1
|
Zwagemaker AF, Kloosterman FR, Gouw SC, Boyce S, Brons P, Cnossen MH, Collins PW, Eikenboom J, Hay C, Hengeveld RCC, Jackson S, Klopper-Tol CAM, Kruip MJHA, Gorkom BLV, Male C, Nieuwenhuizen L, Shapiro S, Fijnvandraat K, Coppens M. Little discrepancy between one-stage and chromogenic factor VIII (FVIII)/IX assays in a large international cohort of persons with nonsevere hemophilia A and B. J Thromb Haemost 2022; 21:850-861. [PMID: 36696222 DOI: 10.1016/j.jtha.2022.11.040] [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] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 11/03/2022] [Accepted: 11/28/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Accurate measurements of coagulation factor activity form an essential part of hemophilia management and are performed by the one-stage or chromogenic assay. Current literature suggests that approximately one-third of persons with nonsevere hemophilia A exhibit assay discrepancy, albeit with a high variability between studies. Such data are scarce in nonsevere hemophilia B. OBJECTIVES To investigate the extent of factor VIII/IX one-stage and chromogenic assay discrepancy in moderate and mild hemophilia A and B. METHODS Persons with previously diagnosed nonsevere hemophilia A and B with a factor level of 2 to 35 IU/dL were included from the international DYNAMO cohort study. Central measurements of the factor VIII and IX activity levels were performed by the one-stage and chromogenic assay. Relative and absolute discrepancy definitions were used, with the International Society on Thrombosis and Haemostasis-Scientific and Standardization Committee proposed ratio of >2.0 or <0.5 being the primary outcome. Discrepancy was also evaluated in a subgroup of 13 persons with mutations previously associated with discrepancy (≥3 cases reported in literature). RESULTS A total of 220 persons were included, of whom 3 (1%) showed assay discrepancy: 2/175 hemophilia A and 1/45 hemophilia B. Six persons (3%) exhibited an absolute difference >10 IU/dL between the assay results. In addition, with more lenient definitions, over 90% of participants (n = 197) had no discrepant results. Only 1 out of 13 persons with a mutation previously associated with discrepancy had significant assay discrepancy. CONCLUSION Little assay discrepancy was observed despite the presence of mutations previously associated with discrepancy, suggesting that the presence and magnitude of assay discrepancy are largely determined by laboratory variables.
Collapse
Affiliation(s)
- Anne-Fleur Zwagemaker
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Pediatric Hematology, Meibergdreef, Amsterdam, The Netherlands
| | - Fabienne R Kloosterman
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Pediatric Hematology, Meibergdreef, Amsterdam, The Netherlands
| | - Samantha C Gouw
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Pediatric Hematology, Meibergdreef, Amsterdam, The Netherlands
| | - Sara Boyce
- Department of Haematology, University Hospital Southampton, Southampton, United Kingdom
| | - Paul Brons
- Department of Pediatric Hemato-Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marjon H Cnossen
- Department of Pediatric Hematology, Erasmus MC Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Peter W Collins
- Cardiff Haemophilia Centre, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Jeroen Eikenboom
- Department of Internal Medicine, Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Charles Hay
- Manchester University Department of Haematology, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Rutger C C Hengeveld
- Amsterdam UMC, University of Amsterdam, Clinical Chemistry, Meibergdreef, Amsterdam, The Netherlands
| | - Shannon Jackson
- Adult Bleeding Disorders Program of BC - Adult Division St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Caroline A M Klopper-Tol
- Amsterdam UMC, University of Amsterdam, Clinical Chemistry, Meibergdreef, Amsterdam, The Netherlands
| | - Marieke J H A Kruip
- Department of Hematology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Christoph Male
- Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | | | - Susan Shapiro
- Department of Haematology, Oxford University Hospitals NHS Foundation, Oxford NIHR Biomedical Research Centre, Oxford, United Kingdom; Radcliffe Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Karin Fijnvandraat
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Pediatric Hematology, Meibergdreef, Amsterdam, The Netherlands; Department of Molecular Cellular Hemostasis, Sanquin Research and Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Michiel Coppens
- Amsterdam UMC, University of Amsterdam, Vascular Medicine, Meibergdreef, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension & Thrombosis, Amsterdam, The Netherlands.
| | | |
Collapse
|
2
|
Kloosterman FR, Zwagemaker AF, Bagot CN, Beckers EAM, Castaman G, Cnossen MH, Collins PW, Hay C, Hof M, Laros-van Gorkom B, Leebeek FWG, Male C, Meijer K, Pabinger I, Shapiro S, Coppens M, Fijnvandraat K, Gouw, SC. The bleeding phenotype in people with nonsevere hemophilia. Blood Adv 2022; 6:4256-4265. [PMID: 35533261 PMCID: PMC9327532 DOI: 10.1182/bloodadvances.2022007620] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/28/2022] [Indexed: 11/20/2022] Open
Abstract
Detailed information on the onset, frequency, and severity of bleeding in nonsevere hemophilia is limited. We aimed to assess the bleeding phenotype of persons with nonsevere hemophilia and to analyze the association between baseline factor VIII/IX (FVIII/IX) levels and the joint bleeding rate. In the DYNAMO (Dynamic Interplay Between Bleeding Phenotype and Baseline Factor Level in Moderate and Mild Hemophilia A and B) study, an international multicenter cohort, we included males with nonsevere hemophilia (FVIII/IX, 0.02-0.35 IU/mL) aged 12 to 55 years. Information on age at first treated (joint) bleed, annual bleeding rates (ABRs), and annual joint bleeding rates (AJBRs) was collected from the medical files. The association between baseline FVIII/IX levels and the joint bleeding rate was assessed by using a frailty model for recurrent events. In total, 304 persons (70 with moderate hemophilia and 234 with mild hemophilia) were included. The median age was 38 years (interquartile range [IQR], 25-49 years), and the median baseline FVIII/IX level was 0.12 IU/mL (IQR, 0.05-0.21 IU/mL). In total, 245 (81%) persons had experienced at least 1 bleed, and 156 (51%) had experienced at least 1 joint bleed. The median age at first bleed and first joint bleed was 8 and 10 years, respectively. The median ABR and AJBR was 0.2 (IQR, 0.1-0.5) and 0.0 (IQR, 0.0-0.2). From baseline FVIII/IX levels 0.02 to 0.05 IU/mL to >0.25 IU/mL, the median ABR decreased from 0.6 (IQR, 0.2-1.4) to 0.1 (IQR, 0.0-0.2) and the AJBR from 0.2 (IQR, 0.0-0.4) to 0.0 (IQR, 0.0-0.0). Baseline FVIII/IX was inversely associated with the joint bleeding rate (P < .001). Low bleeding rates were observed in persons with nonsevere hemophilia. However, one-half of all adolescents and adults had experienced a joint bleed.
Collapse
Affiliation(s)
- Fabienne R. Kloosterman
- Emma Children’s Hospital, Pediatric Hematology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Anne-Fleur Zwagemaker
- Emma Children’s Hospital, Pediatric Hematology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Catherine N. Bagot
- Department of Haematology, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Erik A. M. Beckers
- Division of Hematology, Department of Internal Medicine, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Giancarlo Castaman
- Department of Oncology, Center for Bleeding Disorders, Careggi University Hospital, Florence, Italy
| | - Marjon H. Cnossen
- Department of Pediatric Hematology, Erasmus University Medical Center–Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Peter W. Collins
- Cardiff Haemophilia Centre, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Charles Hay
- University Department of Haematology, The University of Manchester, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Michel Hof
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | | | - Frank W. G. Leebeek
- Department of Hematology, Erasmus University Medical Center, Erasmus MC, Rotterdam, The Netherlands
| | - Christoph Male
- Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Karina Meijer
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ingrid Pabinger
- Clinical Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Susan Shapiro
- Department of Haematology, Oxford University Hospitals NHS Foundation, Oxford NIHR Biomedical Research Centre, Oxford, United Kingdom
- Radcliffe Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Michiel Coppens
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands; and
| | - Karin Fijnvandraat
- Emma Children’s Hospital, Pediatric Hematology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Molecular Cellular Hemostasis, Sanquin Research and Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Samantha C. Gouw,
- Emma Children’s Hospital, Pediatric Hematology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| |
Collapse
|
3
|
Hart DP, Alamelu J, Bhatnagar N, Biss T, Collins PW, Hall G, Hay C, Liesner R, Makris M, Mathias M, Motwani J, Palmer B, Payne J, Percy C, Richards M, Riddell A, Talks K, Tunstall O, Chalmers E. Immune tolerance induction in severe haemophilia A: A UKHCDO inhibitor and paediatric working party consensus update. Haemophilia 2021; 27:932-937. [PMID: 34403546 DOI: 10.1111/hae.14381] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 07/14/2021] [Accepted: 07/14/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In good risk patients (historic inhibitor peak < 200BU), the International Immune Tolerance Study demonstrated equal efficacy to induce tolerance between high (200iu/kg/day) and low dose (50iu/kg ×3 times/week) immune tolerance induction (ITI) regimens. However, the trial stopped early on account of the excessive bleed rate in the low dose ITI arm. METHODS United Kingdom Haemophilia Centre Doctors' Organization (UKHCDO) Paediatric and Inhibitor working parties considered available ITI data alongside the bi-phenotypic antibody emicizumab (Hemlibra®) efficacy and safety data to develop a consensus guideline for the future UK ITI guideline. RESULTS This revision of UKHCDO ITI guidance incorporates the recommendation to use emicizumab as a prophylaxis haemostatic agent to reduce bleeding rates and to facilitate low dose and reduced frequency of FVIII CFC for ITI in the majority of children. CONCLUSION This consensus protocol will facilitate future evaluation of ITI outcomes in the evolving landscape of haemophilia therapeutics and ITI strategies.
