1
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Oomen PP, Begemann MJH, Brand BA, de Haan L, Veling W, Koops S, van Os J, Smit F, Bakker PR, van Beveren N, Boonstra N, Gülöksüz S, Kikkert M, Lokkerbol J, Marcelis M, Rosema BS, de Beer F, Gangadin SS, Geraets CNW, van ‘t Hag E, Haveman Y, van der Heijden I, Voppel AE, Willemse E, van Amelsvoort T, Bak M, Batalla A, Been A, van den Bosch M, van den Brink T, Faber G, Grootens KP, de Jonge M, Knegtering R, Kurkamp J, Mahabir A, Pijnenborg GHM, Staring T, Veen N, Veerman S, Wiersma S, Graveland E, Hoornaar J, Sommer IEC. Longitudinal clinical and functional outcome in distinct cognitive subgroups of first-episode psychosis: a cluster analysis. Psychol Med 2023; 53:2317-2327. [PMID: 34664546 PMCID: PMC10123843 DOI: 10.1017/s0033291721004153] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cognitive deficits may be characteristic for only a subgroup of first-episode psychosis (FEP) and the link with clinical and functional outcomes is less profound than previously thought. This study aimed to identify cognitive subgroups in a large sample of FEP using a clustering approach with healthy controls as a reference group, subsequently linking cognitive subgroups to clinical and functional outcomes. METHODS 204 FEP patients were included. Hierarchical cluster analysis was performed using baseline brief assessment of cognition in schizophrenia (BACS). Cognitive subgroups were compared to 40 controls and linked to longitudinal clinical and functional outcomes (PANSS, GAF, self-reported WHODAS 2.0) up to 12-month follow-up. RESULTS Three distinct cognitive clusters emerged: relative to controls, we found one cluster with preserved cognition (n = 76), one moderately impaired cluster (n = 74) and one severely impaired cluster (n = 54). Patients with severely impaired cognition had more severe clinical symptoms at baseline, 6- and 12-month follow-up as compared to patients with preserved cognition. General functioning (GAF) in the severely impaired cluster was significantly lower than in those with preserved cognition at baseline and showed trend-level effects at 6- and 12-month follow-up. No significant differences in self-reported functional outcome (WHODAS 2.0) were present. CONCLUSIONS Current results demonstrate the existence of three distinct cognitive subgroups, corresponding with clinical outcome at baseline, 6- and 12-month follow-up. Importantly, the cognitively preserved subgroup was larger than the severely impaired group. Early identification of discrete cognitive profiles can offer valuable information about the clinical outcome but may not be relevant in predicting self-reported functional outcomes.
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Affiliation(s)
- Priscilla P. Oomen
- Department of Biomedical Sciences of Cells and Systems, and Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marieke J. H. Begemann
- Department of Biomedical Sciences of Cells and Systems, and Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bodyl A. Brand
- Department of Biomedical Sciences of Cells and Systems, and Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lieuwe de Haan
- Department of Early Psychosis, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Wim Veling
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sanne Koops
- Department of Biomedical Sciences of Cells and Systems, and Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jim van Os
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MheNS), Maastricht University Medical Centre, Maastricht, The Netherlands
- King's College London, King's Health Partners Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Filip Smit
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
- Centre of Economic Evaluation & Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health), Utrecht, The Netherlands
| | - P. Roberto Bakker
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MheNS), Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Nico van Beveren
- Antes Center for Mental Health Care, Rotterdam, The Netherlands
- Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
- Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | - Nynke Boonstra
- NHL/Stenden, University of Applied Sciences, Leeuwarden, The Netherlands
- KieN VIP Mental Health Care Services, Leeuwarden, The Netherlands
| | - Sinan Gülöksüz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MheNS), Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Martijn Kikkert
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Joran Lokkerbol
- Centre of Economic Evaluation & Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health), Utrecht, The Netherlands
| | - Machteld Marcelis
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, The Netherlands
- Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, The Netherlands
| | - Bram-Sieben Rosema
- Department of Biomedical Sciences of Cells and Systems, and Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Franciska de Beer
