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Yang D, Baldwin KD, Balar P, Spiegel DA, Zheng JL, Anari JB. Should I stay or should I go: an assessment of criteria for safe day of surgery discharge of displaced supracondylar humerus fractures. J Pediatr Orthop B 2024:01202412-990000000-00184. [PMID: 38375877 DOI: 10.1097/bpb.0000000000001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Immobilization type and in-hospital observation following surgical management of displaced supracondylar fractures are subject to surgeon preference and training. Our goal was to determine criteria for immediate discharge and optimal type of immobilization. Medical records of 661 patients with type III, IV or flexion-type displaced supracondylar humerus fractures treated at a level 1 pediatric trauma center from January 2013 to September 2019 were reviewed. Patients were separated into 'admission appropriate' (AA = 113) and 'discharge appropriate' (DA = 548) sub-cohorts. Neurovascular deficit at presentation (P < 0.001), post-operative physical exam deterioration (P < 0.001), age (P < 0.001) and post-operative immobilization modality (P = 0.02) were significantly different between AA and DA groups. When comparing patients who presented with neurologic deficit to those neurovascularly intact, there was a significant difference in whether circumferential immobilization was used post-operatively (P < 0.001), IV medication need (P < 0.001), discharge or admission (P < 0.001), neurologic decline (P < 0.001), return to ED (P = 0.008) and vascular compromise (P = 0.05). Twenty-four of the 56 (43%) patients who were AA and had no neurovascular finding on presentation had their immobilization adjusted (bivalved or loosened) to accommodate for swelling overnight. Only 1 was initially maintained in a splint or bivalved cast; the other 23 were initially maintained post-operatively in circumferential immobilization (P = 0.01). Our findings suggest that patients with intact neurovascular exams at presentation are candidates for early discharge, and splinting or bivalved casting may be preferable, especially in patients who are discharged.
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Affiliation(s)
- Daniel Yang
- Department of Orthopaedics, The Children's Hospital of Philadelphia
| | - Keith D Baldwin
- Department of Orthopaedics, The Children's Hospital of Philadelphia
| | - Pooja Balar
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - David A Spiegel
- Department of Orthopaedics, The Children's Hospital of Philadelphia
| | - Jenny L Zheng
- Department of Orthopaedics, The Children's Hospital of Philadelphia
| | - Jason B Anari
- Department of Orthopaedics, The Children's Hospital of Philadelphia
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Nokin MJ, Durieux F, Peixoto P, Chiavarina B, Peulen O, Blomme A, Turtoi A, Costanza B, Smargiasso N, Baiwir D, Scheijen JL, Schalkwijk CG, Leenders J, De Tullio P, Bianchi E, Thiry M, Uchida K, Spiegel DA, Cochrane JR, Hutton CA, De Pauw E, Delvenne P, Belpomme D, Castronovo V, Bellahcène A. Correction: Methylglyoxal, a glycolysis side-product, induces Hsp90 glycation and YAP-mediated tumor growth and metastasis. eLife 2024; 13:e96613. [PMID: 38319293 PMCID: PMC10846855 DOI: 10.7554/elife.96613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
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Syed AN, Zheng JL, Goodbody C, Cahill PJ, Spiegel DA, Baldwin K. Rotation and Asymmetry of the Axial Plane Pelvis in Cerebral Palsy: A CT-Based Study. Children (Basel) 2024; 11:63. [PMID: 38255376 PMCID: PMC10814894 DOI: 10.3390/children11010063] [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: 11/28/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/24/2024]
Abstract
Spinopelvic malignment is commonly seen with non-ambulatory cerebral palsy (CP). Axial plane deformation is not well described in the literature. The purpose of this study was to describe and quantify the axial plane deformity in CP using CT scans and compare it to normal controls. We retrospectively collected data using CT scans of the abdomen and pelvis of 40 patients with GMFCS IV/V CP and neuromuscular scoliosis (CPP) and normal controls (NP) matched by age and sex. Pre-operative Cobb angle was recorded for the CP patients. Pelvic anatomy was evaluated at the supra-acetabular region of bone using two angles-iliac wing angle and sacral ala angle, measured for each hemipelvis. The larger of each hemipelvis angle was considered externally rotated while the smaller angle was considered internally rotated, termed as follows-iliac wing external (IWE) and internal (IWI); sacral ala external (SAE), and internal (SAI). Differences were noted using an independent t-test while correlations with Cobb angle were performed using Pearson's correlation. Iliac wing measurements showed the externally rotated hemipelvis showed a significantly greater magnitude compared with normal controls at 47.3 ± 18.1 degrees vs. 26.4 ± 3.7 degrees in NP (p < 0.001) while no internal rotation was observed (p > 0.05). Sacral ala measurements showed greater magnitude in both external and internal rotation. SAE was 119.5 ± 9.5 degrees in CPP vs. 111.2 ± 7.7 degrees in NP (p < 0.001) while SAI was 114.1 ± 8.5 degrees in CPP vs. 107.9 ± 7.5 degrees in NP (p = 0.001). In the CP cohort, the mean Cobb angle was 61.54 degrees (n = 37/40). Cobb angle correlated with the degree of external iliac wing rotation-IWE (r = 0.457, p = 0.004) and degree of absolute difference in the rotation of the iliac wing (r = 0.506, p = 0.001). The pelvis in a patient with CP scoliosis is asymmetrically oriented exhibiting a greater external rotation of one hemipelvis relative to normal controls. The severity of neuromuscular scoliosis is related to the pelvic axial rotation in CP patients. Axial plane deformity exists in the CP pelvis and this deformity warrants consideration when considering spinopelvic instrumentation strategies and outcomes of supra-pelvic and infra-pelvic pathologies.
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Affiliation(s)
| | | | | | | | - David A. Spiegel
- Division of Orthopaedics, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (A.N.S.); (J.L.Z.); (C.G.); (P.J.C.); (K.B.)
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Kiani SN, Yang D, Zheng JL, Spiegel DA. Clubfoot and the Ponseti Method: A Bibliometric Analysis. JB JS Open Access 2023; 8:e23.00005. [PMID: 37670896 PMCID: PMC10470668 DOI: 10.2106/jbjs.oa.23.00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
Background The aim of the present study was to perform a bibliometric analysis of research articles published on clubfoot to provide a quantitative description of the literature and to gather information on the institutions, journals, researchers, and countries publishing on this topic. Methods This bibliometric analysis consisted of 2 Web of Science searches. The first identified all articles published prior to April 25, 2022, with "clubfoot" in the title, abstract, or keywords, and the second identified all articles with "Ponseti." Studies were exported in BibTeX format and uploaded into Biblioshiny software in RStudio. Descriptive statistics are reported for variables related to the article, author, and country in which the research was conducted. Results A total of 2,177 articles identified using the term "clubfoot" were included. The first article was published in 1902, and there was a 3% annual growth rate. A total of 762 articles identified using the term "Ponseti" were included, with the first published in 1992 and a 13.9% annual growth rate. The Journal of Pediatric Orthopaedics accounted for almost one-quarter of all published reports. Conclusions The literature on clubfoot has expanded in the past decades, and the percentage of studies concerning the Ponseti method has increased dramatically in the years following adoption in the U.S. and, more recently, globally. While a number of studies involved collaboration between authors in high-income and low- and middle-income countries, further collaboration will be essential to evaluate outcomes and help improve service delivery as adoption of this method increases globally. Clinical Relevance This paper explores how the orthopaedic and scientific communities have increasingly contributed to literature on Ponseti casting and clubfoot, and discusses how contributions to the literature are becoming increasingly widespread.
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Affiliation(s)
- Sara N. Kiani
- Division of Orthopedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Daniel Yang
- Division of Orthopedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jenny L. Zheng
- Division of Orthopedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David A. Spiegel
- Division of Orthopedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Badin D, Baldwin KD, Cahill PJ, Spiegel DA, Shah SA, Yaszay B, Newton PO, Sponseller PD. When to Perform Fusion Short of the Pelvis in Patients with Cerebral Palsy?: Indications and Outcomes. JB JS Open Access 2023; 8:JBJSOA-D-22-00123. [PMID: 37073271 PMCID: PMC10106181 DOI: 10.2106/jbjs.oa.22.00123] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Patients with scoliosis secondary to cerebral palsy (CP) are often treated with posterior spinal fusion (PSF) with or without pelvic fixation. We sought to establish criteria to guide the decision of whether or not to perform fusion "short of the pelvis" in this population, and to assess differences in outcomes. Methods Using 2 prospective databases, we analyzed 87 pediatric patients who underwent PSF short of the pelvis from 2008 to 2015 to treat CP-related scoliosis and who had ≥2 years of follow-up. Preoperative radiographic and clinical variables were analyzed for associations with unsatisfactory correction (defined as pelvic obliquity of ≥10°, distal implant dislodgement, and/or reoperation for increasing deformity at 2- or 5-year follow-up). Continuous variables were dichotomized using the Youden index, and a multivariable model of predictors of unsatisfactory correction was created using backward stepwise selection. Finally, radiographic, health-related quality-of-life, and clinical outcomes of patients with fusion short of the pelvis who had neither of the 2 factors associated with unsatisfactory outcomes were compared with those of 2 matched-control groups. Results Deformity correction was unsatisfactory in 29 of 87 patients with fusion short of the pelvis. The final model included preoperative pelvic obliquity of ≥17° (odds ratio [OR], 6.8; 95% confidence interval [CI], 2.3 to 19.7; p < 0.01) and dependent sitting status (OR, 3.2; 95% CI, 1.1 to 9.9; p = 0.04) as predictors of unsatisfactory correction. The predicted probability of unsatisfactory correction increased from 10% when neither of these factors was present to a predicated probability of 27% to 44% when 1 was present and to 72% when both were present. Among matched patients with these factors who had fusion to the pelvis, there was no association with unsatisfactory correction. Patients with independent sitting status and pelvic obliquity of <17° who had fusion short of the pelvis had significantly lower blood loss and hospital length of stay, and better 2-year health-related quality-of-life scores compared with matched controls with fusion to the pelvis. Conclusions In patients with scoliosis secondary to CP, pelvic obliquity of <17° and independent sitting status are associated with a low risk of unsatisfactory correction and better 2-year outcomes when fusion short of the pelvis is performed. These may be used as preoperative criteria to guide the decision of whether to perform fusion short of the pelvis in patients with CP. Level of Evidence Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Daniel Badin
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Keith D. Baldwin
- Division of Orthopedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Patrick J. Cahill
- Division of Orthopedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David A. Spiegel
- Division of Orthopedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Suken A. Shah
- Department of Orthopedic Surgery, Nemours Children’s Hospital, Wilmington, Delaware
| | - Burt Yaszay
- Department of Orthopedics and Sports Medicine, Seattle Children’s Hospital and University of Washington, Seattle, Washington
| | - Peter O. Newton
- Department of Orthopedics, Rady Children’s Hospital and University of California-San Diego Medical Center, San Diego, California
| | - Paul D. Sponseller
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland
- Email for corresponding author:
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deRamon EA, Sabbasani VR, Streeter MD, Liu Y, Newhouse TR, McDonald DM, Spiegel DA. Pentosinane, a Post-Translational Modification of Human Proteins with Underappreciated Stability. J Am Chem Soc 2022; 144:21843-21847. [PMID: 36410375 DOI: 10.1021/jacs.2c09626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Pentosinane is a structurally complex nonenzymatic post-translational modification of proteins believed to be present in all living things. It falls into the category of advanced glycation end products (AGEs) and is structurally related to the other AGEs pentosidine and glucosepane. Although pentosidine and glucosepane have been widely studied for their role in wide-ranging conditions (e.g., diabetes mellitus, Alzheimer's disease, and human aging), relatively little is known about pentosinane. Interestingly, previous reports have suggested that pentosidine may derive from pentosinane. The (patho)physiological significance of pentosinane in humans is largely unexplored. As a first step to address this knowledge gap, we report herein the first total synthesis of pentosinane. Our synthesis is high yielding (1.7% over seven steps), concise, and enantioselective, and it leverages a strategy for synthesizing 2,5-diaminoimidazoles previously developed by our lab. Access to synthetic pentosinane has allowed us to perform additional studies showing that its oxidation to pentosidine is both pH and oxygen dependent and is substantially slower under physiological conditions than previously believed. Additionally, pentosinane rapidly decomposes under harshly acidic conditions typically employed for pentosidine isolation. Taken together, these results suggest that pentosinane is likely to be more abundant in vivo than previously appreciated. We believe these results represent a critical step toward illuminating the role(s) of pentosinane in human biology.
