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Kharbanda RK, Perkins AD, Kennedy J, Banning AP, Baumbach A, Blackman DJ, Dodd M, Evans R, Hildick-Smith D, Jamal Z, Ludman P, Palmer S, Stables R, Clayton T. Routine cerebral embolic protection in transcatheter aortic valve implantation: rationale and design of the randomised British Heart Foundation PROTECT-TAVI trial. EUROINTERVENTION 2023; 18:1428-1435. [PMID: 36706009 PMCID: PMC10111121 DOI: 10.4244/eij-d-22-00713] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/14/2022] [Indexed: 01/28/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is an established treatment for aortic stenosis. Cerebral embolic protection (CEP) devices may impact periprocedural stroke by capturing debris destined for the brain. However, there is a lack of high-quality randomised trial evidence supporting the use of CEP during TAVI. The British Heart Foundation (BHF) PROTECT-TAVI trial will address whether the routine use of CEP reduces the incidence of stroke in patients undergoing TAVI. BHF PROTECT-TAVI is a prospective, open-label, outcome-adjudicated, multicentre randomised controlled trial. The trial is open to all adult patients scheduled for TAVI at participating specialist cardiac centres across the United Kingdom who are able to receive the CEP device. The trial will recruit 7,730 participants. Participants will be randomised in a 1:1 ratio to undergo TAVI with CEP or TAVI without CEP (standard of care). The primary outcome is the incidence of stroke at 72 hours post-TAVI. Key secondary outcomes include the incidence of stroke and all-cause mortality up to 12 months post-TAVI, disability and cognitive outcomes, stroke severity, access site complications and a health economics analysis. The sample size of 7,730 participants has 80% power to detect a 33% relative risk reduction from a 3% incidence of the primary outcome in the controls. Trial recruitment commenced in October 2020. As of October 2022, 3,068 patients have been enrolled. BHF PROTECT-TAVI is designed to provide definitive evidence on the clinical efficacy and cost-effectiveness of using routine CEP with the SENTINEL device to reduce stroke in TAVI.
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Affiliation(s)
- Rajesh K Kharbanda
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Alexander David Perkins
- Clinical Trials Unit and Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - James Kennedy
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Adrian P Banning
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK and Barts Heart Centre, London, UK
| | - Daniel J Blackman
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Matthew Dodd
- Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Richard Evans
- Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - David Hildick-Smith
- Cardiac Surgery, Cardiac Center, Royal Sussex County Hospital, Brighton, UK and Sussex University Hospitals Trust, Brighton, UK
| | - Zahra Jamal
- Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
| | - Rodney Stables
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Tim Clayton
- Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
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Uzbas F, May ID, Parisi AM, Thompson SK, Kaya A, Perkins AD, Memili E. Molecular physiognomies and applications of adipose-derived stem cells. Stem Cell Rev Rep 2016; 11:298-308. [PMID: 25504377 DOI: 10.1007/s12015-014-9578-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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]
Abstract
Adipose-derived stromal/stem cells (ASC) are multipotent with abilities to differentiate into multiple lineages including connective tissue and neural cells. Despite unlimited opportunity and needs for human and veterinary regenerative medicine, applications of adipose-derived stromal/stem cells are at present very limited. Furthermore, the fundamental biological factors regulating stemness in ASC and their stable differentiation into other tissue cells are not fully understood. The objective of this review was to provide an update on the current knowledge of the nature and isolation, molecular and epigenetic determinants of the potency, and applications of adipose-derived stromal/stem cells, as well as challenges and future directions. The first quarter of the review focuses on the nature of ASC, namely their definition, origin, isolation and sorting methods and multilineage differentiation potential, often with a comparison to mesenchymal stem cells of bone marrow. Due to the indisputable role of epigenetic regulation on cell identities, epigenetic modifications (DNA methylation, chromatin remodeling and microRNAs) are described broadly in stem cells but with a focus on ASC. The final sections provide insights into the current and potential applications of ASC in human and veterinary regenerative medicine.
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Affiliation(s)
- F Uzbas
- Helmholtz Zentrum München, Institute of Stem Cell Research, Neuherberg, München, 85764, Germany
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Calabrese LH, Wilke WS, Perkins AD, Tubbs RR. Rheumatoid arthritis complicated by infection with the human immunodeficiency virus and the development of Sjögren's syndrome. Arthritis Rheum 1989; 32:1453-7. [PMID: 2573359 DOI: 10.1002/anr.1780321115] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A patient with seropositive rheumatoid arthritis became infected with the human immunodeficiency virus (HIV) through heterosexual transmission. After the primary phase of the HIV infection, persistent lymphadenopathy, leukopenia, and thrombocytopenia developed. Over the ensuing 3 years, the signs and symptoms of inflammatory polyarthritis completely disappeared, and severe Sjögren's syndrome developed. HIV and its associated immune dysfunction may be responsible for these events.
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Affiliation(s)
- L H Calabrese
- Department of Rheumatic and Immunologic Disease, Cleveland Clinic Foundation, OH 44195-5028
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