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Plagiannakos CG, Hirschfield GM, Lytvyak E, Roberts SB, Ismail M, Gulamhusein AF, Selzner N, Qumosani KM, Worobetz L, Hercun J, Vincent C, Flemming JA, Swain MG, Cheung A, Chen T, Grbic D, Peltekain K, Mason AL, Montano-Loza AJ, Hansen BE. Treatment response and clinical event-free survival in autoimmune hepatitis: a Canadian multicentre cohort study. J Hepatol 2024:S0168-8278(24)00205-8. [PMID: 38527524 DOI: 10.1016/j.jhep.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND & AIMS We sought to identify predictors of outcome for people living with autoimmune hepatitis (AIH). METHODS We evaluated the clinical course of people with AIH across 11 Canadian centres. Biochemical changes were analysed using linear mixed-effect and logistic regression. Clinical outcome was dynamically modelled using time-varying Cox proportional hazard modelling and landmark analysis. RESULTS In 691 patients (median age 49 years, 75.4% female), with a median follow-up of 6 years (25th-75th percentile, 2.5-11), 118 clinical events occurred. Alanine aminotransferase (ALT) normalisation occurred in 63.8% of the cohort by 12-months. Older age at diagnosis (odd ratio [OR] 1.19, 95% CI 1.06-1.35) and female sex (OR 1.94, 95% CI 1.18-3.19) were associated with ALT normalisation at 6 months, whilst baseline cirrhosis status was associated with reduced chance of normalisation at 12 months (OR 0.52, 95% CI 0.33-0.82). Baseline total bilirubin, aminotransferases, and immunoglobulin G (IgG) values, as well as initial prednisone dose, did not predict average ALT reduction. At baseline, older age (hazard ratio [HR] 1.25, 95% CI 1.12-1.40), cirrhosis at diagnosis (HR 3.67, 95% CI 2.48-5.43), and elevated baseline total bilirubin (HR 1.36, 95% CI 1.17-1.58) increased risk of clinical events. Prolonged elevations in ALT (HR 1.07, 95% CI 1.00-1.13) and aspartate aminotransferase (HR 1.13, 95% CI 1.06-1.21), but not IgG (HR 1.01, 95% CI 0.95-1.07), were associated with higher risk of clinical events. Higher ALT at 6 months was associated with worse clinical event-free survival. CONCLUSION In people living with AIH, sustained elevated aminotransferase values, but not IgG, are associated with poorer long-term outcomes. Biochemical response and long-term survival are not associated with starting prednisone dose. IMPACT AND IMPLICATIONS Using clinical data from multiple Canadian liver clinics treating autoimmune hepatitis (AIH), we evaluate treatment response and clinical outcomes. For the first time, we apply mixed-effect and time-varying survival statistical methods to rigorously examine treatment response and the impact of fluctuating liver biochemistry on clinical event-free survival. Key to the study impact, our data is 'real-world', represents a diverse population across Canada, uses continuous measurements over follow-up, and our findings help inform risk stratification of patients. We provide evidence for treating clinicians, as well as those developing and evaluating new therapies, to seek evidence of good treatment response by keeping aminotransferase activity values within the reference range. Our results challenge the role of IgG as a marker of treatment response and if normalisation of IgG should remain an important part of the definition of biochemical remission. Our analysis further highlights that baseline markers of disease severity may not prognosticate early treatment response. Additionally, the initial prednisone dose may be less relevant for achieving aminotransferase normalisation. This is important for patients and treating clinicians given the relevance and importance of side-effects of treatment for patients.
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Affiliation(s)
| | - Gideon M Hirschfield
- Toronto Centre for Liver Disease, University Health Network, Toronto, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
| | - Ellina Lytvyak
- Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Surain B Roberts
- Toronto Centre for Liver Disease, University Health Network, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Marwa Ismail
- Toronto Centre for Liver Disease, University Health Network, Toronto, Canada
| | - Aliya F Gulamhusein
- Toronto Centre for Liver Disease, University Health Network, Toronto, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Nazia Selzner
- Ajmera Transplant Centre, University Health Network, Toronto, Canada
| | | | - Lawrence Worobetz
- Department of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Julian Hercun
- Liver Unit, Department of Medicine, Centre Hospitalier De l'Université De Montréal, Montréal, Canada
| | - Catherine Vincent
- Liver Unit, Department of Medicine, Centre Hospitalier De l'Université De Montréal, Montréal, Canada
| | | | - Mark G Swain
- Liver Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
| | - Angela Cheung
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Tianyan Chen
- Department of Medicine, McGill University Health Centre, Montréal, Canada
| | | | - Kevork Peltekain
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew L Mason
- Division of Gastroenterology and Hepatology, University of Alberta, Edmonton, Canada
| | - Aldo J Montano-Loza
- Division of Gastroenterology and Hepatology, University of Alberta, Edmonton, Canada
| | - Bettina E Hansen
- Toronto Centre for Liver Disease, University Health Network, Toronto, Canada; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
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Khoo JR, Chan PK, Wen C, Lau LCM, Leung TKC, Luk MH, Chan VWK, Cheung A, Cheung MH, Fu H, Chiu KY. Feasible non-surgical options for management of knee osteoarthritis during the COVID-19 pandemic and beyond. Hong Kong Med J 2024; 30:56-61. [PMID: 38369959 DOI: 10.12809/hkmj2210209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Affiliation(s)
- J R Khoo
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - P K Chan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - C Wen
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - L C M Lau
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - T K C Leung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - M H Luk
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - V W K Chan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - A Cheung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - M H Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - H Fu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - K Y Chiu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
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Shuhart C, Cheung A, Gill R, Gani L, Goel H, Szalat A. Executive Summary of the 2023 Adult Position Development Conference of the International Society for Clinical Densitometry: DXA Reporting, Follow-up BMD Testing and Trabecular Bone Score Application and Reporting. J Clin Densitom 2024; 27:101435. [PMID: 38007332 DOI: 10.1016/j.jocd.2023.101435] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
After 15 months of preparation by task force chairs and teams, ISCD's 9th Position Development Conference (PDC) convened in Northbrook, IL, USA on March 28th and 29th, 2023 to approve new ISCD Official Positions in the topic areas of DXA Reporting, Follow-up BMD Testing and TBS Application and Reporting. Three teams of participants work to bring the PDC to fruition: the Steering Committee, Task Forces and Chairs, and the Expert Panel. To reach agreement on draft Official Positions, the PDC follows a scripted process with the UCLA/RAND Appropriateness Method (UCLA/RAM) as its foundation. Multiple rounds of data review, public debate and voting resulted in 32 new or modified Official Positions. Six companion position papers are also published along with this Executive Summary, serving as the detailed substantiation for the Official Positions. This Executive Summary reviews the personnel groups, activities and products of the 2023 PDC, with the entirety of the updated 2023 Official Positions presented in Appendix A. New Official Positions are highlighted in bold.
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Affiliation(s)
- Christopher Shuhart
- Swedish Bone Health and Osteoporosis Center, Swedish Medical Group, Seattle, WA, USA.
| | - Angela Cheung
- Centre of Excellence in Skeletal Health Assessment, University of Toronto, Toronto, Ontario, Canada; Osteoporosis Program, University Health Network and Sinai Health System, Toronto, Ontario, Canada
| | - Ranjodh Gill
- Endocrinology Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA; Endocrine Division, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Linsey Gani
- Department of Endocrinology, Changi General Hospital, Singapore
| | | | - Auryan Szalat
- Osteoporosis Center, Internal Medicine Ward, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Gunes A, Schmitt C, Bilodeau L, Huet C, Belblidia A, Baldwin C, Giard JM, Biertho L, Lafortune A, Couture CY, Cheung A, Nguyen BN, Galun E, Bémeur C, Bilodeau M, Laplante M, Tang A, Faraj M, Estall JL. IL-6 Trans-Signaling Is Increased in Diabetes, Impacted by Glucolipotoxicity, and Associated With Liver Stiffness and Fibrosis in Fatty Liver Disease. Diabetes 2023; 72:1820-1834. [PMID: 37757741 PMCID: PMC10658070 DOI: 10.2337/db23-0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/28/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
Many people living with diabetes also have nonalcoholic fatty liver disease (NAFLD). Interleukin-6 (IL-6) is involved in both diseases, interacting with both membrane-bound (classical) and circulating (trans-signaling) soluble receptors. We investigated whether secretion of IL-6 trans-signaling coreceptors are altered in NAFLD by diabetes and whether this might associate with the severity of fatty liver disease. Secretion patterns were investigated with use of human hepatocyte, stellate, and monocyte cell lines. Associations with liver pathology were investigated in two patient cohorts: 1) biopsy-confirmed steatohepatitis and 2) class 3 obesity. We found that exposure of stellate cells to high glucose and palmitate increased IL-6 and soluble gp130 (sgp130) secretion. In line with this, plasma sgp130 in both patient cohorts positively correlated with HbA1c, and subjects with diabetes had higher circulating levels of IL-6 and trans-signaling coreceptors. Plasma sgp130 strongly correlated with liver stiffness and was significantly increased in subjects with F4 fibrosis stage. Monocyte activation was associated with reduced sIL-6R secretion. These data suggest that hyperglycemia and hyperlipidemia can directly impact IL-6 trans-signaling and that this may be linked to enhanced severity of NAFLD in patients with concomitant diabetes. ARTICLE HIGHLIGHTS IL-6 and its circulating coreceptor sgp130 are increased in people with fatty liver disease and steatohepatitis. High glucose and lipids stimulated IL-6 and sgp130 secretion from hepatic stellate cells. sgp130 levels correlated with HbA1c, and diabetes concurrent with steatohepatitis further increased circulating levels of all IL-6 trans-signaling mediators. Circulating sgp130 positively correlated with liver stiffness and hepatic fibrosis. Metabolic stress to liver associated with fatty liver disease might shift the balance of IL-6 classical versus trans-signaling, promoting liver fibrosis that is accelerated by diabetes.
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Affiliation(s)
- Aysim Gunes
- Institut de recherches cliniques de Montréal (IRCM), Montreal, Quebec, Canada
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Montreal Diabetes Research Centre, Montreal, Quebec, Canada
| | - Clémence Schmitt
- Institut de recherches cliniques de Montréal (IRCM), Montreal, Quebec, Canada
- Programmes de biologie moléculaire, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada
| | - Laurent Bilodeau
- Département de radiologie, Centre hospitalier de l’Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Catherine Huet
- Département de radiologie, Centre hospitalier de l’Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Assia Belblidia
- Département de radiologie, Centre hospitalier de l’Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Cindy Baldwin
- Institut de recherches cliniques de Montréal (IRCM), Montreal, Quebec, Canada
| | - Jeanne-Marie Giard
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Département de médecine, Université de Montréal, Montreal, Quebec, Canada
| | - Laurent Biertho
- Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada
- Département de chirurgie, Faculté de médecine, Université Laval, Quebec City, Quebec, Canada
| | - Annie Lafortune
- Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada
- Département de chirurgie, Faculté de médecine, Université Laval, Quebec City, Quebec, Canada
| | - Christian Yves Couture
- Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada
- Département de biologie moléculaire, biochimie médicale et pathologie, Université Laval, Quebec City, Quebec, Canada
| | - Angela Cheung
- Gastroenterology and Hepatology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Bich N. Nguyen
- Département de pathologie et biologie cellulaire, Université de Montréal, Montreal, Quebec, Canada
| | - Eithan Galun
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Chantal Bémeur
- Département de nutrition, Université de Montréal, Montreal, Quebec, Canada
- Labo HépatoNeuro, Centre de recherche du CHUM, Montreal, Quebec, Canada
| | - Marc Bilodeau
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Département de médecine, Université de Montréal, Montreal, Quebec, Canada
| | - Mathieu Laplante
- Montreal Diabetes Research Centre, Montreal, Quebec, Canada
- Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada
| | - An Tang
- Département de radiologie, Centre hospitalier de l’Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - May Faraj
- Institut de recherches cliniques de Montréal (IRCM), Montreal, Quebec, Canada
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Montreal Diabetes Research Centre, Montreal, Quebec, Canada
- Département de nutrition, Université de Montréal, Montreal, Quebec, Canada
| | - Jennifer L. Estall
- Institut de recherches cliniques de Montréal (IRCM), Montreal, Quebec, Canada
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Montreal Diabetes Research Centre, Montreal, Quebec, Canada
- Programmes de biologie moléculaire, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada
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Pron G, Hwang M, Nasralla M, Smith R, Cheung A, Murphy K. Cost-effectiveness and willing-to-pay thresholds for vertebral augmentation of osteoporotic vertebral fractures, what are they based on: a systematic review. BMJ Open 2023; 13:e062832. [PMID: 37491092 PMCID: PMC10373718 DOI: 10.1136/bmjopen-2022-062832] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE Although there is substantial clinical evidence on the safety and effectiveness of vertebral augmentation for osteoporotic vertebral fractures, cost-effectiveness is less well known. The objective of this study is to provide a systematic review of cost-effectiveness studies and policy-based willingness-to-pay (WTP) thresholds for different vertebral augmentation (VA) procedures, vertebroplasty (VP) and balloon kyphoplasty (BK), for osteoporotic vertebral fractures (OVFs). DESIGN A systematic review targeting cost-effectiveness studies of VA procedures for OVFs. DATA SOURCES Six bibliographic databases were searched from inception up to May 2021. ELIGIBILITY CRITERIA FOR STUDY SELECTION Studies were eligible if meeting all predefined criteria: (1) VP or BK intervention, (2) OVFs and (3) cost-effectiveness study. Articles not written in English, abstracts, editorials, reviews and those reporting only cost data were excluded. DATA EXTRACTION AND SYNTHESIS Information was extracted on study characteristics, cost-effective estimates, summary decisions and payer WTP thresholds. Incremental cost-effective ratio (ICER) was the main outcome measure. Studies were summarised by a structured narrative synthesis organised by comparisons with conservative management (CM). Two independent reviewers assessed the quality (risk of bias) of the systematic review and cost-effectiveness studies by peer-reviewed checklists. RESULTS We identified 520 references through database searching and 501 were excluded as ineligible by titles and abstract. Ten reports were identified as eligible from 19 full-text reviews. ICER for VP versus CM evaluated as cost per quality-adjusted life-year (QALY) ranged from €22 685 (*US$33 395) in Netherlands to £-2240 (*US$-3273), a cost-saving in the UK. ICERs for BK versus CM ranged from £2706 (*US$3954) in UK to kr600 000 (*US$90 910) in Sweden. ICERs were within payer WTP thresholds for a QALY based on historical benchmarks. CONCLUSIONS Both VP and BK were judged cost-effective alternatives to CM for OVFs in economic studies and were within WTP thresholds in multiple healthcare settings.
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Affiliation(s)
- Gaylene Pron
- Dalla Lana School of Public Health, Institute Health Policy Evaluation and Management, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Hwang
- Department Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Mehran Nasralla
- Department Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Roger Smith
- Department Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Angela Cheung
- Department of Medicine and Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Kieran Murphy
- Department Medical Imaging, University Health Network, Toronto, Ontario, Canada
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Katz GM, Bach K, Bobos P, Cheung A, Décary S, Goulding S, Herridge MS, McNaughton CD, Palmer KS, Razak FA, Zhang B, Quinn KL. Understanding How Post-COVID-19 Condition Affects Adults and Health Care Systems. JAMA Health Forum 2023; 4:e231933. [PMID: 37418268 DOI: 10.1001/jamahealthforum.2023.1933] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
Importance Post-COVID-19 condition (PCC), also known as long COVID, encompasses the range of symptoms and sequelae that affect many people with prior SARS-CoV-2 infection. Understanding the functional, health, and economic effects of PCC is important in determining how health care systems may optimally deliver care to individuals with PCC. Observations A rapid review of the literature showed that PCC and the effects of hospitalization for severe and critical illness may limit a person's ability to perform day-to-day activities and employment, increase their risk of incident health conditions and use of primary and short-term health care services, and have a negative association with household financial stability. Care pathways that integrate primary care, rehabilitation services, and specialized assessment clinics are being developed to support the health care needs of people with PCC. However, comparative studies to determine optimal care models based on their effectiveness and costs remain limited. The effects of PCC are likely to have large-scale associations with health systems and economies and will require substantial investment in research, clinical care, and health policy to mitigate these effects. Conclusions and Relevance An accurate understanding of additional health care and economic needs at the individual and health system levels is critical to informing health care resource and policy planning, including identification of optimal care pathways to support people affected by PCC.
