimal residual disease (MRD) in B lymphoblastic leukemia (B-ALL) by flow cytometry is an established prognostic factor used to adjust treatment in most pediatric therapeutic protocols. MRD in B-ALL has been standardized by the Children's Oncology Group (COG) in North America, but not routine clinical labs. The Foundation for National Institutes of Health sought to harmonize MRD measurement among COG, oncology groups, academic, community and government, laboratories. METHODS Listmode data from post-induction marrows were distributed from a reference lab to seven different clinical FCM labs with variable experience in B-ALL MRD. Labs were provided with the COG protocol. Files from 15 cases were distributed to the seven labs. Educational sessions were implemented, and 10 more listmode file cases analyzed. RESULTS Among 105 initial challenges, the overall discordance rate was 26%. In the final round, performance improved considerably; out of 70 challenges, there were five false positives and one false negative (9% discordance), and no quantitative discordance. Four of six deviations occurred in a single lab. Three samples with hematogones were still misclassified as MRD. CONCLUSIONS Despite the provision of the COG standardized analysis protocol, even experienced laboratories require an educational component for B-ALL MRD analysis by FCM. Recognition of hematogones remains challenging for some labs when using the COG protocol. The results from this study suggest that dissemination of MRD testing to other North American laboratories as part of routine clinical management of B-ALL is possible but requires additional educational components to complement standardized methodology. © 2017 International Clinical Cytometry Society.
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Affiliation(s)
- Michael Keeney
- Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Brent L Wood
- Seattle Cancer Care Alliance, Seattle, Washington.,University of Washington, Seattle, Washington
| | - Benjamin D Hedley
- Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | | | | | | | - Gerard Lozanski
- Department of Pathology, Ohio State University, Columbus, Ohio
| | - Adam C Seegmiller
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bruce W Greig
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aaron C Shaver
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | - Gary Kelloff
- Cancer Imaging Program, National Cancer Institute, Bethesda, Maryland
| | | | - Michael J Borowitz
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
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18
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Keeney M, Chung MT, Zielins ER, Paik KJ, McArdle A, Morrison SD, Ransom RC, Barbhaiya N, Atashroo D, Jacobson G, Zare RN, Longaker MT, Wan DC, Yang F. Scaffold-mediated BMP-2 minicircle DNA delivery accelerated bone repair in a mouse critical-size calvarial defect model. J Biomed Mater Res A 2016; 104:2099-107. [PMID: 27059085 DOI: 10.1002/jbm.a.35735] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 02/18/2016] [Revised: 03/29/2016] [Accepted: 04/01/2016] [Indexed: 12/31/2022]
Abstract
Scaffold-mediated gene delivery holds great promise for tissue regeneration. However, previous attempts to induce bone regeneration using scaffold-mediated non-viral gene delivery rarely resulted in satisfactory healing. We report a novel platform with sustained release of minicircle DNA (MC) from PLGA scaffolds to accelerate bone repair. MC was encapsulated inside PLGA scaffolds using supercritical CO2 , which showed prolonged release of MC. Skull-derived osteoblasts transfected with BMP-2 MC in vitro result in higher osteocalcin gene expression and mineralized bone formation. When implanted in a critical-size mouse calvarial defect, scaffolds containing luciferase MC lead to robust in situ protein production up to at least 60 days. Scaffold-mediated BMP-2 MC delivery leads to substantially accelerated bone repair as early as two weeks, which continues to progress over 12 weeks. This platform represents an efficient, long-term nonviral gene delivery system, and may be applicable for enhancing repair of a broad range of tissues types. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2099-2107, 2016.
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Affiliation(s)
- Michael Keeney
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Clark Center E-150, 300 Pasteur Drive, Edwards R105, MC5341, Stanford, California, 94305.,Department of Bioengineering, Stanford University School of Medicine, Clark Center E-150, 300 Pasteur Drive, Edwards R105, MC5341, Stanford, California, 94305
| | - Michael T Chung
- Department of Surgery, Plastic and Reconstructive Surgery Division, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, 257 Campus Drive, Stanford University, Stanford, California, 94305-5148
| | - Elizabeth R Zielins
- Department of Surgery, Plastic and Reconstructive Surgery Division, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, 257 Campus Drive, Stanford University, Stanford, California, 94305-5148
| | - Kevin J Paik
- Department of Surgery, Plastic and Reconstructive Surgery Division, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, 257 Campus Drive, Stanford University, Stanford, California, 94305-5148
| | - Adrian McArdle
- Department of Surgery, Plastic and Reconstructive Surgery Division, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, 257 Campus Drive, Stanford University, Stanford, California, 94305-5148
| | - Shane D Morrison
- Department of Surgery, Plastic and Reconstructive Surgery Division, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, 257 Campus Drive, Stanford University, Stanford, California, 94305-5148
| | - Ryan C Ransom
- Department of Surgery, Plastic and Reconstructive Surgery Division, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, 257 Campus Drive, Stanford University, Stanford, California, 94305-5148
| | - Namrata Barbhaiya
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Clark Center E-150, 300 Pasteur Drive, Edwards R105, MC5341, Stanford, California, 94305.,Department of Bioengineering, Stanford University School of Medicine, Clark Center E-150, 300 Pasteur Drive, Edwards R105, MC5341, Stanford, California, 94305
| | - David Atashroo
- Department of Surgery, Plastic and Reconstructive Surgery Division, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, 257 Campus Drive, Stanford University, Stanford, California, 94305-5148
| | - Gunilla Jacobson
- Department of Chemistry, Stanford University, 333 Campus Drive Mudd Building, Room 121 Stanford, Stanford, California, 94305-4401
| | - Richard N Zare
- Department of Chemistry, Stanford University, 333 Campus Drive Mudd Building, Room 121 Stanford, Stanford, California, 94305-4401
| | - Michael T Longaker
- Department of Surgery, Plastic and Reconstructive Surgery Division, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, 257 Campus Drive, Stanford University, Stanford, California, 94305-5148
| | - Derrick C Wan
- Department of Surgery, Plastic and Reconstructive Surgery Division, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, 257 Campus Drive, Stanford University, Stanford, California, 94305-5148
| | - Fan Yang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Clark Center E-150, 300 Pasteur Drive, Edwards R105, MC5341, Stanford, California, 94305.,Department of Bioengineering, Stanford University School of Medicine, Clark Center E-150, 300 Pasteur Drive, Edwards R105, MC5341, Stanford, California, 94305
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19
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Gottheil S, Khemani E, Copley K, Keeney M, Kinney J, Chin-Yee I, Gob A. Reducing inappropriate ESR testing with computerized clinical decision support. BMJ Qual Improv Rep 2016; 5:bmjquality_uu211376.w4582. [PMID: 27096092 PMCID: PMC4822023 DOI: 10.1136/bmjquality.u211376.w4582] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 03/19/2016] [Accepted: 03/31/2016] [Indexed: 12/20/2022]
Abstract
Laboratory test overutilization increases health care costs, leads to unwarranted investigations, and may have a negative impact on health outcomes. The American Society of Clinical Pathology, in its Choosing Wisely Campaign, advocates that inflammation be investigated with C-reactive protein (CRP) instead of Erythrocyte Sedimentation Rate (ESR). London Health Sciences Centre (LHSC), a tertiary care hospital organization in Ontario, Canada, set a goal to reduce inappropriate ESR orders by 50%. After developing appropriateness criteria for ESR, we used a series of PDSA cycles to reduce inappropriate ESR ordering and analyzed our results with an interrupted time series design. Our intervention began with an educational bulletin and moved to city-wide implementation of computerized Clinical Decision Support (CDS). After implementation, ESR orders decreased by 40% from 386 orders per week to 241 orders per week. Our results are supported by previous literature on the effectiveness of CDS in reducing overutilization and suggest that provider habit is a significant contributor to inappropriate ordering.
