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Sakaie K, Koenig K, Lerner A, Appleby B, Ogrocki P, Pillai JA, Rao S, Leverenz JB, Lowe MJ. Multi-shell diffusion MRI of the fornix as a biomarker for cognition in Alzheimer's disease. Magn Reson Imaging 2024; 109:221-226. [PMID: 38521367 DOI: 10.1016/j.mri.2024.03.030] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 03/05/2024] [Accepted: 03/19/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND AND PURPOSE A substantial fraction of those who had Alzheimer's Disease (AD) pathology on autopsy did not have dementia in life. While biomarkers for AD pathology are well-developed, biomarkers specific to cognitive domains affected by early AD are lagging. Diffusion MRI (dMRI) of the fornix is a candidate biomarker for early AD-related cognitive changes but is susceptible to bias due to partial volume averaging (PVA) with cerebrospinal fluid. The purpose of this work is to leverage multi-shell dMRI to correct for PVA and to evaluate PVA-corrected dMRI measures in fornix as a biomarker for cognition in AD. METHODS Thirty-three participants in the Cleveland Alzheimer's Disease Research Center (CADRC) (19 with normal cognition (NC), 10 with mild cognitive impairment (MCI), 4 with dementia due to AD) were enrolled in this study. Multi-shell dMRI was acquired, and voxelwise fits were performed with two models: 1) diffusion tensor imaging (DTI) that was corrected for PVA and 2) neurite orientation dispersion and density imaging (NODDI). Values of tissue integrity in fornix were correlated with neuropsychological scores taken from the Uniform Data Set (UDS), including the UDS Global Composite 5 score (UDSGC5). RESULTS Statistically significant correlations were found between the UDSGC5 and PVA-corrected measure of mean diffusivity (MDc, r = -0.35, p < 0.05) from DTI and the intracelluar volume fraction (ficvf, r = 0.37, p < 0.04) from NODDI. A sensitivity analysis showed that the relationship to MDc was driven by episodic memory, which is often affected early in AD, and language. CONCLUSION This cross-sectional study suggests that multi-shell dMRI of the fornix that has been corrected for PVA is a potential biomarker for early cognitive domain changes in AD. A longitudinal study will be necessary to determine if the imaging measure can predict cognitive decline.
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Affiliation(s)
- Ken Sakaie
- Imaging Institute, The Cleveland Clinic, 9500 Euclid Ave, Mail code U-15, Cleveland, OH 44195, USA.
| | - Katherine Koenig
- Imaging Institute, The Cleveland Clinic, 9500 Euclid Ave, Mail code U-15, Cleveland, OH 44195, USA
| | - Alan Lerner
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Brian Appleby
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Paula Ogrocki
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jagan A Pillai
- Lou Ruvo Center for Brain Health, The Cleveland Clinic, 9500 Euclid Ave, Mail code U-10, Cleveland, OH 44195, USA
| | - Stephen Rao
- Lou Ruvo Center for Brain Health, The Cleveland Clinic, 9500 Euclid Ave, Mail code U-10, Cleveland, OH 44195, USA
| | - James B Leverenz
- Lou Ruvo Center for Brain Health, The Cleveland Clinic, 9500 Euclid Ave, Mail code U-10, Cleveland, OH 44195, USA
| | - Mark J Lowe
- Imaging Institute, The Cleveland Clinic, 9500 Euclid Ave, Mail code U-15, Cleveland, OH 44195, USA
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Lerner A, Lee AJX, Yan H, Van Griethuysen J, Bartlett AD, Veli M, Jiang Y, Luong M, Naban N, Kane C, Conibear J, Papadatos-Pastos D, Ahmad T, Chao D, Anand G, Asghar US. A Multicentric, Retrospective, Real-world Study on Immune-related Adverse Events in Patients with Advanced Non-small Cell Lung Cancers Treated with Pembrolizumab Monotherapy. Clin Oncol (R Coll Radiol) 2024; 36:193-199. [PMID: 38246850 DOI: 10.1016/j.clon.2024.01.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 12/05/2023] [Accepted: 01/12/2024] [Indexed: 01/23/2024]
Abstract
AIMS We present 7 years of clinical experience with single-agent pembrolizumab immune checkpoint inhibitor immunotherapy in non-small cell lung cancers (NSCLC) from four UK cancer centres. MATERIALS AND METHODS This multi-institutional retrospective cohort study included 226 metastatic NSCLC patients. Outcomes were number and severity of immune-related adverse events (irAEs), median progression-free survival (mPFS) and median overall survival (mOS). RESULTS Within our cohort, 119/226 (53%) patients developed irAEs. Of these, 54/119 (45%) experienced irAEs affecting two or more organ systems. The most common irAEs were diarrhoea and rash. The development of an irAE was associated with better mOS (20.7 versus 8.0 months; P < 0.001) and mPFS (12.0 versus 3.9 months; P < 0.001). The development of grade 3/4 toxicities was associated with worse outcomes compared with the development of grade 1/2 toxicities (mOS 6.1 months versus 25.2 months, P < 0.01; mPFS 5.6 months versus 19.3 months, P = 0.01, respectively). Females had a higher proportion of reported grade 3/4 toxicities (13/44 [29.5%] versus 10/74 [13.5%], P = 0.03). Using a multiple Cox regression model, the presence of irAEs was associated with a better overall survival (hazard ratio = 0.42, 95% confidence interval 0.29-0.61; P < 0.01) and better PFS (hazard ratio 0.38, 95% confidence interval 0.27-0.53; P < 0.001). CONCLUSION In this multicentre retrospective cohort study, the development of at least one irAE was associated with significantly longer mPFS and mOS; however, more severe grade 3 and 4 irAEs were associated with worse outcomes. Delayed-onset irAEs, after the 3-month timepoint, were associated with better clinical outcomes.
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Affiliation(s)
- A Lerner
- North Middlesex University Hospital, London, UK
| | - A J X Lee
- UCL Cancer Institute, University College London, London, UK; University College London Hospitals NHS Foundation Trust, London, UK
| | - H Yan
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - M Veli
- University College London Hospitals NHS Foundation Trust, London, UK; Princess Alexandra Hospital, Harlow, UK
| | - Y Jiang
- University College London Hospitals NHS Foundation Trust, London, UK
| | - M Luong
- University College London Hospitals NHS Foundation Trust, London, UK
| | - N Naban
- North Middlesex University Hospital, London, UK
| | - C Kane
- Mount Vernon Cancer Centre, Northwood, UK
| | | | - D Papadatos-Pastos
- University College London Hospitals NHS Foundation Trust, London, UK; Princess Alexandra Hospital, Harlow, UK
| | - T Ahmad
- University College London Hospitals NHS Foundation Trust, London, UK
| | - D Chao
- Royal Free London Hospital, London, UK
| | - G Anand
- North Middlesex University Hospital, London, UK
| | - U S Asghar
- The Royal Marsden NHS Foundation Trust, Sutton, UK; Concr LTD, Cambridge, UK; Croydon University Hospital, Thornton Heath, UK.
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Wonders K, Schmitz K, Harness JK, Lerner A, Hale ER. The Impact of Supervised, Individualized Exercise on Fatigue and Quality of Life during Adjuvant Radiotherapy for Breast Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e267. [PMID: 37785014 DOI: 10.1016/j.ijrobp.2023.06.1229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Adjuvant radiation therapy in treatment for breast cancer has been shown to improve patient outcomes and reduce mortality rates. However, many patients experience debilitating fatigue as a result. Currently, there are limited treatment options for fatigue in cancer survivors. Options include pharmaceutical agents, psychological interventions, or nutrition strategies, all of which have limited efficacy. Exercise is recommended in survivorship care plans, but it not widely implemented beyond the use of generalized statements or resource guides given to patients. Therefore, the purpose of this study was the examine the impact of an individualized exercise program on fatigue, quality of life, and physical functioning during radiation therapy for breast cancer. MATERIALS/METHODS This multi-institutional prospective trial evaluated the effects of supervised, individualized exercise therapy in 422 patients undergoing adjuvant radiotherapy for breast cancer. Following a comprehensive fitness assessment and the completion of the Brief Fatigue Instrument (BFI) questionnaire, each participant participated in a 12-week individualized exercise program offered through Maple Tree Cancer Alliance. At its conclusion, the patients repeated the assessment and questionnaire. RESULTS Individualized exercise had a positive impact on fitness parameters and severity of fatigue. Specifically, cardiovascular endurance, muscular strength, muscular endurance, and flexibility all significantly improved following the exercise intervention (p<0.05). On average, patients fatigue levels decreased by 31.1% (P<0.01). CONCLUSION These results signify that fatigue levels are positively impacted by exercise among patients with breast cancer.