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Affiliation(s)
- Gabrielle M Katz
- Temerty School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Katie Bach
- PolyBio Research Foundation Board of Directors, Brookings Institution, Washington, DC
| | - Pavlos Bobos
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Angela Cheung
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Sinai Health System and University Health Network, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute and Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
| | - Simon Décary
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Research Center of the Centre Hospitalier de l'Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Margaret S Herridge
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Sinai Health System and University Health Network, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Toronto, Ontario, Canada
| | - Candace D McNaughton
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- ICES, Toronto and Ottawa, Ontario, Canada
| | - Karen S Palmer
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Fahad A Razak
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Betty Zhang
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Kieran L Quinn
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Sinai Health System and University Health Network, Toronto, Ontario, Canada
- ICES, Toronto and Ottawa, Ontario, Canada
- Temmy Latner Centre for Palliative Care, Toronto, Ontario, Canada
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Chan PK, Chan TCW, Mak CYH, Chan THM, Chan SHW, Wong SSC, Fu H, Cheung A, Chan VWK, Cheung MH, Cheung CW, Chiu KY. Pain Relief After Total Knee Arthroplasty with Intravenous and Periarticular Corticosteroid: A Randomized Controlled Trial. J Bone Joint Surg Am 2023; Publish Ahead of Print:00004623-990000000-00809. [PMID: 37220180 DOI: 10.2106/jbjs.22.01218] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a cost-effective procedure, but it is also associated with substantial postoperative pain. The present study aimed to compare pain relief and functional recovery after TKA among groups that received intravenous corticosteroids, periarticular corticosteroids, or a combination of both. METHODS This randomized, double-blinded clinical trial in a local institution in Hong Kong recruited 178 patients who underwent primary unilateral TKA. Six of these patients were excluded because of changes in surgical technique; 4, because of their hepatitis B status; 2, because of a history of peptic ulcer; and 2, because they declined to participate in the study. Patients were randomized 1:1:1:1 to receive placebo (P), intravenous corticosteroids (IVS), periarticular corticosteroids (PAS), or a combination of intravenous and periarticular corticosteroids (IVSPAS). RESULTS The pain scores at rest were significantly lower in the IVSPAS group than in the P group over the first 48 hours (p = 0.034) and 72 hours (p = 0.043) postoperatively. The pain scores during movement were also significantly lower in the IVS and IVSPAS groups than in the P group over the first 24, 48, and 72 hours (p ≤ 0.023 for all). The flexion range of the operatively treated knee was significantly better in the IVSPAS group than in the P group on postoperative day 3 (p = 0.027). Quadriceps power was also greater in the IVSPAS group than in the P group on postoperative days 2 (p = 0.005) and 3 (p = 0.007). Patients in the IVSPAS group were able to walk significantly further than patients in the P group in the first 3 postoperative days (p ≤ 0.003). Patients in the IVSPAS group also had a higher score on the Elderly Mobility Scale than those in the P group (p = 0.036). CONCLUSIONS IVS and IVSPAS yielded similar pain relief, but IVSPAS yielded a larger number of rehabilitation parameters that were significantly better than those in the P group. This study provides new insights into pain management and postoperative rehabilitation following TKA. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- P K Chan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR
| | - T C W Chan
- Department of Anaesthesia, Pain and Perioperative Medicine, Queen Mary Hospital, Hong Kong SAR
| | - C Y H Mak
- Department of Anaesthesia, Pain and Perioperative Medicine, Queen Mary Hospital, Hong Kong SAR
| | - T H M Chan
- Department of Anaesthesia, Pain and Perioperative Medicine, Queen Mary Hospital, Hong Kong SAR
| | - S H W Chan
- Department of Anaesthesia, Pain and Perioperative Medicine, Queen Mary Hospital, Hong Kong SAR
| | - S S C Wong
- Department of Anaesthesiology, The University of Hong Kong, Hong Kong SAR
| | - H Fu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR
| | - A Cheung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR
| | - V W K Chan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR
| | - M H Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR
| | - C W Cheung
- Department of Anaesthesiology, The University of Hong Kong, Hong Kong SAR
| | - K Y Chiu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR
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8
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Cordell HJ, Fryett JJ, Ueno K, Darlay R, Aiba Y, Hitomi Y, Kawashima M, Nishida N, Khor SS, Gervais O, Kawai Y, Nagasaki M, Tokunaga K, Tang R, Shi Y, Li Z, Juran BD, Atkinson EJ, Gerussi A, Carbone M, Asselta R, Cheung A, de Andrade M, Baras A, Horowitz J, Ferreira MAR, Sun D, Jones DE, Flack S, Spicer A, Mulcahy VL, Byan J, Han Y, Sandford RN, Lazaridis KN, Amos CI, Hirschfield GM, Seldin MF, Invernizzi P, Siminovitch KA, Ma X, Nakamura M, Mells GF. Corrigendum to: "An international genome-wide meta-analysis of primary biliary cholangitis: Novel risk loci and candidate drugs" [J Hepatol 75 (2021) 572-581]. J Hepatol 2023; 78:883. [PMID: 36639314 DOI: 10.1016/j.jhep.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Heather J Cordell
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - James J Fryett
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Kazuko Ueno
- Genome Medical Science Project, National Center for Global Health and Medicine (NCGM), Tokyo, Japan
| | - Rebecca Darlay
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Yoshihiro Aiba
- Clinical Research Center, National Hospital Organization, Nagasaki Medical Center, Omura, Japan
| | - Yuki Hitomi
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Minae Kawashima
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nao Nishida
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Seik-Soon Khor
- Genome Medical Science Project, National Center for Global Health and Medicine (NCGM), Tokyo, Japan
| | - Olivier Gervais
- Human Biosciences Unit for the Top Global Course Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan; Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yosuke Kawai
- Genome Medical Science Project, National Center for Global Health and Medicine (NCGM), Tokyo, Japan
| | - Masao Nagasaki
- Human Biosciences Unit for the Top Global Course Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan; Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Katsushi Tokunaga
- Genome Medical Science Project, National Center for Global Health and Medicine (NCGM), Tokyo, Japan
| | - Ruqi Tang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Yongyong Shi
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Collaborative Innovation Center for Brain Science, Shanghai Jiao Tong University, Shanghai, China; Affiliated Hospital of Qingdao University and Biomedical Sciences Institute of Qingdao University (Qingdao Branch of SJTU Bio-X Institutes), Qingdao University, Qingdao, China
| | - Zhiqiang Li
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Collaborative Innovation Center for Brain Science, Shanghai Jiao Tong University, Shanghai, China; Affiliated Hospital of Qingdao University and Biomedical Sciences Institute of Qingdao University (Qingdao Branch of SJTU Bio-X Institutes), Qingdao University, Qingdao, China
| | - Brian D Juran
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth J Atkinson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Alessio Gerussi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Marco Carbone
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Rosanna Asselta
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Angela Cheung
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mariza de Andrade
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Aris Baras
- Regeneron Genetics Center, Tarrytown, New York, USA
| | | | | | - Dylan Sun
- Regeneron Genetics Center, Tarrytown, New York, USA
| | - David E Jones
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Steven Flack
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | - Ann Spicer
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | - Victoria L Mulcahy
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | - Jinyoung Byan
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - Younghun Han
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - Richard N Sandford
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | | | - Christopher I Amos
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - Gideon M Hirschfield
- Toronto Centre for Liver Disease, Division of Gastroenterology and Hepatology, University of Toronto, Toronto, Ontario, Canada
| | | | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Katherine A Siminovitch
- Departments of Medicine, Immunology and Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute and Toronto General Research Institute, Toronto, Ontario, Canada
| | - Xiong Ma
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Minoru Nakamura
- Clinical Research Center, National Hospital Organization, Nagasaki Medical Center, Omura, Japan
| | - George F Mells
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom.
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9
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Plagiannakos CG, Montano-Loza AJ, Lytvyak E, Pallotta J, Mason AL, Qumosani KM, Worobetz L, Flemming JA, Hercun J, Vincent C, Cheung A, Chen T, Grbic D, Swain MG, Gulamhusein A, Hansen BE, Hirschfield GM. A44 A 1000 PATIENT CANADIAN NETWORK FOR AUTOIMMUNE LIVER DISEASE EVALUATION OF CLINICAL AND DEMOGRAPHIC PATTERNS OF AUTOIMMUNE HEPATITIS. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991181 DOI: 10.1093/jcag/gwac036.044] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background We sought to understand how the demographics of autoimmune hepatitis (AIH) have changed over time in Canada. Purpose Using a large multi-centre Canadian cohort of patients with AIH, we describe the trends in patient and disease characteristics at presentation across 30 years of clinical practice. Method Patients from the Canadian Network for Autoimmune Liver Disease with a confirmed diagnosis of AIH (simplified score ≥6) were included for analysis. Patients were grouped into five cohorts according to the year of diagnosis (i.e., <2000, 2000-2004, 2005-2009, 2010-2014, ≥2015). Patient demographics and baseline clinical and biochemistry features of disease activity were investigated using Chi-square tests and Kruskal-Wallis tests adjusted for multiple comparisons. Logistic and linear regression models with estimated means were utilized to further investigate relationships with time and to adjust for confounding. Result(s) 1016 patients followed across 10 Canadian health centres with AIH were diagnosed between November 1965 and December 2021. Overall, 76.4% (n=776) of patients were female, and the median age at diagnosis was 46 years (IQR 28.2 - 58.3). Cirrhosis at presentation was seen in 20.6% of patients (n=209). The median age at diagnosis increased significantly from 31.8 years [IQR 17.9 - 46.8] pre-2000 to 54 years [IQR 9.0 - 95.2] after 2014 (p<0.001; Figure 1a). This effect of time persisted after adjusting for sex and cirrhosis status at diagnosis. Female sex and the presence of cirrhosis at diagnosis were factors independently associated with older age at presentation (p<0.0001). The proportion of patients that presented with cirrhosis at diagnosis increased significantly over calendar time, from 13.7% (n=23) pre-2000 to 30.8% (n=69) after 2014 (p=0.003; Figure 1b). Male sex was independently associated with an increased odds of having cirrhosis at presentation (OR= 1.46, CI 1.02 - 2.07) and higher baseline ALT levels compared to females (p=0.036). The proportion of patients that identified as non-white ethnicity increased significantly from 15.2% (n= 24) pre-2000, to 32% (n= 86) after 2014 (p<0.001, Figure 1b). This effect of time on ethnicity was most pronounced after the year 2010 (OR= 2.32, CI 1.39 - 3.98) and persisted after adjusting for sex. There was no significant pattern of change in sex over calendar time. Image ![]()
Conclusion(s) In Canada, patients with AIH at presentation are now older, have more advanced disease, and are more ethnically diverse than when compared to 30 years ago. Please acknowledge all funding agencies by checking the applicable boxes below Other Please indicate your source of funding; industry Disclosure of Interest None Declared
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Affiliation(s)
- C G Plagiannakos
- Toronto Centre for Liver Disease, Toronto Western and General Hospital, University Health Network,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto
| | - A J Montano-Loza
- Division of Gastroenterology and Hepatology, University of Alberta, Edmonton
| | - E Lytvyak
- Division of Gastroenterology and Hepatology, University of Alberta, Edmonton
| | - J Pallotta
- Toronto Centre for Liver Disease, Toronto Western and General Hospital, University Health Network
| | - A L Mason
- Division of Gastroenterology and Hepatology, University of Alberta, Edmonton
| | - K M Qumosani
- Department of Medicine, Western University, London
| | - L Worobetz
- Department of Medicine, University of Saskatchewan, Saskatoon
| | - J A Flemming
- Medicine and Public Health Sciences, Queen's University, Kingston
| | - J Hercun
- Département De Médecins, Centre Hospitalier De l’Université De Montréal, Montréal
| | - C Vincent
- Département De Médecins, Centre Hospitalier De l’Université De Montréal, Montréal
| | - A Cheung
- Department of Medicine, University of Ottawa, Ottawa
| | - T Chen
- Department of Medicine, McGill University Health Centre, Montréal
| | - D Grbic
- Université De Sherbrooke, Sherbrooke
| | - M G Swain
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
| | - A Gulamhusein
- Toronto Centre for Liver Disease, Toronto Western and General Hospital, University Health Network,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto
| | - B E Hansen
- Toronto Centre for Liver Disease, Toronto Western and General Hospital, University Health Network,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto,Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - G M Hirschfield
- Toronto Centre for Liver Disease, Toronto Western and General Hospital, University Health Network,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto
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10
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Matthewman J, Tadrous M, Mansfield K, Thiruchelvam D, Redelmeier D, Cheung A, Lega I, Prieto-Alhambra D, Cunliffe L, Langan S, Drucker A. 078 Association between oral corticosteroid prescribing patterns and appropriate fracture preventive care: UK and Ontario population-based cohort studies. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.088] [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: 11/19/2022]
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11
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Cheung A, Schachermayer G, Biehler A, Wallis A, Missaire M, Hindges R. Teneurin paralogues are able to localise synaptic sites driven by the intracellular domain and have the potential to form cis-heterodimers. Front Neurosci 2022; 16:915149. [PMID: 36408396 PMCID: PMC9670113 DOI: 10.3389/fnins.2022.915149] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
Synaptic specificity during neurodevelopment is driven by combinatorial interactions between select cell adhesion molecules expressed at the synaptic membrane. These protein-protein interactions are important for instructing the correct connectivity and functionality of the nervous system. Teneurins are one family of synaptic adhesion molecules, highly conserved and widely expressed across interconnected areas during development. These type-II transmembrane glycoproteins are involved in regulating key neurodevelopmental processes during the establishment of neural connectivity. While four teneurin paralogues are found in vertebrates, their subcellular distribution within neurons and interaction between these different paralogues remains largely unexplored. Here we show, through fluorescently tagging teneurin paralogues, that true to their function as synaptic adhesion molecules, all four paralogues are found in a punctate manner and partially localised to synapses when overexpressed in neurons in vitro. Interestingly, each paralogue is differentially distributed across different pre- and post-synaptic sites. In organotypic cultures, Tenm3 is similarly localised to dendritic spines in CA1 neurons, particularly to spine attachment points. Furthermore, we show that the intracellular domain of teneurin plays an important role for synaptic localisation. Finally, while previous studies have shown that the extracellular domain of teneurins allows for active dimer formation and transsynaptic interactions, we find that all paralogues are able to form the full complement of homodimers and cis-heterodimers. This suggests that the combinatorial power to generate distinct molecular teneurin complexes underlying synaptic specificity is even higher than previously thought. The emerging link between teneurin with cancers and neurological disorders only serves to emphasise the importance of further elucidating the molecular mechanisms of teneurin function and their relation to human health and disease.
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Affiliation(s)
- Angela Cheung
- Centre for Developmental Neurobiology, King’s College London, London, United Kingdom
| | - Greta Schachermayer
- Centre for Developmental Neurobiology, King’s College London, London, United Kingdom
| | - Aude Biehler
- Centre for Developmental Neurobiology, King’s College London, London, United Kingdom
| | - Amber Wallis
- Centre for Developmental Neurobiology, King’s College London, London, United Kingdom
| | - Mégane Missaire
- Centre for Developmental Neurobiology, King’s College London, London, United Kingdom
| | - Robert Hindges
- Centre for Developmental Neurobiology, King’s College London, London, United Kingdom
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, United Kingdom
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12
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Wang E, Keller HH, Mourtzakis M, Rodrigues IB, Steinke A, Ashe MC, Thabane L, Brien S, Funnell L, Cheung A, Milligan J, Papaioannou A, Weston ZJ, Straus S, Giangregorio L. MoveStrong at Home: A feasibility study of a model for remote delivery of functional strength and balance training combined with nutrition education for older pre-frail and frail adults.
. Appl Physiol Nutr Metab 2022; 47:1172-1186. [DOI: 10.1139/apnm-2022-0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Exercise and nutrition interventions are often recommended for frailty; however, effective strategies are required for real-world implementation. Our primary aim was to assess the feasibility and acceptability of telephone and virtual delivery of MoveStrong, an 8-week exercise and nutrition program with a 4-week follow-up for older pre-frail and frail adults. A priori criteria for success included: recruitment (≥25/12 weeks), retention at follow-up (≥80%), and adherence to exercise and nutrition sessions (≥70%). We recruited community-dwelling Ontario residents; ≥60 years, ≥1 chronic condition, ≥1 FRAIL scale score. Participants received mailed materials, a personalized exercise program, eleven remote one-on-one training sessions with an exercise physiologist and three online dietitian-led nutrition education sessions. We completed exploratory analyses of secondary outcomes including physical function and dietary protein intake. Semi-structured interviews supported program evaluation. In total, 30 participants were enrolled. 28 (93%) participants completed program and follow-up assessments. Adherence to exercise and nutrition sessions (CI) was 84% (77-91%) and 82% (70-93%) respectively. At program end and follow-up [mean change (CI)], significant improvements were measured in 30-second chair stand test [3.50 (1.12–5.86), 4.54 (1.94–7.13) chair stands] and dietary protein intake [12.9 (5.7–20.0), 9.2 (0.4–18.1) g]. Overall, participants were satisfied with program delivery. Trial registration number: NCT04663685.
