1
|
Tracy A, Loop L, Bhatti S, Anterasian C, Kellogg C, Smiley K, Wu A, Geng B, Eichenfield L. Multidisciplinary atopic dermatitis program: A novel approach to managing difficult-to-control atopic dermatitis patients. Pediatr Dermatol 2024; 41:210-214. [PMID: 38234080 DOI: 10.1111/pde.15533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/01/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND/OBJECTIVES Disease improvement for difficult-to-control pediatric atopic dermatitis may be more challenging to achieve when directed by single specialties due to disjointed and conflicting dialogue with patients. METHODS The Multidisciplinary Atopic Dermatitis Program (MADP) was developed through collaborations with the Rady Children's Hospital and UC San Diego Health Divisions of Dermatology, Allergy & Immunology and Clinical Pharmacy, to create team-based evaluation and management of children and adolescents with atopic dermatitis (AD). The MADP allows concurrent, comprehensive evaluations by multiple specialists to develop treatment plans. The program includes extensive patient education to support shared decision making, incorporating patient and family's perspectives along with those of clinical experts into their care. Objective severity measures and patient reported outcome data were collected, along with assessment of patient and family satisfaction with the MADP. RESULTS Data showed significant improvement in AD severity as assessed by providers, patients and families by the first follow-up visit. BSA mean percentage decreased by up to 56% by the 7th visit, and pruritus (NRS), CLDQI and POEM mean scores decreased by more than 4 points, 12 points, and over 11 points, respectively. After management was initiated in the MADP, 72.73% of patients achieved an EASI 50 and 47.73% achieved an EASI 75 from a baseline mean of 21.7. Patients who continued in clinic beyond the second visit showed further clinically significant decreases in disease measures. CONCLUSIONS The multidisciplinary approach shows success in the treatment of difficult-to-control AD patients with improvements in clinician and patient reported outcome measures.
Collapse
Affiliation(s)
- Alexis Tracy
- Division of Allergy and Immunology, Division of Pediatric Dermatology, Departments of Dermatology and Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego, California, USA
| | - Lauren Loop
- Department of Pediatrics, Division of Allergy and Immunology, University of California, San Diego and Rady's Children's Hospital, San Diego, California, USA
| | - Safiyyah Bhatti
- Division of Allergy and Immunology, Division of Pediatric Dermatology, Departments of Dermatology and Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego, California, USA
| | - Christine Anterasian
- Department of Pediatrics, Division of Pediatric and Infectious Diseases, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Caitlyn Kellogg
- Division of Allergy and Immunology, Division of Pediatric Dermatology, Departments of Dermatology and Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego, California, USA
| | - Kathryn Smiley
- Division of Allergy and Immunology, Division of Pediatric Dermatology, Departments of Dermatology and Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego, California, USA
| | - Alyssa Wu
- Division of Allergy and Immunology, Division of Pediatric Dermatology, Departments of Dermatology and Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego, California, USA
| | - Bob Geng
- Department of Pediatrics, Division of Allergy and Immunology, University of California, San Diego and Rady's Children's Hospital, San Diego, California, USA
| | - Lawrence Eichenfield
- Division of Pediatric Dermatology, Departments of Dermatology and Pediatrics, University of California, San Diego and Rady Children's Hospital, San Diego, California, USA
| |
Collapse
|
2
|
Patel D, Revier MD, Tambay A, Geng B. Implementation of a pediatric synchronous multidisciplinary severe asthma clinic and real-world outcomes. Ann Allergy Asthma Immunol 2024; 132:392-393. [PMID: 37898325 DOI: 10.1016/j.anai.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/08/2023] [Accepted: 10/20/2023] [Indexed: 10/30/2023]
Affiliation(s)
- Divya Patel
- Rady Children's Hospital, San Diego, California.
| | - Michelle Dilley Revier
- Rady Children's Hospital, San Diego, California; Division of Allergy, Immunology, and Rheumatology, University of California San Diego, San Diego, California
| | | | - Bob Geng
- Rady Children's Hospital, San Diego, California
| |
Collapse
|
3
|
Wang H, Sun Z, Zhao W, Geng B. [S100A10 promotes proliferation and invasion of lung adenocarcinoma cells by activating the Akt-mTOR signaling pathway]. Nan Fang Yi Ke Da Xue Xue Bao 2023; 43:733-740. [PMID: 37313814 DOI: 10.12122/j.issn.1673-4254.2023.05.08] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate the effects of expression levels of S100 calcium-binding protein A10 (S100A10) in lung adenocarcinoma (LUAD) on patient prognosis and the regulatory role of S100A10 in lung cancer cell proliferation and metastasis. METHODS Immunohistochemistry was used to detect the expression levels of S100A10 in LUAD and adjacent tissues, and the relationship between S100A10 expression and clinicopathological parameters and prognosis of the patients was statistically analyzed. The lung adenocarcinoma expression dataset in TCGA database was analyzed using gene enrichment analysis (GSEA) to predict the possible regulatory pathways of S100A10 in the development of lung adenocarcinoma. Lactate production and glucose consumption of lung cancer cells with S100A10 knockdown or overexpression were analyzed to assess the level of glycolysis. Western blotting, CCK-8 assay, EdU-594 assay, and Transwell assays were performed to determine the expression level of S100A10 protein, proliferation and invasion ability of lung cancer cells. A549 cells with S100A10 knockdown and H1299 cells with S100A10 overexpression were injected subcutaneously in nude mice, and tumor growth was observed. RESULTS The expression level of S100A10 was significantly upregulated in LUAD tissues as compared with the adjacent tissues, and an elevated S100A10 expression level was associated with lymph node metastasis, advanced tumor stage and distant organ metastasis (P < 0.05), but not with tumor differentiation or the patients' age or gender (P > 0.05). Survival analysis showed that elevated S100A10 expressions in the tumor tissue was associated with a poor outcome of the patients (P < 0.001). In the lung cancer cells, S100A10 overexpression significantly promoted cell proliferation and invasion in vitro (P < 0.001). GSEA showed that the gene sets of glucose metabolism, glycolysis and mTOR signaling pathway were significantly enriched in high expressions of S100A10. In the tumor-bearing nude mice, S100A10 overexpression significantly promoted tumor growth, while S100A10 knockdown obviously suppressed tumor cell proliferation (P < 0.001). CONCLUSION S100A10 overexpression promotes glycolysis by activating the Akt-mTOR signaling pathway to promote proliferation and invasion of lung adenocarcinoma cells.
Collapse
Affiliation(s)
- H Wang
- Department of Oncology, First Affiliated Hospital of Wannan Medical College, Wuhu 24100, China
| | - Z Sun
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Wannan Medical College, Wuhu 24100, China
| | - W Zhao
- Department of Oncology, First Affiliated Hospital of Wannan Medical College, Wuhu 24100, China
| | - B Geng
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Wannan Medical College, Wuhu 24100, China
| |
Collapse
|
4
|
Geng B, Nosbaum A, Boguniewicz M, Lazariciu I, Feeney C, Rebollo F, Koppensteiner H. Effect of Abrocitinib and Dupilumab on Eosinophil Levels in Patients With Moderate-to-Severe Atopic Dermatitis and With or Without Comorbid Asthma or Allergic Rhinitis: A Post Hoc Pooled Analysis of JADE COMPARE and JADE DARE. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.476] [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: 02/05/2023]
|
5
|
Kobayashi RH, Gupta S, Melamed I, Mandujano JF, Kobayashi AL, Ritchie B, Geng B, Atkinson TP, Rehman S, Turpel-Kantor E, Litzman J. Corrigendum: Clinical efficacy, safety and tolerability of a new subcutaneous immunoglobulin 16.5% (Octanorm [Cutaquig ®]) in the treatment of patients with primary immunodeficiencies. Front Immunol 2022; 13:1110388. [PMID: 36605207 PMCID: PMC9809273 DOI: 10.3389/fimmu.2022.1110388] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fimmu.2019.00040.].
Collapse
Affiliation(s)
- Roger H. Kobayashi
- UCLA School of Medicine, Los Angeles, CA, United States,*Correspondence: Roger H. Kobayashi,
| | - Sudhir Gupta
- Division of Basic and Clinical Immunology, University of California, Irvine, Irvine, CA, United States
| | - Isaac Melamed
- IMMUNOe Research Center, Centennial, CO, United States
| | | | | | - Bruce Ritchie
- Divisionof Hematology, Department of Medicine, University of Alberta Hospital, Edmonton, AB, Canada
| | - Bob Geng
- Divisions of Adult and Pediatric Allergy and Immunology, University of California, San Diego, La Jolla, CA, United States
| | - Thomas Prescott Atkinson
- Department of Pediatric Allergy, Asthma and Immunology, University of Alabama, Birmingham, AL, United States
| | - Syed Rehman
- Allergy and Asthma Center Inc., Toledo, OH, United States
| | | | - Jiří Litzman
- Department of Clinical Immunology and Allergology, St Anne’s University Hospital in Brno, Faculty of Medicine, Masaryk University, Brno, Czechia
| |
Collapse
|
6
|
Liu X, Zhang K, Wang L, Geng B, Liu Z, Yi Q, Xia Y. Fluid shear stress-induced down-regulation of miR-146a-5p inhibits osteoblast apoptosis via targeting SMAD4. Physiol Res 2022. [DOI: 10.33549/physiolres.934922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Fluid shear stress (FSS) plays an important role in osteoblast apoptosis. However, the role of miRNA in osteoblast apoptosis under FSS and possible molecular mechanisms remain unknown. Our aim of the study was to explore whether miR-146a-5p regulates osteoblast apoptosis under FSS and its molecular mechanisms. FSS could down-regulate the expression of miR-146a-5p in MC3T3-E1 cells. We confirm that up-regulation of miR-146a-5p promotes osteoblasts apoptosis and down-regulation of miR-146a-5p inhibits osteoblasts apoptosis. We further demonstrated that FSS inhibits osteoblast apoptosis by down-regulated miR-146a-5p. Dual-luciferase reporter assay validated that SMAD4 is a direct target gene of miR-146a-5p. In addition, mimic-146a-5p suppressed FSS-induced up-regulation of SMAD4 protein levels, which suggests that FSS elevated SMAD4 protein expression levels via regulation miR-146a-5p. Further investigations showed that SMAD4 could inhibit osteoblast apoptosis. We demonstrated that miR-146a-5p regulates osteoblast apoptosis via targeting SMAD4. Taken together, our present study showed that FSS-induced down-regulation miR-146a-5p inhibits osteoblast apoptosis via target SMAD4. These findings may provide novel mechanisms for FSS to inhibit osteoblast apoptosis, and also may provide a potential therapeutic target for osteoporosis.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Y Xia
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou Gansu, China
| |
Collapse
|
7
|
Zhang K, Liu K, Yu D, Tang Y, Geng B, Xia Y, Xu P. The Therapeutic and Prognostic Role of Clusterin in Diverse
Musculoskeletal Diseases: A Mini Review. Physiol Res 2022. [DOI: 10.33549/physiolres.934908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This mini-review aims to introduce the association between Secretory clusterin/apolipoprotein J (sCLU) and diverse musculoskeletal diseases. A comprehensive review of the literature was performed to identify basic science and clinical studies, which implied the therapeutic and prognostic role of sCLU in diverse musculoskeletal diseases. sCLU is a multifunctional glycoprotein that is ubiquitously expressed in various tissues and is implicated in many pathophysiological processes. Dysregulated expression of sCLU had been reported to be assocaited with proliferative or apoptotic molecular processes and inflammatory responses, which participated in many pathophysiological processes such as degenerative musculoskeletal diseases including ischemic osteonecrosis, osteoarthritis (OA) and degenerative cervical myelopathy (spinal cord injury), neoplastic musculoskeletal diseases, inflammatory and autoimmune musculoskeletal diseases including Rheumatoid arthritis (RA), joint damage induced by Brucella abortus, Sjogren's syndrome, idiopathic inflammatory myopathies, muscle glucose metabolism, insulin sensitivity and traumatic musculoskeletal diseases. Recent findings of sCLU in these musculoskeletal diseases provides insights on the therapeutic and prognostic role of sCLU in these musculoskeletal diseases. sCLU may serve as a promising therapeutic target for ischemic osteonecrosis, OA and spinal cord injury as well as a potential prognostic biomarker for OA and RA. Moreover, sCLU could act as a prognostic biomarker for osteosarcoma (OS) and a promising therapeutic target for OS resistance. Although many studies support the potential therapeutic and prognostic role of sCLU in some inflammatory and autoimmune-mediated musculoskeletal diseases, more future researches are needed to explore the molecular pathogenic mechanism mediated by sCLU implied in these musculoskeletal diseases.
