1
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Reiche E, Keller PR, Soares V, Schuster CR, Rahmayanti S, Mroueh J, Mroueh V, Billaud M, Hu S, Hoover-Watson H, Lian CG, Tan Y, Doloff JC, Newell-Fugate AE, Coon D. Androgenic steroids induce pathologic scarring in a preclinical porcine model via dysfunctional extracellular matrix deposition. FASEB J 2024; 38:e23561. [PMID: 38530321 DOI: 10.1096/fj.202302144rrr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/19/2024] [Accepted: 03/01/2024] [Indexed: 03/27/2024]
Abstract
Hypertrophic scarring is a major source of morbidity. Sex hormones are not classically considered modulators of scarring. However, based on increased frequency of hypertrophic scarring in patients on testosterone, we hypothesized that androgenic steroids induce abnormal scarring and developed a preclinical porcine model to explore these effects. Mini-swine underwent castration, received no testosterone (noT) or biweekly testosterone therapy (+T), and underwent excisional wounding. To create a delayed wound healing model, a subset of wounds were re-excised at 2 weeks. Scars from postoperative day 42 (POD42) and delayed wounds (POD28) were harvested 6 weeks after initial wounding for analysis via histology, bulk RNA-seq, and mechanical testing. Histologic analysis of scars from +T animals showed increased mean fibrosis area (16 mm2noT, 28 mm2+T; p = .007) and thickness (0.246 mm2noT, 0.406 mm2+T; p < .001) compared to noT. XX+T and XY+T scars had greater tensile burst strength (p = .024 and p = .013, respectively) compared to noT swine. Color deconvolution analysis revealed greater deposition of type I and type III collagen as well as increased collagen type I:III ratio in +T scars. Dermatopathologist histology scoring showed that +T exposure was associated with worse overall scarring (p < .05). Gene ontology analysis found that testosterone exposure was associated with upregulation of cellular metabolism and immune response gene sets, while testosterone upregulated pathways related to keratinization and laminin formation on pathway analysis. In conclusion, we developed a preclinical porcine model to study the effects of the sex hormone testosterone on scarring. Testosterone induces increased scar tissue deposition and appears to increase physical strength of scars via supraphysiologic deposition of collagen and other ECM factors. The increased burst strength seen in both XX and XY animals suggests that hormone administration has a strong influence on scar mechanical properties independent of chromosomal sex. Anti-androgen topical therapies may be a promising future area of research.
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Affiliation(s)
- Erik Reiche
- Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Patrick R Keller
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vance Soares
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Calvin R Schuster
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Siti Rahmayanti
- Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica Mroueh
- Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
| | - Vanessa Mroueh
- Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
| | - Marie Billaud
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sophia Hu
- Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
| | - Hunter Hoover-Watson
- Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
| | - Christine G Lian
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yu Tan
- Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua C Doloff
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Annie E Newell-Fugate
- Department of Veterinary Physiology and Pharmacology, Texas A&M University, College Station, Texas, USA
| | - Devin Coon
- Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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2
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Shi Y, Reker D, Byrne JD, Kirtane AR, Hess K, Wang Z, Navamajiti N, Young CC, Fralish Z, Zhang Z, Lopes A, Soares V, Wainer J, von Erlach T, Miao L, Langer R, Traverso G. Screening oral drugs for their interactions with the intestinal transportome via porcine tissue explants and machine learning. Nat Biomed Eng 2024; 8:278-290. [PMID: 38378821 DOI: 10.1038/s41551-023-01128-9] [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] [Received: 11/09/2020] [Accepted: 10/01/2023] [Indexed: 02/22/2024]
Abstract
In vitro systems that accurately model in vivo conditions in the gastrointestinal tract may aid the development of oral drugs with greater bioavailability. Here we show that the interaction profiles between drugs and intestinal drug transporters can be obtained by modulating transporter expression in intact porcine tissue explants via the ultrasound-mediated delivery of small interfering RNAs and that the interaction profiles can be classified via a random forest model trained on the drug-transporter relationships. For 24 drugs with well-characterized drug-transporter interactions, the model achieved 100% concordance. For 28 clinical drugs and 22 investigational drugs, the model identified 58 unknown drug-transporter interactions, 7 of which (out of 8 tested) corresponded to drug-pharmacokinetic measurements in mice. We also validated the model's predictions for interactions between doxycycline and four drugs (warfarin, tacrolimus, digoxin and levetiracetam) through an ex vivo perfusion assay and the analysis of pharmacologic data from patients. Screening drugs for their interactions with the intestinal transportome via tissue explants and machine learning may help to expedite drug development and the evaluation of drug safety.
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Affiliation(s)
- Yunhua Shi
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel Reker
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - James D Byrne
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - Ameya R Kirtane
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kaitlyn Hess
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Zhuyi Wang
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Natsuda Navamajiti
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Biomedical Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Cameron C Young
- Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Zachary Fralish
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Zilu Zhang
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Aaron Lopes
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Vance Soares
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jacob Wainer
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Thomas von Erlach
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Lei Miao
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Robert Langer
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Giovanni Traverso
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
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3
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Mroueh V, Reiche E, Mroueh J, Keller PR, Marano A, Suresh V, Schuster C, Soares V, Coon D. Androgen therapy worsens scar formation in masculinizing mastectomy. Br J Surg 2023; 110:1422-1424. [PMID: 37303282 DOI: 10.1093/bjs/znad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/12/2023] [Accepted: 04/30/2023] [Indexed: 06/13/2023]
Affiliation(s)
- Vanessa Mroueh
- Division of Plastic and Reconstructive Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Erik Reiche
- Division of Plastic and Reconstructive Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica Mroueh
- Division of Plastic and Reconstructive Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Patrick R Keller
- Division of Plastic and Reconstructive Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Marano
- Division of Plastic and Reconstructive Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Visakha Suresh
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Calvin Schuster
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vance Soares
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Devin Coon
- Division of Plastic and Reconstructive Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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4
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Reiche E, Tan Y, Louis MR, Keller PR, Soares V, Schuster CR, Lu T, O’Brien Coon D. A Novel Mouse Model for Investigating the Effects of Gender-affirming Hormone Therapy on Surgical Healing. Plast Reconstr Surg Glob Open 2022; 10:e4688. [PMID: 36467118 PMCID: PMC9708152 DOI: 10.1097/gox.0000000000004688] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/05/2022] [Indexed: 06/13/2023]
Abstract
Wound healing problems are a major cause of morbidity for gender-affirming surgery (GAS) patients. Prior studies have shown sex differences in wound healing may exist. We hypothesized exogenous testosterone supplementation may impair post-GAS wound healing and developed a model to investigate this phenomenon. Mice were randomized by hormone regimen and gonadectomy (OVX). Gonadectomy or sham occurred on day 0 and mice were assigned to no testosterone (-T), mono- or bi-weekly (T/2T) testosterone groups. Dorsal splinted wounding occurred on day 14 and harvest on day 21. Serum testosterone levels were quantified with mass spectrometry. Tissue underwent analysis with planimetry, qPCR, ELISA, and immunofluorescence. Mean testosterone trough levels for bi-weekly regimen were higher compared to mono-weekly (397 versus 272 ng/dL; P = 0.027). At POD5, 2T injections led to 24.9% and 24.7% increases in mean wound size relative to SHAM and OVX/-T, respectively (P = 0.004; 0.001). Wounds in OVX/+2T mice demonstrated increased gene expression for inflammatory cytokines and macrophage marker F4/80 (P < 0.05). ELISA confirmed elevated wound TNFα levels (P < 0.05). Quantitative multiplex immunofluorescence with F4/80/NOS2/ARG1 showed significant increases in macrophage prevalence in OVX/+2T (P < 0.05). We developed a novel model of GAS hormonal milieu to study effects of exogenous testosterone on wound healing. Optimized twice-weekly dosing yielded serum levels comparable to clinical therapy. We showed exogenous testosterone administered to XX/OVX mice significantly impairs wound healing. A hyperinflammatory wound environment results in increased macrophage proliferation and elevated cytokines. Future efforts are directed toward mechanistic investigation and clinical validation.