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Affiliation(s)
- Ellen Wang
- University of Waterloo, Department of Kinesiology and Health Sciences, Waterloo, Ontario, Canada
| | - Heather H. Keller
- University of Waterloo, Department of Kinesiology and Health Sciences, Waterloo, Ontario, Canada
- Schlegel Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
| | - Marina Mourtzakis
- University of Waterloo, Department of Kinesiology and Health Sciences, Waterloo, Ontario, Canada
| | | | - Alex Steinke
- University of Waterloo, Department of Kinesiology and Health Sciences, Waterloo, Ontario, Canada
| | - Maureen C Ashe
- The University of British Columbia, Department of Family Practice, Vancouver, British Columbia, Canada
| | - Lehana Thabane
- McMaster University, Department of Health Research Methods, Evidence and Impact, Hamilton, Ontario, Canada
- St Joseph’s Healthcare, Biostatistics Unit, Hamilton, Ontario, Canada
- University of Johannesburg, Faculty of Health Sciences, Johannesburg, South Africa
| | - Sheila Brien
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, Toronto, Ontario, Canada
| | - Larry Funnell
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, Toronto, Ontario, Canada
| | - Angela Cheung
- University Health Network, University of Toronto, Department of Medicine, Toronto, Ontario, Canada
| | - James Milligan
- Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada
- McMaster University, Department of Medicine, Hamilton, Ontario, Canada
| | - Alexandra Papaioannou
- McMaster University, Department of Health Research Methods, Evidence and Impact, Hamilton, Ontario, Canada
- McMaster University, Department of Medicine, Hamilton, Ontario, Canada
| | - Zachary J Weston
- Waterloo Wellington Local Health Integration Network, Waterloo, Ontario, Canada
- Wilfrid Laurier University, Faculty of Science, Waterloo, Ontario, Canada
| | - Sharon Straus
- University of Toronto, Department of Geriatric Medicine, Toronto, Ontario, Canada
- CLEAR Health Economics, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Lora Giangregorio
- University of Waterloo, Department of Kinesiology and Health Sciences, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
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13
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Roberts SB, Hirschfield GM, Worobetz LJ, Vincent C, Flemming JA, Cheung A, Qumosani K, Swain M, Grbic D, Ko HH, Peltekian K, Selzner N, Abrahamyan L, Aziz B, Lytvyak E, Tirona K, Gulamhusein AF, Janssen HLA, Montano-Loza AJ, Mason AL, Hansen BE. Ethnicity, disease severity, and survival in Canadian patients with primary biliary cholangitis. Hepatology 2022; 76:303-316. [PMID: 35220609 DOI: 10.1002/hep.32426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/21/2022] [Accepted: 02/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS We investigated associations between ethnicity, survival, and disease severity in a diverse Canadian cohort of patients with primary biliary cholangitis (PBC). APPROACH AND RESULTS Patients with PBC were included from the Canadian Network for Autoimmune Liver Disease. Ethnicity was defined using a modified list adopted from Statistics Canada, and ethnicities with small samples were grouped. Clinical events were defined as liver decompensation, HCC, liver transplantation, or death. Clinical event-free and liver transplantation-free survival were analyzed using Cox regression. Trajectories of serum liver function tests were assessed over time using mixed-effects regression. Health-related quality of life was assessed using the Short Form 36, the PBC-40 questionnaire, and the 5-D Itch scale and analyzed using mixed-effects regression. The cohort included 1538 patients with PBC from six sites and was comprised of 82% White, 4.7% Indigenous, 5.5% East Asian, 2.6% South Asian, and 5.1% miscellaneous ethnicities. Indigenous patients were the only ethnic group with impaired liver transplant-free and event-free survival compared to White patients (HR, 3.66; 95% CI, 2.23-6.01; HR, 3.09; 95% CI, 1.94-4.92). Indigenous patients were more likely to have a clinical event before diagnosis (10%) than all other ethnic groups despite similar age at diagnosis. Indigenous patients presented with higher alkaline phosphatase, total bilirubin, and GLOBE scores than White patients; and these relative elevations persisted during follow-up. CONCLUSIONS Indigenous Canadians with PBC present with advanced disease and have worse long-term outcomes compared to White patients.
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Affiliation(s)
- Surain B Roberts
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Gideon M Hirschfield
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lawrence J Worobetz
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Catherine Vincent
- Département de Médecine, Université de Montréal, Montréal, Quebec, Canada
| | | | - Angela Cheung
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Karim Qumosani
- Department of Medicine, Western University, London, Ontario, Canada
| | - Mark Swain
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dusanka Grbic
- Department de Médecine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Hin Hin Ko
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevork Peltekian
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nazia Selzner
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Lusine Abrahamyan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Bishoi Aziz
- Department of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ellina Lytvyak
- Department of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kattleya Tirona
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Aliya F Gulamhusein
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Harry L A Janssen
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Aldo J Montano-Loza
- Department of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew L Mason
- Department of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Bettina E Hansen
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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14
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Pron G, Hwang M, Smith R, Cheung A, Murphy K. Cost-effectiveness studies of vertebral augmentation for osteoporotic vertebral fractures: a systematic review. Spine J 2022; 22:1356-1371. [PMID: 35257838 DOI: 10.1016/j.spinee.2022.02.013] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Osteoporotic vertebral fractures (OVF) dramatically increase with age and are serious life altering adverse events for seniors resulting in increased rates of institutionalization, morbidity and mortality. Given the expanding population of the elderly and increasing prevalence of OVFs, cost-effective treatment strategies need to be considered. Percutaneous vertebral augmentation (VA) procedures such as vertebroplasty (VP) or balloon kyphoplasty (BK) are increasingly employed to treat painful vertebral fractures not responding to conservative management (CM) of bedrest and analgesia. Both VA procedures have been shown to be effective treatments for OVFs in multiple systematic reviews of randomized controlled trials. In this systematic review, analytical strategies, designs and results were compared for health economic studies evaluating cost-effectiveness of VA procedures, VP or BK for OVFs. Furthermore, assessments of quality (risk of bias) were conducted for the systematic review and the individual studies with peer-reviewed checklists recommended for cost-effectiveness studies. PURPOSE To provide an up-to-date systematic review of peer-reviewed studies evaluating cost-effectiveness of VA procedures, VP or KP for OVFs to support treatment and health care funding decisions. STUDY DESIGN This study is a systematic literature review and structured narrative synthesis. STUDY SAMPLE Peer reviewed health economic studies reporting cost-effectiveness for VA procedures, VP or BK for OVFs OUTCOME MEASURES: The following information extracted from the studies included: report country and year, study design, comparators, population, perspective, health valuations, costing sources and cost-effectiveness measures. For economic studies involving modeling, information was also extracted for model type, time horizon, key model drivers, and handling of uncertainty. Incremental cost-effectiveness ratio (ICER), the ratio of differences between comparator treatment groups in costs and health benefits, was considered the main cost-effectiveness measure. METHODS A systematic review was conducted of MEDLINE, EMBASE, CINAHL, ECONLIT, Cochrane Library and DARE databases up to the review date May 2021. Studies were reviewed for those reporting cost-effectiveness analyses on VA procedures including VP or BK for OVFs. Studies including only costs, abstracts, editorials, methodologies and reviews were not included. The selection of articles was reported in line with PRISMA guidance. A descriptive framework was developed to classify types of cost-effectiveness studies based on methodological differences and a structured narrative synthesis was used to summarize studies. Quality assessments were made with British Medical Journal checklist for individual cost-effectiveness studies and the CiCERO checklist for systematic reviews of cost-effectiveness studies. RESULTS In this systematic review, 520 references were identified through database searching and 501 were excluded as ineligible by titles and abstract based on prior eligibility criteria. From full-text reviews of 19 reports, ten were identified as eligible for the systematic review evaluating cost-effectiveness of VA procedures for OVFs. All references were published between 2008 and 2020. The ten cost-effectiveness studies, three for VP, three for BK and four for both VP and BK, all involved CM for OVFs as a treatment comparator. The studies involved different methods of economic analysis, modeling assumptions, cost and health valuations conducted in different health care setting over different time periods. A framework for the review outlines key features of cost-effectiveness study designs consisting of unmatched, matched, or randomized controls involving cost-effectiveness or cost-utility) analyses. Both VP and BK were cost-effective alternatives to CM for OVFs with earlier health gains and significantly shorter hospital stays. Cost-effectiveness estimates, ICERs, remained relatively stable and within willingness-to-pay thresholds under a range of sensitivity analyses. Comparisons between VP and BK were variable depending on modeling assumptions, but generally the procedures had similar health benefit gains with VP having lower acute procedural costs. CONCLUSIONS Both VP and BK, have been shown to be cost-effective alternatives to CM for osteoporotic vertebral fractures in diverse cost-effectiveness studies conducted in multiple health care settings. Trial-based cost-utility contributed the strongest evidence supporting cost-effectiveness determination for VP and BK for OVFs.
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Affiliation(s)
- Gaylene Pron
- Institute Health Policy Management and Evaluation, University of Toronto, Ontario, Canada
| | - Matthew Hwang
- Department Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario Canada
| | - Roger Smith
- Department Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario Canada
| | - Angela Cheung
- Department Medicine, University Health Network, Toronto, Ontario, Canada
| | - Kieran Murphy
- Department Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario Canada.
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15
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Saá P, Fink RV, Bakkour S, Jin J, Simmons G, Muench MO, Dawar H, Di Germanio C, Hui AJ, Wright DJ, Krysztof DE, Kleinman SH, Cheung A, Nester T, Kessler DA, Townsend RL, Spencer BR, Kamel H, Vannoy JM, Dave H, Busch MP, Stramer SL, Stone M, Jackman RP, Norris PJ. Frequent detection but lack of infectivity of SARS-CoV-2 RNA in pre-symptomatic, infected blood donor plasma. J Clin Invest 2022; 132:159876. [PMID: 35834347 PMCID: PMC9435642 DOI: 10.1172/jci159876] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/12/2022] [Indexed: 11/24/2022] Open
Abstract
Respiratory viruses such as influenza do not typically cause viremia; however, SARS-CoV-2 has been detected in the blood of COVID-19 patients with mild and severe symptoms. Detection of SARS-CoV-2 in blood raises questions about its role in pathogenesis as well as transfusion safety concerns. Blood donor reports of symptoms or a diagnosis of COVID-19 after donation (post-donation information, PDI) preceded or coincided with increased general population COVID-19 mortality. Plasma samples from 2,250 blood donors who reported possible COVID-19–related PDI were tested for the presence of SARS-CoV-2 RNA. Detection of RNAemia peaked at 9%–15% of PDI donors in late 2020 to early 2021 and fell to approximately 4% after implementation of widespread vaccination in the population. RNAemic donors were 1.2- to 1.4-fold more likely to report cough or shortness of breath and 1.8-fold more likely to report change in taste or smell compared with infected donors without detectable RNAemia. No infectious virus was detected in plasma from RNAemic donors; inoculation of permissive cell lines produced less than 0.7–7 plaque-forming units (PFU)/mL and in susceptible mice less than 100 PFU/mL in RNA-positive plasma based on limits of detection in these models. These findings suggest that blood transfusions are highly unlikely to transmit SARS-CoV-2 infection.
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Affiliation(s)
- Paula Saá
- Scientific Affairs, American Red Cross, Gaithersburg, United States of America
| | | | - Sonia Bakkour
- Vitalant Research Institute, San Francisco, United States of America
| | - Jing Jin
- Department of Virology, Vitalant Research Institute, San Francisco, United States of America
| | - Graham Simmons
- Department of Pathology and Laboratory Medicine, Vitalant Research Institute, San Francisco, United States of America
| | - Marcus O Muench
- Vitalant Research Institute, San Francisco, United States of America
| | - Hina Dawar
- Vitalant Research Institute, San Francisco, United States of America
| | - Clara Di Germanio
- Department of Laboratory Medicine, Vitalant Research Institute, San Francisco, United States of America
| | - Alvin J Hui
- Vitalant Research Institute, San Francisco, United States of America
| | | | - David E Krysztof
- Scientific Affairs, American Red Cross, Gaithersburg, United States of America
| | | | | | | | - Debra A Kessler
- Special Services, New York Blood Center, New York, United States of America
| | - Rebecca L Townsend
- Scientific Affairs, American Red Cross, Gaithersburg, United States of America
| | | | - Hany Kamel
- Central Office, Vitalant, Scottsdale, United States of America
| | | | - Honey Dave
- Vitalant Research Institute, San Francisco, United States of America
| | - Michael P Busch
- Vitalant Research Institute, San Francisco, United States of America
| | - Susan L Stramer
- Scientific Affairs, American Red Cross, Gaithersburg, United States of America
| | - Mars Stone
- Department of Laboratory Medicine, Vitalant Research Institute, San Francisco, United States of America
| | - Rachael P Jackman
- Vitalant Research Institute, San Francisco, United States of America
| | - Philip J Norris
- Vitalant Research Institute, San Francisco, United States of America
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M, D'Afflitto M, Deshpande A, Duque Golding J, Frisira E, Germani Batacchi M, Gomaa A, Hay D, Hutchison R, Iakovou A, Iakovou D, Ismail E, Jefferson S, Jones L, Khouli Y, Knowles C, Mason J, McCaughan R, Moffatt J, Morawala A, Nadir H, Neyroud F, Nikookam Y, Parmar A, Pinto L, Ramamoorthy R, Richards E, Thomson S, Trainer C, Valetopoulou A, Vassiliou A, Wantman A, Wilde S, Dickinson M, Rockall T, Senn D, Wcislo K, Zalmay P, Adelekan K, Allen K, Bajaj M, Gatumbu P, Hang S, Hashmi Y, Kaur T, Kawesha A, Kisiel A, Woodmass M, Adelowo T, Ahari D, Alhwaishel K, Atherton R, Clayton B, Cockroft A, Curtis Lopez C, Hilton M, Ismail N, Kouadria M, Lee L, MacConnachie A, Monks F, Mungroo S, Nikoletopoulou C, Pearce L, Sara X, Shahid A, Suresh G, Wilcha R, Atiyah A, Davies E, Dermanis A, Gibbons H, Hyde A, Lawson A, Lee C, Leung-Tack M, Li Saw Hee J, Mostafa O, Nair D, Pattani N, Plumbley-Jones J, Pufal K, Ramesh P, Sanghera J, Saram S, Scadding S, See S, Stringer H, Torrance A, Vardon H, Wyn-Griffiths F, Brew A, Kaur G, Soni D, Tickle A, Akbar Z, Appleyard T, Figg K, Jayawardena P, Johnson A, Kamran Siddiqui Z, Lacy-Colson J, Oatham R, Rowlands B, Sludden E, Turnbull C, Allin D, Ansar Z, Azeez Z, Dale VH, Garg J, Horner A, Jones S, Knight S, McGregor C, McKenna J, McLelland T, Packham-Smith A, Rowsell K, Spector-Hill I, Adeniken E, Baker J, Bartlett M, Chikomba L, Connell B, Deekonda P, Dhar M, Elmansouri A, Gamage K, Goodhew R, Hanna P, Knight J, Luca A, Maasoumi N, Mahamoud F, Manji S, Marwaha PK, Mason F, Oluboyede A, Pigott L, Razaq AM, Richardson M, Saddaoui I, Wijeyendram P, Yau S, Atkins W, Liang K, Miles N, Praveen B, Ashai S, Braganza J, Common J, Cundy A, Davies R, Guthrie J, Handa I, Iqbal M, Ismail R, Jones C, Jones I, Lee KS, Levene A, Okocha M, Olivier J, Smith A, Subramaniam E, Tandle S, Wang A, Watson A, Wilson C, Chan XHF, Khoo E, Montgomery C, Norris M, Pugalenthi PP, Common T, Cook E, Mistry H, Shinmar HS, Agarwal G, Bandyopadhyay S, Brazier B, Carroll L, Goede A, Harbourne A, Lakhani A, Lami M, Larwood J, Martin J, Merchant J, Pattenden S, Pradhan A, Raafat N, Rothwell E, Shammoon Y, Sudarshan R, Vickers E, Wingfield L, Ashworth I, Azizi S, Bhate R, Chowdhury T, Christou A, Davies L, Dwaraknath M, Farah Y, Garner J, Gureviciute E, Hart E, Jain A, Javid S, Kankam HK, Kaur Toor P, Kaz R, Kermali M, Khan I, Mattson A, McManus A, Murphy M, Nair K, Ngemoh D, Norton E, Olabiran A, Parry L, Payne T, Pillai K, Price S, Punjabi K, Raghunathan A, Ramwell A, Raza M, Ritehnia J, Simpson G, Smith W, Sodeinde S, Studd L, Subramaniam M, Thomas J, Towey S, Tsang E, Tuteja D, Vasani J, Vio M, Badran A, Adams J, Anthony Wilkinson J, Asvandi S, Austin T, Bald A, Bix E, Carrick M, Chander B, Chowdhury S, Cooper Drake B, Crosbie S, D Portela S, Francis D, Gallagher C, Gillespie R, Gravett H, Gupta P, Ilyas C, James G, Johny J, Jones A, Kinder F, MacLeod C, Macrow C, Maqsood-Shah A, Mather J, McCann L, McMahon R, Mitham E, Mohamed M, Munton E, Nightingale K, O'Neill K, Onyemuchara I, Senior R, Shanahan A, Sherlock J, Spyridoulias A, Stavrou C, Stokes D, Tamang R, Taylor E, Trafford C, Uden C, Waddington C, Yassin D, Zaman M, Bangi S, Cheng T, Chew D, Hussain N, Imani-Masouleh S, Mahasivam G, McKnight G, Ng HL, Ota HC, Pasha T, Ravindran W, Shah K, Vishnu K S, Zaman S, Carr W, Cope S, Eagles EJ, Howarth-Maddison M, Li CY, Reed J, Ridge A, Stubbs T, Teasdaled D, Umar R, Worthington J, Dhebri A, Kalenderov R, Alattas A, Arain Z, Bhudia R, Chia D, Daniel S, Dar T, Garland H, Girish M, Hampson A, Kyriacou H, Lehovsky K, Mullins W, Omorphos N, Vasdev N, Venkatesh A, Waldock W, Bhandari A, Brown G, Choa G, Eichenauer CE, Ezennia K, Kidwai Z, Lloyd-Thomas A, Macaskill Stewart A, Massardi C, Sinclair E, Skajaa N, Smith M, Tan I, Afsheen N, Anuar A, Azam Z, Bhatia P, Davies-kelly N, Dickinson S, Elkawafi M, Ganapathy M, Gupta S, Khoury EG, Licudi D, Mehta V, Neequaye S, Nita G, Tay VL, Zhao S, Botsa E, Cuthbert H, Elliott J, Furlepa M, Lehmann J, Mangtani A, Narayan A, Nazarian S, Parmar C, Shah D, Shaw C, Zhao Z, Beck C, Caldwell S, Clements JM, French B, Kenny R, Kirk S, Lindsay J, McClung A, McLaughlin N, Watson S, Whiteside E, Alyacoubi S, Arumugam V, Beg R, Dawas K, Garg S, Lloyd ER, Mahfouz Y, Manobharath N, Moonesinghe R, Morka N, Patel K, Prashar J, Yip S, Adeeko ES, Ajekigbe F, Bhat A, Evans C, Farrugia A, Gurung C, Long T, Malik B, Manirajan S, Newport D, Rayer J, Ridha A, Ross E, Saran T, Sinker A, Waruingi D, Allen R, Al Sadek Y, Alves do Canto Brum H, Asharaf H, Ashman M, Balakumar V, Barrington J, Baskaran R, Berry A, Bhachoo H, Bilal A, Boaden L, Chia WL, Covell G, Crook D, Dadnam F, Davis L, De Berker H, Doyle C, Fox C, Gruffydd-Davies M, Hafouda Y, Hill A, Hubbard E, Hunter A, Inpadhas V, Jamshaid M, Jandu G, Jeyanthi M, Jones T, Kantor C, Kwak SY, Malik N, Matt R, McNulty P, Miles C, Mohomed A, Myat P, Niharika J, Nixon A, O'Reilly D, Parmar K, Pengelly S, Price L, Ramsden M, Turnor R, Wales E, Waring H, Wu M, Yang T, Ye TTS, Zander A, Zeicu C, Bellam S, Francombe J, Kawamoto N, Rahman MR, Sathyanarayana A, Tang HT, Cheung J, Hollingshead J, Page V, Sugarman J, Wong E, Chiong J, Fung E, Kan SY, Kiang J, Kok J, Krahelski O, Liew MY, Lyell B, Sharif Z, Speake D, Alim L, Amakye NY, Chandrasekaran J, Chandratreya N, Drake J, Owoso T, Thu YM, Abou El Ela Bourquin B, Alberts J, Chapman D, Rehnnuma N, Ainsworth K, Carpenter H, Emmanuel T, Fisher T, Gabrel M, Guan Z, Hollows S, Hotouras A, Ip Fung Chun N, Jaffer S, Kallikas G, Kennedy N, Lewinsohn B, Liu FY, Mohammed S, Rutherfurd A, Situ T, Stammer A, Taylor F, Thin N, Urgesi E, Zhang N, Ahmad MA, Bishop A, Bowes A, Dixit A, Glasson R, Hatta S, Hatt K, Larcombe S, Preece J, Riordan E, Fegredo D, Haq MZ, Li C, McCann G, Stewart D, Baraza W, Bhullar D, Burt G, Coyle J, Deans J, Devine A, Hird R, Ikotun O, Manchip G, Ross C, Storey L, Tan WWL, Tse C, Warner C, Whitehead M, Wu F, Court EL, Crisp E, Huttman M, Mayes F, Robertson H, Rosen H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Asif S, Kim RY, Fatica T, Sim J, Zhao X, Oh Y, Denoncourt A, Cheung A, Downey M, Mulvihill EE, Kim KH. Hmgcs2-mediated ketogenesis modulates high-fat diet-induced hepatosteatosis. Mol Metab 2022; 61:101494. [PMID: 35421611 PMCID: PMC9039870 DOI: 10.1016/j.molmet.2022.101494] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [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] [Received: 11/17/2021] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Aberrant ketogenesis is correlated with the degree of steatosis in NAFLD patients, and an inborn error of ketogenesis (mitochondrial HMG-CoA synthase deficiency) is commonly associated with the development of the fatty liver. Here we aimed to determine the impact of Hmgcs2-mediated ketogenesis and its modulations on the development and treatment of fatty liver disease. METHODS Loss- and gain-of-ketogenic function through in vivo and in vitro models, achieved by Hmgcs2 knockout and overexpression, respectively, were examined to investigate the role of ketogenesis in the hepatic lipid accumulation during neonatal development and the diet-induced NAFLD mouse model. RESULTS Ketogenic function was decreased in NAFLD mice with a reduction in Hmgcs2 expression. Mice lacking Hmgcs2 developed spontaneous fatty liver phenotype during postnatal development, which was rescued by a shift to a low-fat dietary composition via early weaning. Hmgcs2 heterozygous mice, which exhibited reduced ketogenic activity, were more susceptible to diet-induced NAFLD development, whereas HMGCS2 overexpression in NAFLD mice improved hepatosteatosis and glucose homeostasis. CONCLUSIONS Our study adds new knowledge to the field of ketone body metabolism and shows that Hmgcs2-mediated ketogenesis modulates hepatic lipid regulation under a fat-enriched nutritional environment. The regulation of hepatic ketogenesis may be a viable therapeutic strategy in the prevention and treatment of hepatosteatosis.
