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Pietka G, De Lord C, Matthias G, Cheung B, Atwal S, Furtado M, Cullis J, Grey-Davies L, Narayanan S, McGregor A, Kilner M, Bosworth J, McMullin MF, Coats T, Parcharidou A, Cavenagh J, Byrne J, Iyengar S, Mohammed K, Cross N, Hubank M, Ribeiro S, Khorashad J, Wren D, O'Connor S, Taussig D. Capture-based targeted sequencing using a T-cell control in myeloid malignancies and idiopathic cytopenias. Br J Haematol 2024; 204:1325-1334. [PMID: 38462984 DOI: 10.1111/bjh.19377] [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: 11/21/2023] [Revised: 01/30/2024] [Accepted: 02/20/2024] [Indexed: 03/12/2024]
Abstract
We report on a study of next-generation sequencing in 257 patients undergoing investigations for cytopenias. We sequenced bone marrow aspirates using a target enrichment panel comprising 82 genes and used T cells from paired blood as a control. One hundred and sixty patients had idiopathic cytopenias, 81 had myeloid malignancies and 16 had lymphoid malignancies or other diagnoses. Forty-seven of the 160 patients with idiopathic cytopenias had evidence of somatic pathogenic variants consistent with clonal cytopenias. Only 39 genes of the 82 tested were mutated in the 241 patients with either idiopathic cytopenias or myeloid neoplasms. We confirm that T cells can be used as a control to distinguish between germline and somatic variants. The use of paired analysis with a T-cell control significantly reduced the time molecular scientists spent reporting compared to unpaired analysis. We identified somatic variants of uncertain significance (VUS) in a higher proportion (24%) of patients with myeloid malignancies or clonal cytopenias compared to less than 2% of patients with non-clonal cytopenias. This suggests that somatic VUS are indicators of a clonal process. Lastly, we show that blood depleted of lymphocytes can be used in place of bone marrow as a source of material for sequencing.
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Affiliation(s)
- Grzegorz Pietka
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
- Department of Translational Research, Royal Marsden Hospital NHS Trust, London, UK
| | - Corinne De Lord
- Department of Haematology, St Helier Hospital, London, UK
- Department of Haematology, Royal Marsden Hospital NHS Trust, London, UK
| | - Gwynn Matthias
- Department of Haematology, Queen Alexandra Hospital, Portsmouth, UK
| | - Betty Cheung
- Department of Haematology, Croydon University Hospital, London, UK
| | - Sangeeta Atwal
- Department of Haematology, Kingston Hospital NHS Foundation Trust, London, UK
| | - Michelle Furtado
- Department of Haematology, Royal Cornwall Hospitals NHS Foundation Trust, Cornwall, Truro, UK
| | - Jonathan Cullis
- Department of Haematology, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Liz Grey-Davies
- Department of Haematology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | | | - Andrew McGregor
- Department of Haematology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Mari Kilner
- Department of Haematology, Northumbria Healthcare NHS Foundation Trust, Tyneside, UK
| | - Jenny Bosworth
- Department of Haematology, St Helier Hospital, London, UK
- Department of Haematology, Royal Marsden Hospital NHS Trust, London, UK
| | | | - Thomas Coats
- Department of Haematology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Jamie Cavenagh
- Department of Haematology, St Bartholomew's Hospital, London, UK
| | - Jenny Byrne
- Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sunil Iyengar
- Department of Haematology, Royal Marsden Hospital NHS Trust, London, UK
| | - Kabir Mohammed
- Department of Statistics, Royal Marsden Hospital NHS Trust, London, UK
| | - Nicholas Cross
- Faculty of Medicine, University of Southampton, Southampton, UK
- Wessex Genomics Laboratory Service, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Mike Hubank
- Department of Translational Research, Royal Marsden Hospital Sutton, London, UK
- Division of Molecular Pathology, Clinical Genomics (Research), Institute of Cancer Research, London, UK
| | - Sara Ribeiro
- Department of Molecular Pathology, Royal Marsden Hospital Sutton, London, UK
| | - Jamshid Khorashad
- Department of Molecular Pathology, Royal Marsden Hospital Sutton, London, UK
| | - Dorte Wren
- Department of Molecular Pathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Simon O'Connor
- Department of Histopathology, Royal Marsden NHS Foundation Trust, London, UK
| | - David Taussig
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
- Department of Haematology, Royal Marsden Hospital NHS Trust, London, UK
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Doran SJ, Barfoot T, Wedlake L, Winfield JM, Petts J, Glocker B, Li X, Leach M, Kaiser M, Barwick TD, Chaidos A, Satchwell L, Soneji N, Elgendy K, Sheeka A, Wallitt K, Koh DM, Messiou C, Rockall A. Curation of myeloma observational study MALIMAR using XNAT: solving the challenges posed by real-world data. Insights Imaging 2024; 15:47. [PMID: 38361108 PMCID: PMC10869673 DOI: 10.1186/s13244-023-01591-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/06/2023] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVES MAchine Learning In MyelomA Response (MALIMAR) is an observational clinical study combining "real-world" and clinical trial data, both retrospective and prospective. Images were acquired on three MRI scanners over a 10-year window at two institutions, leading to a need for extensive curation. METHODS Curation involved image aggregation, pseudonymisation, allocation between project phases, data cleaning, upload to an XNAT repository visible from multiple sites, annotation, incorporation of machine learning research outputs and quality assurance using programmatic methods. RESULTS A total of 796 whole-body MR imaging sessions from 462 subjects were curated. A major change in scan protocol part way through the retrospective window meant that approximately 30% of available imaging sessions had properties that differed significantly from the remainder of the data. Issues were found with a vendor-supplied clinical algorithm for "composing" whole-body images from multiple imaging stations. Historic weaknesses in a digital video disk (DVD) research archive (already addressed by the mid-2010s) were highlighted by incomplete datasets, some of which could not be completely recovered. The final dataset contained 736 imaging sessions for 432 subjects. Software was written to clean and harmonise data. Implications for the subsequent machine learning activity are considered. CONCLUSIONS MALIMAR exemplifies the vital role that curation plays in machine learning studies that use real-world data. A research repository such as XNAT facilitates day-to-day management, ensures robustness and consistency and enhances the value of the final dataset. The types of process described here will be vital for future large-scale multi-institutional and multi-national imaging projects. CRITICAL RELEVANCE STATEMENT This article showcases innovative data curation methods using a state-of-the-art image repository platform; such tools will be vital for managing the large multi-institutional datasets required to train and validate generalisable ML algorithms and future foundation models in medical imaging. KEY POINTS • Heterogeneous data in the MALIMAR study required the development of novel curation strategies. • Correction of multiple problems affecting the real-world data was successful, but implications for machine learning are still being evaluated. • Modern image repositories have rich application programming interfaces enabling data enrichment and programmatic QA, making them much more than simple "image marts".
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Affiliation(s)
- Simon J Doran
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK.
- National Cancer Imaging Translational Accelerator, London, UK.
| | - Theo Barfoot
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Jessica M Winfield
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
- Joint Department of Physics, The Royal Marsden NHS Foundation Trust, London, UK
| | - James Petts
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Ben Glocker
- Department of Computing, Imperial College London, London, UK
| | - Xingfeng Li
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Martin Leach
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
- Joint Department of Physics, The Royal Marsden NHS Foundation Trust, London, UK
| | - Martin Kaiser
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
- Haemato-Oncology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Tara D Barwick
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Aristeidis Chaidos
- Department of Haematology, Imperial College Healthcare NHS Trust, London, UK
| | - Laura Satchwell
- Research and Development Statistics Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Neil Soneji
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Khalil Elgendy
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Alexander Sheeka
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Kathryn Wallitt
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Dow-Mu Koh
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
- National Cancer Imaging Translational Accelerator, London, UK
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Christina Messiou
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Andrea Rockall
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
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Dillon MT, Guevara J, Mohammed K, Patin EC, Smith SA, Dean E, Jones GN, Willis SE, Petrone M, Silva C, Thway K, Bunce C, Roxanis I, Nenclares P, Wilkins A, McLaughlin M, Jayme-Laiche A, Benafif S, Nintos G, Kwatra V, Grove L, Mansfield D, Proszek P, Martin P, Moore L, Swales KE, Banerji U, Saunders MP, Spicer J, Forster MD, Harrington KJ. Durable responses to ATR inhibition with ceralasertib in tumors with genomic defects and high inflammation. J Clin Invest 2024; 134:e175369. [PMID: 37934611 PMCID: PMC10786692 DOI: 10.1172/jci175369] [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: 08/31/2023] [Accepted: 11/02/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUNDPhase 1 study of ATRinhibition alone or with radiation therapy (PATRIOT) was a first-in-human phase I study of the oral ATR (ataxia telangiectasia and Rad3-related) inhibitor ceralasertib (AZD6738) in advanced solid tumors.METHODSThe primary objective was safety. Secondary objectives included assessment of antitumor responses and pharmacokinetic (PK) and pharmacodynamic (PD) studies. Sixty-seven patients received 20-240 mg ceralasertib BD continuously or intermittently (14 of a 28-day cycle).RESULTSIntermittent dosing was better tolerated than continuous, which was associated with dose-limiting hematological toxicity. The recommended phase 2 dose of ceralasertib was 160 mg twice daily for 2 weeks in a 4-weekly cycle. Modulation of target and increased DNA damage were identified in tumor and surrogate PD. There were 5 (8%) confirmed partial responses (PRs) (40-240 mg BD), 34 (52%) stable disease (SD), including 1 unconfirmed PR, and 27 (41%) progressive disease. Durable responses were seen in tumors with loss of AT-rich interactive domain-containing protein 1A (ARID1A) and DNA damage-response defects. Treatment-modulated tumor and systemic immune markers and responding tumors were more immune inflamed than nonresponding.CONCLUSIONCeralasertib monotherapy was tolerated at 160 mg BD intermittently and associated with antitumor activity.TRIAL REGISTRATIONClinicaltrials.gov: NCT02223923, EudraCT: 2013-003994-84.FUNDINGCancer Research UK, AstraZeneca, UK Department of Health (National Institute for Health Research), Rosetrees Trust, Experimental Cancer Medicine Centre.