- Department of Biomedical Sciences of Cells and Systems, and Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Shiral S. Gangadin
- Department of Biomedical Sciences of Cells and Systems, and Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Chris N. W. Geraets
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Erna van ‘t Hag
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yudith Haveman
- Department of Biomedical Sciences of Cells and Systems, and Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Inge van der Heijden
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Janssen-Cilag B.V., Breda, the Netherlands
| | - Alban E. Voppel
- Department of Biomedical Sciences of Cells and Systems, and Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elske Willemse
- Department of Biomedical Sciences of Cells and Systems, and Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MheNS), Maastricht University Medical Centre, Maastricht, The Netherlands
- Mondriaan Mental Health Care, Heerlen, The Netherlands
| | - Maarten Bak
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MheNS), Maastricht University Medical Centre, Maastricht, The Netherlands
- Mondriaan Mental Health Care, Heerlen, The Netherlands
| | - Albert Batalla
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Agaath Been
- Dimence Institute for Mental Health, Deventer, Zwolle, The Netherlands
| | | | | | - Gunnar Faber
- Yulius, Mental Health Institute, Dordrecht, The Netherlands
| | - Koen P. Grootens
- Reinier van Arkel Institute for Mental Health Care, ‘s Hertogenbosch, The Netherlands
| | - Martin de Jonge
- Program for Psychosis & Severe Mental Illness, Pro Persona Mental Health, Wolfheze, The Netherlands
| | - Rikus Knegtering
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands
| | - Jörg Kurkamp
- Center for Youth with Psychosis, Mediant ABC Twente, Enschede, The Netherlands
| | | | - Gerdina H. M. Pijnenborg
- Department of Psychotic Disorders, GGZ-Drenthe, Assen, The Netherlands
- Department of Clinical and Developmental Neuropsychology, Faculty BSS, University of Groningen, Groningen, The Netherlands
| | - Tonnie Staring
- Department ABC Early Psychosis, Altrecht Psychiatric Institute, Utrecht, The Netherlands
| | - Natalie Veen
- GGZ Delfland, Delfland Institute for Mental Health Care, Delft, The Netherlands
| | - Selene Veerman
- Community Mental Health, Mental Health Service Noord-Holland Noord, Alkmaar, The Netherlands
| | - Sybren Wiersma
- Early Intervention Psychosis Team, GGZ inGeest Specialized Mental Health Care, Hoofddorp, The Netherlands
| | | | - Joelle Hoornaar
- Antes Center for Mental Health Care, Rotterdam, The Netherlands
| | - Iris E. C. Sommer
- Department of Biomedical Sciences of Cells and Systems, and Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Oomen PP, Gangadin SS, Begemann MJH, Visser E, Mandl RCW, Sommer IEC. The neurobiological characterization of distinct cognitive subtypes in early-phase schizophrenia-spectrum disorders. Schizophr Res 2022; 241:228-237. [PMID: 35176721 DOI: 10.1016/j.schres.2022.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 09/20/2021] [Revised: 01/28/2022] [Accepted: 02/04/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Cognitive deficits are present in some, but not all patients with schizophrenia-spectrum disorders (SSD). We and others have demonstrated three cognitive clusters: cognitively intact patients, patients with deficits in a few domains and those with global cognitive deficits. This study aimed to identify cognitive subtypes of early-phase SSD with matched controls as a reference group, and evaluated cognitive subgroups regarding clinical and brain volumetric measures. METHODS Eighty-six early-phase SSD patients were included. Hierarchical cluster analysis was conducted using global performance on the Brief Assessment of Cognition in Schizophrenia (BACS). Cognitive subgroups were subsequently related to clinical and brain volumetric measures (cortical, subcortical and cortical thickness) using ANCOVA. RESULTS Three distinct cognitive clusters emerged: relative to controls we found one cluster of patients with preserved cognition (n = 25), one moderately impaired cluster (n = 38) and one severely impaired cluster (n = 23). Cognitive subgroups were characterized by differences in volume of the left postcentral gyrus, left middle caudal frontal gyrus and left insula, while differences in cortical thickness were predominantly found in fronto-parietal regions. No differences were demonstrated in subcortical brain volume. DISCUSSION Current results replicate the existence of three distinct cognitive subgroups including one relatively large group with preserved cognitive function. Cognitive subgroups were characterized by differences in cortical regional brain volume and cortical thickness, suggesting associations with cortical, but not subcortical development and cognitive functioning such as attention, executive functions and speed of processing.
