4
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Oishi T, Sasaki Y, Tong Y, Chen L, Onodera T, Iwasa S, Udo E, Furusato B, Fujimori H, Imamichi S, Honda T, Bessho T, Fukuoka J, Ashizawa K, Yanagihara K, Nakao K, Yamada Y, Hiraoka N, Masutani M. A newly established monoclonal antibody against ERCC1 detects major isoforms of ERCC1 in gastric cancer. Glob Health Med 2021; 3:226-235. [PMID: 34532603 DOI: 10.35772/ghm.2021.01001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/25/2021] [Accepted: 05/10/2021] [Indexed: 11/08/2022]
Abstract
Identifying patients resistant to cisplatin treatment is expected to improve cisplatin-based chemotherapy for various types of cancers. Excision repair cross-complementing group 1 (ERCC1) is involved in several repair processes of cisplatin-induced DNA crosslinks. ERCC1 overexpression is reported as a candidate prognostic factor and considered to cause cisplatin resistance in major solid cancers. However, anti-ERCC1 antibodies capable of evaluating expression levels of ERCC1 in clinical specimens were not fully optimized. A mouse monoclonal antibody against human ERCC1 was generated in this study. The developed antibody 9D11 specifically detected isoforms of 201, 202, 203 but not 204, which lacks the exon 3 coding region. To evaluate the diagnostic usefulness of this antibody, we have focused on gastric cancer because it is one of the major cancers in Japan. When ERCC1 expression was analyzed in seventeen kinds of human gastric cancer cell lines, all the cell lines were found to express either 201, 202, and/or 203 as major isoforms of ERCC1, but not 204 by Western blotting analysis. Immunohistochemical staining showed that ERCC1 protein was exclusively detected in nuclei of the cells and a moderate level of constant positivity was observed in nuclei of vascular endothelial cells. It showed a clear staining pattern in clinical specimens of gastric cancers. Antibody 9D11 may thus be useful for estimating expression levels of ERCC1 in clinical specimens.
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Affiliation(s)
- Takayuki Oishi
- Department of Molecular and Genomic Biomedicine, Center for Bioinformatics and Molecular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Laboratory of Collaborative Research, Division of Cellular Signaling, National Cancer Center Research Institute, Tokyo, Japan.,Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Frontier Life Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yuka Sasaki
- Department of Molecular and Genomic Biomedicine, Center for Bioinformatics and Molecular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Laboratory of Collaborative Research, Division of Cellular Signaling, National Cancer Center Research Institute, Tokyo, Japan.,Department of Frontier Life Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ying Tong
- Department of Molecular and Genomic Biomedicine, Center for Bioinformatics and Molecular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Lichao Chen
- Department of Molecular and Genomic Biomedicine, Center for Bioinformatics and Molecular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Frontier Life Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takae Onodera
- Department of Molecular and Genomic Biomedicine, Center for Bioinformatics and Molecular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Laboratory of Collaborative Research, Division of Cellular Signaling, National Cancer Center Research Institute, Tokyo, Japan.,Department of Frontier Life Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Satoru Iwasa
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Emiko Udo
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Cancer Genomics Unit, Clinical Genomics Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Bungo Furusato
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Cancer Genomics Unit, Clinical Genomics Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiroaki Fujimori
- Department of Frontier Life Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shoji Imamichi
- Department of Molecular and Genomic Biomedicine, Center for Bioinformatics and Molecular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Laboratory of Collaborative Research, Division of Cellular Signaling, National Cancer Center Research Institute, Tokyo, Japan
