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Wilson LA, Macken WL, Perry LD, Record CJ, Schon KR, Frezatti RSS, Raga S, Naidu K, Köken ÖY, Polat I, Kapapa MM, Dominik N, Efthymiou S, Morsy H, Nel M, Fassad MR, Gao F, Patel K, Schoonen M, Bisschoff M, Vorster A, Jonvik H, Human R, Lubbe E, Nonyane M, Vengalil S, Nashi S, Srivastava K, Lemmers RJLF, Reyaz A, Mishra R, Töpf A, Trainor CI, Steyn EC, Mahungu AC, van der Vliet PJ, Ceylan AC, Hiz AS, Çavdarlı B, Semerci Gündüz CN, Ceylan GG, Nagappa M, Tallapaka KB, Govindaraj P, van der Maarel SM, Narayanappa G, Nandeesh BN, Wa Somwe S, Bearden DR, Kvalsund MP, Ramdharry GM, Oktay Y, Yiş U, Topaloğlu H, Sarkozy A, Bugiardini E, Henning F, Wilmshurst JM, Heckmann JM, McFarland R, Taylor RW, Smuts I, van der Westhuizen FH, Sobreira CFDR, Tomaselli PJ, Marques W, Bhatia R, Dalal A, Srivastava MVP, Yareeda S, Nalini A, Vishnu VY, Thangaraj K, Straub V, Horvath R, Chinnery PF, Pitceathly RDS, Muntoni F, Houlden H, Vandrovcova J, Reilly MM, Hanna MG. Neuromuscular disease genetics in under-represented populations: increasing data diversity. Brain 2023; 146:5098-5109. [PMID: 37516995 PMCID: PMC10690022 DOI: 10.1093/brain/awad254] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/22/2023] [Accepted: 07/04/2023] [Indexed: 08/01/2023] Open
Abstract
Neuromuscular diseases (NMDs) affect ∼15 million people globally. In high income settings DNA-based diagnosis has transformed care pathways and led to gene-specific therapies. However, most affected families are in low-to-middle income countries (LMICs) with limited access to DNA-based diagnosis. Most (86%) published genetic data is derived from European ancestry. This marked genetic data inequality hampers understanding of genetic diversity and hinders accurate genetic diagnosis in all income settings. We developed a cloud-based transcontinental partnership to build diverse, deeply-phenotyped and genetically characterized cohorts to improve genetic architecture knowledge, and potentially advance diagnosis and clinical management. We connected 18 centres in Brazil, India, South Africa, Turkey, Zambia, Netherlands and the UK. We co-developed a cloud-based data solution and trained 17 international neurology fellows in clinical genomic data interpretation. Single gene and whole exome data were analysed via a bespoke bioinformatics pipeline and reviewed alongside clinical and phenotypic data in global webinars to inform genetic outcome decisions. We recruited 6001 participants in the first 43 months. Initial genetic analyses 'solved' or 'possibly solved' ∼56% probands overall. In-depth genetic data review of the four commonest clinical categories (limb girdle muscular dystrophy, inherited peripheral neuropathies, congenital myopathy/muscular dystrophies and Duchenne/Becker muscular dystrophy) delivered a ∼59% 'solved' and ∼13% 'possibly solved' outcome. Almost 29% of disease causing variants were novel, increasing diverse pathogenic variant knowledge. Unsolved participants represent a new discovery cohort. The dataset provides a large resource from under-represented populations for genetic and translational research. In conclusion, we established a remote transcontinental partnership to assess genetic architecture of NMDs across diverse populations. It supported DNA-based diagnosis, potentially enabling genetic counselling, care pathways and eligibility for gene-specific trials. Similar virtual partnerships could be adopted by other areas of global genomic neurological practice to reduce genetic data inequality and benefit patients globally.