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Affiliation(s)
| | | | | | | | | | | | - Alan Gob
- University of Western Ontario, Canada
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20
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Chintakuntlawar A, Shon W, Erickson-Johnson M, Bilodeau E, Jenkins S, Davidson J, Keeney M, Rivera M, Price D, Moore E, Olsen K, Kasperbauer J, Foote R, Price K, Garcia J. High-Grade Transformation of Acinic Cell Carcinoma: Potentially Underrecognized and Inadequately Treated. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2015.12.282] [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: 11/15/2022]
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21
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Jiang X, Sato T, Yao Z, Keeney M, Pajarinen J, Lin TH, Loi F, Egashira K, Goodman S, Yang F. Local delivery of mutant CCL2 protein-reduced orthopaedic implant wear particle-induced osteolysis and inflammation in vivo. J Orthop Res 2016; 34:58-64. [PMID: 26174978 PMCID: PMC4817847 DOI: 10.1002/jor.22977] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 07/04/2015] [Indexed: 02/04/2023]
Abstract
Total joint replacement (TJR) has been widely used as a standard treatment for late-stage arthritis. One challenge for long-term efficacy of TJR is the generation of ultra-high molecular weight polyethylene wear particles from the implant surface that activates an inflammatory cascade which may lead to bone loss, prosthetic loosening and eventual failure of the procedure. Here, we investigate the efficacy of local administration of mutant CCL2 proteins, such as 7ND, on reducing wear particle-induced inflammation and osteolysis in vivo using a mouse calvarial model. Mice were treated with local injection of 7ND or phosphate buffered saline (PBS) every other day for up to 14 days. Wear particle-induced osteolysis and the effects of 7ND treatment were evaluated using micro-CT, histology, and immunofluorescence staining. Compared with the PBS control, 7ND treatment significantly decreased wear particle-induced osteolysis, which led to a higher bone volume fraction and bone mineral density. Furthermore, immunofluorescence staining showed 7ND treatment decreased the number of recruited inflammatory cells and osteoclasts. Together, our results support the feasibility of local delivery of 7ND for mitigating wear particle-induced inflammation and osteolysis, which may offer a promising strategy for extending the life time of TJRs.
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Affiliation(s)
- Xinyi Jiang
- Department of Orthopaedic Surgery, Stanford University, Stanford, California 94305
| | - Taishi Sato
- Department of Orthopaedic Surgery, Stanford University, Stanford, California 94305
| | - Zhenyu Yao
- Department of Orthopaedic Surgery, Stanford University, Stanford, California 94305
| | - Michael Keeney
- Department of Orthopaedic Surgery, Stanford University, Stanford, California 94305
| | - Jukka Pajarinen
- Department of Orthopaedic Surgery, Stanford University, Stanford, California 94305
| | - Tzu-hua Lin
- Department of Orthopaedic Surgery, Stanford University, Stanford, California 94305
| | - Florence Loi
- Department of Orthopaedic Surgery, Stanford University, Stanford, California 94305
| | - Kensuke Egashira
- Department of Cardiovascular Research, Development, and Translational Medicine, Kyushu University, Fukuoka, Japan
| | - Stuart Goodman
- Department of Orthopaedic Surgery, Stanford University, Stanford, California 94305,Department of Bioengineering, Stanford University, Stanford, California 94305
| | - Fan Yang
- Department of Orthopaedic Surgery, Stanford University, Stanford, California 94305,Department of Bioengineering, Stanford University, Stanford, California 94305
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22
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Abbah SA, Delgado LM, Azeem A, Fuller K, Shologu N, Keeney M, Biggs MJ, Pandit A, Zeugolis DI. Harnessing Hierarchical Nano- and Micro-Fabrication Technologies for Musculoskeletal Tissue Engineering. Adv Healthc Mater 2015; 4:2488-99. [PMID: 26667589 DOI: 10.1002/adhm.201500004] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 06/24/2015] [Indexed: 12/14/2022]
Abstract
Cells within a tissue are able to perceive, interpret and respond to the biophysical, biomechanical, and biochemical properties of the 3D extracellular matrix environment in which they reside. Such stimuli regulate cell adhesion, metabolic state, proliferation, migration, fate and lineage commitment, and ultimately, tissue morphogenesis and function. Current scaffold fabrication strategies in musculoskeletal tissue engineering seek to mimic the sophistication and comprehensiveness of nature to develop hierarchically assembled 3D implantable devices of different geometric dimensions (nano- to macrometric scales) that will offer control over cellular functions and ultimately achieve functional regeneration. Herein, advances and shortfalls of bottom-up (self-assembly, freeze-drying, rapid prototype, electrospinning) and top-down (imprinting) scaffold fabrication approaches, specific to musculoskeletal tissue engineering, are discussed and critically assessed.
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Affiliation(s)
- Sunny A. Abbah
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL); Biosciences Research Building; National University of Ireland Galway (NUI Galway); Galway Ireland
- Network of Excellence for Functional Biomaterials (NFB); Biosciences Research Building; National University of Ireland Galway (NUI Galway); Galway Ireland
- Centre for Research in Medical Devices (CURAM); Biosciences Research Building; National University of Ireland Galway (NUI Galway); Galway Ireland
| | - Luis M. Delgado
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL); Biosciences Research Building; National University of Ireland Galway (NUI Galway); Galway Ireland
- Network of Excellence for Functional Biomaterials (NFB); Biosciences Research Building; National University of Ireland Galway (NUI Galway); Galway Ireland
- Centre for Research in Medical Devices (CURAM); Biosciences Research Building; National University of Ireland Galway (NUI Galway); Galway Ireland
| | - Ayesha Azeem
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL); Biosciences Research Building; National University of Ireland Galway (NUI Galway); Galway Ireland
- Network of Excellence for Functional Biomaterials (NFB); Biosciences Research Building; National University of Ireland Galway (NUI Galway); Galway Ireland
- Centre for Research in Medical Devices (CURAM); Biosciences Research Building; National University of Ireland Galway (NUI Galway); Galway Ireland
| | - Kieran Fuller
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL); Biosciences Research Building; National University of Ireland Galway (NUI Galway); Galway Ireland
- Network of Excellence for Functional Biomaterials (NFB); Biosciences Research Building; National University of Ireland Galway (NUI Galway); Galway Ireland
- Centre for Research in Medical Devices (CURAM); Biosciences Research Building; National University of Ireland Galway (NUI Galway); Galway Ireland
| | - Naledi Shologu
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL); Biosciences Research Building; National University of Ireland Galway (NUI Galway); Galway Ireland
- Network of Excellence for Functional Biomaterials (NFB); Biosciences Research Building; National University of Ireland Galway (NUI Galway); Galway Ireland
- Centre for Research in Medical Devices (CURAM); Biosciences Research Building; National University of Ireland Galway (NUI Galway); Galway Ireland
| | - Michael Keeney
- Department of Orthopaedic Surgery; Stanford School of Medicine; Stanford University CA USA
| | - Manus J. Biggs
- Network of Excellence for Functional Biomaterials (NFB); Biosciences Research Building; National University of Ireland Galway (NUI Galway); Galway Ireland
- Centre for Research in Medical Devices (CURAM); Biosciences Research Building; National University of Ireland Galway (NUI Galway); Galway Ireland
| | - Abhay Pandit
- Network of Excellence for Functional Biomaterials (NFB); Biosciences Research Building; National University of Ireland Galway (NUI Galway); Galway Ireland
- Centre for Research in Medical Devices (CURAM); Biosciences Research Building; National University of Ireland Galway (NUI Galway); Galway Ireland
| | - Dimitrios I. Zeugolis
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL); Biosciences Research Building; National University of Ireland Galway (NUI Galway); Galway Ireland
- Network of Excellence for Functional Biomaterials (NFB); Biosciences Research Building; National University of Ireland Galway (NUI Galway); Galway Ireland
- Centre for Research in Medical Devices (CURAM); Biosciences Research Building; National University of Ireland Galway (NUI Galway); Galway Ireland
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23
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Abstract
Since its introduction in the early 1990s, layer-by-layer (LbL) self-assembly of films has been widely used in the fields of nanoelectronics, optics, sensors, surface coatings, and controlled drug delivery. The growth of this industry is propelled by the ease of film manufacture, low cost, mild assembly conditions, precise control of coating thickness, and versatility of coating materials. Despite the wealth of research on LbL for biomolecule delivery, clinical translation has been limited and slow. This review provides an overview of methods and mechanisms of loading biomolecules within LbL films and achieving controlled release. In particular, this review highlights recent advances in the development of LbL coatings for the delivery of different types of biomolecules including proteins, polypeptides, DNA, particles and viruses. To address the need for co-delivery of multiple types of biomolecules at different timing, we also review recent advances in incorporating compartmentalization into LbL assembly. Existing obstacles to clinical translation of LbL technologies and enabling technologies for future directions are also discussed.