| | - Takuya Honda
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Clinical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tadayoshi Bessho
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazuto Ashizawa
- Cancer Genomics Unit, Clinical Genomics Center, Nagasaki University Hospital, Nagasaki, Japan.,Department of Clinical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazuyoshi Yanagihara
- Division of Biomarker Discovery, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Tokyo, Japan
| | - Kazuhiko Nakao
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yasuhide Yamada
- Department of Medical Oncology, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Comprehensive Cancer Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Nobuyoshi Hiraoka
- Division of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Mitsuko Masutani
- Department of Molecular and Genomic Biomedicine, Center for Bioinformatics and Molecular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Laboratory of Collaborative Research, Division of Cellular Signaling, National Cancer Center Research Institute, Tokyo, Japan.,Department of Frontier Life Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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15
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Lee SM, Falzon M, Blackhall F, Spicer J, Nicolson M, Chaudhuri A, Middleton G, Ahmed S, Hicks J, Crosse B, Napier M, Singer JM, Ferry D, Lewanski C, Forster M, Rolls SA, Capitanio A, Rudd R, Iles N, Ngai Y, Gandy M, Lillywhite R, Hackshaw A. Randomized Prospective Biomarker Trial of ERCC1 for Comparing Platinum and Nonplatinum Therapy in Advanced Non-Small-Cell Lung Cancer: ERCC1 Trial (ET). J Clin Oncol 2017; 35:402-411. [PMID: 27893326 DOI: 10.1200/jco.2016.68.1841] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose Retrospective studies indicate that expression of excision repair cross complementing group 1 (ERCC1) protein is associated with platinum resistance and survival in non-small-cell lung cancer (NSCLC). We conducted the first randomized trial, to our knowledge, to evaluate ERCC1 prospectively and to assess the superiority of nonplatinum therapy over platinum doublet therapy for ERCC1-positive NSCLC as well as noninferiority for ERCC1-negative NSCLC. Patients and Methods This trial had a marker-by-treatment interaction phase III design, with ERCC1 (8F1 antibody) status as a randomization stratification factor. Chemonaïve patients with NSCLC (stage IIIB and IV) were eligible. Patients with squamous histology were randomly assigned to cisplatin and gemcitabine or paclitaxel and gemcitabine; nonsquamous patients received cisplatin and pemetrexed or paclitaxel and pemetrexed. Primary end point was overall survival (OS). We also evaluated an antibody specific for XPF (clone 3F2). The target hazard ratio (HR) for patients with ERCC1-positive NSCLC was ≤ 0.78. Results Of patients, 648 were recruited (177 squamous, 471 nonsquamous). ERCC1-positive rates were 54.5% and 76.7% in nonsquamous and squamous patients, respectively, and the corresponding XPF-positive rates were 70.5% and 68.5%. Accrual stopped early in 2012 for squamous patients because OS for nonplatinum therapy was inferior to platinum therapy (median OS, 7.6 months [paclitaxel and gemcitabine] v 10.7 months [cisplatin and gemcitabine]; HR, 1.46; P = .02). Accrual for nonsquamous patients halted in 2013. Median OS was 8.0 (paclitaxel and pemetrexed) versus 9.6 (cisplatin and pemetrexed) months for ERCC1-positive patients (HR, 1.11; 95% CI, 0.85 to 1.44), and 10.3 (paclitaxel and pemetrexed) versus 11.6 (cisplatin and pemetrexed) months for ERCC1-negative patients (HR, 0.99; 95% CI, 0.73 to 1.33; interaction P = .64). OS HR was 1.09 (95% CI, 0.83 to 1.44) for XPF-positive patients, and 1.39 (95% CI, 0.90 to 2.15) for XPF-negative patients (interaction P = .35). Neither ERCC1 nor XPF were prognostic: among nonsquamous patients, OS HRs for positive versus negative were ERCC1, 1.11 ( P = .32), and XPF, 1.08 ( P = .55). Conclusion Superior outcomes were observed for patients with squamous histology who received platinum therapy compared with nonplatinum chemotherapy; however, selecting chemotherapy by using commercially available ERCC1 or XPF antibodies did not confer any extra survival benefit.