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Affiliation(s)
- Lindsay A Wilson
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - William L Macken
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Luke D Perry
- Institute of Child Health and Centre for Neuromuscular Diseases, Neurosciences Unit, The Dubowitz Neuromuscular Centre, University College London, UCL Great Ormond Street, Great Ormond Street Hospital, London WC1N 3JH, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Christopher J Record
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Katherine R Schon
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Rodrigo S S Frezatti
- Department of Neurosciences, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Sharika Raga
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Division of Paediatric Neurology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
| | - Kireshnee Naidu
- Neurology Research Group, Division of Neurology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Division of Neurology, Department of Medicine, Stellenbosch University, Cape Town, South Africa
| | - Özlem Yayıcı Köken
- Faculty of Medicine, Department of Pediatric Neurology, Akdeniz University, Antalya, Turkey
| | - Ipek Polat
- Faculty of Medicine, Pediatric Neurology Department, Dokuz Eylül University, Izmir, Turkey
- Izmir International Biomedicine and Genome Institute, Dokuz Eylül University, Izmir, Turkey
| | - Musambo M Kapapa
- Department of Physiotherapy, University of Zambia School of Health Sciences & University Teaching Hospital Neurology Research Office, Lusaka, Zambia
| | - Natalia Dominik
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Stephanie Efthymiou
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Heba Morsy
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Melissa Nel
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Neurology Research Group, Division of Neurology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Mahmoud R Fassad
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Fei Gao
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Krutik Patel
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Maryke Schoonen
- Focus Area for Human Metabolomics, North-West University, Potchefstroom, South Africa
| | - Michelle Bisschoff
- Focus Area for Human Metabolomics, North-West University, Potchefstroom, South Africa
| | - Armand Vorster
- Focus Area for Human Metabolomics, North-West University, Potchefstroom, South Africa
| | - Hallgeir Jonvik
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Ronel Human
- Department of Paediatrics, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Elsa Lubbe
- Department of Paediatrics, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Malebo Nonyane
- Department of Paediatrics, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Kosha Srivastava
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Richard J L F Lemmers
- Department of Human Genetics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Alisha Reyaz
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - Rinkle Mishra
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - Ana Töpf
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Christina I Trainor
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Elizabeth C Steyn
- Neurology Research Group, Division of Neurology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Amokelani C Mahungu
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Neurology Research Group, Division of Neurology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Patrick J van der Vliet
- Department of Human Genetics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Ahmet Cevdet Ceylan
- Department of Medical Genetics, Ankara Bilkent City Hospital, Ankara, Turkey
- Faculty of Medicine, Department of Medical Genetics, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - A Semra Hiz
- Faculty of Medicine, Pediatric Neurology Department, Dokuz Eylül University, Izmir, Turkey
- Izmir Biomedicine and Genome Center (IBG), Izmir, Turkey
| | - Büşranur Çavdarlı
- Department of Medical Genetics, Ankara Bilkent City Hospital, Ankara, Turkey
| | - C Nur Semerci Gündüz
- Department of Medical Genetics, Ankara Bilkent City Hospital, Ankara, Turkey
- Faculty of Medicine, Department of Medical Genetics, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Gülay Güleç Ceylan
- Department of Medical Genetics, Ankara Bilkent City Hospital, Ankara, Turkey
- Faculty of Medicine, Department of Medical Genetics, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Madhu Nagappa
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Karthik B Tallapaka
- CSIR—Centre for Cellular and Molecular Biology (CCMB), Hyderabad, Telangana, India
| | - Periyasamy Govindaraj
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, Telangana, India
| | | | - Gayathri Narayanappa
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Bevinahalli N Nandeesh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Somwe Wa Somwe
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Lusaka, Lusaka, Zambia
| | - David R Bearden
- University of Zambia Department of Educational Psychology, Lusaka, Zambia
- Department of Neurology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Michelle P Kvalsund
- Department of Neurology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY 14642, USA
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Gita M Ramdharry
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Yavuz Oktay
- Izmir International Biomedicine and Genome Institute, Dokuz Eylül University, Izmir, Turkey
- Izmir Biomedicine and Genome Center (IBG), Izmir, Turkey
| | - Uluç Yiş
- Faculty of Medicine, Pediatric Neurology Department, Dokuz Eylül University, Izmir, Turkey
| | | | - Anna Sarkozy
- NIHR Great Ormond Street Hospital Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Enrico Bugiardini
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Franclo Henning
- Division of Neurology, Department of Medicine, Stellenbosch University, Cape Town, South Africa
| | - Jo M Wilmshurst
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Division of Paediatric Neurology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
| | - Jeannine M Heckmann
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Neurology Research Group, Division of Neurology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Robert McFarland
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - Robert W Taylor
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - Izelle Smuts
- Department of Paediatrics, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | | | | | - Pedro J Tomaselli
- Department of Neurosciences, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Wilson Marques
- Department of Neurosciences, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - Ashwin Dalal
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, Telangana, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - Sireesha Yareeda