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Affiliation(s)
- Magnus T. Dillon
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Jeane Guevara
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Kabir Mohammed
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | - Emma Dean
- Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | | | | | - Marcella Petrone
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge, United Kingdom
| | - Carlos Silva
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge, United Kingdom
| | - Khin Thway
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Catey Bunce
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | - Anna Wilkins
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Adoracion Jayme-Laiche
- UCL Cancer Institute and University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Sarah Benafif
- UCL Cancer Institute and University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Georgios Nintos
- King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Vineet Kwatra
- King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Lorna Grove
- The Institute of Cancer Research, London, United Kingdom
| | | | - Paula Proszek
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Philip Martin
- Oncology R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Luiza Moore
- Oncology R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | | | - Udai Banerji
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - James Spicer
- King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Martin D. Forster
- UCL Cancer Institute and University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Kevin J. Harrington
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
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Bradley J, Schelbert EB, Bonnett LJ, Lewis GA, Lagan J, Orsborne C, Brown PF, Black N, Naish JH, Williams SG, McDonagh T, Schmitt M, Miller CA. Growth differentiation factor-15 in patients with or at risk of heart failure but before first hospitalisation. Heart 2024; 110:195-201. [PMID: 37567614 PMCID: PMC10850645 DOI: 10.1136/heartjnl-2023-322857] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/13/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVE Identification of patients at risk of adverse outcome from heart failure (HF) at an early stage is a priority. Growth differentiation factor (GDF)-15 has emerged as a potentially useful biomarker. This study sought to identify determinants of circulating GDF-15 and evaluate its prognostic value, in patients at risk of HF or with HF but before first hospitalisation. METHODS Prospective, longitudinal cohort study of 2166 consecutive patients in stage A-C HF undergoing cardiovascular magnetic resonance and measurement of GDF-15. Multivariable linear regression investigated determinants of GDF-15. Cox proportional hazards modelling, Net Reclassification Improvement and decision curve analysis examined its incremental prognostic value. Primary outcome was a composite of first hospitalisation for HF or all-cause mortality. Median follow-up was 1093 (939-1231) days. RESULTS Major determinants of GDF-15 were age, diabetes and N-terminal pro-B-type natriuretic peptide, although despite extensive phenotyping, only around half of the variability of GDF-15 could be explained (R2 0.51). Log-transformed GDF-15 was the strongest predictor of outcome (HR 2.12, 95% CI 1.71 to 2.63) and resulted in a risk prediction model with higher predictive accuracy (continuous Net Reclassification Improvement 0.26; 95% CI 0.13 to 0.39) and with greater clinical net benefit across the entire range of threshold probabilities. CONCLUSION In patients at risk of HF, or with HF but before first hospitalisation, GDF-15 provides unique information and is highly predictive of hospitalisation for HF or all-cause mortality, leading to more accurate risk stratification that can improve clinical decision making. TRIAL REGISTRATION NUMBER NCT02326324.
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Affiliation(s)
- Joshua Bradley
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Erik B Schelbert
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Cardiovascular Magnetic Resonance Center, UPMC, Pittsburgh, Pennsylvania, USA
| | - Laura J Bonnett
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Gavin A Lewis
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Jakub Lagan
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Christopher Orsborne
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Pamela Frances Brown
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Nicholas Black
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Simon G Williams
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Matthias Schmitt
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Christopher A Miller
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
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Rose AJ, Fleming MM, Francis JC, Ning J, Patrikeev A, Chauhan R, Harrington KJ, Swain A. Cell-type-specific tumour sensitivity identified with a bromodomain targeting PROTAC in adenoid cystic carcinoma. J Pathol 2024; 262:37-49. [PMID: 37792636 DOI: 10.1002/path.6209] [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: 04/21/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 10/06/2023]
Abstract
Salivary gland adenoid cystic carcinoma (ACC) is a rare malignancy with limited treatment options. The development of novel therapies is hindered by a lack of preclinical models. We have generated ACC patient-derived xenograft (PDX) lines that retain the physical and genetic properties of the original tumours, including the presence of the common MYB::NFIB or MYBL1::NFIB translocations. We have developed the conditions for the generation of both 2D and 3D tumour organoid patient-derived ACC models that retain MYB expression and can be used for drug studies. Using these models, we show in vitro and in vivo sensitivity of ACC cells to the bromodomain degrader, dBET6. Molecular studies show a decrease in BRD4 and MYB protein levels and target gene expression with treatment. The most prominent effect of dBET6 on tumours in vivo was a change in the relative composition of ACC cell types expressing either myoepithelial or ductal markers. We show that dBET6 inhibits the progenitor function of ACC cells, particularly in the myoepithelial marker-expressing population, revealing a cell-type-specific sensitivity. These studies uncover a novel mechanistic effect of bromodomain inhibitors on tumours and highlight the need to impact both cell-type populations for more effective treatments in ACC patients. © 2023 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Alexandra J Rose
- Division of Cancer Biology, Institute of Cancer Research, London, UK
| | | | - Jeffrey C Francis
- Division of Cancer Biology, Institute of Cancer Research, London, UK
| | - Jian Ning
- Tumour Modelling Facility, Institute of Cancer Research, London, UK
| | | | - Ritika Chauhan
- Genomics Facility, Institute of Cancer Research, London, UK
| | | | - Amanda Swain
- Division of Cancer Biology, Institute of Cancer Research, London, UK
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Pattison N, O'Gara G, Thomas K, Wigmore T, Dyer J. An aromatherapy massage intervention on sleep in the ICU: A randomized controlled feasibility study. Nurs Crit Care 2024; 29:14-21. [PMID: 37533150 DOI: 10.1111/nicc.12957] [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: 09/13/2022] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 08/04/2023]
Abstract
We conducted a feasibility randomized controlled trial exploring the effect of aromatherapy massage on sleep in critically ill patients. Patients were randomized to receive aromatherapy massage or usual care, and feasibility of recruitment and outcome data completion was captured. Sleep (depth) was assessed through Bispectral Index monitoring and self/nurse-reported Richards-Campbell Sleep Questionnaires, and the Sleep in the ICU Questionnaire. Thirty-four patients participated: 17 were randomized to aromatherapy massage and 17 to control. Five participants who received the intervention completed outcomes for analysis (alongside eight controls). A larger study was deemed unfeasible in this population, highlighting the value of testing feasibility of complex interventions, such as massage for sleep in ICU.
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Affiliation(s)
- Natalie Pattison
- University of Hertfordshire, Hatfield, UK
- East and North Herts NHS Trust, Stevenage, UK
| | | | - Karen Thomas
- Intensive Care National Audit and Research Centre, London, UK
| | - Tim Wigmore
- Royal Marsden NHS Foundation Trust, London, UK
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Tawana-Ndolo SM, Zachariah M, Phaladze NA, Sichilongo KF. A solid-phase microextraction gas chromatography-mass spectrometry technique for urinary metabolomics of human samples infected with schistosomiasis-Case of the Okavango Delta, Botswana. Biomed Chromatogr 2023; 37:e5718. [PMID: 37632284 DOI: 10.1002/bmc.5718] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/01/2022] [Accepted: 07/24/2023] [Indexed: 08/27/2023]
Abstract
We present a GC-MS metabolomics workflow for analyzing metabolites in urine samples infected with schistosomiasis. Schistosomiasis, a neglected tropical disease, affects 85% of the global population, with the majority residing in Sub-Saharan Africa. The workflow utilized in this study involved the utilization of the AMDIS freeware, Metab R for pre-processing, and multivariate statistical classification through partial least squares-discriminant analysis (PLS-DA). This classification aimed to categorize volatile metabolites found in urine samples from humans infected with schistosomiasis. All samples were collected from individuals in Botswana. A solid-phase microextraction-fused silica fiber was used to adsorb volatile metabolites from the urine samples and inserted into the GC-MS injection port for data acquisition. The acquired data were then subjected to AMDIS auto-deconvolution, Metab R pre-processing, and statistical evaluation for metabolite mining. A total of 12 metabolites, including 3-chloropropionic acid and heptadecyl ester with an AMDIS match factor of 96% at an approximated amount of 0.35% and cyclohexylamine with an AMDIS match factor of 100% and approximated amount of 0.39%, were identified. PLS-DA was used for the classification of the metabolites. The method showed good sensitivity and specificity as indicated by the receiver operating characteristic measured by the areas under the curves. Results indicated that metabolomics is a useful tool for mining metabolites because of the variance in metabolite composition of infected and non-infected urine samples.
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Affiliation(s)
- Sedireng M Tawana-Ndolo
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
- College of Open Schooling, Botswana Open University, Gaborone Regional Campus, Gaborone, Botswana
| | - Matshediso Zachariah
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Nthabiseng A Phaladze
- School of Nursing, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Kwenga F Sichilongo
- Chemistry Department, Faculty of Science, University of Botswana, Gaborone, Botswana
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Mathisen TF, Pettersen G, Rosenvinge JH, Schmidt U, Sundgot-Borgen J. Effectiveness and acceptability of the physical exercise and dietary therapy in a healthy life center. Int J Eat Disord 2023; 56:1931-1940. [PMID: 37458357 DOI: 10.1002/eat.24020] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE The high burden of eating disorders (EDs) and limited availability of treatment speaks of a need to explore new avenues for treatment delivery. To understand if new treatment avenues are helpful and acceptable to patients, we investigated the effectiveness of Physical Exercise and Dietary Therapy (PED-t) in participants with bulimia nervosa or binge-eating disorder, and acceptability when the PED-t was implemented in a Healthy Life Center in a municipal primary healthcare service. METHOD Exercise physiologists and one dietitian were trained in ED literacy and to run PED-t, before screening women for eligibility. Effectiveness (n = 16) of PED-t and participants' experiences (n = 8) were evaluated by a mixed methods study design. Results were analyzed by relevant statistics and reflexive thematic analysis. RESULTS Of 19 eligible participants, 16 completed treatment. At post-treatment, the Eating Disorder Examination Questionnaire global score, binge-eating frequency, and symptoms of depression were lower, and nine (56% of completers) were in remission. Participants' treatment experiences were classified into two overarching themes: "competence" and "emotional support." Participants reported high acceptance for PED-t, the local venue and group format, and felt that PED-t provided them with coping tools and increased mental strength. However, many also spoke of an unmet need to address emotional eating. DISCUSSION Findings point to a potential for making an effective ED therapy more accessible, and that participants find the local low-threshold delivery within a group-format helpful. With small adjustments, the PED-t could emerge as a promising first-line treatment for bulimic EDs. PUBLIC SIGNIFICANCE STATEMENT Limited access to treatment for EDs, patients' high barriers to help-seeking, and the high rates of limited efficacy from psychotherapy speak of a need to explore new therapies and avenues for delivery. In this study, we build on findings from a controlled ED treatment trial and replicate the beneficial effects and find a high patient acceptance of "physical exercise and diet therapy" implemented in a real, non-clinical setting.
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Affiliation(s)
- Therese Fostervold Mathisen
- Department of Nursing, Health and laboratory science, Faculty of Health, Welfare and Organization, Østfold University College, Fredrikstad, Norway
| | - Gunn Pettersen
- Faculty of Health Sciences, Department of Psychology, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Jan H Rosenvinge
- Faculty of Health Sciences, Department of Psychology, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Ulrike Schmidt
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Section of Eating Disorders, Department of Psychological Medicine, King's College London, London, UK
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Orton MR, Hann E, Doran SJ, Shepherd STC, Ap Dafydd D, Spencer CE, López JI, Albarrán-Artahona V, Comito F, Warren H, Shur J, Messiou C, Larkin J, Turajlic S, Koh DM. Interpretability of radiomics models is improved when using feature group selection strategies for predicting molecular and clinical targets in clear-cell renal cell carcinoma: insights from the TRACERx Renal study. Cancer Imaging 2023; 23:76. [PMID: 37580840 PMCID: PMC10424427 DOI: 10.1186/s40644-023-00594-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 01/10/2023] [Accepted: 07/12/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND The aim of this work is to evaluate the performance of radiomics predictions for a range of molecular, genomic and clinical targets in patients with clear cell renal cell carcinoma (ccRCC) and demonstrate the impact of novel feature selection strategies and sub-segmentations on model interpretability. METHODS Contrast-enhanced CT scans from the first 101 patients recruited to the TRACERx Renal Cancer study (NCT03226886) were used to derive radiomics classification models to predict 20 molecular, histopathology and clinical target variables. Manual 3D segmentation was used in conjunction with automatic sub-segmentation to generate radiomics features from the core, rim, high and low enhancing sub-regions, and the whole tumour. Comparisons were made between two classification model pipelines: a Conventional pipeline reflecting common radiomics practice, and a Proposed pipeline including two novel feature selection steps designed to improve model interpretability. For both pipelines nested cross-validation was used to estimate prediction performance and tune model hyper-parameters, and permutation testing was used to evaluate the statistical significance of the estimated performance measures. Further model robustness assessments were conducted by evaluating model variability across the cross-validation folds. RESULTS Classification performance was significant (p < 0.05, H0:AUROC = 0.5) for 11 of 20 targets using either pipeline and for these targets the AUROCs were within ± 0.05 for the two pipelines, except for one target where the Proposed pipeline performance increased by > 0.1. Five of these targets (necrosis on histology, presence of renal vein invasion, overall histological stage, linear evolutionary subtype and loss of 9p21.3 somatic alteration marker) had AUROC > 0.8. Models derived using the Proposed pipeline contained fewer feature groups than the Conventional pipeline, leading to more straightforward model interpretations without loss of performance. Sub-segmentations lead to improved performance and/or improved interpretability when predicting the presence of sarcomatoid differentiation and tumour stage. CONCLUSIONS Use of the Proposed pipeline, which includes the novel feature selection methods, leads to more interpretable models without compromising prediction performance. TRIAL REGISTRATION NCT03226886 (TRACERx Renal).