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Affiliation(s)
- Siow Ming Lee
- Siow Ming Lee, Mary Falzon, Martin Forster, Arrigo Capitanio, Robin Rudd, Natasha Iles, Yenting Ngai, Michael Gandy, Rachel Lillywhite, and Allan Hackshaw, University College London, University College London Hospitals; James Spicer, Guy's and St Thomas's NHS Foundation Trust; Conrad Lewanski, Charing Cross Hospital, London; Fiona Blackhall, The Christie NHS Foundation Trust, Manchester; Marianne Nicolson, Aberdeen Royal Infirmary, Aberdeen; Abhro Chaudhuri, Lincoln County Hospital, Lincoln; Gary Middleton, University of Birmingham, Birmingham; Samreen Ahmed, Leicester Royal Infirmary, Leicester; Jonathan Hicks, New Victoria Hospital, Kingston Upon Thames; Barbara Crosse, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield; Mark Napier, North Devon District Hospital, Barnstaple; Julian M. Singer, Princess Alexandra Hospital NHS Foundation Trust, Harlow; David Ferry, New Cross Hospital, Wolverhampton; and Sally-Ann Rolls, Withybush General Hospital, Haverfordwest, United Kingdom
| | - Mary Falzon
- Siow Ming Lee, Mary Falzon, Martin Forster, Arrigo Capitanio, Robin Rudd, Natasha Iles, Yenting Ngai, Michael Gandy, Rachel Lillywhite, and Allan Hackshaw, University College London, University College London Hospitals; James Spicer, Guy's and St Thomas's NHS Foundation Trust; Conrad Lewanski, Charing Cross Hospital, London; Fiona Blackhall, The Christie NHS Foundation Trust, Manchester; Marianne Nicolson, Aberdeen Royal Infirmary, Aberdeen; Abhro Chaudhuri, Lincoln County Hospital, Lincoln; Gary Middleton, University of Birmingham, Birmingham; Samreen Ahmed, Leicester Royal Infirmary, Leicester; Jonathan Hicks, New Victoria Hospital, Kingston Upon Thames; Barbara Crosse, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield; Mark Napier, North Devon District Hospital, Barnstaple; Julian M. Singer, Princess Alexandra Hospital NHS Foundation Trust, Harlow; David Ferry, New Cross Hospital, Wolverhampton; and Sally-Ann Rolls, Withybush General Hospital, Haverfordwest, United Kingdom
| | - Fiona Blackhall
- Siow Ming Lee, Mary Falzon, Martin Forster, Arrigo Capitanio, Robin Rudd, Natasha Iles, Yenting Ngai, Michael Gandy, Rachel Lillywhite, and Allan Hackshaw, University College London, University College London Hospitals; James Spicer, Guy's and St Thomas's NHS Foundation Trust; Conrad Lewanski, Charing Cross Hospital, London; Fiona Blackhall, The Christie NHS Foundation Trust, Manchester; Marianne Nicolson, Aberdeen Royal Infirmary, Aberdeen; Abhro Chaudhuri, Lincoln County Hospital, Lincoln; Gary Middleton, University of Birmingham, Birmingham; Samreen Ahmed, Leicester Royal Infirmary, Leicester; Jonathan Hicks, New Victoria Hospital, Kingston Upon Thames; Barbara Crosse, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield; Mark Napier, North Devon District Hospital, Barnstaple; Julian M. Singer, Princess Alexandra Hospital NHS Foundation Trust, Harlow; David Ferry, New Cross Hospital, Wolverhampton; and Sally-Ann Rolls, Withybush General Hospital, Haverfordwest, United Kingdom
| | - James Spicer
- Siow Ming Lee, Mary Falzon, Martin Forster, Arrigo Capitanio, Robin Rudd, Natasha Iles, Yenting Ngai, Michael Gandy, Rachel Lillywhite, and Allan Hackshaw, University College London, University College London Hospitals; James Spicer, Guy's and St Thomas's NHS Foundation Trust; Conrad Lewanski, Charing Cross Hospital, London; Fiona Blackhall, The Christie NHS Foundation Trust, Manchester; Marianne Nicolson, Aberdeen Royal Infirmary, Aberdeen; Abhro Chaudhuri, Lincoln County Hospital, Lincoln; Gary Middleton, University of Birmingham, Birmingham; Samreen Ahmed, Leicester Royal Infirmary, Leicester; Jonathan Hicks, New Victoria Hospital, Kingston Upon Thames; Barbara Crosse, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield; Mark Napier, North Devon District Hospital, Barnstaple; Julian M. Singer, Princess Alexandra Hospital NHS Foundation Trust, Harlow; David Ferry, New Cross Hospital, Wolverhampton; and Sally-Ann Rolls, Withybush General Hospital, Haverfordwest, United Kingdom