- Department of Neurology, Nizam’s Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Venugopalan Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | - Kumarasamy Thangaraj
- CSIR—Centre for Cellular and Molecular Biology (CCMB), Hyderabad, Telangana, India
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Rita Horvath
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Patrick F Chinnery
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Robert D S Pitceathly
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Francesco Muntoni
- Institute of Child Health and Centre for Neuromuscular Diseases, Neurosciences Unit, The Dubowitz Neuromuscular Centre, University College London, UCL Great Ormond Street, Great Ormond Street Hospital, London WC1N 3JH, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Henry Houlden
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Jana Vandrovcova
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Mary M Reilly
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Michael G Hanna
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
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2
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Mole J, Nelson A, Chan E, Cipolotti L, Nachev P. Characterizing phonemic fluency by transfer learning with deep language models. Brain Commun 2023; 5:fcad318. [PMID: 38046096 PMCID: PMC10691875 DOI: 10.1093/braincomms/fcad318] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 10/06/2023] [Accepted: 11/27/2023] [Indexed: 12/05/2023] Open
Abstract
Though phonemic fluency tasks are traditionally indexed by the number of correct responses, the underlying disorder may shape the specific choice of words-both correct and erroneous. We report the first comprehensive qualitative analysis of incorrect and correct words generated on the phonemic ('S') fluency test, in a large sample of patients (n = 239) with focal, unilateral frontal or posterior lesions and healthy controls (n = 136). We conducted detailed qualitative analyses of the single words generated in the phonemic fluency task using categorical descriptions for different types of errors, low-frequency words and clustering/switching. We further analysed patients' and healthy controls' entire sequences of words by employing stochastic block modelling of Generative Pretrained Transformer 3-based deep language representations. We conducted predictive modelling to investigate whether deep language representations of word sequences improved the accuracy of detecting the presence of frontal lesions using the phonemic fluency test. Our qualitative analyses of the single words generated revealed several novel findings. For the different types of errors analysed, we found a non-lateralized frontal effect for profanities, left frontal effects for proper nouns and permutations and a left posterior effect for perseverations. For correct words, we found a left frontal effect for low-frequency words. Our novel large language model-based approach found five distinct communities whose varied word selection patterns reflected characteristic demographic and clinical features. Predictive modelling showed that a model based on Generative Pretrained Transformer 3-derived word sequence representations predicted the presence of frontal lesions with greater fidelity than models of native features. Our study reveals a characteristic pattern of phonemic fluency responses produced by patients with frontal lesions. These findings demonstrate the significant inferential and diagnostic value of characterizing qualitative features of phonemic fluency performance with large language models and stochastic block modelling.
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Affiliation(s)
- Joe Mole
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
- Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Amy Nelson
- Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Edgar Chan
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
- Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Lisa Cipolotti
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
- Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Parashkev Nachev
- Institute of Neurology, University College London, London WC1N 3BG, UK
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Almeida-Magana R, Maroof H, Grierson J, Clow R, Dinneen E, Al-Hammouri T, Muirhead N, Brew-Graves C, Kelly J, Shaw G. E-Consent-a guide to maintain recruitment in clinical trials during the COVID-19 pandemic. Trials 2022; 23:388. [PMID: 35550639 PMCID: PMC9096749 DOI: 10.1186/s13063-022-06333-6] [Citation(s) in RCA: 10] [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] [Received: 12/16/2021] [Accepted: 04/23/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has posed daunting challenges when conducting clinical research. Adopting new technologies such as remote electronic consent (e-Consent) can help overcome them. However, guidelines for e-Consent implementation in ongoing clinical trials are currently lacking. The NeuroSAFE PROOF trial is a randomized clinical trial evaluating the role of frozen section analysis during RARP for prostate cancer. In response to the COVID-19 crisis, recruitment was halted, and a remote e-Consent solution was designed. The aim of this paper is to describe the process of implementation, impact on recruitment rate, and patients' experience using e-Consent. METHODS A substantial amendment of the protocol granted the creation of a remote e-Consent framework based on the REDCap environment, following the structure and content of the already approved paper consent form. Although e-Consent obviated the need for in-person meeting, there was nonetheless counselling sessions performed interactively online. This new pathway offered continuous support to patients through remote consultations. The whole process was judged to be compliant with regulatory requirements before implementation. RESULTS Before the first recruitment suspension, NeuroSAFE PROOF was recruiting an average of 9 patients per month. After e-Consent implementation, 63 new patients (4/month) have been enrolled despite a second lockdown, none of whom would have been recruited using the old methods given restrictions on face-to-face consultations. Patients have given positive feedback on the use of the platform. Limited troubleshooting has been required after implementation. CONCLUSION Remote e-Consent-based recruitment was critical for the continuation of the NeuroSAFE PROOF trial during the COVID-19 pandemic. The described pathway complies with ethical and regulatory guidelines for informed consent, while minimizing face-to-face interactions that increase the risk of COVID-19 transmission. This guide will help researchers integrate e-Consent to ongoing or planned clinical trials while uncertainty about the course of the pandemic continues. TRIAL REGISTRATION NeuroSAFE PROOF trial NCT03317990 . Registered on 23 October 2017. Regional Ethics Committee reference 17/LO/1978.
