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Eneanya ND, Lakin JR, Paasche-Orlow MK, Lindvall C, Moseley ET, Henault L, Hanchate AD, Mandel EI, Wong SPY, Zupanc SN, Davis AD, El-Jawahri A, Quintiliani LM, Chang Y, Waikar SS, Bansal AD, Schell JO, Lundquist AL, Tamura MK, Yu MK, Unruh ML, Argyropoulos C, Germain MJ, Volandes A. Video Images about Decisions for Ethical Outcomes in Kidney Disease (VIDEO-KD): the study protocol for a multi-centre randomised controlled trial. BMJ Open 2022; 12:e059313. [PMID: 35396311 PMCID: PMC8996022 DOI: 10.1136/bmjopen-2021-059313] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Older patients with advanced chronic kidney disease (CKD) often are inadequately prepared to make informed decisions about treatments including dialysis and cardiopulmonary resuscitation. Further, evidence shows that patients with advanced CKD do not commonly engage in advance care planning (ACP), may suffer from poor quality of life, and may be exposed to end-of-life care that is not concordant with their goals. We aim to study the effectiveness of a video intervention on ACP, treatment preferences and other patient-reported outcomes. METHODS AND ANALYSIS The Video Images about Decisions for Ethical Outcomes in Kidney Disease trial is a multi-centre randomised controlled trial that will test the effectiveness of an intervention that includes a CKD-related video decision aid followed by recording personal video declarations about goals of care and treatment preferences in older adults with advancing CKD. We aim to enrol 600 patients over 5 years at 10 sites. ETHICS AND DISSEMINATION Regulatory and ethical aspects of this trial include a single Institutional Review Board mechanism for approval, data use agreements among sites, and a Data Safety and Monitoring Board. We intend to disseminate findings at national meetings and publish our results. TRIAL REGISTRATION NUMBER NCT04347629.
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Affiliation(s)
- Nwamaka D Eneanya
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua R Lakin
- Harvard Medical School, Boston, Massachusetts, USA
- Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Michael K Paasche-Orlow
- Boston University School of Medicine, Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Charlotta Lindvall
- Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Edward T Moseley
- Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lori Henault
- Boston University School of Medicine, Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Amresh D Hanchate
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ernest I Mandel
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Renal (Kidney) Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Susan P Y Wong
- University of Washington, Seattle, Washington State, USA
| | - Sophia N Zupanc
- Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lisa M Quintiliani
- Boston University School of Medicine, Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Yuchiao Chang
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sushrut S Waikar
- Section of Nephrology, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Amar D Bansal
- Section of Palliative Care and Medical Ethics, Department of General Medicine, Division of Renal-Electrolyte, University of Pittsburgh School of Medicine, UPMC Health System, Pittsburgh, Pennsylvania, USA
| | - Jane O Schell
- Section of Palliative Care and Medical Ethics, Department of General Medicine, Division of Renal-Electrolyte, University of Pittsburgh School of Medicine, UPMC Health System, Pittsburgh, Pennsylvania, USA
| | - Andrew L Lundquist
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Manjula Kurella Tamura
- Division of Nephrology, Stanford University School of Medicine; and Geriatric Research Education Clinical Center, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Margaret K Yu
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Mark L Unruh
- Department of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Christos Argyropoulos
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Michael J Germain
- Baystate Medical Center-University of Massachusetts Springfield, Springfield, Massachusetts, USA
| | - Angelo Volandes
- Harvard Medical School, Boston, Massachusetts, USA
- ACP Decisions Non-profit Foundation, Newton, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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2
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Affiliation(s)
- Lucas X Marinacci
- From the Departments of Medicine (L.X.M., A.L.L., D.J.K.), Radiology (F.J.S.), and Pathology (G.K.M.), Massachusetts General Hospital, and the Departments of Medicine (L.X.M., A.L.L., D.J.K.), Radiology (F.J.S.), and Pathology (G.K.M.), Harvard Medical School - both in Boston
| | - F Joseph Simeone
- From the Departments of Medicine (L.X.M., A.L.L., D.J.K.), Radiology (F.J.S.), and Pathology (G.K.M.), Massachusetts General Hospital, and the Departments of Medicine (L.X.M., A.L.L., D.J.K.), Radiology (F.J.S.), and Pathology (G.K.M.), Harvard Medical School - both in Boston
| | - Andrew L Lundquist
- From the Departments of Medicine (L.X.M., A.L.L., D.J.K.), Radiology (F.J.S.), and Pathology (G.K.M.), Massachusetts General Hospital, and the Departments of Medicine (L.X.M., A.L.L., D.J.K.), Radiology (F.J.S.), and Pathology (G.K.M.), Harvard Medical School - both in Boston
| | - David J Kuter
- From the Departments of Medicine (L.X.M., A.L.L., D.J.K.), Radiology (F.J.S.), and Pathology (G.K.M.), Massachusetts General Hospital, and the Departments of Medicine (L.X.M., A.L.L., D.J.K.), Radiology (F.J.S.), and Pathology (G.K.M.), Harvard Medical School - both in Boston
| | - Grace K Mahowald
- From the Departments of Medicine (L.X.M., A.L.L., D.J.K.), Radiology (F.J.S.), and Pathology (G.K.M.), Massachusetts General Hospital, and the Departments of Medicine (L.X.M., A.L.L., D.J.K.), Radiology (F.J.S.), and Pathology (G.K.M.), Harvard Medical School - both in Boston