| | - Marianne Nicolson
- Siow Ming Lee, Mary Falzon, Martin Forster, Arrigo Capitanio, Robin Rudd, Natasha Iles, Yenting Ngai, Michael Gandy, Rachel Lillywhite, and Allan Hackshaw, University College London, University College London Hospitals; James Spicer, Guy's and St Thomas's NHS Foundation Trust; Conrad Lewanski, Charing Cross Hospital, London; Fiona Blackhall, The Christie NHS Foundation Trust, Manchester; Marianne Nicolson, Aberdeen Royal Infirmary, Aberdeen; Abhro Chaudhuri, Lincoln County Hospital, Lincoln; Gary Middleton, University of Birmingham, Birmingham; Samreen Ahmed, Leicester Royal Infirmary, Leicester; Jonathan Hicks, New Victoria Hospital, Kingston Upon Thames; Barbara Crosse, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield; Mark Napier, North Devon District Hospital, Barnstaple; Julian M. Singer, Princess Alexandra Hospital NHS Foundation Trust, Harlow; David Ferry, New Cross Hospital, Wolverhampton; and Sally-Ann Rolls, Withybush General Hospital, Haverfordwest, United Kingdom
| | - Abhro Chaudhuri
- Siow Ming Lee, Mary Falzon, Martin Forster, Arrigo Capitanio, Robin Rudd, Natasha Iles, Yenting Ngai, Michael Gandy, Rachel Lillywhite, and Allan Hackshaw, University College London, University College London Hospitals; James Spicer, Guy's and St Thomas's NHS Foundation Trust; Conrad Lewanski, Charing Cross Hospital, London; Fiona Blackhall, The Christie NHS Foundation Trust, Manchester; Marianne Nicolson, Aberdeen Royal Infirmary, Aberdeen; Abhro Chaudhuri, Lincoln County Hospital, Lincoln; Gary Middleton, University of Birmingham, Birmingham; Samreen Ahmed, Leicester Royal Infirmary, Leicester; Jonathan Hicks, New Victoria Hospital, Kingston Upon Thames; Barbara Crosse, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield; Mark Napier, North Devon District Hospital, Barnstaple; Julian M. Singer, Princess Alexandra Hospital NHS Foundation Trust, Harlow; David Ferry, New Cross Hospital, Wolverhampton; and Sally-Ann Rolls, Withybush General Hospital, Haverfordwest, United Kingdom
| | - Gary Middleton
- Siow Ming Lee, Mary Falzon, Martin Forster, Arrigo Capitanio, Robin Rudd, Natasha Iles, Yenting Ngai, Michael Gandy, Rachel Lillywhite, and Allan Hackshaw, University College London, University College London Hospitals; James Spicer, Guy's and St Thomas's NHS Foundation Trust; Conrad Lewanski, Charing Cross Hospital, London; Fiona Blackhall, The Christie NHS Foundation Trust, Manchester; Marianne Nicolson, Aberdeen Royal Infirmary, Aberdeen; Abhro Chaudhuri, Lincoln County Hospital, Lincoln; Gary Middleton, University of Birmingham, Birmingham; Samreen Ahmed, Leicester Royal Infirmary, Leicester; Jonathan Hicks, New Victoria Hospital, Kingston Upon Thames; Barbara Crosse, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield; Mark Napier, North Devon District Hospital, Barnstaple; Julian M. Singer, Princess Alexandra Hospital NHS Foundation Trust, Harlow; David Ferry, New Cross Hospital, Wolverhampton; and Sally-Ann Rolls, Withybush General Hospital, Haverfordwest, United Kingdom
| | - Samreen Ahmed
- Siow Ming Lee, Mary Falzon, Martin Forster, Arrigo Capitanio, Robin Rudd, Natasha Iles, Yenting Ngai, Michael Gandy, Rachel Lillywhite, and Allan Hackshaw, University College London, University College London Hospitals; James Spicer, Guy's and St Thomas's NHS Foundation Trust; Conrad Lewanski, Charing Cross Hospital, London; Fiona Blackhall, The Christie NHS Foundation Trust, Manchester; Marianne Nicolson, Aberdeen Royal Infirmary, Aberdeen; Abhro Chaudhuri, Lincoln County Hospital, Lincoln; Gary Middleton, University of Birmingham, Birmingham; Samreen Ahmed, Leicester Royal Infirmary, Leicester; Jonathan Hicks, New Victoria Hospital, Kingston Upon Thames; Barbara Crosse, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield; Mark Napier, North Devon District Hospital, Barnstaple; Julian M. Singer, Princess Alexandra Hospital NHS Foundation Trust, Harlow; David Ferry, New Cross Hospital, Wolverhampton; and Sally-Ann Rolls, Withybush General Hospital, Haverfordwest, United Kingdom