Collapse
Affiliation(s)
- Daniel P Hart
- Royal London Hospital Haemophilia Centre, Barts and The London School of Medicine and Dentistry, QMUL, London, UK
| | | | - Neha Bhatnagar
- Oxford Haemophilia Centre, Oxford University Trust, Oxford, UK
| | - Tina Biss
- Newcastle Haemophilia Comprehensive Care Centre, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Peter W Collins
- Cardiff Haemophilia Centre, University of Wales, Cardiff, Wales, UK
| | - Georgina Hall
- Oxford Haemophilia Centre, Oxford University Trust, Oxford, UK
| | - Charles Hay
- Manchester Haemophilia Centre, Manchester, UK.,National Haemophilia Database, United Kingdom Haemophilia centre doctors' organisation (UKHCDO), Manchester, UK
| | - Ri Liesner
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Michael Makris
- Sheffield Haemophilia & Thrombosis Centre, Royal Hallamshire hospital, Sheffield, UK
| | - Mary Mathias
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Ben Palmer
- National Haemophilia Database, United Kingdom Haemophilia centre doctors' organisation (UKHCDO), Manchester, UK
| | - Jeanette Payne
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Charles Percy
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Anne Riddell
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Kate Talks
- Newcastle Haemophilia Comprehensive Care Centre, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Oliver Tunstall
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | |
Collapse
|
4
|
Bolden C, Tilley C, Hay C, Peterson E. Antibody Gene Therapy Mitigates the immunosuppressive effects of 3,4‐Methylenedioxymethamphetamine (MDMA) in the periphery of Male BALB/c Mice. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.05265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Chris Bolden
- University of Texas Health Science Center at HoustonHoustonTX
| | - Cameron Tilley
- University of Arkansas for Medical SciencesLittle RockAR
| | - Charles Hay
- University of Arkansas for Medical SciencesLittle RockAR
| | - Eric Peterson
- University of Arkansas for Medical SciencesLittle RockAR
| |
Collapse
|
5
|
Feddah H, Muller S, Hider S, Hay C, Mallen C. P148 Gastrointestinal symptoms and proton pump inhibitor use in patients with polymyalgia rheumatica: results from the PMR Cohort study. Rheumatology (Oxford) 2020. [DOI: 10.1093/rheumatology/keaa111.143] [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: 11/12/2022] Open
Abstract
Abstract
Background
Polymyalgia Rheumatica (PMR) is a common disorder of older adults, characterised by pain and stiffness in the shoulders and hips. PMR is one of the commonest indications for long-term glucocorticoid use. Because of the well-recognised side effects of glucocorticoids including gastrointestinal disturbances and bleeding, guidelines recommend consideration of gastrointestinal prophylaxis. The aim of this study was to assess the proportion of PMR patients who report 1) gastrointestinal disturbances; and 2) appropriate prophylactic treatment, and to investigate other factors that may be associated with the development of gastrointestinal disturbances.
Methods
652 people diagnosed in primary care with incident PMR were recruited. Participants all responded to a baseline postal survey and were followed up postally at 1, 4, 8, 12, 18 and 24 months. At each time point, participants answered a range of questions relating sociodemographic, general health and their PMR. At baseline, respondents reported proton pump inhibitors (PPI) use and at 4, 12 and 24 months the presence and extent of any gastrointestinal symptoms (ulcer, wind, indigestion, heartburn; not bothered, bothered a little, bothered a lot). The association of gastrointestinal symptoms with age, gender and PPI use was quantified using proportional odds regression.
Results
Overall, 51% of people reported PPI use at baseline. Reporting of gastrointestinal symptoms was commoner at all time points in people prescribed a PPI at baseline (Table 1). There was no association between age and bothersomeness of gastrointestinal symptoms (odds ratio 0.98 (0.96, 1.00)), but more bothersome symptoms were more likely in females (2.44 (1.72, 3.45)). PPI use at baseline was significantly associated with a high level of bothersomeness compared to no/little bother (2.45 (13.39, 4.36)), but not with being bothered compared to not being bothered (1.23 (0.87, 1.74)).
Conclusion
Around half of patients with PMR report gastrointestinal symptoms. Symptoms are more prevalent in females and those prescribed a PPI. This suggests that GPs are prescribing PPIs in those they consider at higher risk of experiencing gastrointestinal symptoms. However, almost half of those without a PPI reported such symptoms within 4 months. Clinicians should be more aware of the potential for gastrointestinal symptoms in PMR.
Disclosures
H. Feddah None. S. Muller None. S. Hider None. C. Hay None. C. Mallen None.
Collapse
Affiliation(s)
- Hamzeh Feddah
- Keele University, School for Primary Community and Social Care, Staffordshire, UNITED KINGDOM
| | - Sara Muller
- Keele University, School for Primary Community and Social Care, Staffordshire, UNITED KINGDOM
| | - Samantha Hider
- Keele University, School for Primary Community and Social Care, Staffordshire, UNITED KINGDOM
| | - Charles Hay
- Keele University, School for Primary Community and Social Care, Staffordshire, UNITED KINGDOM
| | - Christian Mallen
- Keele University, School for Primary Community and Social Care, Staffordshire, UNITED KINGDOM
| |
Collapse
|
6
|
Disher N, Robertson T, Duncan S, Grainger S, Ahn K, Hay C, Leighs T, Palmer J, Lim J, White T, Pemberton J, Iosua E, Hancox B, Coffey S. A061 Exercise Stress Echocardiography as Predictor for Major Adverse Cardiac Events: A Single Centre Retrospective Study. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.05.066] [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: 11/26/2022]
|
7
|
Denny N, Scott M, Hay C, Thachil J. Expecting the unexpected: Acquired haemophilia A in a patient with homozygous factor V deficiency. Haemophilia 2019; 25:e101-e103. [PMID: 30690823 DOI: 10.1111/hae.13669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/14/2018] [Accepted: 11/20/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Nicholas Denny
- Department of Haematology, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Martin Scott
- Department of Haematology, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Charles Hay
- Department of Haematology, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Jecko Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| |
Collapse
|
8
|
Vause S, Clarke B, Tower C, Hay C, Knight M. Mechanical prosthetic heart valves (MPHV) in pregnancy are associated with a high risk of maternal and fetal morbidity and mortality. Heart 2018; 103:1557. [PMID: 28894012 DOI: 10.1136/heartjnl-2017-311762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sarah Vause
- Central Manchester Foundation Trust, Manchester M13 9WL, UK
| | - Bernard Clarke
- Central Manchester Foundation Trust, Manchester M13 9WL, UK
| | - Clare Tower
- Central Manchester Foundation Trust, Manchester M13 9WL, UK
| | - Charles Hay
- Central Manchester Foundation Trust, Manchester M13 9WL, UK
| | | |
Collapse
|
9
|
Owens D, Bray G, Giangrande P, Collins P, Hay C, Gomperts E, Schroth P, Barrowcliffe T, Lee CA. Pharmacokinetics of Recombinant Factor VIII (Recombinate) Using One-stage Clotting and Chromogenic Factor VIII Assay. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1614893] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryIn a study designed to demonstrate the safety and pharmacokinetics of a recombinant factor VIII (Recombinate) manufactured in Andover, MA and Thousand Oaks, CA, two different methods of factor VIII assay (one-stage clotting and Chromogenic substrate) were compared in vivo. The study was performed in four centres in the UK: London, Oxford, Cardiff and Manchester. Two pharmacokinetic studies, at least one week apart, were performed in 30 patients with severe haemophilia A (VIII:C < 2 IU/dl). A dose of 50 IU/kg was administered with sampling pre-infusion, and +0.25, 0.5, 1, 3, 6, 9, 12 and 24 h post-infusion. The aggregate 60 pharmacokinetic study showed a half-life of 12.7 and 13.0 h (p = 0.28) and recovery of 127 and 161 IU/dl (p = 0.0001) using one-stage clotting or chromogenic substrate respectively. In a supplementary experiment, 20 post-infusion samples were re-assayed by 1-stage and chromogenic assay using two plasma (20th British plasma standard and an “in-house” pooled normal plasma) and two concentrate standards, derived from the same type, but different batch of infused concentrate (Recombinate) and pre-diluted in either individual pre-infusion sample or in pooled commercial haemophilic plasma. The use of the Recombinate concentrate standard overcame the significant difference in FVIII levels between 1-stage and chromogenic assay methods when a plasma standard was used (p <0.0001). It is concluded that where potency dosing designation is carried out by an assay system different to that used in the clinical situation, the use of the recombinant concentrate as a standard in post-infusion plasma samples is likely to give more reliable and reproducible results.