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Affiliation(s)
- Ricardo Almeida-Magana
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London, W1W 7TY, UK.
| | - Hanna Maroof
- Department of Urology, Westmoreland Street Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Jack Grierson
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London, W1W 7TY, UK
| | - Rosie Clow
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London, W1W 7TY, UK
| | - Eoin Dinneen
- Department of Urology, Westmoreland Street Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Tarek Al-Hammouri
- Department of Urology, Westmoreland Street Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Nicola Muirhead
- NCITA Clinical Trials Unit, Division of Medicine, University College London, Charles Bell House, 2nd Floor, 43-45 Foley Street, London, W1W 7TY, UK
| | - Chris Brew-Graves
- NCITA Clinical Trials Unit, Division of Medicine, University College London, Charles Bell House, 2nd Floor, 43-45 Foley Street, London, W1W 7TY, UK
| | - John Kelly
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London, W1W 7TY, UK
- Department of Urology, Westmoreland Street Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Greg Shaw
- Department of Urology, Westmoreland Street Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
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Reynolds CJ, Gibbons JM, Pade C, Lin KM, Sandoval DM, Pieper F, Butler DK, Liu S, Otter AD, Joy G, Menacho K, Fontana M, Smit A, Kele B, Cutino-Moguel T, Maini MK, Noursadeghi M, Brooks T, Semper A, Manisty C, Treibel TA, Moon JC, McKnight Á, Altmann DM, Boyton RJ. Heterologous infection and vaccination shapes immunity against SARS-CoV-2 variants. Science 2022; 375:183-192. [PMID: 34855510 PMCID: PMC10186585 DOI: 10.1126/science.abm0811] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [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: 08/25/2021] [Accepted: 11/25/2021] [Indexed: 12/15/2022]
Abstract
The impact of the initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infecting strain on downstream immunity to heterologous variants of concern (VOCs) is unknown. Studying a longitudinal healthcare worker cohort, we found that after three antigen exposures (infection plus two vaccine doses), S1 antibody, memory B cells, and heterologous neutralization of B.1.351, P.1, and B.1.617.2 plateaued, whereas B.1.1.7 neutralization and spike T cell responses increased. Serology using the Wuhan Hu-1 spike receptor binding domain poorly predicted neutralizing immunity against VOCs. Neutralization potency against VOCs changed with heterologous virus encounter and number of antigen exposures. Neutralization potency fell differentially depending on targeted VOCs over the 5 months from the second vaccine dose. Heterologous combinations of spike encountered during infection and vaccination shape subsequent cross-protection against VOC, with implications for future-proof next-generation vaccines.