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Affiliation(s)
- Edward A deRamon
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, Connecticut 06520, United States
| | - Venkata R Sabbasani
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, Connecticut 06520, United States
| | - Matthew D Streeter
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, Connecticut 06520, United States
| | - Yannan Liu
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, Connecticut 06520, United States
| | - Timothy R Newhouse
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, Connecticut 06520, United States
| | - David M McDonald
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, Connecticut 06520, United States
| | - David A Spiegel
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, Connecticut 06520, United States
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Jung E, Cohen AJ, Howell R, Cosme C, Tsang D, Ristic N, Cruz CSD, Spiegel DA, Chupp GL, Gautam S. A dual role for CRTH2 in acute lung injury. bioRxiv 2022:2022.05.29.493897. [PMID: 35665001 PMCID: PMC9164436 DOI: 10.1101/2022.05.29.493897] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Acute respiratory distress syndrome (ARDS) is a life-threatening clinical condition defined by rapid onset respiratory failure following acute lung injury (ALI). Its increased incidence due to COVID-19 and high mortality rate (∼40%) make the study of ARDS pathogenesis a crucial research priority. CRTH2 is a G protein-coupled receptor with established roles in type 2 immunity and well-characterized inhibitors. Prior studies have shown it also promotes neutrophilic inflammation, indicating that CRTH2 inhibition may be a potential therapeutic strategy for ARDS. To test this hypothesis, we first examined the expression pattern of CRTH2 on murine neutrophils. We found it is expressed on neutrophils, but only after extravasation into the lung. Next, we showed that extravasated lung neutrophils generate inflammatory responses upon stimulation with the CRTH2-specific agonist DK-PGD2, as demonstrated by reactive oxygen species (ROS) production. This response was abrogated in CRTH2 KO neutrophils. Inhibition of CRTH2 with fevipiprant suppressed baseline ROS production, indicating an autocrine PGD2-CRTH2 signaling loop. We then evaluated the role of CRTH2 in vivo using a murine model of LPS-induced ALI. Despite the pro-inflammatory effects of CRTH2 on neutrophils in vitro, we observed worsening of lung injury in CRTH2-deficient mice in terms of neutrophilic inflammation, vascular leak, and survival. Bulk RNAseq of lung tissue indicated an impairment in type 2 immune signaling; qPCR and ELISA confirmed downregulation of the key type 2 effector cytokine, IL-4. Thus, CRTH2 appears to play a dual role in ALI, directly promoting neutrophil effector responses, but indirectly suppressing lung injury and neutrophilic inflammation through type 2 immunity. These findings reveal a novel protective function for CRTH2 during lung injury and argue against the use of CRTH2 inhibitors in ARDS.
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Meltzer-Bruhn AT, Landrum MR, Spiegel DA, Cahill PJ, Anari JB, Baldwin KD. Does nutrition consultation in the year leading up to neuromuscular scoliosis surgery result in significant weight gain, or just a larger magnitude curve? Spine Deform 2022; 10:151-158. [PMID: 34427892 DOI: 10.1007/s43390-021-00401-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 08/14/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Patients with neuromuscular scoliosis undergoing posterior instrumented spinal fusion can be underweight, malnourished, and have higher complication rates. A nutrition consult is common in this population and it is unclear if weight gain occurs from the consult or surgery. The purpose of the study was to determine if nutrition consultation in the year prior to spinal fusion resulted in significant differences in weight gain or percentile on the CP growth chart. The secondary aim was to determine if there would be deformity progression during that time. METHODS Retrospective chart and radiograph review was performed for all patients with neuromuscular spinal deformity treated with posterior instrumented spinal fusion at one institution between January 1, 2009 and August 1, 2015. Inclusion criteria included < 20 years old, diagnosis of neuromuscular scoliosis, and 1-year pre-operative percentile on the CP growth chart < 50. Patient demographics, GMFCS level, weight, percentile on appropriate CP growth chart, major curve and pelvic obliquity at 1 year pre-operatively and at surgery were recorded. RESULTS Sixty-eight patients met inclusion criteria. Thirty-seven patients had a nutrition appointment within 1 year pre-operatively, 31 patients did not. There were no significant differences between the groups when comparing increase in weight (p = 0.9), percentile on CP growth charts (p = 0.3), major deformity (p = 0.1), and pelvic obliquity (p = 0.2). Overall, there was a mean 3.2 kg weight gain, 5.2% increase on CP growth charts, 40° increase in major curve, and 5° worsening of pelvic obliquity in the year before surgery. There was an average overall increase in the pre-operative albumin value, but this was not different between groups (p = 0.6). Children who were tube fed gained on average 10.8 percentiles on the CP growth chart, whereas children without gained only 0.5 percentiles (p = 0.002). CONCLUSIONS Nutrition consultations in the year preceding posterior instrumented spinal fusion do not lead to weight optimization prior to surgery in comparison to patients without nutrition consults. Gastrostomy tubes were found to be helpful for weight optimization and should be considered as an alternative nutrition option in pre-operative planning in underweight patients. LEVEL OF EVIDENCE III-therapeutic study: retrospective comparative study.
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Affiliation(s)
| | - Matthew R Landrum
- Department of Orthopedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - David A Spiegel
- Department of Orthopedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Patrick J Cahill
- Department of Orthopedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jason B Anari
- Department of Orthopedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Keith D Baldwin
- Department of Orthopedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Jennings EQ, Ray JD, Zerio CJ, Trujillo MN, McDonald DM, Chapman E, Spiegel DA, Galligan JJ. Sirtuin 2 Regulates Protein LactoylLys Modifications. Chembiochem 2021; 22:2102-2106. [PMID: 33725370 PMCID: PMC8205944 DOI: 10.1002/cbic.202000883] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/11/2021] [Indexed: 12/19/2022]
Abstract
Post-translational modifications (PTMs) play roles in both physiological and pathophysiological processes through the regulation of enzyme structure and function. We recently identified a novel PTM, lactoylLys, derived through a nonenzymatic mechanism from the glycolytic by-product, lactoylglutathione. Under physiologic scenarios, glyoxalase 2 prevents the accumulation of lactoylglutathione and thus lactoylLys modifications. What dictates the site-specificity and abundance of lactoylLys PTMs, however, remains unknown. Here, we report sirtuin 2 as a lactoylLys eraser. Using chemical biology and CRISPR-Cas9, we show that SIRT2 controls the abundance of this PTM both globally and on chromatin. These results address a major gap in our understanding of how nonenzymatic PTMs are regulated and controlled.
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Affiliation(s)
- Erin Q Jennings
- Department of Pharmacology and Toxicology College of Pharmacy, University of Arizona, Tucson, AZ, 85721, USA
| | - Jason D Ray
- Department of Chemistry, Yale University, New Haven, CT, 06520, USA
| | - Christopher J Zerio
- Department of Pharmacology and Toxicology College of Pharmacy, University of Arizona, Tucson, AZ, 85721, USA
| | - Marissa N Trujillo
- Department of Pharmacology and Toxicology College of Pharmacy, University of Arizona, Tucson, AZ, 85721, USA
| | - David M McDonald
- Department of Chemistry, Yale University, New Haven, CT, 06520, USA
| | - Eli Chapman
- Department of Pharmacology and Toxicology College of Pharmacy, University of Arizona, Tucson, AZ, 85721, USA
| | - David A Spiegel
- Department of Chemistry, Yale University, New Haven, CT, 06520, USA
| | - James J Galligan
- Department of Pharmacology and Toxicology College of Pharmacy, University of Arizona, Tucson, AZ, 85721, USA
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Rock CA, Keeney S, Zakharchenko A, Takano H, Spiegel DA, Krieger AM, Ferrari G, Levy RJ. Model studies of advanced glycation end product modification of heterograft biomaterials: The effects of in vitro glucose, glyoxal, and serum albumin on collagen structure and mechanical properties. Acta Biomater 2021; 123:275-285. [PMID: 33444798 DOI: 10.1016/j.actbio.2020.12.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 12/17/2020] [Accepted: 12/22/2020] [Indexed: 01/01/2023]
Abstract
Glutaraldehyde cross-linked heterograft tissues, bovine pericardium (BP) or porcine aortic valves, are the leaflet materials in bioprosthetic heart valves (BHV) used in cardiac surgery for heart valve disease. BHV fail due to structural valve degeneration (SVD), often with calcification. Advanced glycation end products (AGE) are post-translational, non-enzymatic reaction products from sugars reducing proteins. AGE are present in SVD-BHV clinical explants and are not detectable in un-implanted BHV. Prior studies modeled BP-AGE formation in vitro with glyoxal, a glucose breakdown product, and serum albumin. However, glucose is the most abundant AGE precursor. Thus, the present studies investigated the hypothesis that BHV susceptibility to glucose related AGE, together with serum proteins, results in deterioration of collagen structure and mechanical properties. In vitro experiments studied AGE formation in BP and porcine collagen sponges (CS) comparing 14C-glucose and 14C-glyoxal with and without bovine serum albumin (BSA). Glucose incorporation occurred at a significantly lower level than glyoxal (p<0.02). BSA co-incubations demonstrated reduced glyoxal and glucose uptake by both BP and CS. BSA incubation caused a significant increase in BP mass, enhanced by glyoxal co-incubation. Two-photon microscopy of BP showed BSA induced disruption of collagen structure that was more severe with glucose or glyoxal co-incubation. Uniaxial testing of CS demonstrated that glucose or glyoxal together with BSA compared to controls, caused accelerated deterioration of viscoelastic relaxation, and increased stiffness over a 28-day time course. In conclusion, glucose, glyoxal and BSA uniquely contribute to AGE-mediated disruption of heterograft collagen structure and deterioration of mechanical properties.
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Affiliation(s)
- Christopher A Rock
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States
| | - Samuel Keeney
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States
| | - Andrey Zakharchenko
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States
| | - Hajime Takano
- Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States
| | - David A Spiegel
- Department of Chemistry, Yale University, New Haven, CT, 06520, United States
| | - Abba M Krieger
- Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia, PA, 19104, United States
| | - Giovanni Ferrari
- Departments of Surgery and Biomedical Engineering, Columbia University, New York, NY, 10032, United States
| | - Robert J Levy
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States.
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Streeter MD, Rowan S, Ray J, McDonald DM, Volkin J, Clark J, Taylor A, Spiegel DA. Generation and Characterization of Anti-Glucosepane Antibodies Enabling Direct Detection of Glucosepane in Retinal Tissue. ACS Chem Biol 2020; 15:2655-2661. [PMID: 32975399 PMCID: PMC10625846 DOI: 10.1021/acschembio.0c00093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Although there is ample evidence that the advanced glycation end-product (AGE) glucosepane contributes to age-related morbidities and diabetic complications, the impact of glucosepane modifications on proteins has not been extensively explored due to the lack of sufficient analytical tools. Here, we report the development of the first polyclonal anti-glucosepane antibodies using a synthetic immunogen that contains the core bicyclic ring structure of glucosepane. We investigate the recognition properties of these antibodies through ELISAs involving an array of synthetic AGE derivatives and determine them to be both high-affinity and selective in binding glucosepane. We then employ these antibodies to image glucosepane in aging mouse retinae via immunohistochemistry. Our studies demonstrate for the first time accumulation of glucosepane within the retinal pigment epithelium, Bruch's membrane, and choroid: all regions of the eye impacted by age-related macular degeneration. Co-localization studies further suggest that glucosepane colocalizes with lipofuscin, which has previously been associated with lysosomal dysfunction and has been implicated in the development of age-related macular degeneration, among other diseases. We believe that the anti-glucosepane antibodies described in this study will prove highly useful for examining the role of glycation in human health and disease.