Collapse
|
10
|
Cumming A, Hay C, Keeney S. Mutations in von Willebrand Factor Multimerization Domains Are not a Common Cause of Classical Type 1 von Willebrand Disease. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1614853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryType 1 von Willebrand disease (vWD) is an autosomal dominant bleeding disorder of variable penetrance. It is characterised by a mild to moderate bleeding tendency and a quantitative deficiency of von Willebrand factor (vWF) with the full range of vWF multimers. Few mutations have been described which account for the mode of inheritance in dominant vWD type 1. We screened the vWF multimerization domains (regions D1-D3 of the vWF gene) of 12 unrelated patients with dominant vWD type 1 to investigate the hypothesis that multimerization of vWF sub-units may be inhibited or reduced by a “dominant negative” mechanism. Platelet-derived RNA was reverse transcribed and the resulting vWF cDNA amplified by the polymerase chain reaction (PCR) in a series of overlapping fragments. These were subjected to a combination of single-strand conformation polymorphism (SSCP) and heteroduplex analysis. This approach identified mobility shifts on acrylamide gels that represented 12 distinct SSCP and/or heteroduplex patterns in our patient group. DNA sequencing of the region encompassing each mobility shift showed these variants to represent previously described polymorphisms within the vWF coding sequence. Examination in all 12 patients for the previously described G3389T and T3445C mutations proved negative. The molecular pathology of classical type 1 vWD remains enigmatic, mutations having been identified in only a small minority of patients. A common mechanism underlying this disease state has still to be elucidated.
Collapse
|
11
|
Salden A, Hay C, Cumming A, Keeney S. A Whole Blood, Multiplex PCR Detection Method for Factor V Leiden and the Prothrombin G20210A Variant. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1614497] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
12
|
Ludlam C, Collins P, Hay C, Wilde J, Grigeri A, Melsen T, Savidge G, Smith M. Elective Surgery on Factor VIII Inhibitor Patients Using Continuous Infusion of Recombinant Activated Factor VII. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1616516] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryWe examined recombinant activated factor VII (rVIIa) administered by continuous infusion to eight patients with inhibitors to factor VIII, undergoing elective surgery. rVIIa was infused at a fixed rate of 16.5 μg/kg/h for a median of 13.5 days (range 1-26). There was effective haemostasis at this infusion rate in only one of two minor procedures and two of six major operations. Three patients experienced excessive bleeding despite plasma factor VII activity around 10 IU/ml. Serious bleeding occurred in two other patients caused by procedural errors unrelated to rVIIa and required re-operation. The median rVIIa clearance on day 1 was 57 ml/h/kg (range 18-100) and on day 3 was 100 ml/h/kg (range 61-200). Clearance on the final infusion day was not significantly different from day 3. The infusion did not induce pathological activation of the coagulation mechanism. The only thrombotic adverse events were two episodes of superficial thrombophlebitis of the infused vein in one subject. In conclusion, the 16.5 μg/kg/h infusion rate reliably achieves plasma factor VII activity levels of 10 IU/ml, but this level does not provide reliable haemostasis.
Collapse
|
13
|
Bolton-Maggs P, Hay C, Shanks D, Mitchell M, McVey J. The importance of tissue factor source in the management of Factor VII deficiency. Thromb Haemost 2017. [DOI: 10.1160/th06-10-0569] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
14
|
Verghese L, Tingi E, Thachil J, Hay C, Byrd L. Management of parturients with Factor XI deficiency—10 year case series and review of literature. Eur J Obstet Gynecol Reprod Biol 2017. [DOI: 10.1016/j.ejogrb.2017.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
15
|
Collins P, Chalmers E, Alamelu J, Hay C, Liesner R, Makris M, Mathias M, Payne J, Rangarajan S, Richards M, Talks K, Tunstall O, Williams M, Hart DP. First-line immune tolerance induction for children with severe haemophilia A: A protocol from the UK Haemophilia Centre Doctors' Organisation Inhibitor and Paediatric Working Parties. Haemophilia 2017; 23:654-659. [DOI: 10.1111/hae.13264] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2017] [Indexed: 12/29/2022]
Affiliation(s)
- P. Collins
- Arthur Bloom Haemophilia Centre; University Hospital of Wales; Cardiff UK
| | - E. Chalmers
- Haemophilia Centre; Royal Hospital for Children; Glasgow UK
| | - J. Alamelu
- Haemophilia Centre; Evelina London Children's Hospital; London UK
| | - C. Hay
- Haemophilia Centre; University Departmentt of Haematology; Manchester UK
| | - R. Liesner
- Haemophilia Centre; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
| | - M. Makris
- Sheffield Haemophilia and Thrombosis Centre; Royal Hallamshire Hospital; Sheffield UK
| | - M. Mathias
- Haemophilia Centre; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
| | - J. Payne
- Departement of Haematology; Sheffield Children's Hospital; Sheffield UK
| | - S. Rangarajan
- Haemophilia Centre; Hampshire Hospitals NHS Foundation Trust; Basingstoke UK
| | - M. Richards
- Haemophilia Centre; Department of Paediatric Haematology; Leeds Children's Hospital; Leeds UK
| | - K. Talks
- Haemophilia Centre; Newcastle upon Tyne Hospitals NHS Foundation Trust (NUTH); Newcastle UK
| | - O. Tunstall
- Department of Paediatric Haematology; Bristol Royal Hospital for Children; Bristol UK
| | - M. Williams
- Department of Haematology; Birmingham Children's Hospital; Birmingham UK
| | - D. P. Hart
- Barts and The London School of Medicine & Dentistry, QMUL; London UK
| |
Collapse
|
16
|
Levy J, Hay C, Chandipo R, Jordan K, Nyambe I, Mutiti S. Drinking Water Provision and Quality in Low-Income Peri-Urban Communities
of Lusaka, Zambia. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.205] [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: 11/17/2022] Open
|
17
|
Berntorp E, Dolan G, Hay C, Linari S, Santagostino E, Tosetto A, Castaman G, Álvarez-Román MT, Parra Lopez R, Oldenburg J, Albert T, Scholz U, Holmström M, Schved JF, Trossaërt M, Hermans C, Boban A, Ludlam C, Lethagen S. European retrospective study of real-life haemophilia treatment. Haemophilia 2016; 23:105-114. [DOI: 10.1111/hae.13111] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2016] [Indexed: 12/24/2022]
Affiliation(s)