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Affiliation(s)
- P P Oomen
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
| | - S S Gangadin
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - M J H Begemann
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - E Visser
- Department of Psychiatry, University Medical Center, Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - R C W Mandl
- Department of Psychiatry, University Medical Center, Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - I E C Sommer
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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3
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Begemann MJH, Sommer IE, Brand RM, Oomen PP, Jongeneel A, Berkhout J, Molenaar RE, Wielage NN, Toh WL, Rossell SL, Bell IH. Auditory verbal hallucinations and childhood trauma subtypes across the psychosis continuum: a cluster analysis. Cogn Neuropsychiatry 2022; 27:150-168. [PMID: 33980128 DOI: 10.1080/13546805.2021.1925235] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Indexed: 10/21/2022]
Abstract
Introduction: A strong link between voice-hearing experience and childhood trauma has been established. The aim of this study was to identify whether there were unique clusters of childhood trauma subtypes in a sample across the clinical spectrum of auditory verbal hallucinations (AVH) and to examine clinical and phenomenological features across these clusters.Methods: Combining two independent international datasets (the Netherlands and Australia), childhood trauma subtypes were examined using hierarchical cluster analysis. Clinical and phenomenological characteristics were compared across emerging clusters using MANOVA and chi-squared analyses.Results: The total sample (n = 413) included 166 clinical individuals with a psychotic disorder and AVH, 122 non-clinical individuals with AVH and 125 non-clinical individuals without AVH. Three clusters emerged: (1) low trauma (n = 299); (2) emotion-focused trauma (n = 71); (3) multi-trauma (n = 43). The three clusters differed significantly on their AVH ratings of amount of negative content, with trend-level effects for loudness, degree of negative content and degree of experienced distress. Furthermore, perceptions of voices being malevolent, benevolent and resistance towards voices differed significantly.Conclusion: The data revealed different types of childhood trauma had different relationships between clinical and phenomenological features of voice-hearing experiences. Thus, implicating different mechanistic pathways and a need for tailored treatment approaches.
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Affiliation(s)
- M J H Begemann
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - I E Sommer
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - R M Brand
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia
| | - P P Oomen
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - A Jongeneel
- Department of Clinical Psychology, Amsterdam UMCAmsterdam Public Health research institute, Amsterdam, the Netherlands.,Department of Psychosis Research and Innovation, Parnassia Psychiatric Institute, Den Haag, the Netherlands
| | - J Berkhout
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - R E Molenaar
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - N N Wielage
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - W L Toh
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - S L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.,Department of Mental Health, St Vincent's Hospital, Melbourne, Australia
| | - I H Bell
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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4
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Oomen PP, de Boer JN, Brederoo SG, Voppel AE, Brand BA, Wijnen FNK, Sommer IEC. Characterizing speech heterogeneity in schizophrenia-spectrum disorders. J Psychopathol Clin Sci 2022; 131:172-181. [PMID: 35230859 DOI: 10.1037/abn0000736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Schizophrenia-spectrum disorders (SSD) are highly heterogeneous in risk factors, symptom characteristics, and disease course outcome. Although speech anomalies have long been recognized as a core symptom of SSD, speech markers are an unexplored source of symptom heterogeneity that may be informative in recognizing relevant subtypes. This study investigated speech heterogeneity and its relation to clinical characteristics in a large sample of patients with SSD and healthy controls. Speech samples were obtained from 142 patients with SSD and 147 healthy controls by means of open-ended interviews. Speech was analyzed using