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Affiliation(s)
- M. Keeney
- Department of Orthopaedic Surgery, 300 Pasteur Dr., Edwards R105, Stanford, CA 94305, USA
| | - X. Y. Jiang
- Department of Orthopaedic Surgery, 300 Pasteur Dr., Edwards R105, Stanford, CA 94305, USA
| | - M. Yamane
- Program of Human Biology, Stanford University, Stanford, CA 94305, USA
| | - M. Lee
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - S. Goodman
- Department of Orthopaedic Surgery, 300 Pasteur Dr., Edwards R105, Stanford, CA 94305, USA
| | - F. Yang
- Department of Orthopaedic Surgery, 300 Pasteur Dr., Edwards R105, Stanford, CA 94305, USA
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
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24
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Chang SY, Keeney M, Law M, Donovan J, Aubry MC, Garcia J. Detection of human papillomavirus in non-small cell carcinoma of the lung. Hum Pathol 2015; 46:1592-7. [PMID: 26342243 DOI: 10.1016/j.humpath.2015.07.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/16/2015] [Accepted: 07/17/2015] [Indexed: 11/25/2022]
Abstract
High-risk human papillomavirus (hrHPV) is an etiologic agent in squamous cell carcinoma (SqCC) arising in the oropharynx and cervix, and a proven prognostic factor in oropharyngeal SqCC. Many studies have found HPV in non-small cell lung carcinoma (NSCLC). Recent studies advocate the detection of messenger RNA transcripts of E6/E7 as more reliable evidence of transcriptively active HPV in tumor cells. The clinical significance of finding HPV remains unclear in NSCLC. This study sought to determine the prevalence of biologically active HPV infection in NSCLC comparing different methodologies. Surgical pathology material from resected primary lung adenocarcinoma (ADC; n=100) and SqCC (n=96) were retrieved to construct tissue microarrays. In situ hybridization (ISH) for hrHPV DNA (DNA-ISH), hrHPV E6/E7 RNA (RNA-ISH), and p16 immunohistochemistry were performed. Cases of oropharyngeal SqCC with known HPV infection were used as positive controls. Expression of p16 was scored as positive if at least 70% of tumor cells showed diffuse and strong nuclear and cytoplasmic staining. Punctate nuclear hybridization signals by DNA-ISH in the malignant cells defined an HPV-positive carcinoma. Of the 196 patients (range, 33-87 years; 108 men), p16 was positive in 19 ADCs and 9 SqCCs, but HPV DNA-ISH and RNA-ISH were negative in all cases. Our study did not detect HPV infection by DNA-ISH or RNA-ISH in any cases of primary NSCLC despite positive p16 expression in a portion of ADC and SqCC. p16 should therefore not be used as a surrogate marker for HPV infection in NSCLC.
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Affiliation(s)
- Sing Yun Chang
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5.
| | - Michael Keeney
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905
| | - Mark Law
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905
| | - Janis Donovan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905
| | | | - Joaquin Garcia
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905
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25
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Hedley BD, Keeney M, Popma J, Chin-Yee I. Novel lymphocyte screening tube using dried monoclonal antibody reagents. Cytometry B Clin Cytom 2015; 88:361-70. [PMID: 25944189 DOI: 10.1002/cyto.b.21251] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 04/09/2015] [Accepted: 04/27/2015] [Indexed: 11/11/2022]
Abstract
We previously developed a 10-color 11-antibody combination including a viability dye, to screen T-, B-, and natural killer (NK)-cell populations in blood, bone marrow, tissue, and body fluids. Recently, Beckman Coulter has introduced a line of dried reagents that, unlike liquid reagents and cocktails, require no refrigeration, titration, or manipulation before using. We evaluated custom tubes based on our standard lymphocyte screening panel, focusing on comparative analysis, ease of use, and advantages compared with our liquid reagent set. We tested 42 samples from blood (n = 15), bone marrow (n = 17), and tissue (n = 10) with the combination CD4/CD8/KAPPA/LAMBDA/CD19/CD56/CD5/CD20/CD10/CD3/CD45 and a vital dye by both methods and compared positivity and staining intensity for each antigen. Of the 42 samples, 5 were normal samples, 3 were red cell disorders, 20 were B-cell malignancies, 5 T-cell malignancies, 4 myeloid malignancies, and the remaining 5 were other diagnoses. Dried reagents gave equivalent staining intensity results to our standard panel in a variety of sample types, with diagnoses including reactive lymphocytosis, chronic lymphocytic leukemia, and various lymphomas. Our standard panel for evaluation of mature lymphoid malignancies allows rapid assessment of any sample type while providing direct assessment of viability. The dried reagent tube reduces preanalytical work, with simple addition of sample and the viability dye to the tube, saving time, reducing potential errors, and obviating need to titrate and monitor individual antibodies. With a shelf life of at least 12 months, the reagents also offer potential savings in reagent costs by reducing wastage due to expiration or tandem breakdown in standard liquid formulation.
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Affiliation(s)
- Benjamin D Hedley
- Pathology and Laboratory Medicine, Division of Hematology, London Health Sciences Centre, London, Ontario, N6K 5W9, Canada
| | - Michael Keeney
- Pathology and Laboratory Medicine, Division of Hematology, London Health Sciences Centre, London, Ontario, N6K 5W9, Canada
| | - Janice Popma
- Pathology and Laboratory Medicine, Division of Hematology, London Health Sciences Centre, London, Ontario, N6K 5W9, Canada
| | - Ian Chin-Yee
- Department of Medicine, Division of Hematology, London Health Sciences Centre, Schulich School of Medicine Western University of Ontario, London, Ontario, N6K 5W9, Canada
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26
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Hedley BD, Llewellyn-Smith N, Lang S, Hsia CC, MacNamara N, Rosenfeld D, Keeney M. Combined accurate platelet enumeration and reticulated platelet determination by flow cytometry. Cytometry 2015; 88:330-7. [DOI: 10.1002/cyto.b.21245] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 02/21/2015] [Accepted: 04/03/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Benjamin D. Hedley
- Pathology and Laboratory Medicine; London Health Sciences Centre and St. Joseph's Health Care London; London Ontario N6A 4G5 Canada
| | | | - Stephen Lang
- Liverpool Hospital; Elizabeth NSW 2170 Liverpool Australia
| | - Cyrus C. Hsia
- Department of Medicine; Division of Hematology; London Health Sciences Centre, Victoria Hospital; London Ontario N6A 5W9 Canada
| | - Neil MacNamara
- Liverpool Hospital; Elizabeth NSW 2170 Liverpool Australia
| | | | - Michael Keeney
- Pathology and Laboratory Medicine; London Health Sciences Centre and St. Joseph's Health Care London; London Ontario N6A 4G5 Canada
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27
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Lazo-Langner A, Kovacs MJ, Hedley B, Al-Ani F, Keeney M, Louzada ML, Chin-Yee I. Screening of patients with idiopathic venous thromboembolism for paroxysmal nocturnal hemoglobinuria clones. Thromb Res 2015; 135:1107-9. [PMID: 25890452 DOI: 10.1016/j.thromres.2015.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 03/13/2015] [Revised: 04/01/2015] [Accepted: 04/06/2015] [Indexed: 01/06/2023]
Abstract
Paroxysmal nocturnal hemoglobinuria (PNH) is an uncommon disorder characterized by hemolysis, thrombosis and marrow failure. Whereas venous and arterial thrombosis is a very common symptom of the disease, the frequency of PNH clones in patients with unexplained venous thromboembolism, including deep vein thrombosis and pulmonary embolism, has not been studied. We conducted a cross sectional study evaluating the presence of PNH clones in patients with prevalent venous thromboembolism using a high sensitivity flow cytometry assay for erythrocytes and neutrophils. Among the 388 patients enrolled in the study one patient had a detectable PNH clone of 0.02% in the neutrophil population (0.26%; 95% CI 0.05 to 1.45) and no detectable erythrocyte clone. We conclude that the presence of PNH clones in patients with idiopathic venous thrombosis is rare. Screening for PNH clones among VTE patients might be better reserved for patients with signs of hemolysis.
