National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: IIb. The 2020 Preemptive Therapy Working Group Report

Chronic graft-versus-host disease (GVHD) commonly occurs after allogeneic hematopoietic cell transplantation (HCT) despite standard prophylactic immune suppression. Intensified universal prophylaxis approaches are effective but risk possible overtreatment and may interfere with the graft-versus-malignancy immune response. Here we summarize conceptual and practical considerations regarding preemptive therapy of chronic GVHD, namely interventions applied after HCT based on evidence that the risk of developing chronic GVHD is higher than previously appreciated. This risk may be anticipated by clinical factors or risk assignment biomarkers or may be indicated by early signs and symptoms of chronic GVHD that do not fully meet National Institutes of Health diagnostic criteria. However, truly preemptive, individualized, and targeted chronic GVHD therapies currently do not exist. In this report, we (1) review current knowledge regarding clinical risk factors for chronic GVHD, (2) review what is known about chronic GVHD risk assignment biomarkers, (3) examine how chronic GVHD pathogenesis intersects with available targeted therapeutic agents, and (4) summarize considerations for preemptive therapy for chronic GVHD, emphasizing trial development, including trial design and statistical considerations. We conclude that robust risk assignment models that accurately predict chronic GVHD after HCT and early-phase preemptive therapy trials represent the most urgent priorities for advancing this novel area of research.

Identification of potential risk factors associated with highly pathogenic avian influenza subtype H5N1 outbreak occurrence in Lagos and Kano States, Nigeria, during the 2006-2007 epidemics

Highly pathogenic avian influenza HPAI H5N1 was first reported in Africa in 2006, in Nigeria. The country experienced severe outbreaks in 2006 and 2007, strongly affecting the poultry population. Current knowledge on potential risk factors for HPAI H5N1 occurrence in poultry farms in Nigeria is limited. Therefore, we conducted a case-control study to identify potential farm-level risk factors for HPAI H5N1 occurrence in two areas of the country that were affected by the disease in 2006 and 2007, namely the States of Lagos and Kano. A case-control study was conducted at the farm level. A convenience sample of 110 farms was surveyed. Data on farm characteristics, farm management and trade practices were collected. Logistic regression was used to identify factors associated with farms that confirmed positive for HPAI. Having a neighbouring poultry farm was identified as a potential risk factor for disease occurrence [OR, 5.23; 95% CI, (0.88-30.97); P-value = 0.048]. Farm staff washing their hands before handling birds was a protective factor [OR, 0.14; 95% CI, (0.05-0.37); P-value <0.001], as well as not allowing traders to enter the farm [OR, 0.23; 95% CI, (0.08-0.70); P-value = 0.008]. Our study highlighted the importance of trade and proximity between poultry farms in the epidemiology of HPAI H5N1 and the role of biosecurity in disease prevention in Kano and Lagos States. Despite the limitations owing to the sampling strategy, these results are consistent with other risk factor studies previously conducted on HPAI H5N1 in both Africa and other regions, suggesting similar risk factor patterns for HPAI H5N1 virus spread and substantiating current knowledge regarding the epidemiology of the disease. Finally, this study generated information from areas where data are difficult to obtain.

Research in clinical laboratory science: professionals' involvement

OBJECTIVES

To describe current qualitative and quantitative aspects of research engagement and other scholarly activities conducted by clinical laboratory science (CLS) professionals across a range of employment settings.

DESIGN

A link to a 3-part online survey was sent by electronic mail to 7,572 members of the American Society for Clinical Laboratory Science and 500 program directors.

SETTING

email message, on-line survey

PARTICIPANTS

all ASCLS members and all directors of accredited clinical laboratory educational programs

MAIN OUTCOME MEASURES

Quantitative and qualitative measures of professionals' engagement in research and other scholarly activities

RESULTS

556 of 7572 (7.3%) persons completed the survey. Thirty-two percent of survey respondents reported spending between 1 to > 40 work hours per week conducting research with 68% of respondents not participating in research activities. Conducting research is an employment requirement for 18% of survey participants. Twenty-nine percent of respondents have published at least one research article, and 47% of respondents who conduct research have published studies in the journal Clinical Laboratory Science. More than 57% of respondents participate in non-research scholarly activities as part of their employment. CLS professionals who conduct research are more likely to do applied, clinical, or educational research than other types of research. Fifty-seven percent of respondents who conduct research lack external funding for their work. Ninety-three percent of total research dollars is obtained by respondents who hold the Ph.D. degree. The perception of the importance of conducting research varies by employment position. Barriers to participation in research include lack of inclusion of research in the job description, time constraints, inadequate research funding, limited opportunity, and lack of space and equipment.

