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Shah M, DeLaat A, Cavanaugh C. Treatment of membranous nephropathy: Perspectives on current and future therapies. Front Nephrol 2023; 3:1110355. [PMID: 37675368 PMCID: PMC10479573 DOI: 10.3389/fneph.2023.1110355] [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: 11/28/2022] [Accepted: 01/09/2023] [Indexed: 09/08/2023]
Abstract
Primary membranous nephropathy remains one of the most frequent causes of nephrotic syndrome in adults. It is an autoimmune disorder in which auto-antibodies target antigens at the podocytes cell membrane-basement membrane interface. Our understanding of membranous nephropathy has expanded dramatically as of late. After the initial discovery of the phospholipase A2 receptor auto-antibody in 2009, eight more antigens have been discovered. These discoveries have led to refinement in our understanding of the pathogenesis, diagnosis, and natural history of primary membranous nephropathy. Now, many experts advocate for redefining primary membranous nephropathy based on antigen, potentially shedding the primary and secondary nomenclature. Recently, therapies for primary membranous have also expanded. Immunosuppressive therapies like cyclophosphamide and rituximab, which primarily target B-cells, remain the cornerstone of therapy. However, there is still significant room for improvement, as many as 30-40% do not respond to this therapy according to recent trials. Additionally, drugs targeting complement, and other novel therapies are also under investigation. In this review we will discuss the available therapies for primary membranous nephropathy in light of recent clinic trials like GEMRITUX, MENTOR, RI-CYCLO, and STARMEN, as well as management strategies. While the last 10 years have seen a boom in our mechanistic understanding of this ever-diversifying disease, we are likely to see a similar boom in the therapeutic options in the years to come.
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Affiliation(s)
- Monarch Shah
- Division of Nephrology, University of Virginia, Charlottesville, VA, United States
| | - Andrew DeLaat
- Liberty University College of Osteopathic Medicine, Lynchburg, VA, United States
| | - Corey Cavanaugh
- Division of Nephrology, University of Virginia, Charlottesville, VA, United States
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Birt J, Tillett W, Cavanaugh C, Jung Y, Vadhariya A, Ross S, Paulus J, Sprabery AT, Lubrano E. POS1060 CHANGES IN DISEASE ACTIVITY AND PATIENT-REPORTED OUTCOMES IN PSORIATIC ARTHRITIS PATIENTS TREATED WITH IXEKIZUMAB IN A REAL-WORLD US COHORT. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundIxekizumab (IXE), an IL-17A inhibitor, has demonstrated efficacy in clinical trials1-3 but real-world effectiveness (RWE) data are limited.4ObjectivesTo describe changes in disease activity and patient-reported outcomes (PROs) at 6 and 12 months follow-up among psoriatic arthritis (PsA) patients initiating IXE in a routine clinical setting.MethodsThis retrospective cohort study included patients from the OM1 PsA Registry (OM1, Boston, MA), a linked electronic medical record and administrative claims dataset with over 50,000 patients. Eligible patients had ≥1 prescription for IXE (first = index), were ≥18 years old at index, had ≥1 diagnosis code for PsA in the 12 months before or on index, and had ≥12 months of baseline and ≥6 months of follow-up data as of June 2021. For patients with baseline and follow-up measures available, changes in Clinical Disease Activity Index (CDAI), PROs, and other clinical outcomes from baseline to 6 and 12 months were described. For patients on IXE monotherapy, change in CDAI score from baseline to 6 and 12 months was assessed using mixed effects linear models adjusted for age, sex, and baseline CDAI score.ResultsThe study population included 1,812 patients with a mean age of 53.7 years (Table 1). Psoriasis was present in 82% and enthesitis in 28%. Over 60% of patients were obese, and the mean Charlson Comorbidity Index was 1.3. Most patients (84%) had prior treatment with a biologic disease-modifying antirheumatic drug (bDMARD) and 40% with a targeted synthetic DMARD (tsDMARD). The mean number of bDMARDs and tsDMARDs used during all available prior history was 2.3 and 1.1, respectively. The most common prior bDMARDs were secukinumab (n=428, 24%) and adalimumab (n=245, 14%).Table 1.Demographic and Clinical Characteristics by Therapy StatusAll Patients(N=1,812)Monotherapy(N=1,485)Combination Therapy(N=327)Age (years)Mean (s.d.)53.7 (12.2)53.9 (12.3)52.9 (11.7)Median (Q1-Q3)55 (46-62)55 (46-62)54 (45-61)SexFemale1,108 (61.1%)909 (61.2%)199 (60.9%)Male704 (38.9%)576 (38.8%)128 (39.1%)Charlson Comorbidity IndexMean (s.d.)1.3 (1.6)1.3 (1.6)1.5 (1.7)Median (Q1-Q3)1 (0-2)1 (0-2)1 (0-2)BMIUnderweight: <18.510 (0.6%)10 (0.7%)0 (0.0%)Normal weight: 18.5-24.9210 (12.2%)172 (12.2%)38 (12.1%)Overweight: 25-29.9455 (26.5%)379 (27.0%)76 (24.2%)Obese: >= 301,045 (60.8%)845 (60.1%)200 (63.7%)Missing927913Domains of PsA: PsoriasisYes1,490 (82.2%)1,222 (82.3%)268 (82.0%)No322 (17.8%)263 (17.7%)59 (18.0%)Domains of PsA: EnthesitisYes510 (28.1%)409 (27.5%)101 (30.9%)No1,302 (71.9%)1,076 (72.5%)226 (69.1%)Of patients with a baseline CDAI score, 61% had moderate or severe disease activity. For all patients, CDAI scores improved (decreased) by an average of 3.4 and 3.7 points at 6 and 12 months, respectively, from a baseline mean of 15.4. All disease activity measures and PROs improved from baseline to 6 and 12 months (Figure 1). In patients persistent with IXE, 35.3% and 33.7% were in CDAI remission or low disease activity at 6 and 12 months after initiation, respectively. For IXE monotherapy users (82% of patients), at baseline, patients had a mean CDAI of 14.3 (n=131) and 15.1 (n=105) for the 6 and 12 month analyses, respectively. Adjusted mean changes in CDAI from baseline to 6 months (-3.6 points, p < 0.0001) and 12 months (-4.9 points, p < 0.0001) were statistically significant.ConclusionIn this cohort of PsA patients with multiple prior b/tsDMARD failures, improvements in disease activity and PROs were observed at 6 and 12 months after initiating treatment with IXE. Improvements were observed in patients overall and in the monotherapy subgroup. More real-world research on IXE and other bDMARDs are important to understand the effect of treatment choices on clinical and PROs in both bDMARD-naive and experienced PsA patients.References[1]Mease PJ. Ann. Rheum. Dis. 2017;76(1):79-87[2]Nash P. Lancet. 2017;389(10086):2317-2327[3]Mease PJ. Ann. Rheum. Dis. 2020;79(1):123-131[4]Berman J. Biologics. 2021 Nov 18;15:463-470Disclosure of InterestsJulie Birt Shareholder of: Shareholder of Eli Lilly and Company, Employee of: Employee of Eli Lilly and Company, William Tillett Speakers bureau: Abbvie, Amgen, Celgene, Eli-Lilly, Janssen, MSD, Novartis,, Pfizer, UCB, Consultant of: Abbvie, Amgen, Celgene, Eli-Lilly, Janssen, MSD, Novartis, Pfizer, UCB, Grant/research support from: Abbvie, Amgen, Celgene, Eli-Lilly, Janssen, UCB, Cristi Cavanaugh: None declared, Yoojin Jung: None declared, Aisha Vadhariya Shareholder of: Shareholder of Eli Lilly and Company, Employee of: Employee of Eli Lilly and Company, Sarah Ross Shareholder of: Shareholder of Eli Lilly and Company, Employee of: Employee of Eli Lilly and Company, Jess Paulus: None declared, Aubrey Trevelin Sprabery Shareholder of: Shareholder of Eli Lilly and Company, Employee of: Employee of Eli Lilly and Company, Ennio Lubrano: None declared
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Bergman M, Patel J, Saffore C, Mcdearmon-Blondell E, Topuria I, Cavanaugh C. POS1064 CLINICAL AND ECONOMIC BURDEN OF PATIENTS WITH PSORIATIC ARTHRITIS WITH AND WITHOUT AXIAL INVOLVEMENT. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundAxial involvement affects about 12% to 50% of patients (pts) with psoriatic arthritis (PsA),1,2 and these pts report worse pain and function than pts without axial involvement.3 Limited evidence exists quantifying the clinical and economic impact of axial involvement and pain in pts with PsA.ObjectivesTo examine the clinical and economic burden of pts with PsA with and without axial involvement and assess the relationship between pain and frequency/costs of healthcare resource utilization (HCRU).MethodsThis cross-sectional study was conducted using de-identified linked electronic medical record and administrative claims data from the OM1 PsA Registry, a subset of the OM1 Real-World Data Cloud (OM1, Inc, Boston, MA, US). Adults aged ≥18 years with PsA (ICD-10 codes: L40.5x except for L40.53) were divided into two cohorts based on the presence or absence of the diagnosis code for axial involvement (ICD-10: L40.53) during 2019. Demographic and clinical characteristics between pts with and without axial involvement were compared with t-tests or Chi-square tests. Poisson regression models were used to assess the association of pain with HCRU. Mean costs per HCRU encounter (inpatient and emergency department [ED] visits) in 2019 were obtained from Optum’s de-identified Clinformatics Data Mart Database (2007-2019) and multiplied by the mean annual rate of HCRU encounters to generate per patient per year (PPPY) costs.ResultsOf 11,531 pts with PsA, 1,118 (10%) were diagnosed as having axial involvement. The two cohorts were similar in age, Charlson comorbidity score, and biologic disease-modifying antirheumatic drug (DMARD) use (Table 1). More pts with vs without axial involvement were commercially insured, had higher pain, and used opioids. Higher mean annual rates of inpatient (9 vs 5 per 100 pts) and ED (19 vs 14 per 100 