Collapse
Affiliation(s)
| | | | | | | | | | | | - P Xu
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| |
Collapse
|
8
|
Kobayashi RH, Litzman J, Melamed I, Mandujano JF, Kobayashi AL, Ritchie B, Geng B, Atkinson TP, Rehman S, Höller S, Turpel-Kantor E, Kreuwel H, Speer JC, Gupta S. Long-term efficacy, safety, and tolerability of a subcutaneous immunoglobulin 16.5% (cutaquig®) in the treatment of patients with primary immunodeficiencies. Clin Exp Immunol 2022; 210:91-103. [PMID: 36208448 PMCID: PMC9750824 DOI: 10.1093/cei/uxac092] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/30/2022] [Accepted: 10/06/2022] [Indexed: 01/12/2023] Open
Abstract
A prospective study and its long-term extension examined whether weekly treatment of patients with primary immunodeficiencies (PIDs) with a 16.5% subcutaneous immunoglobulin (SCIg; cutaquig®) confers acceptable efficacy, safety, and tolerability over a follow-up of up to 238 weeks (>4 years). Seventy-five patients received 4462 infusions during up to 70 weeks of follow-up in the main study and 27 patients received 2777 infusions during up to 168 weeks of follow-up in the extension. In the main study, there were no serious bacterial infections (SBIs), and the annual rate of other infections was 3.3 (95% CI 2.4, 4.5). One SBI was recorded in the extension, for an SBI rate of 0.02 (upper 99% CI 0.19). The annual rate of all infections over the duration of the extension study was 2.2 (95% CI 1.2, 3.9). Only 15.0% (1085) of 7239 infusions were associated with infusion site reactions (ISRs), leaving 85.0% (6153) of infusions without reactions. The majority of ISRs were mild and transient. ISR incidence decreased over time, from 36.9% to 16% during the main study and from 9% to 2.3% during the extension. The incidence of related systemic adverse events was 14.7% in the main study and 7.4% in the extension. In conclusion, this prospective, long-term study with cutaquig showed maintained efficacy and low rates of local and systemic adverse reactions in PID patients over up to 238 weeks of follow-up.
Collapse
Affiliation(s)
| | - Jiří Litzman
- Department of Clinical Immunology and Allergology, St Anne’s University Hospital in Brno, Faculty of Medicine, Masaryk University, Brno, Czechia
| | | | | | | | - Bruce Ritchie
- Division of Hematology, Department of Medicine, University of Alberta Hospital, Edmonton, AB, Canada
| | - Bob Geng
- Divisions of Allergy and Immunology, University of California San Diego, La Jolla, CA, USA
| | - T Prescott Atkinson
- Department of Pediatric Allergy, Asthma and Immunology, University of Alabama, Birmingham, AL, USA
| | - Syed Rehman
- Allergy and Asthma Center Inc., Toledo, OH, USA
| | - Sonja Höller
- Octapharma Pharmazeutika Produktionsges.m.b.H., Vienna, Austria
| | | | | | | | - Sudhir Gupta
- Division of Basic and Clinical Immunology, University of California Irvine, Irvine, CA, USA
| |
Collapse
|
9
|
Rodriguez KM, Vaught J, Dilley M, Ellsworth K, Heinen A, Abud EM, Zhang Y, Smith RJH, Sheets R, Geng B, Hoffman HM, Worthen HM, Dimmock D, Coufal NG. Rapid genome sequencing identifies novel variants in complement factor I. Cold Spring Harb Mol Case Stud 2022; 8:a006239. [PMID: 36577522 PMCID: PMC9808552 DOI: 10.1101/mcs.a006239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/05/2022] [Indexed: 12/30/2022] Open
Abstract
Complement factor I deficiency (CFID; OMIM #610984) is a rare immunodeficiency caused by deficiencies in the serine protease complement factor I (CFI). CFID is characterized by predisposition to severe pneumococcal infection, often in infancy. We report a previously healthy adolescent male who presented with respiratory failure secondary to pneumococcal pneumonia and severe systemic inflammatory response. Rapid genome sequencing (rGS) identified compound heterozygous variants in CFI in the proband, with a novel maternally inherited likely pathogenic variant, a single nucleotide deletion resulting in premature stop (c.1646del; p.Asn549ThrfsTer25) and a paternally inherited novel likely pathogenic deletion (Chr 4:110685580-110692197del).
Collapse
Affiliation(s)
- Katherine M Rodriguez
- Rady Children's Hospital, San Diego, California 92123, USA
- Division of Pediatric Critical Care, Department of Pediatrics, University of California at San Diego, San Diego, California 92123, USA
- Rady Children's Institute for Genomic Medicine, San Diego, California 92123, USA
| | - Jordan Vaught
- Rady Children's Hospital, San Diego, California 92123, USA
- Department of Pediatrics, Immunology, and Rheumatology, Department of Pediatrics, University of California at San Diego, San Diego, California 92161, USA
| | - Michelle Dilley
- Rady Children's Hospital, San Diego, California 92123, USA
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of California at San Diego, San Diego, California 92161, USA
| | - Kataryzna Ellsworth
- Rady Children's Institute for Genomic Medicine, San Diego, California 92123, USA
| | - Alaina Heinen
- Rady Children's Institute for Genomic Medicine, San Diego, California 92123, USA
| | - Edsel M Abud
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of California at San Diego, San Diego, California 92161, USA
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, California 92093, USA
| | - Yuzhou Zhang
- Molecular Otolaryngology and Renal Research Laboratories, University of Iowa, Iowa City, Iowa 52242, USA
| | - Richard J H Smith
- Molecular Otolaryngology and Renal Research Laboratories, University of Iowa, Iowa City, Iowa 52242, USA
| | - Robert Sheets
- Rady Children's Hospital, San Diego, California 92123, USA
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of California at San Diego, San Diego, California 92161, USA
| | - Bob Geng
- Rady Children's Hospital, San Diego, California 92123, USA
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of California at San Diego, San Diego, California 92161, USA
| | - Hal M Hoffman
- Rady Children's Hospital, San Diego, California 92123, USA
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of California at San Diego, San Diego, California 92161, USA
| | - H Michael Worthen
- Rady Children's Hospital, San Diego, California 92123, USA
- Division of Pediatric Critical Care, Department of Pediatrics, University of California at San Diego, San Diego, California 92123, USA
| | - David Dimmock
- Rady Children's Institute for Genomic Medicine, San Diego, California 92123, USA
| | - Nicole G Coufal
- Rady Children's Hospital, San Diego, California 92123, USA
- Division of Pediatric Critical Care, Department of Pediatrics, University of California at San Diego, San Diego, California 92123, USA
- Rady Children's Institute for Genomic Medicine, San Diego, California 92123, USA
| |
Collapse
|
10
|
Loop L, Leng A, Revier M, Geng B. FROM CVID TO AERD: ADDRESSING EPITHELIAL BARRIER DYSFUNCTION FROM NON-TYPE-2 TO HIGH-TYPE-2 AIRWAY INFLAMMATION. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.849] [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: 11/11/2022]
|
11
|
Loop L, Appiah M, Smiley K, Eichenfield L, Geng B. A NOVEL EFFICIENT APPROACH TO ASSESSING ATOPIC DERMATITIS DISEASE SEVERITY: VIGAXBSA COMPARED TO EASI. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.702] [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: 11/11/2022]
|
12
|
Geier CB, Ellison M, Cruz R, Pawar S, Leiss-Piller A, Zmajkovicova K, McNulty SM, Yilmaz M, Evans MO, Gordon S, Ujhazi B, Wiest I, Abolhassani H, Aghamohammadi A, Barmettler S, Bhar S, Bondarenko A, Bolyard AA, Buchbinder D, Cada M, Cavieres M, Connelly JA, Dale DC, Deordieva E, Dorsey MJ, Drysdale SB, Ehl S, Elfeky R, Fioredda F, Firkin F, Förster-Waldl E, Geng B, Goda V, Gonzalez-Granado L, Grunebaum E, Grzesk E, Henrickson SE, Hilfanova A, Hiwatari M, Imai C, Ip W, Jyonouchi S, Kanegane H, Kawahara Y, Khojah AM, Kim VHD, Kojić M, Kołtan S, Krivan G, Langguth D, Lau YL, Leung D, Miano M, Mersyanova I, Mousallem T, Muskat M, Naoum FA, Noronha SA, Ouederni M, Ozono S, Richmond GW, Sakovich I, Salzer U, Schuetz C, Seeborg FO, Sharapova SO, Sockel K, Volokha A, von Bonin M, Warnatz K, Wegehaupt O, Weinberg GA, Wong KJ, Worth A, Yu H, Zharankova Y, Zhao X, Devlin L, Badarau A, Csomos K, Keszei M, Pereira J, Taveras AG, Beaussant-Cohen SL, Ong MS, Shcherbina A, Walter JE. Disease Progression of WHIM Syndrome in an International Cohort of 66 Pediatric and Adult Patients. J Clin Immunol 2022; 42:1748-1765. [PMID: 35947323 PMCID: PMC9700649 DOI: 10.1007/s10875-022-01312-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/17/2022] [Indexed: 11/26/2022]
Abstract
Warts, hypogammaglobulinemia, infections, and myelokathexis (WHIM) syndrome (WS) is a combined immunodeficiency caused by gain-of-function mutations in the C-X-C chemokine receptor type 4 (CXCR4) gene. We characterize a unique international cohort of 66 patients, including 57 (86%) cases previously unreported, with variable clinical phenotypes. Of 17 distinct CXCR4 genetic variants within our cohort, 11 were novel pathogenic variants affecting 15 individuals (23%). All variants affect the same CXCR4 region and impair CXCR4 internalization resulting in hyperactive signaling. The median age of diagnosis in our cohort (5.5 years) indicates WHIM syndrome can commonly present in childhood, although some patients are not diagnosed until adulthood. The prevalence and mean age of recognition and/or onset of clinical manifestations within our cohort were infections 88%/1.6 years, neutropenia 98%/3.8 years, lymphopenia 88%/5.0 years, and warts 40%/12.1 years. However, we report greater prevalence and variety of autoimmune complications of WHIM syndrome (21.2%) than reported previously. Patients with versus without family history of WHIM syndrome were diagnosed earlier (22%, average age 1.3 years versus 78%, average age 5 years, respectively). Patients with a family history of WHIM syndrome also received earlier treatment, experienced less hospitalization, and had less end-organ damage. This observation reinforces previous reports that early treatment for WHIM syndrome improves outcomes. Only one patient died; death was attributed to complications of hematopoietic stem cell transplantation. The variable expressivity of WHIM syndrome in pediatric patients delays their diagnosis and therapy. Early-onset bacterial infections with severe neutropenia and/or lymphopenia should prompt genetic testing for WHIM syndrome, even in the absence of warts.