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Affiliation(s)
- Erik Reiche
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
- Translational Tissue Engineering Center, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Md
| | - Yu Tan
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
- Translational Tissue Engineering Center, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Md
| | - Matthew R. Louis
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Patrick R. Keller
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Vance Soares
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
- Translational Tissue Engineering Center, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Md
| | - Calvin R. Schuster
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
- Translational Tissue Engineering Center, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Md
| | - Tingying Lu
- The Department of Applied Mathematics and Statistics, Whiting School of Engineering, Johns Hopkins University, Baltimore, Md
| | - Devin O’Brien Coon
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
- Translational Tissue Engineering Center, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Md
- Division of Plastic Surgery, Brigham and Women’s Hospital, Boston, Mass
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5
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Caffarel-Salvador E, Kim S, Soares V, Tian RY, Stern SR, Minahan D, Yona R, Lu X, Zakaria FR, Collins J, Wainer J, Wong J, McManus R, Tamang S, McDonnell S, Ishida K, Hayward A, Liu X, Hubálek F, Fels J, Vegge A, Frederiksen MR, Rahbek U, Yoshitake T, Fujimoto J, Roxhed N, Langer R, Traverso G. A microneedle platform for buccal macromolecule delivery. Sci Adv 2021; 7:eabe2620. [PMID: 33523951 DOI: 10.1126/sciadv.abe2620] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/04/2020] [Indexed: 06/12/2023]
Abstract
Alternative means for drug delivery are needed to facilitate drug adherence and administration. Microneedles (MNs) have been previously investigated transdermally for drug delivery. To date, drug loading into MNs has been limited by drug solubility in the polymeric blend. We designed a highly drug-loaded MN patch to deliver macromolecules and applied it to the buccal area, which allows for faster delivery than the skin. We successfully delivered 1-mg payloads of human insulin and human growth hormone to the buccal cavity of swine within 30 s. In addition, we conducted a trial in 100 healthy volunteers to assess potential discomfort associated with MNs when applied in the oral cavity, identifying the hard palate as the preferred application site. We envisage that MN patches applied on buccal surfaces could increase medication adherence and facilitate the painless delivery of biologics and other drugs to many, especially for the pediatric and elderly populations.
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Affiliation(s)
- Ester Caffarel-Salvador
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Soyoung Kim
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Vance Soares
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Ryan Yu Tian
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Sarah R Stern
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Daniel Minahan
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Raissa Yona
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Xiaoya Lu
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Fauziah R Zakaria
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Joy Collins
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jacob Wainer
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Jessica Wong
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Rebecca McManus
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Siddartha Tamang
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Shane McDonnell
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Keiko Ishida
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Alison Hayward
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Xiewen Liu
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Materials, University of Oxford, Parks Road, Oxford OX1 3PH, UK
| | - František Hubálek
- Global Research Technologies, Global Drug Discovery, and Device R&D, Novo Nordisk A/S, Måløv, Denmark
| | - Johannes Fels
- Global Research Technologies, Global Drug Discovery, and Device R&D, Novo Nordisk A/S, Måløv, Denmark
| | - Andreas Vegge
- Global Research Technologies, Global Drug Discovery, and Device R&D, Novo Nordisk A/S, Måløv, Denmark
| | | | - Ulrik Rahbek
- Global Research Technologies, Global Drug Discovery, and Device R&D, Novo Nordisk A/S, Måløv, Denmark
| | - Tadayuki Yoshitake
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - James Fujimoto
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Niclas Roxhed
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- School of Electrical Engineering and Computer Science, Department of Micro and Nanosystems, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Robert Langer
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Giovanni Traverso
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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6
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Verma M, Chu JN, Salama JAF, Faiz MT, Eweje F, Gwynne D, Lopes A, Hess K, Soares V, Steiger C, McManus R, Koeppen R, Hua T, Hayward A, Collins J, Tamang SM, Ishida K, Miller JB, Katz S, Slocum AH, Sulkowski MS, Thomas DL, Langer R, Traverso G. Development of a long-acting direct-acting antiviral system for hepatitis C virus treatment in swine. Proc Natl Acad Sci U S A 2020; 117:11987-11994. [PMID: 32424082 PMCID: PMC7275718 DOI: 10.1073/pnas.2004746117] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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] [Indexed: 12/20/2022] Open
Abstract
Chronic hepatitis C virus (HCV) infection is a leading cause of cirrhosis worldwide and kills more Americans than 59 other infections, including HIV and tuberculosis, combined. While direct-acting antiviral (DAA) treatments are effective, limited uptake of therapy, particularly in high-risk groups, remains a substantial barrier to eliminating HCV. We developed a long-acting DAA system (LA-DAAS) capable of prolonged dosing and explored its cost-effectiveness. We designed a retrievable coil-shaped LA-DAAS compatible with nasogastric tube administration and the capacity to encapsulate and release gram levels of drugs while resident in the stomach. We formulated DAAs in drug-polymer pills and studied the release kinetics for 1 mo in vitro and in vivo in a swine model. The LA-DAAS was equipped with ethanol and temperature sensors linked via Bluetooth to a phone application to provide patient engagement. We then performed a cost-effectiveness analysis comparing LA-DAAS to DAA alone in various patient groups, including people who inject drugs. Tunable release kinetics of DAAs was enabled for 1 mo with drug-polymer pills in vitro, and the LA-DAAS safely and successfully provided at least month-long release of sofosbuvir in vivo. Temperature and alcohol sensors could interface with external sources for at least 1 mo. The LA-DAAS was cost-effective compared to DAA therapy alone in all groups considered (base case incremental cost-effectiveness ratio $39,800). We believe that the LA-DAA system can provide a cost-effective and patient-centric method for HCV treatment, including in high-risk populations who are currently undertreated.