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Affiliation(s)
- Shaza Asif
- University of Ottawa Heart Institute, Ottawa, ON, K1Y 4W7, Canada; Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, K1H 8M5, Canada
| | - Ri Youn Kim
- University of Ottawa Heart Institute, Ottawa, ON, K1Y 4W7, Canada
| | - Thet Fatica
- University of Ottawa Heart Institute, Ottawa, ON, K1Y 4W7, Canada
| | - Jordan Sim
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, ON, K1H 8M5, Canada
| | - Xiaoling Zhao
- University of Ottawa Heart Institute, Ottawa, ON, K1Y 4W7, Canada
| | - Yena Oh
- University of Ottawa Heart Institute, Ottawa, ON, K1Y 4W7, Canada; Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, K1H 8M5, Canada
| | - Alix Denoncourt
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, K1H 8M5, Canada; Ottawa Institute of Systems Biology, Ottawa, ON, K1H 8M5, Canada
| | - Angela Cheung
- Gastroenterology and Hepatology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, K1H 8M5, Canada; The Ottawa Hospital Research Institute, Chronic Disease Program, Ottawa, ON, K1Y 4E9, Canada
| | - Michael Downey
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, K1H 8M5, Canada; Ottawa Institute of Systems Biology, Ottawa, ON, K1H 8M5, Canada
| | - Erin E Mulvihill
- University of Ottawa Heart Institute, Ottawa, ON, K1Y 4W7, Canada; Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, ON, K1H 8M5, Canada
| | - Kyoung-Han Kim
- University of Ottawa Heart Institute, Ottawa, ON, K1Y 4W7, Canada; Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, K1H 8M5, Canada.
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18
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Cordell HJ, Fryett JJ, Ueno K, Darlay R, Aiba Y, Hitomi Y, Kawashima M, Nishida N, Khor SS, Gervais O, Kawai Y, Nagasaki M, Tokunaga K, Tang R, Shi Y, Li Z, Juran BD, Atkinson EJ, Gerussi A, Carbone M, Asselta R, Cheung A, de Andrade M, Baras A, Horowitz J, Ferreira MA, Sun D, Jones DE, Flack S, Spicer A, Mulcahy VL, Byun J, Han Y, Sandford RN, Lazaridis KN, Amos CI, Hirschfield GM, Seldin MF, Invernizzi P, Siminovitch KA, Ma X, Nakamura M, Mells GF. Corrigendum to 'An international genome-wide meta-analysis of primary biliary cholangitis: Novel risk loci and candidate drugs' [J Hepatol 2021;75(3):572-581]. J Hepatol 2022; 76:489. [PMID: 34895949 PMCID: PMC8935376 DOI: 10.1016/j.jhep.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Heather J. Cordell
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - James J. Fryett
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Kazuko Ueno
- Genome Medical Science Project, National Center for Global Health and Medicine (NCGM), Tokyo, Japan
| | - Rebecca Darlay
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Yoshihiro Aiba
- Clinical Research Center, National Hospital Organization, Nagasaki Medical Center, Omura, Japan
| | - Yuki Hitomi
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Minae Kawashima
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nao Nishida
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Seik-Soon Khor
- Genome Medical Science Project, National Center for Global Health and Medicine (NCGM), Tokyo, Japan
| | - Olivier Gervais
- Human Biosciences Unit for the Top Global Course Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan,Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yosuke Kawai
- Genome Medical Science Project, National Center for Global Health and Medicine (NCGM), Tokyo, Japan
| | - Masao Nagasaki
- Human Biosciences Unit for the Top Global Course Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan,Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Katsushi Tokunaga
- Genome Medical Science Project, National Center for Global Health and Medicine (NCGM), Tokyo, Japan
| | - Ruqi Tang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Yongyong Shi
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Collaborative Innovation Center for Brain Science, Shanghai Jiao Tong University, Shanghai, China,Affiliated Hospital of Qingdao University and Biomedical Sciences Institute of Qingdao University (Qingdao Branch of SJTU Bio-X Institutes), Qingdao University, Qingdao, China
| | - Zhiqiang Li
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Collaborative Innovation Center for Brain Science, Shanghai Jiao Tong University, Shanghai, China,Affiliated Hospital of Qingdao University and Biomedical Sciences Institute of Qingdao University (Qingdao Branch of SJTU Bio-X Institutes), Qingdao University, Qingdao, China
| | - Brian D. Juran
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
| | - Elizabeth J. Atkinson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States
| | - Alessio Gerussi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Marco Carbone
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Rosanna Asselta
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy,Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Angela Cheung
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
| | - Mariza de Andrade
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States
| | - Aris Baras
- Regeneron Genetics Center, Tarrytown, New York, United States
| | - Julie Horowitz
- Regeneron Genetics Center, Tarrytown, New York, United States
| | | | - Dylan Sun
- Regeneron Genetics Center, Tarrytown, New York, United States
| | - David E. Jones
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Steven Flack
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | - Ann Spicer
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | - Victoria L. Mulcahy
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | - Jinyoung Byun
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, United States
| | - Younghun Han
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, United States
| | - Richard N. Sandford
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | | | - Christopher I. Amos
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, United States
| | - Gideon M. Hirschfield
- Toronto Centre for Liver Disease, Division of Gastroenterology and Hepatology, University of Toronto, Toronto, Ontario, Canada
| | | | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Katherine A. Siminovitch
- Departments of Medicine, Immunology and Medical Sciences, University of Toronto, Toronto, Ontario, Canada,Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute and Toronto General Research Institute, Toronto, Ontario, Canada
| | - Xiong Ma
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Minoru Nakamura
- Clinical Research Center, National Hospital Organization, Nagasaki Medical Center, Omura, Japan,Department of Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Omura, Japan
| | - George F. Mells
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom,Corresponding author. Address: Academic Department of Medical Genetics, University of Cambridge, Box 238, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom.
| | - Canadian PBC ConsortiumSiminovitchKatherine A.252627HirschfieldGideon M.28MasonAndrew29VincentCatherine30XieGang31ZhangJinyi32Departments of Medicine, Immunology and Medical Sciences, University of Toronto, CanadaMount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute, CanadaToronto General Research Institute, Toronto, Ontario, CanadaToronto Centre for Liver Disease, Division of Gastroenterology and Hepatology, University of Toronto, Toronto, Ontario, CanadaDept of Medicine, University of Alberta, Edmonton, Alberta, CanadaUniversite de Montreal Hospital Centre, Saint-Luc Hospital, Montreal, Quebec, CanadaLunenfeld Tanenbaum Research Institute, Toronto, CanadaLunenfeld Tanenbaum Research Institute, Toronto, Canada
| | - Chinese PBC ConsortiumTangRuqi33MaXiong33LiZhiqiang3435ShiYongyong3435Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, ChinaBio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Collaborative Innovation Center for Brain Science, Shanghai Jiao Tong University, ChinaAffiliated Hospital of Qingdao University and Biomedical Sciences Institute of Qingdao University (Qingdao Branch of SJTU Bio-X Institutes), Qingdao University, China
| | - Italian PBC Study GroupAffrontiAndrea36AlmasioPiero L.37AlvaroDomenico38AndreonePietro39AndriulliAngelo40AzzaroliFrancesco41BattezzatiPier Maria42BenedettiAntonio43BragazziMaria Consiglia44BrunettoMaurizia45BrunoSavino46CalvarusoVincenza47CardinaleVincenzo48CasellaGiovanni49CazzagonNora50CiaccioAntonio51CocoBarbara52ColliAgostino53ColloredoGuido54ColomboMassimo55ColomboSilvia56CristoferiLaura57CursaroCarmela58CrocèLory Saveria59CrosignaniAndrea60D’AmatoDaphne61DonatoFrancesca62EliaGianfranco63FabrisLuca64FagiuoliStefano65FerrariCarlo66FloreaniAnnarosa67GalliAndrea68GianniniEdoardo69GrattaglianoIgnazio70LamperticoPietro71LleoAna72MalinvernoFederica73MancusoClara74MarraFabio75MarzioniMarco76MassironiSara77MattaliaAlberto78MieleLuca79MilaniChiara80MoriniLorenzo81MoriscoFilomena82MuratoriLuigi83MuratoriPaolo84NiroGrazia A.85O’DonnellSarah86PicciottoAntonio87PortincasaPiero88RigamontiCristina89RoncaVincenzo90RosinaFloriano91SpinziGiancarlo92StrazzaboscoMario93TarocchiMirko94TiribelliClaudio95ToniuttoPierluigi96ValentiLuca97VinciMaria98ZuinMassimo99Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, ItalyGastroenterology & Hepatology Unit, Di.Bi.M.I.S., University of Palermo, Palermo, ItalyDepartment of Medico-Surgical Sciences and Biotechnologies, Polo Pontino, University Sapienza of Rome; Eleonora Lorillard Spencer-Cenci Foundation, Rome, ItalyDepartment of Medical and Surgical Sciences, Bologna University, Bologna, ItalyIRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, ItalyDepartment of Medical and Surgical Sciences (DIMEC) University of Bologna, Bologna, ItalySan Paolo Hospital Medical School, Università di Milano, Milan, ItalyUniversitàPolitecnica delle Marche, Ancona, ItalyDepartment of Medico-Surgical Sciences and Biotechnologies, Polo Pontino, University Sapienza of Rome, Rome, ItalyAzienda Ospedaliera Universitaria Pisana, Pisa, ItalyDepartment of Internal Medicine, Ospedale Fatebene Fratelli e Oftalmico, Milan, ItalySezione di Gastroenterologia e Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S.) University of Palermo, Palermo, ItalyDepartment of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Viale dell'Università37, 00185, Rome, ItalyMedical Department, Desio Hospital, Desio, ItalyDepartment of Surgery, Oncology and Gastroenterology, University of Padua, Padova, ItalyDivision of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, ItalyAzienda Ospedaliera Universitaria Pisana, Pisa, ItalyDepartment of Internal Medicine, AO Provincia di Lecco, Lecco, ItalyDepartment of Internal Medicine, San Pietro Hospital, Bergamo, Ponte San Pietro, ItalyHumanitas Clinical and Research Center, IRCCS, Rozzano, ItalyTreviglio Hospital, Treviglio, ItalyDivision of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, ItalyHepatology Unit, Department of Medical and Surgical Sciences, University Hospital of Bologna, ItalyUniversity of Trieste, & Fondazione Italiana Fegato (FIF) Trieste, ItalySan Paolo Hospital Medical School, Universitàdi Milano, Milan, ItalyDivision of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, ItalyFondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, ItalyAzienda Ospedaliero-Universitaria di Parma, Parma, ItalyUniversity of Padova, Padova, ItalyGastroenterologia Epatologia e Trapiantologia, Papa Giovanni XXIII Hospital, Bergamo, ItalyAzienda Ospedaliero-Universitaria di Parma, Parma, ItalyDepartment. of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, ItalyUniversity of Florence, Florence, ItalyGastroenterology Unit, Department Internal Medicine, Policlinico San Martino, University of Genoa, Genoa, ItalyItalian College of General Practicioners, ASL Bari, ItalyDivision of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Via A. Manzoni 56, 20089 Rozzano (MI), ItalyDivision of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, ItalyDivision of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, ItalyUniversity of Florence, Florence, ItalyUniversità Politecnica delle Marche, Ancona, ItalyDivision of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, ItalySanta Croce Carle Hospital, Cuneo, ItalyInternal Medicine, Gastroenterology and Liver Unit, A. Gemelli Polyclinic, Sacro Cuore Catholic University, 20123 Rome, ItalyDivision of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, ItalyMagenta Hospital, Magenta, ItalyUniversity of Naples, Federico II, Naples, ItalyDepartment of Clinical Medicine, University of Bologna, Bologna, ItalyDepartment of Clinical Medicine, University of Bologna, Bologna, ItalyIRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, ItalyDivision of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, ItalyUniversity of Genoa, Genoa, ItalyDepartment of Interdisciplinary Medicine, University Medical School, Bari, ItalyDepartment of Translational Medicine, Universitàdel Piemonte Orientale UPO, 28100 Novara, ItalyDivision of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, ItalyDivision of Gastroenterology & Hepatology, Center for Predictive Medicine, Gradenigo Hospital, Turin, ItalyAzienda Ospedaliera Valduce, Como, ItalyYale University, New Haven, Connecticut, USAUniversity of Florence, Florence, ItalyUniversity of Trieste, & Fondazione Italiana Fegato (FIF) Trieste, ItalyUniversity of Udine, Udine, ItalyInternal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Policlinico Milano, Department of Pathophysiology and Transplantation, Universitàdegli Studi di Milano, Milan, ItalyOspedale Niguarda, Milan, ItalySan Paolo Hospital Medical School, Università di Milano, Milan, Italy
| | - Japan-PBC-GWAS ConsortiumNakamuraHitomi100AbiruSeigo100NagaokaShinya100KomoriAtsumasa100YatsuhashiHiroshi100IshibashiHiromi100ItoMasahiro100MigitaKiyoshi101OhiraHiromasa101KatsushimaShinji102NaganumaAtsushi102SugiKazuhiro102KomatsuTatsuji102MannamiTomohiko102MatsushitaKouki102YoshizawaKaname102MakitaFujio102NikamiToshiki102NishimuraHideo102KounoHiroshi102KounoHirotaka102OtaHajime102KomuraTakuya102NakamuraYoko102ShimadaMasaaki102HirashimaNoboru102KomedaToshiki102ArioKeisuke102NakamutaMakoto102YamashitaTsutomu102FurutaKiyoshi102KikuchiMasahiro102NaeshiroNoriaki102TakahashiHironao102ManoYutaka102TsunematsuSeiji102YabuuchiIwao102ShimadaYusuke102YamauchiKazuhiko102SugimotoRie102SakaiHironori102MitaEiji102KodaMasaharu102TsurutaSatoru102KamitsukasaHiroshi102SatoTakeaki102MasakiNaohiko102KobataTatsuro102FukushimaNobuyoshi102OharaYukio102MuroToyokichi102TakesakiEiichi102TakakiHitoshi102YamamotoTetsuo102KatoMichio102NagaokiYuko102HayashiShigeki102IshidaJinya102WatanabeYukio102KobayashiMasakazu102KogaMichiaki102SaoshiroTakeo102YaguraMichiyasu102HirataKeisuke102TanakaAtsushu103TakikawaHajime103ZeniyaMikio104AbeMasanori105OnjiMorikazu105KanekoShuichi106HondaMasao106AraiKuniaki106Arinaga-HinoTeruko107HashimotoEtsuko108TaniaiMakiko108UmemuraTakeji109JoshitaSatoru109NakaoKazuhiko110IchikawaTatsuki110ShibataHidetaka110YamagiwaSatoshi111SeikeMasataka112HondaKoichi112SakisakaShotaro113TakeyamaYasuaki113HaradaMasaru114SenjuMichio114YokosukaOsamu115KandaTatsuo115UenoYoshiyuki116KikuchiKentaro117EbinumaHirotoshi118HimotoTakashi119YasunamiMichio120MurataKazumoto121MizokamiMasashi121KawataKazuhito122ShimodaShinji123MiyakeYasuhiro124TakakiAkinobu124YamamotoKazuhide124HiranoKatsuji125IchidaTakafumi125IdoAkio126TsubouchiHirohito126ChayamaKazuaki127HaradaKenichi128NakanumaYasuni128MaeharaYoshihiko129TaketomiAkinobu129ShirabeKen129SoejimaYuji129MoriAkira130YagiShintaro130UemotoShinji130HEgawa131TanakaTomohiro132YamashikiNoriyo132TamuraSumito133SugawaraYasuhiro133KokudoNorihiro133Clinical Research Center, National Hospital Organization (NHO) Nagasaki Medical Center, Omura, JapanDepartment of Gastroenterology and Rheumatic Diseases, Fukushima Medical University of Medicine, Fukushima, JapanHeadquaters of PBC Research in the NHO Study Group for Liver Disease in Japan (NHOSLJ), Clinical Research Center, NHO Nagasaki Medical Center, Omura, Nagasaki, JapanDepartment of Medicine, Teikyo University School of Medicine, Tokyo, JapanDepartment of Gastroenterology and Hepatology, Tokyo Jikei University School of Medicine, Tokyo, JapanDepartment of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Matsuyama, JapanDepartment of Gastroenterology, Kanazawa University Graduate School of Medicine, Kanazawa, JapanDivision of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, JapanDepartment of Medicine and Gastroenterology, Tokyo Women’s Medical University, Tokyo, JapanDepartment of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, JapanDepartment of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JapanDivision of Gastroenterology and Hepatology,Niigata University Graduate School of Medical and Dental Sciences, Niigata, JapanFaculty of Medicine, Oita University, Oita, JapanDepartment of Gastroenterology and Medicine, Fukuoka University School of Medicine, Fukuoka, JapanThe Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, JapanDepartment of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba, JapanDepartment of Gastroenterology, Yamagata University Faculty of Medicine, Yamagata, JapanDepartment of Internal Medicine, Teikyo University Mizonokuchi Hospital, Kawasaki, JapanDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Keio Graduate School of Medicine, Tokyo, JapanDepartment of Medical Technology, Kagawa Prefectural University of Health Sciences, Kagawa, JapanDepartment of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasakin, JapanThe Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Ichikawa, JapanHepatology Division, Department of Internal Medicine II, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka JapanDepartment of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, JapanDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JapanDepartment of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, JapanDepartment of Digestive and Lifestyle–Related Disease, Kagoshima University Graduate School of Medical and Dental Science, Kagoshima, JapanDepartment of Gastroenterology and Metabolism, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, JapanDepartment of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, JapanDepartment of Surgery and Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, JapanDivision of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, JapanDepartment of Surgery, Tokyo Women’s Medical University, Tokyo, JapanOrgan Transplantation Service, The University of Tokyo, Tokyo, JapanHepatobiliary and Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Japan