CONCLUSIONS

CLS professionals participate in research in limited numbers, and are more likely to engage in non-research types of scholarly activities. Numerous barriers are identified which impose limits to conducting research. Over half of CLS's research efforts lack external funding. Although there was broad representation among participants across educational levels, employment settings, and job positions, the number of survey respondents was limited. Possible directions for future research include conducting this survey using members of additional professional organizations.

Research in clinical laboratory science: professionals' educational preparation

OBJECTIVE

To describe the educational preparation of CLS professionals for conducting research.

DESIGN

A link to 3-part online survey was sent by electronic mail to 7,572 members of the American Society for Clinical Laboratory Science and 500 program directors research project. Barriers to participation in research by undergraduates include time limitations within the curriculum, insufficient faculty time, and lack of funds, space, and equipment. Increased emphasis on developing research skills is found in educational programs at the master's degree level.

CONCLUSIONS

The formal educational background of many CLS professionals may leave them unprepared or underprepared for conducting research. Although there was broad representation among participants across educational levels, employment settings, and job positions, the number of survey respondents was limited. Possible directions for future research include conducting this survey using members of additional professional organizations.

Risk assessment for Escherichia coli O157:H7 in marketed unpasteurized milk in selected East African countries

We carried out a study to assess the risk associated with the presence of Shiga toxigenic Escherichia coli (STEC) in informally marketed unpasteurized milk in urban East Africa. Data for the risk models were obtained from on-going and recently completed studies in Kenya and Uganda. Inputs for the model were complemented with data from published literature in similar populations. A fault-tree scenario pathway and modular process risk model approach were used for exposure assessment. Hazard characterization was based on a socioeconomic study with dose-responses derived from the literature. We used a probabilistic approach with Monte Carlo simulation and inputs from farm and household surveys. The qualitative analysis suggested a low to moderate risk of infection from consuming milk and that the widespread consumer practice of boiling milk before consumption was an important risk mitigator. Quantitative analysis revealed that two to three symptomatic STEC infections could be expected for every 10,000 unpasteurized milk portions consumed, with a possible range of 0 to 22 symptomatic cases. Sensitivity analyses to assess the uncertainty and variability associated with the model revealed that the factor with the greatest influence on disease incidence was the prevalence of STEC in dairy cattle. Risk assessment is a potentially useful method for managing food safety in informal markets.

Comparing FAMACHA eye color chart and Hemoglobin Color Scale tests for detecting anemia and improving treatment of bovine trypanosomosis in West Africa

African animal trypanosomosis (AAT) is considered the most important cattle disease in sub-Saharan Africa but its diagnosis in the field is difficult, resulting in inappropriate treatments, excessive delay in treatments and under-treatment. A field study in West Africa investigated the usefulness of anemia in the diagnosis of trypanosomosis. A total of 20,772 cattle blood samples were taken from 121 villages in 3 countries. The average packed cell volume (PCV) of trypanosomosis positive cattle was 23%, versus 28% for negative cattle. In a sub-set of animals, other causes of anemia were investigated showing most of the anemia burden was attributable to trypanosomosis. Anemia was a reasonably accurate indicator of trypanosomosis in the study area, with a sensitivity of 56% and a specificity of 80% and a diagnostic odds ratio of 4.2, the highest of all the signs evaluated (anemia, emaciation, staring coat, lymphadenopathy, fever, lacrimation and salivary or nasal discharge). Having confirmed the usefulness of anemia as a predictor of trypanosomosis, two potential pen-side tests for anemia were evaluated (the first reported trial of their use in cattle), firstly a color chart developed for anemia detection in sheep through visual inspection of conjunctival membranes (FAMACHA) and secondly the Hemoglobin Color Scale (HbCS) developed for assessing hemoglobin levels in human patients by comparing blood drops on filter paper with color standards. In a population of cattle suspected by their owners to be sick with trypanosomosis (n=898) the sensitivity of the HbCS test was 56% and the specificity was 77%, while the sensitivity of the FAMACHA test was 95% and the specificity was 22%. The higher sensitivity but lower specificity suggests the FAMACHA may be useful as a screening test and the HbCS as a confirmatory test. The two tests were also evaluated in cattle randomly selected from the village herd. Using cut-off points to optimize test performance, the HbCS test had a sensitivity of 81% and a specificity of 62% (n=505 cattle), while the FAMACHA had a sensitivity of 92% and a specificity of 30% (n=298 cattle). Recommendations are made for the appropriate use of these tests in the West African region.

