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Youshani AS, Whittle C, Ghosh K. A risk assessment strategy to re-introduce elective neurosurgery patients during COVID-19. Br J Neurosurg 2024; 38:476-480. [PMID: 33829937 DOI: 10.1080/02688697.2021.1900540] [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: 01/04/2021] [Revised: 02/19/2021] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To demonstrate the utilisation of a risk assessment protocol designed to prioritise elective neurosurgical patients against the risks of COVID-19. This tool can be applied to all other surgical specialties. DESIGN Prospective case series of 166 patients. SETTING Single-centre tertiary neurosurgical department. PARTICIPANTS All patients awaiting an elective neurosurgical procedure were included in this study. All emergency or life-threatening neurosurgical pathologies affecting patients were excluded. MAIN OUTCOME MEASURES The risk assessment tool identified patients with progressive neurology and stratified need for surgery against risk of harm during the COVID-19 pandemic. RESULTS Using our risk stratification tool, 6.6% patients required expedited surgery and a further 11.4% patients were removed completely from the waiting list. The majority of patients 47%, required surgery within 3 months. CONCLUSIONS This simple tool encourages surgical departments to establish contact with patients during COVID-19. The clinician acquires up-to-date information regarding patient symptomatology and subsequently determines surgical priority, a timescale required for surgery and overall uses of NHS resources efficiently. We recommend the use of this tool for all neurosurgical departments, with a wider application to other surgical specialties during the ongoing pressures of elective backlogs secondary to the persistent COVID-19 pandemic.
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Affiliation(s)
- Amir Saam Youshani
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Greater Manchester Neurosciences Centre, Manchester, UK
- Division of Neuroscience & Experimental Psychology, Faculty of Biology, Medicine and Health, School of Biological Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Chelsea Whittle
- Department of Neurosurgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Kaushik Ghosh
- Department of Neurosurgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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O'Leary C, Forte G, Mitchell NL, Youshani AS, Dyer A, Wellby MP, Russell KN, Murray SJ, Jolinon N, Jones SA, Stacey K, Davis DM, Henckaerts E, Palmer DN, Kamaly-Asl I, Bigger BW. Intraparenchymal convection enhanced delivery of AAV in sheep to treat Mucopolysaccharidosis IIIC. J Transl Med 2023; 21:437. [PMID: 37407981 PMCID: PMC10320977 DOI: 10.1186/s12967-023-04208-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/15/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Mucopolysaccharidosis IIIC (MPSIIIC) is one of four Sanfilippo diseases sharing clinical symptoms of severe cognitive decline and shortened lifespan. The missing enzyme, heparan sulfate acetyl-CoA: α-glucosaminide-N-acetyltransferase (HGSNAT), is bound to the lysosomal membrane, therefore cannot cross the blood-brain barrier or diffuse between cells. We previously demonstrated disease correction in MPSIIIC mice using an Adeno-Associated Vector (AAV) delivering HGSNAT via intraparenchymal brain injections using an AAV2 derived AAV-truetype (AAV-TT) serotype with improved distribution over AAV9. METHODS Here, intraparenchymal AAV was delivered in sheep using catheters or Hamilton syringes, placed using Brainlab cranial navigation for convection enhanced delivery, to reduce proximal vector expression and improve spread. RESULTS Hamilton syringes gave improved AAV-GFP distribution, despite lower vector doses and titres. AAV-TT-GFP displayed moderately better transduction compared to AAV9-GFP but both serotypes almost exclusively transduced neurons. Functional HGSNAT enzyme was detected in 24-37% of a 140g gyrencephalic sheep brain using AAV9-HGSNAT with three injections in one hemisphere. CONCLUSIONS Despite variabilities in volume and titre, catheter design may be critical for efficient brain delivery. These data help inform a clinical trial for MPSIIIC.
