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Mun CS, Surenkhuu B, Chen YF, Atassi N, Mun J, Kim C, Sheth T, Sarwar MA, Pradeep A, Jain S. Recombinant Deoxyribonuclease I Eye Drops for Ocular Graft Versus Host Disease: Results of a Randomized Clinical Trial. Eye Contact Lens 2024; 50:233-240. [PMID: 38407974 DOI: 10.1097/icl.0000000000001078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 02/28/2024]
Abstract
OBJECTIVE We have previously shown that neutrophil extracellular traps (NETs) are present on the ocular surface of patients with ocular graft versus host disease (oGVHD), contributing to inflammation and surface disease. Therefore, we performed a clinical trial using deoxyribonuclease I (DNAase) eye drops to test the hypothesis that reducing the abundance of NETs from the ocular surface will reduce signs and symptoms of oGVHD. METHODS A prospective, phase I or II, randomized, placebo-controlled, double-masked clinical trial was performed to determine the safety and preliminary efficacy of DNAase (0.1%) eye drops four times daily for 8 weeks in patients with oGVHD (n=58). Intent-to-treat analysis was performed to determine the change in safety outcome measures (drug tolerability and proportion of adverse events) and efficacy outcome measures (ocular surface disease index [OSDI] score and corneal staining) between baseline and week 8. RESULTS Tolerability and adverse events were similar in the vehicle and DNAase groups. Within the DNAase group (but not the vehicle group), corneal staining showed a statistically significant and clinically meaningful reduction at week 8 (3.50 [2.75; 5.00]) compared with baseline (5.00 [3.00; 7.00]). The OSDI score also showed a statistically significant clinically meaningful reduction of 18.4 (9.16; 33.1) ( P <0.001) at week 8 compared with baseline (45.5 [31.8; 50.0]) within the DNAase group. The proportion of eyes that had improvement in subjective global assessment (SGA) and mucous discharge was significantly greater in the DNAase group (55.6% and 57.7% at weeks 4 and 8, respectively; P <0.0001 at both time points) as compared with the vehicle group (35.7% and 34.0% at weeks 4 and 8, respectively). CONCLUSIONS Treatment of patients with oGVHD using DNAase eye drops is safe and demonstrates preliminary efficacy. Deoxyribonuclease I eye drops can potentially reduce the severity of signs and symptoms of ocular surface disease in patients with oGVHD.
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Affiliation(s)
- Christine S Mun
- Corneal Translational Biology Laboratory (C.S.M., B.S., N.A., J.M., C.K., T.S., A.P., S.J.), Department of Ophthalmology and Visual Sciences; Center for Clinical and Translational Science (Y.-F.C.); and Department of Pharmacy Practice (M.A.S.), University of Illinois at Chicago, Chicago, IL
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Thakare N, Tanase F, Saeb-Parsy K, Atassi N, Endriss R, Kamphuis G, Pérez-Fentes D, Hasan M, Brehmer M, Osther P, Jung H, Turney B, Finch W, Burgess N, Irving S, Dragos L, Liatsikos E, Knoll T, Cauni V, Wiseman O. Stone clearance using the EMS Swiss LithoClast® Trilogy: Results of the European multicentre prospective study in comparison to the BAUS national PCNL outcomes on behalf of European Society of UroTechnology. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00665-5] [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: 11/24/2022]
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Thakare N, Tanase F, Saeb-Parsy K, Atassi N, Endriss R, Kamphuis G, Pérez-Fentes D, Hasan M, Brehmer M, Osther P, Jung H, Turney B, Finch W, Burgess N, Irving S, Dragos L, Liatsikos E, Knoll T, Cauni V, Wiseman O. Efficacy and safety of the EMS Swiss LithoClast® Trilogy for PCNL: results of the European multicentre prospective study on behalf of European Section of UroTechnology. World J Urol 2021; 39:4247-4253. [PMID: 33991214 PMCID: PMC8122211 DOI: 10.1007/s00345-021-03710-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/19/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose PCNL requires a lithotrite to efficiently break stones, and some devices include active suction to remove the fragments. We set out to determine the efficacy and safety of the Swiss LithoClast® Trilogy, in a prospective European multicentre evaluation and compared it to published stone clearance rates for Trilogy based on surface area (68.9 mm2/min) and using the 3D calculated stone volume (526.7 mm3/min). Methods Ten European centres participated in this prospective non-randomized study of Trilogy for PCNL. Objective measures of stone clearance rate, device malfunction, complications and stone-free rates were assessed. Each surgeon subjectively evaluated