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Affiliation(s)
- Matthew D Streeter
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, Connecticut 06511, United States
| | - Sheldon Rowan
- Tufts University, JM-USDA Human Nutrition Research Center on Aging, 711 Washington Street, Boston, Massachusetts 02111, United States
| | - Jason Ray
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, Connecticut 06511, United States
| | - David M McDonald
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, Connecticut 06511, United States
| | - Jonathan Volkin
- Tufts University, JM-USDA Human Nutrition Research Center on Aging, 711 Washington Street, Boston, Massachusetts 02111, United States
| | - Jonathan Clark
- Biological Chemistry Laboratory, Babraham Institute, Cambridge CB21 3AT, United Kingdom
| | - Allen Taylor
- Tufts University, JM-USDA Human Nutrition Research Center on Aging, 711 Washington Street, Boston, Massachusetts 02111, United States
| | - David A Spiegel
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, Connecticut 06511, United States
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Swarup I, Hughes MS, Cazzulino A, Spiegel DA, Shah AS. Open Reduction and Suture Fixation of Acute Sternoclavicular Fracture-Dislocations in Children. JBJS Essent Surg Tech 2020; 10:ST-D-19-00074. [PMID: 34055467 DOI: 10.2106/jbjs.st.19.00074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Acute sternoclavicular fracture-dislocation is associated with high-energy trauma and is being increasingly recognized in children1. These injuries are associated with compression of mediastinal structures and can be life-threatening1. The management of acute sternoclavicular fracture-dislocation includes closed reduction or open surgical stabilization; however, limited success is reported with closed reduction2,3. To our knowledge, there are no detailed descriptions of open reduction and suture fixation of acute sternoclavicular fracture-dislocation in children. Description Following diagnosis of acute sternoclavicular fracture-dislocation, the timing of surgical treatment is determined according to several patient and surgical factors. Among patients with hemodynamic instability, respiratory compromise, or evidence of asymmetric perfusion, surgical treatment is needed on an emergency basis. In the absence of these factors, surgical treatment can be performed on an urgent basis. It is important to communicate with vascular or thoracic surgeons prior to proceeding to the operating room because of the rare case in which advanced surgical access or vascular repair is required. In the operating room, general anesthesia and large-bore intravenous access are required. Patients are positioned supine on a radiolucent table, and a small bump is placed between the scapulae to elevate the medial aspect of the clavicle. The contralateral sternoclavicular joint and medial aspect of the clavicle should be prepared into the sterile field, as well as both sides of the groin in case vascular access is needed. A 6 to 8-cm incision is centered on the medial aspect of the clavicle, extending to the manubrium. Standard dissection to the clavicle is performed, and care is taken to maintain the integrity of the sternoclavicular ligament complex. Circumferential dissection of the medial clavicular metaphysis is usually required in order to mobilize the dislocated fragment. Reduction of the physeal fracture usually requires axial traction and extension of the ipsilateral shoulder with the aid of a reduction clamp on the medial clavicular metaphysis. In some cases, a Freer elevator can be placed between the metaphysis and epiphysis to shoehorn the clavicle from posterior to anterior. Once reduced, the fracture-dislocation is usually stable; however, the reduction is augmented with suture fixation. The sternoclavicular joint capsule should be repaired if disrupted, and the incision should be closed in layers. Postoperatively, the arm is placed in a sling, and range of motion is commenced at 4 weeks. Alternatives Alternative management of acute sternoclavicular fracture-dislocation includes closed reduction, plate fixation4, and ligament reconstruction5. Rationale In our experience, closed reduction is often unsuccessful, which is consistent with the experiences reported by other authors2,3. In addition, suture fixation is sufficient and plate fixation is not required because this injury is relatively stable following reduction. Lastly, ligament reconstruction with use of autograft or allograft may be indicated but is more relevant in chronic cases with injury or attenuation of the sternoclavicular ligament complex. Open reduction allows for direct visualization of the fracture reduction, and suture fixation allows for increased stability without the need for hardware or secondary surgical procedures. Expected Outcomes We expect patients to achieve full range of motion and strength without any joint instability as reported by Waters et al.3. Important Tips There is an inherent risk of vascular injury with open reduction and suture fixation. This risk is mitigated with perioperative planning and consultation with vascular or thoracic surgeons. General surgeons should always be available when these procedures are performed in case of vascular issues or emergencies.It is sometimes difficult to reduce the dislocation, but additional maneuvers allow for controlled reduction of the displaced clavicle, such as using a Freer elevator and serrated clamp.Assessing fracture reduction can be difficult intraoperatively. Including the contralateral sternoclavicular joint in the sterile surgical field can be helpful in assessing fracture reduction and osseous contour.
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Affiliation(s)
- Ishaan Swarup
- UCSF Benioff Children's Hospital, San Francisco, California
| | | | | | - David A Spiegel
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Apurva S Shah
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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13
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Frasca A, Xue Y, Kossar AP, Keeney S, Rock C, Zakharchenko A, Streeter M, Gorman RC, Grau JB, George I, Bavaria JE, Krieger A, Spiegel DA, Levy RJ, Ferrari G. Glycation and Serum Albumin Infiltration Contribute to the Structural Degeneration of Bioprosthetic Heart Valves. JACC Basic Transl Sci 2020; 5:755-766. [PMID: 32875167 PMCID: PMC7452200 DOI: 10.1016/j.jacbts.2020.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 12/31/2022]
Abstract
Two novel and interacting mechanisms contributing to BHV SVD are reported: glycation and serum albumin infiltration. Glycation product formation and serum albumin deposition were observed in 45 clinical BHV explanted due to SVD as well as BHV tissue subcutaneously implanted in rats. In vitro exposure to glycation and serum albumin elicited collagen network misalignment similar to that seen in clinical and rat explant BHV tissue. Glycation was sufficient to impair BHV hydrodynamic function in ISO-5840-compliant pulse duplication testing and concomitant serum albumin infiltration exacerbated these effects.
Valvular heart diseases are associated with significant cardiovascular morbidity and mortality, and often require surgical and/or percutaneous repair or replacement. Valve replacement is limited to mechanical and biological prostheses, the latter of which circumvent the need for lifelong anticoagulation but are subject to structural valve degeneration (SVD) and failure. Although calcification is heavily studied, noncalcific SVD, which represent roughly 30% of BHV failures, is relatively underinvestigated. This original work establishes 2 novel and interacting mechanisms—glycation and serum albumin incorporation—that occur in clinical valves and are sufficient to induce hallmarks of structural degeneration as well as functional deterioration.
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Key Words
- AGE, advanced glycation end product
- BHV, bioprosthetic heart valve
- BP, bovine pericardium
- CML, N-carboxymethyl-lysine
- EOA, effective orifice area
- HSA, human serum albumin
- IHC, immunohistochemistry
- PBS, phosphate-buffered saline
- SAVR, surgical aortic valve replacement
- SHG, second harmonic generation
- SVD, structural valve degeneration
- TAVR, transcatheter aortic valve replacement
- advanced glycation end products
- aortic valve disease
- biomaterial
- bioprosthetic heart valve
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Affiliation(s)
- Antonio Frasca
- Department of Surgery, Columbia University, New York, New York
| | - Yingfei Xue
- Department of Surgery, Columbia University, New York, New York
| | | | - Samuel Keeney
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christopher Rock
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Andrey Zakharchenko
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Matthew Streeter
- Department of Chemistry, Yale University, New Haven, Connecticut
| | - Robert C Gorman
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Juan B Grau
- Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Isaac George
- Department of Surgery, Columbia University, New York, New York
| | - Joseph E Bavaria
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Abba Krieger
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David A Spiegel
- Department of Chemistry, Yale University, New Haven, Connecticut
| | - Robert J Levy
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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14
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Stammers M, Ivanova IM, Niewczas IS, Segonds-Pichon A, Streeter M, Spiegel DA, Clark J. Age-related changes in the physical properties, cross-linking, and glycation of collagen from mouse tail tendon. J Biol Chem 2020; 295:10562-10571. [PMID: 32381510 PMCID: PMC7397091 DOI: 10.1074/jbc.ra119.011031] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 05/04/2020] [Indexed: 12/18/2022] Open
Abstract
Collagen is a structural protein whose internal cross-linking critically determines the properties and functions of connective tissue. Knowing how the cross-linking of collagen changes with age is key to understanding why the mechanical properties of tissues change over a lifetime. The current scientific consensus is that collagen cross-linking increases with age and that this increase leads to tendon stiffening. Here, we show that this view should be reconsidered. Using MS-based analyses, we demonstrated that during aging of healthy C57BL/6 mice, the overall levels of collagen cross-linking in tail tendon decreased with age. However, the levels of lysine glycation in collagen, which is not considered a cross-link, increased dramatically with age. We found that in 16-week-old diabetic db/db mice, glycation reaches levels similar to those observed in 98-week-old C57BL/6 mice, while the other cross-links typical of tendon collagen either decreased or remained the same as those observed in 20-week-old WT mice. These results, combined with findings from mechanical testing of tendons from these mice, indicate that overall collagen cross-linking in mouse tendon decreases with age. Our findings also reveal that lysine glycation appears to be an important factor that contributes to tendon stiffening with age and in diabetes.
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Affiliation(s)
| | - Irina M Ivanova
- Babraham Institute, Cambridge, United Kingdom.,John Innes Centre, Norwich, United Kingdom
| | | | | | - Matthew Streeter
- Department of Chemistry, Yale University, New Haven, Connecticut, USA
| | - David A Spiegel
- Department of Chemistry, Yale University, New Haven, Connecticut, USA
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15
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Abstract
Understanding the mechanisms of bacterial cell wall synthesis is essential for microbiology and medicine alike. A key step in this process is peptidoglycan crosslinking, which confers mechanical strength to the cell wall and represents a target for numerous classes of antibiotics. However, the biology of crosslinking remains poorly understood due to a lack of tools for studying the reaction in vivo. Recently, we developed a class of synthetic probes called fluorescent stem peptide mimics (FSPMs) that meet this need, allowing quantification and localization of crosslinking activity in live bacteria. We have utilized FSPMs to describe novel aspects of peptidoglycan synthesis in the human pathogen, Staphylococcus aureus. To enable wider use of our methodology, we provide detailed protocols herein for the synthesis of FSPMs, labeling of live bacteria, and evaluation of crosslinking by flow cytometry and super-resolution microscopy. We believe that FSPMs, together with complementary biosynthetic probes and traditional bacteriologic methods, will help to advance our understanding of peptidoglycan biology and accelerate the search for new antibiotics.
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Affiliation(s)
- Samir Gautam
- Yale University School of Medicine, Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, New Haven, CT, United States; Yale University, Department of Chemistry, New Haven, CT, United States
| | - Taehan Kim
- Yale University, Department of Chemistry, New Haven, CT, United States
| | - Rebecca Howell
- Yale University, Department of Chemistry, New Haven, CT, United States
| | - David A Spiegel
- Yale University, Department of Chemistry, New Haven, CT, United States.