- E. Berntorp
- Clinical Coagulation Research Unit; Lund University; Malmö Sweden
| | - G. Dolan
- St Thomas’ Hospital Haemophilia Centre; St Thomas’ Hospital; London UK
| | - C. Hay
- Department of Haematology; Manchester Royal Infirmary; Manchester UK
| | - S. Linari
- Center for Bleeding Disorders; Careggi University Hospital; Florence Italy
| | - E. Santagostino
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; IRCCS Ca’ Granda Foundation; Maggiore Hospital Policlinico; Milan Italy
| | - A. Tosetto
- Department of Cell Therapy and Hematology; Hemophilia and Thrombosis Center; San Bortolo Hospital; Vicenza Italy
| | - G. Castaman
- Center for Bleeding Disorders; Careggi University Hospital; Florence Italy
- Department of Cell Therapy and Hematology; Hemophilia and Thrombosis Center; San Bortolo Hospital; Vicenza Italy
| | - MT. Álvarez-Román
- Hospital Universitario La Paz, Thrombosis and Haemostasis Unit; Madrid Spain
| | - R. Parra Lopez
- Unidad de Hemofilia; Hospital Vall d'Hebrón; Barcelona Spain
| | - J. Oldenburg
- Institut für Experimentelle Hämatologie und Transfusionsmedizin; Universitätsklinik Bonn; Bonn Germany
| | - T. Albert
- Institut für Experimentelle Hämatologie und Transfusionsmedizin; Universitätsklinik Bonn; Bonn Germany
| | - U. Scholz
- Center of Haemostasis; Leipzig Germany
| | - M. Holmström
- Coagulation Unit; Hematology Centre Karolinska; Karolinska University Hospital; Stockholm Sweden
- Department of Medicine; Karolinska Institutet; Solna Sweden
| | - J.-F. Schved
- Hôpital Saint Eloi; Laboratoire d'hématologie; Montpellier France
| | - M. Trossaërt
- Centre Régional de Traitement de l'Hémophilie CHU; Nantes France
| | - C. Hermans
- Haemostasis and Thrombosis Unit; Haemophilia Clinic St-Luc University Hospital; Brussels Belgium
| | - A. Boban
- Haemostasis and Thrombosis Unit; Haemophilia Clinic St-Luc University Hospital; Brussels Belgium
- Department of Hematology; Medical School of Zagreb; University Hospital Center Zagreb; Zagreb Croatia
| | - C. Ludlam
- Sobi; Stockholm Sweden
- University of Edinburgh; Edinburgh UK
| | - S. Lethagen
- Sobi; Stockholm Sweden
- Copenhagen University; Copenhagen Denmark
| |
Collapse
|
18
|
Brkljac M, Shah S, Hay C, Rodriguez-Merchan EC. Hindfoot fusion in haemophilic arthropathy: 6-year mean follow-up of 41 procedures performed in 28 adult patients. Haemophilia 2016; 22:e87-e98. [DOI: 10.1111/hae.12863] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/21/2015] [Indexed: 11/30/2022]
Affiliation(s)
- M. Brkljac
- Manchester Royal Infirmary; University of Manchester; Manchester UK
| | - S. Shah
- Department of Orthopaedic Surgery; Manchester Royal Infirmary; Manchester UK
| | - C. Hay
- Department of Haematology; Manchester Royal Infirmary; Manchester UK
| | | |
Collapse
|
19
|
Lissitchkov T, Hampton K, Depka M, Hay C, Rangarajan S, Tuddenham E, Holstein K, Huth‐Kühne A, Pabinger I, Knaub S, Bichler J, Oldenburg J. Novel, human cell line‐derived recombinant factor VIII (human‐cl rhFVIII; Nuwiq
®
) in adults with severe haemophilia A: efficacy and safety. Haemophilia 2015; 22:225-231. [DOI: 10.1111/hae.12793] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2015] [Indexed: 11/26/2022]
Affiliation(s)
- T. Lissitchkov
- Specialised Hospital for Active Treatment “Joan Pavel” Sofia Bulgaria
| | | | - M. Depka
- Werlhof‐Institut für Hämostaseologie GmbH Hannover Germany
| | - C. Hay
- Manchester Royal Infirmary Manchester UK
| | - S. Rangarajan
- Basingstoke and North Hampshire Hospital BasingstokeUK
| | | | - K. Holstein
- University Hospital Hamburg‐Eppendorf HamburgGermany
| | - A. Huth‐Kühne
- SRH Kurpfalzkrankenhaus and Hemophilia Center Heidelberg Germany
| | | | - S. Knaub
- Octapharma AG Lachen Switzerland
| | | | - J. Oldenburg
- Institute of Experimental Haematology and Transfusion Medicine Bonn Germany
| |
Collapse
|
20
|
Macnaught G, Ananthakrishnan G, Hinksman L, Yadavali R, Bryden F, Lassman S, Ritchie M, Gallacher K, Hay C, Moss JG. Can 1H MR Spectroscopy be Used to Assess the Success of Uterine Artery Embolisation? Cardiovasc Intervent Radiol 2015; 39:376-84. [DOI: 10.1007/s00270-015-1179-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 07/04/2015] [Indexed: 12/26/2022]
|
21
|
Chowdary P, Lethagen S, Friedrich U, Brand B, Hay C, Abdul Karim F, Klamroth R, Knoebl P, Laffan M, Mahlangu J, Miesbach W, Dalsgaard Nielsen J, Martín-Salces M, Angchaisuksiri P. Safety and pharmacokinetics of anti-TFPI antibody (concizumab) in healthy volunteers and patients with hemophilia: a randomized first human dose trial. J Thromb Haemost 2015; 13:743-54. [PMID: 25641556 DOI: 10.1111/jth.12864] [Citation(s) in RCA: 164] [Impact Index Per Article: 18.2] [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: 11/13/2014] [Accepted: 01/24/2015] [Indexed: 08/31/2023]
Abstract
BACKGROUND Prophylaxis with either intravenous (i.v.) factor VIII (FVIII) or FIX is the gold standard of care for patients with severe hemophilia. A monoclonal antibody (concizumab) targeting tissue factor pathway inhibitor (TFPI) that can be administered subcutaneously (s.c.) has the potential to alter current concepts of prophylaxis in hemophilia. OBJECTIVES To evaluate the safety and describe the pharmacokinetics and pharmacodynamics of single-dose concizumab in healthy volunteers and patients with hemophilia A or B. METHODS In this first human dose, phase 1, multicenter, randomized, double-blind, placebo-controlled trial escalating single i.v. (0.5-9000 μg kg(-1) ) or s.c. (50-3000 μg kg(-1) ) doses of concizumab were administered to healthy volunteers (n = 28) and hemophilia patients (n = 24). RESULTS Concizumab had a favorable safety profile after single i.v. or s.c. administration. There were no serious adverse events and no anti-concizumab antibodies. No clinically relevant changes in platelets, prothrombin time, activated partial thromboplastin time, fibrinogen, or antithrombin were found. A dose-dependent procoagulant effect of concizumab was seen as increased levels of D-dimers and prothrombin fragment 1 + 2. Nonlinear pharmacokinetics of concizumab was observed due to target-mediated clearance. A maximum mean AUC0-∞ of 33 960 h μg mL(-1) and a maximum mean concentration of 247 μg mL(-1) was measured at the highest dose. CONCLUSIONS Concizumab showed a favorable safety profile after i.v. or s.c. administration and nonlinear pharmacokinetics was observed due to target-mediated clearance. A concentration-dependent procoagulant effect of concizumab was observed, supporting further study into the potential use of s.c. concizumab for hemophilia treatment.