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Affiliation(s)
- Malvika Verma
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Jacqueline N Chu
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - John A F Salama
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Mohammed T Faiz
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Feyisope Eweje
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115
| | - Declan Gwynne
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Aaron Lopes
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Kaitlyn Hess
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Vance Soares
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Christoph Steiger
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Rebecca McManus
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Ryan Koeppen
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Tiffany Hua
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Alison Hayward
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Joy Collins
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Siddartha M Tamang
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Keiko Ishida
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Jonathan B Miller
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Stephanie Katz
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - Alexander H Slocum
- Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Mark S Sulkowski
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - David L Thomas
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - Robert Langer
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139;
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Giovanni Traverso
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139;
- Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115
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7
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Verma M, Vishwanath K, Eweje F, Roxhed N, Grant T, Castaneda M, Steiger C, Mazdiyasni H, Bensel T, Minahan D, Soares V, Salama JAF, Lopes A, Hess K, Cleveland C, Fulop DJ, Hayward A, Collins J, Tamang SM, Hua T, Ikeanyi C, Zeidman G, Mule E, Boominathan S, Popova E, Miller JB, Bellinger AM, Collins D, Leibowitz D, Batra S, Ahuja S, Bajiya M, Batra S, Sarin R, Agarwal U, Khaparde SD, Gupta NK, Gupta D, Bhatnagar AK, Chopra KK, Sharma N, Khanna A, Chowdhury J, Stoner R, Slocum AH, Cima MJ, Furin J, Langer R, Traverso G. A gastric resident drug delivery system for prolonged gram-level dosing of tuberculosis treatment. Sci Transl Med 2020; 11:11/483/eaau6267. [PMID: 30867322 PMCID: PMC7797620 DOI: 10.1126/scitranslmed.aau6267] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 02/01/2019] [Indexed: 12/12/2022]
Abstract
Multigram drug depot systems for extended drug release could transform our capacity to effectively treat patients across a myriad of diseases. For example, tuberculosis (TB) requires multimonth courses of daily multigram doses for treatment. To address the challenge of prolonged dosing for regimens requiring multigram drug dosing, we developed a gastric resident system delivered through the nasogastric route that was capable of safely encapsulating and releasing grams of antibiotics over a period of weeks. Initial preclinical safety and drug release were demonstrated in a swine model with a panel of TB antibiotics. We anticipate multiple applications in the field of infectious diseases, as well as for other indications where multigram depots could impart meaningful benefits to patients, helping maximize adherence to their medication.
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Affiliation(s)
- Malvika Verma
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Karan Vishwanath
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Feyisope Eweje
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Niclas Roxhed
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Micro and Nanosystems, KTH Royal Institute of Technology, Stockholm 10044, Sweden
| | - Tyler Grant
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Macy Castaneda
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Christoph Steiger
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Hormoz Mazdiyasni
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Taylor Bensel
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Daniel Minahan
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Vance Soares
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - John A F Salama
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Aaron Lopes
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Kaitlyn Hess
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Cody Cleveland
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Daniel J Fulop
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Alison Hayward
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Joy Collins
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Siddartha M Tamang
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Tiffany Hua
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Chinonyelum Ikeanyi
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Gal Zeidman
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Elizabeth Mule
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Sooraj Boominathan
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Ellena Popova
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Biology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Jonathan B Miller
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Andrew M Bellinger
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Cardiovascular Division, Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - David Collins
- Management Sciences for Health, Medford, MA 02155, USA.,Boston University School of Public Health, Boston, MA 02118, USA
| | - Dalia Leibowitz
- Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | | | | | | | | | - Rohit Sarin
- National Institute of Tuberculosis and Respiratory Diseases, New Delhi 110030, India
| | - Upasna Agarwal
- National Institute of Tuberculosis and Respiratory Diseases, New Delhi 110030, India
| | - Sunil D Khaparde
- Former Deputy Director General and Head of Central TB Division, Government of India, New Delhi 110011, India
| | - Neeraj K Gupta
- Department of Respiratory Medicine, Safdarjung Hospital, New Delhi 110029, India
| | - Deepak Gupta
- Division of Pulmonary and Critical Care Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Anuj K Bhatnagar
- Rajan Babu Institute for Pulmonary Medicine and Tuberculosis, New Delhi 110009, India
| | | | - Nandini Sharma
- Department of Community Medicine, Maulana Azad Medical College, New Delhi 110002, India
| | - Ashwani Khanna
- Lok Nayak Hospital Chest Clinic, New Delhi 110002, India
| | | | - Robert Stoner
- Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,MIT Energy Initiative, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Alexander H Slocum
- Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Michael J Cima
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Robert Langer
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. .,Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Giovanni Traverso
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. .,Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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8
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Raman R, Hua T, Gwynne D, Collins J, Tamang S, Zhou J, Esfandiary T, Soares V, Pajovic S, Hayward A, Langer R, Traverso G. Light-degradable hydrogels as dynamic triggers for gastrointestinal applications. Sci Adv 2020; 6:eaay0065. [PMID: 32010768 PMCID: PMC6968934 DOI: 10.1126/sciadv.aay0065] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 11/14/2019] [Indexed: 05/21/2023]
Abstract
Triggerable materials capable of being degraded by selective stimuli stand to transform our capacity to precisely control biomedical device activity and performance while reducing the need for invasive interventions. Here, we describe the development of a modular and tunable light-triggerable hydrogel system capable of interfacing with implantable devices. We apply these materials to two applications in the gastrointestinal (GI) tract: a bariatric balloon and an esophageal stent. We demonstrate biocompatibility and on-demand triggering of the material in vitro, ex vivo, and in vivo. Moreover, we characterize performance of the system in a porcine large animal model with an accompanying ingestible LED. Light-triggerable hydrogels have the potential to be applied broadly throughout the GI tract and other anatomic areas. By demonstrating the first use of light-degradable hydrogels in vivo, we provide biomedical engineers and clinicians with a previously unavailable, safe, dynamically deliverable, and precise tool to design dynamically actuated implantable devices.
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Affiliation(s)
- Ritu Raman
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Tiffany Hua
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Declan Gwynne
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Joy Collins
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Siddartha Tamang
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Jianlin Zhou
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Tina Esfandiary
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Vance Soares
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Simo Pajovic
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Alison Hayward
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Robert Langer
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Giovanni Traverso
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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9
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Abramson A, Caffarel-Salvador E, Soares V, Minahan D, Tian RY, Lu X, Dellal D, Gao Y, Kim S, Wainer J, Collins J, Tamang S, Hayward A, Yoshitake T, Lee HC, Fujimoto J, Fels J, Frederiksen MR, Rahbek U, Roxhed N, Langer R, Traverso G. A luminal unfolding microneedle injector for oral delivery of macromolecules. Nat Med 2019; 25:1512-1518. [PMID: 31591601 DOI: 10.1038/s41591-019-0598-9] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 08/28/2019] [Indexed: 12/12/2022]
Abstract
Insulin and other injectable biologic drugs have transformed the treatment of patients suffering from diabetes1,2, yet patients and healthcare providers often prefer to use and prescribe less effective orally dosed medications3-5. Compared with subcutaneously administered drugs, oral formulations create less patient discomfort4, show greater chemical stability at high temperatures6, and do not generate biohazardous needle waste7. An oral dosage form for biologic medications is ideal; however, macromolecule drugs are not readily absorbed into the bloodstream through the gastrointestinal tract8. We developed an ingestible capsule, termed the luminal unfolding microneedle injector, which allows for the oral delivery of biologic drugs by rapidly propelling dissolvable drug-loaded microneedles into intestinal tissue using a set of unfolding arms. During ex vivo human and in vivo swine studies, the device consistently delivered the microneedles to the tissue without causing complete thickness perforations. Using insulin as a model drug, we showed that, when actuated, the luminal unfolding microneedle injector provided a faster pharmacokinetic uptake profile and a systemic uptake >10% of that of a subcutaneous injection over a 4-h sampling period. With the ability to load a multitude of microneedle formulations, the device can serve as a platform to orally deliver therapeutic doses of macromolecule drugs.