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Affiliation(s)
- Claire O'Leary
- Stem Cell & Neurotherapies, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
- The Geoffrey Jefferson Brain Research Centre, University of Manchester, Manchester Academic Health Science Centre, Northern Care Alliance, Manchester, UK
| | - Gabriella Forte
- Stem Cell & Neurotherapies, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Nadia L Mitchell
- Department of Molecular Biosciences, Faculty of Agriculture and Life Sciences, Lincoln University, Lincoln, 7647, New Zealand
- Department of Radiology, University of Otago, Christchurch, 8140, New Zealand
| | - Amir Saam Youshani
- Stem Cell & Neurotherapies, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
- The Geoffrey Jefferson Brain Research Centre, University of Manchester, Manchester Academic Health Science Centre, Northern Care Alliance, Manchester, UK
| | - Adam Dyer
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Martin P Wellby
- Department of Molecular Biosciences, Faculty of Agriculture and Life Sciences, Lincoln University, Lincoln, 7647, New Zealand
| | - Katharina N Russell
- Department of Molecular Biosciences, Faculty of Agriculture and Life Sciences, Lincoln University, Lincoln, 7647, New Zealand
| | - Samantha J Murray
- Department of Molecular Biosciences, Faculty of Agriculture and Life Sciences, Lincoln University, Lincoln, 7647, New Zealand
| | - Nelly Jolinon
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Simon A Jones
- Manchester Centre for Genomic Medicine, Willink Unit, Manchester University NHS Foundation Trust, Manchester, UK
| | - Kevin Stacey
- Lydia Becker Institute of Immunology and Inflammation, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, Manchester Collaborative Centre for Inflammation Research, University of Manchester, Manchester, UK
| | - Daniel M Davis
- Department of Life Sciences, Imperial College London, Sir Alexander Fleming Building, South Kensington, London, UK
| | - Els Henckaerts
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
- Laboratory of Viral Cell Biology & Therapeutics, Department of Cellular and Molecular Medicine and Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - David N Palmer
- Department of Molecular Biosciences, Faculty of Agriculture and Life Sciences, Lincoln University, Lincoln, 7647, New Zealand
- Department of Radiology, University of Otago, Christchurch, 8140, New Zealand
| | - Ian Kamaly-Asl
- The Geoffrey Jefferson Brain Research Centre, University of Manchester, Manchester Academic Health Science Centre, Northern Care Alliance, Manchester, UK
- Department of Paediatric Neurosurgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Brian W Bigger
- Stem Cell & Neurotherapies, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK.
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Drosos E, Maye H, Youshani AS, Ehsan S, Burnand C, D’Urso PI. Awake brain surgery for autistic patients: Is it possible? Surg Neurol Int 2022; 13:543. [DOI: 10.25259/sni_719_2022] [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] [Received: 08/10/2022] [Accepted: 11/03/2022] [Indexed: 11/21/2022] Open
Abstract
Background:
Awake neurosurgery is currently the mainstay for eloquent brain lesions. Opting for an awake operation is affected by a number of patient-related factors. We present a case of a patient with autistic spectrum disorder (ASD) that was successfully operated for a brain tumor through awake craniotomy. To the best of our knowledge, this is the first reported case in the literature.
Case Description:
A 42-year-old patient, with known ASD since his childhood, underwent awake craniotomy for a left supplementary motor area tumor. Detailed preoperative preparation of the patient was done to identify special requirements and establish a good patient-team relationship. Intraoperatively, continuous language and motor testing were performed. Conversation and music were the main distractors used. Throughout the operation, the patient remained calm and cooperative, even during a focal seizure. Mapping allowed for >80% resection of the tumor. Postoperatively, the patient recovered without any deficits.
Conclusion:
This case shows that with growing experience and meticulous preparation, the limits of awake craniotomy can be expanded to include more patients that were previously considered unfit.