Collapse
Affiliation(s)
- P Chowdary
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free Hospital, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Merritt AJ, Wilkins BS, Williams MS, Hay C, Byers RJ. Synchronous splenic and bone marrow haemangiolymphangioma: a novel entity. J Clin Pathol 2014; 67:645-7. [DOI: 10.1136/jclinpath-2014-202218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
23
|
Babul S, Korn P, Goldman R, Pike I, Hay C. PREVENTING ADVERSE CONCUSSION OUTCOMES: THE ONLINE CONCUSSION AWARENESS TRAINING TOOLKIT (CATT). Br J Sports Med 2014. [DOI: 10.1136/bjsports-2014-093494.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
24
|
Abstract
OBJECTIVES Pulmonary embolism is believed to be a common cause of death of hospital inpatients. The aims of this study were to estimate the number of deaths caused by pulmonary embolism and the potential to reduce this by the use of caval filters according to accepted indications. DESIGN Review of autopsy reports and death notification records from 2007 and 2008. When pulmonary embolism was given as cause of death (in the autopsy report or in section 1 a-c or part 2 of the Medical Certificate of the Cause of Death), hospital records were reviewed for evidence of pre-mortem diagnosis of pulmonary embolism or deep vein thrombosis (DVT) and for evidence of accepted indications for caval filter placement. SETTING Large UK teaching hospital. PARTICIPANTS Hospital inpatients whose deaths were attributed to pulmonary embolism. MAIN OUTCOME MEASURES Proportion of deaths adjudged at autopsy to be due to pulmonary embolism; evidence of pre-mortem diagnosis of DVT or pulmonary embolism; total number of hospital admission and deaths. RESULTS From a total of 186,517 adult inpatient admissions there were 2583 (1.4%) adult inpatient deaths of which 696 (27%) underwent autopsy. Of those undergoing autopsy, 14 (2.0%, 95% CI 1.2-3.3%) deaths were caused by pulmonary embolism. Pulmonary embolism was recorded as a cause of death in a further 12 (0.7%) of 1773 patients who did not undergo autopsy. Of these, five had a pre-mortem diagnosis of DVT or pulmonary embolism. CONCLUSIONS The proportion of deaths caused by pulmonary embolism appears to be considerably lower than the widely published rate, and of this small number, few have a pre-mortem diagnosis of DVT or pulmonary embolism. There is little scope for further reduction of pulmonary embolism mortality through use of caval filters according to guidelines. Current policy on pulmonary embolism risk prevention appears to be based on an over-estimate of the level of risk.
Collapse
Affiliation(s)
- Douglas Kopcke
- Department of Radiology, Central Manchester University Hospitals, Manchester, UK
| | - Ondina Harryman
- Department of Radiology, Central Manchester University Hospitals, Manchester, UK
| | - Emyr W Benbow
- Department of Pathology, Central Manchester University Hospitals, Manchester, UK
| | - Charles Hay
- Department of Haematology, Central Manchester University Hospitals, Manchester, UK
| | - Nicholas Chalmers
- Department of Radiology, Central Manchester University Hospitals, Manchester, UK
| |
Collapse
|
25
|
Tiede A, Friedrich U, Stenmo C, Allen G, Giangrande P, Goudemand J, Hay C, Holmström M, Klamroth R, Lethagen S, McKenzie S, Miesbach W, Negrier C, Yuste VJ, Berntorp E. Safety and pharmacokinetics of subcutaneously administered recombinant activated factor VII (rFVIIa). J Thromb Haemost 2011; 9:1191-9. [PMID: 21489128 DOI: 10.1111/j.1538-7836.2011.04293.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recombinant activated factor VIIa (rFVIIa) is used to treat bleeds in hemophilia patients with inhibitors. A subcutaneous formulation could potentially improve its half-life and make it suitable for prophylactic treatment. OBJECTIVES A study was conducted to determine the safety of subcutaneously administered rFVIIa in patients with hemophilia and the pharmacokinetic profile (including bioavailability). PATIENTS/METHODS This was a multicenter, open-label, cross-over comparison of single doses of intravenous rFVIIa 90μgkg(-1) and a new formulation of rFVIIa for subcutaneous injection at dose levels of 45, 90, 180, 270 and 360μgkg(-1) . Sixty subjects (12 per dose cohort) with hemophilia A or B were enrolled. RESULTS Subcutaneously administered rFVIIa showed lower mean peak plasma concentrations and prolonged FVII activity (C(max) , 0.44-5.16IU mL(-1) [across doses]; t(1/2) , 12.4h; t(max) , 5.6h) compared with intravenously administered rFVIIa (C(max) , 51.7IUmL(-1) ; t(1/2) , 2.7h; t(max) , <10min). The absolute bioavailability of subcutaneous rFVIIa ranged from 21.1 to 30.1% across dose levels. Dose proportionality was observed within a 2-fold dose increase but not across the full dose range. No thromboembolic events, drug-related serious adverse events, severe injection-site reactions or neutralizing antibodies were reported (primary endpoint). Mild and moderate injection-site reactions were more frequent with subcutaneous than with intravenous injections. CONCLUSION This phase I clinical trial did not identify safety concerns of prolonged exposure to rFVIIa administered subcutaneously in single doses to hemophilia patients.
Collapse
Affiliation(s)
- A Tiede
- Hannover Medical School, Hannover, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Dmoszynska A, Kuliczkowski K, Hellmann A, Trelinski J, Kloczko J, Baglin T, Hay C, O'Shaughnessy D, Zawilska K, Makris M, Shaikh-Zaidi R, Gascoigne E, Dash C. Clinical assessment of Optivate®, a high-purity concentrate of factor VIII with von Willebrand factor, in the management of patients with haemophilia A. Haemophilia 2011; 17:456-62. [PMID: 21371184 PMCID: PMC7165764 DOI: 10.1111/j.1365-2516.2010.02446.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Summary. Factor VIII (FVIII) concentrates have revolutionized the treatment of patients with haemophilia A. Concerns over the transmission of viral infections through these products have been addressed through stringent, donor‐screening procedures and robust antiviral manufacturing steps. Bio Products Laboratory has developed a high‐purity FVIII product with von Willebrand factor, Optivate®. Its safety, tolerability and efficacy as prophylaxis and treatment of bleeds have been established in long‐term studies. Seventy previously treated patients with severe haemophilia A, with ≥20 exposure days, were recruited into two long‐term, multicentre, open‐label studies. The protocols were virtually identical. Patients received Optivate® either prophylactically or on‐demand. A mean of 159.0 EDs were experienced over 11 320 infusions. Under both conditions, Optivate® was well tolerated. Only 10% of patients experienced a treatment‐related adverse event; the most commonly reported were headache (4% of patients) and dizziness (3% of patients). The mean number of bleeds/patient over the 2 year treatment period was 23.5 during prophylactic use and 70.4 during on‐demand use. In patients treated prophylactically, clinical responses to breakthrough bleeds were rated by physicians as excellent or good and as very helpful or helpful by patients in 95% of bleeds. Clinical responses for on‐demand patients were rated as excellent or good by physicians and helpful or very helpful by the patients for 91% of bleeds. There were no viral transmissions or inhibitors. The studies confirm the clinical efficacy and safety of Optivate® in both prophylactic and on‐demand management of patients with haemophilia A.
Collapse
Affiliation(s)
- A Dmoszynska
- Klinika Hematologii, Akademia Medyczna w Lublinie, Lublin, Poland
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Robinson HL, Amara RR, Lai L, Xu Y, De Rosa S, Defawe O, Sato A, Tomaras GD, Qin L, Moss B, Wyatt LS, Hay C, Goepfert P. P19-58 LB. Comparison of the immunogenicity in humans and rhesus macaques of vaccines consisting of DNA priming and MVA boosting and MVA priming and boosting. Retrovirology 2009. [PMCID: PMC2767940 DOI: 10.1186/1742-4690-6-s3-p422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
28
|
Recht M, Nemes L, Matysiak M, Manco-Johnson M, Lusher J, Smith M, Mannucci P, Hay C, Abshire T, O'Brien A, Hayward B, Udata C, Roth DA, Arkin S. Clinical evaluation of moroctocog alfa (AF-CC), a new generation of B-domain deleted recombinant factor VIII (BDDrFVIII) for treatment of haemophilia A: demonstration of safety, efficacy, and pharmacokinetic equivalence to full-length recombinant factor VIII. Haemophilia 2009; 15:869-80. [PMID: 19473411 DOI: 10.1111/j.1365-2516.2009.02027.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BDDrFVIII is a B-domain deleted recombinant factor VIII (rFVIII) product for haemophilia A. Manufacture uniquely includes purification chromatography by synthetic-affinity ligand rather than murine-based monoclonal antibody, as well as an albumin-free cell culture process. BDDrFVIII was studied in 204 patients, including 62 subjects <16 years old, in two studies. A double-blind, randomized, pharmacokinetic (PK) crossover study, utilizing a central laboratory assay (one-stage (OS)) for both drug potency assignment and plasma FVIII-activity measurements, demonstrated that BDDrFVIII was PK-equivalent to a full-length rFVIII. Favourable efficacy and safety were observed: during defined routine prophylaxis in a patient population significant for preexisting target joints, nearly half (45.7%) of patients had no bleeding, and a low-annualized bleed rate (ABR) was achieved (median 1.9); 92.5% of haemorrhages (n = 187) required < or =2 infusions. Three subjects (1.5%, across both studies) developed de novo inhibitors (low-titre, transient), and the primary safety endpoint, based on a prospective Bayesian analysis, demonstrated the absence of neoantigenicity for BDDrFVIII. The PK-equivalence, based on central testing to align test and reference articles, and the novel Bayesian analysis of inhibitor safety in these investigations reflect robust experimental designs with relevance to future studies. This extensive dataset demonstrates the safety and efficacy of BDDrFVIII for haemophilia A.