Collapse
Affiliation(s)
- Christoph B Geier
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center University of Freiburg Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Rheumatology and Clinical Immunology, Center for Chronic Immunodeficiency, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maryssa Ellison
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
| | - Rachel Cruz
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Sumit Pawar
- X4 Pharmaceuticals (Austria) GmbH, Vienna, Austria
| | | | | | - Shannon M McNulty
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Melis Yilmaz
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
| | | | - Sumai Gordon
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
| | - Boglarka Ujhazi
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
| | - Ivana Wiest
- X4 Pharmaceuticals (Austria) GmbH, Vienna, Austria
| | - Hassan Abolhassani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Asghar Aghamohammadi
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Barmettler
- Allergy and Clinical Immunology Unit, Division of Rheumatology, Allergy & Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Saleh Bhar
- Department of Pediatrics, Section of Hematology/Oncology and Critical Care Medicine, Bone Marrow Transplantation, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | | | - Audrey Anna Bolyard
- Severe Chronic Neutropenia International Registry, University of Washington, Seattle, WA, USA
| | - David Buchbinder
- Division of Hematology, CHOC Children's Hospital, Orange, CA, USA
| | - Michaela Cada
- Division of Hematology and Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Mirta Cavieres
- Hematology Unit, Dr Luis Calvo Mackenna Children's Hospital, Santiago, Chile
| | | | - David C Dale
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ekaterina Deordieva
- Immunology, the Dmitry Rogachev National Medical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Morna J Dorsey
- Division of Allergy, Immunology and Blood and Marrow Transplantation, Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Simon B Drysdale
- Paediatric Infectious Diseases Research Group, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Stephan Ehl
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center University of Freiburg Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Reem Elfeky
- Department of Clinical Immunology, Royal Free Hospital, London, UK
| | | | - Frank Firkin
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Vic, Fitzroy, Australia
- Department of Clinical Haematology, St Vincent's Hospital, Vic, Fitzroy, Australia
| | - Elizabeth Förster-Waldl
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Division of Neonatology, Pediatric Intensive Care & Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Center for Congenital Immunodeficiencies, Medical University of Vienna & Jeffrey Modell Diagnostic and Research Center, Vienna, Austria
| | - Bob Geng
- Divisions of Adult and Pediatric Allergy and Immunology, University of California, San Diego, CA, USA
| | - Vera Goda
- Department for Pediatric Hematology and Hemopoietic Stem Cell Transplantation, Central Hospital of Southern Pest - National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Luis Gonzalez-Granado
- Immunodeficiencies Unit, Department of Pediatrics, University Hospital 12 de Octubre, Research Institute Hospital 12 Octubre, Madrid, Spain
| | - Eyal Grunebaum
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Immunology and Allergy, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elzbieta Grzesk
- Department of Pediatrics, Hematology and Oncology Collegium Medicum, Bydgoszcz Nicolaus Copernicus University, Torun, Poland
| | - Sarah E Henrickson
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anna Hilfanova
- Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Mitsuteru Hiwatari
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chihaya Imai
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Department of Pediatrics, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Winnie Ip
- Great Ormond Street Hospital for Children, London, UK
| | - Soma Jyonouchi
- Division of Allergy and Immunology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Hirokazu Kanegane
- Department of Child Health and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yuta Kawahara
- Department of Pediatrics, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Amer M Khojah
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Vy Hong-Diep Kim
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Immunology and Allergy, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marina Kojić
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Sylwia Kołtan
- Department of Pediatrics, Hematology and Oncology Collegium Medicum, Bydgoszcz Nicolaus Copernicus University, Torun, Poland
| | - Gergely Krivan
- Department for Pediatric Hematology and Hemopoietic Stem Cell Transplantation, Central Hospital of Southern Pest - National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Daman Langguth
- Department of Immunology, Sullivan and Nicolaides Pathology, Brisbane, Australia
| | - Yu-Lung Lau
- Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong, China
| | - Daniel Leung
- Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong, China
| | - Maurizio Miano
- Haematology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Irina Mersyanova
- Immunology, the Dmitry Rogachev National Medical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Talal Mousallem
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Duke University Medical Center, Durham, NC, USA
| | - Mica Muskat
- Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Flavio A Naoum
- Academia de Ciência e Tecnologia, Sao Jose do Rio Preto, Brazil
| | - Suzie A Noronha
- Department of Pediatrics, Division of Hematology-Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Monia Ouederni
- Faculty of Médecine, University Tunis El Manar, Tunis, Tunisia
- Department of Pediatrics: Immuno-Hematology and Stem Cell Transplantation, Bone Marrow Transplantation Center of Tunisia, Tunis, Tunisia
| | - Shuichi Ozono
- Department of Pediatrics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - G Wendell Richmond
- Section of Allergy and Immunology, Rush University Medical Center, Chicago, IL, USA
| | - Inga Sakovich
- Research Department, Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Belarus
| | - Ulrich Salzer
- Department of Rheumatology and Clinical Immunology, Center for Chronic Immunodeficiency, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Catharina Schuetz
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Filiz Odabasi Seeborg
- Department of Pediatrics, Section of Immunology, Allergy and Rheumatology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Svetlana O Sharapova
- Research Department, Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Belarus
| | - Katja Sockel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Alla Volokha
- Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Malte von Bonin
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden, Germany
| | - Klaus Warnatz
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center University of Freiburg Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Rheumatology and Clinical Immunology, Center for Chronic Immunodeficiency, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Oliver Wegehaupt
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center University of Freiburg Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Geoffrey A Weinberg
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, University of Rochester Golisano Children's Hospital, Rochester, NY, USA
| | - Ke-Juin Wong
- Sabah Women and Children's Hospital, Sabah, Malaysia
| | - Austen Worth
- Great Ormond Street Hospital for Children, London, UK
| | - Huang Yu
- National Clinical Research Center for Child Health and disorders, Children Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China
| | - Yulia Zharankova
- Research Department, Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Belarus
| | - Xiaodong Zhao
- National Clinical Research Center for Child Health and disorders, Children Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China
| | - Lisa Devlin
- Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
- Regional Immunology Service, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | | | - Krisztian Csomos
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
| | - Marton Keszei
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden
| | - Joao Pereira
- Department of Immunobiology, Yale University School of Medicine, Yale University, New Haven, CT, USA
| | | | | | - Mei-Sing Ong
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Anna Shcherbina
- Immunology, the Dmitry Rogachev National Medical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Jolan E Walter
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA.
- Division of Allergy and Immunology, Massachusetts General Hospital for Children, Boston, MA, USA.
| |
Collapse
|
13
|
Luskin K, Mortazavi D, Bai-Tong S, Bertrand K, Chambers C, Schulkers-Escalante K, Ahmad A, Luedtke S, O'Donoghue AJ, Ghassemian M, Geng B, Leibel SL, Leibel SA. Allergen Content and Protease Activity in Milk Feeds from Mothers of Preterm Infants. Breastfeed Med 2022; 17:947-957. [PMID: 36251466 PMCID: PMC10081709 DOI: 10.1089/bfm.2022.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rationale: There is little information regarding the allergen content of milk feeds in the preterm population. Previous studies have not performed a broad analysis of the allergenic peptide content and protease activity of milk feeds in this population. Methods: To evaluate feasibility, we initially performed mass spectrometry on 4 human milk (HM) samples (2 term and 2 preterm) from the Mommy's Milk Human Milk Biorepository (HMB) and analyzed the results against the University of Nebraska FASTA database and UniProt for a total of 2,211 protein sequences. We then further analyzed five samples from the Microbiome, Atopy, and Prematurity (MAP) study including peptidomic and protease activity analysis. Results: Each HMB sample had between 806 and 1,007 proteins, with 37-44 nonhuman proteins/sample encompassing 26 plant and animal species. In the preterm MAP samples, 784 digested nonhuman proteins were identified, 30 were nonbovine in origin. Proteins from 23 different species including aeroallergens, food, and contact allergens were identified. Protease activity was highest in HM samples without human milk fortifier and lowest in preterm formula. Conclusions: These findings represent the first preterm milk feed mass spectrometry and protease analysis with identification of known allergenic proteins to food, contact, and aeroallergens. These results raise questions of whether the composition of milk feeds in the neonatal intensive care unit impact the development of atopic disease in the preterm population and whether the complex interaction between allergens, proteases, and other HM components can serve to induce sensitization or tolerance to allergens in infants. Clinical Trial Registration Number: NCT04835935.
Collapse
Affiliation(s)
| | - Diba Mortazavi
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
| | - Sherry Bai-Tong
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
| | - Kerri Bertrand
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
| | - Christina Chambers
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
| | | | - Alla Ahmad
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
| | - Stephanie Luedtke
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
| | - Anthony J. O'Donoghue
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
| | - Majid Ghassemian
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
| | - Bob Geng
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
| | - Sandra L. Leibel
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
| | - Sydney A. Leibel
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
| |
Collapse
|
14
|
Wangberg H, Mortazavi D, Kitsen J, Sanni A, Leibel S, Geng B. Dose-dependent association between inhaled corticosteroid use and risk of obesity and metabolic syndrome in asthma. Allergy Asthma Proc 2022; 43:446-453. [PMID: 36065107 DOI: 10.2500/aap.2022.43.220027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Inhaled corticosteroids (ICS) are widely prescribed medications. Some studies have reported that ICS may suppress the hypothalamic-pituitary-adrenal axis and induce systemic effects. Objective: To explore the possibility of a dose-dependent association between the long-term use of ICS and the risk of obesity and other markers of metabolic syndrome. Methods: A 5-year retrospective two-arm cohort study explored patients on asthma and not on ICS relative to patients with asthma who were on varying doses of ICS (low, medium, and high) and attributes such as body mass index (BMI) trajectory and prescription of antihypertensive, antidiabetic, and cholesterol-lowering medications. Results: A total of 229 subjects with asthma were in the control cohort, and 215 subjects with asthma were in the ICS cohort. The ICS cohort was subdivided into individuals on low- (n = 88), medium- (n = 107), or high- (n = 20) dose ICS throughout the 5-year study period. For every 1-year increase in time, the BMI in the high-dose ICS group increased at a rate of 0.25 kg/m² when compared with the subjects in the control group after controlling for age and gender. Also, for every 1-year increase in time, the BMI of those on medium-dose ICS increased by 0.06 kg/m² compared with those in the control group after controlling for age and gender. The subjects on ICS also had a statistically increased risk of being prescribed antihypertensive, antidiabetic, and cholesterol-lowering medications. Conclusion: ICS use in the subjects with asthma was associated with a dose-dependent risk of increasing BMI trajectories over time and an increased requirement for antidiabetic and cholesterol-lowering medications. One possible conclusion from this study is that long-term medium- and high-dose ICS have the potential to induce systemic effects.
Collapse
Affiliation(s)
- Hannah Wangberg
- From the Department of Allergy, Asthma, and Immunology, Scripps Health, San Diego, California; and
| | - Diba Mortazavi
- Department of Allergy and Immunology, University of California San Diego and Rady Children's Hospital, San Diego, California
| | - Jessica Kitsen
- Department of Allergy and Immunology, University of California San Diego and Rady Children's Hospital, San Diego, California
| | - Adepeju Sanni
- Department of Allergy and Immunology, University of California San Diego and Rady Children's Hospital, San Diego, California
| | - Sydney Leibel
- Department of Allergy and Immunology, University of California San Diego and Rady Children's Hospital, San Diego, California
| | - Bob Geng
- Department of Allergy and Immunology, University of California San Diego and Rady Children's Hospital, San Diego, California
| |
Collapse
|
15
|
Bhatti S, Tracy A, Loop L, Villapando N, Wu A, D P, Appia MM, Eichenfield L, Geng B. 33496 Multidisciplinary atopic dermatitis program: A novel approach to managing difficult-to-control atopic dermatitis patients. J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.768] [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]
|
16
|
Zhang K, Liu X, Tang Y, Liu Z, Yi Q, Wang L, Geng B, Xia Y. Fluid Shear Stress Promotes Osteoblast Proliferation and Suppresses Mitochondrial-Mediated Osteoblast Apoptosis Through the miR-214-3p-ATF4 Signaling Axis. Physiol Res 2022. [DOI: 10.33549/physiolres.934917] [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: 11/25/2022] Open
Abstract
MicroRNAs (miRNAs) play vital roles in bone metabolism and participate in the mechanically induced bone alterations. The underlying molecular mechanisms by which fluid shear stress (FSS) regulate the proliferative and apoptotic phenotypic changes of osteoblasts remain elusive. The study aimed to investigate the regulatory effects of FSS on osteoblast proliferative and apoptotic phenotypes and the roles of miR-214-3p-ATF4 (activating transcription factor 4) signaling axis in the mechanomodulation processes. FSS promoted the proliferative activity of osteoblasts and suppressed mitochondrial-mediated osteoblast apoptosis. FSS decreased miR-214-3p expression and increased ATF4 expression in MC3T3-E1 osteoblasts. MiR-214-3p inhibited osteoblast proliferative activity and promoted mitochondrial-mediated osteoblast apoptosis. Overexpression of miR-214-3p attenuated FSS-enhanced osteoblast proliferation and FSS-suppressed mitochondrial-mediated osteoblast apoptosis. We validated that ATF4 acted as a target gene of miR-214-3p. Moreover, miR-214 3p regulated osteoblast proliferation and apoptosis through targeting ATF4. Taken together, our study proved that FSS could suppress mitochondrial-mediated osteoblast apoptosis and promote osteoblast proliferation through the miR-214-3p-ATF4 signaling axis.