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Affiliation(s)
| | - Joseph M. Gibbons
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Corinna Pade
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kai-Min Lin
- Department of Infectious Disease, Imperial College London, London, UK
| | | | - Franziska Pieper
- Department of Infectious Disease, Imperial College London, London, UK
| | - David K. Butler
- Department of Infectious Disease, Imperial College London, London, UK
| | - Siyi Liu
- Department of Infectious Disease, Imperial College London, London, UK
| | | | - George Joy
- St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
| | - Katia Menacho
- St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
| | | | | | - Beatrix Kele
- St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
| | | | - Mala K. Maini
- Division of Infection and Immunity, University College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - COVIDsortium Immune Correlates Network‡
- Department of Infectious Disease, Imperial College London, London, UK
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- UK Health Security Agency, Porton Down, UK
- St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- Royal Free London NHS Foundation Trust, London, UK
- Division of Infection and Immunity, University College London, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Immunology and Inflammation, Imperial College London, London, UK
- Lung Division, Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Tim Brooks
- UK Health Security Agency, Porton Down, UK
| | | | - Charlotte Manisty
- St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Thomas A. Treibel
- St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - James C. Moon
- St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - COVIDsortium Investigators‡
- Department of Infectious Disease, Imperial College London, London, UK
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- UK Health Security Agency, Porton Down, UK
- St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- Royal Free London NHS Foundation Trust, London, UK
- Division of Infection and Immunity, University College London, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Immunology and Inflammation, Imperial College London, London, UK
- Lung Division, Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Áine McKnight
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Daniel M. Altmann
- Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Rosemary J. Boyton
- Department of Infectious Disease, Imperial College London, London, UK
- Lung Division, Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
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Reynolds CJ, Pade C, Gibbons JM, Butler DK, Otter AD, Menacho K, Fontana M, Smit A, Sackville-West JE, Cutino-Moguel T, Maini MK, Chain B, Noursadeghi M, Brooks T, Semper A, Manisty C, Treibel TA, Moon JC, Valdes AM, McKnight Á, Altmann DM, Boyton R. Prior SARS-CoV-2 infection rescues B and T cell responses to variants after first vaccine dose. Science 2021; 372:eabh1282. [PMID: 33931567 PMCID: PMC8168614 DOI: 10.1126/science.abh1282] [Citation(s) in RCA: 209] [Impact Index Per Article: 69.7] [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: 02/21/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022]
Abstract
SARS-CoV-2 vaccine rollout has coincided with the spread of variants of concern. We investigated if single dose vaccination, with or without prior infection, confers cross protective immunity to variants. We analyzed T and B cell responses after first dose vaccination with the Pfizer/BioNTech mRNA vaccine BNT162b2 in healthcare workers (HCW) followed longitudinally, with or without prior Wuhan-Hu-1 SARS-CoV-2 infection. After one dose, individuals with prior infection showed enhanced T cell immunity, antibody secreting memory B cell response to spike and neutralizing antibodies effective against B.1.1.7 and B.1.351. By comparison, HCW receiving one vaccine dose without prior infection showed reduced immunity against variants. B.1.1.7 and B.1.351 spike mutations resulted in increased, abrogated or unchanged T cell responses depending on human leukocyte antigen (HLA) polymorphisms. Single dose vaccination with BNT162b2 in the context of prior infection with a heterologous variant substantially enhances neutralizing antibody responses against variants.
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Affiliation(s)
| | - Corinna Pade
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Joseph M Gibbons
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - David K Butler
- Department of Infectious Disease, Imperial College London, London, UK
| | - Ashley D Otter
- National Infection Service, Public Health England, Porton Down, UK
| | - Katia Menacho
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Marianna Fontana
- Royal Free London NHS Foundation Trust, London, UK
- Division of Medicine, University College London, London, UK
| | | | | | | | - Mala K Maini
- Division of Infection and Immunity, University College London, London, UK
| | - Benjamin Chain
- Division of Infection and Immunity, University College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Tim Brooks
- National Infection Service, Public Health England, Porton Down, UK
| | - Amanda Semper
- National Infection Service, Public Health England, Porton Down, UK
| | - Charlotte Manisty
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Thomas A Treibel
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - James C Moon
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Ana M Valdes
- Academic Rheumatology, Clinical Sciences, Nottingham City Hospital, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Áine McKnight
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Daniel M Altmann
- Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Rosemary Boyton
- Department of Infectious Disease, Imperial College London, London, UK.
- Lung Division, Royal Brompton and Harefield Hospitals, London, UK
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Abstract
PURPOSE OF REVIEW This article aims to review the current and upcoming treatment options of primary muscle channelopathies including the non-dystrophic myotonias and periodic paralyses. RECENT FINDINGS The efficacy of mexiletine in the treatment of myotonia is now supported by two randomised placebo-controlled trials, one of which utilised a novel aggregated n-of-1 design. This has resulted in licencing of the drug via orphan drug status. There is also good evidence that mexiletine is well tolerated and safe in this patient group without the need for intensive monitoring. A range of alternative antimyotonic treatment options include lamotrigine, carbamazepine and ranolazine exist with variable evidence base. In vitro studies have shown insight into reasons for treatment failure of some medications with certain genotypes opening the era of mutation-specific therapy such as use of flecainide. In the periodic paralyses, the ability of MRI to distinguish between reversible oedema and irreversible fatty replacement makes it an increasingly useful tool to guide and assess pharmacological treatment. Unfortunately, the striking efficacy of bumetanide in hypokalaemic periodic paralysis animal models was not replicated in a recent pilot study in humans. SUMMARY The treatment of skeletal muscle channelopathies combines dietary and lifestyle advice together with pharmacological interventions. The rarity of these conditions remains a barrier for clinical studies but the example of the aggregated n-of-1 trial of mexiletine shows that innovative trial design can overcome these hurdles. Further research is required to test efficacy of drugs shown to have promising characteristics in preclinical experiments such as safinamide, riluzule and magnesium for myotonia or bumetanide for hypokalaemic periodic paralysis.