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Lundquist AL, Pelletier RC, Leonard CE, Williams WW, Armstrong KA, Rehm HL, Rhee EP. From Theory to Reality: Establishing a Successful Kidney Genetics Clinic in the Outpatient Setting. Kidney360 2020; 1:1099-1106. [PMID: 35368791 DOI: 10.34067/kid.0004262020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/12/2020] [Indexed: 02/06/2023]
Abstract
Background Genetic testing in nephrology is increasingly described in the literature and several groups have suggested significant clinical benefit. However, studies to date have described experience from established genetic testing centers or from externally funded research programs. Methods We established a de novo kidney genetics clinic within an academic adult general nephrology practice. Key features of this effort included a pipeline for internal referrals, flexible scheduling, close coordination between the nephrologist and a genetic counselor, and utilization of commercial panel-based testing. Over the first year, we examined the outcomes of genetic testing, the time to return of genetic testing, and out-of-pocket cost to patients. Results Thirty patients were referred and 23 were evaluated over the course of five clinic sessions. Nineteen patients underwent genetic testing with new diagnoses in nine patients (47%), inconclusive results in three patients (16%), and clearance for kidney donation in two patients (11%). On average, return of genetic results occurred 55 days (range 9-174 days) from the day of sample submission and the average out-of-pocket cost to patients was $155 (range $0-$1623). Conclusions We established a kidney genetics clinic, without a pre-existing genetics infrastructure or dedicated research funding, that identified a new diagnosis in approximately 50% of patients tested. This study provides a clinical practice model for successfully incorporating genetic testing into ambulatory nephrology care with minimal capital investment and limited financial effect on patients.
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Affiliation(s)
- Andrew L Lundquist
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Renee C Pelletier
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Courtney E Leonard
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Winfred W Williams
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Katrina A Armstrong
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Heidi L Rehm
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts.,Department of Pathology, Harvard Medical School, Harvard, University, Boston, Massachusetts
| | - Eugene P Rhee
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Endres P, Rosovsky R, Zhao S, Krinsky S, Percy S, Kamal O, Roberts RJ, Lopez N, Sise ME, Steele DJR, Lundquist AL, Rhee EP, Hibbert KA, Hardin CC, Mc Causland FR, Czarnecki PG, Mutter W, Tolkoff-Rubin N, Allegretti AS. Filter clotting with continuous renal replacement therapy in COVID-19. J Thromb Thrombolysis 2020; 51:966-970. [PMID: 33026569 PMCID: PMC7539277 DOI: 10.1007/s11239-020-02301-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) appears to be associated with increased arterial and venous thromboembolic disease. These presumed abnormalities in hemostasis have been associated with filter clotting during continuous renal replacement therapy (CRRT). We aimed to characterize the burden of CRRT filter clotting in COVID-19 infection and to describe a CRRT anticoagulation protocol that used anti-factor Xa levels for systemic heparin dosing. Multi-center study of consecutive patients with COVID-19 receiving CRRT. Primary outcome was CRRT filter loss. Sixty-five patients were analyzed, including 17 using an anti-factor Xa protocol to guide systemic heparin dosing. Fifty-four out of 65 patients (83%) lost at least one filter. Median first filter survival time was 6.5 [2.5, 33.5] h. There was no difference in first or second filter loss between the anti-Xa protocol and standard of care anticoagulation groups, however fewer patients lost their third filter in the protocolized group (55% vs. 93%) resulting in a longer median third filter survival time (24 [15.1, 54.2] vs. 17.3 [9.5, 35.1] h, p = 0.04). The rate of CRRT filter loss is high in COVID-19 infection. An anticoagulation protocol using systemic unfractionated heparin, dosed by anti-factor Xa levels is reasonable approach to anticoagulation in this population.
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Affiliation(s)
- Paul Endres
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA
| | - Rachel Rosovsky
- Division of Hematology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Sophia Zhao
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA
| | - Scott Krinsky
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA
| | - Shananssa Percy
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA
| | - Omer Kamal
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Russel J Roberts
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Natasha Lopez
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Meghan E Sise
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA
| | - David J R Steele
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA
| | - Andrew L Lundquist
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA
| | - Eugene P Rhee
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA
| | - Kathryn A Hibbert
- Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - C Corey Hardin
- Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Finnian R Mc Causland
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter G Czarnecki
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Walter Mutter
- Division of Nephrology, Department of Medicine, Newton Wellesley Hospital, Newton, MA, USA
| | - Nina Tolkoff-Rubin
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA
| | - Andrew S Allegretti
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA.