Collapse
Affiliation(s)
- K Zhang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou Gansu, China, Orthopaedics Key Laboratory of Gansu Province, Lanzhou Gansu, China
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Revier MD, Geng B. Mepolizumab prefilled syringe for the treatment of severe eosinophilic asthma: focus on the pediatric population. Expert Rev Respir Med 2022; 16:857-865. [PMID: 35916083 DOI: 10.1080/17476348.2022.2109465] [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: 11/04/2022]
Abstract
INTRODUCTION Eosinophil-targeted therapy with mepolizumab for severe eosinophilic asthma has significantly improved asthma control and patient quality of life though administration in children had been restricted to health-care provider reconstitution of a lyophilized powder into a solution with in-clinic administration until recently. Here, we profile the newly FDA-approved use of mepolizumab as a prefilled syringe for the treatment of severe eosinophilic asthma in children aged 6-11 years old, allowing for home administration. AREAS COVERED A literature search was conducted on PubMed using keywords such as mepolizumab, severe asthma, eosinophils, IL-5, anti-IL-5, children, pediatric, prefilled syringe, and home administration in several combinations. Published literature through July 2022 including clinical trials and prescribing information for mepolizumab for severe eosinophilic asthma, particularly for use in children and as administration as a prefilled syringe, is reviewed. EXPERT OPINION Asthma affects a significant number of children worldwide, and having efficacious, tolerable, targeted precision therapies for this population is crucial. Mepolizumab remains the only targeted anti-IL-5 therapy approved for pediatric asthma down to 6 years of age. The innovation of the prefilled syringe will enable home administration, which would decrease the burden of treatment, and could potentially increase adoption of therapy.
Collapse
Affiliation(s)
- Michelle Dilley Revier
- Rady Children's Hospital, San Diego, California, USA.,Division of Allergy, Immunology and Rheumatology, University of California, San Diego, California, USA
| | - Bob Geng
- Rady Children's Hospital, San Diego, California, USA
| |
Collapse
|
18
|
Appiah M, Loop L, Geng B, Eichenfield L. LB919 Vigxbsa in a pediatric population: a novel tool for evaluating atopic dermatitis severity and responsiveness. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.937] [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: 11/27/2022]
|
19
|
Crane C, Loop L, Anterasian C, Geng B, Ingulli E. Balancing B cell responses to the allograft: implications for vaccination. Front Immunol 2022; 13:948379. [PMID: 35967363 PMCID: PMC9363634 DOI: 10.3389/fimmu.2022.948379] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
Balancing enough immunosuppression to prevent allograft rejection and yet maintaining an intact immune system to respond to vaccinations, eliminate invading pathogens or cancer cells is an ongoing challenge to transplant physicians. Antibody mediated allograft rejection remains problematic in kidney transplantation and is the most common cause of graft loss despite current immunosuppressive therapies. The goal of immunosuppressive therapies is to prevent graft rejection; however, they prevent optimal vaccine responses as well. At the center of acute and chronic antibody mediated rejection and vaccine responses is the B lymphocyte. This review will highlight the role of B cells in alloimmune responses including the dependency on T cells for antibody production. We will discuss the need to improve vaccination rates in transplant recipients and present data on B cell populations and SARS-CoV-2 vaccine response rates in pediatric kidney transplant recipients.
Collapse
Affiliation(s)
- Clarkson Crane
- Department of Pediatrics, Division of Pediatric Nephrology, University of California at San Diego and Rady Children’s Hospital, San Diego, CA, United States
| | - Lauren Loop
- Department of Pediatrics, Division of Allergy and Immunology, University of California at San Diego and Rady Children’s Hospital, San Diego, CA, United States
| | - Christine Anterasian
- Department of Pediatrics, Division of Allergy and Immunology, University of California at San Diego and Rady Children’s Hospital, San Diego, CA, United States
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Washington and Seattle Children's Hospital, Seattle, WA, United States
| | - Bob Geng
- Department of Pediatrics, Division of Allergy and Immunology, University of California at San Diego and Rady Children’s Hospital, San Diego, CA, United States
| | - Elizabeth Ingulli
- Department of Pediatrics, Division of Pediatric Nephrology, University of California at San Diego and Rady Children’s Hospital, San Diego, CA, United States
- *Correspondence: Elizabeth Ingulli,
| |
Collapse
|
20
|
Dellon ES, Khoury P, Muir AB, Liacouras CA, Safroneeva E, Atkins D, Collins MH, Gonsalves N, Falk GW, Spergel JM, Hirano I, Chehade M, Schoepfer AM, Menard-Katcher C, Katzka DA, Bonis PA, Bredenoord AJ, Geng B, Jensen ET, Pesek RD, Feuerstadt P, Gupta SK, Lucendo AJ, Genta RM, Hiremath G, McGowan EC, Moawad FJ, Peterson KA, Rothenberg ME, Straumann A, Furuta GT, Aceves SS. A Clinical Severity Index for Eosinophilic Esophagitis: Development, Consensus, and Future Directions. Gastroenterology 2022; 163:59-76. [PMID: 35606197 PMCID: PMC9233087 DOI: 10.1053/j.gastro.2022.03.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/11/2022] [Accepted: 03/13/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND & AIMS Disease activity and severity of eosinophilic esophagitis (EoE) dictate therapeutic options and management, but the decision-making process for determining severity varies among practitioners. To reduce variability in practice patterns and help clinicians monitor the clinical course of the disease in an office setting, we aimed to create an international consensus severity scoring index for EoE. METHODS A multidisciplinary international group of adult and pediatric EoE researchers and clinicians, as well as non-EoE allergy immunology and gastroenterology experts, formed 3 teams to review the existing literature on histology, endoscopy, and symptoms of EoE in the context of progression and severity. A steering committee convened a 1-day virtual meeting to reach consensus on each team's opinion on salient features of severity across key clinicopathologic domains and distill features that would allow providers to categorize disease severity. RESULTS Symptom features and complications and inflammatory and fibrostenotic features on both endoscopic and histologic examination were collated into a simplified scoring system-the Index of Severity for Eosinophilic Esophagitis (I-SEE)-that can be completed at routine clinic visits to assess disease severity using a point scale of 0-6 for mild, 7-14 for moderate, and ≥15 for severe EoE. CONCLUSIONS A multidisciplinary team of experts iteratively created a clinically usable EoE severity scoring system denominated "I-SEE" to guide practitioners in EoE management by standardizing disease components reflecting disease severity beyond eosinophil counts. I-SEE should be validated and refined using data from future clinical trials and routine clinical practice to increase its utilization and functionality.
Collapse
Affiliation(s)
- Evan S Dellon
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Paneez Khoury
- Human Eosinophil Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Amanda B Muir
- Division of Gastroenterology, Hepatology, and Nutrition, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Chris A Liacouras
- Division of Gastroenterology, Hepatology, and Nutrition, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Center for Pediatric Eosinophilic Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ekaterina Safroneeva
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Dan Atkins
- Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Aurora, Colorado; Children's Hospital Colorado, Aurora, Colorado
| | - Margaret H Collins
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nirmala Gonsalves
- Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Gary W Falk
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jonathan M Spergel
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ikuo Hirano
- Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Mirna Chehade
- Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alain M Schoepfer
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Calies Menard-Katcher
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado
| | | | | | - Albert J Bredenoord
- Department of Gastroenterology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Bob Geng
- University of California San Diego, San Diego, California; Rady Children's Hospital, San Diego, California
| | - Elizabeth T Jensen
- Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Robert D Pesek
- Division of Allergy/Immunology, University of Arkansas for Medicine Sciences, Little Rock, Arkansas; Arkansas Children's Hospital, Little Rock, Arkansas
| | - Paul Feuerstadt
- Division of Gastroenterology, Yale-New Haven Hospital, New Haven, Connecticut; Physicians Alliance of Connecticut, Gastroenterology Center, Hamden, Connecticut
| | - Sandeep K Gupta
- Section of Pediatric Gastroenterology/Hepatology/Nutrition, Indiana University School of Medicine, Indianapolis, Indiana; Riley Hospital for Children, Indianapolis, Indiana; Community Health Network, Indianapolis, Indiana
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Ciudad Real, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain; Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | | | - Girish Hiremath
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Emily C McGowan
- Allergy and Clinical Immunology, University of Virginia, Charlottesville, Virginia
| | - Fouad J Moawad
- Division of Gastroenterology, Scripps Clinic, La Jolla, California
| | - Kathryn A Peterson
- Division of Gastroenterology, University of Utah Health, Salt Lake City, Utah
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Glenn T Furuta
- Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, Gastrointestinal Eosinophilic Diseases Program and Mucosal Inflammation Program, University of Colorado School of Medicine, Aurora, Colorado
| | - Seema S Aceves
- Rady Children's Hospital, San Diego, California; Division of Allergy, Immunology, University of California-San Diego, San Diego, California
| |
Collapse
|
21
|
Dellon ES, Khoury P, Muir AB, Liacouras CA, Safroneeva E, Atkins D, Collins MH, Gonsalves N, Falk GW, Spergel JM, Hirano I, Chehade M, Schoepfer AM, Menard-Katcher C, Katzka DA, Bonis PA, Bredenoord AJ, Geng B, Jensen ET, Pesek RD, Feuerstadt P, Gupta SK, Lucendo AJ, Genta RM, Hiremath G, McGowan EC, Moawad FJ, Peterson KA, Rothenberg ME, Straumann A, Furuta GT, Aceves SS. A Clinical Severity Index for Eosinophilic Esophagitis: Development, Consensus, and Future Directions. J Allergy Clin Immunol 2022; 150:33-47. [PMID: 35606166 PMCID: PMC9549868 DOI: 10.1016/j.jaci.2022.03.015] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/13/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Disease activity and severity of eosinophilic esophagitis (EoE) dictate therapeutic options and management, but the decision-making process for determining severity varies among practitioners. To reduce variability in practice patterns and help clinicians monitor the clinical course of the disease in an office setting, we aimed to create an international consensus severity scoring index for EoE. METHODS A multidisciplinary international group of adult and pediatric EoE researchers and clinicians, as well as non-EoE allergy immunology and gastroenterology experts, formed 3 teams to review the existing literature on histology, endoscopy, and symptoms of EoE in the context of progression and severity. A steering committee convened a 1-day virtual meeting to reach consensus on each team's opinion on salient features of severity across key clinicopathologic domains and distill features that would allow providers to categorize disease severity. RESULTS Symptom features and complications and inflammatory and fibrostenotic features on both endoscopic and histologic examination were collated into a simplified scoring system-the Index of Severity for Eosinophilic Esophagitis (I-SEE)-that can be completed at routine clinic visits to assess disease severity using a point scale of 0-6 for mild, 7-14 for moderate, and ≥15 for severe EoE. CONCLUSIONS A multidisciplinary team of experts iteratively created a clinically usable EoE severity scoring system denominated "I-SEE" to guide practitioners in EoE management by standardizing disease components reflecting disease severity beyond eosinophil counts. I-SEE should be validated and refined using data from future clinical trials and routine clinical practice to increase its utilization and functionality.
Collapse
Affiliation(s)
- Evan S Dellon
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill.
| | - Paneez Khoury
- Human Eosinophil Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda
| | - Amanda B Muir
- Division of Gastroenterology, Hepatology, and Nutrition, Perelman School of Medicine, University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Philadelphia
| | - Chris A Liacouras
- Division of Gastroenterology, Hepatology, and Nutrition, Perelman School of Medicine, University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Philadelphia; Center for Pediatric Eosinophilic Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Dan Atkins
- Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Aurora; Children's Hospital Colorado, Aurora
| | - Margaret H Collins
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati; Cincinnati Children's Hospital Medical Center, Cincinnati
| | - Nirmala Gonsalves
- Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago
| | - Gary W Falk
- The Children's Hospital of Philadelphia, Philadelphia; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jonathan M Spergel
- The Children's Hospital of Philadelphia, Philadelphia; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ikuo Hirano
- Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago
| | - Mirna Chehade
- Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York
| | - Alain M Schoepfer
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne
| | - Calies Menard-Katcher
- Department of Pediatrics, University of Colorado School of Medicine, Aurora; Digestive Health Institute, Children's Hospital Colorado, Aurora
| | | | | | - Albert J Bredenoord
- Department of Gastroenterology, Amsterdam University Medical Center, Amsterdam
| | - Bob Geng
- University of California San Diego, San Diego; Rady Children's Hospital, San Diego
| | - Elizabeth T Jensen
- Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem
| | - Robert D Pesek
- Division of Allergy/Immunology, University of Arkansas for Medicine Sciences, Little Rock; Arkansas Children's Hospital, Little Rock
| | - Paul Feuerstadt
- Division of Gastroenterology, Yale-New Haven Hospital, New Haven; Physicians Alliance of Connecticut, Gastroenterology Center, Hamden
| | - Sandeep K Gupta
- Section of Pediatric Gastroenterology/Hepatology/Nutrition, Indiana University School of Medicine, Indianapolis; Riley Hospital for Children, Indianapolis; Community Health Network, Indianapolis
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Ciudad Real; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid; Instituto de Investigación Sanitaria La Princesa, Madrid
| | | | - Girish Hiremath
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville
| | - Emily C McGowan
- Allergy and Clinical Immunology, University of Virginia, Charlottesville
| | | | | | - Marc E Rothenberg
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati
| | | | - Glenn T Furuta
- Digestive Health Institute, Children's Hospital Colorado, Aurora; Department of Pediatrics, Gastrointestinal Eosinophilic Diseases Program and Mucosal Inflammation Program, University of Colorado School of Medicine, Aurora
| | - Seema S Aceves
- Rady Children's Hospital, San Diego; Division of Allergy, Immunology, University of California-San Diego, San Diego
| |
Collapse
|
22
|
Appiah MM, Haft MA, Kleinman E, Laborada J, Lee S, Loop L, Geng B, Eichenfield LF. Atopic dermatitis. Ann Allergy Asthma Immunol 2022; 129:142-149. [PMID: 35609746 DOI: 10.1016/j.anai.2022.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/08/2022] [Accepted: 05/12/2022] [Indexed: 11/25/2022]
Abstract
Atopic dermatitis (AD) is a very common skin disease associated with substantial burdens on patient health and quality of life. Knowledge regarding the pathogenesis of AD has expanded within recent years, leading to novel and efficacious therapeutic agents. Similarly, our knowledge of the impact of AD on patient's mental and physical health has also expanded. This review summarizes updates on the evolution, comorbidities, and therapeutic options of AD. AD is associated with increased cardiovascular risk, allergic diseases, and adverse mental health outcomes. Topical and systemic therapeutics have drastically altered the landscape of AD therapy in recent years.