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Affiliation(s)
- Evangelos Drosos
- Department of Neurosurgery, Manchester Center for Clinical Neurosciences, Salford, United Kingdom
| | - Helen Maye
- Department of Neurosurgery, Manchester Center for Clinical Neurosciences, Salford, United Kingdom
| | - Amir Saam Youshani
- Department of Neurosurgery, Manchester Center for Clinical Neurosciences, Salford, United Kingdom
| | - Sheeba Ehsan
- Department of Neuropsyhology, Manchester Center for Clinical Neurosciences, Salford, United Kingdom
| | - Cally Burnand
- Department of Anesthesiology, Manchester Center for Clinical Neurosciences, Salford, United Kingdom
| | - Pietro Ivo D’Urso
- Department of Neurosurgery, Manchester Center for Clinical Neurosciences, Salford, United Kingdom
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Tordo J, O'Leary C, Antunes ASLM, Palomar N, Aldrin-Kirk P, Basche M, Bennett A, D'Souza Z, Gleitz H, Godwin A, Holley RJ, Parker H, Liao AY, Rouse P, Youshani AS, Dridi L, Martins C, Levade T, Stacey KB, Davis DM, Dyer A, Clément N, Björklund T, Ali RR, Agbandje-McKenna M, Rahim AA, Pshezhetsky A, Waddington SN, Linden RM, Bigger BW, Henckaerts E. A novel adeno-associated virus capsid with enhanced neurotropism corrects a lysosomal transmembrane enzyme deficiency. Brain 2019; 141:2014-2031. [PMID: 29788236 PMCID: PMC6037107 DOI: 10.1093/brain/awy126] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/21/2018] [Indexed: 12/20/2022] Open
Abstract
Recombinant adeno-associated viruses (AAVs) are popular in vivo gene transfer vehicles. However, vector doses needed to achieve therapeutic effect are high and some target tissues in the central nervous system remain difficult to transduce. Gene therapy trials using AAV for the treatment of neurological disorders have seldom led to demonstrated clinical efficacy. Important contributing factors are low transduction rates and inefficient distribution of the vector. To overcome these hurdles, a variety of capsid engineering methods have been utilized to generate capsids with improved transduction properties. Here we describe an alternative approach to capsid engineering, which draws on the natural evolution of the virus and aims to yield capsids that are better suited to infect human tissues. We generated an AAV capsid to include amino acids that are conserved among natural AAV2 isolates and tested its biodistribution properties in mice and rats. Intriguingly, this novel variant, AAV-TT, demonstrates strong neurotropism in rodents and displays significantly improved distribution throughout the central nervous system as compared to AAV2. Additionally, sub-retinal injections in mice revealed markedly enhanced transduction of photoreceptor cells when compared to AAV2. Importantly, AAV-TT exceeds the distribution abilities of benchmark neurotropic serotypes AAV9 and AAVrh10 in the central nervous system of mice, and is the only virus, when administered at low dose, that is able to correct the neurological phenotype in a mouse model of mucopolysaccharidosis IIIC, a transmembrane enzyme lysosomal storage disease, which requires delivery to every cell for biochemical correction. These data represent unprecedented correction of a lysosomal transmembrane enzyme deficiency in mice and suggest that AAV-TT-based gene therapies may be suitable for treatment of human neurological diseases such as mucopolysaccharidosis IIIC, which is characterized by global neuropathology.
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Affiliation(s)
- Julie Tordo
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Claire O'Leary
- Stem Cell and Neurotherapies, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - André S L M Antunes
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Nuria Palomar
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Patrick Aldrin-Kirk
- Molecular Neuromodulation, Wallenberg Neuroscience Center, Lund University, Lund, Sweden
| | - Mark Basche
- Department of Genetics, UCL Institute of Ophthalmology, London, UK
| | - Antonette Bennett
- Department of Biochemistry and Molecular Biology, Center for Structural Biology, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Zelpha D'Souza
- Stem Cell and Neurotherapies, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Hélène Gleitz
- Stem Cell and Neurotherapies, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Annie Godwin
- Stem Cell and Neurotherapies, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Rebecca J Holley
- Stem Cell and Neurotherapies, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Helen Parker
- Stem Cell and Neurotherapies, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Ai Yin Liao
- Stem Cell and Neurotherapies, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Paul Rouse
- Stem Cell and Neurotherapies, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Amir Saam Youshani
- Stem Cell and Neurotherapies, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Larbi Dridi
- CHU Ste-Justine, University of Montreal, Montreal, Canada
| | - Carla Martins
- CHU Ste-Justine, University of Montreal, Montreal, Canada
| | - Thierry Levade
- Centre Hospitalo-Universitaire de Toulouse, Institut Fédératif de Biologie, Laboratoire de Biochimie Métabolique, and Unité Mixte de Recherche (UMR) 1037 Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche en Cancérologie de Toulouse, Toulouse, France
| | - Kevin B Stacey
- Manchester Collaborative Centre for Inflammation Research, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Daniel M Davis
- Manchester Collaborative Centre for Inflammation Research, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Adam Dyer
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Nathalie Clément
- Department of Pediatrics, Powell Gene Therapy Center, University of Florida, Gainesville, FL, USA
| | - Tomas Björklund