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Affiliation(s)
- Alejandro Lazo-Langner
- Department of Medicine, Division of Hematology, University of Western Ontario, London, Ontario, Canada; Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada.
| | - Michael J Kovacs
- Department of Medicine, Division of Hematology, University of Western Ontario, London, Ontario, Canada
| | - Ben Hedley
- Pathology and Laboratory Medicine, London Health Sciences Centre, London Ontario, Canada
| | - Fatimah Al-Ani
- Department of Medicine, Division of Hematology, University of Western Ontario, London, Ontario, Canada
| | - Michael Keeney
- Pathology and Laboratory Medicine, London Health Sciences Centre, London Ontario, Canada
| | - Martha L Louzada
- Department of Medicine, Division of Hematology, University of Western Ontario, London, Ontario, Canada; Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
| | - Ian Chin-Yee
- Department of Medicine, Division of Hematology, University of Western Ontario, London, Ontario, Canada
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28
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Sutherland DR, Illingworth A, Keeney M, Richards SJ. High‐Sensitivity Detection of PNH Red Blood Cells, Red Cell Precursors, and White Blood Cells. ACTA ACUST UNITED AC 2015; 72:6.37.1-6.37.29. [DOI: 10.1002/0471142956.cy0637s72] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- D. Robert Sutherland
- Laboratory Medicine Program, University Health Network/Toronto General Hospital Toronto Ontario Canada
- Contact author
| | | | - Michael Keeney
- Pathology and Laboratory Medicine, London Health Sciences Centre London Ontario Canada
| | - Stephen J. Richards
- Haematological Malignancy Diagnostic Service, Department of Clinical Haematology, St. James University Hospital Leeds United Kingdom
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29
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Deveza L, Ashoken J, Castaneda G, Tong X, Keeney M, Han LH, Yang F. Microfluidic Synthesis of Biodegradable Polyethylene-Glycol Microspheres for Controlled Delivery of Proteins and DNA Nanoparticles. ACS Biomater Sci Eng 2015; 1:157-165. [DOI: 10.1021/ab500051v] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Lorenzo Deveza
- Department
of Bioengineering, Stanford University 300 Pasteur Drive, Edwards R105,
MC5341, Stanford, California 94305, United States
- MSTP
Program, School of Medicine, Stanford University 300 Pasteur Drive, Stanford, California 94305, United States
| | - Jothikritika Ashoken
- Department
of Biological Sciences, San Jose State University One Washington Square, San Jose, California 95192, United States
| | - Gloria Castaneda
- Department
of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, Stanford, California 94305, United States
| | - Xinming Tong
- Department
of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, Stanford, California 94305, United States
| | - Michael Keeney
- Department
of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, Stanford, California 94305, United States
| | - Li-Hsin Han
- Department
of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, Stanford, California 94305, United States
| | - Fan Yang
- Department
of Bioengineering, Stanford University 300 Pasteur Drive, Edwards R105,
MC5341, Stanford, California 94305, United States
- Department
of Orthopaedic Surgery, Stanford University, 300 Pasteur Drive, Stanford, California 94305, United States
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Keeney M, Halley JG, Rhoads DD, Ansari MQ, Kussick SJ, Karlon WJ, Mehta KU, Dorfman DM, Linden MA. Marked Variability in Reported Minimal Residual Disease Lower Level of Detection of 4 Hematolymphoid Neoplasms: A Survey of Participants in the College of American Pathologists Flow Cytometry Proficiency Testing Program. Arch Pathol Lab Med 2015; 139:1276-80. [DOI: 10.5858/arpa.2014-0543-cp] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context
Flow cytometry is often applied to minimal residual disease (MRD) testing in hematolymphoid neoplasia. Because flow-based MRD tests are developed in the laboratory, testing methodologies and lower levels of detection (LODs) are laboratory dependent.
Objectives
To broadly survey flow cytometry laboratories about MRD testing in laboratories, if performed, including indications and reported LODs.
Design
Voluntary supplemental questions were sent to the 549 laboratories participating in the College of American Pathologists (CAP) FL3-A Survey (Flow Cytometry—Immunophenotypic Characterization of Leukemia/Lymphoma) in the spring of 2014.
Results
A total of 500 laboratories (91%) responded to the supplemental questions as part of the FL3-A Survey by April 2014; of those 500 laboratories, 167 (33%) currently perform MRD for lymphoblastic leukemia, 118 (24%) for myeloid leukemia, 99 (20%) for chronic lymphocytic leukemia, and 91 (18%) for plasma cell myeloma. Other indications include non-Hodgkin lymphoma, hairy cell leukemia, neuroblastoma, and myelodysplastic syndrome. Most responding laboratories that perform MRD for lymphoblastic leukemia reported an LOD of 0.01%. For myeloid leukemia, chronic lymphocytic leukemia, and plasma cell myeloma, most laboratories indicated an LOD of 0.1%. Less than 3% (15 of 500) of laboratories reported LODs of 0.001% for one or more MRD assays performed.
Conclusions
There is major heterogeneity in the reported LODs of MRD testing performed by laboratories subscribing to the CAP FL3-A Survey. To address that heterogeneity, changes to the Flow Cytometry Checklist for the CAP Laboratory Accreditation Program are suggested that will include new requirements that each laboratory (1) document how an MRD assay's LOD is measured, and (2) include the LOD or lower limit of enumeration for flow-based MRD assays in the final diagnostic report.