Collapse
Affiliation(s)
- Margaret M Appiah
- Departments of Dermatology and Pediatrics, University of California San Diego, San Diego, California; Rady Children's Hospital, San Diego, California
| | - Michael A Haft
- Departments of Dermatology and Pediatrics, University of California San Diego, San Diego, California; Rady Children's Hospital, San Diego, California; University of Rochester School of Medicine, New York, New York
| | | | | | - Stephanie Lee
- Departments of Dermatology and Pediatrics, University of California San Diego, San Diego, California; Rady Children's Hospital, San Diego, California
| | - Lauren Loop
- Rady Children's Hospital, San Diego, California
| | - Bob Geng
- Rady Children's Hospital, San Diego, California; Division of Allergy and Immunology, University of California San Diego, San Diego, California
| | - Lawrence F Eichenfield
- Departments of Dermatology and Pediatrics, University of California San Diego, San Diego, California; Rady Children's Hospital, San Diego, California.
| |
Collapse
|
23
|
Geng B, Bachert C, Busse WW, Gevaert P, Lee SE, Niederman MS, Chen Z, Lu X, Khokhar FA, Kapoor U, Pandit-Abid N, Jacob-Nara JA, Rowe PJ, Deniz Y, Ortiz B. Respiratory Infections and Anti-Infective Medication Use From Phase 3 Dupilumab Respiratory Studies. J Allergy Clin Immunol Pract 2022; 10:732-741. [PMID: 34954123 DOI: 10.1016/j.jaip.2021.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/24/2021] [Accepted: 12/04/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Patients with asthma and/or chronic rhinosinusitis with nasal polyps (CRSwNP) experience recurrent respiratory tract infections. Dupilumab targets type 2 inflammation, a common underlying pathophysiology of both conditions, with proven efficacy. OBJECTIVE To examine investigator-reported respiratory infection adverse events and anti-infective medication use with dupilumab versus placebo in patients with moderate-to-severe asthma or severe CRSwNP. METHODS We performed a post hoc analysis of the pivotal phase 3 trials LIBERTY ASTHMA QUEST (NCT02414854) and LIBERTY NP SINUS-52 (NCT02898454) in moderate-to-severe asthma and severe CRSwNP, respectively. RESULTS Investigator-reported respiratory infection events occurred at a significantly lower incidence in patients treated with dupilumab versus placebo, in both asthma (22% lower; P < .0001; 95% CI 0.71-0.85) and CRSwNP (38% lower; P <.0001; 95% CI 0.51-0.75). Reported upper and lower respiratory tract infection events were numerically or significantly lower in dupilumab-treated patients in both conditions, as were the number of patients experiencing investigator-reported infections. Significantly less systemic anti-infective medication use occurred in dupilumab versus placebo in asthma (24% lower; P < .0001; 95% CI 0.70-0.83) and CRSwNP patients (49% lower; P < .0001; 95% CI 0.43-0.61), and significantly fewer dupilumab-treated patients used anti-infective medications. When examined by season and month, the data indicated that investigator-reported respiratory infections and anti-infective medication use were less frequent in dupilumab- versus placebo-treated patients throughout the calendar year. CONCLUSIONS Dupilumab treatment was associated with a reduced incidence of investigator-reported respiratory infections in patients with moderate-to-severe asthma or severe CRSwNP. Further studies are required to determine the mechanism behind this reduction.
Collapse
Affiliation(s)
- Bob Geng
- Division of Allergy and Immunology, University of California, San Diego, Calif.
| | - Claus Bachert
- Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University, Ghent, Belgium; CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - William W Busse
- UW Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Philippe Gevaert
- Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
| | - Stella E Lee
- Division of Otolaryngology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | | | - Zhen Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | | | | | | | | | | | | | - Yamo Deniz
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | | |
Collapse
|
24
|
Craig M, Geng B, Wigby K, Phillips SA, Bakhoum C, Naheedy J, Cernelc-Kohan M. Activated phosphoinositide 3-kinase δ syndrome associated with nephromegaly, growth hormone deficiency, bronchiectasis: a case report. Allergy Asthma Clin Immunol 2022; 18:15. [PMID: 35189965 PMCID: PMC8862239 DOI: 10.1186/s13223-022-00655-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 02/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background Activated phosphoinositide 3-kinase (PI3K) δ syndrome (APDS) is a rare form of primary immunodeficiency with 243 known cases reported in the literature. Known findings associated with the condition include recurrent sinusitis and bronchitis, bronchiectasis, immune cytopenias, mild developmental delay, splenomegaly, and lymphadenopathy. We report the case of a child with APDS accompanied by unique clinical features: nephromegaly and growth hormone deficiency with associated pituitary anatomic abnormality. Case presentation The patient is a nine-year-old boy with a heterozygous de novo variant in phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit δ (p.E1021K), previously reported in association with APDS. Our patient, who had no family history of immunodeficiency, exhibits classic findings of this syndrome but also has unique features that extend the phenotypic spectrum of this disorder. At 5 years of age, the patient showed marked growth deceleration and was demonstrated to have growth hormone (GH) deficiency with associated pituitary anatomic abnormality. He started GH therapy with an excellent response. He additionally has bilateral nephromegaly of unclear etiology, microscopic hematuria and proteinuria, asthma, and has developed left hip pain with arthrocentesis consistent with oligoarticular juvenile idiopathic arthritis. At age nine, the patient was referred to genetics and whole exome sequencing revealed APDS. Though there was initial concern that GH may increase risk for malignancy as GH signals through the PI3K pathway, he was allowed to continue treatment as the PI3K pathway was considered constitutively active at baseline. Conclusions Our patient’s unique presentation adds to the clinical information regarding APDS, demonstrates the utility of genetic testing and illustrates the importance of a multidisciplinary collaborative approach in managing this complex syndrome. Supplementary Information The online version contains supplementary material available at 10.1186/s13223-022-00655-5.
Collapse
|
25
|
Loop L, Geng B, Collins C, Anterasian C, Mortazavi D, Coordinator R, Kitsen J, Newton K, Ingulli E. Long-term Immunosuppression Associated With Disruption Of B-cell Populations And Increased Infection Risk. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.121] [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: 11/27/2022]
|
26
|
Geng B, Clark K, Evangelista M, Wolford E. Low rates of headache and migraine associated with intravenous immunoglobulin infusion using a 15-minute rate escalation protocol in 123 patients with primary immunodeficiency. Front Immunol 2022; 13:1075527. [PMID: 36818468 PMCID: PMC9932595 DOI: 10.3389/fimmu.2022.1075527] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/16/2022] [Indexed: 02/05/2023] Open
Abstract
Introduction Headache and migraine adverse events are common concerns in the administration of intravenous immune globulins (IVIG). Trials of IVIG for primary immunodeficiency (PI) are typically small and have reported headache and migraine data inconsistently. Methods We analyzed headache and migraine in pooled data from three pivotal trials of Gammaplex® 5% and 10% in PI (NCT00278954 from January 18, 2006; NCT01289847 from January 27, 2011; NCT01963143 from September 13, 2013). The trials were pooled in a retrospective analysis that included two 12-month open-label non-comparative trials of the 5% IVIG product and one 6-month open-label crossover bioequivalence trial comparing the 5% IVIG and 10% IVIG products. The population included adult and pediatric patients, who received IVIG infusions of 300-800 mg/kg/infusion every 21 or 28 days using a 15-minute rate escalation protocol. Results In total, 1482 infusions were administered to 123 patients, with 94.6% of infusions achieving the maximum infusion rate. At least one product-related headache was reported in 6.1% (90/1482) of infusions. At least one product-related migraine was reported in 0.5% (7/1482) of infusions. Headache rates were higher for adults vs pediatric patients, females vs males, and 21-day vs 28-day dosing schedules, but were similar for the 5% and 10% IVIG products. Most headaches and migraines occurred during or within 72 hours of the infusion. Rates decreased after the first few infusions. Discussion Patients receiving this IVIG product on a 15-minute rate escalation protocol had low rates of headache and migraine for both the 5% and 10% formulations.
Collapse
Affiliation(s)
- Bob Geng
- Division of Allergy & Immunology, University of California, San Diego, CA, United States
| | - Kim Clark
- Global Medical Department, Bio Products Laboratory, Ltd., Elstree, United Kingdom
| | - Mark Evangelista
- Biostatistics Department, Atlantic Research Group, Charlottesville, VA, United States
| | - Eric Wolford
- Global Medical Department, Bio Products Laboratory, Ltd., Elstree, United Kingdom
| |
Collapse
|
27
|
Dilley M, Geng B. Immediate and Delayed Hypersensitivity Reactions to Antibiotics: Aminoglycosides, Clindamycin, Linezolid, and Metronidazole. Clin Rev Allergy Immunol 2021; 62:463-475. [PMID: 34910281 PMCID: PMC9156451 DOI: 10.1007/s12016-021-08878-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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] [Accepted: 07/13/2021] [Indexed: 11/02/2022]
Abstract
Hypersensitivity reactions including IgE-mediated and delayed cell-mediated reactions to aminoglycosides, clindamycin, linezolid, and metronidazole are rare. For aminoglycosides, allergic contact dermatitis is the most frequent reaction for which patch testing can be a useful step in evaluation. For clindamycin, delayed maculopapular exanthems are the most common reactions. There are case reports of clindamycin associated with drug rash with eosinophilia and systemic symptoms (DRESS), acute generalized exanthematous pustulosis (AGEP), acute febrile neutrophilic dermatosis, and symmetrical drug-related intertriginous and flexural exanthema (SDRIFE). For linezolid, cases of hypersensitivity were exceedingly rare and included urticaria, angioedema, anaphylaxis, delayed rashes, and DRESS. For metronidazole, only rare cases were found across a broad spectrum of reactions including allergic contact dermatitis, fixed drug eruption, angioedema, anaphylaxis, serum sickness-like reaction, SJS/TEN, AGEP, SDRIFE, and a possible case of DRESS. IgE-mediated reactions and anaphylaxis to these types of antibiotics are uncommon, and reports of skin testing concentrations and desensitization protocols are largely limited to case reports and series. Non-irritating skin testing concentrations have been reported for gentamycin, tobramycin, and clindamycin. Published desensitization protocols for intravenous and inhaled tobramycin, oral clindamycin, intravenous linezolid, and oral and intravenous metronidazole have also been reported and are reviewed.