standardized open-source acoustic speech software. Hierarchical clustering was conducted using acoustic speech markers. Symptom severity was rated with the Positive and Negative Syndrome Scale, and cognition was assessed with the Brief Assessment of Cognition for Schizophrenia. Three speech clusters could be distinguished in the patient group that differed regarding speech properties, independent of medication use. One cluster was characterized by mild speech disturbances, while two severely impaired clusters were recognized (fragmented speakers and prolonged pausers). Both clusters with severely impaired speech had more severe cognitive dysfunction than the mildly impaired speakers. Prolonged pausers specifically had difficulties with memory-related tasks. Prolonged pausing, as opposed to fragmented speaking, related to chronic active psychosis and refractory psychotic symptoms. Based on speech clustering, subtypes of patients emerged with distinct disease trajectories, symptomatology, and cognitive functioning. The identification of clinically relevant subgroups within SSD may help to characterize distinct profiles and benefit the tailoring of early intervention and improvement of long-term functional outcome. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | - Bodyl A Brand
- Department of Biomedical Sciences of Cells and Systems
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5
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Nasib LG, Sommer IE, Winter-van Rossum I, de Vries J, Gangadin SS, Oomen PP, Judge G, Blom RE, Luykx JJ, van Beveren NJM, Veen ND, Kroken RA, Johnsen EL. Prednisolone versus placebo addition in the treatment of patients with recent-onset psychotic disorder: a trial design. Trials 2020; 21:492. [PMID: 32513294 PMCID: PMC7278136 DOI: 10.1186/s13063-020-04365-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/05/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The symptom severity of a substantial group of schizophrenia patients (30-40%) does not improve through pharmacotherapy with antipsychotic medication, indicating a clear need for new treatment options to improve schizophrenia outcome. Meta-analyses, genetic studies, randomized controlled trials, and post-mortem studies suggest that immune dysregulation plays a role in the pathophysiology of schizophrenia. Some anti-inflammatory drugs have shown beneficial effects on the symptom severity of schizophrenia patients. Corticosteroids are effective in various chronic inflammatory and autoimmune disorders. Prednisolone, a potent glucocorticosteroid, has minor mineral-corticosteroid potencies and can adequately pass the blood-brain barrier and its side effects and safety profile are well known. Therefore, the effect of prednisolone can be studied as a proof of concept for immune modulation as a treatment for schizophrenia. METHODS/DESIGN In total, 90 subjects aged 18-70 years and diagnosed with schizophrenia, schizoaffective disorder, or schizophreniform disorder (Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) 295.x) or psychosis not otherwise specified (NOS; 298.9) will be included. The time interval between the onset of psychosis and study entry should not exceed 7 years. Patients will be randomized 1:1 to either prednisolone or placebo daily for a period of 6 weeks in addition to a stable dose of antipsychotic medication. Study medication will be initiated at 40 mg for 3 days, after which it will be tapered down within 6 weeks after initiation, following inflammatory bowel diseases treatment guidelines. Primary outcome is change in symptom severity, expressed as change in total score on the Positive and Negative Symptom Scale (PANSS) from baseline to end of treatment. Cognitive functioning (measured through the Brief Assessment of Cognition in Schizophrenia (BACS)) and change in Global Assessment Functioning (GAF) and depressive symptoms as measured with the Calgary Depression Scale for Schizophrenia (CDS) will be assessed, in addition to various immunological biomarkers. Secondary outcomes are a 4- and 6-month follow-up assessment of PANSS, BACS, and GAF scores and immunological biomarkers. Additionally, a subgroup of patients will be included in the magnetic resonance imaging (MRI) part of the study where MR spectroscopy and structural, functional, and diffusion MRI will be conducted. DISCUSSION It is expected that prednisolone addition to current antipsychotic medication use will reduce symptom severity and will improve cognition when compared to placebo. TRIAL REGISTRATION ClinicalTrials.gov, NCT02949232 and NCT03340909. Registered 31 October 2016 and 14 November 2017. EudraCT-number 2014-000520-14 and 2017-000163-32.