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Affiliation(s)
- Nantaporn Jitpimolmard
- Queen Square Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, UCL, London, UK
- Rehabilitation Medicine Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Emma Matthews
- Queen Square Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, UCL, London, UK
- Atkinson-Morley Neuromuscular Centre, St George’s University Hospitals Foundation Trust, London, UK
| | - Doreen Fialho
- Queen Square Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, UCL, London, UK
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Bianco R, Harrison PMC, Hu M, Bolger C, Picken S, Pearce MT, Chait M. Long-term implicit memory for sequential auditory patterns in humans. eLife 2020; 9:e56073. [PMID: 32420868 PMCID: PMC7338054 DOI: 10.7554/elife.56073] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 05/18/2020] [Indexed: 11/17/2022] Open
Abstract
Memory, on multiple timescales, is critical to our ability to discover the structure of our surroundings, and efficiently interact with the environment. We combined behavioural manipulation and modelling to investigate the dynamics of memory formation for rarely reoccurring acoustic patterns. In a series of experiments, participants detected the emergence of regularly repeating patterns within rapid tone-pip sequences. Unbeknownst to them, a few patterns reoccurred every ~3 min. All sequences consisted of the same 20 frequencies and were distinguishable only by the order of tone-pips. Despite this, reoccurring patterns were associated with a rapidly growing detection-time advantage over novel patterns. This effect was implicit, robust to interference, and persisted for 7 weeks. The results implicate an interplay between short (a few seconds) and long-term (over many minutes) integration in memory formation and demonstrate the remarkable sensitivity of the human auditory system to sporadically reoccurring structure within the acoustic environment.
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Affiliation(s)
- Roberta Bianco
- UCL Ear Institute, University College LondonLondonUnited Kingdom
| | - Peter MC Harrison
- School of Electronic Engineering and Computer Science, Queen Mary University of LondonLondonUnited Kingdom
| | - Mingyue Hu
- UCL Ear Institute, University College LondonLondonUnited Kingdom
| | - Cora Bolger
- UCL Ear Institute, University College LondonLondonUnited Kingdom
| | - Samantha Picken
- UCL Ear Institute, University College LondonLondonUnited Kingdom
| | - Marcus T Pearce
- School of Electronic Engineering and Computer Science, Queen Mary University of LondonLondonUnited Kingdom
- Department of Clinical Medicine, Aarhus UniversityAarhusDenmark
| | - Maria Chait
- UCL Ear Institute, University College LondonLondonUnited Kingdom
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Harb AK, Mohammed H, Furegato M, Wayal S, Mercer CH, Hughes G. The association between region of birth and sexually transmitted infections among people of black Caribbean ethnicity attending sexual health services in England, 2015. PLoS One 2020; 15:e0228654. [PMID: 32084155 PMCID: PMC7034901 DOI: 10.1371/journal.pone.0228654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/21/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND/INTRODUCTION In England, people of Black Caribbean (BC) ethnicity are disproportionately affected by sexually transmitted infections (STIs), but it is unclear whether this varies by their region of birth. AIM(S)/OBJECTIVES To examine differences in STI diagnoses among UK- and Caribbean-born BC people. METHODS Data on STI diagnoses in BC people attending specialist sexual health services (SHSs) during 2015 and living in England were obtained from the GUMCAD STI surveillance system, the national surveillance system for STIs in England. Associations between being UK- or Caribbean-born and each of several STI diagnoses were examined, using univariate and multivariable generalised estimated equations logistic regression models adjusted for sexual orientation, place of residence (London vs. non-London), HIV status, area-level deprivation, and STI diagnosis in the last year. All analyses were stratified by age (<25 vs. ≥25 years). RESULTS In 2015, 63,568 BC people made 108,881 attendances at specialist SHSs; 81.9% of these attendances were made by UK-born BCs. The median age (years) was 26 for UK-born and 35 for Caribbean-born people (p≤0.001). Chlamydia, gonorrhoea and non-specific genital infection (NSGI) were the most commonly diagnosed STIs among UK- (5.8%, 2.1% and 2.8%) and Caribbean-born people (4.5%, 1.7% and 3.5%) respectively. Among BCs aged under 25, no significant differences in STIs were found between UK- and Caribbean-born people. Among BCs aged ≥25, compared to Caribbean-born people, those who were UK-born were more likely to be diagnosed with chlamydia (AOR 1.15 [95%C.I. 1.04-1.27]); gonorrhoea (AOR 1.23 [95%C.I. 1.06-1.45]) and genital herpes (AOR 1.23 [95% C.I. 1.10-1.56]) and less likely to be diagnosed with NSGI (AOR 0.89 [95% C.I. 0.80-0.99]) and Trichomoniasis (AOR 0.84 [95% C.I. 0.71-0.99]). DISCUSSION/CONCLUSION STI diagnoses in BC people aged ≥25 attending specialist SHSs vary by region of birth. Country of birth may have an influence on social and sexual networks and therefore transmission of STIs.