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Affiliation(s)
- Matthew R Orton
- Artificial Intelligence Imaging Hub, Royal Marsden NHS Foundation Trust, London, UK
| | - Evan Hann
- Artificial Intelligence Imaging Hub, Royal Marsden NHS Foundation Trust, London, UK
| | - Simon J Doran
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
| | - Scott T C Shepherd
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK
- Renal and Skin Units, Royal Marsden Hospital NHS Foundation Trust, London, UK
- Melanoma and Kidney Cancer Team, Institute of Cancer Research, London, UK
| | - Derfel Ap Dafydd
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, UK
| | | | - José I López
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK
- Biomarkers in Cancer Unit, Biocruces-Bizkaia Health Research Institute, Barakaldo, Spain
| | - Víctor Albarrán-Artahona
- Renal and Skin Units, Royal Marsden Hospital NHS Foundation Trust, London, UK
- Medical Oncology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Francesca Comito
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Hannah Warren
- Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, London, SE1 9RT, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Joshua Shur
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, UK
| | - Christina Messiou
- Artificial Intelligence Imaging Hub, Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, UK
| | - James Larkin
- Renal and Skin Units, Royal Marsden Hospital NHS Foundation Trust, London, UK
- Melanoma and Kidney Cancer Team, Institute of Cancer Research, London, UK
| | - Samra Turajlic
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK
- Renal and Skin Units, Royal Marsden Hospital NHS Foundation Trust, London, UK
- Melanoma and Kidney Cancer Team, Institute of Cancer Research, London, UK
| | - Dow-Mu Koh
- Artificial Intelligence Imaging Hub, Royal Marsden NHS Foundation Trust, London, UK.
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK.
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, UK.
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10
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Hodges N, Battersby N, Rao S, Brown G. Relationship Between Baseline Rectal Tumor Length and Magnetic Resonance Tumor Regression Grade Response to Chemoradiotherapy: A Subanalysis of the TRIGGER Feasibility Study. Ann Surg Oncol 2023; 30:4729-4735. [PMID: 35771366 PMCID: PMC10319655 DOI: 10.1245/s10434-022-11914-5] [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: 03/01/2022] [Accepted: 05/03/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND It is widely believed that small rectal tumors are more likely to have a good response to neoadjuvant treatment, which may influence the selection of patients for a 'watch and wait' strategy. OBJECTIVE The aim of this study was to investigate whether there is a relationship between baseline tumor length on magnetic resonance imaging (MRI) and response to chemoradiotherapy. METHOD The 96 patients with locally advanced rectal cancer randomised (2:1-intervention:control) in the TRIGGER feasibility study where eligible. Baseline tumor length was defined as the maximal cranio-caudal length on baseline MRI (mm) and was recorded prospectively at study registration. Magnetic resonance tumor regression grade (mrTRG) assessment was performed on the post-chemoradiotherapy (CRT) MRI 4-6 weeks (no later than 10 weeks) post completion of CRT. This was routinely reported for patients in the intervention (mrTRG-directed management) arm and reported for the purposes of this study by the central radiologist in the control arm patients. Those with an mrTRG I/II response were defined as 'good responders' and those with an mrTRG III-V response were defined as 'poor responders'. RESULTS Overall, 94 patients had a post-CRT MRI performed and were included. Forty-three (46%) patients had a good response (mrTRG I/II) and 51 (54%) patients had a poor response (mrTRG III/IV). The median tumor length of good responders was 43 mm versus 50 mm (p < 0.001), with considerable overlap in tumor lengths between groups. CONCLUSION Baseline tumor length on MRI is not a clinically useful biomarker to predict mrTRG tumor response to CRT and therefore patient suitability for a deferral of surgery trial.
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Affiliation(s)
- Nicola Hodges
- The Royal Marsden NHS Foundation Trust and Imperial College London, Sutton, UK
- Imperial College, London, UK
| | | | - Sheela Rao
- The Royal Marsden NHS Foundation Trust and Imperial College London, Sutton, UK
| | - Gina Brown
- The Royal Marsden NHS Foundation Trust and Imperial College London, Sutton, UK.
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11
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Schut ARW, de Bruin LE, de Rooij BH, Lidington E, Timbergen MJM, van der Graaf WTA, van Houdt WJ, Bonenkamp JJ, Jones RL, Grünhagen DJ, Sleijfer S, Gennatas S, Verhoef C, Husson O. Physical symptom burden in patients with desmoid-type fibromatosis and its impact on health-related quality of life and healthcare use. Cancer Med 2023. [PMID: 37119048 DOI: 10.1002/cam4.5985] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/24/2023] [Accepted: 04/08/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Desmoid-type fibromatosis (DTF) has a highly variable clinical course with varying intensity of symptoms. The objectives of this study were to identify subgroups of DTF patients based on physical symptom burden and to compare symptom burden subgroups on health-related quality of life (HRQoL) and healthcare use (univariate and multivariate). METHODS Desmoid-type fibromatosis patients from the United Kingdom and the Netherlands received cross-sectional questionnaires on HRQoL (EORTC QLQ-C30), DTF-specific HRQoL (DTF-QoL) and healthcare utilisation. Latent class cluster analysis was performed to identify subgroups based on patients' symptom burden using EORTC QLQ-C30 and DTF-QoL physical symptom items. Multivariate linear and logistic regression analyses were conducted to examine associations of symptom burden with HRQoL and healthcare utilisation, respectively. RESULTS Among 235 DTF patients, four symptom burden clusters were identified, with low symptom burden (24%), intermediate symptom burden-low pain (20%), intermediate symptom burden-high pain (25%) and high symptom burden (31%). DTF patients with high symptom burden had clinically relevant lower HRQoL scores compared to patients with low and intermediate symptom burden (p < 0.001) and reported more general and DTF-related visits to their general practitioner compared to the low symptom burden cluster (p < 0.01). In the multivariate analyses, symptom burden was independently associated with both HRQoL and healthcare utilisation. CONCLUSIONS This study identified four distinct subgroups of DTF patients based on their level of symptom burden, with a considerable number of patients being highly symptomatic. Knowledge of the level of symptom burden DTF patients experience can help to identify patients at risk of poorer outcomes and tailor supportive care to the individual needs of DTF patients.
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Affiliation(s)
- Anne-Rose W Schut
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Leanne E de Bruin
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Belle H de Rooij
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- CoRPS-Center of Research on Psychology in Somatic Diseases/Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Emma Lidington
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Milea J M Timbergen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Winette T A van der Graaf
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Winan J van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Johannes J Bonenkamp
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robin L Jones
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK
- Division of Clinical Studies, Institute of Cancer Research, Royal Marsden NHS Foundation Trust, London, UK
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Stefan Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Spyridon Gennatas
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Olga Husson
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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12
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Harnden A, Davis OA, Box GM, Hayes A, Johnson LD, Henley AT, de Haven Brandon AK, Valenti M, Cheung KMJ, Brennan A, Huckvale R, Pierrat OA, Talbot R, Bright MD, Akpinar HA, Miller DSJ, Tarantino D, Gowan S, de Klerk S, McAndrew PC, Le Bihan YV, Meniconi M, Burke R, Kirkin V, van Montfort RLM, Raynaud FI, Rossanese OW, Bellenie BR, Hoelder S. Discovery of an In Vivo Chemical Probe for BCL6 Inhibition by Optimization of Tricyclic Quinolinones. J Med Chem 2023; 66:5892-5906. [PMID: 37026591 PMCID: PMC10150366 DOI: 10.1021/acs.jmedchem.3c00155] [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: 01/27/2023] [Indexed: 04/08/2023]
Abstract
B-cell lymphoma 6 (BCL6) is a transcriptional repressor and oncogenic driver of diffuse large B-cell lymphoma (DLBCL). Here, we report the optimization of our previously reported tricyclic quinolinone series for the inhibition of BCL6. We sought to improve the cellular potency and in vivo exposure of the non-degrading isomer, CCT373567, of our recently published degrader, CCT373566. The major limitation of our inhibitors was their high topological polar surface areas (TPSA), leading to increased efflux ratios. Reducing the molecular weight allowed us to remove polarity and decrease TPSA without considerably reducing solubility. Careful optimization of these properties, as guided by pharmacokinetic studies, led to the discovery of CCT374705, a potent inhibitor of BCL6 with a good in vivo profile. Modest in vivo efficacy was achieved in a lymphoma xenograft mouse model after oral dosing.
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Affiliation(s)
- Alice
C. Harnden
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Owen A. Davis
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Gary M. Box
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Angela Hayes
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Louise D. Johnson
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Alan T. Henley
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Alexis K. de Haven Brandon
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Melanie Valenti
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Kwai-Ming J. Cheung
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Alfie Brennan
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Rosemary Huckvale
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Olivier A. Pierrat
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Rachel Talbot
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Michael D. Bright
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Hafize Aysin Akpinar
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Daniel S. J. Miller
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Dalia Tarantino
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Sharon Gowan
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Selby de Klerk
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Peter Craig McAndrew
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Yann-Vaï Le Bihan
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Mirco Meniconi
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Rosemary Burke
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Vladimir Kirkin
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Rob L. M. van Montfort
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Florence I. Raynaud
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Olivia W. Rossanese
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Benjamin R. Bellenie
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
| | - Swen Hoelder
- Centre
for Cancer Drug Discovery and Division of Structural Biology, The Institute of Cancer Research, London SM2 5NG, U.K.