Collapse
Affiliation(s)
- Michelle Dilley
- University of California San Diego and Rady Children's Hospital, San Diego, CA, USA.
| | - Bob Geng
- University of California San Diego and Rady Children's Hospital, San Diego, CA, USA
| |
Collapse
|
28
|
Geng B. Legal Text Mining and Analysis Based on Artificial Intelligence. INT J ARTIF INTELL T 2021. [DOI: 10.1142/s0218213022400061] [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: 11/18/2022]
|
29
|
Geng B, Collins C, Loop L, Ozog S, Anterasian C, Ripp C, Newton K, Ingulli E. P090 BALANCE OF B-CELL POPULATIONS IN PEDIATRIC SOLID-ORGAN TRANSPLANT RECIPIENTS ASSOCIATED WITH INFECTION RISK. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.111] [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]
|
30
|
Geng B, Terpstra C, Karlin E, Harder C. D002 RAPID FINGERSTICK BASED POINT-OF-CARE SYSTEM FOR IGE QUANTIFICATION. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.046] [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: 11/29/2022]
|
31
|
Loop L, Eichenfield L, Geng B. P170 DISEASE IMPROVEMENT IN ATOPIC DERMATITIS THROUGH A MULTIDISCIPLINARY APPROACH WITH ALLERGY, DERMATOLOGY, AND CLINICAL PHARMACY. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.148] [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]
|
32
|
Geng B, Craig TJ. Small molecule drugs for atopic dermatitis, rheumatoid arthritis, and hereditary angioedema. Ann Allergy Asthma Immunol 2021; 128:263-268. [PMID: 34673223 DOI: 10.1016/j.anai.2021.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To review recent trends in the development of targeted small molecule drugs (SMDs) for the treatment of immunologically driven disorders, including atopic dermatitis, rheumatoid arthritis, and hereditary angioedema. DATA SOURCES Data sources included peer-reviewed published literature from the PubMed database, published abstracts from scientific and medical meetings, and medication information from the Drugs@FDA database. STUDY SELECTIONS Articles with primary or retrospective trial results, articles with patient or physician survey results, articles providing expert perspectives, and commentary on chronic immunologic disorders, Food and Drug Administration package inserts, and abstracts from scientific meetings were selected. RESULTS Targeted biological therapies have greatly improved response rates and symptom relief for patients with long-term immunologically driven disorders over the past 2 decades. However, recent advances in the understanding of molecular pathways involved in the pathogenesis of these disorders have led to the development of novel targeted SMDs, such as tofacitinib and berotralstat, that can be delivered orally or topically. Few head-to-head studies that compare the safety and efficacy of biologics to SMDs in immunologically driven disorders exist, although some studies suggest that oral and topical modes of administration are preferred by patients and may improve patient quality of life over time. CONCLUSION Scientific advances have led to an increase in the development of targeted SMDs for the treatment of chronic immunologic disorders, which may revolutionize the management of these diseases. Head-to-head studies and real-world evidence are needed to fully compare treatment attributes between biologics and SMDs, including safety, efficacy, adherence, impact on quality of life, and cost-effectiveness.
Collapse
Affiliation(s)
- Bob Geng
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California San Diego, La Jolla, California
| | - Timothy J Craig
- Department of Medicine, Pediatrics, and Biomedical Sciences, Penn State University, Hershey Medical Center, Hershey, Pennsylvania.
| |
Collapse
|
33
|
Geng B, Hebert AA, Takiya L, Miller L, Werth JL, Zang C, Sanders P, Lebwohl MG. Efficacy and Safety Trends with Continuous, Long-Term Crisaborole Use in Patients Aged ≥ 2 Years with Mild-to-Moderate Atopic Dermatitis. Dermatol Ther (Heidelb) 2021; 11:1667-1678. [PMID: 34379285 PMCID: PMC8484488 DOI: 10.1007/s13555-021-00584-y] [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: 05/10/2021] [Accepted: 07/21/2021] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Atopic dermatitis (AD) is a chronic inflammatory skin disease often requiring long-term treatment. Crisaborole significantly improved global AD signs and symptoms in 28-day phase 3 studies of patients aged ≥ 2 years with mild-to-moderate AD (Investigator's Static Global Assessment [ISGA] 2 or 3). A post hoc analysis of a long-term, open-label extension study was conducted to assess efficacy and safety trends of crisaborole in patients stratified by the number of initial consecutive crisaborole treatment cycles, defined as the number of treatment cycles completed before achievement of ISGA 0 (clear)/1 (almost clear). METHODS Patients completing phase 3 studies without drug-related safety issues that precluded further crisaborole treatment were analyzed. Patients with ISGA 0/1 at baseline (the end of a 28-day cycle) did not receive crisaborole for the next 28-day cycle (off-treatment), whereas patients with ISGA ≥ 2 received crisaborole for the next 28-day cycle (on-treatment). Patients were stratified by number of initial consecutive crisaborole treatment cycles. Efficacy was assessed by achievement and maintenance of ISGA 0/1, and safety was assessed by incidence of treatment-emergent adverse events (TEAEs) and treatment-related AEs (TRAEs). RESULTS Overall, 418 patients were included in exclusive cohorts based on number of consecutive on-treatment cycles (1 on-treatment cycle, n = 133; 2 consecutive on-treatment cycles, n = 106; 3 consecutive on-treatment cycles, n = 106; 4 consecutive on-treatment cycles, n = 73). After one to four initial consecutive on-treatment cycles, 77.6, 76.3, 59.4, and 43.1% of patients, respectively, achieved ISGA 0/1. Of these patients, 49.5, 37.8, 44.4, and 45.2%, respectively, maintained ISGA 0/1 at the end of a 28-day cycle off-treatment. Incidence of TRAEs was 4.5, 4.7, 3.8, and 1.4% for patients receiving one to four consecutive on-treatment cycles, respectively. One patient discontinued because of AEs. CONCLUSION These results support the efficacious and safe continuous, long-term use of crisaborole for the management of mild-to-moderate AD. TRIAL REGISTRATION ClinicalTrials.gov: NCT02118766, NCT02118792.
Collapse
Affiliation(s)
- Bob Geng
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, UC San Diego School of Medicine, San Diego, CA, USA
| | - Adelaide A Hebert
- Department of Dermatology, UTHealth McGovern School of Medicine, Houston, TX, USA
| | | | | | | | | | | | - Mark G Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
34
|
Abstract
PURPOSE OF REVIEW There is an emerging body of research on targeted biologic therapies for the treatment of severe inflammatory nasal disorders, especially chronic rhinosinusitis with nasal polyposis (CRSwNP). This paper will evaluate the efficacy of biologic therapies for severe nasal inflammation by summarizing key preclinical trials of biologics for animal models of allergic rhinitis and the recent phase 2 and 3 clinical trials of biologic therapies for CRSwNP. RECENT FINDINGS Biologics that target the IL-4 receptor (dupilumab), IgE (omalizumab), and IL-5 (mepolizumab, reslizumab, and benralizumab) in patients with CRSwNP have shown improvement of various metrics including Sino-Nasal Outcome Test (SNOT-22) scores, Nasal Polyp Scores (NPS), Nasal Congestion Scores (NCS), and Lund-Mackay sinus opacification scores. The efficacy demonstrated through the dupilumab phase 3 trials (LIBERTY NP SINUS-24 and SINUS-52) led to approval of the first biologic for the treatment of CRSwNP. Phase 3 trials for omalizumab (POLYP 1 and 2) and mepolizumab (SYNAPSE study) and post hoc analyses of phase 3 asthma studies for reslizumab and benralizumab have also demonstrated positive results for the use of biologics for patients with CRSwNP. Future efficacy studies and risk/benefit and cost analyses of these biologics and other cytokine targets for allergic rhinitis with and without nasal polyposis need to be performed.
Collapse
Affiliation(s)
- Bob Geng
- University of California San Diego and Rady Children's Hospital, San Diego, CA, USA.
| | - Michelle Dilley
- University of California San Diego and Rady Children's Hospital, San Diego, CA, USA
| | | |
Collapse
|
35
|
Kobayashi RH, Mandujano JF, Rehman SM, Kobayashi AL, Geng B, Atkinson TP, Melamed I, Turpel-Kantor E, Clodi E, Gupta S. Treatment of children with primary immunodeficiencies with a subcutaneous immunoglobulin 16.5% (cutaquig ® [octanorm]). Immunotherapy 2021; 13:813-824. [PMID: 33955240 DOI: 10.2217/imt-2021-0064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Subcutaneous human immunoglobulin (16.5%; octanorm/cutaquig®) was efficacious and well tolerated in patients with primary immunodeficiencies in a Phase III study. A subanalysis of pediatric data is presented here. Materials & methods: Children (2-16 years) previously treated with intravenous human immunoglobulin received weekly subcutaneous human immunoglobulin infusions over 64 weeks. The main objective was to assess the efficacy of cutaquig in preventing serious bacterial infections. Results: 38 children received 2213 infusions of cutaquig. No serious bacterial infections developed during the study. The rate of other infections was 3.1 per person-year and the rate of adverse drug reactions was 0.083 per infusion. Higher immunoglobulin G trough levels were achieved with cutaquig compared with previous intravenous therapy. Conclusion: Once-weekly infusions of cutaquig were efficacious and well tolerated in children with primary immunodeficiencies.
Collapse
Affiliation(s)
- Roger H Kobayashi
- Department of Pediatrics, Division of Immunology and Allergy, UCLA School of Medicine, Los Angeles, CA 90095, USA
| | | | - Syed M Rehman
- Asthma & Allergy Center, Inc., Toledo, OH 43617, USA
| | | | - Bob Geng
- Divisions of Adult and Pediatric, Allergy and Immunology, University of California-San Diego, La Jolla, CA 92093, USA
| | - Thomas Prescott Atkinson
- Department of Pediatric Allergy, Asthma and Immunology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | | | - Eva Turpel-Kantor
- Octapharma Pharmazeutika Produktionsges, m.b.H., Vienna, 1100, Austria
| | - Elisabeth Clodi
- Octapharma Pharmazeutika Produktionsges, m.b.H., Vienna, 1100, Austria
| | - Sudhir Gupta
- Division of Basic and Clinical Immunology, University of California, Irvine, CA 92697, USA
| |
Collapse
|
36
|
Dong B, Xu GC, Liu ST, Liu T, Geng B. MiR-34a affects G2 arrest in prostate cancer PC3 cells via Wnt pathway and inhibits cell growth and migration. Eur Rev Med Pharmacol Sci 2021; 24:8349-8358. [PMID: 32894541 DOI: 10.26355/eurrev_202008_22631] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate the effect and mechanism of miRNA-34a overexpression on proliferation and migration of PC3 prostate cancer cells. PATIENTS AND METHODS Benign prostatic hyperplasia tissue (30 cases), prostate cancer tissue (30 cases), and prostate paracancerous tissue (30 cases) were collected. Levels of miRNA-34a in these fresh tissues were measured by fluorescence quantitative PCR. PC3 cells were divided into non-loaded group and overexpression group. Cells in the non-loaded group were transfected with non-loaded plasmid. Cells in the overexpression group were transfected with miRNA-34a plasmid, and the miRNA-34a level was determined by fluorescence quantitative PCR to confirm the overexpression. Cell proliferation was analyzed by CCK-8 assay. Cell migration rate was measured by cell scratch assay. Flow cytometry was used to detect apoptosis and analyze cell cycle. Western blot was used to measure the expression levels of β-catenin, E-cadherin and Vimentin. RESULTS The expression level of miRNA-34a in prostate cancer tissue was significantly lower than that in prostate paracancerous tissue. Dual-Luciferase reporter gene assay was used to analyze the transcriptional activity of Wnt1 gene. The proliferation and migration of PC3 cells were significantly decreased after overexpression of miRNA-34a, and the differences were statistically significant compared with those in the non-loaded group (p<0.05). Flow cytometry analysis showed that in the overexpression group, the apoptotic rate, as well as the proportion of cells in the G2 phase, was significantly higher than that in the non-loaded group (p<0.05). The β-catenin level in the nucleus of PC3 cells was significantly reduced after overexpression of miRNA-34a. The total protein levels of β-catenin and Vimentin were significantly decreased, whereas the level of E-cadherin in the overexpression group was apparently increased, compared with that in the non-loaded group. The Dual-Luciferase reporter gene showed a decrease in the relative fluorescence intensity of Wnt1 after overexpression of miR-34a (p<0.05). CONCLUSIONS Overexpression of miRNA-34a inhibits Wnt/β-catenin pathway by regulating the transcriptional activity of Wnt1, thereby regulating the proliferation and migration of PC3 cells and promoting apoptosis.