| | - Jonathan Hicks
- Siow Ming Lee, Mary Falzon, Martin Forster, Arrigo Capitanio, Robin Rudd, Natasha Iles, Yenting Ngai, Michael Gandy, Rachel Lillywhite, and Allan Hackshaw, University College London, University College London Hospitals; James Spicer, Guy's and St Thomas's NHS Foundation Trust; Conrad Lewanski, Charing Cross Hospital, London; Fiona Blackhall, The Christie NHS Foundation Trust, Manchester; Marianne Nicolson, Aberdeen Royal Infirmary, Aberdeen; Abhro Chaudhuri, Lincoln County Hospital, Lincoln; Gary Middleton, University of Birmingham, Birmingham; Samreen Ahmed, Leicester Royal Infirmary, Leicester; Jonathan Hicks, New Victoria Hospital, Kingston Upon Thames; Barbara Crosse, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield; Mark Napier, North Devon District Hospital, Barnstaple; Julian M. Singer, Princess Alexandra Hospital NHS Foundation Trust, Harlow; David Ferry, New Cross Hospital, Wolverhampton; and Sally-Ann Rolls, Withybush General Hospital, Haverfordwest, United Kingdom
| | - Barbara Crosse
- Siow Ming Lee, Mary Falzon, Martin Forster, Arrigo Capitanio, Robin Rudd, Natasha Iles, Yenting Ngai, Michael Gandy, Rachel Lillywhite, and Allan Hackshaw, University College London, University College London Hospitals; James Spicer, Guy's and St Thomas's NHS Foundation Trust; Conrad Lewanski, Charing Cross Hospital, London; Fiona Blackhall, The Christie NHS Foundation Trust, Manchester; Marianne Nicolson, Aberdeen Royal Infirmary, Aberdeen; Abhro Chaudhuri, Lincoln County Hospital, Lincoln; Gary Middleton, University of Birmingham, Birmingham; Samreen Ahmed, Leicester Royal Infirmary, Leicester; Jonathan Hicks, New Victoria Hospital, Kingston Upon Thames; Barbara Crosse, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield; Mark Napier, North Devon District Hospital, Barnstaple; Julian M. Singer, Princess Alexandra Hospital NHS Foundation Trust, Harlow; David Ferry, New Cross Hospital, Wolverhampton; and Sally-Ann Rolls, Withybush General Hospital, Haverfordwest, United Kingdom
| | - Mark Napier
- Siow Ming Lee, Mary Falzon, Martin Forster, Arrigo Capitanio, Robin Rudd, Natasha Iles, Yenting Ngai, Michael Gandy, Rachel Lillywhite, and Allan Hackshaw, University College London, University College London Hospitals; James Spicer, Guy's and St Thomas's NHS Foundation Trust; Conrad Lewanski, Charing Cross Hospital, London; Fiona Blackhall, The Christie NHS Foundation Trust, Manchester; Marianne Nicolson, Aberdeen Royal Infirmary, Aberdeen; Abhro Chaudhuri, Lincoln County Hospital, Lincoln; Gary Middleton, University of Birmingham, Birmingham; Samreen Ahmed, Leicester Royal Infirmary, Leicester; Jonathan Hicks, New Victoria Hospital, Kingston Upon Thames; Barbara Crosse, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield; Mark Napier, North Devon District Hospital, Barnstaple; Julian M. Singer, Princess Alexandra Hospital NHS Foundation Trust, Harlow; David Ferry, New Cross Hospital, Wolverhampton; and Sally-Ann Rolls, Withybush General Hospital, Haverfordwest, United Kingdom
| | - Julian M Singer