pts) visits were seen in pts with vs without axial involvement, respectively, which translated to higher mean annual inpatient ($1,899 vs $1,055) and ED ($222 vs $164) visit costs PPPY (Figure 1). A 1-point higher pain score was associated with a higher likelihood of inpatient (52% vs 11%) and ED (20% vs 10%) visits (Table 1) and additional mean annual inpatient ($987 vs $116) and ED ($44 vs $16) visit costs PPPY (Figure 1) in pts with and without axial involvement, respectively.Table 1.Demographics, treatment utilization, and healthcare resource utilizationMean (SD), unless otherwise specifiedPsA pts without axial involvement n=10,413PsA pts with axial involvement n=1,118p-valuesAge, years56.7 (13.0)56.8 (14.0)0.8948Female, n (%)6,401 (61%)653 (58%)0.0494Insurance, n (%)<0.0001 Commercial3,285 (62%)414 (73%) Medicaid110 (2%)18 (3%) Medicare1,618 (30%)103 (18%)Charlson comorbidity score0.4 (1.0)0.4 (1.0)0.9900Pain, VAS (0–10)4.2 (2.6)a4.5 (2.6)b0.0422bDMARD use, n (%)6,871 (66%)753 (67%)0.3762tsDMARD use, n (%)1,117 (11%)91 (8%)0.0072Opioid use, n (%)1,722 (17%)224 (20%)0.0034Inpatient visits/100 pts5 (32)9 (35)0.0021ED visits/100 pts14 (63)19 (72)0.0168Association of pain and HCRU, IRR (95% CI)cInpatient visits1.11 (1.08–1.15)*1.52 (1.13–2.03)**ED visits1.10 (1.07–1.13)*1.20 (1.05–1.38)**bDMARD, biologic DMARD; CI, confidence interval; IRR, incidence rate ratio; MTX, methotrexate; NSAIDs, non-steroidal anti-inflammatory drugs; SD, standard deviation; tsDMARD, targeted synthetic DMARD; VAS, visual analog scale.*p<0.0001 and **p<0.01 for association between 1-point increase in pain and HCRU.an=9,981bn=320cBased on Poisson regression model adjusted for age, sex, race, insurance type, Charlson comorbidity score, and PsA treatments (b/tsDMARDs, MTX, and NSAIDs).ConclusionAxial involvement in PsA was associated with an increased clinical and economic burden. Higher pain was associated with higher HCRU and costs in pts with vs without axial involvement.References[1]Baraliakos X, et al. Clin Exp Rheumatic. 2015;33:S31–5.[2]Ogdie A, et al. J Rheumatol. 2021;48:698–706.[3]Mease PJ, et al. J Rheumatol. 2018;45:1389–96.AcknowledgementsAbbVie funded this study and participated in the study design, research, analysis, data collection, interpretation of data, review, and approval of the abstract. No honoraria or payments were made for authorship. Medical writing support was provided by Julia Zolotarjova, MSc, MWC, of AbbVie.Disclosure of InterestsMartin Bergman Shareholder of: JNJ (parent of Janssen) and Merck, Speakers bureau: AbbVie, Amgen, BMS, Janssen, Merck, Novartis, Pfizer, Sanofi, and Sandoz, Consultant of: AbbVie, Amgen, BMS, Janssen, Merck, Novartis, Pfizer, Sanofi, and Sandoz, Jayeshkumar Patel Shareholder of: May own AbbVie stock or options, Employee of: AbbVie, Christopher Saffore Shareholder of: May own AbbVie stock or options, Employee of: AbbVie, Erin McDearmon-Blondell Shareholder of: May own AbbVie stock or options, Employee of: AbbVie, Ia Topuria Employee of: OM1, Cristi Cavanaugh Employee of: OM1
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Cavanaugh C. Urine Sediment Exam Provides More Diagnostic Information in AKI than Novel Urinary Biomarkers: PRO. Kidney360 2022; 3:597-599. [PMID: 35721626 PMCID: PMC9136907 DOI: 10.34067/kid.0004872021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/09/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Corey Cavanaugh
- Division of Nephrology, University of Virginia, Charlottesville, Virginia
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Cavanaugh C, Okusa MD. The Evolving Role of Novel Biomarkers in Glomerular Disease: A Review. Am J Kidney Dis 2021; 77:122-131. [DOI: 10.1053/j.ajkd.2020.06.016] [Citation(s) in RCA: 6] [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] [Received: 03/02/2020] [Accepted: 06/06/2020] [Indexed: 02/06/2023]
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Cavanaugh C, Donadio G, Starzyk K, Behling M, Curhan G, Gliklich R. FRI0186 JOINT INVOLVEMENT AND DISEASE ACTIVITY IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS: CALCULATION OF SWOLLEN TO TENDER JOINT COUNT RATIO IN A REAL WORLD COHORT IN THE US. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Joint swelling and tenderness are common in patients with systemic lupus erythematosus (SLE). Swollen to tender joint count ratio (STR) is an index originally used in rheumatoid arthritis (RA) which assesses severity of disease activity based on 28 joint counts [1]. In RA, STR is a predictor of treatment response with a higher score indicating greater likelihood of responding.Objectives:To characterize SLE patients in a real-world cohort based on disease activity as defined by STR.Methods:The OM1 SLE Registry (OM1, Boston, MA) follows more than 37,000 SLE patients longitudinally with deep clinical data, including laboratory, patient-reported and disease activity information, and linked administrative claims, starting from 2013. Patients ≥16 years of age with swollen and tender joint counts based on 28 joints on the same encounter were included. STRs were calculated by inserting 1 if the denominator was 0 [2]. Patients were categorized by first available STR as having low (STR <0.5), moderate (0.5 ≤ STR ≤ 1.0), and high (STR >1.0) disease activity. Clinical characteristics were summarized by disease activity group. Definitions of SLE treatments were based on 2019 EULAR recommendations [3].Results:As of December 2019, there were 9,919 patients with at least one STR available in the OM1 SLE Registry. STR was low in 80.4%, moderate in 12.2%, and high in 7.4% of patients. Mean age overall was 52.1 years (standard deviation: 14.8), 92.1% were female, and 71.8% of 7,730 patients with known race were white. Clinical characteristics by STR group are described in Table 1. Antimalarial use decreased and immunosuppressant use increased with increasing STR. Use of select disease-modifying antirheumatic drugs (DMARDs) was higher among patients with moderate or high STR. Lupus nephritis was more common in patients with low STR. A higher proportion of patients with moderate STR had osteoarthritis. The proportion of patients with anxiety and depression decreased with increasing STR. On average, patient and physician global assessments from MDHAQ were higher for patients with moderate STR.Table 1.Clinical characteristics of patients with SLE by swollen:tender joint count ratio groupLowSTR <0.5(N=7,970)Moderate0.5 ≤ STR ≤ 1.0(N=1,211)HighSTR >1.0(N=738)Treatment prior to STR, n (%) Antimalarial5,106 (64.1%)702 (58.0%)427 (57.9%) Biologics (belimumab or rituximab)662 (8.3%)113 (9.3%)70 (9.5%) Immunosuppressants2,310 (29.0%)398 (32.9%)252 (34.1%) Select DMARDs635 (8.0%)165 (13.6%)94 (12.7%) Steroids4,437 (55.7%)785 (64.8%)434 (58.8%)Disease conditions prior to STR, n (%) Anxiety266 (3.3%)25 (2.1%)12 (1.6%) Depression1,127 (14.1%)149 (12.3%)80 (10.8%) Lupus nephritis984 (12.3%)117 (9.7%)72 (9.8%) Osteoarthritis2,336 (29.3%)393 (32.5%)193 (26.2%) Osteoporosis631 (7.9%)95 (7.8%)47 (6.4%)MDHAQ, N1,991388230MDHAQ, mean (SD) Patient global assessment (0-10)4.5 (2.9)5.3 (2.7)4.4 (2.8) Physician global assessment (0-10)2.8 (2.7)3.8 (2.6)2.8 (2.3)Conclusion:Differences in treatments received were apparent between patients of varying disease activity groups with trends towards increased use among patients with higher disease activity. Additional research is needed to determine the utility of this measure for assessing SLE-related outcomes.References:[1]Cipriano et al., Reumatismo 2015 Sept 16;67(2):62-7[2]Hammer HB et al., Arthritis Rheumatol 2016; 68 (suppl 10)[3]Fanouriakis et al., Ann Rheum Dis. 2019;78:736-745Disclosure of Interests:None declared
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Inoue K, Gan G, Ciarleglio M, Zhang Y, Tian X, Pedigo CE, Cavanaugh C, Tate J, Wang Y, Cross E, Groener M, Chai N, Wang Z, Justice A, Zhang Z, Parikh CR, Wilson FP, Ishibe S. Podocyte histone deacetylase activity regulates murine and human glomerular diseases. J Clin Invest 2019; 129:1295-1313. [PMID: 30776024 DOI: 10.1172/jci124030] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [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: 08/06/2018] [Accepted: 01/10/2019] [Indexed: 12/21/2022] Open
Abstract
We identified 2 genes, histone deacetylase 1 (HDAC1) and HDAC2, contributing to the pathogenesis of proteinuric kidney diseases, the leading cause of end-stage kidney disease. mRNA expression profiling from proteinuric mouse glomeruli was linked to Connectivity Map databases, identifying HDAC1 and HDAC2 with the differentially expressed gene set reversible by HDAC inhibitors. In numerous progressive glomerular disease models, treatment with valproic acid (a class I HDAC inhibitor) or SAHA (a pan-HDAC inhibitor) mitigated the degree of proteinuria and glomerulosclerosis, leading to a striking increase in survival. Podocyte HDAC1 and HDAC2 activities were increased in mice podocytopathy models, and podocyte-associated Hdac1 and Hdac2 genetic ablation improved proteinuria and glomerulosclerosis. Podocyte early growth response 1 (EGR1) was increased in proteinuric patients and mice in an HDAC1- and HDAC2-dependent manner. Loss of EGR1 in mice reduced proteinuria and glomerulosclerosis. Longitudinal analysis of the multicenter Veterans Aging Cohort Study demonstrated a 30% reduction in mean annual loss of estimated glomerular filtration rate, and this effect was more pronounced in proteinuric patients receiving valproic acid. These results strongly suggest that inhibition of HDAC1 and HDAC2 activities may suppress the progression of human proteinuric kidney diseases through the regulation of EGR1.