| | - US PBC ConsortiumJuranBrian D.134AtkinsonElizabeth J.135CheungAngela136de AndradeMariza137LazaridisKonstantinos N.138ChalasaniNaga139LuketicVel140OdinJoseph141ChopraKapil142BarasAris143HorowitzJulie143AbecasisGoncalo143CantorMichael143CoppolaGiovanni143EconomidesAris143LottaLuca A.143OvertonJohn D.143ReidJeffrey G.143ShuldinerAlan143BeechertChristina143ForsytheCaitlin143FullerErin D.143GuZhenhua143LattariMichael143LopezAlexander143OvertonJohn D.143SchleicherThomas D.143PadillaMaria Sotiropoulos143ToledoKarina143WidomLouis143WolfSarah E.143PradhanManasi143ManoochehriKia143UlloaRicardo H.143BaiXiaodong143BalasubramanianSuganthi143BarnardLeland143BlumenfeldAndrew143EomGisu143HabeggerLukas143HawesAlicia143KhalidShareef143ReidJeffrey G.143MaxwellEvan K.143SalernoWilliam143StaplesJeffrey C.143JonesMarcus B.143MitnaulLyndon J.143Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United StatesDivision of Biomedical Statistics and Informatics Mayo Clinic, Rochester, Minnesota, United StatesDivision of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United StatesDivision of Biomedical Statistics and Informatics Mayo Clinic, Rochester, Minnesota, United StatesDivision of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United StatesIndiana University, Indiana, United StatesVirginia Commonwealth University, Virginia, United StatesIcahn School of Medicine, Mount Sinai, New York, United StatesUniversity of Pittsburgh, United StatesRegeneron, United States
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19
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Cheung A, Chan PK, Fu H, Cheung MH, Chan VWK, Yan CH, Chiu KY. Total knee arthroplasty is safe for patients aged ≥80 years in Hong Kong. Hong Kong Med J 2021; 27:350-354. [PMID: 34706985 DOI: 10.12809/hkmj208942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Total knee arthroplasty (TKA) is an efficacious operation that improves pain and function in patients with knee arthritis. Because of the population ageing trend in Hong Kong, there is a need to determine the safety profile of TKA in older patients. This study examined the age of patients who underwent TKA in the past 10 years in Hong Kong; the aim was to investigate the mortality safety profile and clinical outcomes of TKA in patients aged ≥80 years. METHODS This study included all patients who underwent primary TKA in the Hospital Authority (HA) from 2010 to 2019. Incidences of 30-day, 90-day, and 1-year mortality were established. Clinical outcomes of patients aged ≥80 years in one cluster of HA hospitals were assessed. RESULTS Between 2010 and 2019, 25 040 TKA procedures were conducted in all HA hospitals; 2491 were conducted in patients aged ≥80 years. The median age at operation was higher during 2015-2019 than during 2010-2014 (70 vs 69 years; P<0.001); furthermore, an increase was observed in the proportion of patients aged ≥80 years at the time of operation. Incidences of 30-day, 90-day, and 1-year mortality were 0.156%, 0.35%, and 1.09%, respectively. CONCLUSIONS In this first study to examine the safety profile of TKA in older patients in Hong Kong, the mean age at the time of TKA and proportion of patients aged ≥80 years have steadily risen in the past decade. Even in older patients, TKA is a reasonably safe procedure.
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Affiliation(s)
- A Cheung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong
| | - P K Chan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong
| | - H Fu
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong
| | - M H Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - V W K Chan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong
| | - C H Yan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - K Y Chiu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
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20
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Akodad M, Sathananthan G, Chatfield AG, Trpkov C, Lounes Y, Chuang A, Wood DA, Boone RH, Moss R, Cheung A, Ye J, Blanke P, Leipsic J, Sathananthan J, Webb JG. Transcatheter mitral valve-in-valve implantation: a 10-year single center experience. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2216] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Transcatheter mitral valve-in-valve (TMVIV) appears a reasonable alternative to surgical redo mitral valve replacement in patients with degenerated mitral prosthesis and high surgical risk with favorable early and mid-terms outcomes. Long-term outcomes are limited by high mortality in a comorbid population.
Purpose
We aimed to evaluate early prosthesis hemodynamic performance and late clinical outcomes following TMVIV.
Methods
All patients who underwent TMVIV for degenerated surgical mitral bioprostheses from 2011 to 2020 in our center were included. Prospectively collected demographic, clinical, procedural, and imaging variables were analyzed. Clinical and echocardiographic outcomes were defined according to Mitral Valve Academic Research Consortium (MVARC) definitions and assessed at 30-day and at the latest follow-up available.
Results
A total of 67 patients were included; mean age 76.9±9.6 years, mean STS score 11.0±6.2%, 53.7% male (n=36). Mechanisms of bioprosthetic failure were mitral stenosis (n=32, 47.8%), mitral regurgitation (n=24, 35.8%), and mixed (n=11, 16.4%). Mean time from mitral valve surgery to TMVIV was 10.2±4.3 years. Access was mostly transapical (n=45; 67.2%), followed by transseptal (n=22; 32.8%). Following the first transseptal procedure in 2016; transseptal access accounted for the majority of procedures (22 of 37 cases, 59.4%).
Technical success was achieved in 65 patients (97.0%). Mean hospitalization was 9.2±10.0 days; shorter with the transseptal as opposed to the transapical approach (6.3±8.1 days versus 11.0±10.5 days, p=0.001). At 30-day echographic follow-up, mean mitral valve gradient was 7.3±2.7 and 1 patient (1.9%) had mitral regurgitation >mild.
At 30-day follow-up, 3 patients had died (4.5%); due to left ventricular outflow tract obstruction (1), heart failure (1), and stroke (1). New pacemakers were required in 2 patients (3.0%) and pacemaker lead dislodgement occurred in 1 patient (1.5%), 4 patients (6.2%) were hospitalized for heart failure. At a median follow-up of 3.8 years [1.7–5.1], 29 patients had died (43.3%), valve thrombosis was found in 6 (8.9%) and endocarditis in 4 patients (6.2%). Mitral valve reintervention was performed in 4 patients (6.2%); redo TMVIV due to valve migration in 1 (1.9%), surgical valve replacement in 1 (1.9%), and delayed redilation with a non-compliant balloon due to underexpansion in 2 patients (3.8%).
Conclusion
TMVIV is associated with acceptable 30-day mitral valve hemodynamics. Long-term mortality remains high in this high-surgical risk comorbid group.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Akodad
- St Paul's Hospital, Vancouver, Canada
| | | | | | - C Trpkov
- St Paul's Hospital, Vancouver, Canada
| | - Y Lounes
- Vancouver General Hospital, Vancouver, Canada
| | - A Chuang
- St Paul's Hospital, Vancouver, Canada
| | - D A Wood
- St Paul's Hospital, Vancouver, Canada
| | - R H Boone
- St Paul's Hospital, Vancouver, Canada
| | - R Moss
- St Paul's Hospital, Vancouver, Canada
| | - A Cheung
- St Paul's Hospital, Vancouver, Canada
| | - J Ye
- St Paul's Hospital, Vancouver, Canada
| | - P Blanke
- St Paul's Hospital, Vancouver, Canada
| | - J Leipsic
- St Paul's Hospital, Vancouver, Canada
| | | | - J G Webb
- St Paul's Hospital, Vancouver, Canada
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21
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Kwan LYA, Lee J, Cheung A, Chan J. 838 Pulmonary Embolectomy: Techniques and Outcomes from The Literature. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Aim
Pulmonary embolectomy involves the surgical removal of a thrombus from the pulmonary tree, with the most popular approaches being surgical embolectomy (SE), percutaneous pulmonary embolectomy (PPE) and minimally invasive thoracotomy (MIT). The latter two new techniques are gradually increasing in popularity in the treatment of acute pulmonary embolism (PE) due to reduced recovery times. This study aims to evaluate and compare the clinical outcomes of the three aforementioned techniques in the treatment of acute PE.
Method
A literature review was performed with PUBMED to identify studies reporting these interventions. 79 papers were included, involving a total of 2445 patients. Patients’ baseline characteristics and perioperative status, inpatient mortality rates and complication rates of each intervention group were individually assessed and compared.
Results
Among all three interventions, SE studies demonstrated the highest in-patient mortality rate (20.8%). Patients receiving SE are also more likely to have pulmonary (2.8%) and other postoperative bleeding (7.4%). PPE patients are more likely to develop gastrointestinal bleeding and surgical site complications (4%). Scatter graph of the SE studies showed a declining trend of mortality rate over time (R²=0.50).
Conclusions
All three methods are effective in treating acute PE, while SE showed a trend of decreasing mortality over time. Further research on PPE and MIT is needed to define its place in the treatment of acute PE.
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Affiliation(s)
- L Y A Kwan
- St Georges, University of London, London, United Kingdom
| | - J Lee
- Darent Valley Hospital, Dartford, United Kingdom
| | - A Cheung
- Medway Maritime Hospital, Medway, United Kingdom
| | - J Chan
- University of Bristol, Bristol, United Kingdom
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22
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Cordell HJ, Fryett JJ, Ueno K, Darlay R, Aiba Y, Hitomi Y, Kawashima M, Nishida N, Khor SS, Gervais O, Kawai Y, Nagasaki M, Tokunaga K, Tang R, Shi Y, Li Z, Juran BD, Atkinson EJ, Gerussi A, Carbone M, Asselta R, Cheung A, de Andrade M, Baras A, Horowitz J, Ferreira MAR, Sun D, Jones DE, Flack S, Spicer A, Mulcahy VL, Byan J, Han Y, Sandford RN, Lazaridis KN, Amos CI, Hirschfield GM, Seldin MF, Invernizzi P, Siminovitch KA, Ma X, Nakamura M, Mells GF. An international genome-wide meta-analysis of primary biliary cholangitis: Novel risk loci and candidate drugs. J Hepatol 2021; 75:572-581. [PMID: 34033851 PMCID: PMC8811537 DOI: 10.1016/j.jhep.2021.04.055] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [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] [Received: 08/25/2020] [Revised: 03/11/2021] [Accepted: 04/07/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUNDS & AIMS Primary biliary cholangitis (PBC) is a chronic liver disease in which autoimmune destruction of the small intrahepatic bile ducts eventually leads to cirrhosis. Many patients have inadequate response to licensed medications, motivating the search for novel therapies. Previous genome-wide association studies (GWAS) and meta-analyses (GWMA) of PBC have identified numerous risk loci for this condition, providing insight into its aetiology. We undertook the largest GWMA of PBC to date, aiming to identify additional risk loci and prioritise candidate genes for in silico drug efficacy screening. METHODS We combined new and existing genotype data for 10,516 cases and 20,772 controls from 5 European and 2 East Asian cohorts. RESULTS We identified 56 genome-wide significant loci (20 novel) including 46 in European, 13 in Asian, and 41 in combined cohorts; and a 57th genome-wide significant locus (also novel) in conditional analysis of the European cohorts. Candidate genes at newly identified loci include FCRL3, INAVA, PRDM1, IRF7, CCR6, CD226, and IL12RB1, which each play key roles in immunity. Pathway analysis reiterated the likely importance of pattern recognition receptor and TNF signalling, JAK-STAT signalling, and differentiation of T helper (TH)1 and TH17 cells in the pathogenesis of this disease. Drug efficacy screening identified several medications predicted to be therapeutic in PBC, some of which are well-established in the treatment of other autoimmune disorders. CONCLUSIONS This study has identified additional risk loci for PBC, provided a hierarchy of agents that could be trialled in this condition, and emphasised the value of genetic and genomic approaches to drug discovery in complex disorders. LAY SUMMARY Primary biliary cholangitis (PBC) is a chronic liver disease that eventually leads to cirrhosis. In this study, we analysed genetic information from 10,516 people with PBC and 20,772 healthy individuals recruited in Canada, China, Italy, Japan, the UK, or the USA. We identified several genetic regions associated with PBC. Each of these regions contains several genes. For each region, we used diverse sources of evidence to help us choose the gene most likely to be involved in causing PBC. We used these 'candidate genes' to help us identify medications that are currently used for treatment of other conditions, which might also be useful for treatment of PBC.
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Affiliation(s)
- Heather J Cordell
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - James J Fryett
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Kazuko Ueno
- Genome Medical Science Project, National Center for Global Health and Medicine (NCGM), Tokyo, Japan
| | - Rebecca Darlay
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Yoshihiro Aiba
- Clinical Research Center, National Hospital Organization, Nagasaki Medical Center, Omura, Japan
| | - Yuki Hitomi
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Minae Kawashima
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nao Nishida
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Seik-Soon Khor
- Genome Medical Science Project, National Center for Global Health and Medicine (NCGM), Tokyo, Japan
| | - Olivier Gervais
- Human Biosciences Unit for the Top Global Course Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan; Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yosuke Kawai
- Genome Medical Science Project, National Center for Global Health and Medicine (NCGM), Tokyo, Japan
| | - Masao Nagasaki
- Human Biosciences Unit for the Top Global Course Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan; Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Katsushi Tokunaga
- Genome Medical Science Project, National Center for Global Health and Medicine (NCGM), Tokyo, Japan
| | - Ruqi Tang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Yongyong Shi
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Collaborative Innovation Center for Brain Science, Shanghai Jiao Tong University, Shanghai, China; Affiliated Hospital of Qingdao University and Biomedical Sciences Institute of Qingdao University (Qingdao Branch of SJTU Bio-X Institutes), Qingdao University, Qingdao, China
| | - Zhiqiang Li
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Collaborative Innovation Center for Brain Science, Shanghai Jiao Tong University, Shanghai, China; Affiliated Hospital of Qingdao University and Biomedical Sciences Institute of Qingdao University (Qingdao Branch of SJTU Bio-X Institutes), Qingdao University, Qingdao, China
| | - Brian D Juran
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
| | - Elizabeth J Atkinson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States
| | - Alessio Gerussi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Marco Carbone
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Rosanna Asselta
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Angela Cheung
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
| | - Mariza de Andrade
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States
| | - Aris Baras
- Regeneron Genetics Center, Tarrytown, New York, United States
| | - Julie Horowitz
- Regeneron Genetics Center, Tarrytown, New York, United States
| | | | - Dylan Sun
- Regeneron Genetics Center, Tarrytown, New York, United States
| | - David E Jones
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Steven Flack
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | - Ann Spicer
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | - Victoria L Mulcahy
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | - Jinyoung Byan
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, United States
| | - Younghun Han
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, United States
| | - Richard N Sandford
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | | | - Christopher I Amos
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, United States
| | - Gideon M Hirschfield
- Toronto Centre for Liver Disease, Division of Gastroenterology and Hepatology, University of Toronto, Toronto, Ontario, Canada
| | | | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Katherine A Siminovitch
- Departments of Medicine, Immunology and Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute and Toronto General Research Institute, Toronto, Ontario, Canada
| | - Xiong Ma
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Minoru Nakamura
- Clinical Research Center, National Hospital Organization, Nagasaki Medical Center, Omura, Japan; Department of Hepatology, Nagasaki Graduate School of Biomedical Sciences, Japan
| | - George F Mells
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom.