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Affiliation(s)
- Elazer R Edelman
- From the Department of Medicine, Brigham and Women's Hospital (E.R.E.), the Departments of Medicine (N.M.B., A.L.L.), Radiology (L.L.A.), and Pathology (A.S.D.), Massachusetts General Hospital, and the Departments of Medicine (E.R.E., N.M.B., A.L.L.), Radiology (L.L.A.), and Pathology (A.S.D.), Harvard Medical School - all in Boston, and the Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge (E.R.E.)
| | - Neel M Butala
- From the Department of Medicine, Brigham and Women's Hospital (E.R.E.), the Departments of Medicine (N.M.B., A.L.L.), Radiology (L.L.A.), and Pathology (A.S.D.), Massachusetts General Hospital, and the Departments of Medicine (E.R.E., N.M.B., A.L.L.), Radiology (L.L.A.), and Pathology (A.S.D.), Harvard Medical School - all in Boston, and the Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge (E.R.E.)
| | - Laura L Avery
- From the Department of Medicine, Brigham and Women's Hospital (E.R.E.), the Departments of Medicine (N.M.B., A.L.L.), Radiology (L.L.A.), and Pathology (A.S.D.), Massachusetts General Hospital, and the Departments of Medicine (E.R.E., N.M.B., A.L.L.), Radiology (L.L.A.), and Pathology (A.S.D.), Harvard Medical School - all in Boston, and the Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge (E.R.E.)
| | - Andrew L Lundquist
- From the Department of Medicine, Brigham and Women's Hospital (E.R.E.), the Departments of Medicine (N.M.B., A.L.L.), Radiology (L.L.A.), and Pathology (A.S.D.), Massachusetts General Hospital, and the Departments of Medicine (E.R.E., N.M.B., A.L.L.), Radiology (L.L.A.), and Pathology (A.S.D.), Harvard Medical School - all in Boston, and the Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge (E.R.E.)
| | - Anand S Dighe
- From the Department of Medicine, Brigham and Women's Hospital (E.R.E.), the Departments of Medicine (N.M.B., A.L.L.), Radiology (L.L.A.), and Pathology (A.S.D.), Massachusetts General Hospital, and the Departments of Medicine (E.R.E., N.M.B., A.L.L.), Radiology (L.L.A.), and Pathology (A.S.D.), Harvard Medical School - all in Boston, and the Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge (E.R.E.)
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Abstract
IMPORTANCE Urine sediment microscopy is commonly performed during the evaluation of kidney disease. Interobserver reliability of nephrologists' urine sediment examination has not been well studied. OBJECTIVE Assess interobserver reliability of the urine sediment examination. DESIGN, SETTING, AND PARTICIPANTS In this diagnostic test study, urine samples were prospectively collected from a convenience sample of adult patients from an academic hospital in the United States undergoing kidney biopsy from July 11, 2018, to March 20, 2019. Digital images and videos of urine sediment findings were captured using a bright-field microscope. These images and videos along with urine dipstick results were incorporated in online surveys and sent to expert nephrologists at 15 US teaching hospitals. They were asked to identify individual sediment findings and the most likely underlying disease process. EXPOSURES Urine dipstick results and urine sediment images from patients undergoing native kidney biopsy. MAIN OUTCOMES AND MEASURES Interobserver reliability of urine sediment microscopy findings estimated by overall percent agreement and Fleiss κ coefficients. Secondary outcomes included concordance of diagnoses suspected by nephrologists with corresponding kidney biopsy results. RESULTS In total, 10 surveys from 10 patients containing 76 study questions on individual features were sent to 21 nephrologists, 14 (67%) of whom completed them all. Their combined 1064 responses were analyzed. Overall percent agreement for casts was an estimated 59% (95% CI, 50%-69%), κ = 0.52 (95% CI, 0.42-0.62). For other sediment findings, overall percent agreement was an estimated 69% (95% CI, 61%-77%), κ = 0.65 (95% CI, 0.56-0.73). The κ estimates ranged from 0.13 (95% CI, 0.10-0.17) for mixed cellular casts to 0.90 (95% CI, 0.87-0.94) for squamous epithelial cells. CONCLUSIONS AND RELEVANCE In this study, substantial variability occurred in the interpretation of urine sediment findings, even among expert nephrologists. Educational or technological innovations may help improve the urine sediment as a diagnostic tool.