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16
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Rowan S, Jiang S, Chang ML, Volkin J, Cassalman C, Smith KM, Streeter MD, Spiegel DA, Moreira-Neto C, Rabbani N, Thornalley PJ, Smith DE, Waheed NK, Taylor A. A low glycemic diet protects disease-prone Nrf2-deficient mice against age-related macular degeneration. Free Radic Biol Med 2020; 150:75-86. [PMID: 32068111 PMCID: PMC7747150 DOI: 10.1016/j.freeradbiomed.2020.02.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/30/2020] [Accepted: 02/12/2020] [Indexed: 12/16/2022]
Abstract
Age-related macular degeneration (AMD) is a major blinding disease, affecting over 14% of the elderly. Risk for AMD is related to age, diet, environment, and genetics. Dietary modulation of AMD risk is a promising treatment modality, but requires appropriate animal models to demonstrate advantages of diet. Mice lacking the antioxidant transcription factor Nrf2 (Nfe2l2) develop age-related retinopathy relevant to human AMD. Here we evaluated the effect of consuming high glycemic (HG) or low glycemic (LG) diets until 18-months of age on development of features relevant to AMD in Nrf2-null mice. Nrf2-null mice that consumed HG diets developed atrophic AMD, characterized by photoreceptor degeneration, retinal pigment epithelium (RPE) atrophy and pigmentary abnormalities, basal laminar deposits, and loss of the choriocapillaris. In contrast, Nrf2-null-mice that consumed LG diets did not develop retinal disease phenotypes. Consumption of HG diets was associated with accumulation of advanced glycation end-products in the RPE and systemically, whereas consumption of the LG diet was associated with increased levels of anti-glycative and anti-oxidative detoxification machinery. Together our data indicate that the Nrf2-null HG mouse is a good model for atrophic AMD studies and that the LG diet can activate protective pathways to prevent AMD, even in a genetically predisposed animal.
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Affiliation(s)
- Sheldon Rowan
- Laboratory for Nutrition and Vision Research, JM-USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, 02111, USA; Friedman School of Nutrition and Science Policy, Tufts University, Boston, MA, 02111, USA; Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, 02111, USA.
| | - Shuhong Jiang
- Laboratory for Nutrition and Vision Research, JM-USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, 02111, USA; Inner Mongolia Autonomous Region People's Hospital, Hohhot, Inner Mongolia, 010017, China
| | - Min-Lee Chang
- Laboratory for Nutrition and Vision Research, JM-USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, 02111, USA
| | - Jonathan Volkin
- Laboratory for Nutrition and Vision Research, JM-USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, 02111, USA
| | - Christa Cassalman
- Department of Pathology and Laboratory Medicine, Tufts University School of Medicine, Boston, MA, 02111, USA
| | - Kelsey M Smith
- Laboratory for Nutrition and Vision Research, JM-USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, 02111, USA; Friedman School of Nutrition and Science Policy, Tufts University, Boston, MA, 02111, USA
| | | | - David A Spiegel
- Department of Chemistry, Yale University, New Haven, CT, 06520, USA
| | - Carlos Moreira-Neto
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, 02111, USA
| | - Naila Rabbani
- Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, University Hospital, Coventry, CV2 2DX, UK; Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Paul J Thornalley
- Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, University Hospital, Coventry, CV2 2DX, UK; Diabetes Research Center, Qatar Biomedical Research Institute, Hamad Bin Khalifa University, Qatar Foundation, P.O. Box 34110, Doha, Qatar
| | - Donald E Smith
- Laboratory for Nutrition and Vision Research, JM-USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, 02111, USA
| | - Nadia K Waheed
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, 02111, USA
| | - Allen Taylor
- Laboratory for Nutrition and Vision Research, JM-USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, 02111, USA; Friedman School of Nutrition and Science Policy, Tufts University, Boston, MA, 02111, USA; Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, 02111, USA.
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17
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GALLIGAN JAMES, Gaffney DO, Jennings EQ, Anderson CC, Marentette JO, Shi T, Oxvig AMS, Streeter MD, Johannsen M, Spiegel DA, Chapman E, Roede JR. Non‐Enzymatic Lysine Lactoylation of Glycolytic Enzymes. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.02010] [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]
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18
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Sabbasani VR, Wang K, Streeter MD, Spiegel DA. One‐Step Synthesis of 2,5‐Diaminoimidazoles and Total Synthesis of Methylglyoxal‐Derived Imidazolium Crosslink (MODIC). Angew Chem Int Ed Engl 2019. [DOI: 10.1002/ange.201911156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Venkata R. Sabbasani
- Department of Chemistry Yale University 225 Prospect Street New Haven CT 06511 USA
| | - Kung‐Pern Wang
- Department of Chemistry Yale University 225 Prospect Street New Haven CT 06511 USA
| | - Matthew D. Streeter
- Department of Chemistry Yale University 225 Prospect Street New Haven CT 06511 USA
| | - David A. Spiegel
- Department of Chemistry Yale University 225 Prospect Street New Haven CT 06511 USA
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19
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Sabbasani VR, Wang K, Streeter MD, Spiegel DA. One-Step Synthesis of 2,5-Diaminoimidazoles and Total Synthesis of Methylglyoxal-Derived Imidazolium Crosslink (MODIC). Angew Chem Int Ed Engl 2019; 58:18913-18917. [PMID: 31713976 PMCID: PMC6973230 DOI: 10.1002/anie.201911156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Indexed: 01/28/2023]
Abstract
Here we describe a general method for the synthesis of 2,5-diaminoimidazoles, which involves a thermal reaction between α-aminoketones and substituted guanylhydrazines without the need for additives. As one of the few known ways to access the 2,5-diaminoimidazole motif, our method greatly expands the number of reported diaminoimidazoles and further supports our previous observations that these compounds spontaneously adopt the non-aromatic 4(H) tautomer. The reaction works successfully on both cyclic and acyclic amino ketone starting materials, as well as a range of substituted guanylhydrazines. Following optimization, the method was applied to the efficient synthesis of the advanced glycation end product (AGE) methylglyoxal-derived imidazolium crosslink (MODIC). We expect that this method will enable rapid access to a variety of biologically important 2,5-diaminoimidazole-containing products.
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Affiliation(s)
| | - Kung‐Pern Wang
- Department of ChemistryYale University225 Prospect StreetNew HavenCT06511USA
| | - Matthew D. Streeter
- Department of ChemistryYale University225 Prospect StreetNew HavenCT06511USA
| | - David A. Spiegel
- Department of ChemistryYale University225 Prospect StreetNew HavenCT06511USA
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20
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De Coen R, Nuhn L, Perera C, Arista-Romero M, Risseeuw MDP, Freyn A, Nachbagauer R, Albertazzi L, Van Calenbergh S, Spiegel DA, Peterson BR, De Geest BG. Synthetic Rhamnose Glycopolymer Cell-Surface Receptor for Endogenous Antibody Recruitment. Biomacromolecules 2019; 21:793-802. [DOI: 10.1021/acs.biomac.9b01483] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Ruben De Coen
- Department of Pharmaceutics, Ghent University, 9000 Ghent, Belgium
| | - Lutz Nuhn
- Max Planck Institute for Polymer Research, 55128 Mainz, Germany
| | - Chamani Perera
- Higuchi Biosciences Center, University of Kansas, Lawrence, Kansas 66047, United States
| | - Maria Arista-Romero
- Nanoscopy for Nanomedicine Group, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), 08028 Barcelona, Spain
- Department of Biomedical Engineering, Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, 5612AZ Eindhoven, The Netherlands
| | | | - Alec Freyn
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York 10029, United States
| | - Raffael Nachbagauer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Lorenzo Albertazzi
- Nanoscopy for Nanomedicine Group, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), 08028 Barcelona, Spain
- Department of Biomedical Engineering, Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, 5612AZ Eindhoven, The Netherlands
| | | | - David A. Spiegel
- Department of Chemistry, Yale University, New Haven, Connecticut 06511, United States
| | - Blake R. Peterson
- Division of Medicinal Chemistry and Pharmacognosy, The Ohio State University, Columbus, Ohio 43210, United States
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21
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LeBrun DG, Del Rosario J, Kelly JD, Wren SM, Spiegel DA, Mkandawire N, Gosselin RA, Kushner AL. An Estimation of the Burden of Sports Injuries among African Adolescents. J Epidemiol Glob Health 2019; 8:171-175. [PMID: 30864759 PMCID: PMC7377560 DOI: 10.2991/j.jegh.2017.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 10/25/2017] [Indexed: 11/06/2022] Open
Abstract
The extent to which sports injuries contribute to the burden of injury among adolescents in low- and middle-income countries (LMICs) is unknown. The goal of this study was to estimate the incidence of sports injuries among adolescents in Africa. Data from the World Health Organization Global School-Based Student Health surveys were used to estimate the annual number of African adolescents sustaining sports injuries. Gender-stratified injury rates were calculated and applied to every African country’s adolescent population to estimate country-specific and continent-wide injury totals. A total of 21,858 males and 24,691 females from 14 countries were included in the analysis. Country-specific annual sports injury rates ranged from 13.5% to 38.1% in males and 5.2% to 20.2% in females. Weighted average sports injury rates for males and females were 23.7% (95% CI 23.1%–24.2%) and 12.5% (95% CI 12.1%–12.9%), respectively. When these rates were extrapolated to the adolescent populations of the African continent, an estimated 15,477,798 (95% CI 15,085,955–15,804,333) males and 7,943,625 (95% CI 7,689,429–8,197,821) females sustained sports injuries. Our findings suggest that over 23 million African adolescents sustained sports injuries annually. Further work will help to more precisely define the burden of sports injuries in LMICs and the role that surgery can play in mitigating this burden.