Collapse
Affiliation(s)
- B Dong
- Department of Urinary Surgery (I), The Second Affiliated Hospital of Qiqihar Medical University, Qiqihar. P.R. China.
| | | | | | | | | |
Collapse
|
37
|
Phipatanakul W, Mauger DT, Guilbert TW, Bacharier LB, Durrani S, Jackson DJ, Martinez FD, Fitzpatrick AM, Cunningham A, Kunselman S, Wheatley LM, Bauer C, Davis CM, Geng B, Kloepfer KM, Lapin C, Liu AH, Pongracic JA, Teach SJ, Chmiel J, Gaffin JM, Greenhawt M, Gupta MR, Lai PS, Lemanske RF, Morgan WJ, Sheehan WJ, Stokes J, Thorne PS, Oettgen HC, Israel E. Preventing asthma in high risk kids (PARK) with omalizumab: Design, rationale, methods, lessons learned and adaptation. Contemp Clin Trials 2021; 100:106228. [PMID: 33242697 PMCID: PMC7887056 DOI: 10.1016/j.cct.2020.106228] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 11/27/2022]
Abstract
Asthma remains one of the most important challenges to pediatric public health in the US. A large majority of children with persistent and chronic asthma demonstrate aeroallergen sensitization, which remains a pivotal risk factor associated with the development of persistent, progressive asthma throughout life. In individuals with a tendency toward Type 2 inflammation, sensitization and exposure to high concentrations of offending allergens is associated with increased risk for development of, and impairment from, asthma. The cascade of biological responses to allergens is primarily mediated through IgE antibodies and their production is further stimulated by IgE responses to antigen exposure. In addition, circulating IgE impairs innate anti-viral immune responses. The latter effect could magnify the effects of another early life exposure associated with increased risk of the development of asthma - viral infections. Omalizumab binds to circulating IgE and thus ablates antigen signaling through IgE-related mechanisms. Further, it has been shown restore IFN-α response to rhinovirus and to reduce asthma exacerbations during the viral season. We therefore hypothesized that early blockade of IgE and IgE mediated responses with omalizumab would prevent the development and reduce the severity of asthma in those at high risk for developing asthma. Herein, we describe a double-blind, placebo-controlled trial of omalizumab in 2-3 year old children at high risk for development of asthma to prevent the development and reduce the severity of asthma. We describe the rationale, methods, and lessons learned in implementing this potentially transformative trial aimed at prevention of asthma.
Collapse
Affiliation(s)
- Wanda Phipatanakul
- Boston Children's Hospital, Division of Allergy and Immunology, United States of America; Harvard Medical School, Boston, MA, United States of America.
| | - David T Mauger
- Pennsylvania State University, Hershey, PA, United States of America
| | - Theresa W Guilbert
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
| | - Leonard B Bacharier
- Washington University and St. Louis Children's Hospital, St. Louis, MO, United States of America
| | - Sandy Durrani
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
| | | | - Fernando D Martinez
- Asthma and Airway Research Center, University of Arizona, Tucson, AZ, United States of America
| | | | - Amparito Cunningham
- Boston Children's Hospital, Division of Allergy and Immunology, United States of America
| | - Susan Kunselman
- Pennsylvania State University, Hershey, PA, United States of America
| | - Lisa M Wheatley
- NIH/National Institute of Allergy and Infectious Diseases, Bethesda, MD, United States of America
| | - Cindy Bauer
- Phoenix Children's Hospital, Phoenix, AZ, United States of America
| | - Carla M Davis
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States of America
| | - Bob Geng
- Rady Children's Hospital, UC San Diego, San Diego, CA, United States of America
| | - Kirsten M Kloepfer
- Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Craig Lapin
- Connecticut Children's Medical Center, Division of Pulmonary Hartford, CT, United States of America
| | - Andrew H Liu
- Children's Hospital Colorado, University of Colorado, Aurora, CO, United States of America
| | - Jacqueline A Pongracic
- Ann and Robert Lurie Children's Hospital of Chicago, Chicago, IL, United States of America
| | - Stephen J Teach
- Children's National Hospital, Washington, DC, United States of America
| | - James Chmiel
- NIH/National Institute of Allergy and Infectious Diseases, Bethesda, MD, United States of America
| | - Jonathan M Gaffin
- Harvard Medical School, Boston, MA, United States of America; Boston Children's Hospital, Division of Pulmonary Medicine, Boston, MA, United States of America
| | - Matthew Greenhawt
- Children's Hospital Colorado, University of Colorado, Aurora, CO, United States of America
| | - Meera R Gupta
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States of America
| | - Peggy S Lai
- Harvard Medical School, Boston, MA, United States of America; Massachusetts General Hospital, Division of Pulmonary and Critical Care, Boston, MA, United States of America
| | | | - Wayne J Morgan
- Asthma and Airway Research Center, University of Arizona, Tucson, AZ, United States of America
| | - William J Sheehan
- Children's National Hospital, Washington, DC, United States of America
| | - Jeffrey Stokes
- Washington University and St. Louis Children's Hospital, St. Louis, MO, United States of America
| | - Peter S Thorne
- University of Iowa, College of Public Health, Department of Occupational and Environmental Health, Iowa City, IA, United States of America
| | - Hans C Oettgen
- Boston Children's Hospital, Division of Allergy and Immunology, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Elliot Israel
- Harvard Medical School, Boston, MA, United States of America; Brigham and Women's Hospital, Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Boston, MA, United States of America
| |
Collapse
|
38
|
Abstract
Background: Primary immunodeficiency diseases (PIDD) consist of a heterogeneous group of disorders characterized by various aspects of immune dysregulation. Although the most universally recognized manifestation of PIDD is an increased susceptibility to infections, there is a growing body of evidence that patients with PIDD often have a higher incidence of lung disease, autoimmunity, autoinflammatory disorders, and malignancy. Objective: The purpose of this study was to better understand the noninfectious complications of PIDD by determining the comorbid disease prevalence across various age groups, genders, and immunoglobulin replacement types compared with the general population. Methods: A large U.S. insurance claims database was retrospectively analyzed for patients who had a diagnosis of PIDD and who had received intravenous immunoglobulin (IVIG) or subcutaneous immunoglobulin (SCIG). The prevalences of 31 different comorbid conditions in the Elixhauser comorbidity index were compared among the 3125 patients in the PIDD population to > 37 million controls separated by gender and by 10-year age cohorts. Results: In the PIDD population, statistically significantly higher comorbid diagnoses included chronic obstructive pulmonary disease-asthma in 51.5%, rheumatoid disease in 14%, deficiency anemia in 11.8%, hypothyroidism in 21.2%, lymphoma in 16.7%, neurologic disorders in 9.7%, arrhythmias in 19.9%, electrolyte disorders in 23.6%, coagulopathies in 16.9%, and weight loss in 8.4%. Conclusion: PIDD that require immunoglobulin replacement are associated with an increased risk of numerous comorbid conditions that affect morbidity and mortality. Recognition and increased awareness of these noninfectious complications can allow for better monitoring, care coordination, targeted treatments, and improved prognosis.
Collapse
Affiliation(s)
- Michelle Dilley
- From the Division of Allergy, Immunology and Rheumatology, University of California San Diego and Rady Children's Hospital, San Diego, California
| | - Hannah Wangberg
- From the Division of Allergy, Immunology and Rheumatology, University of California San Diego and Rady Children's Hospital, San Diego, California
| | - Joshua Noone
- Department of Public Health Sciences, University of North Carolina, Charlotte, North Carolina
| | - Bob Geng
- From the Division of Allergy, Immunology and Rheumatology, University of California San Diego and Rady Children's Hospital, San Diego, California
| |
Collapse
|
39
|
Grobman L, Kitsen J, Mortazavi D, Geng B. Correlation of skin prick testing to environmental allergens. Ann Allergy Asthma Immunol 2020; 126:378-384.e2. [PMID: 33122125 DOI: 10.1016/j.anai.2020.10.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/15/2020] [Accepted: 10/22/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND To diagnose and adequately treat allergies, identification of sensitizing allergens is crucial. Skin prick or serum immunoglobulin E testing determines sensitization to potential allergens. Consensus varies regarding degree of cross-reactivity between aeroallergens. OBJECTIVE To quantify correlations between aeroallergen skin prick test results. METHODS A total of 11,832 patients' quantitative skin prick test results and basic characteristics were obtained from a tertiary academic center's electronic medical record and deidentified. Data were analyzed using Spearman's rank correlation coefficients to detect nonlinear associations between wheal sizes of skin prick test results. RESULTS The highest correlation among grasses was 0.903 (fescue and red top). Of note, 13 more grass pairs had correlation more than 0.8, and 19 had correlation between 0.7 and 0.8. The Northern grass comparative results are from a satellite clinic that tested more grasses than the main clinic, in which only Kentucky blue and Bermuda were tested (correlation 0.768; n = 9348). Highest correlation among weeds was 0.74 (lambs quarter and pigweed). In addition, 6 more weed pairs had correlation more than 0.7. Highest correlation among trees was 0.724 (palm and alder) and 6 more tree pairs had correlation more than 0.7. Highest correlation among molds was 0.711 (Helminthosporium and Epicoccum). Dust mite correlation between Dermatophagoides farinae and Dermatophagoides pteronyssinus was 0.848 (n = 10,022). CONCLUSION This study confirmed the expected high degrees of correlation not only between skin prick test results of related environmental allergens but also between less closely related Northern grasses and Bermuda grass. This has implications for simplification of testing and immunotherapy protocols in the future.
Collapse
Affiliation(s)
- Lillian Grobman
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California, San Diego, La Jolla, California.
| | - Jessica Kitsen
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Diba Mortazavi
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Bob Geng
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California, San Diego, La Jolla, California
| |
Collapse
|
40
|
Leibel S, Geng B, Phipatanakul W, Lee E, Hartigan P. Screening Social Determinants of Health in a Multidisciplinary Severe Asthma Clinical Program. Pediatr Qual Saf 2020; 5:e360. [PMID: 33204931 PMCID: PMC7665245 DOI: 10.1097/pq9.0000000000000360] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/06/2020] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. Asthma is the most common cause of chronic disease in children and has high healthcare utilization costs. Minority children living in poverty have a higher asthma burden. These health disparities are associated with the social determinants of health (SDH). A severe asthma clinic was implemented at Rady Children’s Hospital in San Diego to determine whether a multidisciplinary approach, including an asthma home visit addressing SDH, would lead to decreased healthcare utilization in terms of emergency department (ED) visits and hospitalizations.
Collapse
Affiliation(s)
- Sydney Leibel
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, UC San Diego School of Medicine/Rady Children's Hospital, San Diego, Calif
| | - Bob Geng
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, UC San Diego School of Medicine/Rady Children's Hospital, San Diego, Calif
| | - Wanda Phipatanakul
- Division of Asthma, Allergy and Immunology, Department of Pediatrics, Harvard Medical School/Boston Children's Hospital, Boston, Mass
| | - Euyhyun Lee
- Altman Clinical and Translational Research Institute, UC San Diego, San Diego, Calif
| | - Phyllis Hartigan
- Center for Healthier Communities, Rady Children's Hospital, San Diego, Calif
| |
Collapse
|
41
|
Galant-Swafford J, Geng B, Leibel S, Akuthota P, Tucker S, Cernelc-Kohan M, Sheets R, Nation J, Jefferson AA. Two pediatric cases of ANCA-negative eosinophilic granulomatosis with polyangiitis successfully treated with dupilumab. J Allergy Clin Immunol Pract 2020; 8:3643-3646.e1. [PMID: 32668296 DOI: 10.1016/j.jaip.2020.06.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Jessica Galant-Swafford
- Division of Rheumatology, Department of Medicine, Allergy & Immunology, University of California San Diego, San Diego, Calif.