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Affiliation(s)
- K Wonders
- Maple Tree Cancer Alliance, Dayton, OH; Wright State University, Dayton, OH
| | - K Schmitz
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - A Lerner
- Maple Tree Cancer Alliance, Dayton, OH
| | - E R Hale
- Kettering Health Cancer Center, Kettering, OH
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Rajabli F, Benchek P, Tosto G, Kushch N, Sha J, Bazemore K, Zhu C, Lee WP, Haut J, Hamilton-Nelson KL, Wheeler NR, Zhao Y, Farrell JJ, Grunin MA, Leung YY, Kuksa PP, Li D, Lucio da Fonseca E, Mez JB, Palmer EL, Pillai J, Sherva RM, Song YE, Zhang X, Iqbal T, Pathak O, Valladares O, Kuzma AB, Abner E, Adams PM, Aguirre A, Albert MS, Albin RL, Allen M, Alvarez L, Apostolova LG, Arnold SE, Asthana S, Atwood CS, Ayres G, Baldwin CT, Barber RC, Barnes LL, Barral S, Beach TG, Becker JT, Beecham GW, Beekly D, Benitez BA, Bennett D, Bertelson J, Bird TD, Blacker D, Boeve BF, Bowen JD, Boxer A, Brewer J, Burke JR, Burns JM, Buxbaum JD, Cairns NJ, Cantwell LB, Cao C, Carlson CS, Carlsson CM, Carney RM, Carrasquillo MM, Chasse S, Chesselet MF, Chin NA, Chui HC, Chung J, Craft S, Crane PK, Cribbs DH, Crocco EA, Cruchaga C, Cuccaro ML, Cullum M, Darby E, Davis B, De Jager PL, DeCarli C, DeToledo J, Dick M, Dickson DW, Dombroski BA, Doody RS, Duara R, Ertekin-Taner NI, Evans DA, Faber KM, Fairchild TJ, Fallon KB, Fardo DW, Farlow MR, Fernandez-Hernandez V, Ferris S, Foroud TM, Frosch MP, Fulton-Howard B, Galasko DR, Gamboa A, Gearing M, Geschwind DH, Ghetti B, Gilbert JR, Goate AM, Grabowski TJ, Graff-Radford NR, Green RC, Growdon JH, Hakonarson H, Hall J, Hamilton RL, Harari O, Hardy J, Harrell LE, Head E, Henderson VW, Hernandez M, Hohman T, Honig LS, Huebinger RM, Huentelman MJ, Hulette CM, Hyman BT, Hynan LS, Ibanez L, Jarvik GP, Jayadev S, Jin LW, Johnson K, Johnson L, Kamboh MI, Karydas AM, Katz MJ, Kauwe JS, Kaye JA, Keene CD, Khaleeq A, Kim R, Knebl J, Kowall NW, Kramer JH, Kukull WA, LaFerla FM, Lah JJ, Larson EB, Lerner A, Leverenz JB, Levey AI, Lieberman AP, Lipton RB, Logue M, Lopez OL, Lunetta KL, Lyketsos CG, Mains D, Margaret FE, Marson DC, Martin ERR, Martiniuk F, Mash DC, Masliah E, Massman P, Masurkar A, McCormick WC, McCurry SM, McDavid AN, McDonough S, McKee AC, Mesulam M, Miller BL, Miller CA, Miller JW, Montine TJ, Monuki ES, Morris JC, Mukherjee S, Myers AJ, Nguyen T, O'Bryant S, Olichney JM, Ory M, Palmer R, Parisi JE, Paulson HL, Pavlik V, Paydarfar D, Perez V, Peskind E, Petersen RC, Pierce A, Polk M, Poon WW, Potter H, Qu L, Quiceno M, Quinn JF, Raj A, Raskind M, Reiman EM, Reisberg B, Reisch JS, Ringman JM, Roberson ED, Rodriguear M, Rogaeva E, Rosen HJ, Rosenberg RN, Royall DR, Sager MA, Sano M, Saykin AJ, Schneider JA, Schneider LS, Seeley WW, Slifer SH, Small S, Smith AG, Smith JP, Sonnen JA, Spina S, St George-Hyslop P, Stern RA, Stevens AB, Strittmatter SM, Sultzer D, Swerdlow RH, Tanzi RE, Tilson JL, Trojanowski JQ, Troncoso JC, Tsuang DW, Van Deerlin VM, van Eldik LJ, Vance JM, Vardarajan BN, Vassar R, Vinters HV, Vonsattel JP, Weintraub S, Welsh-Bohmer KA, Whitehead PL, Wijsman EM, Wilhelmsen KC, Williams B, Williamson J, Wilms H, Wingo TS, Wisniewski T, Woltjer RL, Woon M, Wright CB, Wu CK, Younkin SG, Yu CE, Yu L, Zhu X, Kunkle BW, Bush WS, Wang LS, Farrer LA, Haines JL, Mayeux R, Pericak-Vance MA, Schellenberg GD, Jun GR, Reitz C, Naj AC. Multi-ancestry genome-wide meta-analysis of 56,241 individuals identifies LRRC4C, LHX5-AS1 and nominates ancestry-specific loci PTPRK , GRB14 , and KIAA0825 as novel risk loci for Alzheimer's disease: the Alzheimer's Disease Genetics Consortium. medRxiv 2023:2023.07.06.23292311. [PMID: 37461624 PMCID: PMC10350126 DOI: 10.1101/2023.07.06.23292311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Limited ancestral diversity has impaired our ability to detect risk variants more prevalent in non-European ancestry groups in genome-wide association studies (GWAS). We constructed and analyzed a multi-ancestry GWAS dataset in the Alzheimer's Disease (AD) Genetics Consortium (ADGC) to test for novel shared and ancestry-specific AD susceptibility loci and evaluate underlying genetic architecture in 37,382 non-Hispanic White (NHW), 6,728 African American, 8,899 Hispanic (HIS), and 3,232 East Asian individuals, performing within-ancestry fixed-effects meta-analysis followed by a cross-ancestry random-effects meta-analysis. We identified 13 loci with cross-ancestry associations including known loci at/near CR1 , BIN1 , TREM2 , CD2AP , PTK2B , CLU , SHARPIN , MS4A6A , PICALM , ABCA7 , APOE and two novel loci not previously reported at 11p12 ( LRRC4C ) and 12q24.13 ( LHX5-AS1 ). Reflecting the power of diverse ancestry in GWAS, we observed the SHARPIN locus using 7.1% the sample size of the original discovering single-ancestry GWAS (n=788,989). We additionally identified three GWS ancestry-specific loci at/near ( PTPRK ( P =2.4×10 -8 ) and GRB14 ( P =1.7×10 -8 ) in HIS), and KIAA0825 ( P =2.9×10 -8 in NHW). Pathway analysis implicated multiple amyloid regulation pathways (strongest with P adjusted =1.6×10 -4 ) and the classical complement pathway ( P adjusted =1.3×10 -3 ). Genes at/near our novel loci have known roles in neuronal development ( LRRC4C, LHX5-AS1 , and PTPRK ) and insulin receptor activity regulation ( GRB14 ). These findings provide compelling support for using traditionally-underrepresented populations for gene discovery, even with smaller sample sizes.
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Donington J, Hu X, Zhang S, Song Y, Gao C, Arunachalam A, Chirovsky D, Lerner A, Jiang A, Signorovitch J, Samkari A. 95P Neoadjuvant treatment pattern and association between real-world event-free survival (rwEFS) and overall survival (OS) in patients (pts) with resected early-stage non-small cell lung cancer (eNSCLC). J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00350-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Zaman A, Caywood L, Prough M, Clouse J, Harrington S, Adams L, Fuzzell D, Fuzzell S, Laux R, Hochstetler SD, Ogrocki P, Lerner A, Vance JM, Haines JL, Scott WK, Pericak-Vance MA, Cuccaro ML. Psychometric Approaches to Defining Cognitive Phenotypes in the Old Order Amish. Int J Geriatr Psychiatry 2023; 38:e5903. [PMID: 36929524 DOI: 10.1002/gps.5903] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/11/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Memory and cognitive problems are central to the diagnosis of Alzheimer's disease (AD). Psychometric approaches to defining phenotypes can aid in identify genetic variants associated with AD. However, these approaches have mostly been limited to affected individuals. Defining phenotypes of both affected and unaffected individuals may help identify genetic variants associated with both AD and healthy aging. This study compares psychometric methods for developing cognitive phenotypes that are more granular than clinical classifications. METHODS 682 older Old Order Amish individuals were included in the analysis. Adjusted Z-scores of cognitive tests were used to create four models including 1) global threshold scores or 2) memory threshold scores, and 3) global clusters and 4) memory clusters. An ordinal regression examined the coherence of the models with clinical classifications [cognitively impaired (CI), mildly impaired (MI), cognitively unimpaired (CU)], APOE-e4, sex, and age. An ANOVA examined the best model phenotypes for differences in clinical classification, APOE-e4, domain Z-scores (memory, language, executive function, and processing speed), sex, and age. RESULTS The memory cluster identified four phenotypes and had the best fit (χ2 = 491.66). Individuals in the worse performing phenotypes were more likely to be classified as CI or MI and to have APOE-e4. Additionally, all four phenotypes performed significantly differently from one another on the domains of memory, language, and executive functioning. CONCLUSIONS Memory cluster stratification identified the cognitive phenotypes that best aligned with clinical classifications, APOE-e4, and cognitive performance We predict these phenotypes will prove useful in searching for protective genetic variants. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Andrew Zaman
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Laura Caywood
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael Prough
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jason Clouse
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sharlene Harrington
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Larry Adams
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Denise Fuzzell
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Sarada Fuzzell
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Renee Laux
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Sherri D Hochstetler
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Paula Ogrocki
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
| | - Alan Lerner
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
| | - Jeffery M Vance
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA.,Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jonathan L Haines
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA.,Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, USA
| | - William K Scott
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA.,Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Margaret A Pericak-Vance
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA.,Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael L Cuccaro
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA.,Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
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Mah E, Lanctôt K, Chen QZ, Shade D, Scherer R, Vieira D, Coulibaly H, Rosenberg P, Lerner A, Padala P, Brawman-Mintzer O, van Dyck C, Porsteinsson A, Mintzer J, Herrmann N. Cost Consequence Analysis of ADMET 2. The American Journal of Geriatric Psychiatry 2023. [DOI: 10.1016/j.jagp.2022.12.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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8
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Sajatovic M, Herrmann L, Knebusch C, Sarna K, Lerner A, Fuentes-Casiano E, Burant C. TARGETING KNOWLEDGE, BARRIERS, AND FACILITATORS TO PARTICIPATION IN DEMENTIA RESEARCH (THE POWER PROJECT). Innov Aging 2022. [DOI: 10.1093/geroni/igac059.1878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Racial and ethnic minorities are under-represented in dementia research. We tested a conceptually-driven health communication approach targeting evidence-based barriers and facilitators to research participation vs. dementia awareness training. Input from the minority advisory board (MAB) of the Cleveland Alzheimer’s Disease Research Center (CADRC) informed development of 2 brief health communication videos which differentially focused on research barriers and facilitators (POWER) versus an education control (EDU). A randomized controlled on-line survey compared POWER vs. EDU among 200 individuals ≥ 50 years. We examined pre/post video change in research motivation measured by the transtheoretical model, dementia knowledge and cumulative barriers and facilitators. Interim analysis included 129 individuals who completed the pre-video survey, mean age 58.8 (SD 14.9), 101 (78.3 %) women, 54 (41.9 %) non-white. 100 (77.5 %) completed the post-video survey. Whole sample dementia knowledge improved from pre (mean 4.6, SD 1.3) vs. post (5.8, SD 0.7) video (p <.01), as did facilitators to research from pre (22.4, SD 2.7) vs. post (22.8, SD 3.0) video (p=.02), while there was no significant change in barriers. Research motivation was increased pre (10.8, SD 2.0) vs. post (22.8, SD 3.0) video (p=.02). Overall, dementia knowledge improved more with EDU vs. POWER (p=.04). African-American participants trended towards greater improvement in dementia knowledge with EDU vs. POWER (p=.07), while non-African-Americans had greater facilitator improvement with POWER vs. EDU (p=.03). Targeted communication approaches that address knowledge gaps and both barriers and facilitators to participation may improve engagement of diverse groups in dementia research.
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Affiliation(s)
- Martha Sajatovic
- Case Western Reserve University School of Medicine , Cleveland, Ohio , United States
| | - Lynn Herrmann
- Northern Illinois University , DeKalb, Illinois , United States
| | - Clare Knebusch
- University Hospitals Cleveland Medical Center , Cleveland, Ohio , United States
| | - Kaylee Sarna
- Case Western Reserve University , Cleveland, Ohio , United States
| | - Alan Lerner
- Case Western Reserve University School of Medicine , Cleveland, Ohio , United States
| | - Edna Fuentes-Casiano
- Case Western Reserve University School of Medicine , Cleveland, Ohio , United States
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Shao C, Zhu J, Ma X, Siedlak SL, Cohen ML, Lerner A, Wang W. C19orf12 ablation causes ferroptosis in mitochondrial membrane protein-associated with neurodegeneration. Free Radic Biol Med 2022; 182:23-33. [PMID: 35182730 PMCID: PMC8957567 DOI: 10.1016/j.freeradbiomed.2022.02.006] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/01/2022] [Accepted: 02/08/2022] [Indexed: 12/11/2022]
Abstract
Mitochondrial membrane protein-associated with neurodegeneration (MPAN) is a rare genetic disease characterized by aggressive neurodegeneration and massive iron accumulation in patients' brains. Genetics studies identified defects in C19orf12 locus being associated with MPAN which likely caused loss of function although underlying pathogenic mechanism(s) remain elusive. In the present study, we investigated C19orf12 knockout (KO) M17 neuronal cells and primary skin fibroblasts from MPAN patients with C19orf12 homozygous G58S or heterozygous C19orf12 p99fs*102 mutations as cellular models of MPAN. C19orf12 KO cells and MPAN fibroblast cells demonstrated mitochondrial fragmentation and dysfunction, iron overload and increased oxidative damage. Antioxidant NAC and iron chelator DFO rescued both oxidative stress and mitochondrial deficits. Moreover, C19orf12 KO cells and MPAN fibroblast cells were susceptible to erastin- or RSL3-induced ferroptosis which could be almost completely prevented by pretreatment of iron chelator DFO. Importantly, we also found mitochondrial fragmentation and increased ferroptosis related oxidative damage in neurons in the biopsied cortical tissues from an MPAN patient. Collectively, these results supported the notion that iron overload and ferroptosis likely play an important role in the pathogenesis of MPAN.