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Affiliation(s)
- Alex Abramson
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.,David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Ester Caffarel-Salvador
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.,David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Vance Soares
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.,David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Daniel Minahan
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.,David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Ryan Yu Tian
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.,David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Xiaoya Lu
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.,David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - David Dellal
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Yuan Gao
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.,David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Soyoung Kim
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.,David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jacob Wainer
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.,David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Joy Collins
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.,David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Siddartha Tamang
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.,David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Alison Hayward
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.,David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.,Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Tadayuki Yoshitake
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Hsiang-Chieh Lee
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - James Fujimoto
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Johannes Fels
- Global Research Technologies, Global Drug Discovery, Måløv, Denmark.,Device R&D, Novo Nordisk, Måløv, Denmark
| | | | - Ulrik Rahbek
- Global Research Technologies, Global Drug Discovery, Måløv, Denmark.,Device R&D, Novo Nordisk, Måløv, Denmark
| | - Niclas Roxhed
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.,David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Micro and Nanosystems, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Robert Langer
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA. .,David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA. .,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA. .,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA. .,Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Giovanni Traverso
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA. .,David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA. .,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA. .,Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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10
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Kong YL, Zou X, McCandler CA, Kirtane AR, Ning S, Zhou J, Abid A, Jafari M, Rogner J, Minahan D, Collins JE, McDonnell S, Cleveland C, Bensel T, Tamang S, Arrick G, Gimbel A, Hua T, Ghosh U, Soares V, Wang N, Wahane A, Hayward A, Zhang S, Smith BR, Langer R, Traverso G. 3D-Printed Gastric Resident Electronics. Adv Mater Technol 2018; 4:1800490. [PMID: 32010758 PMCID: PMC6988123 DOI: 10.1002/admt.201800490] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/06/2018] [Indexed: 05/20/2023]
Abstract
Long-term implantation of biomedical electronics into the human body enables advanced diagnostic and therapeutic functionalities. However, most long-term resident electronics devices require invasive procedures for implantation as well as a specialized receiver for communication. Here, a gastric resident electronic (GRE) system that leverages the anatomical space offered by the gastric environment to enable residence of an orally delivered platform of such devices within the human body is presented. The GRE is capable of directly interfacing with portable consumer personal electronics through Bluetooth, a widely adopted wireless protocol. In contrast to the passive day-long gastric residence achieved with prior ingestible electronics, advancement in multimaterial prototyping enables the GRE to reside in the hostile gastric environment for a maximum of 36 d and maintain ≈15 d of wireless electronics communications as evidenced by the studies in a porcine model. Indeed, the synergistic integration of reconfigurable gastric-residence structure, drug release modules, and wireless electronics could ultimately enable the next-generation remote diagnostic and automated therapeutic strategies.
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Affiliation(s)
- Yong Lin Kong
- Department of Mechanical Engineering University of Utah Salt Lake City, UT 84112, USA
| | - Xingyu Zou
- Department of Mechanical Engineering University of Utah Salt Lake City, UT 84112, USA
- Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
- Charles Stark Draper Laboratory Cambridge, MA 02139, USA
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA 02139, USA
- Division of Gastroenterology Brigham and Women’s Hospital Harvard Medical School Boston, MA 02115, USA
- Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge, MA 02139, USA
| | - Caitlin A. McCandler
- Department of Mechanical Engineering University of Utah Salt Lake City, UT 84112, USA
- Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
- Charles Stark Draper Laboratory Cambridge, MA 02139, USA
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA 02139, USA
- Division of Gastroenterology Brigham and Women’s Hospital Harvard Medical School Boston, MA 02115, USA
- Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge, MA 02139, USA
| | - Ameya R. Kirtane
- Department of Mechanical Engineering University of Utah Salt Lake City, UT 84112, USA
- Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
- Charles Stark Draper Laboratory Cambridge, MA 02139, USA
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA 02139, USA
- Division of Gastroenterology Brigham and Women’s Hospital Harvard Medical School Boston, MA 02115, USA
- Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge, MA 02139, USA
| | - Shen Ning
- Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
| | - Jianlin Zhou
- Department of Mechanical Engineering University of Utah Salt Lake City, UT 84112, USA
- Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
- Charles Stark Draper Laboratory Cambridge, MA 02139, USA
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA 02139, USA
- Division of Gastroenterology Brigham and Women’s Hospital Harvard Medical School Boston, MA 02115, USA
- Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge, MA 02139, USA
| | - Abubakar Abid
- Department of Mechanical Engineering University of Utah Salt Lake City, UT 84112, USA
- Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
- Charles Stark Draper Laboratory Cambridge, MA 02139, USA
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA 02139, USA
- Division of Gastroenterology Brigham and Women’s Hospital Harvard Medical School Boston, MA 02115, USA
- Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge, MA 02139, USA
| | - Mousa Jafari
- Department of Mechanical Engineering University of Utah Salt Lake City, UT 84112, USA
- Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
- Charles Stark Draper Laboratory Cambridge, MA 02139, USA
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA 02139, USA
- Division of Gastroenterology Brigham and Women’s Hospital Harvard Medical School Boston, MA 02115, USA
- Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge, MA 02139, USA
| | - Jaimie Rogner
- Department of Mechanical Engineering University of Utah Salt Lake City, UT 84112, USA
- Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
- Charles Stark Draper Laboratory Cambridge, MA 02139, USA
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA 02139, USA
- Division of Gastroenterology Brigham and Women’s Hospital Harvard Medical School Boston, MA 02115, USA
- Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge, MA 02139, USA
| | - Daniel Minahan
- Department of Mechanical Engineering University of Utah Salt Lake City, UT 84112, USA
- Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
- Charles Stark Draper Laboratory Cambridge, MA 02139, USA
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA 02139, USA
- Division of Gastroenterology Brigham and Women’s Hospital Harvard Medical School Boston, MA 02115, USA
- Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge, MA 02139, USA
| | - Joy E. Collins
- Department of Mechanical Engineering University of Utah Salt Lake City, UT 84112, USA
- Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
- Charles Stark Draper Laboratory Cambridge, MA 02139, USA
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA 02139, USA
- Division of Gastroenterology Brigham and Women’s Hospital Harvard Medical School Boston, MA 02115, USA
- Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge, MA 02139, USA
| | - Shane McDonnell
- Department of Mechanical Engineering University of Utah Salt Lake City, UT 84112, USA
- Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
- Charles Stark Draper Laboratory Cambridge, MA 02139, USA
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA 02139, USA
- Division of Gastroenterology Brigham and Women’s Hospital Harvard Medical School Boston, MA 02115, USA
- Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge, MA 02139, USA
| | - Cody Cleveland
- Department of Mechanical Engineering University of Utah Salt Lake City, UT 84112, USA
- Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
- Charles Stark Draper Laboratory Cambridge, MA 02139, USA
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA 02139, USA
- Division of Gastroenterology Brigham and Women’s Hospital Harvard Medical School Boston, MA 02115, USA
- Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge, MA 02139, USA
| | - Taylor Bensel
- Department of Mechanical Engineering University of Utah Salt Lake City, UT 84112, USA
- Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
- Charles Stark Draper Laboratory Cambridge, MA 02139, USA
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA 02139, USA
- Division of Gastroenterology Brigham and Women’s Hospital Harvard Medical School Boston, MA 02115, USA
- Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge, MA 02139, USA