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Cheung A, Dufour S, Jones G, Kostoulas P, Stevenson MA, Singanallur NB, Firestone SM. Bayesian latent class analysis when the reference test is imperfect. REV SCI TECH OIE 2021; 40:271-286. [PMID: 34140724 DOI: 10.20506/rst.40.1.3224] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Latent class analysis (LCA) has allowed epidemiologists to overcome the practical constraints faced by traditional diagnostic test evaluation methods, which require both a gold standard diagnostic test and ample numbers of appropriate reference samples. Over the past four decades, LCA methods have expanded to allow epidemiologists to evaluate diagnostic tests and estimate true prevalence using imperfect tests over a variety of complex data structures and scenarios, including during the emergence of novel infectious diseases. The objective of this review is to provide an overview of recent developments in LCA methods, as well as a practical guide to applying Bayesian LCA (BLCA) to the evaluation of diagnostic tests. Before conducting a BLCA, the suitability of BLCA for the pathogen of interest, the availability of appropriate samples, the number of diagnostic tests, and the structure of the data should be carefully considered. While formulating the model, the model's structure and specification of informative priors will affect the likelihood that useful inferences can be drawn. With the growing need for advanced analytical methods to evaluate diagnostic tests for newly emerging diseases, LCA is a promising field of research for both the veterinary and medical disciplines.
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Lim F, Guo D, Chen J, Law A, Poon ZY, Cheung A, Tan JC, Kong SL, Loh AHL, Tan MGK, Li S, Lim KH, Thumboo J, Ng CT, Hwang W, Low A, Fan X. POS0417 EXOGENOUS CXCL5 RESTORES ENDOGENOUS BLOOD-TISSUE CHEMOKINE GRADIENT TO IMPROVE SURVIVAL IN MURINE LUPUS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disease that is potentially fatal. There is an unmet need to improve current therapies. In patients with SLE, we observed that serum CXCL5 levels were significantly lower than healthy control subjects and negatively correlated with disease activity(1-9).Objectives:The aim of this study is to elucidate the effect of supplemental serum CXCL5 in abrogating the pathological processes of SLE.Methods:Ten doses of exogenous CXCL5 (3µg/kg) was administered to 16-week-old Faslpr mice weekly by intravenous injection. Mice were monitored for 10 weeks. Splenic immune profile was measured by flow cytometry. Circulating cytokine and immunoglobulin profile were detected by Luminex technology. Renal function was evaluated by urinary spot albumin creatinine ratio. In situ renal immune cell infiltration and complement 3 deposition were detected by Haematoxylin and Eosin (H&E) and immunohistochemistry staining. The molecular pathways involved were examined by RNA sequencing.Results:In Faslpr mice, intravenous administration of exogenous CXCL5 significantly improved mouse survival with concomitant reduction of autoantibody secretion, proteinuria, complement 3 deposition, neutrophil infiltration and lupus nephritis classes. Through evaluating the changes of immune profile, cytokine profile and molecular pathways, we found that intravenous CXCL5 reduced inflammation via an orchestral effect of regulating neutrophil trafficking and modulating helper T cell-mediated immune response. Pharmacokinetic and real-time Polymerase Chain Reaction studies further demonstrated that this orchestration was triggered by a cascade reaction - restoring vascular under-expressed CXCL5 by an exogenous stimulation, re-establishing the normal serum levels of endogenous CXCL5 and reverting the CXCL5 chemokine gradient between inflamed tissues and blood circulation.Conclusion:Managing the dysregulation of CXCL5 by exogenous supplement may provide a new option for SLE therapy.References:[1]Dufies M, Grytsai O, Ronco C, et al. New CXCR1/CXCR2 inhibitors represent an effective treatment for kidney or head and neck cancers sensitive or refractory to reference treatments. Theranostics. 2019;9(18):5332-5346. doi:10.7150/thno.34681[2]Yildirim K, Colak E, Aktimur R, et al. Clinical Value of CXCL5 for Determining of Colorectal Cancer. Asian Pac J Cancer Prev. Sep 26 2018;19(9):2481-2484. doi:10.22034/apjcp.2018.19.9.2481[3]Wu K, Yu S, Liu Q, Bai X, Zheng X. The clinical significance of CXCL5 in non-small cell lung cancer. Onco Targets Ther. 2017;10:5561-5573. doi:10.2147/ott.s148772[4]Zhao J, Ou B, Han D, et al. Tumor-derived CXCL5 promotes human colorectal cancer metastasis through activation of the ERK/Elk-1/Snail and AKT/GSK3beta/beta-catenin pathways. Mol Cancer. Mar 29 2017;16(1):70. doi:10.1186/s12943-017-0629-4[5]Han KQ, Han H, He XQ, et al. Chemokine CXCL1 may serve as a potential molecular target for hepatocellular carcinoma. Cancer Med. Oct 2016;5(10):2861-2871. doi:10.1002/cam4.843[6]Pappa CA, Tsirakis G, Kanellou P, et al. Monitoring serum levels ELR+ CXC chemokines and the relationship between microvessel density and angiogenic growth factors in multiple myeloma. Cytokine. Dec 2011;56(3):616-20. doi:10.1016/j.cyto.2011.08.034[7]Zhang L, Li H, Ge C, et al. CXCL3 contributes to CD133(+) CSCs maintenance and forms a positive feedback regulation loop with CD133 in HCC via Erk1/2 phosphorylation. Sci Rep. Jun 3 2016;6:27426. doi:10.1038/srep27426[8]Matsubara J, Honda K, Ono M, et al. Reduced plasma level of CXC chemokine ligand 7 in patients with pancreatic cancer. Cancer Epidemiol Biomarkers Prev. Jan 2011;20(1):160-71. doi:10.1158/1055- 9965.epi-10-0397[9]Ma Y, Ren Y, Dai ZJ, Wu CJ, Ji YH, Xu J. IL-6, IL-8 and TNF-alpha levels correlate with disease stage in breast cancer patients. Adv Clin Exp Med. May-Jun 2017;26(3):421-426. doi:10.17219/acem/62120Disclosure of Interests:None declared
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Gui C, Rocos B, Lohkamp LN, Cheung A, Bleakney R, Massicotte E. Utility of the spinal instability neoplastic score to identify patients with Gorham-Stout disease requiring spine surgery. Surg Neurol Int 2021; 12:227. [PMID: 34221558 PMCID: PMC8247937 DOI: 10.25259/sni_311_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/19/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Gorham-Stout disease (GSD) is a rare syndrome presenting with progressive osteolysis which in the spine can lead to cord injury, instability, and deformity. Here, the early spine surgery may prevent catastrophic outcomes. Case Description: A 25-year-old male with GSD involving the T2 to T6 levels presented with acute traumatic kyphoscoliosis at T3 and T4 and left lower extremity paraparesis. The CT scan 4 weeks before this showed progressing osteolysis versus the CT 5 years ago. Unfortunately, the patient underwent delayed treatment resulting in permanent neurological sequelae. Surgery included a laminectomy and vertebrectomy of T3/T4 with instrumented fusion from T1-10. The use of the spinal instability neoplastic score (SINS) is a useful tool to prompt early referral to spine surgeons. Conclusion: We recommend using the SINS score in GSD patients who develop spinal lesions to prompt early referral for consideration of surgery.
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Affiliation(s)
- Chloe Gui
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Brett Rocos
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Laura-Nanna Lohkamp
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Angela Cheung
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Robert Bleakney
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Eric Massicotte
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
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Chan VW, Chan PK, Fu H, Cheung MH, Cheung A, Yan CH, Chiu KY. Preoperative optimization to prevent periprosthetic joint infection in at-risk patients. J Orthop Surg (Hong Kong) 2021; 28:2309499020947207. [PMID: 32851909 DOI: 10.1177/2309499020947207] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Periprosthetic joint infection (PJI) remains an important complication with devastating consequences after total joint arthroplasties. With the increasing number of arthroplasties worldwide, the number of PJI will increase correspondingly with a significant economic burden to our healthcare system. It is likely impossible to completely eradicate PJI; hence, assessment and optimization of its risk factors to preventing such a disastrous complication will be the key. There are many strategies to prevent PJI in the preoperative, intraoperative, or postoperative phases. The preoperative assessment provides a unique opportunity to screen and diagnose underlying comorbidities and optimize modifiable risk factors before elective surgeries. In this review, we will focus on current literature in preoperative assessment of various modifiable risk factors and share the experience and practical approach in our institution in preoperative optimization to reduce PJI in total joint arthroplasties.
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Affiliation(s)
- Vincent Wk Chan
- Division of Joint Replacement Surgery, Department of Orthopaedics and Traumatology, The University of Hong Kong, 26473Queen Mary Hospital, Hong Kong, SAR, China
| | - P K Chan
- Division of Joint Replacement Surgery, Department of Orthopaedics and Traumatology, The University of Hong Kong, 26473Queen Mary Hospital, Hong Kong, SAR, China
| | - H Fu
- Division of Joint Replacement Surgery, Department of Orthopaedics and Traumatology, The University of Hong Kong, 26473Queen Mary Hospital, Hong Kong, SAR, China
| | - M H Cheung
- Division of Joint Replacement Surgery, Department of Orthopaedics and Traumatology, The University of Hong Kong, 26473Queen Mary Hospital, Hong Kong, SAR, China
| | - A Cheung
- Division of Joint Replacement Surgery, Department of Orthopaedics and Traumatology, The University of Hong Kong, 26473Queen Mary Hospital, Hong Kong, SAR, China
| | - C H Yan
- Division of Joint Replacement Surgery, Department of Orthopaedics and Traumatology, The University of Hong Kong, 26473Queen Mary Hospital, Hong Kong, SAR, China
| | - K Y Chiu
- Division of Joint Replacement Surgery, Department of Orthopaedics and Traumatology, The University of Hong Kong, 26473Queen Mary Hospital, Hong Kong, SAR, China
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Vasileva A, Hanafi N, Matelski J, Wu J, deHaas E, Huang Q, Nadj R, Cheung A, Martinu T, Ghany R, Keshavjee S, Cypel M, Tikkanen J, Ryan C, Chow C. Intra-Subject Variance of Respiratory Oscillometry Reflects Graft Injury and is Associated with Acute Rejection and Chronic Lung Allograft Dysfunction (CLAD) Post Lung Transplant (LTx). J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1880] [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: 10/21/2022] Open
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Montano-Loza AJ, Allegretti JR, Cheung A, Ebadi M, Jones D, Kerkar N, Levy C, Rizvi S, Vierling JM, Alvarez F, Bai W, Gilmour S, Gulamhusein A, Guttman O, Hansen BE, MacParland S, Mason A, Onofrio F, Santamaria P, Stueck A, Swain M, Vincent C, Ricciuto A, Hirschfield G. Single Topic Conference on Autoimmune Liver Disease from the Canadian Association for the Study of the Liver. Can Liver J 2021; 4:401-425. [PMID: 35989897 PMCID: PMC9235119 DOI: 10.3138/canlivj-2021-0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 11/20/2022]
Abstract
Autoimmune liver disease (AILD) spans a spectrum of chronic disorders affecting the liver parenchyma and biliary system. Three main categories of AILD are autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), and primary sclerosing cholangitis (PSC). This review condenses the presentation and discussions of the Single Topic Conference (STC) on AILD that was held in Ottawa, Ontario, in November 2019. We cover generalities regarding disease presentation and clinical diagnosis; mechanistic themes; treatment paradigms; clinical trials, including approaches and challenges to new therapies; and looking beyond traditional disease boundaries. Although these diseases are considered autoimmune, the etiology and role of environmental triggers are poorly understood. AILDs are progressive and chronic conditions that affect survival and quality of life. Advances have been made in PBC treatment because second-line treatments are now available (obeticholic acid, bezafibrate); however, a significant proportion still present suboptimal response. AIH treatment has remained unchanged for several decades, and data suggest that fewer than 50% of patients achieve a complete response and as many as 80% develop treatment-related side effects. B-cell depletion therapy to treat AIH is in an early stage of development and has shown promising results. An effective treatment for PSC is urgently needed. Liver transplant remains the best option for patients who develop decompensated cirrhosis or hepatocellular carcinoma within specific criteria, but recurrent AILD might occur. Continued efforts are warranted to develop networks for AILD aimed at assessing geo-epidemiological, clinical, and biochemical differences to capture the new treatment era in Canada.
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Affiliation(s)
- Aldo J Montano-Loza
- Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, Alberta, Canada
| | - Jessica R Allegretti
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Angela Cheung
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Maryam Ebadi
- Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, Alberta, Canada
| | - David Jones
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Nanda Kerkar
- Division of Gastroenterology, Hepatology and Nutrition, Golisano Children's Hospital at Strong, University of Rochester Medical Center, New York, USA
| | - Cynthia Levy
- Schiff Center for Liver Diseases, University of Miami, Miami, Florida, USA
| | - Sumera Rizvi
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | | | - Fernando Alvarez
- Department of Pediatrics, Hôpital Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Wayne Bai
- Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, Alberta, Canada
| | - Susan Gilmour
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Aliya Gulamhusein
- Ajmera Family Transplant Centre, Toronto General Research Institute, Departments of Laboratory Medicine and Pathobiology and Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Orlee Guttman
- Division of Gastroenterology, Hepatology and Nutrition, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Bettina E Hansen
- Ajmera Family Transplant Centre, Toronto General Research Institute, Departments of Laboratory Medicine and Pathobiology and Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Sonya MacParland
- Ajmera Family Transplant Centre, Toronto General Research Institute, Departments of Laboratory Medicine and Pathobiology and Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Mason
- Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, Alberta, Canada
| | - Fernanda Onofrio
- Ajmera Family Transplant Centre, Toronto General Research Institute, Departments of Laboratory Medicine and Pathobiology and Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Pere Santamaria
- Department of Microbiology, Immunology & Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Ashley Stueck
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mark Swain
- Calgary Liver Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Catherine Vincent
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Amanda Ricciuto
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gideon Hirschfield
- Toronto Centre for Liver Disease, University Health Network & Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Conradi L, Lubos E, Reichenspurner H, Denti P, Cheung A. Transcatheter Mitral Valve Implantation with TIARA: Transapical Results and Transseptal Design. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Reid A, Anastasius M, Ben Zekry S, Turaga M, Webb J, Boone R, Moss R, Cheung A, Ye J, Leipsic J, Blanke P. Geometrical predictors of small virtual neoLVOT size in functional mitral regurgitation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2642] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
LVOT obstruction is a potentially lethal complication of transcatheter mitral valve replacement (TMVR). An anticipated neoLVOT area of <2cm2 is presumed to imply prohibitive risk. Measurement of the anticipated neoLVOT can be time consuming and requires specialist software to facilitate virtual valve implantation.
Purpose
To determine simple geometrical predictors of prohibitive neoLVOT size.
Methods
165 consecutive, non-calcific FMR patients referred to a transcatheter heart valve program were analysed. Segmentation of the mitral annulus and left heart geometry was performed using CT. Suitability for a default D-shaped TMVR was determined by proprietary annular inclusion criteria. Systolic neoLVOT area was determined via virtual valve implantation of the default TMVR.
Results
Sufficient image data for annular and neoLVOT suitability assessment was available in 152 patients. 105 patients (69%) were suitable for TMVR based on annular measurements. Of these, neoLVOT area was >2cm2 in 88 (84%). Overall, compared to patients not suitable for TMVR (n=64), those suitable had larger ventricles with lower LVEF, and larger annuli (table 1). Using binomial logistic regression involving the variables within table 1, LVESD was the sole statistically significant variable to predict neoLVOT area of <2cm2 (p=0.02). LVESD <48mm had 82% sensitivity and 94% specificity for the presence of prohibitive neoLVOT (figure 1).
Conclusion
Smaller LVESD is a strong predictor of small neoLVOT, and hence LVOT obstruction post default D-shaped TMVR implantation. This simple measure may therefore be used to streamline patient selection for advanced pre-procedural imaging analysis.