Collapse
Affiliation(s)
- M Recht
- Hemophilia Treatment Center, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Rosenfeld M, Hay C. Managing chronic pain and return to work in the "real world": a case study. Work 2008; 30:317-321. [PMID: 18525156] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Affiliation(s)
- M Rosenfeld
- The Positive Approach: Prevention and Rehabilitation Services, Toronto, Ont., Canada.
| | | |
Collapse
|
30
|
Lee J, Dash C, Chernova T, Baglin T, Collins P, Serban M, Hay C, Matysiak M, Mitchell V, Plyusch O, Rusen L, Stasyshyn O. USE OF A HIGH PURITY FACTOR IX (FIX) CONCENTRATE IN SURGERY. J Thromb Haemost 2007. [DOI: 10.1111/j.1538-7836.2007.tb01095.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
31
|
Cumming A, Grundy P, Keeney S, Lester W, Enayat S, Guilliatt A, Bowen D, Pasi J, Keeling D, Hill F, Bolton-Maggs PHB, Hay C, Collins P. An investigation of the von Willebrand factor genotype in UK patients diagnosed to have type 1 von Willebrand disease. Thromb Haemost 2007. [PMID: 17080221 DOI: 10.1160/th06-07-0383] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Forty families diagnosed by UK centres to have type 1 VWD were recruited. Following review, six families were re-diagnosed to have type 2 VWD, one to have a platelet storage pool disorder, and one family was determined to be unaffected. Direct DNA sequencing of the promoter region and all exons and intronic boundaries of the VWF gene identified six mutations likely to be causative of VWD in index cases of nine of the 32 (28%) confirmed type 1 VWD families. These included R1205H (3614G > A) VWD Vicenza, P1648fsX45 (4944delT), D141G (422A > G) and three splice site mutations: 3108 + 5G > A, 7437 + 1G > A and 3379 + 1G > A. The Y1584C (4751A > G) polymorphism was present in eight additional families. No significant VWF gene mutation or polymorphism was identified in 15 of the 32 type 1VWD index cases (47%). Haplotype studies were performed using a panel of VWF polymorphisms to investigate the segregation in families of VWD phenotype with the VWF gene. In 13 of the 32 families it was likely that VWD segregated with the VWF gene. In eight families (25%) VWD clearly did not segregate with the VWF gene. We suggest that mutation screening of the VWF gene has limited general utility in genetic diagnostic and family studies in type 1 VWD. If genetic studies are performed, the incomplete penetrance and variable expressivity of type 1 VWD must be taken into account. Unless linkage of VWD phenotype with the VWF gene can be clearly demonstrated, the results of any genetic family studies should be interpreted with caution.
Collapse
Affiliation(s)
- Anthony Cumming
- University Department of Haematology, Manchester Royal Infirmary, Manchester, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Cumming A, Grundy P, Keeney S, Lester W, Enayat S, Guilliatt A, Bowen D, Pasi J, Keeling D, Hill F, Bolton-Maggs PHB, Hay C, Collins P. An investigation of the von Willebrand factor genotype in UK patients diagnosed to have type 1 von Willebrand disease. Thromb Haemost 2006; 96:630-41. [PMID: 17080221] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Forty families diagnosed by UK centres to have type 1 VWD were recruited. Following review, six families were re-diagnosed to have type 2 VWD, one to have a platelet storage pool disorder, and one family was determined to be unaffected. Direct DNA sequencing of the promoter region and all exons and intronic boundaries of the VWF gene identified six mutations likely to be causative of VWD in index cases of nine of the 32 (28%) confirmed type 1 VWD families. These included R1205H (3614G > A) VWD Vicenza, P1648fsX45 (4944delT), D141G (422A > G) and three splice site mutations: 3108 + 5G > A, 7437 + 1G > A and 3379 + 1G > A. The Y1584C (4751A > G) polymorphism was present in eight additional families. No significant VWF gene mutation or polymorphism was identified in 15 of the 32 type 1VWD index cases (47%). Haplotype studies were performed using a panel of VWF polymorphisms to investigate the segregation in families of VWD phenotype with the VWF gene. In 13 of the 32 families it was likely that VWD segregated with the VWF gene. In eight families (25%) VWD clearly did not segregate with the VWF gene. We suggest that mutation screening of the VWF gene has limited general utility in genetic diagnostic and family studies in type 1 VWD. If genetic studies are performed, the incomplete penetrance and variable expressivity of type 1 VWD must be taken into account. Unless linkage of VWD phenotype with the VWF gene can be clearly demonstrated, the results of any genetic family studies should be interpreted with caution.
Collapse
Affiliation(s)
- Anthony Cumming
- University Department of Haematology, Manchester Royal Infirmary, Manchester, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Abstract
Immune tolerance induction (ITI) is the most common approach used to eliminate inhibitors that develop in hemophilia A patients following exposure to factor (F) VIII therapy. ITI generally requires ongoing long-term exposure to factor replacement therapy using FVIII or FIX. Although plasma-derived products have been the mainstay of ITI therapy in the past, recent data indicate that high-purity (i.e., recombinant) rFVIII products are probably equally effective. For patients who have failed to respond to ITI treatment, or for those at high risk to do so, immunosuppressive therapy may be helpful. Rituximab has demonstrated a possible clinical benefit in hemophilic and nonhemophilic patients developing FVIII inhibitors, but benefit in those with congenital hemophilia and inhibitors has not been established and more extensive clinical studies are needed. More recently, research on reducing the incidence of inhibitor development has included mutagenizing key epitopes of the FVIII antigenic molecule to alter its immunogenicity without affecting biological activity, as well as induction of tolerance by gene therapy with immunodominant A2 and C2 domains of FVIII presented by B cells as immunoglobulin fusion proteins.
Collapse
Affiliation(s)
- Charles Hay
- Manchester Royal Infirmary, Manchester, United Kingdom.
| | | | | | | |
Collapse
|
34
|
Abstract
Inhibitor development continues to be a severe complication worldwide of haemophilia therapy. Given the difficulties associated with the treatment of inhibitors in both the developed and the developing world, prediction and prevention of inhibitors following exposure to factor VIII or IX in the young child has become a management priority. Two different clinical approaches to minimizing or delaying inhibitor development are highlighted in this manuscript. Challenges in the therapy of existing inhibitors persist. However, the nature of the issues faced by physicians in the developed and developing worlds vary considerably. Both are discussed in this manuscript by representatives of both worlds, who face these challenges on a daily basis.
Collapse
Affiliation(s)
- D Dimichele
- Department of Pediatrics, Weill Medical College of Cornell University, New York, NY 10021, USA.
| | | | | | | |
Collapse
|
35
|
Dolan G, Bevan D, Giangrande P, Hampton K, Hay C, Ludlam C, Mcverry B, Pasi K, Winter M. Crit Care 2005; 9:P343. [DOI: 10.1186/cc3406] [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: 11/10/2022] Open
|
36
|
Hay C, Micko C, Prescott MF, Liau G, Robinson K, De Leon H. Differential cell cycle progression patterns of infiltrating leukocytes and resident cells after balloon injury of the rat carotid artery. Arterioscler Thromb Vasc Biol 2001; 21:1948-54. [PMID: 11742869 DOI: 10.1161/hq1201.100256] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The heterogeneous nature of the cell populations involved in vascular repair remains a major hurdle for the assessment of the cellular events that take place in injured arteries. The present experiments were designed to estimate the proportions and cell cycle progression of infiltrating leukocytes versus resident vascular cells after balloon injury of the rat common carotid artery. After tissue disaggregation, cell suspension samples from each artery were analyzed by flow cytometry. Cells were stained with anti-CD45 or anti-alpha-smooth muscle actin antibodies to identify leukocytes and smooth muscle cells, respectively. A day after injury, a 12-fold increase in CD45+ leukocytes was found. Double labeling with CD45 and CD-3, ED-1, or granulocyte markers revealed that most infiltrating cells were monocytes and granulocytes. Approximately 14% of infiltrating leukocytes were found to enter apoptosis at day 1, and 17% entered S phase at day 3. In contrast, the highest proliferation rate of resident alpha-smooth muscle actin-positive cells was observed at day 7 (19%). The present results demonstrate that infiltrating leukocytes and resident vascular smooth muscle cells have dissimilar cell cycle profiles. Furthermore, our study demonstrates the feasibility of using flow cytometry to quantitatively determine the cell types and their relative activation state in injured arteries.