| | - Siid Tamang
- Department of Mechanical Engineering University of Utah Salt Lake City, UT 84112, USA
- Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
- Charles Stark Draper Laboratory Cambridge, MA 02139, USA
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA 02139, USA
- Division of Gastroenterology Brigham and Women’s Hospital Harvard Medical School Boston, MA 02115, USA
- Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge, MA 02139, USA
| | - Graham Arrick
- Department of Mechanical Engineering University of Utah Salt Lake City, UT 84112, USA
- Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
- Charles Stark Draper Laboratory Cambridge, MA 02139, USA
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA 02139, USA
- Division of Gastroenterology Brigham and Women’s Hospital Harvard Medical School Boston, MA 02115, USA
- Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge, MA 02139, USA
| | - Alla Gimbel
- Department of Mechanical Engineering University of Utah Salt Lake City, UT 84112, USA
- Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
- Charles Stark Draper Laboratory Cambridge, MA 02139, USA
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA 02139, USA
- Division of Gastroenterology Brigham and Women’s Hospital Harvard Medical School Boston, MA 02115, USA
- Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge, MA 02139, USA
| | - Tiffany Hua
- Department of Mechanical Engineering University of Utah Salt Lake City, UT 84112, USA
- Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
- Charles Stark Draper Laboratory Cambridge, MA 02139, USA
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA 02139, USA
- Division of Gastroenterology Brigham and Women’s Hospital Harvard Medical School Boston, MA 02115, USA
- Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge, MA 02139, USA
| | - Udayan Ghosh
- Department of Mechanical Engineering University of Utah Salt Lake City, UT 84112, USA
| | - Vance Soares
- Department of Mechanical Engineering University of Utah Salt Lake City, UT 84112, USA
- Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
- Charles Stark Draper Laboratory Cambridge, MA 02139, USA
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA 02139, USA
- Division of Gastroenterology Brigham and Women’s Hospital Harvard Medical School Boston, MA 02115, USA
- Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge, MA 02139, USA
| | - Nancy Wang
- Department of Mechanical Engineering University of Utah Salt Lake City, UT 84112, USA
- Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
- Charles Stark Draper Laboratory Cambridge, MA 02139, USA
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA 02139, USA
- Division of Gastroenterology Brigham and Women’s Hospital Harvard Medical School Boston, MA 02115, USA
- Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge, MA 02139, USA
| | - Aniket Wahane
- Department of Mechanical Engineering University of Utah Salt Lake City, UT 84112, USA
- Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
- Charles Stark Draper Laboratory Cambridge, MA 02139, USA
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA 02139, USA
- Division of Gastroenterology Brigham and Women’s Hospital Harvard Medical School Boston, MA 02115, USA
- Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge, MA 02139, USA
| | - Alison Hayward
- Department of Mechanical Engineering University of Utah Salt Lake City, UT 84112, USA
- Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
- Charles Stark Draper Laboratory Cambridge, MA 02139, USA
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA 02139, USA
- Division of Gastroenterology Brigham and Women’s Hospital Harvard Medical School Boston, MA 02115, USA
- Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge, MA 02139, USA
| | - Shiyi Zhang
- Department of Mechanical Engineering University of Utah Salt Lake City, UT 84112, USA
- Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
- Charles Stark Draper Laboratory Cambridge, MA 02139, USA
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA 02139, USA
- Division of Gastroenterology Brigham and Women’s Hospital Harvard Medical School Boston, MA 02115, USA
- Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge, MA 02139, USA
| | - Brian R. Smith
- Department of Mechanical Engineering University of Utah Salt Lake City, UT 84112, USA
- Boston University School of Medicine 72 E Concord St, Boston, MA 02118, USA
- Charles Stark Draper Laboratory Cambridge, MA 02139, USA
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA 02139, USA
- Division of Gastroenterology Brigham and Women’s Hospital Harvard Medical School Boston, MA 02115, USA
- Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge, MA 02139, USA
| | - Robert Langer
- Charles Stark Draper Laboratory Cambridge, MA 02139, USA
| | - Giovanni Traverso
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA 02139, USA
- Division of Gastroenterology Brigham and Women’s Hospital Harvard Medical School Boston, MA 02115, USA
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11
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Valverde J, Vinagreiro M, Gouveia P, Koch P, Soares V, Gomes T. Sarcoma the great "masquerader" hematoma/deep vein thrombosis manifestation. Int J Surg Case Rep 2016; 28:348-351. [PMID: 27792978 PMCID: PMC5090197 DOI: 10.1016/j.ijscr.2016.10.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/15/2016] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The clinical presentation of patients with soft-tissue sarcoma is highly variable. Most patients present with a painless mass, typically one that is increasing in size, and few have systemic symptoms such as fever, weight loss, or malaise. Soft tissue sarcomas can initially present as, or even be misdiagnosed as, deep venous thrombosis (DVT), leading to a late diagnosis. CASE REPORT A 51-year-old woman presented to the hospital with complaints of pain and swelling in her left thigh, interpreted as an infected hematoma with an associated deep vein thrombosis and treated accordingly. The patient presented to our emergency department two more times. In the last visit and due to an unresolving clinical scenario a MRI and surgical byopsies were made that confirmed a sarcoma diagnosis. DISCUSSION When a patient presents with an expanding, nontraumatic mass simulating a haematoma, several other differential diagnoses should be considered including aneurysm, bleeding tendency, chronic expanding haematoma and soft-tissue sarcoma. The growth of the tumor undetected while being treated for the DVT and then posteriorly for the hematoma, was without a doubt dismal to the patient, so earlier diagnosis would have been preferable. CONCLUSION When a patient presents with an unusual history of hematoma in the extremities, it is necessary to consider the possibility of a malignant soft tissue tumor.
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Affiliation(s)
- J Valverde
- Rua Dr. Eduardo Torres, 4464-513 Senhora da Hora, Portugal.
| | - M Vinagreiro
- Rua Dr. Eduardo Torres, 4464-513 Senhora da Hora, Portugal
| | - P Gouveia
- Rua Dr. Eduardo Torres, 4464-513 Senhora da Hora, Portugal
| | - P Koch
- Rua Dr. Eduardo Torres, 4464-513 Senhora da Hora, Portugal
| | - V Soares
- Rua Dr. Eduardo Torres, 4464-513 Senhora da Hora, Portugal
| | - T Gomes
- Rua Dr. Eduardo Torres, 4464-513 Senhora da Hora, Portugal
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12
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Abstract
AbstractSurface micromachining is used with amorphous silicon, microcrystalline silicon, silicon nitride and aluminum films as structural materials to form bridge and cantilever structures. Low temperature processing (between 110 and 250 °C) allowed fabrication of structures and devices on glass substrates. Two processes involving different materials as the sacrificial layer are presented: silicon nitride and photoresist. The mechanical integrity of the fabricated structures is discussed. As examples of possible device applications of this technology, air-gap thin film transistors and the electrostatic actuation of bridges and cantilevers are presented.
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13
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Barroso DE, Carvalho DM, Casagrande ST, Rebelo MC, Soares V, Zahner V, Solari CA, Nogueira SA. Microbiological epidemiological history of meningococcal disease in Rio de Janeiro, Brazil. Braz J Infect Dis 2010. [DOI: 10.1590/s1413-86702010000300008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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14
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Barroso DE, Carvalho D, Casagrande S, Rebelo M, Soares V, Zahner V, Solari C, Nogueira S. Microbiological epidemiological history of meningococcal disease in Rio de Janeiro, Brazil. Braz J Infect Dis 2010. [DOI: 10.1016/s1413-8670(10)70051-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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15
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Barroso DE, Carvalho DM, Casagrande ST, Rebelo MC, Soares V, Zahner V, Solari CA, Nogueira SA. Microbiological epidemiological history of meningococcal disease in Rio de Janeiro, Brazil. Braz J Infect Dis 2010; 14:242-251. [PMID: 20835507] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Indexed: 05/29/2023] Open
Abstract
The main objectives of the present study were to investigate the clinical and laboratory features of meningococcal disease in the city of Rio de Janeiro, Brazil, during the overlap of 2 epidemics in the 1990s. We conducted a study of a series of cases of meningococcal disease admitted in a Meningitis Reference Hospital. All clinical isolates available were analyzed by means of microbiological epidemiological markers. In 1990, Neisseria meningitidis serogroup B:4,7:P1.19,15, 1.7,1 sulfadiazine-resistant of the ET-5 complex emerged causing epidemic disease. Despite mass vaccination campaign (VaMengoc B+C®), the ET-5 clone remained hyperendemic after the epidemic peaked. In 1993 to 1995, an epidemic of serogroup C belonged to the cluster A4 overlapped, with a significant shift in the age distribution toward older age groups and an increase of sepsis. Serogroup C epidemics are a recurrent problem in Rio de Janeiro, which can be hindered with the introduction of a conjugate vaccine. We hope the data presented here brings useful information to discuss vaccines strategies and early management of suspected cases.