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Affiliation(s)
- Michael Keeney
- From the Department of Hematology, London Health Sciences Centre, London, Ontario, Canada (Mr Keeney); the Department of Surveys, College of American Pathologists, Northfield, Illinois (Ms Halley); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Rhoads); the Department of Clinical Pathology, Cleveland Clinic, Cleveland, Ohio (Dr Ansari); PhenoPat
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Madl CM, Keeney M, Li X, Han LH, Yang F. Co-Release of Cells and Polymeric Nanoparticles from Sacrificial Microfibers Enhances Nonviral Gene Delivery Inside 3D Hydrogels. Tissue Eng Part C Methods 2014; 20:798-805. [DOI: 10.1089/ten.tec.2013.0669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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)
| | - Michael Keeney
- Department of Orthopedic Surgery, Stanford University, Stanford, California
| | - Xiaolan Li
- Department of Chemical Engineering, Tsinghua University, Beijing, China
| | - Li-Hsin Han
- Department of Orthopedic Surgery, Stanford University, Stanford, California
| | - Fan Yang
- Department of Bioengineering, Stanford University, Stanford, California
- Department of Orthopedic Surgery, Stanford University, Stanford, California
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Lin TH, Yao Z, Sato T, Keeney M, Li C, Pajarinen J, Yang F, Egashira K, Goodman SB. Suppression of wear-particle-induced pro-inflammatory cytokine and chemokine production in macrophages via NF-κB decoy oligodeoxynucleotide: a preliminary report. Acta Biomater 2014; 10:3747-55. [PMID: 24814879 DOI: 10.1016/j.actbio.2014.04.034] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/01/2014] [Accepted: 04/29/2014] [Indexed: 12/28/2022]
Abstract
Total joint replacement (TJR) is very cost-effective surgery for end-stage arthritis. One important goal is to decrease the revision rate, mainly because TJR has been extended to younger patients. Continuous production of ultra-high molecular weight polyethylene (UHMWPE) wear particles induces macrophage infiltration and chronic inflammation, which can lead to periprosthetic osteolysis. Targeting individual pro-inflammatory cytokines directly has not reversed the osteolytic process in clinical trials, owing to compensatory up-regulation of other pro-inflammatory factors. It is hypothesized that targeting the important transcription factor NF-κB could mitigate the inflammatory response to wear particles, potentially diminishing osteolysis. In the current study, NF-κB activity in mouse RAW 264.7 and human THP1 macrophage cell lines, as well as primary mouse and human macrophages, was suppressed via competitive binding with double strand decoy oligodeoxynucleotide (ODN) containing an NF-κB binding element. It was found that macrophage exposure to UHMWPE particles induced multiple pro-inflammatory cytokine and chemokine expression, including TNF-α, MCP1, MIP1α and others. Importantly, the decoy ODN significantly suppressed the induced cytokine and chemokine expression in both murine and human macrophages, and resulted in suppression of macrophage recruitment. The strategic use of decoy NF-κB ODN, delivered locally, could potentially diminish particle-induced periprosthetic osteolysis.
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Fletcher M, Sutherland DR, Whitby L, Whitby A, Richards SJ, Acton E, Keeney M, Borowitz M, Illingworth A, Reilly JT, Barnett D. Standardizing leucocyte PNH clone detection: an international study. Cytometry B Clin Cytom 2014; 86:311-8. [PMID: 24715466 DOI: 10.1002/cyto.b.21174] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 02/13/2014] [Accepted: 03/18/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Consensus and Practical Guidelines for robust high-sensitivity detection of glycophosphatidylinostitol-deficient structures on red blood cells and white blood cells in paroxysmal nocturnal hemoglobinuria (PNH) were recently published. METHODS UK NEQAS LI issued three stabilized samples manufactured to contain no PNH cells (normal), approximately 0.1% and 8% PNH leucocyte populations, together with instrument-specific Standard Operating Procedures (SOPs) and pretitered antibody cocktails to 19 international laboratories experienced in PNH testing. Samples were tested using both standardized protocol/reagents and in-house protocols. Additionally, samples were issued to all participants in the full PNH External Quality Assessment (EQA) programs. RESULTS Expert laboratory results showed no difference in PNH clone detection rates when using standardized and their "in-house" methods, though lower variation around the median was found for the standardized approach compared to in-house methods. Neutrophil analysis of the sample containing an 8% PNH population, for example, showed an interquartile range of 0.48% with the standardized approach compared with 1.29% for in-house methods. Results from the full EQA group showed the greatest variation with an interquartile range of 1.7% and this was demonstrated to be significantly different (P<0.001) to the standardized cohort. CONCLUSIONS The results not only demonstrate that stabilized whole PNH blood samples are suitable for use with currently recommended high-sensitivity reagent cocktails/protocols but also highlight the importance of using carefully selected conjugates alongside the standardized protocols. While much more variation was seen among the full UK NEQAS LI EQA group, the standardized approach lead to reduced variation around the median even for the experienced laboratories.
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Affiliation(s)
- Matthew Fletcher
- UK NEQAS for Leucocyte Immunophenotyping (UK NEQAS LI), Department of Haematology, Royal Hallamshire Hospital, Sheffield, United Kingdom
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Fletcher M, Sutherland DR, Whitby L, Whitby A, Richards SJ, Acton E, Keeney M, Borowitz M, Illingworth A, Reilly JT, Barnett D. Standardizing Leucocyte PNH clone detection: An international study. Cytometry B Clin Cytom 2014:n/a-n/a. [PMID: 24659169 DOI: 10.1002/cytob.21174] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 02/13/2014] [Accepted: 03/18/2014] [Indexed: 11/07/2022]
Abstract
Background: Consensus and Practical Guidelines for robust high-sensitivity detection of glycophosphatidylinostitol (GPI)-deficient structures on Red Blood Cells (RBCs) and White Blood Cells (WBCs) in Paroxysmal Nocturnal Hemoglobinuria (PNH) were recently published. Methods: UK NEQAS LI issued 3 stabilized samples manufactured to contain no PNH cells (normal), approximately 0.1% and 8% PNH leucocyte populations, together with instrument-specific SOPs and pre-titered antibody cocktails to 19 international laboratories experienced in PNH testing. Samples were tested using both standardized protocol/reagents and in-house protocols. Additionally, samples were issued to all participants in the full PNH EQA programmes. Results: Expert laboratory results showed no difference in PNH clone detection rates when using standardized and their 'in-house' methods though lower variation around the median was found for the standardized approach compared to in-house methods. Neutrophil analysis of the sample containing an 8% PNH population, for example, showed an interquartile range of 0.48% with the standardized approach compared with 1.29% for in-house methods. Results from the full EQA group showed the greatest variation with an inter-quartile range of 1.70 and this was demonstrated to be significantly different (P<0.001) to the standardized cohort. Conclusions: The results not only demonstrate that stabilized whole PNH blood samples are suitable for use with currently recommended high-sensitivity reagent cocktails/protocols but also highlight the importance of using carefully selected conjugates alongside the standardized protocols. While much more variation was seen amongst the full UK NEQAS LI EQA group, the standardized approach lead to reduced variation around the median even for the experienced laboratories. © 2014 Clinical Cytometry Society.
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Affiliation(s)
- Matthew Fletcher
- UK NEQAS for Leucocyte Immunophenotyping (UK NEQAS LI), Department of Haematology, Royal Hallamshire Hospital, Sheffield, UK
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Lowes LE, Hedley BD, Keeney M, Allan AL. Adaptation of semiautomated circulating tumor cell (CTC) assays for clinical and preclinical research applications. J Vis Exp 2014:e51248. [PMID: 24637923 DOI: 10.3791/51248] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The majority of cancer-related deaths occur subsequent to the development of metastatic disease. This highly lethal disease stage is associated with the presence of circulating tumor cells (CTCs). These rare cells have been demonstrated to be of clinical significance in metastatic breast, prostate, and colorectal cancers. The current gold standard in clinical CTC detection and enumeration is the FDA-cleared CellSearch system (CSS). This manuscript outlines the standard protocol utilized by this platform as well as two additional adapted protocols that describe the detailed process of user-defined marker optimization for protein characterization of patient CTCs and a comparable protocol for CTC capture in very low volumes of blood, using standard CSS reagents, for studying in vivo preclinical mouse models of metastasis. In addition, differences in CTC quality between healthy donor blood spiked with cells from tissue culture versus patient blood samples are highlighted. Finally, several commonly discrepant items that can lead to CTC misclassification errors are outlined. Taken together, these protocols will provide a useful resource for users of this platform interested in preclinical and clinical research pertaining to metastasis and CTCs.