ergonomic and device effectiveness, on a 1–10 scale (10 = extremely ergonomic/effective) and compared to their usual lithotrite on a 1–10 scale (10 = extremely effective). Results One hundred and fifty seven PCNLs using Trilogy were included (53% male, 47% female; mean age 55 years, range 13–84 years). Mean stone clearance rate was 65.55 mm2/min or 945 mm3/min based on calculated 3D volume. Stone-free rate on fluoroscopy screening at the end of the procedure was 83%. Feedback for suction effectiveness was 9.0 with 9.1 for combination and 9.0 for overall effectiveness compared to lithotrite used previously. Ergonomic score was 8.1, the least satisfactory element. Complications included 13 (8.2%) Clavien–Dindo Grade II and 2 (1.3%) Grade III. Probe breakage was seen in 9 (5.7%), none required using a different lithotrite. Conclusions We have demonstrated that Trilogy is highly effective at stone removal. From a user perspective, the device was perceived by surgeons to be highly effective overall and compared to the most commonly used previous lithotrite, with an excellent safety profile.
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Affiliation(s)
- N Thakare
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 0QQ, UK.
| | - F Tanase
- Department of Urology, Colentina Clinical Hospital, Șoseaua Ștefan cel Mare 19-21, Bucharest, Romania
| | - K Saeb-Parsy
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - N Atassi
- Department of Urology, Sindelfingen-Boblingen Medical Center, Sindelfingen, Baden-Wurttemberg, Germany
| | - R Endriss
- Department of Urology, Sindelfingen-Boblingen Medical Center, Sindelfingen, Baden-Wurttemberg, Germany
| | - G Kamphuis
- Amsterdam UMC Locatie AMC, Department of Urology, Amsterdam University Medical Center, Meibergdreef, 91105 AZ, Amsterdam, The Netherlands
| | - D Pérez-Fentes
- Department of Urology, University Hospital Complex of Santiago de Compostela, 15706, Santiago de Compostela, Spain
| | - M Hasan
- Department of Urology, Danderyd University Hospital, Stockholm, Sweden
| | - M Brehmer
- Department of Urology, Danderyd University Hospital, Stockholm, Sweden
| | - P Osther
- Lillebaelt Hospital, Department of Urology, University of Southern Denmark, Beriderbakken 4, Vejle, Denmark
| | - H Jung
- Lillebaelt Hospital, Department of Urology, University of Southern Denmark, Beriderbakken 4, Vejle, Denmark
| | - B Turney
- The Churchill Hospital, Oxford, OX3 7LJ, UK
| | - W Finch
- Department of Urology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Ln, Norwich, NR4 7UY, UK
| | - N Burgess
- Department of Urology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Ln, Norwich, NR4 7UY, UK
| | - S Irving
- Department of Urology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Ln, Norwich, NR4 7UY, UK
| | - L Dragos
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - E Liatsikos
- Department of Urology, University Hospital, University of Patras, Rio, 26500, Patras, Greece
| | - T Knoll
- Department of Urology, Sindelfingen-Boblingen Medical Center, Sindelfingen, Baden-Wurttemberg, Germany
| | - V Cauni
- Department of Urology, Colentina Clinical Hospital, Șoseaua Ștefan cel Mare 19-21, Bucharest, Romania
| | - O Wiseman
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 0QQ, UK
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Wiseman O, Tanse F, Saeb-Parsy K, Atassi N, Endriss R, Kamphuis G, Pèrez Fentes D, Hassan M, Brehmer M, Osther P, Jung H, Turney B, Finch W, Burgess N, Irving S, Liatsikos E, Knoll T, Cauni V. The efficacy and safety of the EMS Lithoclast Trilogy: A European multicenter prospective study on behalf of ESUT. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33852-0] [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: 11/29/2022] Open
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Mun C, Gulati S, Tibrewal S, Chen YF, An S, Surenkhuu B, Raju I, Buwick M, Ahn A, Kwon JE, Atassi N, Pradeep A, Rondelli D, Jain S. A Phase I/II Placebo-Controlled Randomized Pilot Clinical Trial of Recombinant Deoxyribonuclease (DNase) Eye Drops Use in Patients With Dry Eye Disease. Transl Vis Sci Technol 2019; 8:10. [PMID: 31110911 PMCID: PMC6504128 DOI: 10.1167/tvst.8.3.10] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 02/11/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose To determine whether DNase eye drops have the potential to reduce signs and symptoms of dry eye disease (DED). Methods A placebo-controlled, randomized clinical trial was performed to compare the safety and efficacy of DNase eye drops 0.1% four times a day for 8 weeks in patients with severe tear deficient DED. The change in safety outcome measures (drug tolerability and proportion of adverse