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Affiliation(s)
- Changjuan Shao
- Department of Pathology, Case Western Reserve University, Cleveland, OH, USA
| | - Julia Zhu
- Department of Pathology, Case Western Reserve University, Cleveland, OH, USA; Hathaway Brown School, Shaker Heights, OH, USA
| | - Xiaopin Ma
- Department of Pathology, Case Western Reserve University, Cleveland, OH, USA
| | - Sandra L Siedlak
- Department of Pathology, Case Western Reserve University, Cleveland, OH, USA
| | - Mark L Cohen
- Department of Pathology, Case Western Reserve University, Cleveland, OH, USA
| | - Alan Lerner
- Department of Neurology, University Hospitals Case Medical Center, Beachwood, OH, USA
| | - Wenzhang Wang
- Department of Pathology, Case Western Reserve University, Cleveland, OH, USA.
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Kim C, Haldiman T, Kang SG, Hromadkova L, Han ZZ, Chen W, Lissemore F, Lerner A, de Silva R, Cohen ML, Westaway D, Safar JG. Distinct populations of highly potent TAU seed conformers in rapidly progressing Alzheimer's disease. Sci Transl Med 2022; 14:eabg0253. [PMID: 34985969 DOI: 10.1126/scitranslmed.abg0253] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Chae Kim
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Tracy Haldiman
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Sang-Gyun Kang
- Centre for Prions and Protein Folding Diseases, University of Alberta, Edmonton T6G 2M8, Canada
| | - Lenka Hromadkova
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Zhuang Zhuang Han
- Centre for Prions and Protein Folding Diseases, University of Alberta, Edmonton T6G 2M8, Canada
| | - Wei Chen
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.,National Prion Disease Pathology Surveillance Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Frances Lissemore
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Alan Lerner
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Rohan de Silva
- Reta Lila Weston Institute of Neurological Studies and Department of Molecular Neuroscience, UCL Institute of Neurology, London WC1N 1PJ, UK
| | - Mark L Cohen
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.,National Prion Disease Pathology Surveillance Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - David Westaway
- Centre for Prions and Protein Folding Diseases, University of Alberta, Edmonton T6G 2M8, Canada
| | - Jiri G Safar
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.,Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
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11
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Lerner A, Keshwani K, Okines A, Sanderson B, Board R, Flynn M, Sharkey E, Konstantis A, Roylance R, Hanna D, King J, Murphy R, Rehman F, Guppy A, Westbury C, Takeuchi E, Spurrell E, Jayaweera H, Raja F. A Multicentre Retrospective Study of Fulvestrant Use and Efficacy in Advanced/Metastatic Breast Cancer. Clin Oncol (R Coll Radiol) 2022; 34:261-266. [DOI: 10.1016/j.clon.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 11/17/2021] [Accepted: 12/16/2021] [Indexed: 11/26/2022]
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12
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Dvornikova KA, Bystrova EY, Churilov LP, Lerner A. Pathogenesis of the inflammatory bowel disease in context of SARS-COV-2 infection. Mol Biol Rep 2021; 48:5745-5758. [PMID: 34296352 PMCID: PMC8297608 DOI: 10.1007/s11033-021-06565-w] [Citation(s) in RCA: 9] [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: 02/17/2021] [Accepted: 07/13/2021] [Indexed: 02/07/2023]
Abstract
To date, the latest research results suggest that the novel severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) can enter host cells directly via the gastrointestinal tract by binding to the enterocyte-expressed ACE2 receptor, or indirectly as a result of infection of type II alveolar epithelial cells. At the same time, entry of SARS-CoV-2 through the gastrointestinal tract initiates the activation of innate and adaptive immune responses, the formation of an excessive inflammatory reaction and critical increase in the expression of proinflammatory cytokines, which, subsequently, can presumably increase inflammation and induce intestinal damage in patients suffering from inflammatory bowel disease (IBD). The aims of the present review were to reveal and analyze possible molecular pathways and consequences of the induction of an innate and adaptive immune response during infection with SARS-CoV-2 in patients with IBD. A thorough literature search was carried out by using the keywords: IBD, SARS-CoV-2, COVID-19. Based on the screening, a number of intracellular and extracellular pathways were considered and discussed, which can impact the immune response during SARS-CoV-2 infection in IBD patients. Additionally, the possible consequences of the infection for such patients were estimated. We further hypothesize that any virus, including the new SARS-CoV-2, infecting intestinal tissues and/or entering the host's body through receptors located on intestinal enterocytes may be a trigger for the onset of IBD in individuals with a genetic predisposition and/or the risk of developing IBD associated with other factors.
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Affiliation(s)
- K. A. Dvornikova
- Pavlov Institute of Physiology, Russian Academy of Sciences, Saint Petersburg, Russian Federation
| | - E. Yu. Bystrova
- Pavlov Institute of Physiology, Russian Academy of Sciences, Saint Petersburg, Russian Federation
| | - L. P. Churilov
- Saint Petersburg State University, Saint Petersburg, Russian Federation
| | - A. Lerner
- Chaim Sheba Medical Center, The Zabludowicz Research Center for Autoimmune Diseases, Tel Hashomer, Israel
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13
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Wright CB, Auchus AP, Lerner A, Ambrosius WT, Ay H, Bates JT, Chen J, Meschia JF, Pancholi S, Papademetriou V, Rastogi A, Sweeney M, Willard JJ, Yee J, Oparil S. Effect of Intensive Versus Standard Blood Pressure Control on Stroke Subtypes. Hypertension 2021; 77:1391-1398. [PMID: 33583199 DOI: 10.1161/hypertensionaha.120.16027] [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] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Clinton B Wright
- From the Division of Clinical Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Alexander P Auchus
- Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.)
| | - Alan Lerner
- Department of Neurology, Case Western Reserve University, Cleveland, OH (A.L.)
| | - Walter T Ambrosius
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC (W.T.A., J.J.W.)
| | - Hakan Ay
- Departments of Neurology and Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (H.A.)
| | - Jeffrey T Bates
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (J.T.B.)
| | - Jing Chen
- Department of Medicine, Tulane School of Medicine, New Orleans, LA (J.C.)
| | - James F Meschia
- Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.)
| | - Suchita Pancholi
- Department of Medicine, University of South Carolina School of Medicine, Columbia (S.P.)
| | | | - Anjay Rastogi
- Department of Medicine, UCLA School of Medicine, Los Angeles, CA (A.R.)
| | - Mary Sweeney
- Department of Medicine, Emory University School of Medicine, Atlanta, GA (M.S.)
| | - James J Willard
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC (W.T.A., J.J.W.)
| | - Jerry Yee
- Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI (J.Y.)
| | - Suzanne Oparil
- Department of Medicine, University of Alabama at Birmingham (S.O.)
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14
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Alifrangis C, Lee A, Fernando S, Cakir O, Koliou P, Lerner A, Forgenie J, Akers C, Harland S, Freeman A, Walkden M, Hadway P, Alnajjar H, Muneer A, Mitra A. 784P Perioperative multimodality treatment in high-risk node-positive penile cancer: A single institution study of patients treated in a supraregional centre. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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15
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Lerner A, Keshwani K, Sanderson B, Board R, Flynn M, Sharkey E, Okines A, Konstantis A, Roylance R, Hanna D, King J, Murphy R, Rehman F, Guppy A, Westbury C, Takeuchi E, Spurrell E, Raja F. Is Universal Patient Access to Fulvestrant in Hormone Receptor-positive Advanced Breast Cancer Justified? A UK Retrospective Multicentre Study. Clin Oncol (R Coll Radiol) 2020. [DOI: 10.1016/j.clon.2020.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Ducharme S, Dols A, Laforce R, Devenney E, Kumfor F, van den Stock J, Dallaire-Théroux C, Seelaar H, Gossink F, Vijverberg E, Huey E, Vandenbulcke M, Masellis M, Trieu C, Onyike C, Caramelli P, de Souza LC, Santillo A, Waldö ML, Landin-Romero R, Piguet O, Kelso W, Eratne D, Velakoulis D, Ikeda M, Perry D, Pressman P, Boeve B, Vandenberghe R, Mendez M, Azuar C, Levy R, Le Ber I, Baez S, Lerner A, Ellajosyula R, Pasquier F, Galimberti D, Scarpini E, van Swieten J, Hornberger M, Rosen H, Hodges J, Diehl-Schmid J, Pijnenburg Y. Recommendations to distinguish behavioural variant frontotemporal dementia from psychiatric disorders. Brain 2020; 143:1632-1650. [PMID: 32129844 PMCID: PMC7849953 DOI: 10.1093/brain/awaa018] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [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: 09/21/2019] [Revised: 11/27/2019] [Accepted: 12/08/2019] [Indexed: 12/12/2022] Open
Abstract
The behavioural variant of frontotemporal dementia (bvFTD) is a frequent cause of early-onset dementia. The diagnosis of bvFTD remains challenging because of the limited accuracy of neuroimaging in the early disease stages and the absence of molecular biomarkers, and therefore relies predominantly on clinical assessment. BvFTD shows significant symptomatic overlap with non-degenerative primary psychiatric disorders including major depressive disorder, bipolar disorder, schizophrenia, obsessive-compulsive disorder, autism spectrum disorders and even personality disorders. To date, ∼50% of patients with bvFTD receive a prior psychiatric diagnosis, and average diagnostic delay is up to 5-6 years from symptom onset. It is also not uncommon for patients with primary psychiatric disorders to be wrongly diagnosed with bvFTD. The Neuropsychiatric International Consortium for Frontotemporal Dementia was recently established to determine the current best clinical practice and set up an international collaboration to share a common dataset for future research. The goal of the present paper was to review the existing literature on the diagnosis of bvFTD and its differential diagnosis with primary psychiatric disorders to provide consensus recommendations on the clinical assessment. A systematic literature search with a narrative review was performed to determine all bvFTD-related diagnostic evidence for the following topics: bvFTD history taking, psychiatric assessment, clinical scales, physical and neurological examination, bedside cognitive tests, neuropsychological assessment, social cognition, structural neuroimaging, functional neuroimaging, CSF and genetic testing. For each topic, responsible team members proposed a set of minimal requirements, optimal clinical recommendations, and tools requiring further research or those that should be developed. Recommendations were listed if they reached a ≥ 85% expert consensus based on an online survey among all consortium participants. New recommendations include performing at least one formal social cognition test in the standard neuropsychological battery for bvFTD. We emphasize the importance of 3D-T1 brain MRI with a standardized review protocol including validated visual atrophy rating scales, and to consider volumetric analyses if available. We clarify the role of 18F-fluorodeoxyglucose PET for the exclusion of bvFTD when normal, whereas non-specific regional metabolism abnormalities should not be over-interpreted in the case of a psychiatric differential diagnosis. We highlight the potential role of serum or CSF neurofilament light chain to differentiate bvFTD from primary psychiatric disorders. Finally, based on the increasing literature and clinical experience, the consortium determined that screening for C9orf72 mutation should be performed in all possible/probable bvFTD cases or suspected cases with strong psychiatric features.