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Affiliation(s)
- Drake G LeBrun
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.,Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd., Jordan Medical Education Center, Philadelphia, PA 19104, USA
| | - Julius Del Rosario
- School of Engineering and Applied Science, University of Pennsylvania, 220 South 33rd Street, 107 Towne Building, Philadelphia, PA 19104, USA
| | - John D Kelly
- Division of Sports Medicine, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 235 S 33rd St, Philadelphia, PA 19104, USA
| | - Sherry M Wren
- Department of Surgery, Stanford University, School of Medicine, 300 Pasteur Dr, Stanford, CA 94305, USA
| | - David A Spiegel
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA
| | - Nyengo Mkandawire
- Department of Orthopaedic Surgery, University of Malawi, College of Medicine, P/B 360, Chichiri, Blantyre 3, Malawi.,Flinders University School of Medicine, Sturt Rd, Bedford Park, South Australia 5042, Australia
| | - Richard A Gosselin
- Institute of Global Orthopaedics and Traumatology, Department of Orthopaedic Surgery, University of California San Francisco, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA 94110, USA
| | - Adam L Kushner
- Department of Surgery, Columbia University College of Physicians and Surgeons, 177 Fort Washington Ave., New York, NY 10032, USA.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.,Surgeons OverSeas, 99 Avenue B, Suite 5E, New York, NY 10009, USA
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22
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Kolman SE, Ohara SY, Bhatia A, Feygin T, Colo D, Baldwin KD, Mcdonald-Mcginn D, Spiegel DA. The Clinical Utility of Flexion-extension Cervical Spine MRI in 22q11.2 Deletion Syndrome. J Pediatr Orthop 2019; 39:e674-e679. [PMID: 31503223 DOI: 10.1097/bpo.0000000000000994] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Our goal is to correlate the findings on flexion and extension radiographs with dynamic magnetic resonance imaging (MRI), and the clinical history, in a nonrandomly selected cohort of patients with 22q11.2 deletion syndrome (22q). METHODS All patients with the 22q who had a dynamic MRI from January 2004 to March 2015 were included. We analyzed multiple radiographic measurements on both the dynamic plain films and the MRIs, and correlated these findings with a review of each patient's medical record. RESULTS Multiple congenital anomalies were identified as noted in previous studies, and 61% of the patients had a failure of fusion of the anterior (n=2, 9%), posterior (n=2, 9%), or anterior and posterior arches (n=10, 43%). Quantitative measurements were impossible to report with certainty because of the upper cervical anomalies, and no cases of instability were identified using a qualitative assessment. We identified spinal cord encroachment (30%) and impingement (18%); however, none of the patients had any signal change in their spinal cord. None of these findings could be definitively correlated with any clinical symptoms. A single patient was diagnosed with a Chiari I malformation, while another had cerebellar ectopia. CONCLUSIONS Although the upper cervical anomalies are extremely common in 22q, we did not identify cases of instability on dynamic plain radiographs and MRI. Although our findings do not support routine screening with flexion and extension MRI, this study may be required in patients with neurological symptoms and/or findings or abnormalities on dynamic plain radiographs. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | | | - Aashim Bhatia
- Monroe Carell Jr. Children's Hospital, Nashville, TN
| | - Tamara Feygin
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Dino Colo
- University Medical Center Utrecht, Utrecht, The Netherlands
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23
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DeFrancesco CJ, Miller DJ, Cahill PJ, Spiegel DA, Flynn JM, Baldwin KD. Releasing the tether: Weight normalization following corrective spinal fusion in cerebral palsy. J Orthop Surg (Hong Kong) 2019; 26:2309499018782556. [PMID: 29938586 DOI: 10.1177/2309499018782556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Feeding difficulties are common among patients with cerebral palsy (CP) and neuromuscular (NM) scoliosis. We theorize that posterior spinal fusion (PSF) reduces intra-abdominal pressure, resulting in improved feeding and subsequent weight gain. We hypothesized that, among nonambulatory patients with CP and NM scoliosis, we would observe significant gain in weight following PSF. METHODS Fifty subjects with nonambulatory CP who underwent PSF for NM scoliosis were included. Age and weight were recorded for the preoperative year; on the day of surgery; and at 6-month, 1-year, and 2-year follow-up. Weights were converted to weight percentiles using CP-specific growth charts. The weight percentile distributions were compared between time points using descriptive statistics as well as regression analysis. RESULTS The average change in weight from the day of surgery to 2-year follow-up was +3.4 percentiles. Patients who started out under the 50th percentile gained an average of 17.3 percentiles in the first year after PSF ( p = 0.009). Regression analysis showed that patients with baseline weight <50th percentile tended to gain in weight percentile over the first postoperative year ( β = 1.990, p = 0.001). No trend was present among this group prior to surgery ( p = 0.692) or during the second postoperative year ( p = 0.945). No trends were noted prior to or after surgery for patients with baseline weights ≥50th percentile. No significant association was observed between curve severity (measured by preoperative Cobb angle) and weight change. CONCLUSIONS This series is the first to document significant weight gain after PSF for NM scoliosis, supporting the theory that spinal correction improves digestive function. LEVEL OF EVIDENCE Prognostic level II.
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Affiliation(s)
| | - Daniel J Miller
- 1 Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Patrick J Cahill
- 1 Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - David A Spiegel
- 1 Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - John M Flynn
- 1 Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Keith D Baldwin
- 1 Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Kim NY, Goddard TN, Sohn S, Spiegel DA, Crawford JM. Biocatalytic Reversal of Advanced Glycation End Product Modification. Chembiochem 2019; 20:2402-2410. [PMID: 31013547 DOI: 10.1002/cbic.201900158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Indexed: 01/01/2023]
Abstract
Advanced glycation end products (AGEs) are a heterogeneous group of molecules that emerge from the condensation of sugars and proteins through the Maillard reaction. Despite a significant number of studies showing strong associations between AGEs and the pathologies of aging-related illnesses, it has been a challenge to establish AGEs as causal agents primarily due to the lack of tools in reversing AGE modifications at the molecular level. Herein, we show that MnmC, an enzyme involved in a bacterial tRNA-modification pathway, is capable of reversing the AGEs carboxyethyl-lysine (CEL) and carboxymethyl-lysine (CML) back to their native lysine structure. Combining structural homology analysis, site-directed mutagenesis, and protein domain dissection studies, we generated a variant of MnmC with improved catalytic properties against CEL in its free amino acid form. We show that this enzyme variant is also active on a CEL-modified peptidomimetic and an AGE-containing peptide that has been established as an authentic ligand of the receptor for AGEs (RAGE). Our data demonstrate that MnmC variants are promising lead catalysts toward the development of AGE-reversal tools and a better understanding of AGE biology.
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Affiliation(s)
- Nam Y Kim
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, CT, 06511, USA.,Chemical Biology Institute, Yale University, 600 West Campus Drive, West Haven, CT, 06516, USA
| | - Tyler N Goddard
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, CT, 06511, USA.,Chemical Biology Institute, Yale University, 600 West Campus Drive, West Haven, CT, 06516, USA
| | - Seungjung Sohn
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, CT, 06511, USA
| | - David A Spiegel
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, CT, 06511, USA.,Department of Pharmacology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Jason M Crawford
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, CT, 06511, USA.,Chemical Biology Institute, Yale University, 600 West Campus Drive, West Haven, CT, 06516, USA.,Department of Microbial Pathogenesis, Yale School of Medicine, 295 Congress Avenue, New Haven, CT, 06536, USA
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25
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Mistovich RJ, Jacobs LJ, Campbell RM, Spiegel DA, Flynn JM, Baldwin KD. Infection Control in Pediatric Spinal Deformity Surgery: A Systematic and Critical Analysis Review. JBJS Rev 2019; 5:e3. [PMID: 28514262 DOI: 10.2106/jbjs.rvw.16.00071] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- R Justin Mistovich
- Division of Pediatric Orthopaedic Surgery, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Lloydine J Jacobs
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Robert M Campbell
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David A Spiegel
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - John M Flynn
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Keith D Baldwin
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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26
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Banskota B, Yadav P, Rajbhandari T, Shrestha OP, Talwar D, Banskota A, Spiegel DA. Outcomes of the Ponseti Method for Untreated Clubfeet in Nepalese Patients Seen Between the Ages of One and Five Years and Followed for at Least 10 Years. J Bone Joint Surg Am 2018; 100:2004-2014. [PMID: 30516623 DOI: 10.2106/jbjs.18.00445] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND To our knowledge, there are no reports of the Ponseti method initiated after walking age and with >10 years of follow-up. Our goal was to report the clinical findings and patient-reported outcomes for children with a previously untreated idiopathic clubfoot who were seen when they were between 1 and 5 years old, were treated with the Ponseti method, and had a minimum follow-up of 10 years. METHODS A retrospective review of medical records was supplemented by a follow-up evaluation of physical findings (alignment and range of motion) and patient-reported outcomes using the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C). The initial treatment was graded as successful if a plantigrade foot was achieved without the need for an extensive soft-tissue release and/or osseous procedure. RESULTS We located 145 (91%) of 159 patients (220 clubfeet). The average age at treatment was 3 years (range, 1 to 5 years), and the average duration of follow-up was 11 years (range, 10 to 12 years). The initial scores according to the systems of Pirani et al. and Diméglio et al. averaged 5 and 17, respectively, and an average of 8 casts were required. Surgical treatment, most commonly a percutaneous Achilles tendon release (197 feet; 90%), was required in 96% of the feet. A plantigrade foot was achieved in 95% of the feet. Complete relapse was rare (3%), although residual deformities were common. Patient-reported outcomes were favorable. CONCLUSIONS A plantigrade foot was achieved in 95% of the feet initially and was maintained in most of the patients, although residual deformities were common. Patient-reported outcomes were satisfactory, and longer-term follow-up with age-appropriate outcome measures will be required to evaluate function in adulthood. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Bibek Banskota
- Hospital and Rehabilitation Center for Disabled Children, Banepa, Nepal
| | - Prakash Yadav
- Hospital and Rehabilitation Center for Disabled Children, Banepa, Nepal
| | - Tarun Rajbhandari
- Hospital and Rehabilitation Center for Disabled Children, Banepa, Nepal
| | - O P Shrestha
- Hospital and Rehabilitation Center for Disabled Children, Banepa, Nepal
| | - Divya Talwar
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ashok Banskota
- Hospital and Rehabilitation Center for Disabled Children, Banepa, Nepal
| | - David A Spiegel
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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27
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Anari JB, Cahill PJ, Flynn JM, Spiegel DA, Baldwin KD. Intra-operative computed tomography guided navigation for pediatric pelvic instrumentation: A technique guide. World J Orthop 2018; 9:185-189. [PMID: 30364843 PMCID: PMC6198293 DOI: 10.5312/wjo.v9.i10.185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/29/2018] [Accepted: 08/05/2018] [Indexed: 02/06/2023] Open
Abstract
Pelvic instrumentation for neuromuscular scoliosis has been part of neuromuscular scoliosis surgery since the era of the Luque Galveston construct. Unit Rod (Medtronic Sofamor-Danek, Nashville, TN) instrumentation brought with it the concept of cantilever correction by placing the implants in the pelvis and then gradually bringing the rod to the spine by sequentially tightening the sublaminar wires, with the goal of creating a level pelvis over a straight spine. More recently surgeons have utilized pedicle screw constructs in which the corrective strategies have varied. Challenges with pelvic fixation using iliac screws linked to the spinal rod have led to the development of the S2-alar-iliac technique (S2AI) in which the spinal rod connects to the pelvic screw. The screw is placed in the S2 ala, crosses the sacro-iliac joint and into the ilium through a large column of supra-acetabular bone. This column is the same area used for anterior inferior iliac spine external fixation frames used in trauma surgery. S2AI screw placement can be technically difficult and can require experienced radiology technologists to provide the appropriate views. Additionally, although the technique was originally described being placed via freehand technique with intra-operative flouroscopy, the freehand technique suffers from the anatomic anomalies present in the pelvis in neuromuscular scoliosis. As such, we prefer to place them using intra-operative navigation for all pediatric spinal deformity cases. Below in detail we report our intra-operative technique and an illustrative case example.
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Affiliation(s)
- Jason B Anari
- Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, United States
| | - Patrick J Cahill
- Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, United States
| | - John M Flynn
- Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, United States
| | - David A Spiegel
- Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, United States
| | - Keith D Baldwin
- Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, United States
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28
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Premkumar A, Ying X, Mack Hardaker W, Massawe HH, Mshahaba DJ, Mandari F, Pallangyo A, Temu R, Masenga G, Spiegel DA, Sheth NP. Access to Orthopaedic Surgical Care in Northern Tanzania: A Modelling Study. World J Surg 2018; 42:3081-3088. [DOI: 10.1007/s00268-018-4630-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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29
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Ashley B, Spiegel DA, Cahill P, Talwar D, Baldwin KD. Post-operative fever in orthopaedic surgery: How effective is the 'fever workup?'. J Orthop Surg (Hong Kong) 2018; 25:2309499017727953. [PMID: 28851265 DOI: 10.1177/2309499017727953] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Defining the appropriate threshold at which to initiate a fever workup is imperative to promote patient safety, appropriate resource utilization, and antibiotic stewardship. Our group performed a systematic review of the available literature on perioperative fever (POF) workups in orthopaedic patients to evaluate the frequency, timing and utility of blood cultures (BC) and other investigations in the POF workup, to determine the clinical relevance of any infections and to evaluate their cost effectiveness. METHODS Studies were identified by searching MEDLINE, EMBASE, Pubmed, Cochrane and Google Scholar for articles through September 2016. Forty-nine articles were retrieved and 22 articles met the pre-determined inclusion criteria. Proportions of positive studies were noted and averaged using random effects analysis. RESULTS Post-operative pyrexia ranged in prevalence between 8.1% and 87.3%. The studies routinely performed during a fever workup had wide ranges of diagnostic yield, including chest X-rays from 0% to 40%, urinalyses from 8.2% to 38.7%, urine cultures from 0% to 22.4% and BC from 0% to 13.3%. Only two patients with positive BC developed clinical sepsis. Cost per fever evaluation ranged from $350 to $950. CONCLUSION The findings of this review suggest that early post-operative fever is an expected event following orthopaedic surgery. Based on the available literature, any kind of workup in the absence of localizing symptoms in the third post-operative day or before is unwarranted and is an inappropriate use of hospital resources.