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Affiliation(s)
| | - Geliang Gan
- Yale School of Public Health, Department of Biostatistics, Yale Center for Analytical Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Maria Ciarleglio
- Yale School of Public Health, Department of Biostatistics, Yale Center for Analytical Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Yan Zhang
- State Key Laboratory of Organ Failure Research, Nanfang Hospital.,Department of Cardiology, Nanfang Hospital, and.,Center for Bioinformatics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | | | | | - Corey Cavanaugh
- Department of Internal Medicine, and.,Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Janet Tate
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Ying Wang
- Department of Internal Medicine, and
| | | | | | | | - Zhen Wang
- Department of Internal Medicine, and
| | - Amy Justice
- Department of Internal Medicine, and.,VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Zhenhai Zhang
- State Key Laboratory of Organ Failure Research, Nanfang Hospital.,Department of Cardiology, Nanfang Hospital, and.,Center for Bioinformatics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Chirag R Parikh
- Department of Internal Medicine, Division of Nephrology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Francis P Wilson
- Department of Internal Medicine, and.,Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut, USA
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Mathieu J, Detraux D, Kuppers D, Wang Y, Cavanaugh C, Sidhu S, Levy S, Robitaille AM, Ferreccio A, Bottorff T, McAlister A, Somasundaram L, Artoni F, Battle S, Hawkins RD, Moon RT, Ware CB, Paddison PJ, Ruohola-Baker H. Folliculin regulates mTORC1/2 and WNT pathways in early human pluripotency. Nat Commun 2019; 10:632. [PMID: 30733432 PMCID: PMC6367455 DOI: 10.1038/s41467-018-08020-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 12/05/2018] [Indexed: 01/05/2023] Open
Abstract
To reveal how cells exit human pluripotency, we designed a CRISPR-Cas9 screen exploiting the metabolic and epigenetic differences between naïve and primed pluripotent cells. We identify the tumor suppressor, Folliculin(FLCN) as a critical gene required for the exit from human pluripotency. Here we show that FLCN Knock-out (KO) hESCs maintain the naïve pluripotent state but cannot exit the state since the critical transcription factor TFE3 remains active in the nucleus. TFE3 targets up-regulated in FLCN KO exit assay are members of Wnt pathway and ESRRB. Treatment of FLCN KO hESC with a Wnt inhibitor, but not ESRRB/FLCN double mutant, rescues the cells, allowing the exit from the naïve state. Using co-immunoprecipitation and mass spectrometry analysis we identify unique FLCN binding partners. The interactions of FLCN with components of the mTOR pathway (mTORC1 and mTORC2) reveal a mechanism of FLCN function during exit from naïve pluripotency. The pathways involved in exit from pluripotency in human embryonic stem cells are poorly understood. Here, the authors performed a CRISPR-based screen to identify genes that promote exit from naïve pluripotency and find a role for folliculin (FLCN) by regulating the mTOR and Wnt pathways.
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Affiliation(s)
- J Mathieu
- Department of Biochemistry, University of Washington, Seattle, WA, 98195, USA.,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA.,Department of Comparative Medicine, University of Washington, Seattle, WA, 98109, USA
| | - D Detraux
- Department of Biochemistry, University of Washington, Seattle, WA, 98195, USA.,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA.,Laboratory of Cellular Biochemistry and Biology (URBC), University of Namur, Namur, 5000, Belgium
| | - D Kuppers
- Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Y Wang
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA.,Paul G. Allen School of Computer Science & Engineering, University of Washington, Seattle, WA, 98109, USA
| | - C Cavanaugh
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA.,Department of Comparative Medicine, University of Washington, Seattle, WA, 98109, USA
| | - S Sidhu
- Department of Biochemistry, University of Washington, Seattle, WA, 98195, USA.,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA
| | - S Levy
- Department of Biochemistry, University of Washington, Seattle, WA, 98195, USA.,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA
| | - A M Robitaille
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA.,Department of Pharmacology, University of Washington, Seattle, WA, 98195, USA
| | - A Ferreccio
- Department of Biochemistry, University of Washington, Seattle, WA, 98195, USA.,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA
| | - T Bottorff
- Department of Biochemistry, University of Washington, Seattle, WA, 98195, USA.,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA
| | - A McAlister
- Department of Biochemistry, University of Washington, Seattle, WA, 98195, USA.,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA
| | - L Somasundaram
- Department of Biochemistry, University of Washington, Seattle, WA, 98195, USA.,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA
| | - F Artoni
- Department of Biochemistry, University of Washington, Seattle, WA, 98195, USA.,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA
| | - S Battle
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA.,Department of Medical Genetics & Genome Sciences, University of Washington, Seattle, WA, 98195, USA
| | - R D Hawkins
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA.,Department of Medical Genetics & Genome Sciences, University of Washington, Seattle, WA, 98195, USA
| | - R T Moon
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA.,Department of Pharmacology, University of Washington, Seattle, WA, 98195, USA
| | - C B Ware
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA.,Department of Comparative Medicine, University of Washington, Seattle, WA, 98109, USA
| | - P J Paddison
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA. .,Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA.
| | - H Ruohola-Baker
- Department of Biochemistry, University of Washington, Seattle, WA, 98195, USA. .,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA.