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Affiliation(s)
- Simon Ducharme
- Department of Psychiatry, McGill University Health Centre, McGill University, Montreal, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, 3801 University Str., Montreal, Quebec, H3A 2B4, Canada
| | - Annemiek Dols
- Department of Old Age Psychiatry, GGZ InGeest, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire (CIME), Laval University, Quebec, Canada
| | - Emma Devenney
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Fiona Kumfor
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Jan van den Stock
- Laboratory for Translational Neuropsychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | | | - Harro Seelaar
- Department of Neurology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Flora Gossink
- Department of Old Age Psychiatry, GGZ InGeest, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Everard Vijverberg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Edward Huey
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Department of Psychiatry, Colombia University, New York, USA
| | - Mathieu Vandenbulcke
- Department of Geriatric Psychiatry, University Hospitals Leuven, Leuven, Belgium
| | - Mario Masellis
- Department of Neurology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Calvin Trieu
- Department of Old Age Psychiatry, GGZ InGeest, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Chiadi Onyike
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Research Group, Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Leonardo Cruz de Souza
- Behavioral and Cognitive Neurology Research Group, Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Maria Landqvist Waldö
- Division of Clinical Sciences Helsingborg, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Olivier Piguet
- Division of Clinical Sciences Helsingborg, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Wendy Kelso
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Australia
| | - Dhamidhu Eratne
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Australia
| | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Australia
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - David Perry
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, USA
| | - Peter Pressman
- Department of Neurology, University of Colorado Denver, Aurora, USA
| | - Bradley Boeve
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rik Vandenberghe
- Department of Neurology, University Hospital Leuven, Leuven, Belgium
| | - Mario Mendez
- Department of Neurology, UCLA Medical Centre, University of California Los Angeles, Los Angeles, USA
| | - Carole Azuar
- Department of Neurology, Hôpital La Pitié Salpêtrière, Paris, France
| | - Richard Levy
- Department of Neurology, Hôpital La Pitié Salpêtrière, Paris, France
| | - Isabelle Le Ber
- Department of Neurology, Hôpital La Pitié Salpêtrière, Paris, France
| | - Sandra Baez
- Department of Psychology, Andes University, Bogota, Colombia
| | - Alan Lerner
- Department of Neurology, University Hospital Cleveland Medical Center, Cleveland, USA
| | - Ratnavalli Ellajosyula
- Department of Neurology, Manipal Hospital and Annasawmy Mudaliar Hospital, Bangalore, India
| | - Florence Pasquier
- Univ Lille, Inserm U1171, Memory Center, CHU Lille, DISTAlz, Lille, France
| | - Daniela Galimberti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Centro Dino Ferrari, Milan, Italy
- Fondazione IRCCS Ca’ Granda, Ospedale Policlinico, Neurodegenerative Diseases Unit Milan, Italy
| | - Elio Scarpini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Centro Dino Ferrari, Milan, Italy
- Fondazione IRCCS Ca’ Granda, Ospedale Policlinico, Neurodegenerative Diseases Unit Milan, Italy
| | - John van Swieten
- Department of Neurology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Howard Rosen
- Memory and Aging Center, University of California San Francisco, San Francisco, USA
| | - John Hodges
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Munich, Germany
| | - Yolande Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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17
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Agardh D, Matthias T, Wusterhausen P, Neidhöfer S, Heller A, Lerner A. Antibodies against neo-epitope of microbial and human transglutaminase complexes as biomarkers of childhood celiac disease. Clin Exp Immunol 2020; 199:294-302. [PMID: 31663117 PMCID: PMC7008223 DOI: 10.1111/cei.13394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2019] [Indexed: 12/19/2022] Open
Abstract
Tissue transglutaminase (tTG) and microbial transglutaminase (mTG) cross-link gliadins to form complexes that expose immunogenic neo-epitopes to produce tTG and mTG-neo-epitope antibodies. The aim of this study was to test the diagnostic performance of antibodies against non-complexed and complexed forms of transglutaminases, to correlate their activities to the intestinal damage and to explore age group dependency in celiac disease (CD). A total of 296 children with untreated CD and 215 non-celiac disease controls were checked by in-house enzyme-linked immunosorbent assays detecting immunoglobulin (Ig)A, IgG or combined detection of IgA and IgG (check) against tTG, AESKULISA® tTG New Generation (tTG-neo) and mTG-neo (RUO), IgA and IgG antibodies against deamidated gliadin peptide (DGP) and human IgA anti-endomysium antibodies (EMA) using AESKUSLIDES® EMA. Intestinal pathology was graded according the revised Marsh criteria, and age dependencies of the antibody activities were analysed. Using cut-offs estimated from receiver operating characteristic (ROC) curves, the highest area under curve (AUC) of the TG assays was 0·963 for tTG-neo check, followed by tTG check (0·962) when the diagnosis was based on enteric mucosal histology. tTG-neo check was the most effective to reflect the intestinal abnormalities in CD (r = 0·795, P < 0·0001). High levels of anti-mTG-neo IgG and anti-tTG-neo IgG appeared in the earlier age groups, as compared to anti-tTG IgG (P < 0·001). Considering antibody diagnostic performance based on AUC, enteric damage reflection and predictability at an early age, the anti-neo tTG check was the most effective diagnostic biomarker for pediatric CD. The mTG neo check might represent a new marker for CD screening, diagnosis and predictability.
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Affiliation(s)
- D. Agardh
- Diabetes and Celiac Disease UnitDepartment of Clinical SciencesLund UniversityMalmöSweden
- Department of PediatricsSkåne University HospitalMalmöSweden
| | | | | | | | - A. Heller
- AESKU.KIPP InstituteWendelsheimGermany
| | - A. Lerner
- AESKU.KIPP InstituteWendelsheimGermany
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18
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Makrinou E, Drong AW, Christopoulos G, Lerner A, Chapa-Chorda I, Karaderi T, Lavery S, Hardy K, Lindgren CM, Franks S. Genome-wide methylation profiling in granulosa lutein cells of women with polycystic ovary syndrome (PCOS). Mol Cell Endocrinol 2020; 500:110611. [PMID: 31600550 PMCID: PMC7116598 DOI: 10.1016/j.mce.2019.110611] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 05/12/2019] [Revised: 08/20/2019] [Accepted: 10/04/2019] [Indexed: 02/08/2023]
Abstract
Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder amongst women of reproductive age, whose aetiology remains unclear. To improve our understanding of the molecular mechanisms underlying the disease, we conducted a genome-wide DNA methylation profiling in granulosa lutein cells collected from 16 women suffering from PCOS, in comparison to 16 healthy controls. Samples were collected by follicular aspiration during routine egg collection for IVF treatment. Study groups were matched for age and BMI, did not suffer from other disease and were not taking confounding medication. Comparing women with polycystic versus normal ovarian morphology, after correcting for multiple comparisons, we identified 106 differentially methylated CpG sites with p-values <5.8 × 10-8 that were associated with 88 genes, several of which are known to relate either to PCOS or to ovarian function. Replication and validation of the experiment was done using pyrosequencing to analyse six of the identified differentially methylated sites. Pathway analysis indicated potential disruption in canonical pathways and gene networks that are, amongst other, associated with cancer, cardiogenesis, Hedgehog signalling and immune response. In conclusion, these novel findings indicate that women with PCOS display epigenetic changes in ovarian granulosa cells that may be associated with the heterogeneity of the disorder.
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Affiliation(s)
- E Makrinou
- Imperial College London, Faculty of Medicine, Institute of Reproductive and Developmental Biology, London, W12 0NN, UK.
| | - A W Drong
- Big Data Institute at the Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, OX3 7LF, UK
| | - G Christopoulos
- IVF Unit, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, W12 0NN, UK
| | - A Lerner
- Imperial College London, Faculty of Medicine, Institute of Reproductive and Developmental Biology, London, W12 0NN, UK
| | - I Chapa-Chorda
- Imperial College London, Faculty of Medicine, Institute of Reproductive and Developmental Biology, London, W12 0NN, UK
| | - T Karaderi
- Wellcome Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK; Department of Biological Sciences, Faculty of Arts and Sciences, Eastern Mediterranean University, Famagusta, Cyprus
| | - S Lavery
- IVF Unit, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, W12 0NN, UK
| | - K Hardy
- Imperial College London, Faculty of Medicine, Institute of Reproductive and Developmental Biology, London, W12 0NN, UK
| | - C M Lindgren
- Big Data Institute at the Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, OX3 7LF, UK; Wellcome Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - S Franks
- Imperial College London, Faculty of Medicine, Institute of Reproductive and Developmental Biology, London, W12 0NN, UK
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19
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Carr SJ, Jaeger J, Bian S, He P, Maserejian N, Wang W, Maruff P, Enayetallah A, Wang Y, Chen Z, Lerner A, Tatsuoka C. Associating Cognition With Amyloid Status Using Partially Ordered Set Analysis. Front Neurol 2019; 10:976. [PMID: 31572291 PMCID: PMC6753225 DOI: 10.3389/fneur.2019.00976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/10/2019] [Accepted: 08/27/2019] [Indexed: 11/13/2022] Open
Abstract
Background: The presence of brain amyloid-beta positivity is associated with cognitive impairment and dementia, but whether there are specific aspects of cognition that are most linked to amyloid-beta is unclear. Analysis of neuropsychological test data presents challenges since a single test often requires drawing upon multiple cognitive functions to perform well. It can thus be imprecise to link performance on a given test to a specific cognitive function. Our objective was to provide insight into how cognitive functions are associated with brain amyloid-beta positivity among samples consisting of cognitively normal and mild cognitively impaired (MCI) subjects, by using partially ordered set models (POSETs). Methods: We used POSET classification models of neuropsychological test data to classify samples to detailed cognitive profiles using ADNI2 and AIBL data. We considered 3 gradations of episodic memory, cognitive flexibility, verbal fluency, attention and perceptual motor speed, and performed group comparisons of cognitive functioning stratified by amyloid positivity (yes/no) and age (<70, 70-80, 81-90 years). We also employed random forest methods stratified by age to assess the effectiveness of cognitive testing in predicting amyloid positivity, in addition to demographic variables, and APOE4 allele count. Results: In ADNI2, differences in episodic memory and attention by amyloid were found for <70, and 70-80 years groups. In AIBL, episodic memory differences were found in the 70-80 years age group. In both studies, no cognitive differences were found in the 81-90 years group. The random forest analysis indicates that variable importance in classification depends on age. Cognitive testing that targets an intermediate level of episodic memory and delayed recall, in addition to APOE4 allele count, are the most important variables in both studies. Conclusions: In the ADNI2 and AIBL samples, the associations between specific cognitive abilities and brain amyloid-beta positivity depended on age, but in general episodic memory was most consistently predictive of brain amyloid-beta positivity. Random forest methods and OOB error rates establish the feasibility of predicting the presence of brain beta-amyloid using cognitive testing, APOE4 genotyping and demographic variables.
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Affiliation(s)
- Sarah J.A. Carr
- Department of Neurology, Case Western Reserve University, Cleveland, OH, United States
- Neuroimaging Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Judith Jaeger
- CognitionMetrics, LLC, Wilmington, DE, United States
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, United States
| | | | - Ping He
- Biogen, Cambridge, MA, United States
| | | | | | - Paul Maruff
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
- CogState Ltd., Melbourne, VIC, Australia
| | | | - Yanming Wang
- Department of Radiology, Case Western Reserve University, Cleveland, OH, United States
| | - Zhengyi Chen
- Department of Neurology, Case Western Reserve University, Cleveland, OH, United States
| | - Alan Lerner
- Department of Neurology, Case Western Reserve University, Cleveland, OH, United States
- Neurological Institute, University Hospitals Cleveland Medical Center, Beachwood, OH, United States
| | - Curtis Tatsuoka
- Department of Neurology, Case Western Reserve University, Cleveland, OH, United States
- Neurological Institute, University Hospitals Cleveland Medical Center, Beachwood, OH, United States
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, United States
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20
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Barisano G, Bigjahan B, Metting S, Cen S, Amezcua L, Lerner A, Toga AW, Law M. Signal Hyperintensity on Unenhanced T1-Weighted Brain and Cervical Spinal Cord MR Images after Multiple Doses of Linear Gadolinium-Based Contrast Agent. AJNR Am J Neuroradiol 2019; 40:1274-1281. [PMID: 31345942 DOI: 10.3174/ajnr.a6148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/06/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The clinical implications of gadolinium deposition in the CNS are not fully understood, and it is still not known whether gadolinium tends to be retained more in the brain compared with the spinal cord. In this study, we assessed the effects of linear gadolinium-based contrast agents on the T1 signal intensity of 3 cerebral areas (dentate nucleus, globus pallidus, and the less studied substantia nigra) and the cervical spinal cord in a population of patients with MS. MATERIALS AND METHODS A single-center population of 100 patients with MS was analyzed. Patients underwent 2-16 contrast-enhanced MRIs. Fifty patients received ≤5 linear gadolinium injections, and 50 patients had ≥6 injections: Fifty-two patients had both Gd-DTPA and gadobenate dimeglumine injections, and 48 patients received only gadobenate dimeglumine. A quantitative analysis of signal intensity changes was independently performed by 2 readers on the first and last MR imaging scan. The globus pallidus-to-thalamus, substantia nigra-to-midbrain, dentate nucleus-to-middle cerebellar peduncle, and the cervical spinal cord-to-pons signal intensity ratios were calculated. RESULTS An increase of globus pallidus-to-thalamus (mean, +0.0251 ± 0.0432; P < .001), dentate nucleus-to-middle cerebellar peduncle (mean, +0.0266 ± 0.0841; P = .002), and substantia nigra-to-midbrain (mean, +0.0262 ± 0.0673; P < .001) signal intensity ratios after multiple administrations of linear gadolinium-based contrast agents was observed. These changes were significantly higher in patients who received ≥6 injections (P < .001) and positively correlated with the number of injections and the accumulated dose of contrast. No significant changes were detected in the spinal cord (mean, +0.0008 ± 0.0089; P = .400). CONCLUSIONS Patients with MS receiving ≥6 linear gadolinium-based contrast agent injections showed a significant increase in the signal intensity of the globus pallidus, dentate nucleus, and substantia nigra; no detectable changes were observed in the cervical spinal cord.