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Affiliation(s)
- Blair Ashley
- 1 Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - David A Spiegel
- 2 Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Patrick Cahill
- 2 Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Divya Talwar
- 2 Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Keith D Baldwin
- 2 Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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30
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Leung JC, Bedermann AA, Njardarson JT, Spiegel DA, Murphy GK, Hama N, Twenter BM, Dong P, Shirahata T, McDonald IM, Inoue M, Taniguchi N, McMahon TC, Schneider CM, Tao N, Stoltz BM, Wood JL. Total Synthesis of (±)-Phomoidride D. Angew Chem Int Ed Engl 2018. [DOI: 10.1002/ange.201712369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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)
- Joyce C. Leung
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Aaron A. Bedermann
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Jón T. Njardarson
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - David A. Spiegel
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Graham K. Murphy
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Naoto Hama
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Barry M. Twenter
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Ping Dong
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Tatsuya Shirahata
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Ivar M. McDonald
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Munenori Inoue
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Nobuaki Taniguchi
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Travis C. McMahon
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Christopher M. Schneider
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Nancy Tao
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Brian M. Stoltz
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - John L. Wood
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
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31
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Leung JC, Bedermann AA, Njardarson JT, Spiegel DA, Murphy GK, Hama N, Twenter BM, Dong P, Shirahata T, McDonald IM, Inoue M, Taniguchi N, McMahon TC, Schneider CM, Tao N, Stoltz BM, Wood JL. Total Synthesis of (±)-Phomoidride D. Angew Chem Int Ed Engl 2018; 57:1991-1994. [DOI: 10.1002/anie.201712369] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Joyce C. Leung
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Aaron A. Bedermann
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Jón T. Njardarson
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - David A. Spiegel
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Graham K. Murphy
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Naoto Hama
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Barry M. Twenter
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Ping Dong
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Tatsuya Shirahata
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Ivar M. McDonald
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Munenori Inoue
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Nobuaki Taniguchi
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Travis C. McMahon
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Christopher M. Schneider
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Nancy Tao
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - Brian M. Stoltz
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
| | - John L. Wood
- Department of Chemistry and Biochemistry; Baylor University; One Bear Place 97348 Waco TX 76798 USA
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32
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LeBrun DG, del Rosario J, Kelly JD, Wren SM, Spiegel DA, Mkandawire N, Gosselin RA, Kushner AL. An Estimation of the Burden of Sports Injuries among African Adolescents. J Epidemiol Glob Health 2018. [DOI: 10.1016/j.jegh.2017.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Drake G. LeBrun
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd., Jordan Medical Education Center, Philadelphia, PA 19104, USA
| | - Julius del Rosario
- School of Engineering and Applied Science, University of Pennsylvania, 220 South 33rd Street, 107 Towne Building, Philadelphia, PA 19104, USA
| | - John D. Kelly
- Division of Sports Medicine, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 235 S 33rd St, Philadelphia, PA 19104, USA
| | - Sherry M. Wren
- Department of Surgery, Stanford University, School of Medicine, 300 Pasteur Dr, Stanford, CA 94305, USA
| | - David A. Spiegel
- Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA
| | - Nyengo Mkandawire
- Department of Orthopaedic Surgery, University of Malawi, College of Medicine, P/B 360, Chichiri, Blantyre 3, Malawi
- Flinders University School of Medicine, Sturt Rd, Bedford Park, South Australia 5042, Australia
| | - Richard A. Gosselin
- Institute of Global Orthopaedics and Traumatology, Department of Orthopaedic Surgery, University of California San Francisco, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA 94110, USA
| | - Adam L. Kushner
- Department of Surgery, Columbia University College of Physicians and Surgeons, 177 Fort Washington Ave., New York, NY 10032, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
- Surgeons OverSeas, 99 Avenue B, Suite 5E, New York, NY 10009, USA
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Kolman SE, Glanzman AM, Prosser L, Spiegel DA, Baldwin KD. Factors that Predict Overall Health and Quality of Life in Non-Ambulatory Individuals with Cerebral Palsy. Iowa Orthop J 2018; 38:147-152. [PMID: 30104938 PMCID: PMC6047378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND It is unknown what role specific tasks associated with personal care, positioning, communication and social interaction, and comfort and emotions play in predicting the overall health and quality of life of individuals with non-ambulatory cerebral palsy (CP). In this study, we prospectively evaluated which of these factors were significant predictors of overall health and quality of life. METHODS Parents and guardians of non-ambulatory children, adolescents and young adults with CP were prospectively recruited from the Cerebral Palsy Clinic of a large pediatric academic hospital. Caregivers completed the CP Child Questionnaire®. Univariate analyses were used to identify relationships between overall health, overall quality of life (QOL), and responses in the following categories: personal care and activities of daily living, positioning and transfer mobility, comfort and emotions, and communication and social interaction. Significant predictors of overall health and QOL were then determined via logistic regression. RESULTS 64 patients ages 0-20 years and Gross Motor Function Classification System levels IV and V were included in our study (mean age 9.16 ±4.96 years). Overall QOL (OR 194.2, 95% CI, 9.5-3964.9) and comfort while sitting (OR 15.9, 95% CI, 1.2-205.3) were significant predictors of overall health. Feelings of unhappiness or sadness (OR 59.9, 95% CI, 1.6-2209.8), difficulty understanding the parent or guardian (OR 29.8, 95% CI, 1.6-543.7), and not attending school (OR 57.2, 95% CI, 2.6-1274.4) were significant predictors of lower overall quality of life. CONCLUSIONS Overall QOL appears to predict overall health. Factors associated with comfort and emotions and communication and social interaction appear to predict overall QOL to a greater extent than personal care and transfer mobility.Level of Evidence: Prognostic II.
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LeBrun DG, Talwar D, Pham TA, Banskota B, Spiegel DA. Predictors of healthcare seeking delays among children with chronic musculoskeletal disorders in Nepal. J Epidemiol Glob Health 2017; 7:299-304. [PMID: 29110873 PMCID: PMC7384576 DOI: 10.1016/j.jegh.2017.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 08/14/2017] [Accepted: 10/02/2017] [Indexed: 11/10/2022] Open
Abstract
Background: Healthcare seeking behaviors among children with musculoskeletal disorders are poorly understood. We sought to analyze healthcare seeking delays among children with chronic musculoskeletal conditions in Nepal and identify predictors of clinically significant delays. Methods: A cross-sectional study was conducted at a large pediatric musculoskeletal rehabilitation center in Nepal. Baseline sociodemographic data and healthcare seeking behaviors were assessed via interviews with 75 randomly selected caregivers. Delays of at least 3 months between disease recognition and presentation to a health worker were considered clinically significant. Predictors of significant delay were assessed via multivariable logistic regression. Results: Clubfoot was the most common condition seen in the study sample (N = 33; 37%). Mean and median presentation delays were 33 months and 14 months, respectively. Sixty-seven percent of children were delayed at least 3 months and 40% were delayed at least 2 years. Caregiver occupation in agriculture or unskilled labor was associated with an increased risk of delayed presentation (adjusted OR = 4.05; 95% CI: 1.36–12.09). Conclusions: Children with chronic musculoskeletal disorders in Nepal face significant delays in accessing healthcare. This poses a major clinical problem as the delayed diagnosis and treatment of childhood musculoskeletal disorders can complicate management options and decrease long-term quality of life.
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Affiliation(s)
- Drake G LeBrun
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Divya Talwar
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Tuyetnhi A Pham
- The Wharton School, University of Pennsylvania, Philadelphia, PA, USA.
| | - Bibek Banskota
- Department of Orthopaedics, Hospital and Rehabilitation Centre for Disabled Children, Banepa, Nepal.
| | - David A Spiegel
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Orthopaedics, Hospital and Rehabilitation Centre for Disabled Children, Banepa, Nepal.
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Chirkin E, Muthusamy V, Mann P, Roemer T, Nantermet PG, Spiegel DA. Neutralization of Pathogenic Fungi with Small-Molecule Immunotherapeutics. Angew Chem Int Ed Engl 2017. [DOI: 10.1002/ange.201707536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Egor Chirkin
- Department of Chemistry; Yale University; 225 Prospect Street New Haven CT 06511 USA
| | - Viswanathan Muthusamy
- Department of Chemistry; Yale University; 225 Prospect Street New Haven CT 06511 USA
| | - Paul Mann
- Merck & Co., Inc.; 2000 Galloping Hill Road Kenilworth NJ 07033 USA
| | - Terry Roemer
- Prokaryotics, Inc.; 1000 Morris Ave, STEM Bldg., Suite 5-13 Union NJ 07083 USA
| | | | - David A. Spiegel
- Department of Chemistry; Yale University; 225 Prospect Street New Haven CT 06511 USA
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36
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Nokin MJ, Durieux F, Bellier J, Peulen O, Uchida K, Spiegel DA, Cochrane JR, Hutton CA, Castronovo V, Bellahcène A. Hormetic potential of methylglyoxal, a side-product of glycolysis, in switching tumours from growth to death. Sci Rep 2017; 7:11722. [PMID: 28916747 PMCID: PMC5600983 DOI: 10.1038/s41598-017-12119-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [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: 06/14/2017] [Accepted: 09/04/2017] [Indexed: 02/07/2023] Open
Abstract
Metabolic reprogramming toward aerobic glycolysis unavoidably favours methylglyoxal (MG) and advanced glycation end products (AGEs) formation in cancer cells. MG was initially considered a highly cytotoxic molecule with potential anti-cancer value. However, we have recently demonstrated that MG enhanced tumour growth and metastasis. In an attempt to understand this dual role, we explored MG-mediated dicarbonyl stress status in four breast and glioblastoma cancer cell lines in relation with their glycolytic phenotype and MG detoxifying capacity. In glycolytic cancer cells cultured in high glucose, we observed a significant increase of the conversion of MG to D-lactate through the glyoxalase system. Moreover, upon exogenous MG challenge, glycolytic cells showed elevated amounts of intracellular MG and induced de novo GLO1 detoxifying enzyme and Nrf2 expression. Thus, supporting the adaptive nature of glycolytic cancer cells to MG dicarbonyl stress when compared to non-glycolytic ones. Finally and consistent with the pro-tumoural role of MG, we showed that low doses of MG induced AGEs formation and tumour growth in vivo, both of which can be reversed using a MG scavenger. Our study represents the first demonstration of a hormetic effect of MG defined by a low-dose stimulation and a high-dose inhibition of tumour growth.
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Affiliation(s)
- Marie-Julie Nokin
- Metastasis Research Laboratory, GIGA-CANCER, University of Liège, Liège, Belgium
| | - Florence Durieux
- Metastasis Research Laboratory, GIGA-CANCER, University of Liège, Liège, Belgium
| | - Justine Bellier
- Metastasis Research Laboratory, GIGA-CANCER, University of Liège, Liège, Belgium
| | - Olivier Peulen
- Metastasis Research Laboratory, GIGA-CANCER, University of Liège, Liège, Belgium
| | - Koji Uchida
- Laboratory of Food Chemistry, Department of Applied Biological Chemistry, Graduate School of Agricultural and Life Sciences, University of Tokyo, Tokyo, Japan
| | - David A Spiegel
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, Connecticut, USA
| | - James R Cochrane
- School of Chemistry and Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Melbourne, Australia
| | - Craig A Hutton
- School of Chemistry and Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Melbourne, Australia
| | - Vincent Castronovo
- Metastasis Research Laboratory, GIGA-CANCER, University of Liège, Liège, Belgium
| | - Akeila Bellahcène
- Metastasis Research Laboratory, GIGA-CANCER, University of Liège, Liège, Belgium.