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Cavanaugh C, Perazella MA. Urine Sediment Examination in the Diagnosis and Management of Kidney Disease: Core Curriculum 2019. Am J Kidney Dis 2019; 73:258-272. [DOI: 10.1053/j.ajkd.2018.07.012] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/12/2018] [Indexed: 11/11/2022]
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Dmytrenko O, Kunikowska A, Utter D, Stewart F, Cavanaugh C. A novel energy-efficient version of the Calvin cycle. N Biotechnol 2018. [DOI: 10.1016/j.nbt.2018.05.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Kinnison DE, Gille J, Barnett J, Randall C, Harvey VL, Lambert A, Khosravi R, Alexander MJ, Bernath PF, Boone CD, Cavanaugh C, Coffey M, Craig C, Dean VC, Eden T, Ellis D, Fahey DW, Francis G, Halvorson C, Hannigan J, Hartsough C, Hepplewhite C, Krinsky C, Lee H, Mankin B, Marcy TP, Massie S, Nardi B, Packman D, Popp PJ, Santee ML, Yudin V, Walker KA. Global observations of HNO3from the High Resolution Dynamics Limb Sounder (HIRDLS): First results. ACTA ACUST UNITED AC 2008. [DOI: 10.1029/2007jd008814] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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12
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Alexander MJ, Gille J, Cavanaugh C, Coffey M, Craig C, Eden T, Francis G, Halvorson C, Hannigan J, Khosravi R, Kinnison D, Lee H, Massie S, Nardi B, Barnett J, Hepplewhite C, Lambert A, Dean V. Global estimates of gravity wave momentum flux from High Resolution Dynamics Limb Sounder observations. ACTA ACUST UNITED AC 2008. [DOI: 10.1029/2007jd008807] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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13
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Shipley D, Spigel DR, Cavanaugh C, Moore Y, Hainsworth JD, Jones S, Burris HA, Sade L, Yardley DA, Greco F. Phase II trial of satraplatin and paclitaxel in the first-line treatment of advanced non-small cell lung cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.18073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
18073 Background: Satraplatin (S) is a novel oral platinum analogue that has shown promising activity in a number of solid tumor settings. Our center previously conducted a phase I trial combining S and paclitaxel (P) in patients (pts) with refractory malignancies, establishing safety for this combination. This single center community-based trial was designed to examine the role of S/P in pts with newly diagnosed advanced non-small cell lung cancer (NSCLC). Methods: The primary endpoint is the objective response rate (ORR). Eligibility criteria: newly diagnosed and unresectable stage IIIB/IV NSCLC, measurable disease, ECOG PS 0–2, and informed consent. Treatment: S 80 mg/m2 PO days 1–5 and P 200mg/m2 IV day 1, every 28 days for a maximum of 6 cycles. Pts were restaged every 8 weeks. Results: 28 pts were enrolled from 2/06 to 12/06 (trial ongoing, n = 40 planned). Data are available on 24 pts for analysis. Baseline characteristics: median age 67 years; male/female, 58%/42%; and ECOG PS 0/1/2, 25%/63%/12%; adenocarcinoma/squamous/large cell/unspecified, 33%/42%/1%/24%. The ORR was 17% (95% CI 5%-37%). 10 pts (42%) had stable disease (SD) and 5 pts (21%) had progressive disease. The disease control rate (ORR + SD) was 59%. 5 pts were not evaluable due to: death (3 pts - 1 possibly due to treatment- related sepsis), and physician/pt preference (1 pt each). With a median follow-up of 8.3 months, the median time to progression is 4 months. Grade (G) 3/4 non-hematologic toxicity occurring in = 5%: infection (29%), nausea, vomiting (17% each), anorexia, hyperglycemia (13% each), and fatigue (8%). G3/4 hematologic toxicity: leukopenia (21%), neutropenia (41%), and thrombocytopenia (29%). Conclusions: In this preliminary analysis, S/P appears to have comparable activity to other platinum-based regimens. In an effort to reduce myelosuppression this trial has been amended to a S dose of 70 mg/m2. Additional accrual and follow-up are needed to better assess the safety and efficacy of this combination regimen. No significant financial relationships to disclose.
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Affiliation(s)
- D. Shipley
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; GPC Biotech, Princeton, NJ
| | - D. R. Spigel
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; GPC Biotech, Princeton, NJ
| | - C. Cavanaugh
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; GPC Biotech, Princeton, NJ
| | - Y. Moore
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; GPC Biotech, Princeton, NJ
| | - J. D. Hainsworth
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; GPC Biotech, Princeton, NJ
| | - S. Jones
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; GPC Biotech, Princeton, NJ
| | - H. A. Burris
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; GPC Biotech, Princeton, NJ
| | - L. Sade
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; GPC Biotech, Princeton, NJ
| | - D. A. Yardley
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; GPC Biotech, Princeton, NJ
| | - F. Greco
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; GPC Biotech, Princeton, NJ
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14
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Schroeder RE, Morrison EE, Cavanaugh C, West MP, Montgomery J. Improving communication among health professionals through education: a pilot study. J Health Adm Educ 2001; 17:175-98. [PMID: 11184900] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Communication can be thought of as a message that is sent, received, and understood. Each discipline of the health profession has its own jargon and means of expressing ideas in shorthand. These separate forms of communicating are effective among those of the same background but are often at the root of misunderstandings between professional groups. This article reviews communication theory and traces the difficulties created when inter-disciplinary teams of healthcare try to work together and communicate. As multi-disciplinary teams are increasingly dealing with the complex problems of today's healthcare system, clear communication and understanding has never been more important. If educators could assist in creating an understanding of vocabulary used for decision processes, communication could improve. The authors of this study performed a multi-stage Delphi survey that grouped terms used by administrators and clinicians and produced a lexicon of corresponding terms. An expert panel then reviewed and modified the list. The result is a lexicon that can be useful to assist clinicians and administrators to communicate with each other. By utilizing clinical terminology, or vice versa, instead of management or clinical jargon, some of the translation done by administration or clinicians could be reduced. Examples of how the lexicon can be utilized are provided in the article. This includes using it in health administration education to demonstrate the variances in clinical/managerial terms. It could also be provided as a primer to physicians, nurses, and other health professionals who assume administrative positions to enhance their communication with administrators.
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Affiliation(s)
- R E Schroeder
- University of Mary HardinBaylor, Belton, TX 76513, USA
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15
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Affiliation(s)
- D L Distel
- Department of Biochemistry, Microbiology, and Molecular Biology, University of Maine, Orono 04469-5735, USA.