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Affiliation(s)
- David Eduardo Barroso
- Instituto Estadual de Infectologia São Sebastião, Rio de Janeiro, RJ, Brazil. ocruz.br
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16
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Abstract
In order to assess the effects of mycophenolate mofetil (MMF) on the development of adriamycin-induced nephropathy, the development of this nephropathy in rats treated with MMF was compared to that in non-treated animals (group ADR + V) over 28 weeks. At weeks 8, 16 and 20, 24-h proteinuria of the treated group statistically differed from that of the non-treated group. However, no significant difference in proteinuria was observed thereafter between the groups. At the end of the experiment, there was no significant difference between both groups regarding the frequency of glomerular lesion (Group ADR + V: Md = 35%, P25 = 20%, P75 = 68%; Group ADR + MMF: Md = 27%, P25 = 9.5%, P75 = 54%); tubulointerstitial lesion index (Group ADR + V: Md = 7, P25 = 1.5, P75 = 9; Group ADR + MMF: Md = 8, P25 = 2, P75 = 9); glomerulosclerosis area (group ADR + V = 2779 microm2, P25 = 751.8 microm2, P75 = 3115 microm2; Group ADR + MMF = 1147 microm2, P25 = 3969.7 microm2, P75 = 1560 microm2); and, interstitial fibrosis area (Group ADR + V: Md = 218200 microm2, P25 = 78670 microm2, P75 = 282700 microm2 group ADR + MMF: Md = 136000, P25 = 25010, P75 = 255800 microm2). In conclusion, MMF caused a temporary reduction in proteinuria but did not change the severity of the renal lesion observed after 28 weeks.
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Affiliation(s)
- M Ryuzo
- Botucatu Medical School, Dept. of Internal Medicine, Division of Nephrology, SP, Brazil
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17
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Abstract
In the present work, 199 patients with leprosy who underwent autopsy between 1970 and 1986 were retrospectively studied to determine the prevalence, types, clinical characteristics, and etiologic factors of renal lesions (RLs) in leprosy. Patients were divided into two groups: 144 patients with RLs (RL+) and 55 patients without RLs (RL-). RLs observed in 72% of the autopsied patients were amyloidosis (AMY) in 61 patients (31%), glomerulonephritis (GN) in 29 patients (14%), nephrosclerosis (NPS) in 22 patients (11%), tubulointerstitial nephritis (TIN) in 18 patients (9%), granuloma in 2 patients (1%), and other lesions in 12 patients (6%). AMY occurred most frequently in patients with lepromatous leprosy (36%; nonlepromatous leprosy, 5%; P < 0.01), recurrent erythema nodosum leprosum (33%; P < 0.02), and trophic ulcers (27%; 0.05 < P < 0.10). Ninety-seven percent of AMY was found in patients with lepromatous leprosy, 88% showed recurrent trophic ulcers, and 76% presented with erythema nodosum leprosum. NPS was found in older patients with arterial hypertension, neoplastic diseases, infectious diseases, and vasculitis associated with GN. Most patients with AMY presented with proteinuria (95%) and renal failure (88%). The most frequent causes of death were renal failure in patients with AMY (57%), infectious diseases in patients with GN (41%) and TIN (45%), and cardiovascular diseases in patients with NPS (41%). No difference in survival rates was observed among RL- patients and those with AMY, GN, NPS, or TIN.
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18
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Abstract
In this study, the graft outcome in renal allograft recipients with [high cholesterol group (HCG), n = 30] or without [normal cholesterol group (NCG), n = 42] hypercholesterolemia and with [high triglyceride group (HTG), n = 33] or without [normal triglyceride group (NTG), n = 36] hypertriglyceridemia were prospectively compared. At 6 months post-transplantation, no significant difference was observed between the groups (NTG compared with HTG, and NCG compared with HCG) regarding age, presence of arterial hypertension, kind of donor (living related or cadaveric), immunosuppressive therapy, number of rejection episodes per patient, frequency of patients with acute cellular rejection, prevalence of patients with diabetes mellitus or proteinuria > 3 g/24 h, and mean serum creatinine. The probability of doubling serum creatinine during follow-up was statistically different between NTG and HTG (12 months: NTG = 0.03, HTG = 0.15; 36 months: NTG = 0.08, HTG = 0.33: 60 months: NTG = 0.08, HTG = 0.48; and 120 months: NTG = 0.18, HTG = 0.48), but not between NCG and HCG (12 months: NCG = 0.05, HCG = 0.13; 36 months: NCG = 0.13, HCG = 0.24; 60 months: NCG = 0.19, HCG = 0.31; 84 months: NCG = 0.27, HCG = 0.31). There was no significant difference in actuarial graft survival between HCG and NCG or between NTG and HTG. Hypertriglyceridemia, but not hypercholesterolemia, was associated with loss of graft function.
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Affiliation(s)
- M F Carvalho
- Department of Internal Medicine, Botucatu Medical School, UNESP, Brazil.
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19
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Kissel H, Timokhina I, Hardy MP, Rothschild G, Tajima Y, Soares V, Angeles M, Whitlow SR, Manova K, Besmer P. Point mutation in kit receptor tyrosine kinase reveals essential roles for kit signaling in spermatogenesis and oogenesis without affecting other kit responses. EMBO J 2000; 19:1312-26. [PMID: 10716931 PMCID: PMC305672 DOI: 10.1093/emboj/19.6.1312] [Citation(s) in RCA: 280] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2000] [Revised: 01/31/2000] [Accepted: 01/31/2000] [Indexed: 01/14/2023] Open
Abstract
The Kit receptor tyrosine kinase functions in hemato- poiesis, melanogenesis and gametogenesis. Kit receptor-mediated cellular responses include proliferation, survival, adhesion, secretion and differentiation. In mast cells, Kit-mediated recruitment and activation of phosphatidylinositol 3'-kinase (PI 3-kinase) produces phosphatidylinositol 3'-phosphates, plays a critical role in mediating cell adhesion and secretion and has contributory roles in mediating cell survival and proliferation. To investigate the consequences in vivo of blocking Kit-mediated PI 3-kinase activation we have mutated the binding site for the p85 subunit of PI 3-kinase in the Kit gene, using a knock-in strategy. Mutant mice have no pigment deficiency or impairment of steady-state hematopoiesis. However, gametogenesis is affected in several ways and tissue mast cell numbers are affected differentially. While primordial germ cells during embryonic development are not affected, Kit(Y719F)/Kit(Y719F) males are sterile due to a block at the premeiotic stages in spermatogenesis. Furthermore, adult males develop Leydig cell hyperplasia. The Leydig cell hyperplasia implies a role for Kit in Leydig cell differentiation and/or steroidogenesis. In mutant females follicle development is impaired at the cuboidal stages resulting in reduced fertility. Also, adult mutant females develop ovarian cysts and ovarian tubular hyperplasia. Therefore, a block in Kit receptor-mediated PI 3-kinase signaling may be compensated for in hematopoiesis, melanogenesis and primordial germ cell development, but is critical in spermatogenesis and oogenesis.