Collapse
Affiliation(s)
- C Hay
- Genetic Therapy, Inc, Gaithersburg, MD, USA
| | | | | | | | | | | |
Collapse
|
37
|
Hay C, Hissler M, Fischmeister C, Rault-Berthelot J, Toupet L, Nyulászi L, Réau R. Phosphole-containing pi-conjugated systems: from model molecules to polymer films on electrodes. Chemistry 2001; 7:4222-36. [PMID: 11686602 DOI: 10.1002/1521-3765(20011001)7:19<4222::aid-chem4222>3.0.co;2-3] [Citation(s) in RCA: 228] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Two series of 2,5-dipyridyl- and 2,5-dithienylphosphole derivatives containing sigma3- or sigma4-P atoms were prepared, and their optical (UV/Vis absorption, fluorescence spectra) and electrochemical properties were systematically evaluated. These physical properties depend mainly on the natures of the 2,5-substituents and of the phosphorus moiety, and they revealed that these compounds contain extended pi-conjugated systems. Structure-property relationships were established on the basis of these experimental data and ab initio calculations on the parent molecules. The limited aromatic character and low-lying LUMO of the phosphole ring appear to be crucial for achieving a highly delocalised pi system. Electrooxidation of 2,5-dithienylphosphole derivatives affords electroactive films with low optical band gaps. As observed for the corresponding monomers, the optical and electrochemical properties of the polymers can be varied over a wide range by modifying the nature of the phosphorus moiety.
Collapse
Affiliation(s)
- C Hay
- Organométalliques et Catalyse Chimie et Electrochimie Moléculaires, UMR 6509, CNRS-Université de Rennes 1, Institut de Chimie de Rennes, France
| | | | | | | | | | | | | |
Collapse
|
38
|
Hay C. Club doctors and physiotherapists. Br J Sports Med 2001; 35:207; author reply 207-8. [PMID: 11375886 PMCID: PMC1724336 DOI: 10.1136/bjsm.35.3.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
39
|
Hay C, Fischmeister C, Hissler M, Toupet L, Réau R. Electropolymerization of pi-Conjugated Oligomers Containing Phosphole Cores and Terminal Thienyl Moieties: Optical and Electronic Properties We thank the CNRS, the MENRT, the Conseil Régional de Bretagne for financial support of this work and Prof. C. Moinet for helpful discussions. Angew Chem Int Ed Engl 2000; 39:1812-1815. [PMID: 10934371 DOI: 10.1002/(sici)1521-3773(20000515)39:10<1812::aid-anie1812>3.0.co;2-d] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- C Hay
- Organométalliques et Catalyse Chimie et Electrochimie Moléculaires UMR 6509, CNRS-Université de Rennes Campus de Beaulieu, 35042 Rennes Cedex (France)
| | | | | | | | | |
Collapse
|
40
|
Hollingsworth RA, Hay C, Richards B. An Internet implementation of an international clinical study. Stud Health Technol Inform 2000; 68:528-31. [PMID: 10724944] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
This paper describes a clinical study that is being conducted in 15 countries world-wide via the internet. The study concerns the removal of Factor VIII inhibitors in haemophilic children. The suitability of the Internet for this type of study is explored together with the technology (Active Server Pages, Secure Sockets Layer) that is involved in the creation of such a system.
Collapse
|
41
|
Abstract
The aim of this study was to assess the process and outcome of hospitalised patients (inpatients) for whom whole-body CT was requested but not performed. For 6 months the reasons why CT was not performed were recorded, together with relevant discussions with clinicians. Subsequent referrals for alternative investigations were noted. The eventual outcome of the patients was monitored via the patients' records. Eighty-three (8%) of 1001 inpatient requests were identified for which body CT was not performed after an electronically generated request. Fifty-five requests were not accepted by the radiology department during the vetting process for a variety of reasons (often more than one): criteria used for rejection often overlapped and included referrals outside national guidelines (n = 20), better alternative investigations (n = 29), time constraints (n = 19), over-zealous requests (n = 17) and clinicians' erroneous interpretation of preceding imaging investigations (n = 9). Sixteen CT exams were cancelled by a clinician. An additional 12 exams were not performed for miscellaneous non-medical reasons. In no case could a patient's death be ascribed to CT not being performed. Most (981 of 1001, 98%) CT requests comply with current guidelines, disproving a perception that many radiological referrals are inappropriate. In our health care system radiologists have to turn down some appropriate CT referrals due to a lack of CT capacity. Although lack of CT contributed to delay in diagnosis, no patient died as a direct result of not having CT.
Collapse
Affiliation(s)
- R L Harrison
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | | | | | | |
Collapse
|
42
|
Lee CA, Owens D, Bray G, Giangrande P, Collins P, Hay C, Gomperts E, Schroth P, Barrowcliffe T. Pharmacokinetics of recombinant factor VIII (recombinate) using one-stage clotting and chromogenic factor VIII assay. Thromb Haemost 1999; 82:1644-7. [PMID: 10613649] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
In a study designed to demonstrate the safety and pharmacokinetics of a recombinant factor VIII (Recombinate) manufactured in Andover, MA and Thousand Oaks, CA, two different methods of factor VIII assay (one-stage clotting and Chromogenic substrate) were compared in vivo. The study was performed in four centres in the UK: London, Oxford, Cardiff and Manchester. Two pharmacokinetic studies, at least one week apart, were performed in 30 patients with severe haemophilia A (VIII:C < 2 IU/dl). A dose of 50 IU/kg was administered with sampling pre-infusion, and +0.25, 0.5, 1, 3, 6, 9, 12 and 24 h post-infusion. The aggregate 60 pharmacokinetic study showed a half-life of 12.7 and 13.0 h (p = 0.28) and recovery of 127 and 161 IU/dl (p = 0.0001) using one-stage clotting or chromogenic substrate respectively. In a supplementary experiment, 20 post-infusion samples were re-assayed by 1-stage and chromogenic assay using two plasma (20th British plasma standard and an "in-house" pooled normal plasma) and two concentrate standards, derived from the same type, but different batch of infused concentrate (Recombinate) and pre-diluted in either individual pre-infusion sample or in pooled commercial haemophilic plasma. The use of the Recombinate concentrate standard overcame the significant difference in FVIII levels between 1-stage and chromogenic assay methods when a plasma standard was used (p <0.0001). It is concluded that where potency dosing designation is carried out by an assay system different to that used in the clinical situation, the use of the recombinant concentrate as a standard in post-infusion plasma samples is likely to give more reliable and reproducible results.
Collapse
Affiliation(s)
- C A Lee
- Haemophilia Centre and Haemostasis Unit, Royal Free Hospital, London, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Brander C, Yang OO, Jones NG, Lee Y, Goulder P, Johnson RP, Trocha A, Colbert D, Hay C, Buchbinder S, Bergmann CC, Zweerink HJ, Wolinsky S, Blattner WA, Kalams SA, Walker BD. Efficient processing of the immunodominant, HLA-A*0201-restricted human immunodeficiency virus type 1 cytotoxic T-lymphocyte epitope despite multiple variations in the epitope flanking sequences. J Virol 1999; 73:10191-8. [PMID: 10559335 PMCID: PMC113072 DOI: 10.1128/jvi.73.12.10191-10198.1999] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Immune escape from cytotoxic T-lymphocyte (CTL) responses has been shown to occur not only by changes within the targeted epitope but also by changes in the flanking sequences which interfere with the processing of the immunogenic peptide. However, the frequency of such an escape mechanism has not been determined. To investigate whether naturally occurring variations in the flanking sequences of an immunodominant human immunodeficiency virus type 1 (HIV-1) Gag CTL epitope prevent antigen processing, cells infected with HIV-1 or vaccinia virus constructs encoding different patient-derived Gag sequences were tested for recognition by HLA-A*0201-restricted, p17-specific CTL. We found that the immunodominant p17 epitope (SL9) and its variants were efficiently processed from minigene expressing vectors and from six HIV-1 Gag variants expressed by recombinant vaccinia virus constructs. Furthermore, SL9-specific CTL clones derived from multiple donors efficiently inhibited virus replication when added to HLA-A*0201-bearing cells infected with primary or laboratory-adapted strains of virus, despite the variability in the SL9 flanking sequences. These data suggest that escape from this immunodominant CTL response is not frequently accomplished by changes in the epitope flanking sequences.