- Siow Ming Lee, Mary Falzon, Martin Forster, Arrigo Capitanio, Robin Rudd, Natasha Iles, Yenting Ngai, Michael Gandy, Rachel Lillywhite, and Allan Hackshaw, University College London, University College London Hospitals; James Spicer, Guy's and St Thomas's NHS Foundation Trust; Conrad Lewanski, Charing Cross Hospital, London; Fiona Blackhall, The Christie NHS Foundation Trust, Manchester; Marianne Nicolson, Aberdeen Royal Infirmary, Aberdeen; Abhro Chaudhuri, Lincoln County Hospital, Lincoln; Gary Middleton, University of Birmingham, Birmingham; Samreen Ahmed, Leicester Royal Infirmary, Leicester; Jonathan Hicks, New Victoria Hospital, Kingston Upon Thames; Barbara Crosse, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield; Mark Napier, North Devon District Hospital, Barnstaple; Julian M. Singer, Princess Alexandra Hospital NHS Foundation Trust, Harlow; David Ferry, New Cross Hospital, Wolverhampton; and Sally-Ann Rolls, Withybush General Hospital, Haverfordwest, United Kingdom
| | - David Ferry
- Siow Ming Lee, Mary Falzon, Martin Forster, Arrigo Capitanio, Robin Rudd, Natasha Iles, Yenting Ngai, Michael Gandy, Rachel Lillywhite, and Allan Hackshaw, University College London, University College London Hospitals; James Spicer, Guy's and St Thomas's NHS Foundation Trust; Conrad Lewanski, Charing Cross Hospital, London; Fiona Blackhall, The Christie NHS Foundation Trust, Manchester; Marianne Nicolson, Aberdeen Royal Infirmary, Aberdeen; Abhro Chaudhuri, Lincoln County Hospital, Lincoln; Gary Middleton, University of Birmingham, Birmingham; Samreen Ahmed, Leicester Royal Infirmary, Leicester; Jonathan Hicks, New Victoria Hospital, Kingston Upon Thames; Barbara Crosse, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield; Mark Napier, North Devon District Hospital, Barnstaple; Julian M. Singer, Princess Alexandra Hospital NHS Foundation Trust, Harlow; David Ferry, New Cross Hospital, Wolverhampton; and Sally-Ann Rolls, Withybush General Hospital, Haverfordwest, United Kingdom
| | - Conrad Lewanski
- Siow Ming Lee, Mary Falzon, Martin Forster, Arrigo Capitanio, Robin Rudd, Natasha Iles, Yenting Ngai, Michael Gandy, Rachel Lillywhite, and Allan Hackshaw, University College London, University College London Hospitals; James Spicer, Guy's and St Thomas's NHS Foundation Trust; Conrad Lewanski, Charing Cross Hospital, London; Fiona Blackhall, The Christie NHS Foundation Trust, Manchester; Marianne Nicolson, Aberdeen Royal Infirmary, Aberdeen; Abhro Chaudhuri, Lincoln County Hospital, Lincoln; Gary Middleton, University of Birmingham, Birmingham; Samreen Ahmed, Leicester Royal Infirmary, Leicester; Jonathan Hicks, New Victoria Hospital, Kingston Upon Thames; Barbara Crosse, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield; Mark Napier, North Devon District Hospital, Barnstaple; Julian M. Singer, Princess Alexandra Hospital NHS Foundation Trust, Harlow; David Ferry, New Cross Hospital, Wolverhampton; and Sally-Ann Rolls, Withybush General Hospital, Haverfordwest, United Kingdom
| | - Martin Forster
- Siow Ming Lee, Mary Falzon, Martin Forster, Arrigo Capitanio, Robin Rudd, Natasha Iles, Yenting Ngai, Michael Gandy, Rachel Lillywhite, and Allan Hackshaw, University College London, University College London Hospitals; James Spicer, Guy's and St Thomas's NHS Foundation Trust; Conrad Lewanski, Charing Cross Hospital, London; Fiona Blackhall, The Christie NHS Foundation Trust, Manchester; Marianne Nicolson, Aberdeen Royal Infirmary, Aberdeen; Abhro Chaudhuri, Lincoln County Hospital, Lincoln; Gary Middleton, University of Birmingham, Birmingham; Samreen Ahmed, Leicester Royal Infirmary, Leicester; Jonathan Hicks, New Victoria Hospital, Kingston Upon Thames; Barbara Crosse, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield; Mark Napier, North Devon District Hospital, Barnstaple; Julian M. Singer, Princess Alexandra Hospital NHS Foundation Trust, Harlow; David Ferry, New Cross Hospital, Wolverhampton; and Sally-Ann Rolls, Withybush General Hospital, Haverfordwest, United Kingdom
| | - Sally-Ann Rolls