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Affiliation(s)
- Lyliana G Nasib
- Department of Psychiatry, UMC Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Iris E Sommer
- Cognitive Neurosciences, Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, Groningen, The Netherlands.,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Inge Winter-van Rossum
- Department of Psychiatry, UMC Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Shiral S Gangadin
- Department of Psychiatry, UMC Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Cognitive Neurosciences, Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, Groningen, The Netherlands
| | - Priscilla P Oomen
- Department of Psychiatry, UMC Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Cognitive Neurosciences, Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Renske E Blom
- Department of Psychiatry, UMC Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jurjen J Luykx
- Department of Psychiatry, UMC Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Translational Neuroscience, UMC Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Psychiatry, ZNA Hospitals, Antwerp, Belgium.,Department of Psychiatry, SymforaMeander Hospital, Amersfoort, The Netherlands
| | - Nico J M van Beveren
- Antes Center for Mental Health Care, Rotterdam, The Netherlands.,Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands.,Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
| | | | - Rune A Kroken
- Norment, Division of Psychiatry, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Pb 7800, 5020, Bergen, Norway
| | - Erik L Johnsen
- Norment, Division of Psychiatry, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Pb 7800, 5020, Bergen, Norway
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6
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Begemann MJH, Thompson IA, Veling W, Gangadin SS, Geraets CNW, van 't Hag E, Müller-Kuperus SJ, Oomen PP, Voppel AE, van der Gaag M, Kikkert MJ, Van Os J, Smit HFE, Knegtering RH, Wiersma S, Stouten LH, Gijsman HJ, Wunderink L, Staring ABP, Veerman SRT, Mahabir AGS, Kurkamp J, Pijnenborg GHM, Veen ND, Marcelis M, Grootens KP, Faber G, van Beveren NJ, Been A, van den Brink T, Bak M, van Amelsvoort TAMJ, Ruissen A, Blanke C, Groen K, de Haan L, Sommer IEC. To continue or not to continue? Antipsychotic medication maintenance versus dose-reduction/discontinuation in first episode psychosis: HAMLETT, a pragmatic multicenter single-blind randomized controlled trial. Trials 2020; 21:147. [PMID: 32033579 PMCID: PMC7006112 DOI: 10.1186/s13063-019-3822-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 10/22/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Antipsychotic medication is effective for symptomatic treatment in schizophrenia-spectrum disorders. After symptom remission, continuation of antipsychotic treatment is associated with lower relapse rates and lower symptom severity compared to dose reduction/discontinuation. Therefore, most guidelines recommend continuation of treatment with antipsychotic medication for at least 1 year. Recently, however, these guidelines have been questioned as one study has shown that more patients achieved long-term functional remission in an early discontinuation condition-a finding that was not replicated in another recently published long-term study. METHODS/DESIGN The HAMLETT (Handling Antipsychotic Medication Long-term Evaluation of Targeted Treatment) study is a multicenter pragmatic single-blind randomized controlled trial in two parallel conditions (1:1) investigating the effects of continuation versus dose-reduction/discontinuation of antipsychotic medication after remission of a first episode of psychosis (FEP) on personal and social functioning, psychotic symptom severity, and health-related quality of life. In total 512 participants will be included, aged between 16 and 60 years, in symptomatic remission from a FEP for 3-6 months, and for whom psychosis was not associated with severe or life-threatening self-harm or violence. Recruitment will take place at 24 Dutch sites. Patients are randomized (1:1) to: continuation of antipsychotic medication until at least 1 year after remission (original dose allowing a maximum reduction of 25%, or another antipsychotic drug in similar dose range); or gradual dose reduction till eventual discontinuation of antipsychotics according to a tapering schedule. If signs of relapse occur in this arm, medication dose can be increased again. Measurements are conducted at baseline, at 3, and 6 months post-baseline, and yearly during a follow-up period of 4 years. DISCUSSION The HAMLETT study will offer evidence to guide patients and clinicians regarding questions concerning optimal treatment duration and when to taper off medication after remission of a FEP. Moreover, it may provide patient characteristics associated with safe dose reduction with a minimal risk of relapse. TRIAL STATUS Protocol version 1.3, October 2018. The study is active and currently recruiting patients (since September 2017), with the first 200 participants by the end of 2019. We anticipate completing recruitment in 2022 and final assessments (including follow-up 3.5 years after phase one) in 2026. TRIAL REGISTRATION European Clinical Trials Database, EudraCT number 2017-002406-12. Registered 7 June 2017.