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Affiliation(s)
- H Kissel
- Molecular Biology Program, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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20
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Abstract
Three experimental protocols were carried out with the aim of evaluating the role of protein restriction on the progression of the established adriamycin-induced nephropathy, and whether the protective effect of the diet persists after the diet is discontinued. The effect of a low protein diet (LPD) was studied for 6 weeks in protocol 1, 16 weeks in protocol 2 and for 28 weeks in protocol 3. In protocol 3, one group (LL) received LPD and another (NN) was given a normal protein diet (NPD). A third group (LN) received LPD for 16 weeks and then NPD for 12 weeks and a fourth group (NL) was fed NPD for 16 weeks and then LPD for 12 weeks. In protocol 1 the tubulo-interstitial index (TILI) of rats on LPD (Md = 2, P25 = 0.0; P75 = 3.5) after six weeks, was smaller than that of the animals on NPD (Md = 6.0; P25 = 3.0; P75 = 8.0; p < 0.05). In protocol 2, the group taking LPD presented an area of interstitial fibrosis (IF) (Md = 0.5%, P25 0.2%; P75 = 1.9%) smaller than that of the NPD group (Md = 6.8%; P25 = 5.2%; P75 = 7.1%; p < 0.05). No significant difference in the area of glomerulosclerosis (GSA) was observed between the animals on LPD (Md = 0.0%; P25 = 0.0%, P75 = 0.0%) and NPD (Md = 0.37%; P25 = 02%, P75 = 1.25%; p > 0.05). In protocol 3, the group LL showed GSA (Md = 1.3%; P25 0.6%, P75 = 2.5%) and IF (Md = 3.6%; P25 = 1.6%; P75 = 5.9%) smaller that those of LN (GSA Md = 10.1%; P25 = 6.6%; P75 = 14.8%; IF: Md = 17.3%; P25 = 14.1%; P75 = 24.5%), NL (GSA: Md = 9.1%; P25 = 5.8%; P75 = 11.7%; IF: Md = 25.0%; P25 = 20.4%; P75 = 30%), and NN (GSA: Md = 6.75%; P25 = 4.9%; P75 = 11.7%; IF: Md = 20.9%; P25 = 16.2%; P75 = 32.4%). In conclusion, in order to be effective, LPD must be introduced early and maintained for a long period of tune.
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Affiliation(s)
- P Barretti
- Department of Internal Medicine, Botucatu Medical School-UNESP, Brazil
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21
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Feldmeier H, Daccal RC, Martins MJ, Soares V, Martins R. Genital manifestations of schistosomiasis mansoni in women: important but neglected. Mem Inst Oswaldo Cruz 1999; 93 Suppl 1:127-33. [PMID: 9921334 DOI: 10.1590/s0074-02761998000700018] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [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: 11/22/2022] Open
Abstract
Egg-induced lesions in the upper and the lower female reproductive tract are important complications of the infection with Schistosoma mansoni. The understanding of the pathophysiology and pathology of genital lesions is only rudimentary, simple and reliable diagnostic tools are not at hand, epidemiological data do not exist and how to treat best the women affected, is not known. In view of recent advances in the understanding of genital lesions induced by S. haematobium the existing literature is critically analyzed and possible consequences of female genital schistosomiasis are outlined. We estimate that 6 to 27% girls and women with intestinal schistosomiasis, at least temporarily, suffer from pathology induced by eggs sequestered somewhere in their genital organs. This is a matter of concern and warrants more research into the epidemiology, pathology, diagnosis and therapy of this disease entity.
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Affiliation(s)
- H Feldmeier
- Faculty of Medicine, Free University of Berlin, Germany.
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22
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Tomihara-Newberger C, Haub O, Lee HG, Soares V, Manova K, Lacy E. The amn gene product is required in extraembryonic tissues for the generation of middle primitive streak derivatives. Dev Biol 1998; 204:34-54. [PMID: 9851841 DOI: 10.1006/dbio.1998.9034] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [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: 11/22/2022]
Abstract
The primitive streak is the defining feature of the gastrulating mouse embryo. Currently, little is known in the mouse about the mechanisms that mediate the assembly of the primitive streak or about the signaling pathways that specify the different types of mesoderm and endoderm generated from the streak. To gain insight into primitive streak assembly and function, we have conducted a detailed phenotypic characterization of amnionless, a transgene-induced insertional mouse mutation that arrests embryonic development during gastrulation. Our histological and molecular analyses, when examined in the context of the mouse gastrula fate map, lead to the model that middle streak formation is specifically impaired in the amnionless mutant. Significantly, these observations argue that the formation of the middle streak is mediated by a pathway that is genetically separable from those that direct the specification of the distal and proximal streak regions. Intriguingly, our findings from wt ES cell left and right arrow amnionless-/- blastocyst chimeras indicate that this proposed separate pathway for middle streak formation is dependent on amnionless gene functions in the visceral endoderm.
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Affiliation(s)
- C Tomihara-Newberger
- Sloan-Kettering Division, Graduate School of Medical Sciences, Cornell University, 1275 York Avenue, New York, New York, 10021, USA
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23
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Tajima Y, Moore MA, Soares V, Ono M, Kissel H, Besmer P. Consequences of exclusive expression in vivo of Kit-ligand lacking the major proteolytic cleavage site. Proc Natl Acad Sci U S A 1998; 95:11903-8. [PMID: 9751763 PMCID: PMC21738 DOI: 10.1073/pnas.95.20.11903] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.7] [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: 11/18/2022] Open
Abstract
Membrane growth factors that are processed to produce soluble ligands may function both as soluble factors and as membrane factors. The membrane growth factor Kit-ligand (KL), the ligand of the Kit receptor tyrosine kinase, is encoded at the Sl locus, and mice carrying Sl mutations have defects in hematopoiesis, gametogenesis, and melanogenesis. Two alternatively spliced KL transcripts encode two cell-associated KL protein products, KL-1 and KL-2. The KL-2 protein lacks the major proteolytic cleavage site for the generation of soluble KL, thus representing a more stable cell-associated form of KL. We investigated the consequences of exclusive expression of KL-2 in vivo. The KL gene in embryonic stem cells was modified and KL exon 6 was replaced with a PGKneoNTRtkpA cassette by homologous recombination, and mice carrying the SlKL2 allele were obtained. SlKL2/SlKL2 mice had only slightly reduced levels of soluble KL in their serum, suggesting that in vivo KL-2 may be processed to produce soluble KL-2S. The steady-state characteristics of the hematopoietic system and progenitor numbers were normal, and the mutant animals were not anemic. However, mast cell numbers in the skin and peritoneum were reduced and the mutant animals displayed increased sensitivity to sublethal doses of gamma-irradiation. Therefore, KL-2 may substitute for KL-1 in most situations with the exception of the production of mast cells, and induced proteolytic cleavage of KL-1 to produce soluble KL may have a role in the regeneration of hematopoietic tissue after radiation injury.