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Chirkin E, Muthusamy V, Mann P, Roemer T, Nantermet PG, Spiegel DA. Neutralization of Pathogenic Fungi with Small-Molecule Immunotherapeutics. Angew Chem Int Ed Engl 2017; 56:13036-13040. [PMID: 28793176 DOI: 10.1002/anie.201707536] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 07/24/2017] [Revised: 08/08/2017] [Indexed: 12/16/2022]
Abstract
Systemic fungal infections represent an important public health concern, and new antifungal agents are highly desirable. Herein, we describe the design, synthesis, and biological evaluation of a novel class of antifungal compounds called antibody-recruiting molecules targeting fungi (ARM-Fs). Our approach relies on the use of non-peptidic small molecules, which selectively bind fungal cells and recruit endogenous antibodies to their surfaces, resulting in immune-mediated clearance. Using the opportunistic fungal pathogen Candida albicans as a model, we identified a highly specific bifunctional molecule able to mediate the engulfment and phagocytosis of C. albicans cells by human immune cells in biologically relevant functional assays. This work represents a novel therapeutic approach to treating fungal illness with significant potential to complement and/or combine with existing treatment strategies.
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Affiliation(s)
- Egor Chirkin
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, CT, 06511, USA
| | - Viswanathan Muthusamy
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, CT, 06511, USA
| | - Paul Mann
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA
| | - Terry Roemer
- Prokaryotics, Inc., 1000 Morris Ave, STEM Bldg., Suite 5-13, Union, NJ, 07083, USA
| | | | - David A Spiegel
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, CT, 06511, USA
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38
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Abstract
Solid-supported chemical libraries have proven useful for the rapid and cost-effective discovery of bioactive compounds. However, traditional on-bead screening involves time-intensive chemical characterization of hit compounds and high false positive rates. Herein, we report a new platform for encoded chemical synthesis and solid-supported screening using p-Chips, microsized silicon microtransponders capable of storing and emitting unique numerical identifiers (IDs). By encoding the structures of library members using p-Chip IDs, we can track compound identities throughout both split-and-pool synthesis and protein binding assays without destructive cleavage. Thanks to the numerical IDs, our p-Chip platform can provide binding constants for library members simply by stripping and reprobing with different protein concentrations, unlike traditional on-bead assays. To showcase these features, we synthesized a library of 108 hemagglutinin (HA) peptide variants using split-and-pool approach, and measured EC50s for each variant directly on p-Chips. On-chip EC50s obtained from these studies showed excellent correlation (80%) with those obtained using traditional ELISA methods. Our screen also yielded a false positive rate of 14%, markedly superior to that reported for conventional bead-based binding studies (66-96%).1-9 On the basis of these results, we believe the p-Chip platform has the potential to improve the effectiveness of solid-supported high-throughput screening by a significant margin.
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Affiliation(s)
- Julian Vastl
- Department of Chemistry, Yale University, 225
Prospect Street, New Haven, Connecticut 06511, United States
| | - Tina Wang
- Department of Chemistry, Yale University, 225
Prospect Street, New Haven, Connecticut 06511, United States
| | - Thi B. Trinh
- Department of Chemistry, Yale University, 225
Prospect Street, New Haven, Connecticut 06511, United States
| | - David A. Spiegel
- Department of Chemistry, Yale University, 225
Prospect Street, New Haven, Connecticut 06511, United States
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Abstract
OBJECTIVES The purpose of this study was to assess surgical availability and readiness in 8 African countries using the WHO's Service Availability and Readiness Assessment (SARA) tool. SETTING We analysed data for surgical services, including basic and comprehensive surgery, comprehensive obstetric care, blood transfusion, and infection prevention, obtained from the WHO's SARA surveys in Sierra Leone, Uganda, Mauritania, Benin, Zambia, Burkina Faso, Democratic Republic of Congo and Togo. PRIMARY AND SECONDARY OUTCOME MEASURES Among the facilities that were expected to offer surgical services (N=3492), there were wide disparities between the countries in the number of facilities per 100 000 population that reported offering basic surgery (1.0-12.1), comprehensive surgery (0.1-0.8), comprehensive obstetric care (0.1-0.8) and blood transfusion (0.1-0.8). Only 0.1-0.3 facilities per 100 000 population had all three bellwether procedures available, namely laparotomy, open fracture management and caesarean section. In all the countries, the facilities that reported offering surgical services generally had a shortage of the necessary items for offering the services and this varied greatly between the countries, with the facilities having on average 27-53% of the items necessary for offering basic surgery, 56-83% for comprehensive surgery, 49-72% for comprehensive obstetric care and 54-80% for blood transfusion. Furthermore, few facilities had all the necessary items present. However, facilities that reported offering surgical services had on average most of the necessary items for the prevention of infection. CONCLUSIONS There are important gaps in the surgical services in the 8 African countries surveyed. Efforts are therefore urgently needed to address deficiencies in the availability and readiness to deliver surgical services in these nations, and this will require commitment from multiple stakeholders. SARA may be used to monitor availability and readiness at regular intervals, which will enable stakeholders to evaluate progress and identify gaps and areas for improvement.
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Affiliation(s)
- D A Spiegel
- Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - B Droti
- World Health Organization, Geneva, Switzerland
| | - P Relan
- North Shore University Hospital, Manhasset, New York, USA
| | - S Hobson
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - M N Cherian
- World Health Organization, Geneva, Switzerland
| | - K O'Neill
- World Health Organization, Geneva, Switzerland
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40
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Nokin MJ, Durieux F, Peixoto P, Chiavarina B, Peulen O, Blomme A, Turtoi A, Costanza B, Smargiasso N, Baiwir D, Scheijen JL, Schalkwijk CG, Leenders J, De Tullio P, Bianchi E, Thiry M, Uchida K, Spiegel DA, Cochrane JR, Hutton CA, De Pauw E, Delvenne P, Belpomme D, Castronovo V, Bellahcène A. Methylglyoxal, a glycolysis side-product, induces Hsp90 glycation and YAP-mediated tumor growth and metastasis. eLife 2016; 5:e19375. [PMID: 27759563 PMCID: PMC5081250 DOI: 10.7554/elife.19375] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 10/17/2016] [Indexed: 12/20/2022] Open
Abstract
Metabolic reprogramming toward aerobic glycolysis unavoidably induces methylglyoxal (MG) formation in cancer cells. MG mediates the glycation of proteins to form advanced glycation end products (AGEs). We have recently demonstrated that MG-induced AGEs are a common feature of breast cancer. Little is known regarding the impact of MG-mediated carbonyl stress on tumor progression. Breast tumors with MG stress presented with high nuclear YAP, a key transcriptional co-activator regulating tumor growth and invasion. Elevated MG levels resulted in sustained YAP nuclear localization/activity that could be reverted using Carnosine, a scavenger for MG. MG treatment affected Hsp90 chaperone activity and decreased its binding to LATS1, a key kinase of the Hippo pathway. Cancer cells with high MG stress showed enhanced growth and metastatic potential in vivo. These findings reinforce the cumulative evidence pointing to hyperglycemia as a risk factor for cancer incidence and bring renewed interest in MG scavengers for cancer treatment.
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Affiliation(s)
- Marie-Julie Nokin
- Metastasis Research Laboratory, GIGA-CANCER, University of Liège, Liège, Belgium
| | - Florence Durieux
- Metastasis Research Laboratory, GIGA-CANCER, University of Liège, Liège, Belgium
| | - Paul Peixoto
- Metastasis Research Laboratory, GIGA-CANCER, University of Liège, Liège, Belgium
| | - Barbara Chiavarina
- Metastasis Research Laboratory, GIGA-CANCER, University of Liège, Liège, Belgium
| | - Olivier Peulen
- Metastasis Research Laboratory, GIGA-CANCER, University of Liège, Liège, Belgium
| | - Arnaud Blomme
- Metastasis Research Laboratory, GIGA-CANCER, University of Liège, Liège, Belgium
| | - Andrei Turtoi
- Metastasis Research Laboratory, GIGA-CANCER, University of Liège, Liège, Belgium
| | - Brunella Costanza
- Metastasis Research Laboratory, GIGA-CANCER, University of Liège, Liège, Belgium
| | - Nicolas Smargiasso
- Mass Spectrometry Laboratory, GIGA-Systems Biology and Chemical Biology, University of Liège, Liège, Belgium
| | | | - Jean L Scheijen
- Laboratory for Metabolism and Vascular Medicine, Department of Internal Medicine, Maastricht University, Maastricht, Netherlands
| | - Casper G Schalkwijk
- Laboratory for Metabolism and Vascular Medicine, Department of Internal Medicine, Maastricht University, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Justine Leenders
- Laboratory of Medicinal Chemistry - CIRM, University of Liège, Liège, Belgium
| | - Pascal De Tullio
- Laboratory of Medicinal Chemistry - CIRM, University of Liège, Liège, Belgium
| | - Elettra Bianchi
- Department of Pathology, CHU, University of Liège, Liège, Belgium
| | - Marc Thiry
- Laboratory of Cellular and Tissular Biology, GIGA-Neurosciences, University of Liège, Liège, Belgium
| | - Koji Uchida
- Laboratory of Food and Biodynamics, Graduate School of Bioagricultural Sciences, University of Nagoya, Nagoya, Japan
| | - David A Spiegel
- Department of Chemistry, Yale University, New Haven, United States
| | - James R Cochrane
- School of Chemistry and Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Melbourne, Australia
| | - Craig A Hutton
- School of Chemistry and Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Melbourne, Australia
| | - Edwin De Pauw
- Mass Spectrometry Laboratory, GIGA-Systems Biology and Chemical Biology, University of Liège, Liège, Belgium
| | | | | | - Vincent Castronovo
- Metastasis Research Laboratory, GIGA-CANCER, University of Liège, Liège, Belgium
| | - Akeila Bellahcène
- Metastasis Research Laboratory, GIGA-CANCER, University of Liège, Liège, Belgium
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41
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Gupta S, Groen TA, Stewart BT, Shrestha S, Spiegel DA, Nwomeh BC, Groen RS, Kushner AL. The spatial distribution of injuries in need of surgical intervention in Nepal. Geospat Health 2016; 11:359. [PMID: 27245791 DOI: 10.4081/gh.2016.359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 09/24/2015] [Accepted: 10/16/2015] [Indexed: 06/05/2023]
Abstract
Geographic information system modelling can accurately represent the geospatial distribution of disease burdens to inform health service delivery. Given the dramatic topography of Nepal and a high prevalence of unmet surgical needs, we explored the consequences of topography on the prevalence of surgical conditions. The Nepalese Surgeons OverSeas Assessment of Surgical Need (SOSAS) is a validated, countrywide, cluster randomised survey that assesses surgical need in lowand middle-income countries; it was performed in Nepal in 2014. Data on conditions potentially affected by topography (e.g. fractures, hernias, injuries, burns) were extracted from the database. A national digital elevation model was used to determine altitude, aspect, slope steepness and curvature of the SOSAS survey sites. Forward stepwise linear regression was performed with prevalence of each surgical condition as the response variable and topographic data as explanatory variables. The highest correlation coefficient was for models predicting hernias and fractures, both explaining 21% of the variance. The model fitted to death due to fall would become significant when an outlier was excluded (P<0.001; R2=0.27). Excluding the outlier yielded a better-fitted model to burn injury (stepwise regression) without any explanatory variables. Other models trended towards a correlation, but did not have sufficient power to detect a difference. This study identified slight correlation between elevation and the prevalence of hernias and fall injuries. Further investigation on the effects of topography and geography on surgical conditions is needed to help determine if the data would be useful for directing allocation of surgical resources.
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Affiliation(s)
- Shailvi Gupta
- University of California, San Francisco East Bay and Surgeons OverSeas, Oakland, CA.