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Affiliation(s)
- Ragnar Palsson
- Renal Division, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Nephrology, National University Hospital of Iceland, Reykjavik, Iceland
| | - Mia R. Colona
- Renal Division, Brigham and Women’s Hospital, Boston, Massachusetts
- Renal Section, Department of Medicine, Boston University Medical Center, Boston, Massachusetts
| | - Melanie P. Hoenig
- Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Andrew L. Lundquist
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
| | - James E. Novak
- Division of Nephrology, Henry Ford Hospital, Detroit, Michigan
| | - Mark A. Perazella
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Sushrut S. Waikar
- Renal Division, Brigham and Women’s Hospital, Boston, Massachusetts
- Renal Section, Department of Medicine, Boston University Medical Center, Boston, Massachusetts
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7
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Affiliation(s)
- Andrew L Lundquist
- From the Departments of Medicine (A.L.L., S.K.), Radiology (A.M.), and Pathology (K.J.T.), Massachusetts General Hospital, and the Departments of Medicine (A.L.L., S.K.), Radiology (A.M.), and Pathology (K.J.T.), Harvard Medical School - both in Boston
| | - Sahir Kalim
- From the Departments of Medicine (A.L.L., S.K.), Radiology (A.M.), and Pathology (K.J.T.), Massachusetts General Hospital, and the Departments of Medicine (A.L.L., S.K.), Radiology (A.M.), and Pathology (K.J.T.), Harvard Medical School - both in Boston
| | - Amirkasra Mojtahed
- From the Departments of Medicine (A.L.L., S.K.), Radiology (A.M.), and Pathology (K.J.T.), Massachusetts General Hospital, and the Departments of Medicine (A.L.L., S.K.), Radiology (A.M.), and Pathology (K.J.T.), Harvard Medical School - both in Boston
| | - Kristen J Tomaszewski
- From the Departments of Medicine (A.L.L., S.K.), Radiology (A.M.), and Pathology (K.J.T.), Massachusetts General Hospital, and the Departments of Medicine (A.L.L., S.K.), Radiology (A.M.), and Pathology (K.J.T.), Harvard Medical School - both in Boston
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Wang J, Wen Y, Zhou M, Shi X, Jiang L, Li M, Yu Y, Li X, Li X, Zhang W, Lundquist AL, Chen L. Ectopic germinal center and megalin defect in primary Sjogren syndrome with renal Fanconi syndrome. Arthritis Res Ther 2017; 19:120. [PMID: 28577559 PMCID: PMC5455124 DOI: 10.1186/s13075-017-1317-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 12/29/2016] [Accepted: 05/02/2017] [Indexed: 01/15/2023] Open
Abstract
Background This study reports the clinical and pathological features of 12 cases of primary Sjogren syndrome (pSS) with renal involvement presenting with proximal tubular dysfunction in a single center, and investigates the possible correlation of ectopic germinal center formation and megalin/cubilin down-expression. Method Clinical and pathological records were reviewed. Immunohistochemistry was carried out to detect megalin, cubilin, CD21 and IL-17 expression. Results Patients presented with different degrees of proximal renal tubule lesion and decreased estimated glomerular filtration rate (eGFR). Renal biopsy revealed tubulointerstitial nephritis, with tubular epithelial cell degeneration, tubular atrophy, interstitial inflammation and focal fibrosis. Immunohistochemistry revealed decreased expression of megalin and cubilin, two important multiligand protein receptors on the brush border of proximal tubular epithelial cells. IL-17 secreted by Th17 subtype effector T cells was diffusely detected in the renal proximal tubule, with a negative correlation of IL-17 and megalin expression. In addition, ectopic germinal centers characterized by CD21+ follicular dendritic cells were present in the renal interstitium. In patients with a decreased eGFR, treatment with 4 weeks of glucocorticoid therapy resulted in an improved eGFR in 75% of patients. Conclusion We report 12 cases of pSS characterized by Fanconi syndrome. The decreased megalin and cubilin expression may contribute to the proximal tubular reabsorption defect, possibly secondary to Th17 infiltration and formation of ectopic germinal centers.
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Affiliation(s)
- Jing Wang
- Nephrology Department, Chinese Academy of Medical Science, Peking Union Medical College Hospital, Tsing Hua University, Beijing, China
| | - Yubing Wen
- Nephrology Department, Chinese Academy of Medical Science, Peking Union Medical College Hospital, Tsing Hua University, Beijing, China
| | - Mengyu Zhou
- Nephrology Department, Chinese Academy of Medical Science, Peking Union Medical College Hospital, Tsing Hua University, Beijing, China
| | - Xiaoxiao Shi
- Nephrology Department, Chinese Academy of Medical Science, Peking Union Medical College Hospital, Tsing Hua University, Beijing, China
| | - Lanping Jiang
- Nephrology Department, Chinese Academy of Medical Science, Peking Union Medical College Hospital, Tsing Hua University, Beijing, China
| | - Mingxi Li
- Nephrology Department, Chinese Academy of Medical Science, Peking Union Medical College Hospital, Tsing Hua University, Beijing, China
| | - Yang Yu
- Nephrology Department, Chinese Academy of Medical Science, Peking Union Medical College Hospital, Tsing Hua University, Beijing, China. .,Department of Nephrology, Chinese Academy of Medical Science, Peking Union Medical College Hospital, No 1, Shuaifuyan, Wangfujing St, Beijing, 100730, China.
| | - Xuemei Li
- Nephrology Department, Chinese Academy of Medical Science, Peking Union Medical College Hospital, Tsing Hua University, Beijing, China
| | - Xuewang Li
- Nephrology Department, Chinese Academy of Medical Science, Peking Union Medical College Hospital, Tsing Hua University, Beijing, China
| | - Wen Zhang
- Nephrology Department, Chinese Academy of Medical Science, Peking Union Medical College Hospital, Tsing Hua University, Beijing, China
| | - Andrew L Lundquist
- Division of Nephrology, Massachussetts General Hospital, Boston, MA, USA
| | - Limeng Chen
- Nephrology Department, Chinese Academy of Medical Science, Peking Union Medical College Hospital, Tsing Hua University, Beijing, China.