| | - Bob Geng
- Division of Allergy, Immunology & Rheumatology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, Calif
| | - Sydney Leibel
- Division of Allergy, Immunology & Rheumatology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, Calif
| | - Praveen Akuthota
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California San Diego, San Diego, Calif
| | - Suzanne Tucker
- Division of Laboratory Services and Pathology, Rady Children's Hospital San Diego, San Diego, Calif
| | - Matejka Cernelc-Kohan
- Division of Pulmonary and Respiratory Medicine, Rady Children's Hospital San Diego, San Diego, Calif
| | - Robert Sheets
- Division of Allergy, Immunology & Rheumatology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, Calif
| | - Javan Nation
- Division of Otolaryngology, Rady Children's Hospital San Diego, San Diego, Calif
| | - Akilah A Jefferson
- Division of Allergy, Immunology & Rheumatology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, Calif
| |
Collapse
|
42
|
Luskin K, Leibel S, Ghassemian M, Chambers C, Kitsen J, Mortazavi D, Bertrand K, Geng B. Analysis of Non-Human Proteins/Peptides in Human Breast Milk by Mass Spectrometry. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.432] [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]
|
43
|
Geng B, Dixon A, Yoo B, Janampally P, Lyon R, Haselkorn T, Holweg C, Jarjour N. Impact Of Body Mass Index On Omalizumab Response In Adults With Moderate-to-Severe Allergic Asthma. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
44
|
Lebwohl M, Hebert A, Takiya L, Miller L, Werth J, Zang C, Sanders P, Geng B. Efficacy Trends With Continuous Long-Term Use of Crisaborole in Patients With Mild-to-Moderate Atopic Dermatitis (AD). J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.264] [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]
|
45
|
Gao J, Liu W, Geng B, Lei Q, Han H, Zhou Y, Liu J, Cao D, Li H, Li F. Effect of Plant Essential Oil on Growth Performance and Immune Function During Rearing Period in Laying Hens. Braz J Poult Sci 2020. [DOI: 10.1590/1806-9061-2019-1244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- J Gao
- Shandong Academy of Agricultural Sciences, China; Sericultural Research Institute of Shandong Province, China
| | - W Liu
- Shandong Academy of Agricultural Sciences, China; Poultry Breeding Engineering Technology Center of Shandong Province, China
| | - B Geng
- Sericultural Research Institute of Shandong Province, China
| | - Q Lei
- Shandong Academy of Agricultural Sciences, China; Poultry Breeding Engineering Technology Center of Shandong Province, China
| | - H Han
- Shandong Academy of Agricultural Sciences, China; Poultry Breeding Engineering Technology Center of Shandong Province, China
| | - Y Zhou
- Shandong Academy of Agricultural Sciences, China; Poultry Breeding Engineering Technology Center of Shandong Province, China
| | - J Liu
- Shandong Academy of Agricultural Sciences, China; Poultry Breeding Engineering Technology Center of Shandong Province, China
| | - D Cao
- Shandong Academy of Agricultural Sciences, China; Poultry Breeding Engineering Technology Center of Shandong Province, China
| | - H Li
- Shandong Academy of Agricultural Sciences, China; Poultry Breeding Engineering Technology Center of Shandong Province, China
| | - F Li
- Shandong Academy of Agricultural Sciences, China; Poultry Breeding Engineering Technology Center of Shandong Province, China
| |
Collapse
|
46
|
Anterasian C, Duong R, Gruenemeier P, Ernst C, Kitsen J, Geng B. Quality of Life Differences for Primary Immunodeficiency Patients on Home SCIG versus IVIG. J Clin Immunol 2019; 39:814-822. [PMID: 31673923 PMCID: PMC6863943 DOI: 10.1007/s10875-019-00705-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/09/2019] [Indexed: 11/29/2022]
Abstract
Background Patients with primary immunodeficiency disease (PIDD) and antibody deficiency require lifelong immunoglobulin replacement therapy. While both subcutaneous immunoglobulin (SCIG) and intravenous immunoglobulin (IVIG) replacement therapy are effective in preventing infection, patients with PIDD still experience worse health-related quality of life (hrQOL) outcomes. Objective Assess differences in hrQOL for PIDD patients receiving home SCIG versus IVIG. Methods SF-36 surveys were administered by a specialty pharmacy to 630 PIDD patients receiving home SCIG and IVIG at baseline and then every 3 months between 2014 and 2016. Results were analyzed using two-sample t tests and linear mixed effects model. Analysis was repeated for different age categories and trended over time. Results Patients receiving SCIG reported statistically significant higher energy fatigue scores (+ 9 points, p < 0.001) but lower perceived role limitations due to physical health scores (− 14 points, p < 0.001). These differences were only observed in patients > 36 years of age. There were no differences in the composite SF-36 score for patients receiving SCIG versus IVIG (+ 1, p = 0.66). Immunoglobulin-naïve patients all improved their hrQOL, but a larger improvement was seen in those initiating SCIG versus IVIG. Conclusion Patients with PIDD on home IVIG versus SCIG have similar composite hrQOL scores as measured by the SF-36. In the adult population, initiating immunoglobulin replacement with SCIG may result in more hrQOL improvement compared with IVIG, although personal preferences should also be considered. Clinical Implications Patients with PIDD on home IVIG versus SCIG have similar composite health-related quality of life scores as measured by the SF-36. Capsule Summary Patients with primary immune-deficiency on home IVIG versus SCIG have similar composite health-related quality of life scores as measured by the SF-36. Personal preferences are important in deciding whether to treat with IVIG or SCIG. Electronic supplementary material The online version of this article (10.1007/s10875-019-00705-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Christine Anterasian
- Division of Allergy/Immunology, University of California, San Diego, San Diego, CA, 92123, USA
| | - Richard Duong
- Division of Allergy/Immunology, University of California, San Diego, San Diego, CA, 92123, USA
| | | | | | - Jessica Kitsen
- Division of Allergy/Immunology, University of California, San Diego, San Diego, CA, 92123, USA
| | - Bob Geng
- Division of Allergy/Immunology, University of California, San Diego, San Diego, CA, 92123, USA.
| |
Collapse
|
47
|
Gerstlauer M, Szepfalusi Z, Golden D, Geng B, de Blic J. Real-life safety of 5-grass pollen tablet in 5-to-9-year-old children with allergic rhinoconjunctivitis. Ann Allergy Asthma Immunol 2019; 123:70-80. [PMID: 31009701 DOI: 10.1016/j.anai.2019.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/12/2019] [Accepted: 04/14/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although 5-grass pollen sublingual immunotherapy has a good safety profile in controlled clinical trials, additional safety information among pediatric patients in a real-world setting would be useful. OBJECTIVE To further document the safety of 5-grass tablet among children aged 5 to 9 years with allergic rhinoconjunctivitis (ARC). METHODS This multicenter, observational study included allergy immunotherapy-naïve 5- to 9-year-old children with grass pollen-induced ARC prescribed with 5-grass tablet daily (3-day dose escalation to 300 index of reactivity [IR]). Patients were followed up daily for safety and tolerability over the first 30 treatment days. Adverse events (AEs) and adverse drug reactions (ADRs) were analyzed descriptively. RESULTS Three hundred seven children (mean age, 7.1 years) were enrolled. Fifty-eight percent were confirmed as polysensitized, and 36% had mild-to-moderate asthma. Of 307 patients, 233 (76%) reported AEs, and 173/307 (56%) reported ADRs, most frequently mild application-site reactions (throat irritation, oral pruritus, oral paresthesia). Sixteen of 307 (5.2%) patients withdrew because of ADRs. In 143 of 173 (83%) patients, ADRs first occurred within 1 week of starting treatment. More than half of the ADRs lasted less than 2 days, and ADRs resolved spontaneously in 161 of 173 (93%) patients. Recurrences of ADRs were reported in 45 of 173 (26%) patients and were also mainly application-site reactions. No notable differences were found in ADRs related to whether patients had asthma at inclusion. Neither epinephrine use nor admission to intensive care unit was reported. CONCLUSION The safety profile of 5-grass tablet in pediatric ARC patients aged 5 to 9 years was consistent with safety findings in older patients, most ADRs being at the application site and mild to moderate. ClinicalTrials.gov identifier: NCT02295969; EUPAS registration number: 8104.
Collapse
Affiliation(s)
- Michael Gerstlauer
- Pediatric Pneumology and Allergology unit, Medical University of Augsburg, Augsburg, Germany.
| | - Zsolt Szepfalusi
- Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - David Golden
- Allergy & Immunology, Medstar Franklin Square Medical Center, Baltimore, Maryland
| | - Bob Geng
- Divisions of Adult and Pediatric Allergy and Immunology, Rady Children's Hospital Severe Asthma Clinic, University of California, San Diego, California
| | - Jacques de Blic
- Pediatric Pneumology and Allergology unit, Necker-Enfants Malades Hospital, Paris, France; Université Paris Descartes, Paris, France
| |
Collapse
|
48
|
Kobayashi RH, Gupta S, Melamed I, Mandujano JF, Kobayashi AL, Ritchie B, Geng B, Atkinson TP, Rehman S, Turpel-Kantor E, Litzman J. Clinical Efficacy, Safety and Tolerability of a New Subcutaneous Immunoglobulin 16.5% (Octanorm [Cutaquig®]) in the Treatment of Patients With Primary Immunodeficiencies. Front Immunol 2019; 10:40. [PMID: 30778345 PMCID: PMC6369354 DOI: 10.3389/fimmu.2019.00040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 10/18/2018] [Accepted: 01/09/2019] [Indexed: 01/07/2023] Open
Abstract
Introduction: Subcutaneously administered immunoglobulin (SCIG) is increasingly used to treat patients with primary immunodeficiencies (PIDs). Octanorm (marketed as cutaquig® in USA and Canada) is a new 16.5% solution of human SCIG, manufactured by a process based on that of the intravenous preparation (IVIG) octagam®. Objectives: To investigate the efficacy, safety and tolerability of octanorm in a prospective, open-label, single-arm phase 3 study involving adult and pediatric patients with PIDs (NCT01888484; clinicaltrials.gov/ct2/show/NCT01888484). Methods: Patients who were previously treated with IVIG received a total of 64 weekly SCIG infusions, including 12 weekly infusions during the wash-in/wash-out period, followed by 52 weekly infusions during the evaluation period. Results: A total of 61 patients aged 2-73 years received 3,497 infusions of octanorm. The mean dose per patient was 0.175 g/kg/infusion. The mean calculated dose conversion factor from the patients' previous IVIG dose for octanorm was 1.37. No serious bacterial infections developed during the study. The rate of other infections per person-year during the primary observation period was 3.43 (upper 95% CI 4.57). All but one non-bacterial infection were mild or moderate in intensity. IgG trough levels were constant during the course of the study. Eleven patients (18.0%) experienced 14 mild or moderate systemic adverse events (AEs) related to octanorm. The rate of related AEs per infusion was 0.004. In 76.7% of infusions, no infusion site reactions were observed and only two (0.3%) reactions were deemed severe. The incidence of site reactions decreased with successive infusions. Conclusion: The new 16.5% SCIG octanorm was shown to be efficacious in preventing infections in PIDs, and was well tolerated.
Collapse
Affiliation(s)
- Roger H. Kobayashi
- UCLA School of Medicine, Los Angeles, CA, United States,*Correspondence: Roger H. Kobayashi
| | - Sudhir Gupta
- Division of Basic and Clinical Immunology, University of California, Irvine, Irvine, CA, United States
| | - Isaac Melamed
- IMMUNOe Research Center, Centennial, CO, United States
| | | | | | - Bruce Ritchie
- Division of Hematology, Department of Medicine, University of Alberta Hospital, Edmonton, AB, Canada
| | - Bob Geng
- Divisions of Adult and Pediatric Allergy and Immunology, University of California, San Diego, La Jolla, CA, United States
| | - Thomas Prescott Atkinson
- Department of Pediatric Allergy, Asthma and Immunology, University of Alabama, Birmingham, AL, United States
| | - Syed Rehman
- Allergy and Asthma Center Inc., Toledo, OH, United States
| | | | - Jiří Litzman
- Department of Clinical Immunology and Allergology, St Anne's University Hospital in Brno, Faculty of Medicine, Masaryk University, Brno, Czechia
| |
Collapse
|
49
|
Grobman L, Geng B. CROSS REACTIVITY OF SKIN PRICK TEST RESULTS TO ENVIRONMENTAL AERO-ALLERGENS. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.091] [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]
|
50
|
Abstract
BACKGROUND Eight to ten percent of patients believe that they are allergic to penicillin, yet only 10% of those patients have evidence of an immunoglobulin E (IgE) mediated allergy upon penicillin skin testing (PST). In the adult population, a negative PST result is associated with a low risk of immediate reaction on oral challenge, but further studies are needed in the pediatric population. OBJECTIVE To calculate the negative predictive value (NPV) of the current skin testing regimen of penicillin, benzylpenicilloyl-polylysine (the major determinant), and ampicillin in a pediatric outpatient population to assess the utility of adding the minor determinant mixture to the skin testing regimen. METHODS A retrospective chart review was conducted of all pediatric patients seen in a single-center pediatric allergy/immunology outpatient clinic between January 1, 2010, and March 1, 2016, who underwent PST for presumed penicillin drug allergy. RESULTS Only 38% of patients who underwent PST had a drug reaction history consistent with an IgE-mediated reaction. 28.8% of the patients had a positive PST result. The addition of ampicillin to the standard PST regimen of penicillin and benzylpenicilloyl-polylysine identified an additional 4.1% of patients. Two patients (3.2%) reacted on oral challenge with a minor rash. The NPV of the PST regimen was 98%. No significant predictive variables for a positive PST result were identified. CONCLUSION Given the high NPV of the current PST regimen, we do not recommend additional testing with the minor determinant mixture. Despite this high NPV, the utility of PST in the low-risk, low-pretest probability outpatient pediatric population was limited, and select patients may be able to proceed directly to oral challenge.
Collapse
|