Ultrasensitive detection and characterization of posttranslational modifications using surface-enhanced Raman spectroscopy

Posttranslational modification (PTM) of proteins is likely to be the most common mechanism of altering the expression of genetic information. It is essential to characterize PTMs to establish a complete understanding of the activities of proteins. Here, we present a sensitive detection method using surface-enhanced Raman spectroscopy (SERS) that can detect PTMs from as little as zeptomoles of peptide. We demonstrate, using model peptides, the ability of SERS to detect a variety of protein modifications, such as acetylation, trimethylation, phosphorylation, and ubiquitination. In addition, we show the capability to obtain positional information for modifications such as trimethylation and phosphorylation using SERS and wavelet decomposition data analysis techniques. We further show that it is possible to apply SERS to detect PTMs from biological samples such as histones. We envision that this detection method might be a valuable technique that is complementary to mass spectrometry in obtaining orthogonal chemical and modification-specific information from biological samples at sensitive levels.

A suite of algorithms for the comprehensive analysis of complex protein mixtures using high-resolution LC-MS

MOTIVATION

Comparing two or more complex protein mixtures using liquid chromatography mass spectrometry (LC-MS) requires multiple analysis steps to locate and quantitate natural peptides within a single experiment and to align and normalize findings across multiple experiments.

RESULTS

We describe msInspect, an open-source application comprising algorithms and visualization tools for the analysis of multiple LC-MS experimental measurements. The platform integrates novel algorithms for detecting signatures of natural peptides within a single LC-MS measurement and combines multiple experimental measurements into a peptide array, which may then be mined using analysis tools traditionally applied to genomic array analysis. The platform supports quantitation by both label-free and isotopic labeling approaches. The software implementation has been designed so that many key components may be easily replaced, making it useful as a workbench for integrating other novel algorithms developed by a growing research community.

AVAILABILITY

The msInspect software is distributed freely under an Apache 2.0 license. The software as well as a Zip file with all peptide feature files and scripts needed to generate the tables and figures in this article are available at http://proteomics.fhcrc.org/.

Denoising array-based comparative genomic hybridization data using wavelets

Array-based comparative genomic hybridization (array-CGH) provides a high-throughput, high-resolution method to measure relative changes in DNA copy number simultaneously at thousands of genomic loci. Typically, these measurements are reported and displayed linearly on chromosome maps, and gains and losses are detected as deviations from normal diploid cells. We propose that one may consider denoising the data to uncover the true copy number changes before drawing inferences on the patterns of aberrations in the samples. Nonparametric techniques are particularly suitable for data denoising as they do not impose a parametric model in finding structures in the data. In this paper, we employ wavelets to denoise the data as wavelets have sound theoretical properties and a fast computational algorithm, and are particularly well suited for handling the abrupt changes seen in array-CGH data. A simulation study shows that denoising data prior to testing can achieve greater power in detecting the aberrant spot than using the raw data without denoising. Finally, we illustrate the method on two array-CGH data sets.

Can epidemiology and economics make a meaningful contribution to national animal-disease control?

The general role of veterinary epidemiology and economics to national animal-disease control throughout the world is considered for the four main groupings of animal diseases: zoonotic, food-borne, endemic and epidemic diseases. This is done by considering how veterinary epidemiology and economics has contributed to priority setting (which diseases come first?), decision-making (for a given disease, which strategy is best?), and disease control implementation (how can optimal delivery and adoption of selected interventions best be achieved?). Within each of these categories, progress made and future opportunities are discussed. In addition, a review is made of how veterinary epidemiology and economics has been institutionalised. We conclude that veterinary epidemiology and economics holds a unique role in the development of national policies and strategies for improved animal health world-wide. However, we consider that we must capitalise more on the unique comparative advantage of the partnership between veterinarians and agricultural economists. We believe that much remains to be done to improve the "institutionalisation" of veterinary epidemiology and economics, and the adoption and impact of the products of our unique partnership, particularly in countries of the developing world.

PET versus SPECT for determining myocardial tissue viability using fluorine-18-fluorodeoxyglucose

The U.S. Food and Drug Administration regulates the manufacture and distribution of 18F-FDG. Acquisition and use of this radiopharmaceutical for myocardial imaging at our institution required approval by our Institutional Review Board. Our initial objective was to present a scientific validation for use of this radiopharmaceutical in adjudicating the "viable versus scarred myocardium question," using either a PET scanner or a gamma camera equipped with 511-keV collimators. We believe that our nuclear medicine colleagues who find themselves in a similar business/legal situation regarding the acquisition and use of 18F-FDG will find this review useful. We reviewed the literature to document the efficacy of 18F-FDG, in general, in assessing myocardial viability. We then did a literature-based comparison of PET scanner methodology versus modified gamma camera methodology for imaging 18F-FDG emissions. Imaging 18F-FDG with a modified gamma camera appears to be an effective alternative to imaging with a standard PET camera for assessing myocardial viability.