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13
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Gonzalez-Rodriguez E, Zol-Hanlon M, Bineva-Todd G, Marchesi A, Skehel M, Mahoney KE, Roustan C, Borg A, Di Vagno L, Kjær S, Wrobel AG, Benton DJ, Nawrath P, Flitsch SL, Joshi D, González-Ramírez A, Wilkinson KA, Wilkinson RJ, Wall EC, Hurtado-Guerrero R, Malaker SA, Schumann B. O-Linked Sialoglycans Modulate the Proteolysis of SARS-CoV-2 Spike and Likely Contribute to the Mutational Trajectory in Variants of Concern. ACS Cent Sci 2023; 9:393-404. [PMID: 36968546 PMCID: PMC10037455 DOI: 10.1021/acscentsci.2c01349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Indexed: 06/18/2023]
Abstract
The emergence of a polybasic cleavage motif for the protease furin in SARS-CoV-2 spike has been established as a major factor for human viral transmission. The region N-terminal to that motif is extensively mutated in variants of concern (VOCs). Besides furin, spikes from these variants appear to rely on other proteases for maturation, including TMPRSS2. Glycans near the cleavage site have raised questions about proteolytic processing and the consequences of variant-borne mutations. Here, we identify that sialic acid-containing O-linked glycans on Thr678 of SARS-CoV-2 spike influence furin and TMPRSS2 cleavage and posit O-linked glycosylation as a likely driving force for the emergence of VOC mutations. We provide direct evidence that the glycosyltransferase GalNAc-T1 primes glycosylation at Thr678 in the living cell, an event that is suppressed by mutations in the VOCs Alpha, Delta, and Omicron. We found that the sole incorporation of N-acetylgalactosamine did not impact furin activity in synthetic O-glycopeptides, but the presence of sialic acid reduced the furin rate by up to 65%. Similarly, O-glycosylation with a sialylated trisaccharide had a negative impact on TMPRSS2 cleavage. With a chemistry-centered approach, we substantiate O-glycosylation as a major determinant of spike maturation and propose disruption of O-glycosylation as a substantial driving force for VOC evolution.
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Affiliation(s)
- Edgar Gonzalez-Rodriguez
- Chemical
Glycobiology Laboratory, The Francis Crick
Institute, NW1 1AT London, United Kingdom
- Department
of Chemistry, Imperial College London, W12 0BZ London, United Kingdom
| | - Mia Zol-Hanlon
- Chemical
Glycobiology Laboratory, The Francis Crick
Institute, NW1 1AT London, United Kingdom
- Signalling
and Structural Biology Lab, The Francis
Crick Institute, NW1 1AT London, United Kingdom
| | - Ganka Bineva-Todd
- Chemical
Glycobiology Laboratory, The Francis Crick
Institute, NW1 1AT London, United Kingdom
| | - Andrea Marchesi
- Chemical
Glycobiology Laboratory, The Francis Crick
Institute, NW1 1AT London, United Kingdom
- Department
of Chemistry, Imperial College London, W12 0BZ London, United Kingdom
| | - Mark Skehel
- Proteomics
Science Technology Platform, The Francis
Crick Institute, NW1 1AT London, United Kingdom
| | - Keira E. Mahoney
- Department
of Chemistry, Yale University, 275 Prospect Street, 06511 New Haven, Connecticut, United States
| | - Chloë Roustan
- Structural
Biology Science Technology Platform, The
Francis Crick Institute, NW1 1AT London, United Kingdom
| | - Annabel Borg
- Structural
Biology Science Technology Platform, The
Francis Crick Institute, NW1 1AT London, United Kingdom
| | - Lucia Di Vagno
- Chemical
Glycobiology Laboratory, The Francis Crick
Institute, NW1 1AT London, United Kingdom
- Proteomics
Science Technology Platform, The Francis
Crick Institute, NW1 1AT London, United Kingdom
| | - Svend Kjær
- Structural
Biology Science Technology Platform, The
Francis Crick Institute, NW1 1AT London, United Kingdom
| | - Antoni G. Wrobel
- Structural
Biology of Disease Processes Laboratory, Francis Crick Institute, NW1 1AT London, United Kingdom
| | - Donald J. Benton
- Structural
Biology of Disease Processes Laboratory, Francis Crick Institute, NW1 1AT London, United Kingdom
| | - Philipp Nawrath
- Structural
Biology of Disease Processes Laboratory, Francis Crick Institute, NW1 1AT London, United Kingdom
| | - Sabine L. Flitsch
- Manchester
Institute of Biotechnology, University of
Manchester, 131 Princess Street, M1 7DN Manchester, United Kingdom
| | - Dhira Joshi
- Chemical
Biology Science Technology Platform, The
Francis Crick Institute, NW1 1AT London, United Kingdom
| | | | - Katalin A. Wilkinson
- Tuberculosis
Laboratory, The Francis Crick Institute, NW1 1AT London, United Kingdom
- Wellcome
Centre for Infectious Diseases Research in Africa, University of Cape Town, 7925 Observatory, Cape Town, South Africa
| | - Robert J. Wilkinson
- Tuberculosis
Laboratory, The Francis Crick Institute, NW1 1AT London, United Kingdom
- Wellcome
Centre for Infectious Diseases Research in Africa, University of Cape Town, 7925 Observatory, Cape Town, South Africa
- Department
of Infectious Diseases, Imperial College
London, W12 0NN London, United Kingdom
- Institute
of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, 7925 Observatory, Cape Town, South Africa
| | - Emma C. Wall
- The Francis
Crick Institute, NW1 1AT London, United Kingdom
- University
College London Hospitals (UCLH) Biomedical Research Centre, W1T 7DN London, United Kingdom
| | - Ramón Hurtado-Guerrero
- Institute
of Biocomputation and Physics of Complex Systems, University of Zaragoza, 50018 Zaragoza, Spain
- Copenhagen
Center for Glycomics, Department of Cellular and Molecular Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Fundación
ARAID, 50018 Zaragoza, Spain
| | - Stacy A. Malaker
- Department
of Chemistry, Yale University, 275 Prospect Street, 06511 New Haven, Connecticut, United States
| | - Benjamin Schumann
- Chemical
Glycobiology Laboratory, The Francis Crick
Institute, NW1 1AT London, United Kingdom
- Department
of Chemistry, Imperial College London, W12 0BZ London, United Kingdom
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14
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Bonfield S, Ruparel M, Waller J, Dickson JL, Janes SM, Quaife SL. Preferences for Decision Control among a High-Risk Cohort Offered Lung Cancer Screening: A Brief Report of Secondary Analyses from the Lung Screen Uptake Trial (LSUT). MDM Policy Pract 2023; 8:23814683231163190. [PMID: 37009636 PMCID: PMC10064161 DOI: 10.1177/23814683231163190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/16/2023] [Indexed: 03/30/2023] Open
Abstract
Background. Personal autonomy in lung cancer screening is advocated internationally, but health systems diverge in their approach, mandating either shared decision making (with a health care professional) or individual decision making. Studies of other cancer screening programs have found that individual preferences for the level of involvement in screening decisions vary across different sociodemographic groups and that aligning approaches with individual preferences has the potential to improve uptake. Method. For the first time, we examined preferences for decision control among a cohort of UK-based high-risk lung cancer screening candidates ( N = 727). We used descriptive statistics to report the distribution of preferences and chi-square tests to examine associations between decision preferences and sociodemographic variables. Results. Most (69.7%) preferred to be involved in the decision with varying degrees of input from a health care professional. Few (10.2%) wanted to make the decision alone. Preferences were also associated with educational attainment. Conclusion. These findings suggest one-size-fits-all approaches may be inadequate in meeting diverse preferences, particularly those placing sole onus on the individual. Highlights Preferences for involvement in decision making about lung cancer screening are heterogeneous among high-risk individuals in the United Kingdom and vary by educational attainment. Further work is needed to understand how policy makers might implement hybrid approaches to accommodate individual preferences and optimize lung cancer screening program outcomes.
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Affiliation(s)
- Stefanie Bonfield
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Mamta Ruparel
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Jo Waller
- School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - Jennifer L. Dickson
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Samuel M. Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Samantha L. Quaife
- Samantha L. Quaife, Centre for Cancer Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK; ()
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15
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Farbstein D, Lukito S, Yorke I, Wilson E, Crudgington H, El-Aalem O, Cliffe C, Bergou N, Itani L, Owusu A, Sedgwick R, Singh N, Tarasenko A, Tucker G, Woodhouse E, Suzuki M, Myerscough AL, Lopez Chemas N, Abdel-Halim N, Del Giovane C, Epstein S, Ougrin D. Risk and protective factors for self-harm and suicide in children and adolescents: a systematic review and meta-analysis protocol. BMJ Open 2022; 12:e058297. [PMID: 36428021 PMCID: PMC9703327 DOI: 10.1136/bmjopen-2021-058297] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 11/01/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Self-harm and suicide are major public health concerns among children and adolescents. Many risk and protective factors for suicide and self-harm have been identified and reported in the literature. However, the capacity of these identified risk and protective factors to guide assessment and management is limited due to their great number. This protocol describes an ongoing systematic review and meta-analysis which aims to examine longitudinal studies of risk factors for self-harm and suicide in children and adolescents, to provide a comparison of the strengths of association of the various risk factors for self-harm and suicide and to shed light on those that require further investigation. METHODS AND ANALYSIS We perform a systematic search of the literature using the databases EMBASE, PsycINFO, Medline, CINAHL and HMIC from inception up to 28 October 2020, and the search will be updated before the systematic review publication. Additionally, we will contact experts in the field, including principal investigators whose peer-reviewed publications are included in our systematic review as well as investigators from our extensive research network, and we will search the reference lists of relevant reviews to retrieve any articles that were not identified in our search. We will extract relevant data and present a narrative synthesis and combine the results in meta-analyses where there are sufficient data. We will assess the risk of bias for each study using the Newcastle-Ottawa Scale and present a summary of the quantity and the quality of the evidence for each risk or protective factor. ETHICS AND DISSEMINATION Ethical approval will not be sought as this is a systematic review of the literature. Results will be published in mental health journals and presented at conferences focused on suicide prevention. PROSPERO REGISTRATION NUMBER CRD42021228212.