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Affiliation(s)
- G Barisano
- From the Department of Radiology (G.B., B.B., S.M., S.C., A.L., M.L.) .,Stevens Neuroimaging and Informatics Institute (G.B., B.B., A.W.T., M.L.)
| | - B Bigjahan
- From the Department of Radiology (G.B., B.B., S.M., S.C., A.L., M.L.).,Stevens Neuroimaging and Informatics Institute (G.B., B.B., A.W.T., M.L.)
| | - S Metting
- From the Department of Radiology (G.B., B.B., S.M., S.C., A.L., M.L.)
| | - S Cen
- From the Department of Radiology (G.B., B.B., S.M., S.C., A.L., M.L.)
| | - L Amezcua
- Department of Neurology (L.A.), Keck School of Medicine, University of Southern California, Los Angeles, California
| | - A Lerner
- From the Department of Radiology (G.B., B.B., S.M., S.C., A.L., M.L.)
| | - A W Toga
- Stevens Neuroimaging and Informatics Institute (G.B., B.B., A.W.T., M.L.)
| | - M Law
- From the Department of Radiology (G.B., B.B., S.M., S.C., A.L., M.L.).,Stevens Neuroimaging and Informatics Institute (G.B., B.B., A.W.T., M.L.)
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Lerner A, Owens LA, Coates M, Simpson C, Poole G, Velupillai J, Liyanage M, Christopoulos G, Lavery S, Hardy K, Franks S. Expression of genes controlling steroid metabolism and action in granulosa-lutein cells of women with polycystic ovaries. Mol Cell Endocrinol 2019; 486:47-54. [PMID: 30802529 DOI: 10.1016/j.mce.2019.02.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 11/19/2018] [Revised: 01/15/2019] [Accepted: 02/18/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Aberrant function of granulosa cells has been implicated in the pathophysiology of PCOS. MATERIALS & METHODS Granulosa lutein (GL) cells were collected during oocyte retrieval for IVF/ICSI. RT-qPCR was used to compare gene expression between 12 control women, 12 with ovulatory PCO and 12 with anovulatory PCOS. To examine which genes are directly regulated by androgens, GL cells from an additional 12 control women were treated in-vitro with 10 nM dihydrotestosterone (DHT). RESULTS GL cells from women with PCOS showed reduced expression of CYP11A1 3-fold (p = 0.005), HSD17B1 1.8-fold (p = 0.02) and increased expression of SULT1E1 7-fold (p = 0.0003). Similar results were seen in ovulatory women with PCO. GL cells treated with 10 nM DHT showed a 4-fold (p = 0.03) increase in expression of SULT1E1 and a 5-fold reduction in SRD5A1 (p = 0.03). CONCLUSIONS These findings support the notion that aberrant regulation of steroid metabolism or action play a part in ovarian dysfunction in PCOS.
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Affiliation(s)
- A Lerner
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, London, UK
| | - L A Owens
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, London, UK.
| | - M Coates
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, London, UK
| | - C Simpson
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, London, UK
| | - G Poole
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, London, UK
| | - J Velupillai
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, London, UK
| | - M Liyanage
- Wolfson Fertility Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - G Christopoulos
- Wolfson Fertility Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - S Lavery
- Wolfson Fertility Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - K Hardy
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, London, UK
| | - S Franks
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, London, UK
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Lerner A, Akers C, Forgenie J, Muneer A, Alifrangis C, Mitra A. Adjuvant Radiotherapy in the Management of High Risk Penile Cancer – Outcomes from a Single Institution. Clin Oncol (R Coll Radiol) 2019. [DOI: 10.1016/j.clon.2018.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Owens LA, Abbara A, Lerner A, O'floinn S, Christopoulos G, Khanjani S, Islam R, Hardy K, Hanyaloglu AC, Lavery SA, Dhillo WS, Franks S. The direct and indirect effects of kisspeptin-54 on granulosa lutein cell function. Hum Reprod 2019; 33:292-302. [PMID: 29206944 DOI: 10.1093/humrep/dex357] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/13/2017] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What are the in vivo and in vitro actions of kisspeptin-54 on the expression of genes involved in ovarian reproductive function, steroidogenesis and ovarian hyperstimulation syndrome (OHSS) in granulosa lutein (GL) cells when compared with traditional triggers of oocyte maturation? SUMMARY ANSWER The use of kisspeptin-54 as an oocyte maturation trigger augmented expression of genes involved in ovarian steroidogenesis in human GL cells including, FSH receptor (FSHR), LH/hCG receptor (LHCGR), steroid acute regulatory protein (STAR), aromatase, estrogen receptors alpha and beta (ESR1, ESR2), 3-beta-hydroxysteroid dehydrogenase type 2 (3BHSD2) and inhibin A (INHBA), when compared to traditional maturation triggers, but did not alter markers of OHSS. WHAT IS KNOWN ALREADY hCG is the most widely used trigger of oocyte maturation, but is associated with an increased risk of OHSS. The use of GnRH agonists to trigger oocyte maturation is a safer alternative to hCG. More recently, kisspeptin-54 has emerged as a novel therapeutic option that safely triggers oocyte maturation even in women at high risk of OHSS. Kisspeptin indirectly stimulates gonadotropin secretion by acting on hypothalamic GnRH neurons. Kisspeptin and its receptor are also expressed in the human ovary, but there is limited data on the direct action of kisspeptin on the ovary. STUDY DESIGN SIZE, DURATION Forty-eight women undergoing IVF treatment for infertility consented to kisspeptin-54 triggering and/or granulosa cell collection and were included in the study. Twelve women received hCG, 12 received GnRH agonist and 24 received kisspeptin-54 to trigger oocyte maturation. In the kisspeptin-54 group, 12 received one injection of kisseptin-54 (9.6 nmol/kg) and 12 received two injections of kisspeptin-54 at a 10 h interval (9.6 nmol/kg × 2). PARTICIPANTS/MATERIALS, SETTING, METHODS Follicular fluid was aspirated and pooled from follicles during the retrieval of oocytes for IVF/ICSI. GL cells were isolated and either RNA extracted immediately or cultured in vitro ± kisspeptin or hCG. MAIN RESULTS AND THE ROLE OF CHANCE GL cells from women who had received kisspeptin-54 had a 14-fold and 8-fold higher gene expression of FSHR and a 2-fold (ns) and 2.5-fold (P < 0.05) higher expression of LHCGR than GL cells from women who had received hCG or GnRH agonist, respectively. CYP19A1 expression was 3.6-fold (P < 0.05) and 4.5-fold (P < 0.05) higher, STAR expression was 3.4-fold (P < 0.01) and 1.8-fold (P < 0.05) higher, HSD3B2 expression was 7.5- (P < 0.01) and 2.5-fold higher (P < 0.05), INHBA was 2.5-fold (P < 0.01) and 2.5-fold (P < 0.01) higher in GL cells from women who had received kisspeptin-54 than hCG or GnRHa, respectively. ESR1 (P < 0.05) and ESR2 (P < 0.05) both showed 3-fold higher expression in cells from kisspeptin treated than GnRHa treated women. Markers of vascular permeability and oocyte growth factors were unchanged (VEGFA, SERPINF1, CDH5, amphiregulin, epiregulin). Gene expression of kisspeptin receptor was unchanged. Whereas treating GL cells in vitro with hCG induced steroidogenic gene expression, kisspeptin-54 had no significant direct effects on either OHSS genes or steroidogenic genes. LIMITATIONS REASONS FOR CAUTION Most women in the study had PCOS, which may limit applicability to other patient groups. For the analysis of the in vitro effects of kisspeptin-54, it is important to note that GL cells had already been exposed in vivo to an alternate maturation trigger. WIDER IMPLICATIONS OF THE FINDINGS The profile of serum gonadotropins seen with kisspeptin administration compared to other triggers more closely resemble that of the natural cycle as compared with hCG. Thus, kisspeptin could potentially permit an ovarian environment augmented for steroidogenesis, in particular progesterone synthesis, which is required for embryo implantation. STUDY FUNDING/COMPETING INTEREST(S) Dr Owens is supported by an Imperial College London PhD Scholarship. Dr Abbara is supported by an National Institute of Health Research Academic Clinical Lectureship. The authors do not have any conflict of interest to declare. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT01667406.
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Affiliation(s)
- L A Owens
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College, Du Cane Road, London W12 0NN, UK
| | - A Abbara
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | - A Lerner
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College, Du Cane Road, London W12 0NN, UK
| | - S O'floinn
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College, Du Cane Road, London W12 0NN, UK
| | - G Christopoulos
- Department of Reproductive Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - S Khanjani
- Department of Reproductive Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - R Islam
- Department of Reproductive Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - K Hardy
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College, Du Cane Road, London W12 0NN, UK
| | - A C Hanyaloglu
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College, Du Cane Road, London W12 0NN, UK
| | - S A Lavery
- Department of Reproductive Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, UK
| | - W S Dhillo
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | - S Franks
- Institute of Reproductive and Developmental Biology, Hammersmith Hospital, Imperial College, Du Cane Road, London W12 0NN, UK
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Perrotta F, Nankivell M, Adizie J, Elshafi M, Jafri S, Maqsood U, Munavvar M, Woolhouse I, Lerner A, Evison M, Booton R, Baldwin D, Janes S, Yarmus L, Bianco A, Navani N. Performance of endobronchial ultrasound-guided transbronchial needle aspiration in PD-L1 testing in patients with NSCLC. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30095-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Grace K, Lerner A, Mikal J, Sangli G. A qualitative investigation of childbearing and seasonal hunger in peri-urban Ouagadougou, Burkina Faso. Popul Environ 2017; 38:369-380. [PMID: 29937612 PMCID: PMC6009842 DOI: 10.1007/s11111-016-0268-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Poor women who live in peri-urban communities are often faced with food insecurity due to seasonal variations in food availability and accessibility. Additionally, in these communities, fertility levels are often elevated despite geographic proximity to urban areas with low cost contraception. We conducted five focus group interviews to investigate the lived experiences of childbearing in peri-urban Ouagadougou, Burkina Faso to understand the behavioral and biological determinants of fertility outcomes. In the analysis of the interviews we pay particular attention to seasonal food insecurity experiences and the biological and behavioral determinants of childbearing. Our results suggest that there are less optimal times of year for childbearing and that poor, peri-urban women adjust their behavior accordingly. The results also suggest that there remain important barriers to contraceptive use even in cases where individuals associate pregnancy and childbearing with physical and psychological risk. This paper provides greater depth in understanding the determinants of fertility in resource-poor, peri-urban communities and points to some barriers for lowering fertility in similar areas.