Collapse
MESH Headings
- Adolescent
- Amino Acid Sequence
- Antigen Presentation
- Cell Line, Transformed
- Child
- Child, Preschool
- Epitopes, T-Lymphocyte/genetics
- Epitopes, T-Lymphocyte/immunology
- Gene Products, gag/genetics
- Gene Products, gag/immunology
- Genetic Variation
- Genetic Vectors
- HIV Antigens/genetics
- HIV Antigens/immunology
- HIV Infections/immunology
- HIV Infections/virology
- HIV-1/genetics
- HIV-1/immunology
- HLA-A2 Antigen/immunology
- Humans
- Immunodominant Epitopes/genetics
- Immunodominant Epitopes/immunology
- Molecular Sequence Data
- Mutagenesis, Site-Directed
- Peptides/immunology
- Plasmids
- Recombination, Genetic
- Sequence Homology, Amino Acid
- T-Lymphocytes, Cytotoxic/immunology
- Vaccinia virus
- Viral Proteins
- gag Gene Products, Human Immunodeficiency Virus
Collapse
Affiliation(s)
- C Brander
- AIDS Research Center and Infectious Disease Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Keeney S, Cumming A, Hay C. Mutations in von Willebrand factor multimerization domains are not a common cause of classical type 1 von Willebrand disease. Thromb Haemost 1999; 82:1446-50. [PMID: 10595636] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Type 1 von Willebrand disease (vWD) is an autosomal dominant bleeding disorder of variable penetrance. It is characterised by a mild to moderate bleeding tendency and a quantitative deficiency of von Willebrand factor (vWF) with the full range of vWF multimers. Few mutations have been described which account for the mode of inheritance in dominant vWD type 1. We screened the vWF multimerization domains (regions D1-D3 of the vWF gene) of 12 unrelated patients with dominant vWD type 1 to investigate the hypothesis that multimerization of vWF sub-units may be inhibited or reduced by a "dominant negative" mechanism. Platelet-derived RNA was reverse transcribed and the resulting vWF cDNA amplified by the polymerase chain reaction (PCR) in a series of overlapping fragments. These were subjected to a combination of single-strand conformation polymorphism (SSCP) and heteroduplex analysis. This approach identified mobility shifts on acrylamide gels that represented 12 distinct SSCP and/or heteroduplex patterns in our patient group. DNA sequencing of the region encompassing each mobility shift showed these variants to represent previously described polymorphisms within the vWF coding sequence. Examination in all 12 patients for the previously described G3389T and T3445C mutations proved negative. The molecular pathology of classical type 1 vWD remains enigmatic, mutations having been identified in only a small minority of patients. A common mechanism underlying this disease state has still to be elucidated.
Collapse
Affiliation(s)
- S Keeney
- University Department of Haematology, Manchester Royal Infirmary, UK.
| | | | | |
Collapse
|
45
|
Hallenbeck PL, Chang YN, Hay C, Golightly D, Stewart D, Lin J, Phipps S, Chiang YL. A novel tumor-specific replication-restricted adenoviral vector for gene therapy of hepatocellular carcinoma. Hum Gene Ther 1999; 10:1721-33. [PMID: 10428217 DOI: 10.1089/10430349950017725] [Citation(s) in RCA: 185] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Transducing and distributing a vector throughout a tumor mass are presently insufficient for effective cancer gene therapy. To overcome these difficulties an adenoviral vector was designed that would replicate specifically in tumor cells. This tumor-specific replication-restricted adenoviral (TSRRA) vector was constructed by requiring that the essential E1A gene be expressed from a tumor-specific promoter, namely, the alpha-fetoprotein (AFP) gene promoter. This promoter was chosen since the AFP gene is highly expressed in 70-80% of patients with hepatocellular carcinoma (HCC) but not in normal adults. HCC is one of the major worldwide causes of cancer death. A vector was constructed (AvE1a04i) and demonstrated to replicate in human AFP-producing HCC cell lines. However, little replication was observed in seven other, non-AFP-producing human cell lines, as well as primary cultures of normal human lung epithelial and endothelial cells. In addition, AvE1a04i was shown to prevent tumor growth of an ex vivo-transduced AFP-expressing HCC cell line but not a non-AFP-expressing cell line. Finally, in situ administration of AvE1a04i into preestablished tumors resulted in a greater than 50% long-term survival rate. This novel TSRRA vector for HCC demonstrated both specificity and efficacy in vitro and in vivo.
Collapse
Affiliation(s)
- P L Hallenbeck
- Genetic Therapy, a Novartis Company, Gaithersburg, MD 20878, USA
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Keeney S, Salden A, Hay C, Cumming A. A whole blood, multiplex PCR detection method for factor V Leiden and the prothrombin G20210A variant. Thromb Haemost 1999; 81:464-5. [PMID: 10102480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
|
47
|
Abstract
The process of deinstitutionalization of people with chronic mental disabilities in Western countries has often produced a spatial concentration of ex-psychiatric patients, and of mental health services, in inner city urban neighbourhoods. In this paper, the geography of mental health services and patients in Dunedin is examined, and it is shown that a concentration does exist in one neighbourhood. The history and characteristics of this neighbourhood are described. The key factors in contemporary New Zealand that have generated this spatial pattern are then considered, and Dunedin's centralized mental health geography is contrasted with the North American "zone of dependence" phenomenon. The paper concludes by considering to what extent Dunedin's emergent geography of mental health provides a supportive environment for people with mental illnesses, and exploring the policy implications for health care planners and service providers.
Collapse
Affiliation(s)
- B Gleeson
- Urban Research Program, Australian National University, Canberra, Australia
| | | | | |
Collapse
|
48
|
Hay C, Rosenberg E. Immunologic response to HIV. AIDS Clin Care 1998; 10:1-3. [PMID: 11365074] [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] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- C Hay
- Massachusetts General Hospital, Boston, MA
| | | |
Collapse
|
49
|
Abstract
The discovery of the inducible form of cyclo-oxygenase, known as cyclo-oxygenase-2 (COX-2), has provided insight into the mechanisms involved in the inflammatory response. Peripheral inflammation induced by intraplantar injection of carrageenan is associated with a marked increase in COX-2 mRNA and prostaglandins in the surrounding tissue and the accompanying oedema is sensitive to COX-2-selective drugs. In this study, we investigated whether COX-2 in spinal cord was similarly induced by carrageenan and whether the associated development of altered pain sensitivity, hyperalgesia was affected by the COX-2 selective inhibitor DuP 697. Intraplantar injection of carrageenan caused a marked hyperalgesia at 4 h which was significantly attenuated by treatment with DuP 697 (10 mg kg-1). At the same time levels of COX-2 mRNA in lumbar spinal cord were significantly increased two-fold by carrageenan treatment. However, DuP 697 potentiated COX-2 mRNA induction, which indicates the existence of a potential regulatory mechanism to overcome COX-2 inhibition.
Collapse
Affiliation(s)
- C Hay
- Department of Biochemistry, Charing Cross and Westminster Medical School, London, UK
| | | |
Collapse
|
50
|
Abstract
Cognitive function items are increasingly included in quality of life measures, and complaints of concentration and memory difficulties are often reported by cancer patients. The aim of this study was to examine the factors influencing patients' level of complaint by comparing subjective reports with objective test performance of a sample of adult lymphoma patients, disease-free and > or = 6 months after treatment. There was no significant difference between complainers and non-complainers in sociodemographic or clinical characteristics or in their performance on standard neuropsychometric tests of concentration and memory. Those reporting concentration and memory difficulties had significantly higher scores on measures of anxiety, depression and fatigue. This calls into question the validity of including cognitive function items in self-report quality of life measures. Patients who report concentration and memory difficulties should be screened for clinically significant and potentially remediable mood disorder. Objective testing remains the method of choice for assessing higher mental function.
Collapse
Affiliation(s)
- A Cull
- Imperial Cancer Research Fund, Medical Oncology Unit, Western General Hospital, Edinburgh, UK
| | | | | | | | | | | |
Collapse
|