Predicting NeoLVOT size <2 cm2
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Reid
- University of British Columbia, Vancouver, Canada
| | - M Anastasius
- University of British Columbia, Vancouver, Canada
| | - S Ben Zekry
- University of British Columbia, Vancouver, Canada
| | - M Turaga
- University of British Columbia, Vancouver, Canada
| | - J Webb
- University of British Columbia, Vancouver, Canada
| | - R Boone
- University of British Columbia, Vancouver, Canada
| | - R Moss
- University of British Columbia, Vancouver, Canada
| | - A Cheung
- University of British Columbia, Vancouver, Canada
| | - J Ye
- University of British Columbia, Vancouver, Canada
| | - J Leipsic
- University of British Columbia, Vancouver, Canada
| | - P Blanke
- University of British Columbia, Vancouver, Canada
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Razzaghi H, Kahn KE, Black CL, Lindley MC, Jatlaoui TC, Fiebelkorn AP, Havers FP, D’Angelo DV, Cheung A, Ruther NA, Williams WW. Influenza and Tdap Vaccination Coverage Among Pregnant Women - United States, April 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1391-1397. [PMID: 33001873 PMCID: PMC7537555 DOI: 10.15585/mmwr.mm6939a2] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Goeppert B, Folseraas T, Roessler S, Kloor M, Volckmar AL, Endris V, Buchhalter I, Stenzinger A, Grzyb K, Grimsrud MM, Gornicka B, von Seth E, Reynolds GM, Franke A, Gotthardt DN, Mehrabi A, Cheung A, Verheij J, Arola J, Mäkisalo H, Eide TJ, Weidemann S, Cheville JC, Mazza G, Hirschfield GM, Ponsioen CY, Bergquist A, Milkiewicz P, Lazaridis KN, Schramm C, Manns MP, Färkkilä M, Vogel A, Boberg KM, Schirmacher P, Karlsen TH. Genomic Characterization of Cholangiocarcinoma in Primary Sclerosing Cholangitis Reveals Therapeutic Opportunities. Hepatology 2020; 72:1253-1266. [PMID: 31925805 DOI: 10.1002/hep.31110] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [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: 08/11/2019] [Accepted: 12/17/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Lifetime risk of biliary tract cancer (BTC) in primary sclerosing cholangitis (PSC) may exceed 20%, and BTC is currently the leading cause of death in patients with PSC. To open new avenues for management, we aimed to delineate clinically relevant genomic and pathological features of a large panel of PSC-associated BTC (PSC-BTC). APPROACH AND RESULTS We analyzed formalin-fixed, paraffin-embedded tumor tissue from 186 patients with PSC-BTC from 11 centers in eight countries with all anatomical locations included. We performed tumor DNA sequencing at 42 clinically relevant genetic loci to detect mutations, translocations, and copy number variations, along with histomorphological and immunohistochemical characterization. Regardless of the anatomical localization, PSC-BTC exhibited a uniform molecular and histological characteristic similar to extrahepatic cholangiocarcinoma. We detected a high frequency of genomic alterations typical of extrahepatic cholangiocarcinoma, such as TP53 (35.5%), KRAS (28.0%), CDKN2A (14.5%), and SMAD4 (11.3%), as well as potentially druggable mutations (e.g., HER2/ERBB2). We found a high frequency of nontypical/nonductal histomorphological subtypes (55.2%) and of the usually rare BTC precursor lesion, intraductal papillary neoplasia (18.3%). CONCLUSIONS Genomic alterations in PSC-BTC include a significant number of putative actionable therapeutic targets. Notably, PSC-BTC shows a distinct extrahepatic morpho-molecular phenotype, independent of the anatomical location of the tumor. These findings advance our understanding of PSC-associated cholangiocarcinogenesis and provide strong incentives for clinical trials to test genome-based personalized treatment strategies in PSC-BTC.
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Affiliation(s)
- Benjamin Goeppert
- Department of General Pathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Trine Folseraas
- Norwegian PSC Research Center Department of Transplantation Medicine, Division of Surgery, Inflammatory Medicine and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Research Institute of Internal Medicine, Division of Surgery, Inflammatory Medicine and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway.,K.G. Jebsen Inflammation Research Center, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Section for Gastroenterology, Department of Transplantation Medicine, Division of Surgery, Inflammatory Medicine and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Stephanie Roessler
- Department of General Pathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Kloor
- Department of Applied Tumor Biology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Anna-Lena Volckmar
- Department of General Pathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Volker Endris
- Department of General Pathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ivo Buchhalter
- Department of General Pathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.,Institute of Pathology, Omics IT and Data Management Core Facility, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Albrecht Stenzinger
- Department of General Pathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Krzysztof Grzyb
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Marit M Grimsrud
- Norwegian PSC Research Center Department of Transplantation Medicine, Division of Surgery, Inflammatory Medicine and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Research Institute of Internal Medicine, Division of Surgery, Inflammatory Medicine and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Barbara Gornicka
- Department of Pathology, Medical University of Warsaw, Warsaw, Poland
| | - Erik von Seth
- Department of Gastroenterology and Hepatology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Gary M Reynolds
- Center for Liver Research, NIHR Birmingham Liver Biomedical Research Unit, University of Birmingham, Birmingham, United Kingdom
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts University, Kiel, Germany
| | - Daniel N Gotthardt
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Angela Cheung
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Joanne Verheij
- Department of Pathology, Academic Medical Center, Amsterdam, the Netherlands
| | - Johanna Arola
- Department of Pathology, Haartman Institute and Huslab, Helsinki University Hospital, Helsinki, Finland
| | - Heikki Mäkisalo
- Department of Transplantation and Liver Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Tor J Eide
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Sören Weidemann
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Giuseppe Mazza
- Division of Medicine, Institute for Liver and Digestive Health Royal Free Hospital, University College London, London, United Kingdom
| | - Gideon M Hirschfield
- Center for Liver Research, NIHR Birmingham Liver Biomedical Research Unit, University of Birmingham, Birmingham, United Kingdom.,University Hospital Birmingham, NHS Foundation Trust, Birmingham, United Kingdom
| | - Cyriel Y Ponsioen
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands
| | - Annika Bergquist
- Department of Gastroenterology and Hepatology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Piotr Milkiewicz
- Liver and Internal Medicine Unit, Medical University of Warsaw, Warsaw, Poland.,Translational Medicine Group, Pomeranian Medical University, Szczecin, Poland
| | | | - Christoph Schramm
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Martti Färkkilä
- Department of Gastroenterology & Hepatology, Helsinki University Hospital, Helsinki, Finland
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | | | - Kirsten M Boberg
- Norwegian PSC Research Center Department of Transplantation Medicine, Division of Surgery, Inflammatory Medicine and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Research Institute of Internal Medicine, Division of Surgery, Inflammatory Medicine and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway.,K.G. Jebsen Inflammation Research Center, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Section for Gastroenterology, Department of Transplantation Medicine, Division of Surgery, Inflammatory Medicine and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Peter Schirmacher
- Department of General Pathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Tom H Karlsen
- Norwegian PSC Research Center Department of Transplantation Medicine, Division of Surgery, Inflammatory Medicine and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Research Institute of Internal Medicine, Division of Surgery, Inflammatory Medicine and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway.,K.G. Jebsen Inflammation Research Center, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Section for Gastroenterology, Department of Transplantation Medicine, Division of Surgery, Inflammatory Medicine and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway
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Cheung A, Audhya I, Szabo S, Harwood M, Gooch K. LIMB GIRDLE MUSCULAR DYSTROPHIES. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chow J, Tam A, Cheung K, Lee V, Chiang C, Tong M, Wong E, Cheung A, Chan S, Lai J, Ngan R, Ng W, Lee A, Au K. 913MO Second primary cancer after intensity-modulated radiotherapy for nasopharyngeal carcinoma in Hong Kong (2001-2010): A territory-wide study by HKNPCSG. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1028] [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: 10/23/2022] Open
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Chan VWK, Chan PK, Woo YC, Fu H, Cheung A, Cheung MH, Yan CH, Chiu KY. Universal haemoglobin A1c screening reveals high prevalence of dysglycaemia in patients undergoing total knee arthroplasty. Hong Kong Med J 2020; 26:304-310. [PMID: 32764157 DOI: 10.12809/hkmj208459] [Citation(s) in RCA: 2] [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: 11/05/2022] Open
Abstract
INTRODUCTION Diabetes mellitus is an established modifiable risk factor for periprosthetic joint infection (PJI). Haemoglobin A1c (HbA1c) is a glycaemic marker that correlates with diabetic complications and PJI. As diabetes and prediabetes are frequently asymptomatic, and there is increasing evidence to suggest a correlation between dysglycaemia and osteoarthritis, it is reasonable to provide HbA1c screening before total knee arthroplasty (TKA). The aim of the present study was to determine the prevalence of dysglycaemia in patients who underwent TKA and investigate whether HbA1c screening and optimisation of glycaemic control before TKA affects the incidence of PJI after TKA. METHODS Patients who underwent primary TKA before and after routine HbA1c screening was introduced in our unit were reviewed. Prediabetes and diabetes were defined according to the American Diabetes Association. Patients with HbA1c ≥7.5% were referred to an endocrinologist for optimisation of glycaemic control before TKA. The incidence PJI, defined according to the Musculoskeletal Infection Society criteria, was recorded. RESULTS A total of 729 patients (934 knees) had HbA1c screening before TKA. Of them, 17 (2.3%) and 184 (25.2%) patients had known prediabetes and diabetes, respectively, and 265 (36.4%) and 12 (1.6%) had undiagnosed prediabetes and diabetes, respectively. The incidence of PJI was significantly lower in all patients who received HbA1c screening compared with those who did not (0.2% vs 1.02%, P=0.027). CONCLUSION Screening for HbA1c before TKA provides a cost-effective opportunity to identify undiagnosed dysglycaemia. Patients identified as having dysglycaemia receive modified treatment, significantly reducing the rate of PJI when compared with historical controls.
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Affiliation(s)
- V W K Chan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong
| | - P K Chan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong
| | - Y C Woo
- Department of Medicine, Queen Mary Hospital, Hong Kong
| | - H Fu
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong
| | - A Cheung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong
| | - M H Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - C H Yan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - K Y Chiu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
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Raman S, Mou B, Hsu F, Valev B, Cheung A, Vallières I, Ma R, McKenzie M, Beaton L, Rackley T, Gondara L, Nichol A. Whole Brain Radiotherapy Versus Stereotactic Radiosurgery in Poor-Prognosis Patients with One to 10 Brain Metastases: A Randomised Feasibility Study. Clin Oncol (R Coll Radiol) 2020; 32:442-451. [DOI: 10.1016/j.clon.2020.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/31/2019] [Accepted: 01/14/2020] [Indexed: 12/21/2022]
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Fan X, Guo D, Ng CT, Law A, Poon ZY, Cheung A, Lim KH, Thumboo J, Hwang W, Low A. AB0128 CXCL5 DAMPENS INFLAMMATION IN THE PRE-CLINICAL MODEL OF SYSTEMIC LUPUS ERYTHEMATOSUS VIA THE ORCHESTRAL EFFECT OF REGULATING NEUTROPHIL TRAFFICKING AND SUPPRESSING HELPER T CELL-MEDIATED IMMUNE RESPONSE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Patients with systemic lupus erythematosus (SLE) suffer from severe morbidity and mortality1-4, either from the disease itself or from side effects of immunosuppression5. Discovery of novel effective therapies with less toxicity is an urgent need.Objectives:The aim of this study is to elucidate the therapeutic potential and working mechanism of cytokine CXCL5 in lupus mice.Methods:Treatment with CXCL5, bone marrow (BM)-MSCs, standard of care (SOC) with combination of methylprednisolone and cyclophosphamide was given to 16-week-old Faslprmice. Mice were monitored for 10 weeks. Splenic immune cell subsets were measured by flow cytometry. Circulating cytokine and immunoglobulin were detected by Luminex technology. Renal function was evaluated by urinary spot albumin creatinine ratio. In situ renal immune cell infiltration and complement 3 deposition were detected by Haematoxylin and Eosin (H&E) staining and immunohistochemistry.Results:CXCL5 demonstrated consistent and potent immunosuppressive capacity in suppressing SLE with reduced autoantibody secretion, lymphoproliferation and preserved kidney function. With further exploration, we proved that CXCL5 reduced the proliferation of helper T cells (TH1 and TH2) in thein vitrofunctional assay. When we administrated CXCL5 to lupus mice, it promoted the proliferation of regulatory T cells and reduced the proliferation of TH17 cells, macrophages and neutrophils. Multiple proinflammatory cytokines including IL-2, IL-6, IL-12, IL-17A, KC/CXCL1, MIP-1β/CCL4 and TNF-α were also reduced. When combined with SOC, CXCL5 boosted its therapeutic effect and reduced the relevant indices of disease activity. When we correlated the effect of four different treatment groups (CXCL5, BM-MSCs, SOC, and CXCL5 plus SOC) on mice survival and target cell changes, we found that TH17 cells were the key effector cells involved in the pathogenesis of SLE.Conclusion:These findings demonstrated that CXCL5 dampens inflammation in the pre-clinical model of systemic lupus erythematosus via the orchestral effect of regulating neutrophil trafficking and suppressing helper T cell-mediated immune response. Administrating exogenous CXCL5 might be an attractive option to treat patients with lupus.References:[1]Ji S, Guo Q, Han Y, Tan G, Luo Y, Zeng F. Mesenchymal stem cell transplantation inhibits abnormal activation of Akt/GSK3beta signaling pathway in T cells from systemic lupus erythematosus mice.Cell Physiol Biochem.2012;29(5-6):705-712.[2]Peng SL. Altered T and B lymphocyte signaling pathways in lupus.Autoimmun Rev.2009;8(3):179-183.[3]Ferucci ED, Johnston JM, Gaddy JR, et al. Prevalence and incidence of systemic lupus erythematosus in a population-based registry of American Indian and Alaska Native people, 2007-2009.Arthritis Rheumatol.2014;66(9):2494-2502.[4]Jakes RW, Bae SC, Louthrenoo W, Mok CC, Navarra SV, Kwon N. Systematic review of the epidemiology of systemic lupus erythematosus in the Asia-Pacific region: prevalence, incidence, clinical features, and mortality.Arthritis Care Res (Hoboken).2012;64(2):159-168.[5]Sattwika PD, Mustafa R, Paramaiswari A, Herningtyas EH. Stem cells for lupus nephritis: a concise review of current knowledge.Lupus.2018;27(12):1881-1897.Acknowledgments:The work was supported by SMART II Centre Grant (NMRC/CG/M011/2017_SGH) and SingHealth Foundation (SHF/FG638P/2016).Disclosure of Interests:None declared
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Chan PK, Hwang YY, Cheung A, Yan CH, Fu H, Chan T, Fung WC, Cheung MH, Chan VWK, Chiu KY. Blood transfusions in total knee arthroplasty: a retrospective analysis of a multimodal patient blood management programme. Hong Kong Med J 2020; 26:201-207. [PMID: 32371607 DOI: 10.12809/hkmj198289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Transfusion is associated with increased perioperative morbidity and mortality in patients undergoing total knee arthroplasty (TKA). Patient blood management (PBM) is an evidence-based approach to maintain blood mass via haemoglobin maintenance, haemostasis optimisation, and blood loss minimisation. The aim of the present study was to assess the effectiveness of a multimodal PBM approach in our centre. METHODS This was a single-centre retrospective study of patients who underwent primary TKA in Queen Mary Hospital in Hong Kong in 2013 or 2018, using data from the Clinical Data Analysis and Reporting System and a local joint registry database. Patient demographics, preoperative haemoglobin, length of stay, readmission, mean units of transfusion, postoperative prosthetic joint infection, and mortality data were compared between groups. RESULTS In total, 262 and 215 patients underwent primary TKA in 2013 and 2018, respectively. The mean transfusion rate significantly decreased after PBM implementation (2013: 31.3%; 2018: 1.9%, P<0.001); length of stay after TKA also significantly decreased (2013: 14.49±8.10 days; 2018: 8.77±10.14 days, P<0.001). However, there were no statistically significant differences in readmission, early prosthetic joint infection, or 90-day mortality rates between the two groups. CONCLUSION Our PBM programme effectively reduced the allogeneic blood transfusion rate in patients undergoing TKA in our institution. Thus, PBM should be considered in current TKA protocols to reduce rates of transfusions and related complications.
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Affiliation(s)
- P K Chan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Y Y Hwang
- Department of Medicine, Queen Mary Hospital, Hong Kong
| | - A Cheung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - C H Yan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - H Fu
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - T Chan
- Department of Anaesthesiology, Queen Mary Hospital, Hong Kong
| | - W C Fung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - M H Cheung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - V W K Chan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - K Y Chiu
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
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Wesley MG, Soto G, Arriola CS, Gonzales M, Newes-Adeyi G, Romero C, Veguilla V, Levine MZ, Silva M, Ferdinands JM, Dawood FS, Reynolds SB, Hirsch A, Katz M, Matos E, Ticona E, Castro J, Castillo M, Bravo E, Cheung A, Phadnis R, Martin ET, Tinoco Y, Neyra Quijandria JM, Azziz-Baumgartner E, Thompson MG. Prospective cohort study of influenza vaccine effectiveness among healthcare personnel in Lima, Peru: Estudio Vacuna de Influenza Peru, 2016-2018. Influenza Other Respir Viruses 2020; 14:391-402. [PMID: 32249553 PMCID: PMC7298283 DOI: 10.1111/irv.12737] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 01/13/2023] Open
Abstract
Background The Estudio Vacuna de Influenza Peru (VIP) cohort aims to describe the frequency of influenza virus infection, identify predictors of vaccine acceptance, examine the effects of repeated influenza vaccination on immunogenicity, and evaluate influenza vaccine effectiveness among HCP. Methods The VIP cohort prospectively followed HCP in Lima, Peru, during the 2016‐2018 influenza seasons; a fourth year is ongoing. Participants contribute blood samples before and after the influenza season and after influenza vaccination (for vaccinees). Weekly surveillance is conducted to identify acute respiratory or febrile illnesses (ARFI). When an ARFI is identified, participants self‐collect nasal swabs that are tested for influenza viruses by real‐time reverse transcriptase‐polymerase chain reaction. Influenza vaccination status and 5‐year vaccination history are ascertained. We analyzed recruitment and enrollment results for 2016‐2018 and surveillance participation for 2016‐2017. Results In the first 3 years of the cohort, VIP successfully contacted 92% of potential participants, enrolled 76% of eligible HCP, and retained >90% of participants across years. About half of participants are medical assistants (54%), and most provide “hands‐on” medical care (76%). Sixty‐nine percent and 52% of participants completed surveillance for >70% of weeks in years 1 and 2, respectively. Fewer weeks of completed surveillance was associated with older age (≥50 years), being a medical assistant, self‐rated health of fair or poor, and not receiving the influenza vaccine during the current season (P‐values < .05). Conclusions The VIP cohort provides an opportunity to address knowledge gaps about influenza virus infection, vaccination uptake, effectiveness and immunogenicity among HCP.