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Affiliation(s)
- Lori E Lowes
- London Regional Cancer Program, London Health Sciences Centre; Department of Anatomy & Cell Biology, Schulich School of Medicine and Dentistry, Western University
| | | | - Michael Keeney
- Special Hematology/Flow Cytometry, London Health Sciences Centre; Lawson Health Research Institute
| | - Alison L Allan
- London Regional Cancer Program, London Health Sciences Centre; Department of Anatomy & Cell Biology, Schulich School of Medicine and Dentistry, Western University; Lawson Health Research Institute; Department of Oncology, Western University;
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Goodman SB, Gibon E, Pajarinen J, Lin TH, Keeney M, Ren PG, Nich C, Yao Z, Egashira K, Yang F, Konttinen YT. Novel biological strategies for treatment of wear particle-induced periprosthetic osteolysis of orthopaedic implants for joint replacement. J R Soc Interface 2014; 11:20130962. [PMID: 24478281 DOI: 10.1098/rsif.2013.0962] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Wear particles and by-products from joint replacements and other orthopaedic implants may result in a local chronic inflammatory and foreign body reaction. This may lead to persistent synovitis resulting in joint pain and swelling, periprosthetic osteolysis, implant loosening and pathologic fracture. Strategies to modulate the adverse effects of wear debris may improve the function and longevity of joint replacements and other orthopaedic implants, potentially delaying or avoiding complex revision surgical procedures. Three novel biological strategies to mitigate the chronic inflammatory reaction to orthopaedic wear particles are reported. These include (i) interference with systemic macrophage trafficking to the local implant site, (ii) modulation of macrophages from an M1 (pro-inflammatory) to an M2 (anti-inflammatory, pro-tissue healing) phenotype in the periprosthetic tissues, and (iii) local inhibition of the transcription factor nuclear factor kappa B (NF-κB) by delivery of an NF-κB decoy oligodeoxynucleotide, thereby interfering with the production of pro-inflammatory mediators. These three approaches have been shown to be viable strategies for mitigating the undesirable effects of wear particles in preclinical studies. Targeted local delivery of specific biologics may potentially extend the lifetime of orthopaedic implants.
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Affiliation(s)
- S B Goodman
- Department of Orthopaedic Surgery, Stanford University, , Stanford, CA, USA
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Keeney M, Onyiah S, Zhang Z, Tong X, Han LH, Yang F. Modulating polymer chemistry to enhance non-viral gene delivery inside hydrogels with tunable matrix stiffness. Biomaterials 2013; 34:9657-65. [DOI: 10.1016/j.biomaterials.2013.08.050] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 08/19/2013] [Indexed: 01/03/2023]
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Yao Z, Keeney M, Lin TH, Pajarinen J, Barcay K, Waters H, Egashira K, Yang F, Goodman S. Mutant monocyte chemoattractant protein 1 protein attenuates migration of and inflammatory cytokine release by macrophages exposed to orthopedic implant wear particles. J Biomed Mater Res A 2013; 102:3291-7. [PMID: 24123855 DOI: 10.1002/jbm.a.34981] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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: 05/03/2013] [Revised: 09/11/2013] [Accepted: 09/25/2013] [Indexed: 12/31/2022]
Abstract
Wear particles generated from total joint replacements can stimulate macrophages to release chemokines, such as monocyte chemoattractant protein 1 (MCP-1), which is the most important chemokine regulating systemic and local cell trafficking and infiltration of monocyte/macrophages in chronic inflammation. One possible strategy to curtail the adverse events associated with wear particles is to mitigate migration and activation of monocyte/macrophages. The purpose of this study is to modulate the adverse effects of particulate biomaterials and inflammatory stimuli such as endotoxin by interfering with the biological effects of the chemokine MCP-1. In the current study, the function of MCP-1 was inhibited by the mutant MCP-1 protein called 7ND, which blocks its receptor, the C-C chemokine receptor type 2 (CCR2) on macrophages. Addition of 7ND decreased MCP-1-induced migration of THP-1 cells in cell migration experiments in a dose-dependent manner. Conditioned media from murine macrophages exposed to clinically relevant polymethylmethacrylate (PMMA) particles with/without endotoxin [lipopolysaccharide (LPS)] had a chemotactic effect on human macrophages, which was decreased dramatically by 7ND. 7ND demonstrated no adverse effects on the viability of macrophages, and the capability of mesenchymal stem cells (MSCs) to form bone at the doses tested. Finally, proinflammatory cytokine production was mitigated when macrophages were exposed to PMMA particles with/without LPS in the presence of 7ND. Our studies confirm that the MCP-1 mutant protein 7ND can decrease macrophage migration and inflammatory cytokine release without adverse effects at the doses tested. Local delivery of 7ND at the implant site may provide a therapeutic strategy to diminish particle-associated periprosthetic inflammation and osteolysis.
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Affiliation(s)
- Zhenyu Yao
- Department of Orthopaedic Surgery, Stanford University, Stanford, California
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Abstract
Flow cytometry has become an essential tool for identification and characterization of hematological cancers and now, due to technological improvements, allows the identification and rapid enumeration of small tumor populations that may be present after induction therapy (minimal residual disease, MRD). The quantitation of MRD has been shown to correlate with relapse and survival rates in numerous diseases and in certain cases, and evidence of MRD is used to alter treatment protocols. Recent improvements in hardware allow for high data rate collection. Improved fluorochromes take advantage of violet laser excitation and maximize signal-to-noise ratio allowing the population of interest to be isolated in multiparameter space. This isolation, together with a low background rate, permits for detection of residual tumor populations in a background of normal cells. When counting such rare events, the distribution is governed by Poisson statistics, with precision increasing with higher numbers of cells collected. In several hematological malignancies, identification of populations at frequencies of 0.01% and lower has been attained. The choice of antibodies used in MRD detection facilitates the definition of a fingerprint to identify abnormal populations throughout treatment. Tumor populations can change phenotype, and an approach that relies on 'different from normal' has proven useful, particularly in the acute leukemias. Flow cytometry can and is used for detection of MRD in many hematological diseases; however, standardized approaches for specific diseases must be developed to ensure precise identification and enumeration that may alter the course of patient treatment.
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Affiliation(s)
- B D Hedley
- Special Hematology, London Health Sciences Centre, London, ON, Canada
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40
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Abstract
Controlled vascular growth is critical for successful tissue regeneration and wound healing, as well as for treating ischemic diseases such as stroke, heart attack or peripheral arterial diseases. Direct delivery of angiogenic growth factors has the potential to stimulate new blood vessel growth, but is often associated with limitations such as lack of targeting and short half-life in vivo. Gene therapy offers an alternative approach by delivering genes encoding angiogenic factors, but often requires using virus, and is limited by safety concerns. Here we describe a recently developed strategy for stimulating vascular growth by programming stem cells to overexpress angiogenic factors in situ using biodegradable polymeric nanoparticles. Specifically our strategy utilized stem cells as delivery vehicles by taking advantage of their ability to migrate toward ischemic tissues in vivo. Using the optimized polymeric vectors, adipose-derived stem cells were modified to overexpress an angiogenic gene encoding vascular endothelial growth factor (VEGF). We described the processes for polymer synthesis, nanoparticle formation, transfecting stem cells in vitro, as well as methods for validating the efficacy of VEGF-expressing stem cells for promoting angiogenesis in a murine hindlimb ischemia model.