- Siow Ming Lee, Mary Falzon, Martin Forster, Arrigo Capitanio, Robin Rudd, Natasha Iles, Yenting Ngai, Michael Gandy, Rachel Lillywhite, and Allan Hackshaw, University College London, University College London Hospitals; James Spicer, Guy's and St Thomas's NHS Foundation Trust; Conrad Lewanski, Charing Cross Hospital, London; Fiona Blackhall, The Christie NHS Foundation Trust, Manchester; Marianne Nicolson, Aberdeen Royal Infirmary, Aberdeen; Abhro Chaudhuri, Lincoln County Hospital, Lincoln; Gary Middleton, University of Birmingham, Birmingham; Samreen Ahmed, Leicester Royal Infirmary, Leicester; Jonathan Hicks, New Victoria Hospital, Kingston Upon Thames; Barbara Crosse, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield; Mark Napier, North Devon District Hospital, Barnstaple; Julian M. Singer, Princess Alexandra Hospital NHS Foundation Trust, Harlow; David Ferry, New Cross Hospital, Wolverhampton; and Sally-Ann Rolls, Withybush General Hospital, Haverfordwest, United Kingdom
| | - Arrigo Capitanio
- Siow Ming Lee, Mary Falzon, Martin Forster, Arrigo Capitanio, Robin Rudd, Natasha Iles, Yenting Ngai, Michael Gandy, Rachel Lillywhite, and Allan Hackshaw, University College London, University College London Hospitals; James Spicer, Guy's and St Thomas's NHS Foundation Trust; Conrad Lewanski, Charing Cross Hospital, London; Fiona Blackhall, The Christie NHS Foundation Trust, Manchester; Marianne Nicolson, Aberdeen Royal Infirmary, Aberdeen; Abhro Chaudhuri, Lincoln County Hospital, Lincoln; Gary Middleton, University of Birmingham, Birmingham; Samreen Ahmed, Leicester Royal Infirmary, Leicester; Jonathan Hicks, New Victoria Hospital, Kingston Upon Thames; Barbara Crosse, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield; Mark Napier, North Devon District Hospital, Barnstaple; Julian M. Singer, Princess Alexandra Hospital NHS Foundation Trust, Harlow; David Ferry, New Cross Hospital, Wolverhampton; and Sally-Ann Rolls, Withybush General Hospital, Haverfordwest, United Kingdom
| | - Robin Rudd
- Siow Ming Lee, Mary Falzon, Martin Forster, Arrigo Capitanio, Robin Rudd, Natasha Iles, Yenting Ngai, Michael Gandy, Rachel Lillywhite, and Allan Hackshaw, University College London, University College London Hospitals; James Spicer, Guy's and St Thomas's NHS Foundation Trust; Conrad Lewanski, Charing Cross Hospital, London; Fiona Blackhall, The Christie NHS Foundation Trust, Manchester; Marianne Nicolson, Aberdeen Royal Infirmary, Aberdeen; Abhro Chaudhuri, Lincoln County Hospital, Lincoln; Gary Middleton, University of Birmingham, Birmingham; Samreen Ahmed, Leicester Royal Infirmary, Leicester; Jonathan Hicks, New Victoria Hospital, Kingston Upon Thames; Barbara Crosse, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield; Mark Napier, North Devon District Hospital, Barnstaple; Julian M. Singer, Princess Alexandra Hospital NHS Foundation Trust, Harlow; David Ferry, New Cross Hospital, Wolverhampton; and Sally-Ann Rolls, Withybush General Hospital, Haverfordwest, United Kingdom
| | - Natasha Iles
- Siow Ming Lee, Mary Falzon, Martin Forster, Arrigo Capitanio, Robin Rudd, Natasha Iles, Yenting Ngai, Michael Gandy, Rachel Lillywhite, and Allan Hackshaw, University College London, University College London Hospitals; James Spicer, Guy's and St Thomas's NHS Foundation Trust; Conrad Lewanski, Charing Cross Hospital, London; Fiona Blackhall, The Christie NHS Foundation Trust, Manchester; Marianne Nicolson, Aberdeen Royal Infirmary, Aberdeen; Abhro Chaudhuri, Lincoln County Hospital, Lincoln; Gary Middleton, University of Birmingham, Birmingham; Samreen Ahmed, Leicester Royal Infirmary, Leicester; Jonathan Hicks, New Victoria Hospital, Kingston Upon Thames; Barbara Crosse, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield; Mark Napier, North Devon District Hospital, Barnstaple; Julian M. Singer, Princess Alexandra Hospital NHS Foundation Trust, Harlow; David Ferry, New Cross Hospital, Wolverhampton; and Sally-Ann Rolls, Withybush General Hospital, Haverfordwest, United Kingdom
| | - Yenting Ngai