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Sise ME, Wisocky J, Rosales IA, Chute D, Holmes JA, Corapi KM, Babitt JL, Tangren JS, Hashemi N, Lundquist AL, Williams WW, Mount DB, Andersson KL, Rennke HG, Smith RN, Colvin R, Thadhani RI, Chung RT. Lupus-like Immune Complex-mediated Glomerulonephritis in Patients with Hepatitis C Virus Infection Treated with Oral, Interferon-free, Direct-acting Antiviral Therapy. Kidney Int Rep 2016; 1:135-143. [PMID: 27990496 PMCID: PMC5155703 DOI: 10.1016/j.ekir.2016.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Meghan E Sise
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Jessica Wisocky
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Ivy A Rosales
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Donald Chute
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Jacinta A Holmes
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Kristin M Corapi
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Jodie L Babitt
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Jessica S Tangren
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Nikroo Hashemi
- Department of Gastroenterology and Hepatology, Brigham and Women's Hospital, Boston, MA
| | - Andrew L Lundquist
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Winfred W Williams
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - David B Mount
- Renal Unit, Brigham and Women's Hospital, Boston, MA
| | - Karin L Andersson
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Helmut G Rennke
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | - R Neal Smith
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Robert Colvin
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Ravi I Thadhani
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Raymond T Chung
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA
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Sise ME, Bloom AK, Wisocky J, Lin MV, Gustafson JL, Lundquist AL, Steele D, Thiim M, Williams WW, Hashemi N, Kim AY, Thadhani R, Chung RT. Treatment of hepatitis C virus-associated mixed cryoglobulinemia with direct-acting antiviral agents. Hepatology 2016; 63:408-17. [PMID: 26474537 PMCID: PMC4718772 DOI: 10.1002/hep.28297] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [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: 03/24/2015] [Accepted: 10/12/2015] [Indexed: 12/11/2022]
Abstract
UNLABELLED Hepatitis C virus (HCV) is the most common cause of mixed cryoglobulinemia syndrome (MCS). The efficacy and safety of all-oral direct-acting antiviral (DAA) therapy in HCV-associated MCS (HCV-MCS) is largely unknown. The authors studied case series of patients with HCV-MCS who were treated with sofosbuvir-based regimens and historical controls treated with pegylated interferon and ribavirin in a single health care network. HCV-MCS was defined by circulating cryoglobulin associated with systemic vasculitis symptoms. Renal involvement (n = 7) was established by kidney biopsy (n = 5) or by two or more of the following clinical findings: reduced kidney function, proteinuria, or hematuria with other causes excluded (n = 2). Twelve patients received DAA therapy between December 2013 and September 2014. Median age was 61 years, 58% were male, and 50% had cirrhosis. Median baseline serum creatinine was 0.97 mg/dL (range 0.7-2.47). Four patients received rituximab concurrent with DAA therapy. Sustained virological response rate at 12 weeks (SVR12) was 83% overall. Patients with glomerulonephritis who achieved SVR12 experienced an improvement in serum creatinine and a reduction in proteinuria. Cryoglobulin levels decreased in 89% of patients, with median percent decreasing from 1.5% to 0.5% and completely disappearing in four of nine cases who had cryoglobulins measured after treatment. Serious adverse events were infrequent (17%). In contrast, the historical cohort treated with pegylated interferon and ribavirin experienced only 10% SVR12, with 100% experiencing at least one adverse event and 50% experiencing premature discontinuation due to adverse events. CONCLUSION SVR12 rates for sofosbuvir-based DAA regimens in HCV-MCS were 83%, significantly higher than historical controls treated with pegylated interferon and ribavirin; patients with glomerulonephritis experienced improvement in renal function, including those not concomitantly treated with immunosuppression.