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Affiliation(s)
- Marieke J H Begemann
- Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands.
| | - Ilse A Thompson
- Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Wim Veling
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Shiral S Gangadin
- Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chris N W Geraets
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Erna van 't Hag
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sanne J Müller-Kuperus
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Priscilla P Oomen
- Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Alban E Voppel
- Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Mark van der Gaag
- Parnassia Psychiatric Institute, The Hague, The Netherlands
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - Martijn J Kikkert
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Jim Van Os
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - H Filip E Smit
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Centre of Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental Health), Utrecht, The Netherlands
| | - Rikus H Knegtering
- Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sybren Wiersma
- Early Intervention Psychosis Team, GGZ inGeest Specialized Mental Health Care, Hoofddorp, The Netherlands
| | - Luyken H Stouten
- Centre for Early Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Harm J Gijsman
- Program for Psychosis & Severe Mental Illness, Pro Persona Mental Health, Wolfheze, The Netherlands
| | - Lex Wunderink
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Education and Research, Friesland Mental Health Care Services, Leeuwarden, The Netherlands
| | - Anton B P Staring
- Department ABC, Altrecht Psychiatric Institute, Utrecht, The Netherlands
| | - Selene R T Veerman
- Community Mental Health, Mental Health Service Noord-Holland Noord, Alkmaar, The Netherlands
| | | | - Jörg Kurkamp
- Center for Youth with Psychosis, Mediant ABC Twente, Enschede, The Netherlands
| | | | - Natalie D Veen
- GGZ Delfland, Delfland Institute for Mental Health Care, Delft, The Netherlands
| | - Machteld Marcelis
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, The Netherlands
- Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, The Netherlands
| | - Koen P Grootens
- Reinier van Arkel Institute for Mental Health Care, 's Hertogenbosch, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Gunnar Faber
- Yulius, Mental Health Institute, Dordrecht, The Netherlands
| | - Nico J van Beveren
- Antes Center for Mental Health Care, Rotterdam, The Netherlands
- Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
- Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | - Agaath Been
- Center for Developmental Disorders, Dimence Institute for Mental Health, Deventer, The Netherlands
| | | | - Maarten Bak
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, The Netherlands
- Mondriaan Mental Health Care, Heerlen, The Netherlands
| | - Therese A M J van Amelsvoort
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, The Netherlands
- Mondriaan Mental Health Care, Heerlen, The Netherlands
| | | | - Christine Blanke
- Anoiksis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karin Groen
- MIND Ypsilon, Organization of Relatives and Carers of People with a Vulnerability to Psychosis, The Hague, The Netherlands
| | - Lieuwe de Haan
- Department of Early Psychosis, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Iris E C Sommer
- Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
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7
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Scheltens NME, van der Weijden K, Adriaanse SM, van Assema D, Oomen PP, Krudop WA, Lammertsma AA, Barkhof F, Koene T, Teunissen CE, Scheltens P, van der Flier WM, Pijnenburg YAL, Yaqub M, Ossenkoppele R, van Berckel BNM. Hypometabolism of the posterior cingulate cortex is not restricted to Alzheimer's disease. Neuroimage Clin 2018; 19:625-632. [PMID: 29984170 PMCID: PMC6030576 DOI: 10.1016/j.nicl.2018.05.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 04/18/2018] [Accepted: 05/19/2018] [Indexed: 11/15/2022]
Abstract
When differential diagnosis of dementia includes both Alzheimer's disease (AD) and the behavioural variant of frontotemporal dementia (bvFTD), distribution of cerebral glucose metabolism as measured using [18F]‑2‑fluoro‑2‑deoxy‑d‑glucose positron emission tomography ([18F]FDG-PET) may be helpful. One important clue for differentiation is the presence of hypometabolism in the posterior cingulate cortex (PCC), usually associated with AD. PCC hypometabolism however, could also be present in bvFTD. Therefore, the specificity of PCC hypometabolism was examined. Based on visual reading PCC hypometabolism was present in 69–73/81 probable AD patients, in 10–16/33 probable bvFTD patients, and in 0–1/22 cognitive normal (CN) subjects. Findings were validated using a PCC to reference tissue [18F]FDG standard uptake value ratio (SUVr) cut-off, which was derived from the receiver operating characteristic (ROC) separating probable AD from CN, resulting in 9–14/33 bvFTD patients having PCC hypometabolism, depending on the reference tissue used. In conclusion, PCC hypometabolism is not restricted to AD.