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Affiliation(s)
- Ana K. Harb
- National Infection Service, Public Health England, London, United Kingdom
- * E-mail:
| | - Hamish Mohammed
- National Infection Service, Public Health England, London, United Kingdom
- Centre for Population Research in Sexual Health and HIV, University College London, London, United Kingdom
| | - Martina Furegato
- National Infection Service, Public Health England, London, United Kingdom
- The Applied Diagnostic Research and Evaluation Unit (ADREU), St George’s, University, City, London, United Kingdom
| | - Sonali Wayal
- Centre for Population Research in Sexual Health and HIV, University College London, London, United Kingdom
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, London, United Kingdom
| | - Catherine H. Mercer
- Centre for Population Research in Sexual Health and HIV, University College London, London, United Kingdom
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, London, United Kingdom
| | - Gwenda Hughes
- National Infection Service, Public Health England, London, United Kingdom
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, London, United Kingdom
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Vindrola-Padros C, Eyre L, Baxter H, Cramer H, George B, Wye L, Fulop NJ, Utley M, Phillips N, Brindle P, Marshall M. Addressing the challenges of knowledge co-production in quality improvement: learning from the implementation of the researcher-in-residence model. BMJ Qual Saf 2019; 28:67-73. [PMID: 29866766 PMCID: PMC6373423 DOI: 10.1136/bmjqs-2017-007127] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 07/05/2017] [Revised: 05/07/2018] [Accepted: 05/13/2018] [Indexed: 11/04/2022]
Abstract
The concept of knowledge co-production is used in health services research to describe partnerships (which can involve researchers, practitioners, managers, commissioners or service users) with the purpose of creating, sharing and negotiating different knowledge types used to make improvements in health services. Several knowledge co-production models have been proposed to date, some involving intermediary roles. This paper explores one such model, researchers-in-residence (also known as 'embedded researchers').In this model, researchers work inside healthcare organisations, operating as staff members while also maintaining an affiliation with academic institutions. As part of the local team, researchers negotiate the meaning and use of research-based knowledge to co-produce knowledge, which is sensitive to the local context. Even though this model is spreading and appears to have potential for using co-produced knowledge to make changes in practice, a number of challenges with its use are emerging. These include challenges experienced by the researchers in embedding themselves within the practice environment, preserving a clear focus within their host organisations and maintaining academic professional identity.In this paper, we provide an exploration of these challenges by examining three independent case studies implemented in the UK, each of which attempted to co-produce relevant research projects to improve the quality of care. We explore how these played out in practice and the strategies used by the researchers-in-residence to address them. In describing and analysing these strategies, we hope that participatory approaches to knowledge co-production can be used more effectively in the future.
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Affiliation(s)
| | - Laura Eyre
- Primary Care and Population Health, University College London, London, UK
| | - Helen Baxter
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, Bristol, UK
| | - Helen Cramer
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, Bristol, UK
| | | | - Lesley Wye
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, Bristol, UK
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, London, UK
| | - Martin Utley
- Clinical Operational Research Unit, UCL, London, UK
| | - Natasha Phillips
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Peter Brindle
- Avon Primary Care Research Collaborative, Bristol, UK
| | - Martin Marshall
- Primary Care and Population Health, University College London, London, UK
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