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Affiliation(s)
- Meghan E. Sise
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital
| | - Allyson K. Bloom
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital
| | - Jessica Wisocky
- Liver Center, Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital
| | - Ming V. Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, Brigham and Women’s Hospital
| | - Jenna L. Gustafson
- Liver Center, Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital
| | - Andrew L. Lundquist
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital
| | - David Steele
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital
| | - Michael Thiim
- Liver Center, Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital
| | - Winfred W. Williams
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital
| | - Nikroo Hashemi
- Division of Gastroenterology and Hepatology, Department of Medicine, Brigham and Women’s Hospital
| | - Arthur Y. Kim
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital
| | - Ravi Thadhani
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital
| | - Raymond T. Chung
- Liver Center, Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital
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11
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Tricarico D, Mele A, Liss B, Ashcroft FM, Lundquist AL, Desai RR, George AL, Conte Camerino D. Reduced expression of Kir6.2/SUR2A subunits explains KATP deficiency in K+-depleted rats. Neuromuscul Disord 2007; 18:74-80. [PMID: 17825556 DOI: 10.1016/j.nmd.2007.07.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Revised: 05/17/2007] [Accepted: 07/25/2007] [Indexed: 11/24/2022]
Abstract
We investigated on the mechanism responsible for the reduced ATP-sensitive K(+)(K(ATP)) channel activity recorded from skeletal muscle of K(+)-depleted rats. Patch-clamp and gene expression measurements of K(ATP) channel subunits were performed. A down-regulation of the K(ATP) channel subunits Kir6.2(-70%) and SUR2A(-46%) in skeletal muscles of K(+)-depleted rats but no changes in the expression of Kir6.1, SUR1 and SUR2B subunits were observed. A reduced K(ATP) channel currents of -69.5% in K(+)-depleted rats was observed. The Kir6.2/SUR2A-B agonist cromakalim showed similar potency in activating the K(ATP) channels of normokalaemic and K(+)-depleted rats but reduced efficacy in K(+)-depleted rats. The Kir6.2/SUR1-2B agonist diazoxide activated K(ATP) channels in normokalaemic and K(+)-depleted rats with equal potency and efficacy. The down-regulation of the Kir6.2 explains the reduced K(ATP) channel activity in K(+)-depleted rats. The lower expression of SUR2A explains the reduced efficacy of cromakalim; preserved SUR1 expression accounts for the efficacy of diazoxide. Kir6.2/SUR2A deficiency is associated with impaired muscle function in K(+)-depleted rats and in hypoPP.
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Affiliation(s)
- Domenico Tricarico
- Department of Pharmacobiology, Faculty of Pharmacy, University of Bari, via Orabona no 4, 70120 Bari, Italy.
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12
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Lundquist AL, Chari RS, Wood JH, Miller GG, Schaefer HM, Raiford DS, Wright KJ, Gorden DL. Serum sickness following rabbit antithymocyte-globulin induction in a liver transplant recipient: case report and literature review. Liver Transpl 2007; 13:647-50. [PMID: 17377915 DOI: 10.1002/lt.21098] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [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] [Indexed: 12/24/2022]
Abstract
Thymoglobulin (Genzyme, Cambridge, MA) is an antithymocyte globulin preparation used for induction immunosuppression therapy in solid organ transplantation. It is being utilized with increasing frequency in orthotopic liver transplantation (OLT) in an effort to minimize or delay the use of calcineurin inhibitors due to their inherent nephrotoxicity. Experience with thymoglobulin in OLT remains limited. We report a case of serum sickness in a patient who received thymoglobulin following OLT. The patient experienced intermittent fevers, polyarthralgia, and acute renal failure 9 days after completion of thymoglobulin administration. The patient's symptoms resolved rapidly and completely with a course of intravenous steroids. We review a set of diagnostic criteria for serum sickness and emphasize the importance of early recognition of the process. Early treatment of serum sickness with steroids or plasmapheresis is highly effective and can reduce unnecessary morbidity from this unusual sequela of induction immunosuppression with antithymocyte globulin.
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Affiliation(s)
- Andrew L Lundquist
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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13
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Tricarico D, Mele A, Lundquist AL, Desai RR, George AL, Conte Camerino D. Hybrid assemblies of ATP-sensitive K+ channels determine their muscle-type-dependent biophysical and pharmacological properties. Proc Natl Acad Sci U S A 2006; 103:1118-23. [PMID: 16418275 PMCID: PMC1347972 DOI: 10.1073/pnas.0505974103] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
ATP-sensitive K(+) channels (K(ATP)) are an octameric complex of inwardly rectifying K(+) channels (Kir6.1 and Kir6.2) and sulfonylurea receptors (SUR1 and SUR2A/B), which are involved in several diseases. The tissue-selective expression of the subunits leads to different channels; however, the composition and role of the functional channel in native muscle fibers is not known. In this article, the properties of K(ATP) channels of fast-twitch and slow-twitch muscles were compared by combining patch-clamp experiments with measurements of gene expression. We found that the density of K(ATP) currents/area was muscle-type specific, being higher in fast-twitch muscles compared with the slow-twitch muscle. The density of K(ATP) currents/area was correlated with the level of Kir6.2 expression. SUR2A was the most abundant subunit expressed in all muscles, whereas the vascular SUR2B subunit was expressed but at lower levels. A significant expression of the pancreatic SUR1 was also found in fast-twitch muscles. Pharmacological experiments showed that the channel response to the SUR1 agonist diazoxide, SUR2A/B agonist cromakalim, SUR1 antagonist tolbutamide, and the SUR1/SUR2A/B-antagonist glibenclamide matched the SURs expression pattern. Muscle-specific K(ATP) subunit compositions contribute to the physiological performance of different muscle fiber types and determine the pharmacological actions of drugs modulating K(ATP) activity in muscle diseases.