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Affiliation(s)
- Kathryn Grace
- Please address all correspondence and requests for materials to corresponding author, Kathryn Grace. , 558 Social Sciences Building, 267-19 Avenue South, Minneapolis, MN 55455
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Alkhachroum AM, Weiss D, Lerner A, De Georgia MA. Spinal cord infarct caused from suspected fibrocartilaginous embolism. Spinal Cord Ser Cases 2017; 3:17027. [PMID: 28546875 DOI: 10.1038/scsandc.2017.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/08/2017] [Revised: 03/19/2017] [Accepted: 04/07/2017] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION We report a case of spinal cord infarct as a result of suspected fibrocartilaginous embolism (FCE). CASE PRESENTATION A 23-year-old man presented with sudden onset cervical and upper back pain followed by progressive weakness in his extremities after throwing a baseball. History, neurologic examination and spinal cord imaging were consistent with spinal cord infarct. We believe the cause was from FCE. DISCUSSION Though rare, physicians should be familiar with this diagnosis and the proposed mechanisms. There is no specific treatment for FCE-related spinal cord infarct and long-term prognosis is largely dependent on the degree of spinal cord injury.
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Affiliation(s)
- Ayham M Alkhachroum
- Department of Neurology, University Hospitals Cleveland Medical Center, Neurological Institute, Cleveland, OH, USA
| | - Danielle Weiss
- Department of Neurology, University Hospitals Cleveland Medical Center, Neurological Institute, Cleveland, OH, USA
| | - Alan Lerner
- Department of Neurology, University Hospitals Cleveland Medical Center, Neurological Institute, Cleveland, OH, USA
| | - Michael A De Georgia
- Department of Neurology, University Hospitals Cleveland Medical Center, Neurological Institute, Cleveland, OH, USA
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Nutman A, Lerner A, Schwartz D, Carmeli Y. Evaluation of carriage and environmental contamination by carbapenem-resistant Acinetobacter baumannii. Clin Microbiol Infect 2016; 22:949.e5-949.e7. [DOI: 10.1016/j.cmi.2016.08.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/14/2016] [Accepted: 08/15/2016] [Indexed: 10/21/2022]
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Matthias T, Jeremias P, Neidhöfer S, Lerner A. The industrial food additive, microbial transglutaminase, mimics tissue transglutaminase and is immunogenic in celiac disease patients. Autoimmun Rev 2016; 15:1111-1119. [PMID: 27640315 DOI: 10.1016/j.autrev.2016.09.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [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: 07/26/2016] [Accepted: 08/03/2016] [Indexed: 12/12/2022]
Abstract
Microbial transglutaminase (mTg) is capable of cross-linking numerous molecules. It is a family member of human tissue transglutaminase (tTg), and is involved in CD. Despite declarations of the safety of mTg for industrial use, direct evidence for immunogenicity of the enzyme is lacking. The serological activity of mTg, tTg, gliadin complexed mTg (mTg neo-epitope) and gliadin complexed tTg (tTg neo-epitope) were studied in 95 pediatric celiac patients (CD), 99 normal children (NC), 79 normal adults (NA) and 45 children with nonspecific abdominal pain (AP). Sera were tested by ELISAs, detecting IgA, IgG or both IgA and IgG (check): AESKULISA® tTg (tTg), AESKULISA® tTg New Generation (tTg neo-epitope (tTg-neo)), microbial transglutaminase (mTg) and mTg neo-epitope (mTg-neo). Marsh criteria were used for the degree of intestinal injury. Parallel, mTg and tTg neo-epitopes were purified by asymmetric field flow fractionation, confirmed by multi-light-scattering and SDS-PAGE, and analyzed in adult CD and control groups by competition ELISAs. No sequence homology but active site similarity were detected on alignment of the 2 Tgs. Comparing pediatric CD patients with the 2 normal groups: mTg-neo IgA, IgG and IgA+IgG antibody activities exceed the comparable mTg ones (p<0.0001). All mTg-neo and tTg-neo levels were higher (p<0.001). tTg IgA and IgG+IgA were higher than mTg IgA and IgA+IgG (p<0.0001). The levels of tTg-neo IgA/IgG were higher than tTg IgA/IgG (p<0.0001). The sequential antibody activities best reflecting the increased intestinal damage were tTg-neo check>tTg-neo IgA≥mTg-neo IgG>tTg-neo IgG>mTg-neo check>mTg-neo IgA. Taken together, tTg-neo check, tTg-neo IgA and mTg-neo IgG correlated best with intestinal pathology (r2=0.6454, r2=0.6165, r2=0.5633; p<0.0001, p<0.0001, p<0.0001, respectively). Purified mTg-neo IgG and IgA showed an increased immunoreactivity compared to single mTg and gliadin (p<0.001) but similar immunoreactivity to the tTg-neo IgG and IgA ELISA. Using competition ELISA, the mTg neo-epitopes and tTg neo-epitopes have identical outcomes in CD sera both showing a decrease in optical density of 55±6% (p<0.0002). mTg is immunogenic in children with CD and, by complexing to gliadin, its immunogenicity is enhanced. Anti-mTg-neo-epitope IgG antibodies correlate with intestinal damage to a comparable degree as anti-tTg-neo IgA. mTg and tTg display a comparable immunopotent epitope. mTg-neo IgG is a new marker for CD. Further studies are needed to explore the pathogenic potential of anti-mTg antibodies in CD.
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Affiliation(s)
- T Matthias
- AESKU.KIPP Institute, Wendelsheim, Germany
| | - P Jeremias
- AESKU.KIPP Institute, Wendelsheim, Germany
| | | | - A Lerner
- AESKU.KIPP Institute, Wendelsheim, Germany; B. Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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Stewart T, Caffrey DG, Gilman RH, Mathai SC, Lerner A, Hernandez A, Pinto ME, Huaylinos Y, Cabrera L, Wise RA, Miranda JJ, Checkley W. Can a simple test of functional capacity add to the clinical assessment of diabetes? Diabet Med 2016; 33:1133-9. [PMID: 26599981 PMCID: PMC4955604 DOI: 10.1111/dme.13032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 01/06/2023]
Abstract
AIM To identify impairment in functional capacity associated with complicated and non-complicated diabetes using the 6-min walk distance test. METHODS We enrolled 111 adults, aged ≥40 years, with Type 2 diabetes from a hospital facility and 150 healthy control subjects of similar age and sex from a community site in Lima, Peru. All participants completed a 6-min walk test. RESULTS The mean age of the 261 participants was 58.3 years, and 43.3% were male. Among those with diabetes, 67 (60%) had non-complicated diabetes and 44 (40%) had complications such as peripheral neuropathy, retinopathy or nephropathy. The mean unadjusted 6-min walk distances were 376 m and 394 m in adults with and without diabetes complications, respectively, vs 469 m in control subjects (P<0.001). In multivariable regression, the subjects with diabetes complications walked 84 m less far (95% CI -104 to -63 m) and those without complications walked 60 m less far (-77 to -42 m) than did control subjects. When using HbA1c level as a covariate in multivariable regression, participants walked 13 m less far (-16.9 to -9.9 m) for each % increase in HbA1c . CONCLUSIONS The subjects with diabetes had lower functional capacity compared with healthy control subjects with similar characteristics. Differences in 6-min walk distance were even apparent in the subjects without diabetes complications. Potential mechanisms that could explain this finding are early cardiovascular disease or deconditioning.
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Affiliation(s)
- T Stewart
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - D G Caffrey
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - R H Gilman
- Program in Disease Control and Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- A.B. PRISMA, Lima, Peru
| | - S C Mathai
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - A Lerner
- Program in Disease Control and Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - A Hernandez
- Division of Endocrinology, Department of Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - M E Pinto
- Division of Endocrinology, Department of Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Y Huaylinos
- Division of Endocrinology, Department of Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru
| | | | - R A Wise
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - J J Miranda
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - W Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Program in Disease Control and Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Affiliation(s)
- A. Lerner
- ACETO Chemical Company 126-02 Northern Blvd. Flushing, NY 11368
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Affiliation(s)
- B Gao
- Department of Radiology Yantai Yuhuangding Hospital Qingdao University Yantai, Shandong, China Department of Radiology Keck School of Medicine University of Southern California Los Angeles, California
| | - A Lerner
- Department of Radiology Keck School of Medicine University of Southern California Los Angeles, California
| | - M Law
- Department of Radiology Keck School of Medicine University of Southern California Los Angeles, California
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Abstract
The clinical decision-making process for patients with severe trauma of the extremities for primary amputation or to initiate extensive reconstructive measures for limb salvage in the best interests of the patient can be complex and difficult. The many factors influencing the decision-making process, such as local anatomical, pathomechanical, physiological, psychosocial and general factors are demonstrated and discussed. In the past, the role of scores supporting the decision-making process for amputation or limb salvage has been overestimated. In the LEAP study it could clearly be demonstrated that none of the sometimes highly complex scores could fulfill the expectations to predict successful limb salvage or the need for amputation. In this article it is shown that initiators and authors of scores achieved much higher sensitivity and specificity in the inaugural studies compared to the standardized and controlled conditions used in the LEAP study. For a long time, a lack of feeling in the feet was considered a safe and reliable criterion for amputation but the LEAP study has made a substantial contribution to demythologizing this as a lead symptom. Patients with severe trauma of the ankle or foot requiring a free flap or ankle arthrodesis have a significantly worse outcome compared to patients with a below knee amputation. Taking all these influencing factors into consideration, a comprehensive algorithm is presented that facilitates, strengthens and standardizes decision-making for amputation or limb salvage. This algorithm consists of four modules: 1) decision-making, 2) emergency treatment, 3) definitive treatment and 4) fine tuning. In the decision-making module not only local and general injury severity are addressed but the expected result, the general condition, comorbidities, compliance and the will of the patient are also included.
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Affiliation(s)
- C Krettek
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - A Lerner
- Department of Orthopedic Surgery, Ziv Medical Center, Rambam st. Zefat, 13100, Zefat, Israel
| | - P Giannoudis
- Department of Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, UK
| | - C Willy
- Abteilung Unfallchirurgie und Orthopädie, Septisch-Rekonstruktive Chirurgie, Bundeswehrkrankenhaus Berlin, Scharnhorststr. 13, 10115, Berlin, Deutschland
| | - C W Müller
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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Lerner A, Solter E, Rachi E, Adler A, Rechnitzer H, Miron D, Krupnick L, Sela S, Aga E, Ziv Y, Peretz A, Labay K, Rahav G, Geffen Y, Hussein K, Eluk O, Carmeli Y, Schwaber MJ. Detection and characterization of carbapenemase-producing Enterobacteriaceae in wounded Syrian patients admitted to hospitals in northern Israel. Eur J Clin Microbiol Infect Dis 2015; 35:149-54. [PMID: 26581423 DOI: 10.1007/s10096-015-2520-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/30/2015] [Indexed: 11/29/2022]
Abstract
Since 2013, four hospitals in northern Israel have been providing care for Syrian nationals, primarily those wounded in the ongoing civil war. We analyzed carbapenemase-producing Enterobacteriaceae (CPE) isolates obtained from these patients. Isolate identification was performed using the VITEK 2 system. Polymerase chain reaction (PCR) was performed for the presence of bla KPC, bla NDM, and bla OXA-48. Susceptibility testing and genotyping were performed on selected isolates. During the study period, 595 Syrian patients were hospitalized, most of them young men. Thirty-two confirmed CPE isolates were grown from cultures taken from 30 patients. All but five isolates were identified as Klebsiella pneumoniae and Escherichia coli. Nineteen isolates produced NDM and 13 produced OXA-48. Among a further 29 isolates tested, multilocus sequence typing (MLST) showed that ST278 and ST38 were the major sequence types among the NDM-producing K. pneumoniae and OXA-48-producing E. coli isolates, respectively. Most were resistant to all three carbapenems in use in Israel and to gentamicin, but susceptible to colistin and fosfomycin. The source for bacterial acquisition could not be determined; however, some patients admitted to different medical centers were found to carry the same sequence type. CPE containing bla NDM and bla OXA-48 were prevalent among Syrian wounded hospitalized patients in northern Israel. The finding of the same sequence type among patients at different medical centers implies a common, prehospital source for these patients. These findings have implications for public health throughout the region.