- Molecular Neuromodulation, Wallenberg Neuroscience Center, Lund University, Lund, Sweden
| | - Robin R Ali
- Department of Genetics, UCL Institute of Ophthalmology, London, UK
| | - Mavis Agbandje-McKenna
- Department of Biochemistry and Molecular Biology, Center for Structural Biology, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ahad A Rahim
- Department of Pharmacology, UCL School of Pharmacy, University College London, London, UK
| | | | - Simon N Waddington
- Gene Transfer Technology Group, Institute for Women's Health, University College London, London, UK.,Wits/SAMRC Antiviral Gene Therapy Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - R Michael Linden
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Brian W Bigger
- Stem Cell and Neurotherapies, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Els Henckaerts
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
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5
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Yu K, Youshani AS, Wilkinson FL, O'Leary C, Cook P, Laaniste L, Liao A, Mosses D, Waugh C, Shorrock H, Pathmanaban O, Macdonald A, Kamaly-Asl I, Roncaroli F, Bigger BW. A nonmyeloablative chimeric mouse model accurately defines microglia and macrophage contribution in glioma. Neuropathol Appl Neurobiol 2018; 45:119-140. [PMID: 29679380 PMCID: PMC7379954 DOI: 10.1111/nan.12489] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 04/02/2018] [Indexed: 12/28/2022]
Abstract
Aims Resident and peripherally derived glioma associated microglia/macrophages (GAMM) play a key role in driving tumour progression, angiogenesis, invasion and attenuating host immune responses. Differentiating these cells’ origins is challenging and current preclinical models such as irradiation‐based adoptive transfer, parabiosis and transgenic mice have limitations. We aimed to develop a novel nonmyeloablative transplantation (NMT) mouse model that permits high levels of peripheral chimerism without blood‐brain barrier (BBB) damage or brain infiltration prior to tumour implantation. Methods NMT dosing was determined in C57BL/6J or Pep3/CD45.1 mice conditioned with concentrations of busulfan ranging from 25 mg/kg to 125 mg/kg. Donor haematopoietic cells labelled with eGFP or CD45.2 were injected via tail vein. Donor chimerism was measured in peripheral blood, bone marrow and spleen using flow cytometry. BBB integrity was assessed with anti‐IgG and anti‐fibrinogen antibodies. Immunocompetent chimerised animals were orthotopically implanted with murine glioma GL‐261 cells. Central and peripheral cell contributions were assessed using immunohistochemistry and flow cytometry. GAMM subpopulation analysis of peripheral cells was performed using Ly6C/MHCII/MerTK/CD64. Results NMT achieves >80% haematopoietic chimerism by 12 weeks without BBB damage and normal life span. Bone marrow derived cells (BMDC) and peripheral macrophages accounted for approximately 45% of the GAMM population in GL‐261 implanted tumours. Existing markers such as CD45 high/low proved inaccurate to determine central and peripheral populations while Ly6C/MHCII/MerTK/CD64 reliably differentiated GAMM subpopulations in chimerised and unchimerised mice. Conclusion NMT is a powerful method for dissecting tumour microglia and macrophage subpopulations and can guide further investigation of BMDC subsets in glioma and neuro‐inflammatory diseases.
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Affiliation(s)
- K Yu
- Stem Cell and Neurotherapies Laboratory, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Department of Neurosurgery, Salford Royal Hospital, Salford, UK
| | - A S Youshani
- Stem Cell and Neurotherapies Laboratory, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Department of Neurosurgery, Salford Royal Hospital, Salford, UK
| | - F L Wilkinson
- Stem Cell and Neurotherapies Laboratory, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Centre for Bioscience, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - C O'Leary
- Stem Cell and Neurotherapies Laboratory, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - P Cook
- Manchester Collaborative Centre for Inflammation Research, University of Manchester, Manchester, UK
| | - L Laaniste
- Division of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - A Liao
- Stem Cell and Neurotherapies Laboratory, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - D Mosses
- Department of Neurosurgery, Royal Manchester Children's Hospital, Manchester, UK
| | - C Waugh
- Stem Cell and Neurotherapies Laboratory, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - H Shorrock
- Stem Cell and Neurotherapies Laboratory, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - O Pathmanaban
- Stem Cell and Neurotherapies Laboratory, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Department of Neurosurgery, Salford Royal Hospital, Salford, UK
| | - A Macdonald
- Manchester Collaborative Centre for Inflammation Research, University of Manchester, Manchester, UK
| | - I Kamaly-Asl
- Department of Neurosurgery, Royal Manchester Children's Hospital, Manchester, UK
| | - F Roncaroli
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - B W Bigger
- Stem Cell and Neurotherapies Laboratory, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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6