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Affiliation(s)
- Domenico Tricarico
- Department of Pharmacobiology, Faculty of Pharmacy, University of Bari, via Orabona no. 4, 70120 Bari, Italy
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14
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Lundquist AL, Turner CL, Ballester LY, George AL. Expression and transcriptional control of human KCNE genes. Genomics 2006; 87:119-28. [PMID: 16303284 DOI: 10.1016/j.ygeno.2005.09.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2005] [Revised: 09/06/2005] [Accepted: 09/07/2005] [Indexed: 11/26/2022]
Abstract
Potassium channels are essential for a variety of cellular processes ranging from membrane excitability to cellular proliferation. The KCNE genes (KCNE1-5) encode a family of single-transmembrane-domain proteins that modulate the properties of several potassium channels, suggesting a physiologic role for these accessory subunits in many human tissues. To investigate the expression and transcriptional control of KCNE genes we mapped transcription start sites, delineated 5' genomic structure, and characterized functional promoter elements for each gene. We identified alternatively spliced transcripts for both KCNE1 and KCNE3, including a cardiac-specific KCNE1 transcript. Analysis of relative expression levels of KCNE1-5 in a panel of human tissues revealed distinct, but overlapping, expression patterns. The coexpression of multiple functionally distinct KCNE genes in some tissues infers complex accessory subunit modification of potassium channels. Identification of the core promoter elements necessary for transcriptional control of the KCNE genes facilitates future work investigating factors responsible for tissue-specific expression as well as the discovery of promoter variants associated with disease.
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Affiliation(s)
- Andrew L Lundquist
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
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15
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Brink PA, Crotti L, Corfield V, Goosen A, Durrheim G, Hedley P, Heradien M, Geldenhuys G, Vanoli E, Bacchini S, Spazzolini C, Lundquist AL, Roden DM, George AL, Schwartz PJ. Phenotypic Variability and Unusual Clinical Severity of Congenital Long-QT Syndrome in a Founder Population. Circulation 2005; 112:2602-10. [PMID: 16246960 DOI: 10.1161/circulationaha.105.572453] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.5] [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] [Indexed: 01/06/2023]
Abstract
Background—
In the congenital long-QT syndrome (LQTS), there can be a marked phenotypic heterogeneity. Founder effects, by which many individuals share a mutation identical by descent, represent a powerful tool to further understand the underlying mechanisms and to predict the natural history of mutation-associated effects. We are investigating one such founder effect, originating in South Africa in approximately
ad
1700 and segregating the same KCNQ1 mutation (A341V).
Methods and Results—
The study population involved 320 subjects, 166 mutation carriers (MCs) and 154 noncarriers. When not taking β-blocker therapy, MCs had a wide range of QTc values (406 to 676 ms), and 12% of individuals had a normal QTc (≤440 ms). A QTc >500 ms was associated with increased risk for cardiac events (OR=4.22; 95% CI, 1.12 to 15.80;
P
=0.033). We also found that MCs with a heart rate <73 bpm were at significantly lower risk (OR=0.23; 95% CI, 0.06 to 0.86;
P
=0.035). This study also unexpectedly determined that KCNQ1-A341V is associated with greater risk than that reported for large databases of LQT1 patients: A341V MCs are more symptomatic by age 40 years (79% versus 30%) and become symptomatic earlier (7±4 versus 13±9 years, both
P
<0.001). Accordingly, functional studies of KCNQ1-A341V in CHO cells stably expressing IK
s
were conducted and identified a dominant negative effect of the mutation on wild-type channels.
Conclusions—
KCNQ1-A341V is a mutation associated with an unusually severe phenotype, most likely caused by the dominant negative effect of the mutation. The availability of an extended kindred with a common mutation allowed us to identify heart rate, an autonomic marker, as a novel risk factor.
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Affiliation(s)
- Paul A Brink
- Department of Internal Medicine, University of Stellenbosch, South Africa
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16
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Crotti L, Lundquist AL, Insolia R, Pedrazzini M, Ferrandi C, De Ferrari GM, Vicentini A, Yang P, Roden DM, George AL, Schwartz PJ. KCNH2-K897T is a genetic modifier of latent congenital long-QT syndrome. Circulation 2005; 112:1251-8. [PMID: 16116052 DOI: 10.1161/circulationaha.105.549071] [Citation(s) in RCA: 176] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Clinical heterogeneity among patients with long-QT syndrome (LQTS) sharing the same disease-causing mutation is usually attributed to variable penetrance. One potential explanation for this phenomenon is the coexistence of modifier gene alleles, possibly common single nucleotide polymorphisms, altering arrhythmia susceptibility. We demonstrate this concept in a family segregating a novel, low-penetrant KCNH2 mutation along with a common single nucleotide polymorphism in the same gene. METHODS AND RESULTS The proband is a 44-year-old white woman with palpitations associated with presyncope since age 20, who presented with ventricular fibrillation and cardiac arrest. Intermittent QT prolongation was subsequently observed (max QTc, 530 ms), and LQT2 was diagnosed after the identification of a missense KCNH2 mutation (A1116V) altering a conserved residue in the distal carboxyl-terminus of the encoded HERG protein. The proband also carried the common KCNH2 polymorphism K897T on the nonmutant allele. Relatives who carried A1116V without K897T were asymptomatic, but some exhibited transient mild QTc prolongation, suggesting latent disease. Heterologous expression studies performed in cultured mammalian cells and using bicistronic vectors linked to different fluorescent proteins demonstrated that coexpression of A1116V with K897T together resulted in significantly reduced current amplitude as compared with coexpression of either allele with WT-HERG. Thus, the presence of KCNH2-K897T is predicted to exaggerate the IKr reduction caused by the A1116V mutation. These data explain why symptomatic LQTS occurred only in the proband carrying both alleles. CONCLUSIONS We have provided evidence that a common KCNH2 polymorphism may modify the clinical expression of a latent LQT2 mutation. A similar mechanism may contribute to the risk for sudden death in more prevalent cardiac diseases.