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Affiliation(s)
- Dan Farbstein
- Child and Adolescent Psychiatry Unit, Psychiatric Division, Rambam Health Care Campus, Haifa, Israel
- Technion Israel Institute of Technology, The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Steve Lukito
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Isabel Yorke
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emma Wilson
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, London, UK
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Holly Crudgington
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, London, UK
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Omar El-Aalem
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Charlotte Cliffe
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nicol Bergou
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lynn Itani
- Emirates Health Services, Maudsley Health, Al Amal Psychiatric Hospital, Dubai, UAE
| | - Andy Owusu
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Nidhita Singh
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Gavin Tucker
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Emma Woodhouse
- Compass Psychological Services Ltd, London, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mimi Suzuki
- Unit for Social and Community Psychiatry, Queen Mary University of London & East London NHS Foundation Trust, London, UK
| | - Anna Louise Myerscough
- Unit for Social and Community Psychiatry, Queen Mary University of London & East London NHS Foundation Trust, London, UK
| | - Natalia Lopez Chemas
- Unit for Social and Community Psychiatry, Queen Mary University of London & East London NHS Foundation Trust, London, UK
| | - Nadia Abdel-Halim
- Unit for Social and Community Psychiatry, Queen Mary University of London & East London NHS Foundation Trust, London, UK
| | - Cinzia Del Giovane
- Department of Medical and Surgical Sciences for Children and Adults, University-Hospital of Modena and Reggio Emilia, Modena, Italy
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Sophie Epstein
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dennis Ougrin
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Youth Resilience Research Unit, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
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Alexander JL, Ibraheim H, Richards C, Shum B, Pavlidis P, Hunter N, Teare JP, Wotherspoon A, Furness A, Turajlic S, Pickering L, Larkin J, Speight A, Papa S, Powell N. Oral beclomethasone dipropionate is an effective treatment for immune checkpoint inhibitor induced colitis. J Immunother Cancer 2022; 10:e005490. [PMID: 36113896 PMCID: PMC9486376 DOI: 10.1136/jitc-2022-005490] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Systemic corticosteroids are the mainstay of treatment for immune checkpoint inhibitor induced (CPI) colitis but are associated with complications including life-threatening infection. The topically acting oral corticosteroid beclomethasone dipropionate (BD) is an effective treatment for mild to moderate flares of ulcerative colitis, and has fewer side effects than systemic corticosteroids. We hypothesized that BD would be an effective treatment for CPI-induced colitis. METHODS We performed a retrospective analysis of all patients who started BD for CPI-induced colitis at three UK cancer centers between November 2017 and October 2020. All patients underwent endoscopic assessment and biopsy. The initial regimen of BD was 5 mg once daily for 28 days. Data were collected from electronic patient records. Clinical outcomes were assessed at 28 days after initiation of treatment. RESULTS Twenty-two patients (14 male) with a median age of 64 (range 45-84) with CPI-induced colitis were treated with BD. At baseline, the median number of loose stools in a 24-hour period was six (common terminology criteria for adverse events, CTCAE grade diarrhea=2). Thirteen patients (59%) were dependent on systemic corticosteroids prior to starting BD. Baseline sigmoidoscopy showed moderate inflammation (Mayo Endoscopic Score (MES) = 2) in two patients (9%), mild inflammation (MES=1) in nine patients (41%) and normal findings (MES=0) in eleven patients (50%). Twenty patients (91%) had histopathological features of inflammation. All 22 patients (100%) had a clinical response to BD and 21 (95%) achieved clinical remission with a return to baseline stool frequency (CTCAE diarrhea=0). Ten patients (45%) had symptomatic relapse on cessation of BD, half within 7 days of stopping. All patients recaptured response on restarting BD. No adverse events were reported in patients treated with BD. CONCLUSIONS Topical BD represents an appealing alternative option to systemic immunosuppressive treatments to treat colonic inflammation. In this study, BD was effective and safe at inducing remission in CPI-induced colitis, which was refractory to systemic corticosteroids. Further randomized studies are needed to confirm these findings and determine the optimum dosing regimen.
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Affiliation(s)
- James L Alexander
- Department of Gastroenterology, Royal Marsden NHS Foundation Trust, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Hajir Ibraheim
- Department of Gastroenterology, Royal Marsden NHS Foundation Trust, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Camellia Richards
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Ben Shum
- Renal & Skin Units, Royal Marsden NHS Foundation Trust, London, UK
| | - Polychronis Pavlidis
- Experimental Immunobiology, King's College London, London, UK
- Department of Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK
| | - Nikki Hunter
- Renal & Skin Units, Royal Marsden NHS Foundation Trust, London, UK
| | - Julian P Teare
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Andrew Wotherspoon
- Department of Histopathology, Royal Marsden NHS Foundation Trust, London, UK
| | - Andrew Furness
- Renal & Skin Units, Royal Marsden NHS Foundation Trust, London, UK
| | - Samra Turajlic
- Renal & Skin Units, Royal Marsden NHS Foundation Trust, London, UK
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK
| | - Lisa Pickering
- Renal & Skin Units, Royal Marsden NHS Foundation Trust, London, UK
| | - James Larkin
- Renal & Skin Units, Royal Marsden NHS Foundation Trust, London, UK
| | - Ally Speight
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Sophie Papa
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Nick Powell
- Department of Gastroenterology, Royal Marsden NHS Foundation Trust, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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Hainsworth E, McGrowder E, McHugh J, Bancroft E, Mahabir S, Webber W, Eeles R, Cruickshank S. How can we recruit more men of African or African-Caribbean ancestry into our research? Co-creating a video to raise awareness of prostate cancer risk and the PROFILE study. Res Involv Engagem 2022; 8:14. [PMID: 35436967 PMCID: PMC9014400 DOI: 10.1186/s40900-022-00347-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Men of African ancestry are at increased risk of developing prostate cancer (PrCa) compared to men from other backgrounds. The PROFILE study aims to understand whether genetic information can better target who needs PrCa screening. PROFILE has so far had difficulty reaching men of African or African -Caribbean ancestry to take part. In this involvement project we worked in partnership with a group of such men to co-create a video to raise awareness of PrCa risk amongst this community and promote participation in the study. METHODS We recruited seven men of African or African-Caribbean ancestry who completed an initial survey on the Cancer Patients' Voice platform. We then held an online discussion panel and maintained contact to encourage dialogue and planning of the video. Utilising a participatory approach, the ideas for the video were decided in collaboration with the panel who held expert knowledge of various communities and understood the messages that would best resonate and engage with other men of the same origins. Once the video had been edited and finalised, two members of the group expressed interest in writing up the project and are listed as co-authors. RESULTS The video in its entirety was driven by the panel's ideas. The choice of a barber shop setting; leading with a positive case study and highlighting the importance of men's family members rather than a focus on scientific language, statistics or researchers were all features that were discussed and agreed upon by the panel. The men shared the video within their networks. It was placed on websites and promoted as part of a social media campaign during Black History Month. CONCLUSIONS Groups with the greater healthcare needs and the most to gain from advances in care and treatment can often be the most excluded from research participation. This is pertinent in PrCa research where men of African or African-Caribbean ancestry are at greater risk. The project gave equal power and decision making to the men and provides an example of successful inclusive involvement. The result was a unique approach to making a study video.
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Affiliation(s)
- Emma Hainsworth
- Royal Marsden NHS Foundation Trust, 203 Fulham Rd, London, SW3 6JJ UK
| | - Eva McGrowder
- The Institute of Cancer Research SRD Building, 1st Floor D1S5, 15 Cotswold Road, Sutton, SM2 5NG Surrey UK
| | - Jana McHugh
- The Institute of Cancer Research SRD Building, 1st Floor D1S5, 15 Cotswold Road, Sutton, SM2 5NG Surrey UK
| | - Elizabeth Bancroft
- The Institute of Cancer Research SRD Building, 1st Floor D1S5, 15 Cotswold Road, Sutton, SM2 5NG Surrey UK
| | - Sean Mahabir
- Royal Marsden NHS Foundation Trust, 203 Fulham Rd, London, SW3 6JJ UK
| | | | - Rosalind Eeles
- The Institute of Cancer Research SRD Building, 1st Floor D1S5, 15 Cotswold Road, Sutton, SM2 5NG Surrey UK
| | - Susanne Cruickshank
- Royal Marsden NHS Foundation Trust, 203 Fulham Rd, London, SW3 6JJ UK
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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18
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Cortese S, Del Giovane C, Chamberlain S, Philipsen A, Young S, Bilbow A, Cipriani A. Pharmacological and non-pharmacological interventions for adults with ADHD: protocol for a systematic review and network meta-analysis. BMJ Open 2022; 12:e058102. [PMID: 35277411 PMCID: PMC8919448 DOI: 10.1136/bmjopen-2021-058102] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION It is unclear how pharmacological and non-pharmacological interventions compare with each other in terms of efficacy and tolerability for core symptoms and additional problems in adults with attention-deficit/hyperactivity disorder (ADHD). We aim to conduct the first network meta-analysis (NMA) comparing pharmacological and non-pharmacological interventions (or their combinations) in adults with ADHD. METHODS AND ANALYSIS We will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for NMAs. We will search a broad set of electronic databases/registries and contact drug companies and experts in the field to retrieve published and unpublished randomised controlled trials (RCTs) (parallel or cross-over) of medications (either licensed or unlicensed) and any non-pharmacological intervention in adults (≥18 years) with ADHD. Primary outcomes will be: (1) change in severity of ADHD core symptoms, and (2) acceptability (all-cause discontinuation). Secondary outcomes will include tolerability (drop-out due to side effects) and change in the severity of emotional dysregulation, executive dysfunctions and quality of life. The risk of bias in each individual RCT included in the NMA will be assessed using the Cochrane Risk of Bias tool-version 2. We will evaluate the transitivity assumption comparing the distribution of possible effect modifiers across treatment comparisons. We will perform Bayesian NMA for each outcome with random-effects model in OpenBUGS. Pooled estimates of NMA will be obtained using the Markov Chains Monte Carlo method. We will judge the credibility in the evidence derived from the NMA using the CINeMA tool (which includes assessment of publication bias). We will conduct a series of sensitivity analyses to assess the robustness of the findings. ETHICS AND DISSEMINATION As this is the protocol for an aggregate-data level NMA, ethical approval will not be required. Results will be disseminated at national/international conferences and in peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42021265576.
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Affiliation(s)
- Samuele Cortese
- School of Psychology, Centre for Innovation in Mental Health (CIMH), Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, USA
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Cinzia Del Giovane
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio, Modena, Italy
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Samuel Chamberlain
- Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, Rheinische Friedrich-Wilhelms-Universitat Bonn, Bonn, Germany
| | - Susan Young
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Andrea Bilbow
- Attention Deficit Disorder Information and Support Service, London, UK
- ADHD-Europe, Brussels, Belgium
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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Vorontsova I, Vallmitjana A, Torrado B, Schilling TF, Hall JE, Gratton E, Malacrida L. In vivo macromolecular crowding is differentially modulated by aquaporin 0 in zebrafish lens: Insights from a nanoenvironment sensor and spectral imaging. Sci Adv 2022; 8:eabj4833. [PMID: 35171678 PMCID: PMC8849302 DOI: 10.1126/sciadv.abj4833] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 12/23/2021] [Indexed: 05/14/2023]
Abstract
Macromolecular crowding is crucial for cellular homeostasis. In vivo studies of macromolecular crowding and water dynamics are needed to understand their roles in cellular physiology and fate determination. Macromolecular crowding in the lens is essential for normal optics, and an understanding of its regulation will help prevent cataract and presbyopia. Here, we combine the use of the nanoenvironmental sensor [6-acetyl-2-dimethylaminonaphthalene (ACDAN)] to visualize lens macromolecular crowding with in vivo studies of aquaporin 0 zebrafish mutants that disrupt its regulation. Spectral phasor analysis of ACDAN fluorescence reveals water dipolar relaxation and demonstrates that mutations in two zebrafish aquaporin 0s, Aqp0a and Aqp0b, alter water state and macromolecular crowding in living lenses. Our results provide in vivo evidence that Aqp0a promotes fluid influx in the deeper lens cortex, whereas Aqp0b facilitates fluid efflux. This evidence reveals previously unidentified spatial regulation of macromolecular crowding and spatially distinct roles for Aqp0 in the lens.