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Affiliation(s)
- Nienke M E Scheltens
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
| | - Kars van der Weijden
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Sofie M Adriaanse
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Danielle van Assema
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Priscilla P Oomen
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Welmoed A Krudop
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; Institutes of Neurology and Healthcare Engineering, UCL, London, UK
| | - Teddy Koene
- Alzheimer Center and Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Yolande A L Pijnenburg
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Maqsood Yaqub
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Rik Ossenkoppele
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Bart N M van Berckel
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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8
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Scheltens NM, Adriaanse S, Oomen PP, Ossenkoppele R, Krudop WA, Lammertsma AA, Barkhof F, Koene T, Teunissen CE, Scheltens P, Flier WM, Pijnenburg YA, Berckel BN. IC‐02‐03: Hypometabolism of the posterior cingulate cortex is not restricted to Alzheimer's disease. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Nienke M.E. Scheltens
- Neuroscience Campus AmsterdamAmsterdamNetherlands
- VU University Medical CenterAmsterdamNetherlands
| | - Sofie Adriaanse
- Neuroscience Campus AmsterdamAmsterdamNetherlands
- VU University Medical CenterAmsterdamNetherlands
| | - Priscilla P. Oomen
- Neuroscience Campus AmsterdamAmsterdamNetherlands
- VU University Medical CenterAmsterdamNetherlands
| | - Rik Ossenkoppele
- Neuroscience Campus AmsterdamAmsterdamNetherlands
- VU University Medical CenterAmsterdamNetherlands
- University of California San FranciscoSan FranciscoCAUSA
| | - Welmoed A. Krudop
- Neuroscience Campus AmsterdamAmsterdamNetherlands
- VU University Medical CenterAmsterdamNetherlands
| | - Adriaan A. Lammertsma
- Neuroscience Campus AmsterdamAmsterdamNetherlands
- VU University Medical CenterAmsterdamNetherlands
| | - Frederik Barkhof
- Neuroscience Campus AmsterdamAmsterdamNetherlands
- VU University Medical CenterAmsterdamNetherlands
| | - Teddy Koene
- Neuroscience Campus AmsterdamAmsterdamNetherlands
- VU University Medical CenterAmsterdamNetherlands
| | - Charlotte E. Teunissen
- Neuroscience Campus AmsterdamAmsterdamNetherlands
- VU University Medical CenterAmsterdamNetherlands
| | - Philip Scheltens
- Neuroscience Campus AmsterdamAmsterdamNetherlands
- VU University Medical CenterAmsterdamNetherlands
| | - Wiesje M. Flier
- Neuroscience Campus AmsterdamAmsterdamNetherlands
- VU University Medical CenterAmsterdamNetherlands
| | - Yolande A.L. Pijnenburg
- Neuroscience Campus AmsterdamAmsterdamNetherlands
- VU University Medical CenterAmsterdamNetherlands
| | - Bart N.M. Berckel
- Neuroscience Campus AmsterdamAmsterdamNetherlands
- VU University Medical CenterAmsterdamNetherlands
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9
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Scheltens NM, Adriaanse S, Oomen PP, Ossenkoppele R, Krudop WA, Lammertsma AA, Barkhof F, Koene T, Teunissen CE, Scheltens P, Flier WM, Pijnenburg YA, Berckel BN. P1‐180: Hypometabolism of the posterior cingulate cortex is not restricted to Alzheimer's disease. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.06.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Nienke M.E. Scheltens