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Affiliation(s)
- Meredith G Wesley
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Giselle Soto
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Carmen Sofia Arriola
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Candice Romero
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Vic Veguilla
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Min Z Levine
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria Silva
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Jill M Ferdinands
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sue B Reynolds
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Avital Hirsch
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - Mark Katz
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | | | | | - Juan Castro
- Hospital Nacional Daniel Alcides Carrion, Lima, Peru
| | - Maria Castillo
- Instituto Nacional de Salud del Niño, Lima, Peru.,Medical School, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eduar Bravo
- Medical School, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | | | - Yeny Tinoco
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
| | | | | | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Mahr C, McGee E, Cheung A, Mokadam N, Strueber M, Slaughter M, Danter M, Levy W, Cheng R, Beckman J, May D, Ismyrloglou E, Tsintzos S, Silvestry S. Cost-Effectiveness of Thoracotomy Approach for the Implantation of a Small Intrapericardial Centrifugal LVAD. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.450] [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: 11/24/2022] Open
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Tafur M, Cheung A, Menezes RJ, Feld J, Janssen H, Hirschfield GM, Jhaveri KS. Risk stratification in primary sclerosing cholangitis: comparison of biliary stricture severity on MRCP versus liver stiffness by MR elastography and vibration-controlled transient elastography. Eur Radiol 2020; 30:3735-3747. [DOI: 10.1007/s00330-020-06728-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 02/07/2023]
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YAN G, Norris K, Nee R, Greene T, Scialla J, Hu N, Yu W, Cheung A. SUN-127 CKD STAGE PROGRESSION AND DEATH FOLLOWING CKD ONSET: RESULTS FROM A U.S. LARGE INCIDENT CKD POPULATION WITH 10 YEARS OF FOLLOW-UP. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.654] [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: 10/24/2022] Open
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Lai KP, Cheung A, Ho CH, Tam NYK, Li JW, Lin X, Chan TF, Lee NPY, Li R. Transcriptomic analysis reveals the oncogenic role of S6K1 in hepatocellular carcinoma. J Cancer 2020; 11:2645-2655. [PMID: 32201535 PMCID: PMC7065997 DOI: 10.7150/jca.40726] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/22/2019] [Accepted: 01/19/2020] [Indexed: 12/20/2022] Open
Abstract
The p70 ribosomal protein S6 kinase 1 (S6K1), a serine/threonine kinase, is commonly overexpressed in a variety of cancers. However, its expression level and functional roles in hepatocellular carcinoma (HCC), which ranks as the third leading cause of cancer-related death worldwide, is still largely unknown. In the current report, we show the in vivo and in vitro overexpression of S6K1 in HCC. In the functional analysis, we demonstrate that S6K1 is required for the proliferation and colony formation abilities in HCC. By using comparative transcriptomic analysis followed by gene ontology enrichment analysis and Ingenuity Pathway Analysis, we find that the depletion of S6K1 can elevate the expression of a cluster of apoptotic genes, tumor suppressor genes and immune responsive genes. Moreover, the knockdown of S6K1 is predicted to reduce the tumorigenicity of HCC through the regulation of hubs of genes including STAT1, HDAC4, CEBPA and ONECUT1. In conclusion, we demonstrate the oncogenic role of S6K1 in HCC, suggesting the possible use of S6K1 as a therapeutic target for HCC treatment.
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Affiliation(s)
- Keng Po Lai
- Guanxi Key Laboratory of Tumor Immunology and Microenvironmental Regulation, Guilin Medical University, Guilin, PR China.,Department of Chemistry, City University of Hong Kong, Hong Kong SAR, China
| | - Angela Cheung
- Department of Chemistry, City University of Hong Kong, Hong Kong SAR, China
| | - Cheuk Hin Ho
- Department of Chemistry, City University of Hong Kong, Hong Kong SAR, China
| | - Nathan Yi-Kan Tam
- Department of Chemistry, City University of Hong Kong, Hong Kong SAR, China
| | - Jing Woei Li
- Department of Chemistry, City University of Hong Kong, Hong Kong SAR, China
| | - Xiao Lin
- School of Life Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ting Fung Chan
- School of Life Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.,State Key Laboratory of Agrobiotechnology, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Nikki Pui-Yue Lee
- Department of Surgery, University of Hong Kong, Hong Kong SAR, China
| | - Rong Li
- Guanxi Key Laboratory of Tumor Immunology and Microenvironmental Regulation, Guilin Medical University, Guilin, PR China
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Adreak N, Peng D, Zhao Y, Cheung A. MINISTERNOTOMY AORTIC VALVE REPLACEMENT PROVIDES EQUIVALENT SHORT- AND LONG-TERM SURVIVAL RATES IN BC PATIENTS IN COMPARISON WITH THE STANDARD APPROACH. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.608] [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: 10/25/2022] Open
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Ng W, Lee M, Fung T, Wong C, Cheung A, Chow J, Au K, Poon D, Lai J, Chiang C, Lee V, Lee A. Analysis of Radiotherapy to Recurrent Nasopharyngeal Carcinoma (NPC) in Hong Kong. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1659] [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: 11/25/2022]
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Sinha M, Griffith M, Betts C, Choe G, Sivagnanam S, Cheung A, Tamaki W, Liu E, Sudduth-Klinger J, Vaccaro G, Lopez C, Fong L, Coussens L, Tempero M. Immune modulatory effects of ibrutinib in pancreatic ductal adenocarcinoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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YAN G, Norris K, Nee R, Oliver N, Greene T, Yu W, Cheung A. SUN-263 COMPARISON OF MORTALITY AND END-STAGE RENAL DISEASE (ESRD) AMONG RACIAL/ETHNIC GROUPS IN THE U.S. VETERAN INCIDENT CKD POPULATION. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Cheung A, Trevers KE, Reyes-Corral M, Antinucci P, Hindges R. Expression and Roles of Teneurins in Zebrafish. Front Neurosci 2019; 13:158. [PMID: 30914911 PMCID: PMC6423166 DOI: 10.3389/fnins.2019.00158] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 10/24/2018] [Accepted: 02/12/2019] [Indexed: 12/21/2022] Open
Abstract
The teneurins, also known as Ten-m/Odz, are highly conserved type II transmembrane glycoproteins widely expressed throughout the nervous system. Functioning as dimers, these large cell-surface adhesion proteins play a key role in regulating neurodevelopmental processes such as axon targeting, synaptogenesis and neuronal wiring. Synaptic specificity is driven by molecular interactions, which can occur either in a trans-homophilic manner between teneurins or through a trans-heterophilic interaction across the synaptic cleft between teneurins and other cell-adhesion molecules, such as latrophilins. The significance of teneurins interactions during development is reflected in the widespread expression pattern of the four existing paralogs across interconnected regions of the nervous system, which we demonstrate here via in situ hybridization and the generation of transgenic BAC reporter lines in zebrafish. Focusing on the visual system, we will also highlight the recent developments that have been made in furthering our understanding of teneurin interactions and their functionality, including the instructive role of teneurin-3 in specifying the functional wiring of distinct amacrine and retinal ganglion cells in the vertebrate visual system underlying a particular functionality. Based on the distinct expression pattern of all teneurins in different retinal cells, it is conceivable that the combination of different teneurins is crucial for the generation of discrete visual circuits. Finally, mutations in all four human teneurin genes have been linked to several types of neurodevelopmental disorders. The opportunity therefore arises that findings about the roles of zebrafish teneurins or their orthologs in other species shed light on the molecular mechanisms in the etiology of such human disorders.
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Affiliation(s)
- Angela Cheung
- Centre for Developmental Neurobiology, King's College London, London, United Kingdom.,MRC Centre for Neurodevelopmental Disorders, King's College London, London, United Kingdom
| | - Katherine E Trevers
- Centre for Developmental Neurobiology, King's College London, London, United Kingdom.,MRC Centre for Neurodevelopmental Disorders, King's College London, London, United Kingdom
| | - Marta Reyes-Corral
- Centre for Developmental Neurobiology, King's College London, London, United Kingdom
| | - Paride Antinucci
- Centre for Developmental Neurobiology, King's College London, London, United Kingdom
| | - Robert Hindges
- Centre for Developmental Neurobiology, King's College London, London, United Kingdom.,MRC Centre for Neurodevelopmental Disorders, King's College London, London, United Kingdom
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49
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Gee J, Coleman RE, Cheung KL, Evans A, Holcombe C, Skene A, Rea D, Ahmed S, Jahan A, Horgan K, Rauchhaus P, Littleford R, Finlay P, Cheung A, Cullberg M, de Bruin E, Foxley A, Koulai L, Pass M, Schiavon G, Rugman P, Deb R, Robertson JFR. Abstract P2-12-01: Dose- and exposure-response relationship and biomarker correlation analysis in breast tumors from patients treated with capivasertib, an AKT inhibitor, in the STAKT randomized, placebo controlled pre-surgical study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-12-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Capivasertib (AZD5363), an AKT1,2,3 inhibitor, significantly improved progression-free and overall survival when added to paclitaxel in triple negative breast cancer (BC) patients (Schmid et al. ASCO 2018). We have previously reported in STAKT, robust target inhibition at 480mg BD versus placebo, including significant decreases in the primary biomarkers (PBs) - Ki67, pPRAS40 & pGSK3β - in primary BCs (Robertson et al. SABCS 2017). We now report the dose- and exposure-response relationship of capivasertib and the correlation between primary and secondary (pAKT, pS6, nuclear FOXO3a) tumor biomarkers.
Design: STAKT was a two-stage, double blind, randomized, placebo controlled 'window-of-opportunity' trial in newly diagnosed ER+ BC patients. Stage 1 assessed capivasertib at a dose of 480mg BD p.o. versus placebo. Stage 2 assessed capivasertib at two lower doses 360mg and 240mg BD. Tumor biopsies were taken prior to 1st dose and after 4.5 days of dosing. Evaluable patients (who required pre-defined minimum baseline PD values for PBs) included placebo (n=11), capivasertib at 480mg (n=17), 360mg (n=5) and 240mg (n=6). Blood samples for pharmacokinetic (PK) studies were scheduled at pre-dose; 2, 4, optional 6 & 8 hrs post first dose on Day 1; ˜2-4 h post last dose on Day 5 (before biopsy). The % change from baseline for PBs were evaluated against the following exposure variables (placebo=0): i) Dose, ii) Observed Cmax Day 1 (˜2h post-dose), iii) Observed plasma concentration on Day 5, iv) Model-predicted plasma concentration Day 5 at time of biopsy, and v) Model-predicted AUC on Day 5. Spearman correlation coefficient measured the strength and direction of association between biomarkers.
Results:
· Significant mean reductions in % change from baseline were observed for the PBs pGSK3β (-39%; p<0.006), pPRAS40 (-50%; p<0.0001) and Ki67 (-23%; p=0.052) at 480mg versus placebo. At 360mg and 240mg, mean % changes from baseline in pGSK3β were -27% and -9%, respectively; in pPRAS40 -45% and -28%, respectively; and in Ki67 0% and +22%, respectively.
· Dose-response relationships for individual % change from baseline could be described by an Emax model for all PBs. Overall, the correlation to PK exposure (observed or predicted) was similar to the correlation to dose.
· Correlation coefficient analyses between biomarkers at capivasertib 480mg BD identified- i) Positive correlations for pGSK3β with Ki67 (ρ = 0.52, p-value < 0.05) & with pS6 (ρ = 0.54, p-value<0.05); ii) Negative correlations between FOXO3a and Ki67 (ρ = -0.75, p-value<0.001) pGSK3β (ρ = -0.71, p-value<0.001) & also pS6 (ρ = -0.61, p-value<0.001).Correlation coefficients for lower doses are not robust due to small sample size in these groups.
Conclusions
· Capivasertib caused dose- and concentration- dependent effects on biomarkers after only 4.5 days.
· Significant changes in the PBs were demonstrated at 480 mg BD. Biomarker changes was observed at 360mg and 240mg BD, but statistical analysis was limited by the small sample size at lower doses.
· Correlation between a number of tumor biomarkers (relative changes) were identified for capivasertib 480mg BD.
Citation Format: Gee J, Coleman RE, Cheung KL, Evans A, Holcombe C, Skene A, Rea D, Ahmed S, Jahan A, Horgan K, Rauchhaus P, Littleford R, Finlay P, Cheung A, Cullberg M, de Bruin E, Foxley A, Koulai L, Pass M, Schiavon G, Rugman P, Deb R, Robertson JFR. Dose- and exposure-response relationship and biomarker correlation analysis in breast tumors from patients treated with capivasertib, an AKT inhibitor, in the STAKT randomized, placebo controlled pre-surgical study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-12-01.
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Affiliation(s)
- J Gee
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - RE Coleman
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - KL Cheung
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - A Evans
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - C Holcombe
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - A Skene
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - D Rea
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - S Ahmed
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - A Jahan
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - K Horgan
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - P Rauchhaus
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - R Littleford
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - P Finlay
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - A Cheung
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - M Cullberg
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - E de Bruin
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - A Foxley
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - L Koulai
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - M Pass
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - G Schiavon
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - P Rugman
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - R Deb
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - JFR Robertson
- Cardiff University, Cardiff, United Kingdom; University of Sheffield, Sheffield, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom; Royal Liverpool University Hospital, Liverpool, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Leicester Royal Infirmary, Leicester, Leicestershire, United Kingdom; Kings Mill Hospital, Mansfield, Nottinghamshire, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, United Kingdom; University of Dundee, Dundee, United Kingdom; AstraZeneca, Pepparedsleden 1, Sweden; AstraZeneca, Melbourn, Hertfordshire, United Kingdom; Royal Derby Hospital, Derby, Derbyshire, United Kingdom; University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
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50
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Tietz-Bogert PS, Kim M, Cheung A, Tabibian JH, Heimbach JK, Rosen CB, Nandakumar M, Lazaridis KN, LaRusso NF, Sung J, O'Hara SP. Metabolomic Profiling of Portal Blood and Bile Reveals Metabolic Signatures of Primary Sclerosing Cholangitis. Int J Mol Sci 2018; 19:ijms19103188. [PMID: 30332763 PMCID: PMC6214107 DOI: 10.3390/ijms19103188] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/11/2018] [Accepted: 10/13/2018] [Indexed: 02/08/2023] Open
Abstract
Primary sclerosing cholangitis (PSC) is a pathogenically complex, chronic, fibroinflammatory disorder of the bile ducts without known etiology or effective pharmacotherapy. Emerging in vitro and in vivo evidence support fundamental pathophysiologic mechanisms in PSC centered on enterohepatic circulation. To date, no studies have specifically interrogated the chemical footprint of enterohepatic circulation in PSC. Herein, we evaluated the metabolome and lipidome of portal venous blood and bile obtained at the time of liver transplantation in patients with PSC (n = 7) as compared to individuals with noncholestatic, end-stage liver disease (viral, metabolic, etc. (disease control, DC, n = 19)) and to nondisease controls (NC, living donors, n = 12). Global metabolomic and lipidomic profiling was performed on serum derived from portal venous blood (portal serum) and bile using ultraperformance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) and differential mobility spectroscopy-mass spectroscopy (DMS-MS; complex lipid platform). The Mann–Whitney U test was used to identify metabolites that significantly differed between groups. Principal-component analysis (PCA) showed significant separation of both PSC and DC from NC for both portal serum and bile. Metabolite set enrichment analysis of portal serum and bile demonstrated that the liver-disease cohorts (PSC and DC) exhibited similar enrichment in several metabolite categories compared to NC. Interestingly, the bile in PSC was uniquely enriched for dipeptide and polyamine metabolites. Finally, analysis of patient-matched portal serum and biliary metabolome revealed that these biological fluids were more homogeneous in PSC than in DC or NC, suggesting aberrant bile formation and enterohepatic circulation. In summary, PSC and DC patients exhibited alterations in several metabolites in portal serum and bile, while PSC patients exhibited a unique bile metabolome. These specific alterations in PSC are amenable to hypothesis testing and, potentially, therapeutic pharmacologic manipulation.
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Affiliation(s)
- Pamela S Tietz-Bogert
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA.
- Center for Cell Signaling in Gastroenterology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Minsuk Kim
- Microbiome Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA.
- Division of Surgical Research, Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA.
| | - Angela Cheung
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA.
| | - James H Tabibian
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA.
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA 91342, USA.
| | - Julie K Heimbach
- Division of Transplant Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
| | - Charles B Rosen
- Division of Transplant Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
| | | | - Konstantinos N Lazaridis
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA.
- Center for Cell Signaling in Gastroenterology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Nicholas F LaRusso
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA.
- Center for Cell Signaling in Gastroenterology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Jaeyun Sung
- Microbiome Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA.
- Division of Surgical Research, Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA.
| | - Steven P O'Hara
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA.
- Center for Cell Signaling in Gastroenterology, Mayo Clinic, Rochester, MN 55905, USA.
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