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Affiliation(s)
- A Lerner
- National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel. .,Reference Laboratory, National Center for Infection Control, 6 Weizmann St., Tel Aviv, 6423906, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - E Solter
- National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Rachi
- National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel.,Reference Laboratory, National Center for Infection Control, 6 Weizmann St., Tel Aviv, 6423906, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Adler
- National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel.,Reference Laboratory, National Center for Infection Control, 6 Weizmann St., Tel Aviv, 6423906, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Rechnitzer
- Department of Infectious Disease Consultation Service, Ziv Medical Center, Safed, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel
| | - D Miron
- Department of Infectious Disease Consultation Service, Ziv Medical Center, Safed, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel
| | - L Krupnick
- Department of Infectious Disease Consultation Service, Ziv Medical Center, Safed, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel
| | - S Sela
- Infectious Disease Unit, Galilee Medical Center, Nahariya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel
| | - E Aga
- Infectious Disease Unit, Galilee Medical Center, Nahariya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel
| | - Y Ziv
- Infectious Disease Unit, Galilee Medical Center, Nahariya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel
| | - A Peretz
- Infectious Disease Unit, Baruch Padeh Medical Center, Poriya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel
| | - K Labay
- Infectious Disease Unit, Baruch Padeh Medical Center, Poriya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel
| | - G Rahav
- Infectious Disease Unit, Baruch Padeh Medical Center, Poriya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel
| | - Y Geffen
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - K Hussein
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - O Eluk
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Y Carmeli
- National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M J Schwaber
- National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lerner A, Phillips I, Ezhil V. Early mortality following radiotherapy – meeting standards and improving patient selection. Clin Oncol (R Coll Radiol) 2015. [DOI: 10.1016/j.clon.2015.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Petersen RB, Lissemore FM, Appleby B, Aggarwal N, Boyatzis R, Casadesus G, Cummings J, Jack A, Perry G, Safar J, Sajatovic M, Surewicz WK, Wang Y, Whitehouse P, Lerner A. From Neurodegeneration to Brain Health: An Integrated Approach. J Alzheimers Dis 2015; 46:271-83. [DOI: 10.3233/jad-150043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Robert B. Petersen
- Department of Pathology, Case Western Reserve University, Cleveland, OH, USA
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
| | | | - Brian Appleby
- Department of Pathology, Case Western Reserve University, Cleveland, OH, USA
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA
- Department of Neurology, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Neelum Aggarwal
- Department of Neurology, Rush University Medical Center, Chicago, IL, USA
| | - Richard Boyatzis
- Departments of Organizational Behavior, Cognitive Science, and Psychology, Case Western Reserve University, Cleveland, OH, USA
| | | | - Jeff Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Anthony Jack
- Department of Philosophy, Case Western Reserve University, Cleveland, OH, USA
| | - George Perry
- Department of Biology, University of Texas, San Antonio, TX, USA
| | - Jiri Safar
- Department of Pathology, Case Western Reserve University, Cleveland, OH, USA
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
| | - Martha Sajatovic
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA
| | - Witold K. Surewicz
- Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, OH, USA
| | - Yanming Wang
- Departments of Radiology, Chemistry, and Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Peter Whitehouse
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
| | - Alan Lerner
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
- Department of Neurology, University Hospitals Case Medical Center, Cleveland, OH, USA
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Vunsh R, Heinig U, Malitsky S, Aharoni A, Avidov A, Lerner A, Edelman M. Manipulating duckweed through genome duplication. Plant Biol (Stuttg) 2015; 17 Suppl 1:115-119. [PMID: 25040392 DOI: 10.1111/plb.12212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 04/19/2014] [Indexed: 06/03/2023]
Abstract
Significant inter- and intraspecific genetic variation exists in duckweed, thus the potential for genome plasticity and manipulation is high. Polyploidy is recognised as a major mechanism of adaptation and speciation in plants. We produced several genome-duplicated lines of Landoltia punctata (Spirodela oligorrhiza) from both whole plants and regenerating explants using a colchicine-based cocktail. These lines stably maintained an enlarged frond and root morphology. DNA ploidy levels determined by florescence-activated cell sorting indicated genome duplication. Line A4 was analysed after 75 biomass doublings. Frond area, fresh and dry weights, rhizoid number and length were significantly increased versus wild type, while the growth rate was unchanged. This resulted in accumulation of biomass 17-20% faster in the A4 plants. We sought to determine if specific differences in gene products are found in the genome duplicated lines. Non-targeted ultra performance LC-quadrupole time of flight mass spectrometry was employed to compare some of the lines and the wild type to seek identification of up-regulated metabolites. We putatively identified differential metabolites in Line A65 as caffeoyl hexoses. The combination of directed genome duplication and metabolic profiling might offer a path for producing stable gene expression, leading to altered production of secondary metabolites.
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Affiliation(s)
- R Vunsh
- Department of Plant Sciences, Weizmann Institute of Science, Rehovot, Israel
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Williams M, Singer RA, Lerner A. A simple technique to estimate best- and worst-case survival in patients with metastatic colorectal cancer treated with chemotherapy. Ann Oncol 2014; 25:2014-2019. [PMID: 25096608 DOI: 10.1093/annonc/mdu372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patients with incurable cancer usually want specific information about prognosis, and clinicians' estimates are often inaccurate. Studies in breast and lung cancer have suggested that simple multiples of the median overall survival (OS) can accurately estimate the time at which 90%, 75%, 25% and 10% of patients are alive. PATIENTS AND METHODS We identified 46 phase III randomised clinical trials of chemotherapy in metastatic colorectal cancer, representing data from 29 011 patients. We extracted data on demographics, treatment and survival from 96 patient cohorts and assessed agreement with the estimated survival time points, calculated as 0.25, 0.5, 2 and 3 times the median OS. RESULTS Median OS was 16.8 months in the trials. There were 342 assessable time points. For 301 of these, the estimated survival time was within 0.75-1.33 of the actual survival time (88% agreement). The worst agreement (76%) was at the earliest (90%) level of survival. CONCLUSIONS Simple multiples of the median OS give reasonable estimates of the times at which different survival levels are reached in patients with metastatic colorectal cancer. Taken with previous studies, these findings are likely to be valid across a large range of patients. We would encourage clinicians to think of prognosis as a trajectory, and to consider quoting survival ranges instead of point estimates, in discussions with patients.
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Affiliation(s)
- M Williams
- Department of Clinical Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London.
| | - R A Singer
- Department of Clinical Oncology, Kent and Canterbury Hospital, Canterbury
| | - A Lerner
- Department of Clinical Oncology, The Royal Surrey County Hospital, Guildford, UK
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Lerner A, Talati E. Teaching Law And Educating Lawyers: Closing The Gap Through Multidisciplinary Experiential Learning. IJCLE 2014. [DOI: 10.19164/ijcle.v10i0.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<p>Interdisciplinary legal education found its roots nearly a century ago, but recently there has been a renewed trend both in the literature and in practice to increase interdisciplinary opportunities in clinical and scholarly activities. In the classroom, proponents have argued that interdisciplinary education is essential to understanding the cultural and social contexts in which legal conflicts arise. Additionally, scholars praise the interdisciplinary model – in both teaching and practice – for its tendency to generate a higher level of thinking from those considering problems from diverse viewpoints. The use of interdisciplinary models also promotes mutual respect between professionals from different disciplines, a working knowledge of the domain of another discipline, enhanced communication through learning both the mechanisms and vocabulary of other professions, and increased understanding another discipline’s “rules, beliefs, and ethical principles.” Finally, creating an interdisciplinary framework can enhance the efficacy of the lawyer’s problem solving efforts through providing a means by which goals, strategies, and unique insights of different “helping professions” can be united in pursuit of a common purpose.</p><p>The value that interdisciplinary approaches offer is often sharply countered by the challenges it creates. The most common challenges are those created by perceived or actual role boundaries within individual professions and the process of professional socialization that occurs during traditional legal training. Although this first criticism is challenging, it is not impossible to overcome. The second barrier to productive interdisciplinary work is also mutable, and reversing a socialization process that disfavors interdisciplinary experiences should therefore be a primary focus of legal educators. This paper proposes that interdisciplinary advocacy for children involved in the child welfare system provides an intense experiential learning process, which engages students in a mutually dependent relationship with students from other disciplines and promotes long-term appreciation and facility for interdisciplinary work. It describes this experience in the context of one such clinic, providing a model for the development of future interdisciplinary endeavors.</p>
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Lerner A, Debanne S, Belkin J, Lass J, Riedel T, Steinemann T, Sami S, Gilmore G. P1‐388: VISUAL AND COGNITIVE IMPROVEMENT FOLLOWING CATARACT SURGERY IN SUBJECTS WITH DEMENTIA. Alzheimers Dement 2014. [DOI: 10.1016/j.jalz.2014.05.630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Alan Lerner
- Case Western Reserve UniversityBeachwoodOhioUnited States
| | - Sara Debanne
- Case Western Reserve UniversityClevelandOhioUnited States
| | - Julie Belkin
- University Hospitals Case Medical CenterClevelandOhioUnited States
| | - Jon Lass
- Case Western Reserve UniversityClevelandOhioUnited States
| | - Tatiana Riedel
- Case Western Reserve UniversityClevelandOhioUnited States
| | | | - Susie Sami
- University Hospitals Case Medical CenterClevelandOhioUnited States
| | - Grover Gilmore
- Case Western Reserve UniversityClevelandOhioUnited States
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Hu XY, Fang XM, Chen HW, Yao XJ, Qian PY, Zhou JY, Guo J, Lerner A, Hu CH. Early detection of acute radiation-induced lung injury with multi-section CT perfusion imaging: An initial experience. Clin Radiol 2014; 69:853-60. [PMID: 24837694 DOI: 10.1016/j.crad.2014.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 02/12/2014] [Accepted: 03/27/2014] [Indexed: 10/25/2022]
Abstract
AIM To explore the value of 64-section computed tomography (CT) perfusion imaging (CTPI) in the early diagnosis of acute radiation-induced lung injury (ARILI). MATERIALS AND METHODS Fifty-one patients with oesophageal cancers or malignant thymomas received postoperative radiation therapy with a 60-62 Gy dose and underwent CTPI at pre- and post-radiation therapy time points (week 0, week 4, week 8, and week 12 respectively). The CTPI values were prospectively compared and analysed in order to evaluate the diagnostic utility of CTPI in the early diagnosis of ARILI. RESULTS Eighteen cases (18/51) of ARILI were diagnosed. The mean values of relative regional blood flow (rrBF), relative regional volume (rrBV), and relative regional permeability surface (rrPS) in the ARILI group were correspondingly higher than those of the non-ARILI group. At week 4, rrBF, rrBV, and rrPS in the ARILI group were significantly higher than those at pre-radiation (each p < 0.05). In the non-ARILI group, rrBF and rrBV were higher than those at pre-radiation (each p < 0.05); however, rrPS was not statistically different from that of pre-irradiation. Applying the diagnostic threshold value of rrPS = 1.22, the sensitivity, specificity, and positive and negative predictive values of CTPI for early diagnosis of ARILI were better than those of CT. CONCLUSION CTPI metrics may reflect haemodynamic changes in the post-irradiation lung and can detect cases of early ARILI that appear normal at CT. CTPI is a promising technique for early diagnosis of ARILI.