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16
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Jenkins C, Kennedy D, Austin L, Boateng Y, Todd E, Cavanaugh C, Pakalnis A, Robinson W, Hislop D, Raine C, Stepka-Tracey C, Ellis L, Hermayer KL. Community programs and screening related to diabetes and its complications. J S C Med Assoc 1998; 94:493-500. [PMID: 9844315] [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: 02/09/2023]
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17
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Gilbert CJ, Petros WP, Vredenburgh J, Hussein A, Ross M, Rubin P, Fehdrau R, Cavanaugh C, Berry D, McKinstry C, Peters WP. Pharmacokinetic interaction between ondansetron and cyclophosphamide during high-dose chemotherapy for breast cancer. Cancer Chemother Pharmacol 1998; 42:497-503. [PMID: 9788577 DOI: 10.1007/s002800050851] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.0] [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: 11/26/2022]
Abstract
PURPOSE Both ondansetron and cyclophosphamide are thought to be metabolized by hepatic microsomal processes. The purpose of this study was to evaluate the potential pharmacokinetic interactions between ondansetron and high-dose alkylating agent chemotherapy. METHODS A total of 54 breast cancer patients receiving high-dose cyclophosphamide, cisplatin and carmustine were treated prospectively in four sequential cohorts. Cohorts I and II received continuous infusions of both ondansetron and prochlorperazine, and cohorts III and IV received a continuous infusion of ondansetron alone at the same doses. All patients received lorazepam every 4 h. A group of 75 matched historical controls had received a continuous infusion of prochlorperazine with lorazepam. Pharmacokinetic monitoring of each drug used in the high-dose chemotherapy regimen was conducted. RESULTS Median AUCs of cyclophosphamide in patients receiving ondansetron (73.6 mg/ml x min) were lower than those of the control patients (88.3 mg/ml x min, n = 75, P = 0.0004), but the median cisplatin AUC was approximately 10% higher and no difference in the disposition of carmustine was demonstrated. Patients treated with ondansetron displayed a higher frequency of headaches than the controls. The frequency of achieving complete emetic control was greater in the ondansetron + prochlorperazine groups compared to the ondansetron alone groups and was greater in both these groups than in the prochlorperazine alone group on the first day of therapy only. CONCLUSION Ondansetron altered the systemic exposure to cyclophosphamide when these agents were administered concomitantly. Ondansetron did not substantially improve overall emetic control when used alone but may improve control in combination with prochlorperazine. Future randomized studies are needed to delineate the effect of ondansetron on the disposition of the active cyclophosphamide metabolites so that clinical implications can be addressed.
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Affiliation(s)
- C J Gilbert
- Duke University Bone Marrow Transplant Program, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
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18
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Abstract
Although the current clinical formulation of paclitaxel (Taxol) is an important new anti-cancer agent, it has significant side effects, some of which are related to its formulation in Cremophor/ethanol. Paclitaxel is difficult to formulate for i.v. administration because of its poor aqueous solubility. Here, we report the therapeutic effects of 2 liposome formulations of paclitaxel against human ovarian A121 tumor growing as an s.c. xenograft in athymic nude mice. The liposome formulations used were ETL and TTL, which have I or 3 lipid components, respectively. TTL was used as a reconstituted lyophilate or as a stable aqueous suspension. ETL was used as a reconstituted lyophilate only. Both paclitaxel-liposome formulations were much better tolerated than Taxol after i.v. or i.p. administration. The acute reactions seen after Taxol administration did not occur when paclitaxel-liposome formulations were administered. All ETL and TTL preparations significantly delayed A121 tumor growth similarly to Taxol at equivalent doses and schedules. Based on pharmacokinetic data, it is possible that paclitaxel rapidly dissociates from ETL or TTL after i.v. administration and distributes in a manner similarly to Taxol. ETL and TTL formulations may be useful clinically not only for eliminating toxic effects of the Cremophor/ethanol vehicle but also for allowing alterations in route and schedule of drug administration.
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Affiliation(s)
- A Sharma
- Department of Experimental Therapeutics, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
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19
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Sharma A, Mayhew E, Bolcsak L, Cavanaugh C, Harmon P, Janoff A, Bernacki RJ. Activity of paclitaxel liposome formulations against human ovarian tumor xenografts. Int J Cancer 1997. [PMID: 9096672 DOI: 10.1002/(sici)1097-0215(19970328)71:1<103::aid-ijc17>3.0.c0;2-j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Although the current clinical formulation of paclitaxel (Taxol) is an important new anti-cancer agent, it has significant side effects, some of which are related to its formulation in Cremophor/ethanol. Paclitaxel is difficult to formulate for i.v. administration because of its poor aqueous solubility. Here, we report the therapeutic effects of 2 liposome formulations of paclitaxel against human ovarian A121 tumor growing as an s.c. xenograft in athymic nude mice. The liposome formulations used were ETL and TTL, which have I or 3 lipid components, respectively. TTL was used as a reconstituted lyophilate or as a stable aqueous suspension. ETL was used as a reconstituted lyophilate only. Both paclitaxel-liposome formulations were much better tolerated than Taxol after i.v. or i.p. administration. The acute reactions seen after Taxol administration did not occur when paclitaxel-liposome formulations were administered. All ETL and TTL preparations significantly delayed A121 tumor growth similarly to Taxol at equivalent doses and schedules. Based on pharmacokinetic data, it is possible that paclitaxel rapidly dissociates from ETL or TTL after i.v. administration and distributes in a manner similarly to Taxol. ETL and TTL formulations may be useful clinically not only for eliminating toxic effects of the Cremophor/ethanol vehicle but also for allowing alterations in route and schedule of drug administration.