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Keeney M, Waters H, Barcay K, Jiang X, Yao Z, Pajarinen J, Egashira K, Goodman SB, Yang F. Mutant MCP-1 protein delivery from layer-by-layer coatings on orthopedic implants to modulate inflammatory response. Biomaterials 2013; 34:10287-95. [PMID: 24075408 DOI: 10.1016/j.biomaterials.2013.09.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 09/09/2013] [Indexed: 12/27/2022]
Abstract
Total joint replacement (TJR) is a common and effective surgical procedure for hip or knee joint reconstruction. However, the production of wear particles is inevitable for all TJRs, which activates macrophages and initiates an inflammatory cascade often resulting in bone loss, prosthetic loosening and eventual TJR failure. Macrophage Chemoattractant Protein-1 (MCP-1) is one of the most potent cytokines responsible for macrophage cell recruitment, and previous studies suggest that mutant MCP-1 proteins such as 7ND may be used as a decoy drug to block the receptor and reduce inflammatory cell recruitment. Here we report the development of a biodegradable, layer-by-layer (LBL) coating platform that allows efficient loading and controlled release of 7ND proteins from the surface of orthopedic implants using as few as 14 layers. Scanning electron microscopy and fluorescence imaging confirmed effective coating using the LBL procedure on titanium rods. 7ND protein loading concentration and release kinetics can be modulated by varying the polyelectrolytes of choice, the polymer chemistry, the pH of the polyelectrolyte solution, and the degradation rate of the LBL assembly. The released 7ND from LBL coating retained its bioactivity and effectively reduced macrophage migration towards MCP-1. Finally, the LBL coating remained intact following a femoral rod implantation procedure as determined by immunostaining of the 7ND coating. The LBL platform reported herein may be applied for in situ controlled release of 7ND protein from orthopedic implants, to reduce wear particle-induced inflammatory responses in an effort to prolong the lifetime of implants.
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Affiliation(s)
- Michael Keeney
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, USA.
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Brown W, Keeney M, Hedley BD. Initial performance evaluation of the UniCel® DxH slide maker/stainer Coulter® cellular analysis system. Int J Lab Hematol 2013; 36:172-83. [PMID: 24028789 DOI: 10.1111/ijlh.12150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 08/06/2013] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Despite the advancements in instrumentation within hematology laboratories, there is still a need for review of a peripheral blood film (PBF). For a thorough PBF evaluation, it is critical that a well spread and stained film is available. METHODS In this study, we evaluated an automatic slide maker/stainer (DxH-SMS, Beckman Coulter) compared with manually prepared blood films on 124 normal and abnormal samples. The primary goal of the study was to determine whether or not the DxH-SMS was able to consistently and reproducibly prepare and stain blood films of exemplary quality, without carryover between specimens. Additionally, repeatability of white blood cell distribution, comparability of morphology to reference methodologies, and grading of acceptance criteria outlined in the CLSI document H20-A2 were assessed. RESULTS Carryover was not an issue and repeatability was within expected limits. There was excellent agreement of the 5-part differential between the automated blood films made by the DxH-SMS compared with the manually prepared reference blood film. There was no difference in identification and enumeration of blasts, variant lymphocytes, or nucleated red blood cells (P < 0.05). Red cell morphology showed excellent agreement. CONCLUSION Blood films prepared by the DxH-SMS are of excellent quality, reproducible, and compare well with manually prepared slides. Introduction to our laboratory has improved and standardized slide quality.
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Affiliation(s)
- W Brown
- Special Hematology, London Health Sciences Centre, London, ON, Canada
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Keeney M, Ong SG, Padilla A, Yao Z, Goodman S, Wu JC, Yang F. Development of poly(β-amino ester)-based biodegradable nanoparticles for nonviral delivery of minicircle DNA. ACS Nano 2013; 7:7241-50. [PMID: 23837668 PMCID: PMC3789527 DOI: 10.1021/nn402657d] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Gene therapy provides a powerful tool for regulating cellular processes and tissue repair. Minicircle (MC) DNA are supercoiled DNA molecules free of bacterial plasmid backbone elements and have been reported to enhance prolonged gene expression compared to conventional plasmids. Despite the great promise of MC DNA for gene therapy, methods for safe and efficient MC DNA delivery remain lacking. To overcome this bottleneck, here we report the development of a poly(β-amino ester) (PBAE)-based, biodegradable nanoparticulate platform for efficient delivery of MC DNA driven by a Ubc promoter in vitro and in vivo. By synthesizing and screening a small library of 18 PBAE polymers with different backbone and end-group chemistry, we identified lead cationic PBAE structures that can complex with minicircle DNA to form nanoparticles, and delivery efficiency can be further modulated by tuning PBAE chemistry. Using human embryonic kidney 293 cells and mouse embryonic fibroblasts as model cell types, we identified a few PBAE polymers that allow efficient MC delivery at levels that are comparable or even surpassing Lipofectamine 2000. The biodegradable nature of PBAE-based nanoparticles facilitates in vivo applications and clinical translation. When injected via intraperitoneal route in vivo, MC alone resulted in high transgene expression, and a lead PBAE/MC nanoparticle formulation achieved a further 2-fold increase in protein expression compared to MC alone. Together, our results highlight the promise of PBAE-based nanoparticles as promising nonviral gene carriers for MC delivery, which may provide a valuable tool for broad applications of MC DNA-based gene therapy.
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Affiliation(s)
- Michael Keeney
- Department of Orthopedic Surgery, Stanford University, Stanford, CA 94305, USA
| | - Sang-Ging Ong
- Department of Medicine, Division of Cardiology, Stanford University, Stanford, CA 94305, USA
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA 94305, USA
| | - Amanda Padilla
- Department of Orthopedic Surgery, Stanford University, Stanford, CA 94305, USA
| | - Zhenyu Yao
- Department of Orthopedic Surgery, Stanford University, Stanford, CA 94305, USA
| | - Stuart Goodman
- Department of Orthopedic Surgery, Stanford University, Stanford, CA 94305, USA
| | - Joseph C Wu
- Department of Medicine, Division of Cardiology, Stanford University, Stanford, CA 94305, USA
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA 94305, USA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA 94305, USA
- Correspondence to Fan Yang, PhD. And Joseph C Wu, MD, PhD. ; ; Phone: 650-725-7128
| | - Fan Yang
- Department of Orthopedic Surgery, Stanford University, Stanford, CA 94305, USA
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
- Correspondence to Fan Yang, PhD. And Joseph C Wu, MD, PhD. ; ; Phone: 650-725-7128
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Sutherland DR, Acton E, Keeney M, Davis BH, Illingworth A. Use of CD157 in FLAER-based assays for high-sensitivity PNH granulocyte and PNH monocyte detection. Cytometry 2013; 86:44-55. [DOI: 10.1002/cyto.b.21111] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 06/03/2013] [Accepted: 06/24/2013] [Indexed: 11/12/2022]
Affiliation(s)
- D. R. Sutherland
- Laboratory Medicine Program, Toronto General Hospital; University Health Network; Toronto Ontario Canada
| | - E. Acton
- Laboratory Medicine Program, Toronto General Hospital; University Health Network; Toronto Ontario Canada
| | - M. Keeney
- London Laboratory Services Group, London Health Sciences; London Ontario Canada
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Sutherland DR, Acton E, Keeney M, Davis BH, Illingworth A. Use of CD157 in FLAER-based assays for high-sensitivity PNH granulocyte and PNH monocyte detection. Cytometry B Clin Cytom 2013:n/a-n/a. [PMID: 23893962 DOI: 10.1002/cytob.21111] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 06/03/2013] [Accepted: 06/24/2013] [Indexed: 02/28/2024]
Abstract
Background: Recent Flow Cytometric guidelines to detect Paroxysmal Nocturnal Hemoglobinuria (PNH) in white blood cells recommend using FLAER-based assays to detect granulocytes and monocytes lacking expression of GPI-linked structures. However national proficiency testing results continue to suggest a need for improved testing algorithms, including the need to optimize diagnostic analytes in PNH. Methods: CD157 is another GPI-linked structure expressed on both granulocytes and monocytes and here we assess its ability to replace CD24 and CD14 in predicate 4-color granulocyte and monocyte assays respectively. We also assess a single tube, 5-color combination of FLAER, CD157, CD64, CD15 and CD45 to simultaneously detect PNH clones in granulocyte and monocyte lineages. Results: Delineation of PNH from normal phenotypes with 4- or 5-color CD157-based assays compared favorably with 4-color predicate methods and PNH clone size data were similar and highly correlated (R2 >0.99) with predicate values over a range (0.06% - 99.8%) of samples. Both CD157-based assays exhibited similar high levels of sensitivity and low background levels in normal samples. Conclusion: While CD157-based 4- and 5-color assays generated closely similar results to the predicate assays on a range of PNH and normal samples, the 5-color assay has significant advantages. Only a single 5-color WBC reagent cocktail is required to detect both PNH granulocytes and monocytes. Additionally, sample preparation and analysis time is reduced yielding significant efficiencies in technical resources and reagent costs. All 4- and 5-color reagent sets stained stabilized whole blood PNH preparations, used in external quality assurance programs. © 2013 Clinical Cytometry Society.