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Affiliation(s)
- Irene Vorontsova
- Physiology and Biophysics, University of California, Irvine, Irvine, CA, USA
- Developmental and Cell Biology, University of California, Irvine, Irvine, CA, USA
- Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA
| | | | - Belén Torrado
- Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Thomas F. Schilling
- Developmental and Cell Biology, University of California, Irvine, Irvine, CA, USA
| | - James E. Hall
- Physiology and Biophysics, University of California, Irvine, Irvine, CA, USA
| | - Enrico Gratton
- Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Leonel Malacrida
- Departamento de Fisiopatología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
- Advanced Bioimaging Unit, Institut Pasteur of Montevideo and Universidad de la República, Montevideo, Uruguay
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20
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Penders J, Nagelkerke A, Cunnane EM, Pedersen SV, Pence IJ, Coombes RC, Stevens MM. Single Particle Automated Raman Trapping Analysis of Breast Cancer Cell-Derived Extracellular Vesicles as Cancer Biomarkers. ACS Nano 2021; 15:18192-18205. [PMID: 34735133 PMCID: PMC9286313 DOI: 10.1021/acsnano.1c07075] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Extracellular vesicles (EVs) secreted by cancer cells provide an important insight into cancer biology and could be leveraged to enhance diagnostics and disease monitoring. This paper details a high-throughput label-free extracellular vesicle analysis approach to study fundamental EV biology, toward diagnosis and monitoring of cancer in a minimally invasive manner and with the elimination of interpreter bias. We present the next generation of our single particle automated Raman trapping analysis─SPARTA─system through the development of a dedicated standalone device optimized for single particle analysis of EVs. Our visualization approach, dubbed dimensional reduction analysis (DRA), presents a convenient and comprehensive method of comparing multiple EV spectra. We demonstrate that the dedicated SPARTA system can differentiate between cancer and noncancer EVs with a high degree of sensitivity and specificity (>95% for both). We further show that the predictive ability of our approach is consistent across multiple EV isolations from the same cell types. Detailed modeling reveals accurate classification between EVs derived from various closely related breast cancer subtypes, further supporting the utility of our SPARTA-based approach for detailed EV profiling.
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Affiliation(s)
- Jelle Penders
- Department
of Materials, Imperial College London, London SW7 2AZ, United Kingdom
- Department
of Bioengineering, Imperial College London, London SW7 2AZ, United Kingdom
- Institute
of Biomedical Engineering, Imperial College
London, London SW7 2AZ, United Kingdom
| | - Anika Nagelkerke
- Department
of Materials, Imperial College London, London SW7 2AZ, United Kingdom
- Department
of Bioengineering, Imperial College London, London SW7 2AZ, United Kingdom
- Institute
of Biomedical Engineering, Imperial College
London, London SW7 2AZ, United Kingdom
| | - Eoghan M. Cunnane
- Department
of Materials, Imperial College London, London SW7 2AZ, United Kingdom
- Department
of Bioengineering, Imperial College London, London SW7 2AZ, United Kingdom
- Institute
of Biomedical Engineering, Imperial College
London, London SW7 2AZ, United Kingdom
| | - Simon V. Pedersen
- Department
of Materials, Imperial College London, London SW7 2AZ, United Kingdom
- Department
of Bioengineering, Imperial College London, London SW7 2AZ, United Kingdom
- Institute
of Biomedical Engineering, Imperial College
London, London SW7 2AZ, United Kingdom
| | - Isaac J. Pence
- Department
of Materials, Imperial College London, London SW7 2AZ, United Kingdom
- Department
of Bioengineering, Imperial College London, London SW7 2AZ, United Kingdom
- Institute
of Biomedical Engineering, Imperial College
London, London SW7 2AZ, United Kingdom
| | - R. Charles Coombes
- Department
of Surgery and Cancer, Hammersmith Hospital, Imperial College, London W120HS, United Kingdom
| | - Molly M. Stevens
- Department
of Materials, Imperial College London, London SW7 2AZ, United Kingdom
- Department
of Bioengineering, Imperial College London, London SW7 2AZ, United Kingdom
- Institute
of Biomedical Engineering, Imperial College
London, London SW7 2AZ, United Kingdom
- E-mail:
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21
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Gilley J, Jackson O, Pipis M, Estiar MA, Al-Chalabi A, Danzi MC, van Eijk KR, Goutman SA, Harms MB, Houlden H, Iacoangeli A, Kaye J, Lima L, Ravits J, Rouleau GA, Schüle R, Xu J, Züchner S, Cooper-Knock J, Gan-Or Z, Reilly MM, Coleman MP. Enrichment of SARM1 alleles encoding variants with constitutively hyperactive NADase in patients with ALS and other motor nerve disorders. eLife 2021; 10:e70905. [PMID: 34796871 PMCID: PMC8735862 DOI: 10.7554/elife.70905] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022] Open
Abstract
SARM1, a protein with critical NADase activity, is a central executioner in a conserved programme of axon degeneration. We report seven rare missense or in-frame microdeletion human SARM1 variant alleles in patients with amyotrophic lateral sclerosis (ALS) or other motor nerve disorders that alter the SARM1 auto-inhibitory ARM domain and constitutively hyperactivate SARM1 NADase activity. The constitutive NADase activity of these seven variants is similar to that of SARM1 lacking the entire ARM domain and greatly exceeds the activity of wild-type SARM1, even in the presence of nicotinamide mononucleotide (NMN), its physiological activator. This rise in constitutive activity alone is enough to promote neuronal degeneration in response to otherwise non-harmful, mild stress. Importantly, these strong gain-of-function alleles are completely patient-specific in the cohorts studied and show a highly significant association with disease at the single gene level. These findings of disease-associated coding variants that alter SARM1 function build on previously reported genome-wide significant association with ALS for a neighbouring, more common SARM1 intragenic single nucleotide polymorphism (SNP) to support a contributory role of SARM1 in these disorders. A broad phenotypic heterogeneity and variable age-of-onset of disease among patients with these alleles also raises intriguing questions about the pathogenic mechanism of hyperactive SARM1 variants.
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Affiliation(s)
- Jonathan Gilley
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of CambridgeCambridgeUnited Kingdom
| | - Oscar Jackson
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of CambridgeCambridgeUnited Kingdom
| | - Menelaos Pipis
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology and The National Hospital for NeurologyLondonUnited Kingdom
| | - Mehrdad A Estiar
- Department of Human Genetics, McGill UniversityMontrealCanada
- The Neuro (Montreal Neurological Institute-Hospital), McGill UniversityMontrealCanada
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College LondonLondonUnited Kingdom
- Department of Neurology, King's College Hospital, King’s College LondonLondonUnited Kingdom
| | - Matt C Danzi
- Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics, University of Miami Miller School of MedicineMiamiUnited States
| | - Kristel R van Eijk
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht UniversityUtrechtNetherlands
| | - Stephen A Goutman
- Department of Neurology, University of MichiganAnn ArborUnited States
| | - Matthew B Harms
- Institute for Genomic Medicine, Columbia UniversityNew YorkUnited States
| | - Henry Houlden
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology and The National Hospital for NeurologyLondonUnited Kingdom
| | - Alfredo Iacoangeli
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College LondonLondonUnited Kingdom
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUnited Kingdom
- National Institute for Health Research Biomedical Research Centre and Dementia Unit at South London and Maudsley NHS Foundation Trust and King's College LondonLondonUnited Kingdom
| | - Julia Kaye
- Center for Systems and Therapeutics, Gladstone InstitutesSan FranciscoUnited States
| | - Leandro Lima
- Center for Systems and Therapeutics, Gladstone InstitutesSan FranciscoUnited States
- Gladstone Institute of Data Science and Biotechnology, Gladstone InstitutesSan FranciscoUnited States
| | - Queen Square Genomics
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology and The National Hospital for NeurologyLondonUnited Kingdom
| | - John Ravits
- Department of Neurosciences, University of California, San DiegoLa JollaUnited States
| | - Guy A Rouleau
- Department of Human Genetics, McGill UniversityMontrealCanada
- The Neuro (Montreal Neurological Institute-Hospital), McGill UniversityMontrealCanada
- Department of Neurology and Neurosurgery, McGill UniversityMontrealCanada
| | - Rebecca Schüle
- Center for Neurology and Hertie Institute für Clinical Brain Research, University of Tübingen, German Center for Neurodegenerative DiseasesTübingenGermany
| | - Jishu Xu
- Center for Neurology and Hertie Institute für Clinical Brain Research, University of Tübingen, German Center for Neurodegenerative DiseasesTübingenGermany
| | - Stephan Züchner
- Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics, University of Miami Miller School of MedicineMiamiUnited States
| | - Johnathan Cooper-Knock
- Sheffield Institute for Translational Neuroscience, University of SheffieldSheffieldUnited Kingdom
| | - Ziv Gan-Or
- Department of Human Genetics, McGill UniversityMontrealCanada
- The Neuro (Montreal Neurological Institute-Hospital), McGill UniversityMontrealCanada
- Department of Neurology and Neurosurgery, McGill UniversityMontrealCanada
| | - Mary M Reilly
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology and The National Hospital for NeurologyLondonUnited Kingdom
| | - Michael P Coleman
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of CambridgeCambridgeUnited Kingdom
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Alexander JL, Ibraheim H, Sheth B, Little J, Khan MS, Richards C, Hunter N, Chauhan D, Ratnakumaran R, McHugh K, Pinato DJ, Nathan P, Choy J, Crusz SM, Furness A, Turajlic S, Pickering L, Larkin J, Teare JP, Papa S, Speight A, Sharma A, Powell N. Clinical outcomes of patients with corticosteroid refractory immune checkpoint inhibitor-induced enterocolitis treated with infliximab. J Immunother Cancer 2021; 9:e002742. [PMID: 34233964 PMCID: PMC8264884 DOI: 10.1136/jitc-2021-002742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Immune checkpoint inhibitors (CPIs) have changed the treatment landscape for many cancers, but also cause severe inflammatory side effects including enterocolitis. CPI-induced enterocolitis is treated empirically with corticosteroids, and infliximab (IFX) is used in corticosteroid-refractory cases. However, robust outcome data for these patients are scarce. METHODS We conducted a multicenter (six cancer centers), cohort study of outcomes in patients treated with IFX for corticosteroid-refractory CPI-induced enterocolitis between 2007 and 2020. The primary outcome was corticosteroid-free clinical remission (CFCR) with Common Terminology Criteria for Adverse Events (CTCAE) grade 0 for diarrhea at 12 weeks after IFX initiation. We also assessed cancer outcomes at 1 year using RECIST V1.1 criteria. RESULTS 127 patients (73 male; median age 59 years) were treated with IFX for corticosteroid-refractory CPI-induced enterocolitis. Ninety-six (75.6%) patients had diarrhea CTCAE grade >2 and 115 (90.6%) required hospitalization for colitis. CFCR was 41.2% at 12 weeks and 50.9% at 26 weeks. In multivariable logistic regression, IFX-resistant enterocolitis was associated with rectal bleeding (OR 0.19; 95% CI 0.04 to 0.80; p=0.03) and absence of colonic crypt abscesses (OR 2.16; 95% CI 1.13 to 8.05; p=0.03). Cancer non-progression was significantly more common in patients with IFX-resistant enterocolitis (64.4%) as compared with patients with IFX-responsive enterocolitis (37.5%; p=0.013). CONCLUSION This is the largest study to date reporting outcomes of IFX therapy in patients with corticosteroid-refractory CPI-induced enterocolitis. Using predefined robust endpoints, we have demonstrated that fewer than half of patients achieved CFCR. Our data also indicate that cancer outcomes may be better in patients developing prolonged and severe inflammatory side effects of CPI therapy.