- VU University Medical CenterAmsterdamNetherlands
- Neuroscience Campus AmsterdamAmsterdamNetherlands
| | - Sofie Adriaanse
- VU University Medical CenterAmsterdamNetherlands
- Neuroscience Campus AmsterdamAmsterdamNetherlands
| | - Priscilla P. Oomen
- VU University Medical CenterAmsterdamNetherlands
- Neuroscience Campus AmsterdamAmsterdamNetherlands
| | - Rik Ossenkoppele
- VU University Medical CenterAmsterdamNetherlands
- Neuroscience Campus AmsterdamAmsterdamNetherlands
- University of California San FranciscoSan FranciscoCAUSA
| | - Welmoed A. Krudop
- VU University Medical CenterAmsterdamNetherlands
- Neuroscience Campus AmsterdamAmsterdamNetherlands
| | - Adriaan A. Lammertsma
- VU University Medical CenterAmsterdamNetherlands
- Neuroscience Campus AmsterdamAmsterdamNetherlands
| | - Frederik Barkhof
- VU University Medical CenterAmsterdamNetherlands
- Neuroscience Campus AmsterdamAmsterdamNetherlands
| | - Teddy Koene
- VU University Medical CenterAmsterdamNetherlands
- Neuroscience Campus AmsterdamAmsterdamNetherlands
| | - Charlotte E. Teunissen
- VU University Medical CenterAmsterdamNetherlands
- Neuroscience Campus AmsterdamAmsterdamNetherlands
| | - Philip Scheltens
- VU University Medical CenterAmsterdamNetherlands
- Neuroscience Campus AmsterdamAmsterdamNetherlands
| | - Wiesje M. Flier
- VU University Medical CenterAmsterdamNetherlands
- Neuroscience Campus AmsterdamAmsterdamNetherlands
| | - Yolande A.L. Pijnenburg
- VU University Medical CenterAmsterdamNetherlands
- Neuroscience Campus AmsterdamAmsterdamNetherlands
| | - Bart N.M. Berckel
- VU University Medical CenterAmsterdamNetherlands
- Neuroscience Campus AmsterdamAmsterdamNetherlands
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10
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Schalken JA, Roebroek AJ, Oomen PP, Wagenaar SS, Debruyne FM, Bloemers HP, Van de Ven WJ. fur gene expression as a discriminating marker for small cell and nonsmall cell lung carcinomas. J Clin Invest 1987; 80:1545-9. [PMID: 2824565 PMCID: PMC442422 DOI: 10.1172/jci113240] [Citation(s) in RCA: 130] [Impact Index Per Article: 3.5] [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: 01/02/2023] Open
Abstract
The recently discovered fur gene encodes a membrane-associated protein with a recognition function. To further characterize the gene, we studied its expression by Northern blot analysis using poly(A)-selected RNA from a variety of organs of African green monkey and rat. The fur gene appeared to be differentially expressed, relatively high levels of fur mRNA being present in specimens of liver and kidney, low levels in brain, spleen, and thymus, and very low levels in heart muscle, lung, and testis. mRNA levels in specimens of human lung tissue without neoplastic lesions were also very low. Similar analyses of primary human lung carcinomas of different histopathological types revealed a highly selective and strong elevation of fur expression in nonsmall cell lung carcinomas, but not in small cell lung carcinomas. These results indicate that fur expression can be used to discriminate between these two types of human lung cancer.
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Affiliation(s)
- J A Schalken
- Department of Urology, University of Nijmegen, The Netherlands
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