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Yu KKH, Taylor JT, Pathmanaban ON, Youshani AS, Beyit D, Dutko-Gwozdz J, Benson R, Griffiths G, Peers I, Cueppens P, Telfer BA, Williams KJ, McBain C, Kamaly-Asl ID, Bigger BW. High content screening of patient-derived cell lines highlights the potential of non-standard chemotherapeutic agents for the treatment of glioblastoma. PLoS One 2018; 13:e0193694. [PMID: 29499065 PMCID: PMC5834163 DOI: 10.1371/journal.pone.0193694] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/19/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Glioblastoma (GBM) is the most common primary brain malignancy in adults, yet survival outcomes remain poor. First line treatment is well established, however disease invariably recurs and improving prognosis is challenging. With the aim of personalizing therapy at recurrence, we have established a high content screening (HCS) platform to analyze the sensitivity profile of seven patient-derived cancer stem cell lines to 83 FDA-approved chemotherapy drugs, with and without irradiation. METHODS Seven cancer stem cell lines were derived from patients with GBM and, along with the established cell line U87-MG, each patient-derived line was cultured in tandem in serum-free conditions as adherent monolayers and three-dimensional neurospheres. Chemotherapeutics were screened at multiple concentrations and cells double-stained to observe their effect on both cell death and proliferation. Sensitivity was classified using high-throughput algorithmic image analysis. RESULTS Cell line specific drug responses were observed across the seven patient-derived cell lines. Few agents were seen to have radio-sensitizing effects, yet some drug classes showed a marked difference in efficacy between monolayers and neurospheres. In vivo validation of six drugs suggested that cell death readout in a three-dimensional culture scenario is a more physiologically relevant screening model and could be used effectively to assess the chemosensitivity of patient-derived GBM lines. CONCLUSION The study puts forward a number of non-standard chemotherapeutics that could be useful in the treatment of recurrent GBM, namely mitoxantrone, bortezomib and actinomycin D, whilst demonstrating the potential of HCS to be used for personalized treatment based on the chemosensitivity profile of patient tumor cells.
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Affiliation(s)
- Kenny Kwok-Hei Yu
- Brain Tumour Research Group, Stem Cell and Neurotherapies Laboratory, Division of Cell Matrix Biology & Regenerative Medicine, University of Manchester, Manchester, United Kingdom
| | - Jessica T. Taylor
- Brain Tumour Research Group, Stem Cell and Neurotherapies Laboratory, Division of Cell Matrix Biology & Regenerative Medicine, University of Manchester, Manchester, United Kingdom
| | - Omar N. Pathmanaban
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Manchester Academic Health Sciences Centre, Salford, United Kingdom
| | - Amir Saam Youshani
- Brain Tumour Research Group, Stem Cell and Neurotherapies Laboratory, Division of Cell Matrix Biology & Regenerative Medicine, University of Manchester, Manchester, United Kingdom
| | - Deniz Beyit
- Imagen Therapeutics, Manchester, United Kingdom
| | | | | | | | - Ian Peers
- Inferstats Consulting, Alderley Park, Biohub, Cheshire, United Kingdom
| | - Peter Cueppens
- Inferstats Consulting, Alderley Park, Biohub, Cheshire, United Kingdom
| | - Brian A. Telfer
- Division of Pharmacy & Optometry, School of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Kaye J. Williams
- Division of Pharmacy & Optometry, School of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Catherine McBain
- Department of Clinical Oncology, The Christie NHS FT, Manchester, United Kingdom
| | - Ian D. Kamaly-Asl
- Children’s Brain Tumour Research Network (CBTRN), Royal Manchester Children’s Hospital, Manchester, United Kingdom
- Department of Neurosurgery, Royal Manchester Children’s Hospital, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Brian W. Bigger
- Brain Tumour Research Group, Stem Cell and Neurotherapies Laboratory, Division of Cell Matrix Biology & Regenerative Medicine, University of Manchester, Manchester, United Kingdom
- * E-mail:
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7
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Youshani AS, Yu K, Wilkinson F, O’leary C, Cook P, Liao A, Pathmanaban O, Waugh C, Shorrock H, Macdonald A, Roncaroli F, Kamaly-asl I, Bigger B. Identifying tumour associated macrophages and microglia in an experimental glioblastoma model. Neuro Oncol 2018. [DOI: 10.1093/neuonc/nox238.105] [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: 11/14/2022] Open
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8
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Youshani AS, Yu K, Wilkinson F, O’Leary C, Cook P, Liao A, Pathmanaban O, Waugh C, Shorrock H, MacDonald A, Roncaroli F, Kamaly-Asl I, Bigger B. IMMU-50. A NOVEL CHIMERIC MODEL TO ACCURATELY IDENTIFY TAMMs IN GLIOBLASTOMA. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.508] [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: 11/14/2022] Open
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Mirza O, Varadarajan V, Youshani AS, Willatt DJ. Escherichia coli positive infratentorial subdural empyema secondary to mastoiditis and underlying cholesteatoma. BMJ Case Rep 2014; 2014:bcr-2014-204498. [PMID: 24777089 DOI: 10.1136/bcr-2014-204498] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Infratentorial subdural empyema is a neurosurgical emergency that is associated with an alarmingly high morbidity and mortality if appropriate management is delayed. It is an important differential to consider when confronted with a patient with a reduced Glasgow Coma Scale, focal neurology and symptoms of raised intracranial pressure in the presence of a head and neck infection. It is also important that the primary team managing these patients is aware of the many pathogens that may be involved, including Escherichia coli. Early recognition, prompt diagnosis, timely involvement of the appropriate multidisciplinary teams, including neurosurgery, otorhinolaryngology, radiology and microbiology should be sought, and urgent intervention are imperative in avoiding a fatal outcome. This article presents a case of E coli-positive infratentorial subdural empyema secondary to mastoiditis due to underlying cholesteatoma, and a review of the pertinent literature.