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Affiliation(s)
- James L Alexander
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Hajir Ibraheim
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Bhavisha Sheth
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Jessica Little
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Muhammad Saheb Khan
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Camellia Richards
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Nikki Hunter
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Dharmisha Chauhan
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | | | - Kathleen McHugh
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - David J Pinato
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, UK
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Paul Nathan
- Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Julia Choy
- Medical Oncology, Barts Health NHS Trust, London, UK
| | | | - Andrew Furness
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Samra Turajlic
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
- Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - Lisa Pickering
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - James Larkin
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Julian P Teare
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Sophie Papa
- Medical Oncology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Ally Speight
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Anand Sharma
- Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Nick Powell
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
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Nenclares P, Gunn L, Soliman H, Bover M, Trinh A, Leslie I, Wong KH, Melcher A, Newbold K, Nutting CM, Ap Dafydd D, Bhide SA, Harrington K. On-treatment immune prognostic score for patients with relapsed and/or metastatic head and neck squamous cell carcinoma treated with immunotherapy. J Immunother Cancer 2021; 9:e002718. [PMID: 34103355 PMCID: PMC8190047 DOI: 10.1136/jitc-2021-002718] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Previous studies have suggested that inflammatory markers (neutrophil-to-lymphocyte ratio (NLR), lactate dehydrogenase (LDH) and fibrinogen) are prognostic biomarkers in patients with a variety of solid cancers, including those treated with immune checkpoint inhibitors (ICIs). We aimed to develop a model that predicts response and survival in patients with relapsed and/or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) treated with immunotherapy. METHODS Analysis of 100 consecutive patients with unresectable R/M HNSCC who were treated with ICI. Baseline and on-treatment (day 28) NLR, fibrinogen and LDH were calculated and correlated with response, progression-free survival (PFS) and overall survival (OS) using univariate and multivariate analyses. The optimal cut-off values were derived using maximally selected log-rank statistics. RESULTS Low baseline NLR and fibrinogen levels were associated with response. There was a statistically significant correlation between on-treatment NLR and fibrinogen and best overall response. On-treatment high NLR and raised fibrinogen were significantly associated with poorer outcome. In multivariate analysis, on-treatment NLR (≥4) and on-treatment fibrinogen (≥4 ng/mL) showed a significant negative correlation with OS and PFS. Using these cut-off points, we generated an on-treatment score for OS and PFS (0-2 points). The derived scoring system shows appropriate discrimination and suitability for OS (HR 2.4, 95% CI 1.7 to 3.4, p<0.0001, Harrell's C 0.67) and PFS (HR 1.8, 95% CI 1.4 to 2.3, p<0.0001, Harrell's C 0.68). In the absence of an external validation cohort, results of fivefold cross-validation of the score and evaluation of median OS and PFS on the Kaplan-Meier survival distribution between trained and test data exhibited appropriate accuracy and concordance of the model. CONCLUSIONS NLR and fibrinogen levels are simple, inexpensive and readily available biomarkers that could be incorporated into an on-treatment scoring system and used to help predict survival and response to ICI in patients with R/M HNSCC.
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Affiliation(s)
- Pablo Nenclares
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Lucinda Gunn
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Heba Soliman
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Mateo Bover
- Head and Neck Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Amy Trinh
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Isla Leslie
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Kee Howe Wong
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Alan Melcher
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Kate Newbold
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Chris M Nutting
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Derfel Ap Dafydd
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Shreerang A Bhide
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Kevin Harrington
- Head and Neck Unit, Royal Marsden Hospital NHS Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
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24
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Brickute D, Beckley A, Allott L, Braga M, Barnes C, Thorley KJ, Aboagye EO. Synthesis and evaluation of 3'-[ 18F]fluorothymidine-5'-squaryl as a bioisostere of 3'-[ 18F]fluorothymidine-5'-monophosphate. RSC Adv 2021; 11:12423-12433. [PMID: 35423725 PMCID: PMC8696986 DOI: 10.1039/d1ra00205h] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/14/2021] [Indexed: 11/21/2022] Open
Abstract
The squaryl moiety has emerged as an important phosphate bioisostere with reportedly greater cell permeability. It has been used in the synthesis of several therapeutic drug molecules including nucleoside and nucleotide analogues but is yet to be evaluated in the context of positron emission tomography (PET) imaging. We have designed, synthesised and evaluated 3'-[18F]fluorothymidine-5'-squaryl ([18F]SqFLT) as a bioisostere to 3'-[18F]fluorothymidine-5'-monophosphate ([18F]FLTMP) for imaging thymidylate kinase (TMPK) activity. The overall radiochemical yield (RCY) was 6.7 ± 2.5% and radiochemical purity (RCP) was >90%. Biological evaluation in vitro showed low tracer uptake (<0.3% ID mg-1) but significantly discriminated between wildtype HCT116 and CRISPR/Cas9 generated TMPK knockdown HCT116shTMPK-. Evaluation of [18F]SqFLT in HCT116 and HCT116shTMPK- xenograft mouse models showed statistically significant differences in tumour uptake, but lacked an effective tissue retention mechanism, making the radiotracer in its current form unsuitable for PET imaging of proliferation.
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Affiliation(s)
- D Brickute
- Comprehensive Cancer Imaging Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital W12 0NN London UK
| | - A Beckley
- Comprehensive Cancer Imaging Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital W12 0NN London UK
| | - L Allott
- Comprehensive Cancer Imaging Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital W12 0NN London UK
| | - M Braga
- Comprehensive Cancer Imaging Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital W12 0NN London UK
| | - C Barnes
- Comprehensive Cancer Imaging Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital W12 0NN London UK
| | - K J Thorley
- University of Kentucky, Department of Chemistry Lexington KY 40506 USA
| | - E O Aboagye
- Comprehensive Cancer Imaging Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital W12 0NN London UK
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25
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Wilkins A, Fontana E, Nyamundanda G, Ragulan C, Patil Y, Mansfield D, Kingston J, Errington-Mais F, Bottomley D, von Loga K, Bye H, Carter P, Tinkler-Hundal E, Noshirwani A, Downs J, Dillon M, Demaria S, Sebag-Montefiore D, Harrington K, West N, Melcher A, Sadanandam A. Differential and longitudinal immune gene patterns associated with reprogrammed microenvironment and viral mimicry in response to neoadjuvant radiotherapy in rectal cancer. J Immunother Cancer 2021; 9:e001717. [PMID: 33678606 PMCID: PMC7939016 DOI: 10.1136/jitc-2020-001717] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Rectal cancers show a highly varied response to neoadjuvant radiotherapy/chemoradiation (RT/CRT) and the impact of the tumor immune microenvironment on this response is poorly understood. Current clinical tumor regression grading systems attempt to measure radiotherapy response but are subject to interobserver variation. An unbiased and unique histopathological quantification method (change in tumor cell density (ΔTCD)) may improve classification of RT/CRT response. Furthermore, immune gene expression profiling (GEP) may identify differences in expression levels of genes relevant to different radiotherapy responses: (1) at baseline between poor and good responders, and (2) longitudinally from preradiotherapy to postradiotherapy samples. Overall, this may inform novel therapeutic RT/CRT combination strategies in rectal cancer. METHODS We generated GEPs for 53 patients from biopsies taken prior to preoperative radiotherapy. TCD was used to assess rectal tumor response to neoadjuvant RT/CRT and ΔTCD was subjected to k-means clustering to classify patients into different response categories. Differential gene expression analysis was performed using statistical analysis of microarrays, pathway enrichment analysis and immune cell type analysis using single sample gene set enrichment analysis. Immunohistochemistry was performed to validate specific results. The results were validated using 220 pretreatment samples from publicly available datasets at metalevel of pathway and survival analyses. RESULTS ΔTCD scores ranged from 12.4% to -47.7% and stratified patients into three response categories. At baseline, 40 genes were significantly upregulated in poor (n=12) versus good responders (n=21), including myeloid and stromal cell genes. Of several pathways showing significant enrichment at baseline in poor responders, epithelial to mesenchymal transition, coagulation, complement activation and apical junction pathways were validated in external cohorts. Unlike poor responders, good responders showed longitudinal (preradiotherapy vs postradiotherapy samples) upregulation of 198 immune genes, reflecting an increased T-cell-inflamed GEP, type-I interferon and macrophage populations. Longitudinal pathway analysis suggested viral-like pathogen responses occurred in post-treatment resected samples compared with pretreatment biopsies in good responders. CONCLUSION This study suggests potentially druggable immune targets in poor responders at baseline and indicates that tumors with a good RT/CRT response reprogrammed from immune "cold" towards an immunologically "hot" phenotype on treatment with radiotherapy.
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Affiliation(s)
- Anna Wilkins
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
- The Francis Crick Institute, London, UK
| | - Elisa Fontana
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
- Current Affiliation: Sarah Cannon Research Institute, London, UK
| | - Gift Nyamundanda
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
| | | | - Yatish Patil
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
| | - David Mansfield
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
| | - Jennifer Kingston
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Fiona Errington-Mais
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Daniel Bottomley
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Katharina von Loga
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
- The Royal Marsden Hospital, London, UK
| | - Hannah Bye
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
- The Royal Marsden Hospital, London, UK
| | - Paul Carter
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
- The Royal Marsden Hospital, London, UK
| | - Emma Tinkler-Hundal
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Amir Noshirwani
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Jessica Downs
- Division of Cancer Biology, Institute of Cancer Research, London, UK
| | - Magnus Dillon
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
| | | | | | - Kevin Harrington
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
| | - Nick West
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Alan Melcher
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
| | - Anguraj Sadanandam
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
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Abstract
Frontotemporal dementia (FTD) is an uncommon cause of behavioural change in adults under the age of 50. A 44-year-old man presented with progressive neuropsychiatric disturbance characterised by social withdrawal, apathy, loss of empathy, motor stereotypies and hyperorality. Cognitive testing identified severe impairment, including executive dysfunction. MR scan of the brain showed bilateral symmetrical frontal atrophy. There was no relevant family history, and targeted genetic testing for FTD-associated variants in MAPT, GRN and C9orf72 genes proved negative. He became more withdrawn with disinhibited behaviour; his condition progressively worsened and he died 6 years later. The pathological diagnosis was frontotemporal lobar degeneration with fused-in-sarcoma (FUS) pathology, a rare sporadic cause of FTD, accounting for only 5%-10% of cases, its characteristic features including very young onset, motor stereotypies and hyperorality.
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Affiliation(s)
- Matthew Gowell
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Ian Baker
- Russell Cairns Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Olaf Ansorge
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Masud Husain
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
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27
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Micha AE, Sinnett V, Downey K, Allen S, Bishop B, Hector LR, Patrick EP, Edmonds R, Barry PA, Krupa KDC, Rusby JE. Patient and clinician satisfaction and clinical outcomes of Magseed compared with wire-guided localisation for impalpable breast lesions. Breast Cancer 2020; 28:196-205. [PMID: 32974810 PMCID: PMC7796883 DOI: 10.1007/s12282-020-01149-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/17/2020] [Indexed: 01/09/2023]
Abstract
Background Guide-wire localisation remains the most commonly used technique for localisation of impalpable breast lesions in the UK. One alternative is magnetic seed localisation. We aimed to investigate patient and clinician satisfaction in two consecutive cohorts, describe re-excision and positive margin rates, and explore reasons for positive margins and the implications for localisation techniques. Methods A single-institution prospective service evaluation of two cohorts of consecutive cases of wire and then Magseed localisation was carried out. Data were collected on patient and clinician satisfaction, clinico-pathological findings, and causes of involved margins. T tests were used to compare continuous variables and Chi-squared test for satisfaction outcomes. Results 168 consecutive cases used wire-guided localisation (WGL) and 128 subsequent cases used Magseeds. Patients reported less anxiety between localisation and surgery in the Magseed group, and clinicians reported greater ease of use of Magseeds. There were no differences in lesion size, surgical complexity, or re-excision rate between the groups. In a subset of patients receiving standard wide local excision (i.e., excluding mammoplasties), the impact on margin involvement was investigated. There was no significant difference in radiological under-sizing or accuracy of localisation. However, specimen weight and eccentricity of the lesion were statistically significantly lower in the Magseed group. Despite this, re-excision rates were not significantly different (p = 0.4). Conclusions This is the first large study of satisfaction with localisation and showed clinician preference for Magseed and a reduction in patient anxiety. It also demonstrated similar positive margin rates despite smaller specimen weights in the Magseed group. Magnetic seed localisation offers an acceptable clinical alternative to guide wire localisation. The impact on local service provision should also be considered.