- Siow Ming Lee, Mary Falzon, Martin Forster, Arrigo Capitanio, Robin Rudd, Natasha Iles, Yenting Ngai, Michael Gandy, Rachel Lillywhite, and Allan Hackshaw, University College London, University College London Hospitals; James Spicer, Guy's and St Thomas's NHS Foundation Trust; Conrad Lewanski, Charing Cross Hospital, London; Fiona Blackhall, The Christie NHS Foundation Trust, Manchester; Marianne Nicolson, Aberdeen Royal Infirmary, Aberdeen; Abhro Chaudhuri, Lincoln County Hospital, Lincoln; Gary Middleton, University of Birmingham, Birmingham; Samreen Ahmed, Leicester Royal Infirmary, Leicester; Jonathan Hicks, New Victoria Hospital, Kingston Upon Thames; Barbara Crosse, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield; Mark Napier, North Devon District Hospital, Barnstaple; Julian M. Singer, Princess Alexandra Hospital NHS Foundation Trust, Harlow; David Ferry, New Cross Hospital, Wolverhampton; and Sally-Ann Rolls, Withybush General Hospital, Haverfordwest, United Kingdom
| | - Michael Gandy
- Siow Ming Lee, Mary Falzon, Martin Forster, Arrigo Capitanio, Robin Rudd, Natasha Iles, Yenting Ngai, Michael Gandy, Rachel Lillywhite, and Allan Hackshaw, University College London, University College London Hospitals; James Spicer, Guy's and St Thomas's NHS Foundation Trust; Conrad Lewanski, Charing Cross Hospital, London; Fiona Blackhall, The Christie NHS Foundation Trust, Manchester; Marianne Nicolson, Aberdeen Royal Infirmary, Aberdeen; Abhro Chaudhuri, Lincoln County Hospital, Lincoln; Gary Middleton, University of Birmingham, Birmingham; Samreen Ahmed, Leicester Royal Infirmary, Leicester; Jonathan Hicks, New Victoria Hospital, Kingston Upon Thames; Barbara Crosse, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield; Mark Napier, North Devon District Hospital, Barnstaple; Julian M. Singer, Princess Alexandra Hospital NHS Foundation Trust, Harlow; David Ferry, New Cross Hospital, Wolverhampton; and Sally-Ann Rolls, Withybush General Hospital, Haverfordwest, United Kingdom
| | - Rachel Lillywhite
- Siow Ming Lee, Mary Falzon, Martin Forster, Arrigo Capitanio, Robin Rudd, Natasha Iles, Yenting Ngai, Michael Gandy, Rachel Lillywhite, and Allan Hackshaw, University College London, University College London Hospitals; James Spicer, Guy's and St Thomas's NHS Foundation Trust; Conrad Lewanski, Charing Cross Hospital, London; Fiona Blackhall, The Christie NHS Foundation Trust, Manchester; Marianne Nicolson, Aberdeen Royal Infirmary, Aberdeen; Abhro Chaudhuri, Lincoln County Hospital, Lincoln; Gary Middleton, University of Birmingham, Birmingham; Samreen Ahmed, Leicester Royal Infirmary, Leicester; Jonathan Hicks, New Victoria Hospital, Kingston Upon Thames; Barbara Crosse, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield; Mark Napier, North Devon District Hospital, Barnstaple; Julian M. Singer, Princess Alexandra Hospital NHS Foundation Trust, Harlow; David Ferry, New Cross Hospital, Wolverhampton; and Sally-Ann Rolls, Withybush General Hospital, Haverfordwest, United Kingdom
| | - Allan Hackshaw
- Siow Ming Lee, Mary Falzon, Martin Forster, Arrigo Capitanio, Robin Rudd, Natasha Iles, Yenting Ngai, Michael Gandy, Rachel Lillywhite, and Allan Hackshaw, University College London, University College London Hospitals; James Spicer, Guy's and St Thomas's NHS Foundation Trust; Conrad Lewanski, Charing Cross Hospital, London; Fiona Blackhall, The Christie NHS Foundation Trust, Manchester; Marianne Nicolson, Aberdeen Royal Infirmary, Aberdeen; Abhro Chaudhuri, Lincoln County Hospital, Lincoln; Gary Middleton, University of Birmingham, Birmingham; Samreen Ahmed, Leicester Royal Infirmary, Leicester; Jonathan Hicks, New Victoria Hospital, Kingston Upon Thames; Barbara Crosse, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield; Mark Napier, North Devon District Hospital, Barnstaple; Julian M. Singer, Princess Alexandra Hospital NHS Foundation Trust, Harlow; David Ferry, New Cross Hospital, Wolverhampton; and Sally-Ann Rolls, Withybush General Hospital, Haverfordwest, United Kingdom
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