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Affiliation(s)
- Omar Mirza
- Department of ENT, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
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Youshani AS, Mehta B, Davies K, Beer H, De S. Management of Bell's palsy in children: an audit of current practice, review of the literature and a proposed management algorithm. Emerg Med J 2013; 32:274-80. [PMID: 24317290 DOI: 10.1136/emermed-2013-202385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We carried out a complete audit cycle, reviewing our management of paediatric patients with Bell's palsy within 72 h of symptom onset. Our protocol was published after the initial audit in 2009, and a re-audit was carried out in 2011. We aimed to improve our current practice in accordance with up-to-date evidence-based research on the use of steroids and antivirals. PATIENTS AND METHODS A total of 17 patients were included in the first cycle, but only eight patients met our inclusion and exclusion criteria for the re-audit. We assessed documentation of House-Brackmann (HB) grade on presentation, initial treatment, follow-up and recovery. RESULTS The first cycle revealed inconsistent management with steroids (41%), antivirals (6%), steroids and antivirals (6%) or nothing at all (47%). In addition, only 65% of patients were followed-up in the ear, nose and throat (ENT) clinic. Our management protocol was published in 2010, and a re-audit was completed. Our results showed 100% compliance with steroid treatment and 100% follow-up with the ENT team. A thorough literature review revealed some additional benefit from the use of antivirals. CONCLUSIONS At present there is insufficient evidence to discount the use of steroids and antivirals. Therefore, with our new management protocol, we recommend the use of steroids in patients presenting within 72 h of symptom onset, and antivirals for patients with a HB grade of IV or higher.
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Affiliation(s)
- Amir Saam Youshani
- Department of Otolaryngology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Bimal Mehta
- Department of Accident & Emergency, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Katharine Davies
- Department of Otolaryngology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Helen Beer
- Department of Otolaryngology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Sujata De
- Department of Otolaryngology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Youshani AS, Thomas L, Sharma RK. Day case tonsillectomy for the treatment of obstructive sleep apnoea syndrome in children: Alder Hey experience. Int J Pediatr Otorhinolaryngol 2011; 75:207-10. [PMID: 21131063 DOI: 10.1016/j.ijporl.2010.10.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 10/28/2010] [Accepted: 10/30/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND The aim of this study was to assess the safety of paediatric adeno-tonsillectomy for obstructive sleep apnoea syndrome (OSAS) performed as a day case procedure. METHODOLOGY Postoperative airway related complications were prospectively evaluated in children undergoing adeno-tonsillectomy for OSAS over a 12-month period in a tertiary care centre. All data was analysed and descriptive statistics performed. RESULTS The overall incidence of postoperative airway related complications were 21 (10.4%) in 202 consecutively operated children. Eleven were in children with other medical co-morbidities (n=37) of which 8 occurred after 6h. Amongst those without any medical illnesses (n=165), two (1.2%) developed OSAS related complication after 6h of surgery only one of which needed medical/nursing intervention. The incidence of postoperative desaturations after 6h was 21.6% in those with co-morbidities. CONCLUSION It is safe to perform day case adeno-tonsillectomy for OSAS in children without any medical co-morbidities while those with other medical illnesses should be planned as in-patient procedures.
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Affiliation(s)
- Amir Saam Youshani
- Alder Hey Children's NHS Foundation Trust, Alder Road, Liverpool L12 2AP, United Kingdom.
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