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Affiliation(s)
- Y Tajima
- Molecular Biology, Cornell University, 1275 York Avenue, New York, NY 10021, USA
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24
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Affiliation(s)
- M F Carvalho
- Department of Internal Medicine, Botucatu Medical School-UNESP, Brazil
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25
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Carvalho MF, Adoni T, Saggioro FP, Soares V. Effectiveness of short-term OKT3 therapy in the treatment of steroid-resistant renal allograft rejection. Transplant Proc 1998; 30:2876-7. [PMID: 9745607 DOI: 10.1016/s0041-1345(98)00851-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- M F Carvalho
- Department of Internal Medicine, Botucatu Medical School-UNESP, São Paulo, Brazil
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26
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Rosti V, Tremml G, Soares V, Pandolfi PP, Luzzatto L, Bessler M. Murine embryonic stem cells without pig-a gene activity are competent for hematopoiesis with the PNH phenotype but not for clonal expansion. J Clin Invest 1997; 100:1028-36. [PMID: 9276719 PMCID: PMC508277 DOI: 10.1172/jci119613] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.1] [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: 02/05/2023] Open
Abstract
Paroxysmal nocturnal hemoglobinuria (PNH) develops in patients who have had a somatic mutation in the X-linked PIG-A gene in a hematopoietic stem cell; as a result, a proportion of blood cells are deficient in all glycosyl phosphatidylinositol (GPI)-anchored proteins. Although the PIG-A mutation explains the phenotype of PNH cells, the mechanism enabling the PNH stem cell to expand is not clear. To examine this growth behavior, and to investigate the role of GPI-linked proteins in hematopoietic differentiation, we have inactivated the pig-a gene by homologous recombination in mouse embryonic stem (ES) cells. In mouse chimeras, pig-a- ES cells were able to contribute to hematopoiesis and to differentiate into mature red cells, granulocytes, and lymphocytes with the PNH phenotype. The proportion of PNH red cells was substantial in the fetus, but decreased rapidly after birth. Likewise, PNH granulocytes could only be demonstrated in the young mouse. In contrast, the percentage of lymphocytes deficient in GPI-linked proteins was more stable. In vitro, pig-a- ES cells were able to form pig-a- embryoid bodies and to undergo hematopoietic (erythroid and myeloid) differentiation. The number and the percentage of pig-a- embryoid bodies with hematopoietic differentiation, however, were significantly lower when compared with wild-type embryoid bodies. Our findings demonstrate that murine ES cells with a nonfunctional pig-a gene are competent for hematopoiesis, and give rise to blood cells with the PNH phenotype. pig-a inactivation on its own, however, does not confer a proliferative advantage to the hematopoietic stem cell. This provides direct evidence for the notion that some additional factor(s) are needed for the expansion of the mutant clone in patients with PNH.
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Affiliation(s)
- V Rosti
- Department of Human Genetics, Memorial Sloan-Kettering Cancer Center, Molecular Biology and Cell Biology Programs, Sloan Kettering Institute, 1275 York Avenue, New York, New York 10021, USA
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27
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He LZ, Tribioli C, Rivi R, Peruzzi D, Pelicci PG, Soares V, Cattoretti G, Pandolfi PP. Acute leukemia with promyelocytic features in PML/RARalpha transgenic mice. Proc Natl Acad Sci U S A 1997; 94:5302-7. [PMID: 9144232 PMCID: PMC24673 DOI: 10.1073/pnas.94.10.5302] [Citation(s) in RCA: 281] [Impact Index Per Article: 10.4] [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: 02/04/2023] Open
Abstract
Acute promyelocytic leukemia (APL) is associated with reciprocal chromosomal translocations involving the retinoic acid receptor alpha (RARalpha) locus on chromosome 17. In the majority of cases, RARalpha translocates and fuses with the promyelocytic leukemia (PML) gene located on chromosome 15. The resulting fusion genes encode the two structurally unique PML/RARalpha and RARalpha/PML fusion proteins as well as aberrant PML gene products, the respective pathogenetic roles of which have not been elucidated. We have generated transgenic mice in which the PML/RARalpha fusion protein is specifically expressed in the myeloid-promyelocytic lineage. During their first year of life, all the PML/RARalpha transgenic mice have an abnormal hematopoiesis that can best be described as a myeloproliferative disorder. Between 12 and 14 months of age, 10% of them develop a form of acute leukemia with a differentiation block at the promyelocytic stage that closely mimics human APL even in its response to retinoic acid. Our results are conclusive in vivo evidence that PML/RARalpha plays a crucial role in the pathogenesis of APL.
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MESH Headings
- Aging
- Animals
- Blood Cell Count
- Bone Marrow/pathology
- Cell Differentiation/drug effects
- Chromosomes, Human, Pair 17
- DNA Primers
- Hematopoiesis
- Hematopoietic Stem Cells/cytology
- Hematopoietic Stem Cells/drug effects
- Hematopoietic Stem Cells/pathology
- Humans
- Leukemia, Promyelocytic, Acute/blood
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/pathology
- Lymphocytes/cytology
- Lymphocytes/drug effects
- Lymphocytes/pathology
- Mice
- Mice, Transgenic
- Myeloproliferative Disorders/genetics
- Myeloproliferative Disorders/physiopathology
- Neoplasm Proteins
- Nuclear Proteins
- Polymerase Chain Reaction
- Promyelocytic Leukemia Protein
- Receptors, Retinoic Acid/biosynthesis
- Receptors, Retinoic Acid/genetics
- Recombinant Fusion Proteins/biosynthesis
- Reference Values
- Retinoic Acid Receptor alpha
- Spleen/pathology
- Transcription Factors/biosynthesis
- Transcription Factors/genetics
- Translocation, Genetic
- Tretinoin/pharmacology
- Tumor Suppressor Proteins
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Affiliation(s)
- L Z He
- Department of Human Genetics, Memorial Sloan-Kettering Cancer Center, Molecular Biology and Cell Biology Programs, Sloan-Kettering Institute, 1275 York Avenue, New York, NY, 10021, USA
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28
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Garcia-Zapata MT, Marsden PD, das Virgens D, Penna R, Soares V, do Brasil IA, de Castro CN, Prata A, Macêdo V. [Control of transmission of Chagas disease in Mambai-Goias, Brazil (1982-1984)]. Rev Soc Bras Med Trop 1986; 19:219-25. [PMID: 3150589 DOI: 10.1590/s0037-86821986000400004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
A aplicação de inseticidas em Mambaí-GO, desde 1980, está determinando uma diminuição progressiva inicial de Triatoma infestans no intradomicilio, mas não a sua eliminação. A infestação triatominica foi detectada através de diversos métodos de vigilância imediata (transversal) e a longo prazo (longitudinal), com a colaboração dos próprios moradores. No primeiro ano de controle foi observada uma queda signiflcante de 28,6 % a 13,5%, mas devido a uma falha no programa de expurgos, em 1981, esta cifra voltou a elevar-se (23,2%). A continuidade desses expurgos nos anos seguintes resultou em um declínio gradual, atingindo em 1984 o nível de 14,2%. Simultaneamente a percentagem intradomiciliar de T. sórdida tendeu a aumentar, embora a infecção tripanossômica tenha sido sempre mínima. O conjunto destes achados sugerem que o controle do T. infestans com o uso exclusivo de inseticidas (BHC e Deltametrina) é difícil e oneroso. Precisando-se, portanto, o uso de medidas supletivas integradas aos sistemas de controle de doença de Chagas, que encorajam a participação ativa das comunidades afligidas, estimuladas mediante programas educativos.
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29
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Torno CO, Soares V, Vexenat A, Cuba CC, Barreto AC, Alvarenga NJ, Marsden PD. A case study of xenodiagnosis. Rev Inst Med Trop Sao Paulo 1981; 23:229-32. [PMID: 7034132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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30
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Soares V, Gomes JG, Marques AP. [Results of plastic surgery in Queyrat's erythroplasia]. An Bras Dermatol 1968; 43:304-5. [PMID: 4915930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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