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Affiliation(s)
- A Sharma
- Department of Experimental Therapeutics, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
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20
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Peters WP, Ross M, Vredenburgh JJ, Hussein A, Rubin P, Dukelow K, Cavanaugh C, Beauvais R, Kasprzak S. The use of intensive clinic support to permit outpatient autologous bone marrow transplantation for breast cancer. Semin Oncol 1994; 21:25-31. [PMID: 7916487] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Recent studies have explored feasibility and cost considerations of administering high-dose chemotherapy with hematopoietic support in the outpatient setting. Between October 1991 and April 1993, we studied 110 women with primary metastatic breast cancer undergoing high-dose chemotherapy with hematopoietic support. Ninety-two patients were managed in an outpatient clinic after high-dose chemotherapy and autologous bone marrow transplantation and peripheral blood progenitor cells. The remaining 18 patients received the same high-dose treatment and hematopoietic support in the hospital and were discharged to a nearby hotel each night; these patients were the pilot group for this effort and also served as a control group. High-dose chemotherapy consisted of cyclophosphamide/cisplatin/carmustine. Chemotherapy was well tolerated, allowing 95% of 65 eligible patients enrolled since November 1992 to be discharged soon after chemotherapy for outpatient posttransplant support. Approximately 70% of these patients required either no hospital readmission or brief readmissions of 1 to 4 days. Median days of hospitalization required for historical groups of patients receiving high-dose chemotherapy plus bone marrow support as inpatient therapy, high-dose chemotherapy with colony-stimulating factor-primed peripheral blood progenitor cells and autologous bone marrow transplantation as inpatient therapy in a traditional transplant model, and outpatient management of autologous bone marrow transplantation patients were 37, 24.5, and 7 days, respectively, despite the same high-dose chemotherapy. Charges related to the transplant procedure were reduced by 50% over the last 2 to 5 years using the outpatient management approach. This procedure may be applicable to patients with other forms of cancer receiving intensive chemotherapeutic regimens. The use of outpatient management in a transplant setting is highly cost effective.
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Affiliation(s)
- W P Peters
- Bone Marrow Transplant Program, Duke University Medical Center, Durham, NC 27710
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21
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Holm BA, Hudak BB, Keicher L, Cavanaugh C, Baker RR, Hu P, Matalon S. Mechanisms of H2O2-mediated injury to type II cell surfactant metabolism and protection with PEG-catalase. Am J Physiol 1991; 261:C751-7. [PMID: 1951666 DOI: 10.1152/ajpcell.1991.261.5.c751] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Alterations in type II pneumocyte function, including surfactant biosynthesis, may play a significant role in the development and pathophysiology of oxidant-induced lung injury. The results of this study showed that type II cells exposed to 50-300 microM H2O2 demonstrated a dose-dependent decrease in phosphatidylcholine (PC) synthesis with only minimal changes in cell viability. The activities of the choline-phosphate cytidyltransferase and cholinephosphotransferase, specific enzymes of PC synthesis, were not significantly decreased by the exposure. However, the activity of glycerol-3-phosphate acyltransferase, a sulfhydryl-dependent enzyme involved in an early stage of phospholipid synthesis, was decreased by the exposures in a manner that was similar to that seen for PC synthesis. Further studies showed that incubation of type II cells with polyethylene glycol-conjugated catalase for 1 h resulted in an increase in the cell-associated catalase activity (53 +/- 5 vs. 6.7 +/- 1.5 units/mg protein for controls). Confocal microscopy analysis showed that a significant portion of this activity was located intracellularly. More importantly, these cells were protected from changes in PC synthesis rates when subsequently incubated with 300 microM H2O2. These results indicate that the deleterious effects of H2O2 on type II cell surfactant synthesis may be pharmacologically modified in vitro, a concept that may have utility with regard to the modulation of in vivo lung injuries.
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Affiliation(s)
- B A Holm
- Department of Gynecology/Obstetrics, State University of New York, Buffalo 14222
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22
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Abstract
This study determined the influence of teeth, mouth, and face on self-image and personal esthetic satisfaction in adults. A random sample of 125 patients completed a five-item questionnaire about personal esthetic satisfaction and oral self-image. As a group, general dental variables were stronger predictors of esthetic satisfaction than orthodontic variables (P less than .01). Discrepancies between clinical findings and patterns of self-perception and satisfaction suggest the dentist and patient should plan together for esthetic dental treatment.
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Affiliation(s)
- L M Neumann
- University of Illinois, Chicago Department of Operative Dentistry 60612
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23
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Humphrey DM, Cavanaugh C. Microvascular function in skin windows. Am J Pathol 1987; 126:423-31. [PMID: 3548407 PMCID: PMC1899638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The dermal microvasculature is an integral component of skin windows. However, in spite of the obvious dependence of the skin window model on vascular function, its almost exclusive application has been the study of leukocyte function and recovery of the cellular components of inflammatory exudates. In the studies reported here, skin window chambers were employed for assessment of function of the underlying microvasculature in rats given intravenous infusions of Evans blue dye or colloidal carbon. Increased vascular permeability was documented by photometric measurement of Evans blue dye, and vascular labeling of dermal vessels with colloidal carbon was assessed histologically. Zymosan-activated serum elicited accumulation of both leukocytes and Evans blue dye in chamber fluid overlying skin windows, confirming the responsiveness of the preparations. With serotonin as a model vasoactive substance, both increased vascular permeability and vascular labeling were directly related to serotonin concentration in the chamber fluid. It is estimated that plasma exudates were distributed as approximately 10% in the fluid and 90% in the dermis. Finally, serotonin-induced exudates recovered from the 0.3-ml chambers were estimated to be up to 3 microliter of plasma based on Evans blue dye measurement or up to 70 micrograms of protein based on Lowry assay. Thus, soluble components of skin window exudates were recovered for examination, and the dermal microvasculature was shown to be an important functional component of the skin window model that was directly accessible for study.
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