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Affiliation(s)
- Lia Crotti
- Department of Cardiology, University of Pavia, IRCCS Policlinico S. Matteo, Pavia, Italy
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17
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Lundquist AL, Manderfield LJ, Vanoye CG, Rogers CS, Donahue BS, Chang PA, Drinkwater DC, Murray KT, George AL. Expression of multiple KCNE genes in human heart may enable variable modulation of. J Mol Cell Cardiol 2005; 38:277-87. [PMID: 15698834 DOI: 10.1016/j.yjmcc.2004.11.012] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.8] [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] [Received: 08/21/2004] [Revised: 10/28/2004] [Accepted: 11/02/2004] [Indexed: 11/26/2022]
Abstract
Voltage-gated potassium (K(V)) channels are modulated by at least three distinct classes of proteins including the KCNE family of single transmembrane accessory subunits. In the human genome, KCNE proteins are encoded by five genes designated KCNE1 through KCNE5. KCNE1 associates with KCNQ1 in vitro to generate a potassium current closely resembling the slowly activating delayed rectifier (I(Ks)). Other KCNE proteins also affect the activity of heterologously expressed KCNQ1. To investigate the potential physiological relevance of this gene family in human heart, we examined the relative expression of KCNQ1 and all five KCNE genes in samples derived from normal tissues representing major regions of human heart by real-time, quantitative RT-PCR. KCNE genes are expressed in human heart with a relative abundance ranking of KCNE1 > KCNE4 > KCNE5 approximately KCNE3 >> KCNE2. In situ hybridization revealed prominent expression of KCNE1 and KCNE3-5 in human atrial myocytes. In cardiomyopathic hearts, expression of KCNE1, KCNE3, KCNE4, and KCNQ1 was significantly increased, while KCNE2 and KCNE5 exhibited reduced expression. In a cell line stably expressing KCNQ1 and KCNE1, transient expression of KCNE3, KCNE4, or KCNE5 significantly altered I(Ks) current profiles. Even in the presence of additional KCNE1, KCNE4 and KCNE5 exert dominant effects on I(Ks). Although KCNE1 is the predominant KCNE family member expressed in human heart, the abundance of other KCNE transcripts including potential KCNQ1 suppressors (KCNE4 and KCNE5) and their altered expression patterns in disease lead us to speculate that a balance of KCNE accessory subunits may be important for cardiac K(V) channel function.
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Affiliation(s)
- Andrew L Lundquist
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
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18
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19
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Abstract
Tufted capuchins (Cebus apella) were provided with a task that facilitated the use and modification of sticks as probing tools. It was found that subjects aged 10 years or older at initial task exposure were less likely to use tools than were younger subjects. Furthermore, juveniles whose mothers died before the subjects were aged 3 years were less likely to use tools than were juveniles whose mothers survived through this period. The ability to use tools was not related to subject sex or to access to the tool site or raw tool materials. Subjects modified tools both before and during their use, and the relative percentage of tools modified increased with subject age. Thus, it appears that capuchins most readily acquire tool use before the age of 10 years and that early disruption of the mother-infant relationship has deleterious effects on the emergence of instrumental behavior.
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Affiliation(s)
- G C Westergaard
- Laboratory of Comparative Ethology, National Institute of Child Health and Human Development, Poolesville, Maryland 20837, USA.
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20
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21
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Abstract
This research investigated the effects of posture on lateral bias for food reaching in tufted capuchin monkeys ( Cebus apella ) by comparing hand preferences for quadrupedal and bipedal reaching. Several findings of this investigation warrant discussion. First, we found a population-level bias towards use of the right hand for bipedal reaching but not for quadrupedal reaching. Second, adults exhibited a greater right-hand preference for bipedal reaching than did immatures. Third, subjects showed a greater right-hand preference, and a greater strength of preference independent of direction, for bipedal reaching than for quadrupedal reaching. Fourth, we found a significant positive relation between the direction of hand preference for quadrupedal and bipedal reaching. We believe that capuchins provide an alternative primate model to chimpanzees for the evolution of human bipedalism and right-handedness. One implication of this model is that right-handedness emerged in hominids prior to extensive expansion of brain size and elaboration of material culture.
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Affiliation(s)
- G C Westergaard
- National Institutes of Health Animal Center, P.O. Box 529, Poolesville, MD 20837, USA
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