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Affiliation(s)
- Aikaterini E Micha
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
| | - Victoria Sinnett
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
| | - Kate Downey
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Steve Allen
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Briony Bishop
- Royal Marsden NHS Foundation Trust, London, UK
- Bedfordshire Hospitals NHS Trust, South Wing, Kempston Rd, Bedford, MK42 9DJ, UK
| | - Lauren R Hector
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
| | - Elaine P Patrick
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
| | | | - Peter A Barry
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
- Institute for Cancer Research, Sutton, UK
| | - Katherine D C Krupa
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
| | - Jennifer E Rusby
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK.
- Institute for Cancer Research, Sutton, UK.
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28
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McTiernan CD, Simpson FC, Haagdorens M, Samarawickrama C, Hunter D, Buznyk O, Fagerholm P, Ljunggren MK, Lewis P, Pintelon I, Olsen D, Edin E, Groleau M, Allan BD, Griffith M. LiQD Cornea: Pro-regeneration collagen mimetics as patches and alternatives to corneal transplantation. Sci Adv 2020; 6:6/25/eaba2187. [PMID: 32917640 PMCID: PMC7299624 DOI: 10.1126/sciadv.aba2187] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 05/08/2020] [Indexed: 05/13/2023]
Abstract
Transplantation with donor corneas is the mainstay for treating corneal blindness, but a severe worldwide shortage necessitates the development of other treatment options. Corneal perforation from infection or inflammation is sealed with cyanoacrylate glue. However, the resulting cytotoxicity requires transplantation. LiQD Cornea is an alternative to conventional corneal transplantation and sealants. It is a cell-free, liquid hydrogel matrix for corneal regeneration, comprising short collagen-like peptides conjugated with polyethylene glycol and mixed with fibrinogen to promote adhesion within tissue defects. Gelation occurs spontaneously at body temperature within 5 min. Light exposure is not required-particularly advantageous because patients with corneal inflammation are typically photophobic. The self-assembling, fully defined, synthetic collagen analog is much less costly than human recombinant collagen and reduces the risk of immune rejection associated with xenogeneic materials. In situ gelation potentially allows for clinical application in outpatient clinics instead of operating theaters, maximizing practicality, and minimizing health care costs.
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Affiliation(s)
- Christopher D McTiernan
- Centre de Recherche Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada
- Department of Ophthalmology and Institute of Biomedical Engineering, Université de Montréal, Montréal, QC, Canada
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Fiona C Simpson
- Centre de Recherche Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada
- Department of Ophthalmology and Institute of Biomedical Engineering, Université de Montréal, Montréal, QC, Canada
| | - Michel Haagdorens
- Department of Ophthalmology, Visual Optics and Visual Rehabilitation, University of Antwerp, Antwerp, Belgium
| | - Chameen Samarawickrama
- Centre for Vision Research, The Westmead Institute for Medical Research, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Institute for Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Damien Hunter
- Centre for Vision Research, The Westmead Institute for Medical Research, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Oleksiy Buznyk
- Institute for Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Per Fagerholm
- Institute for Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Monika K Ljunggren
- Institute for Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Philip Lewis
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - Isabel Pintelon
- Laboratory of Cell Biology and Histology, University of Antwerp, Antwerp, Belgium
| | | | - Elle Edin
- Centre de Recherche Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada
- Department of Ophthalmology and Institute of Biomedical Engineering, Université de Montréal, Montréal, QC, Canada
| | - Marc Groleau
- Centre de Recherche Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada
| | - Bruce D Allan
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
| | - May Griffith
- Centre de Recherche Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada.
- Department of Ophthalmology and Institute of Biomedical Engineering, Université de Montréal, Montréal, QC, Canada
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29
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Molteni E, Colombo K, Pastore V, Galbiati S, Recla M, Locatelli F, Galbiati S, Fedeli C, Strazzer S. Joint Neuropsychological Assessment through Coma/Near Coma and Level of Cognitive Functioning Assessment Scales Reduces Negative Findings in Pediatric Disorders of Consciousness. Brain Sci 2020; 10:E162. [PMID: 32178348 PMCID: PMC7140001 DOI: 10.3390/brainsci10030162] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 02/28/2020] [Accepted: 03/10/2020] [Indexed: 01/26/2023] Open
Abstract
The present study aimed to: (a) characterize the emergence to a conscious state (CS) in a sample of children and adolescents with severe brain injury during the post-acute rehabilitation and through two different neuropsychological assessment tools: the Rappaport Coma/Near Coma Scale (CNCS) and Level of Cognitive Functioning Assessment Scale (LOCFAS); (b) compare the evolution in patients with brain lesions due to traumatic and non-traumatic etiologies; and (c) describe the relationship between the emergence to a CS and some relevant clinical variables. In this observational prospective longitudinal study, 92 consecutive patients were recruited. Inclusion criteria were severe disorders of consciousness (DOC), Glasgow Coma Scale (GCS) score ≤8 at insult, age 0 to 18 years, and direct admission to inpatient rehabilitation from acute care. The main outcome measures were CNCS and LOCFAS, both administered three and six months after injury. The cohort globally shifted towards milder DOC over time, moving from overall 'moderate/near coma' at three months to 'near/no coma' at six months post-injury. The shift was captured by both CNCS and LOCFAS. CNCS differentiated levels of coma at best, while LOCFAS was superior in characterizing the emergence from coma. Agreement between scales was fair, and reduced negative findings at less than 10%. Patients with traumatic brain injury (TBI) vs. non-traumatic brain injury (NTBI) were older and had neurosurgical intervention more frequently. No relation between age and the level of consciousness was found overall. Concurrent administration of CNCS and LOCFAS reduced the rate of false negatives and better detected signs of arousal and awareness. This provides indication to administer both tools to increase measurement precision.
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Affiliation(s)
- Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, and Centre for Medical Engineering, King’s College, London SE1 7EU, UK
| | - Katia Colombo
- Neuropsychological and Cognitive-behavioral Service, Neurophysiatric Department, Scientific Institute, I.R.C.C.S. Eugenio Medea, 23842 Bosisio Parini, Italy; (V.P.); (S.G.); (M.R.); (C.F.)
| | - Valentina Pastore
- Neuropsychological and Cognitive-behavioral Service, Neurophysiatric Department, Scientific Institute, I.R.C.C.S. Eugenio Medea, 23842 Bosisio Parini, Italy; (V.P.); (S.G.); (M.R.); (C.F.)
| | - Susanna Galbiati
- Neuropsychological and Cognitive-behavioral Service, Neurophysiatric Department, Scientific Institute, I.R.C.C.S. Eugenio Medea, 23842 Bosisio Parini, Italy; (V.P.); (S.G.); (M.R.); (C.F.)
| | - Monica Recla
- Neuropsychological and Cognitive-behavioral Service, Neurophysiatric Department, Scientific Institute, I.R.C.C.S. Eugenio Medea, 23842 Bosisio Parini, Italy; (V.P.); (S.G.); (M.R.); (C.F.)
| | - Federica Locatelli
- Neurophysiatric Department, Scientific Institute, I.R.C.C.S. Eugenio Medea, 23842 Bosisio Parini, Italy; (F.L.); (S.G.); (S.S.)
| | - Sara Galbiati
- Neurophysiatric Department, Scientific Institute, I.R.C.C.S. Eugenio Medea, 23842 Bosisio Parini, Italy; (F.L.); (S.G.); (S.S.)
| | - Claudia Fedeli
- Neuropsychological and Cognitive-behavioral Service, Neurophysiatric Department, Scientific Institute, I.R.C.C.S. Eugenio Medea, 23842 Bosisio Parini, Italy; (V.P.); (S.G.); (M.R.); (C.F.)
| | - Sandra Strazzer
- Neurophysiatric Department, Scientific Institute, I.R.C.C.S. Eugenio Medea, 23842 Bosisio Parini, Italy; (F.L.); (S.G.); (S.S.)
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Minchom A, Yuan W, Crespo M, Gurel B, Figueiredo I, Wotherspoon A, Miranda S, Riisnaes R, Ferreira A, Bertan C, Pereira R, Clarke M, Baker C, Ang JE, Fotiadis N, Tunariu N, Carreira S, Popat S, O'Brien M, Banerji U, de Bono J, Lopez J. Molecular and immunological features of a prolonged exceptional responder with malignant pleural mesothelioma treated initially and rechallenged with pembrolizumab. J Immunother Cancer 2020; 8:e000713. [PMID: 32169873 PMCID: PMC7069263 DOI: 10.1136/jitc-2020-000713] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This case represents an exceptional response to pembrolizumab in a patient with epithelioid mesothelioma with a further response on rechallenge. CASE PRESENTATION A 77-year-old woman with advanced epithelioid mesothelioma extensively pretreated with chemotherapy demonstrated a prolonged response of 45 months to 52 cycles of pembrolizumab. On rechallenge with pembrolizumab, further disease stability was achieved. Serial biopsies and analysis by immunohistochemistry and immunofluorescence demonstrated marked immune infiltration and documented the emergency of markers of immune exhaustion. Whole exome sequencing demonstrated a reduction in tumor mutational burden consistent with subclone elimination by immune checkpoint inhibitor (CPI) therapy. The relapse biopsy had missense mutation in BTN2A1. CONCLUSION This case supports rechallenge of programme death receptor 1 inhibitor in cases of previous CPI sensitivity and gives molecular insights.
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Affiliation(s)
- Anna Minchom
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Sutton, UK
| | - Wei Yuan
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Sutton, UK
| | - Mateus Crespo
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Sutton, UK
| | - Bora Gurel
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Sutton, UK
| | - Ines Figueiredo
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Sutton, UK
| | | | - Susana Miranda
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Sutton, UK
| | - Ruth Riisnaes
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Sutton, UK
| | - Ana Ferreira
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Sutton, UK
| | - Claudia Bertan
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Sutton, UK
| | - Rita Pereira
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Sutton, UK
| | - Matt Clarke
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Sutton, UK
| | - Chloe Baker
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Sutton, UK
| | - Joo Ern Ang
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Sutton, UK
| | - Nicos Fotiadis
- Department of Radiology, Royal Marsden Hospital, London, UK
| | - Nina Tunariu
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Sutton, UK
| | - Suzanne Carreira
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Sutton, UK
| | | | | | - Udai Banerji
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Sutton, UK
| | - Johann de Bono
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Sutton, UK
| | - Juanita Lopez
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Sutton, UK
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