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Affiliation(s)
- D R Sutherland
- Laboratory Medicine Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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Nii M, Lai JH, Keeney M, Han LH, Behn A, Imanbayev G, Yang F. The effects of interactive mechanical and biochemical niche signaling on osteogenic differentiation of adipose-derived stem cells using combinatorial hydrogels. Acta Biomater 2013; 9:5475-83. [PMID: 23153761 DOI: 10.1016/j.actbio.2012.11.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 10/11/2012] [Accepted: 11/02/2012] [Indexed: 01/09/2023]
Abstract
Stem cells reside in a multi-factorial environment containing biochemical and mechanical signals. Changing biochemical signals in most scaffolds often leads to simultaneous changes in mechanical properties, which makes it difficult to elucidate the complex interplay between niche cues. Combinatorial studies on cell-material interactions have emerged as a tool to facilitate analyses of stem cell responses to various niche cues, but most studies to date have been performed on two-dimensional environments. Here we developed three-dimensional combinatorial hydrogels with independent control of biochemical and mechanical properties to facilitate analysis of interactive biochemical and mechanical signaling on adipose-derived stem cell osteogenesis in three dimensions. Our results suggest that scaffold biochemical and mechanical signals synergize only at specific combinations to promote bone differentiation. Leading compositions were identified to have intermediate stiffness (∼55kPa) and low concentration of fibronectin (10μg ml(-1)), which led to an increase in osteocalcin gene expression of over 130-fold. Our results suggest that scaffolds with independently tunable niche cues could provide a powerful tool for conducting mechanistic studies to decipher how complex niche cues regulate stem cell fate in three dimensions, and facilitate rapid identification of optimal niche cues that promote desirable cellular processes or tissue regeneration.
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Keeney M, Mathur M, Cheng E, Tong X, Yang F. Effects of polymer end-group chemistry and order of deposition on controlled protein delivery from layer-by-layer assembly. Biomacromolecules 2013; 14:794-800. [PMID: 23360295 DOI: 10.1021/bm3018559] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Layer-by-layer (LBL) assembly is an attractive platform for controlled release of biologics given its mild fabrication process and versatility in coating substrates of any shape. Proteins can be incorporated into LBL coatings by sequentially depositing oppositely charged polyelectrolytes, which self-assemble into nanoscale films on medical devices or tissue engineering scaffolds. However, previously reported LBL platforms often require the use of a few hundred layers to avoid burst release, which hinders their broad translation due to the lengthy fabrication process, cost, and batch-to-batch variability. Here we report a biodegradable LBL platform composed of only 10 layers with tunable protein release kinetics, which is an order of magnitude less than previously reported LBL platforms. We performed a combinatorial study to examine the effects of polymer chemistry and order of deposition of poly(β-amino) esters on protein release kinetics under 81 LBL assembly conditions. Using the optimal "polyelectrolyte couples" for constructing the LBL film, basic fibroblast growth factor (bFGF) was released gradually over 14 days with retained biological activity to stimulate cell proliferation. The method reported herein is applicable for coating various substrates including metals, polymers, and ceramics and may be used for a broad range of biomedical and tissue engineering applications.
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Affiliation(s)
- Michael Keeney
- Departments of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, USA
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Abstract
Implants are widely used for orthopaedic applications such as fixing fractures, repairing non-unions, obtaining a joint arthrodesis, total joint arthroplasty, spinal reconstruction, and soft tissue anchorage. Previously, orthopaedic implants were designed simply as mechanical devices; the biological aspects of the implant were a byproduct of stable internal/external fixation of the device to the surrounding bone or soft tissue. More recently, biologic coatings have been incorporated into orthopaedic implants in order to modulate the surrounding biological environment. This opinion article reviews current and potential future use of biologic coatings for orthopaedic implants to facilitate osseointegration and mitigate possible adverse tissue responses including the foreign body reaction and implant infection. While many of these coatings are still in the preclinical testing stage, bioengineers, material scientists and surgeons continue to explore surface coatings as a means of improving clinical outcome of patients undergoing orthopaedic surgery.
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Affiliation(s)
- Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA.
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Chung MT, Liu C, Hyun JS, Lo DD, Montoro DT, Hasegawa M, Li S, Sorkin M, Rennert R, Keeney M, Yang F, Quarto N, Longaker MT, Wan DC. CD90 (Thy-1)-positive selection enhances osteogenic capacity of human adipose-derived stromal cells. Tissue Eng Part A 2013; 19:989-97. [PMID: 23216074 DOI: 10.1089/ten.tea.2012.0370] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [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 Stem cell-based bone tissue engineering with adipose-derived stromal cells (ASCs) has shown great promise for revolutionizing treatment of large bone deficits. However, there is still a lack of consensus on cell surface markers identifying osteoprogenitors. Fluorescence-activated cell sorting has identified a subpopulation of CD105(low) cells with enhanced osteogenic differentiation. The purpose of the present study was to compare the ability of CD90 (Thy-1) to identify osteoprogenitors relative to CD(105). METHODS Unsorted cells, CD90(+), CD90(-), CD105(high), and CD105(low) cells were treated with an osteogenic differentiation medium. For evaluation of in vitro osteogenesis, alkaline phosphatase (ALP) staining and alizarin red staining were performed at 7 days and 14 days, respectively. RNA was harvested after 7 and 14 days of differentiation, and osteogenic gene expression was examined by quantitative real-time polymerase chain reaction. For evaluation of in vivo osteogenesis, critical-sized (4-mm) calvarial defects in nude mice were treated with the hydroxyapatite-poly(lactic-co-glycolic acid) scaffold seeded with the above-mentioned subpopulations. Healing was followed using micro-CT scans for 8 weeks. Calvaria were harvested at 8 weeks postoperatively, and sections were stained with Movat's Pentachrome. RESULTS Transcriptional analysis revealed that the CD90(+) subpopulation was enriched for a more osteogenic subtype relative to the CD105(low) subpopulation. Staining at day 7 for ALP was greatest in the CD90(+) cells, followed by the CD105(low) cells. Staining at day 14 for alizarin red demonstrated the greatest amount of mineralized extracellular matrix in the CD90(+) cells, again followed by the CD105(low) cells. Quantification of in vivo healing at 2, 4, 6, and 8weeks postoperatively demonstrated increased bone formation in defects treated with CD90(+) ASCs relative to all other groups. On Movat's Pentachrome-stained sections, defects treated with CD90(+) cells showed the most robust bony regeneration. Defects treated with CD90(-) cells, CD105(high) cells, and CD105(low) cells demonstrated some bone formation, but to a lesser degree when compared with the CD90(+) group. CONCLUSIONS While CD105(low) cells have previously been shown to possess an enhanced osteogenic potential, we found that CD90(+) cells are more capable of forming bone both in vitro and in vivo. These data therefore suggest that CD90 may be a more effective marker than CD105 to isolate a highly osteogenic subpopulation for bone tissue engineering.
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Affiliation(s)
- Michael T Chung
- Hagey Laboratory for Pediatric Regenerative Medicine, Plastic and Reconstructive Surgery Division, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305-5148, USA
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