events) and efficacy outcome measures (Ocular Surface Disease Index [OSDI] score, corneal and conjunctival staining) were analyzed between baseline and week 8. Results Tolerability and adverse events were similar in placebo group and DNase group. Within the DNase group (but not placebo group), corneal staining showed a statistically significant and clinically meaningful reduction at week 8 compared with baseline. The OSDI score also showed a significant median reduction of 27.3 at week 8 compared with baseline within the DNase group. The median reduction in corneal staining and mucoid debris/strands was significantly greater in the DNase group as compared with the placebo group. In the DNase group, the median reduction in OSDI (-20.75) was more than placebo group (-8.43); however, the difference between groups was borderline significant. Conclusions In this pilot study, treatment of severe tear deficient DED patients with DNase eye drops appears safe, well tolerated, and has the potential to reduce the severity of signs and symptoms. Translational Relevance Data from this pilot clinical trial demonstrate the therapeutic potential of DNase eye drops in dry eye disease, possibly due to degradation neutrophil extracellular traps (NETs) from the ocular surface.
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Affiliation(s)
- Christine Mun
- Corneal Translational Biology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Shilpa Gulati
- Corneal Translational Biology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Sapna Tibrewal
- Corneal Translational Biology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Yi-Fan Chen
- Center for Clinical and Translational Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Seungwon An
- Corneal Translational Biology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Bayasgalan Surenkhuu
- Corneal Translational Biology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Ilangovan Raju
- Corneal Translational Biology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Morgan Buwick
- Corneal Translational Biology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Anna Ahn
- Corneal Translational Biology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Ji-Eun Kwon
- Corneal Translational Biology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Nour Atassi
- Corneal Translational Biology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Anubhav Pradeep
- Corneal Translational Biology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Damiano Rondelli
- Department of Medicine, Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Sandeep Jain
- Corneal Translational Biology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
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Banno H, Schoenfeld D, Cudkowicz M, Atassi N. Vital capacity: High test-retest variability in ALS patients with bulbar weakness. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.577] [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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Atassi N, Lee A, Chang J, Macklin E, Cudkowicz M. Delays in Diagnosing Amyotrophic Lateral Sclerosis (P03.174). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.174] [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] Open
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Kelly PJ, Kistler JP, Shih VE, Mandell R, Atassi N, Barron M, Lee H, Silveira S, Furie KL. Inflammation, Homocysteine, and Vitamin B6 Status After Ischemic Stroke. Stroke 2004; 35:12-5. [PMID: 14657454 DOI: 10.1161/01.str.0000106481.59944.2f] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Epidemiological studies have described an association between low vitamin B6 (measured as pyridoxal 5'-phosphate [PLP]) and ischemic stroke, independent of homocysteine (tHcy). We investigated B6 status, tHcy, and inflammation (measured by C-reactive protein [CRP]) in patients with stroke and controls. METHODS Consecutive cases with new ischemic stroke were compared with matched controls. Fasting tHcy, PLP, and CRP were measured. RESULTS The adjusted odds ratio of low PLP in the highest compared with the lowest CRP quartile was 16.6 (2, 139.9, P=0.01). Age, CRP, supplemental vitamin use, and albumin were independent predictors of PLP (P<0.05 for all). No relationship was observed between CRP and tHcy. CONCLUSIONS The relationship between inflammation and low B6 status may partially explain the findings of previous epidemiological studies.
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Affiliation(s)
- P J Kelly
- Stroke Service, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Fruit St, Boston, Mass 02114, USA.
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