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Affiliation(s)
- X-Y Hu
- Imaging Center, Wuxi People's Hospital, Nanjing Medical University, Jiangsu Province 214023, China
| | - X-M Fang
- Imaging Center, Wuxi People's Hospital, Nanjing Medical University, Jiangsu Province 214023, China.
| | - H-W Chen
- Imaging Center, Wuxi People's Hospital, Nanjing Medical University, Jiangsu Province 214023, China
| | - X-J Yao
- Imaging Center, Wuxi People's Hospital, Nanjing Medical University, Jiangsu Province 214023, China
| | - P-Y Qian
- Imaging Center, Wuxi People's Hospital, Nanjing Medical University, Jiangsu Province 214023, China
| | - J-Y Zhou
- Radiotherapy Center, The First Affiliated Hospital of Suzhou University, Jiangsu Province 226001, China
| | - J Guo
- Radiotherapy Center, The First Affiliated Hospital of Suzhou University, Jiangsu Province 226001, China
| | - A Lerner
- Department of Radiology, LAC+USC Medical Center, University of Southern California, 1200 N State St, Los Angeles, CA, United States of America
| | - C-H Hu
- Imaging Center, The First Affiliated Hospital of Suzhou University, Jiangsu Province 226001, China.
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Jennings L, Campbell S, Yaar R, Mahalingam M, Sahni D, Lerner A, Rünger T. Generalized syringotropic mycosis fungoides responsive to extracorporeal photopheresis. Br J Dermatol 2014; 170:200-2. [DOI: 10.1111/bjd.12547] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- L. Jennings
- Department of Dermatology; Boston University Medical Center; Boston MA 02118 U.S.A
| | - S.M. Campbell
- Department of Dermatology; Boston University Medical Center; Boston MA 02118 U.S.A
| | - R. Yaar
- Dermatopathology Section; Department of Dermatology; Boston University Medical Center; Boston MA 02118 U.S.A
| | - M. Mahalingam
- Dermatopathology Section; Department of Dermatology; Boston University Medical Center; Boston MA 02118 U.S.A
| | - D. Sahni
- Department of Dermatology; Boston University Medical Center; Boston MA 02118 U.S.A
| | - A. Lerner
- Department of Hematology and Medical Oncology; Boston University Medical Center; Boston MA 02118 U.S.A
| | - T.M. Rünger
- Department of Dermatology; Boston University Medical Center; Boston MA 02118 U.S.A
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Amezcua L, Lerner A, Ledezma K, Conti D, Law M, Weiner L, Langer-Gould A. Spinal cord lesions and disability in Hispanics with multiple sclerosis. J Neurol 2013; 260:2770-6. [PMID: 23912723 DOI: 10.1007/s00415-013-7054-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 07/03/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022]
Abstract
Longitudinally extensive spinal cord lesions (LESCLs) are believed to occur predominantly with opticospinal multiple sclerosis (OSMS) and are associated with disability. The purpose of this study is to describe the prevalence and patterns of spinal cord lesions in Hispanics with multiple sclerosis (MS) and OSMS and their association with disability. A cross-sectional study of 164 patients with complete MRIs was used. In each case the spinal cord was classified: LESCLs, scattered spinal cord lesions (sSCLs) or no spinal cord lesions (noSCLs). Clinical course was defined as classical MS or OSMS. Risk of disability (Expanded Disability Status Scale ≥4.0) was adjusted for age, disease duration and sex using logistic regression. A total of 125/164 (73 %) MS patients had spinal cord lesions (sSCLs, 57 %; LESCLs, 19 %), but only 11 (7 %) had OSMS. LESCLs were associated with disability (p < 0.0001), longer disease duration (p < 0.0001) and MS (n = 21 vs. n = 10 OSMS; p < 0.0001). LESCLs were also associated with the greatest risk to disability (OR 7.3, 95 % CIs 1.9-26.5; p = 0.003; sSCLs OR 2.5, 95 % CIs 0.9-7.1; p = 0.09) compared with noSCLs. LESCLs are more common than OSMS and are associated with worse disability even in patients with MS. These results suggest that LESCLs are a more important marker of disability in MS than OSMS and may be an early indicator of more aggressive disease in this population.
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Affiliation(s)
- L Amezcua
- Department of Neurology, Keck School of Medicine, MS Comprehensive Care Center, University of Southern California (USC), 1520 San Pablo St, Suite 3000, Los Angeles, CA, 90033, USA,
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Lerner A, Schenk C, Miller M, Jain A, Tatsuoka C. P2–295: Diagnostic testing and medication utilization in Alzheimer's disease in a large de‐identified database. Alzheimers Dement 2013. [DOI: 10.1016/j.jalz.2013.05.942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Alan Lerner
- Case Western Reserve University Beachwood Ohio United States
| | - Christian Schenk
- University Hospitals Case Medical Center Cleveland Ohio United States
| | | | - Anil Jain
- Explorys, Inc. Cleveland Ohio United States
| | - Curtis Tatsuoka
- Case Western Reserve University Cleveland Ohio United States
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Boxer AL, Knopman DS, Kaufer DI, Grossman M, Onyike C, Graf-Radford N, Mendez M, Kerwin D, Lerner A, Wu CK, Koestler M, Shapira J, Sullivan K, Klepac K, Lipowski K, Ullah J, Fields S, Kramer JH, Merrilees J, Neuhaus J, Mesulam MM, Miller BL. Memantine in patients with frontotemporal lobar degeneration: a multicentre, randomised, double-blind, placebo-controlled trial. Lancet Neurol 2013; 12:149-56. [PMID: 23290598 DOI: 10.1016/s1474-4422(12)70320-4] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Memantine has been used off-label to treat frontotemporal lobar degeneration (FTD). A previous 26-week open-label study suggested a transient, modest benefit on neuropsychiatric symptoms as measured by the neuropsychiatric inventory (NPI). We aimed to determine whether memantine is an effective treatment for FTD. METHODS We did a randomised, parallel group, double-blind, placebo-controlled trial of 20 mg memantine taken orally daily for 26 weeks in patients with FTD. Participants met Neary criteria for behavioural variant FTD (bvFTD) or semantic dementia and had characteristic brain atrophy. Use of acetylcholinesterase inhibitors was prohibited. Individuals were randomly assigned to receive either memantine or matched placebo tablets (1:1) in blocks of two and four patients. All patients and study personnel were masked to treatment assignment. Primary endpoints were the change in total NPI score and clinical global impression of change (CGIC) score after 26 weeks and were analysed by intention to treat. This study is registered with Clinicaltrials.gov, number NCT00545974. FINDINGS Of 100 patients screened, 81 were randomly assigned to receive memantine (39 patients) or placebo (42 patients). Five (6%) patients discontinued, and 76 completed the 26-week treatment. Enrolment numbers were lower than planned because of many patients' preference to take memantine or cholinesterase inhibitors off-label rather than participate in a clinical trial. Memantine treatment had no effect on either the NPI (mean difference 2·2, 95% CI -3·9 to 8·3, p=0·47) or CGIC (mean difference 0·0, -0·4 to 0·4, p=0·90) after 26 weeks of treatment. Memantine was generally well tolerated; however, patients in the memantine group had more frequent cognitive adverse events (six patients) than those in the placebo group (one). INTERPRETATION Memantine treatment showed no benefit in patients with FTD. These data do not support memantine use in FTD. FUNDING Forest Research Institute.
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Affiliation(s)
- Adam L Boxer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA.
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Lerner A, Adler A, Abu-Hanna J, Meitus I, Navon-Venezia S, Carmeli Y. Environmental contamination by carbapenem-resistant Enterobacteriaceae. J Clin Microbiol 2013; 51:177-81. [PMID: 23115260 PMCID: PMC3536203 DOI: 10.1128/jcm.01992-12] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 10/22/2012] [Indexed: 11/20/2022] Open
Abstract
In the last decade, the global emergence of carbapenem resistance in Enterobacteriaceae has posed great concern to public health. Data concerning the role of environmental contamination in the dissemination of carbapenem-resistant Enterobacteriaceae (CRE) are currently lacking. Here, we aimed to examine the extent of CRE contamination in various sites in the immediate surroundings of CRE carriers and to assess the effects of sampling time and cleaning regimens on the recovery rate. We evaluated the performance of two sampling methods, CHROMAgar KPC contact plate and eSwab, for the detection of environmental CRE. eSwab was followed either by direct plating or by broth enrichment. First, 14 sites in the close vicinity of the carrier were evaluated for environmental contamination, and 5, which were found to be contaminated, were further studied. The environmental contamination decreased with distance from the patient; the bed area was the most contaminated site. Additionally, we found that the sampling time and the cleaning regimen were critical factors affecting the prevalence of environmental CRE contamination. We found that the CHROMAgar KPC contact plate method was a more effective technique for detecting environmental CRE than were eSwab-based methods. In summary, our study demonstrated that the vicinity of patients colonized with CRE is often contaminated by these organisms. Using selective contact plates to detect environmental contamination may guide cleaning efficacy and assist with outbreak investigation in an effort to limit the spread of CRE.
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Affiliation(s)
- A Lerner
- Division of Epidemiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Yang Y, Tatsuoka C, Einstadter D, Lerner A. O4‐10‐04: Identifying high risk subjects for Alzheimer's disease among subjects with mild cognitive impairment using partially ordered models of neuropsychological functioning. Alzheimers Dement 2012. [DOI: 10.1016/j.jalz.2012.05.1692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Yan Yang
- Case Western Reserve UniversityClevelandOhioUnited States
| | | | - Douglas Einstadter
- Case Western Reserve UniversityMetroHealth HospitalClevelandOhioUnited States
| | - Alan Lerner
- Case Western Reserve UniversityClevelandOhioUnited States
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Boxer A, Knopman D, Kaufer D, Grossman M, Onyike C, Graff‐Radford N, Mendez M, Kerwin D, Lerner A, Wu C, Koestler M, Schapira J, Ullah J, Nicholson R, Miller B. P2‐403: A randomized, multicenter, placebo controlled trial of memantine for behavioral variant FTD and semantic variant PPA. Alzheimers Dement 2012. [DOI: 10.1016/j.jalz.2012.05.1113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Adam Boxer
- University of California, San FranciscoSan FranciscoCaliforniaUnited States
| | | | - Daniel Kaufer
- University of North CarolinaChapel HillNorth CarolinaUnited States
| | - Murray Grossman
- University of PennsylvaniaPhiladelphiaPennsylvaniaUnited States
| | | | | | | | | | - Alan Lerner
- Case Western UniversityClevelandOhioUnited States
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Abstract
Alum (AlK(SO(4))(2)) is an adjuvant commonly utilized in vaccines, and is a ubiquitous element used extensively in contemporary life. Food, air, water, waste, the earth's surface, and pharmaceuticals all represent pathways of aluminum (Al) exposure. Crohn's disease (CD) is a chronic relapsing intestinal inflammation in genetically susceptible individuals and is caused by yet unidentified environmental factors. Al is a potential factor for the induction of inflammation in CD, and its immune activities share many characteristics with the immune pathology of CD: many luminal bacterial or dietary compounds can be adsorbed to the metal surface and induce Th1 profile cytokines, shared cytokines/chemokines, co-stimulatory molecules, and intracellular pathways and stress-related molecular expression enhancement, affecting intestinal macrobiota, trans-mural granuloma formation, and colitis induction in an animal CD model. The inflammasome plays a central role in Al mode of action and in CD pathophysiology. It is suggested that Al adjuvant activity can fit between the aberrations of innate and adaptive immune responses occurring in CD. The CD mucosa is confronted with numerous inappropriate bacterial components adsorbed on the Al compound surface, constituting a pro-inflammatory supra-adjuvant. Al fits the diagnostic criteria of the newly described autoimmune/inflammatory syndrome induced by adjuvants. If a cause and effect relationship can be established, the consequences will greatly impact public health and CD prevention and management.
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Affiliation(s)
- A Lerner
- Pediatric Gastroenterology and Nutrition Unit, Carmel Medical Center, Haifa, Israel.
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Rao-Frisch A, Shams T, Smyth S, Lerner A. Cerebrovascular Diseases Complicating Ventriculoperitoneal Shunt Response in Secondary Normal Pressure Hydrocephalus (P07.191). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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