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42
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Vastl J, Kartika R, Park K, Cho AE, Spiegel DA. Peptidines: glycine-amidine-based oligomers for solution- and solid-phase synthesis. Chem Sci 2016; 7:3317-3324. [PMID: 29997824 PMCID: PMC6006957 DOI: 10.1039/c5sc03882k] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 10/13/2015] [Accepted: 01/31/2016] [Indexed: 12/17/2022] Open
Abstract
Efforts to emulate biological oligomers have given rise to a host of useful technologies, ranging from solid-phase peptide and nucleic acid synthesis to various peptidomimetic platforms. Herein we introduce a novel class of peptide-like oligomers called "peptidines" wherein each carbonyl O-atom within poly-N-alkyl glycine oligomers is replaced with a functionalized N-atom. Compared to peptoids or peptides, the presence of this amidine N-substituent in peptidines effectively doubles the number of diversification sites per monomeric unit, and can decrease their overall conformational flexibility. We have developed iterative solution- and solid-phase protocols for the straightforward assembly of peptidines containing diverse backbone and amidine substituents, derived from readily available primary and secondary amines. We have also performed crystallographic and computational studies, which demonstrate a strong preference for the trans (E) amidine geometry. Given their straightforward synthetic preparation and high functional group density, peptidines have the potential to serve as useful tools for library generation, peptide mimicry, and the identification of biologically active small molecules.
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Affiliation(s)
- Julian Vastl
- Department of Chemistry , Yale University , 225 Prospect Street , New Haven , CT 06511 , USA .
| | - Rendy Kartika
- Department of Chemistry , Louisinanna State University , 337 Chemistry and Materials Building , Baton Rouge , LA 70803 , USA
| | - Kichul Park
- Department of Bioinformatics , Korea University Sejong Campus , 2511 Sejong-ro , Sejong City 399-770 , Korea
| | - Art E Cho
- Department of Bioinformatics , Korea University Sejong Campus , 2511 Sejong-ro , Sejong City 399-770 , Korea
| | - David A Spiegel
- Department of Chemistry , Yale University , 225 Prospect Street , New Haven , CT 06511 , USA . .,Department of Pharmacology , Yale University , 333 Cedar Street , New Haven , CT 06520 , USA
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43
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Rullo AF, Fitzgerald KJ, Muthusamy V, Liu M, Yuan C, Huang M, Kim M, Cho AE, Spiegel DA. Re-engineering the Immune Response to Metastatic Cancer: Antibody-Recruiting Small Molecules Targeting the Urokinase Receptor. Angew Chem Int Ed Engl 2016; 55:3642-6. [PMID: 26879524 DOI: 10.1002/anie.201510866] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [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: 11/23/2015] [Revised: 12/23/2015] [Indexed: 12/19/2022]
Abstract
Developing selective strategies to treat metastatic cancers remains a significant challenge. Herein, we report the first antibody-recruiting small molecule (ARM) that is capable of recognizing the urokinase-type plasminogen activator receptor (uPAR), a uniquely overexpressed cancer cell-surface marker, and facilitating the immune-mediated destruction of cancer cells. A co-crystal structure of the ARM-U2/uPAR complex was obtained, representing the first crystal structure of uPAR complexed with a non-peptide ligand. Finally, we demonstrated that ARM-U2 substantially suppresses tumor growth in vivo with no evidence of weight loss, unlike the standard-of-care agent doxorubicin. This work underscores the promise of antibody-recruiting molecules as immunotherapeutics for treating cancer.
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Affiliation(s)
- Anthony F Rullo
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, CT, 06511, USA
| | - Kelly J Fitzgerald
- Department of Pharmacology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Viswanathan Muthusamy
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, CT, 06511, USA
| | - Min Liu
- State Key Laboratory of Structural Chemistry, Fujian Institute of Research on the Structure of Matter, Chinese Academy of Sciences, 155 Yang Qiao West Road, Fuzhou, Fujian, 350002, China
| | - Cai Yuan
- State Key Laboratory of Structural Chemistry, Fujian Institute of Research on the Structure of Matter, Chinese Academy of Sciences, 155 Yang Qiao West Road, Fuzhou, Fujian, 350002, China
| | - Mingdong Huang
- State Key Laboratory of Structural Chemistry, Fujian Institute of Research on the Structure of Matter, Chinese Academy of Sciences, 155 Yang Qiao West Road, Fuzhou, Fujian, 350002, China
| | - Minsup Kim
- Department of Bioinformatics, Korea University, 2511 Sejong-ro, Sejong, 339-700, Korea
| | - Art E Cho
- Department of Bioinformatics, Korea University, 2511 Sejong-ro, Sejong, 339-700, Korea
| | - David A Spiegel
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, CT, 06511, USA. .,Department of Pharmacology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.
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44
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Rullo AF, Fitzgerald KJ, Muthusamy V, Liu M, Yuan C, Huang M, Kim M, Cho AE, Spiegel DA. Re-engineering the Immune Response to Metastatic Cancer: Antibody-Recruiting Small Molecules Targeting the Urokinase Receptor. Angew Chem Int Ed Engl 2016. [DOI: 10.1002/ange.201510866] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Anthony F. Rullo
- Department of Chemistry; Yale University; 225 Prospect Street New Haven CT 06511 USA
| | - Kelly J. Fitzgerald
- Department of Pharmacology; Yale School of Medicine; 333 Cedar Street New Haven CT 06520 USA
| | - Viswanathan Muthusamy
- Department of Chemistry; Yale University; 225 Prospect Street New Haven CT 06511 USA
| | - Min Liu
- State Key Laboratory of Structural Chemistry; Fujian Institute of Research on the Structure of Matter; Chinese Academy of Sciences; 155 Yang Qiao West Road Fuzhou Fujian 350002 China
| | - Cai Yuan
- State Key Laboratory of Structural Chemistry; Fujian Institute of Research on the Structure of Matter; Chinese Academy of Sciences; 155 Yang Qiao West Road Fuzhou Fujian 350002 China
| | - Mingdong Huang
- State Key Laboratory of Structural Chemistry; Fujian Institute of Research on the Structure of Matter; Chinese Academy of Sciences; 155 Yang Qiao West Road Fuzhou Fujian 350002 China
| | - Minsup Kim
- Department of Bioinformatics; Korea University; 2511 Sejong-ro Sejong 339-700 Korea
| | - Art E. Cho
- Department of Bioinformatics; Korea University; 2511 Sejong-ro Sejong 339-700 Korea
| | - David A. Spiegel
- Department of Chemistry; Yale University; 225 Prospect Street New Haven CT 06511 USA
- Department of Pharmacology; Yale School of Medicine; 333 Cedar Street New Haven CT 06520 USA
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45
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Gautam S, Kim T, Lester E, Deep D, Spiegel DA. Wall teichoic acids prevent antibody binding to epitopes within the cell wall of Staphylococcus aureus. ACS Chem Biol 2016; 11:25-30. [PMID: 26502318 DOI: 10.1021/acschembio.5b00439] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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
Staphylococcus aureus is a Gram-positive bacterial pathogen that produces a range of infections including cellulitis, pneumonia, and septicemia. The principle mechanism in antistaphylococcal host defense is opsonization with antibodies and complement proteins, followed by phagocytic clearance. Here we use a previously developed technique for installing chemical epitopes in the peptidoglycan cell wall to show that surface glycopolymers known as wall teichoic acids conceal cell wall epitopes, preventing their recognition and opsonization by antibodies. Thus, our results reveal a previously unrecognized immunoevasive role for wall teichoic acids in S. aureus: repulsion of peptidoglycan-targeted antibodies.
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Affiliation(s)
- Samir Gautam
- Department
of Chemistry, Yale University, 225 Prospect Street, New Haven, Connecticut 06511, United States
| | - Taehan Kim
- Department
of Chemistry, Yale University, 225 Prospect Street, New Haven, Connecticut 06511, United States
| | - Evan Lester
- Department
of Chemistry, Yale University, 225 Prospect Street, New Haven, Connecticut 06511, United States
| | - Deeksha Deep
- Department
of Chemistry, Yale University, 225 Prospect Street, New Haven, Connecticut 06511, United States
| | - David A. Spiegel
- Department
of Chemistry, Yale University, 225 Prospect Street, New Haven, Connecticut 06511, United States
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46
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Gray MA, Tao RN, DePorter SM, Spiegel DA, McNaughton BR. Back Cover: A Nanobody Activation Immunotherapeutic that Selectively Destroys HER2-Positive Breast Cancer Cells (ChemBioChem 2/2016). Chembiochem 2016. [DOI: 10.1002/cbic.201500679] [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: 11/06/2022]
Affiliation(s)
- Melissa A. Gray
- Department of Chemistry; Colorado State University; Fort Collins CO 80523 USA
| | - Ran N. Tao
- Department of Chemistry; Yale University; 225 Prospect Street New Haven CT 06511 USA
| | - Sandra M. DePorter
- Department of Chemistry; Colorado State University; Fort Collins CO 80523 USA
| | - David A. Spiegel
- Department of Chemistry; Yale University; 225 Prospect Street New Haven CT 06511 USA
| | - Brian R. McNaughton
- Department of Chemistry; Colorado State University; Fort Collins CO 80523 USA
- Department of Biochemistry and Molecular Biology; Colorado State University; Fort Collins CT 80523 USA
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47
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Affiliation(s)
- Andrew G Georgiadis
- Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104
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48
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Gray MA, Tao RN, DePorter SM, Spiegel DA, McNaughton BR. A Nanobody Activation Immunotherapeutic that Selectively Destroys HER2-Positive Breast Cancer Cells. Chembiochem 2015; 17:155-8. [PMID: 26556305 DOI: 10.1002/cbic.201500591] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [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: 11/06/2015] [Indexed: 01/18/2023]
Abstract
We report a rationally designed nanobody activation immunotherapeutic that selectively redirects anti-dinitrophenyl (anti-DNP) antibodies to the surface of HER2-positive breast cancer cells, resulting in their targeted destruction by antibody-dependent cellular cytotoxicity. As nanobodies are relatively easy to express, stable, can be humanized, and can be evolved to potently and selectively bind virtually any disease-relevant cell surface receptor, we anticipate broad utility of this therapeutic strategy.
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Affiliation(s)
- Melissa A Gray
- Department of Chemistry, Colorado State University, Fort Collins, CO, 80523, USA
| | - Ran N Tao
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, CT, 06511, USA
| | - Sandra M DePorter
- Department of Chemistry, Colorado State University, Fort Collins, CO, 80523, USA
| | - David A Spiegel
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, CT, 06511, USA
| | - Brian R McNaughton
- Department of Chemistry, Colorado State University, Fort Collins, CO, 80523, USA. .,Department of Biochemistry and Molecular Biology, Colorado State University, Fort Collins, CT, 80523, USA.
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49
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Dafre AL, Goldberg J, Wang T, Spiegel DA, Maher P. Methylglyoxal, the foe and friend of glyoxalase and Trx/TrxR systems in HT22 nerve cells. Free Radic Biol Med 2015; 89:8-19. [PMID: 26165190 PMCID: PMC5624793 DOI: 10.1016/j.freeradbiomed.2015.07.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 06/03/2015] [Accepted: 07/06/2015] [Indexed: 01/28/2023]
Abstract
Methylglyoxal (MGO) is a major glycating agent that reacts with basic residues of proteins and promotes the formation of advanced glycation end products (AGEs) which are believed to play key roles in a number of pathologies, such as diabetes, Alzheimer's disease, and inflammation. Here, we examined the effects of MGO on immortalized mouse hippocampal HT22 nerve cells. The endpoints analyzed were MGO and thiol status, the glyoxalase system, comprising glyoxalase 1 and 2 (GLO1/2), and the cytosolic and mitochondrial Trx/TrxR systems, as well as nuclear Nrf2 and its target genes. We found that nuclear Nrf2 is induced by MGO treatment in HT22 cells, as corroborated by induction of the Nrf2-controlled target genes and proteins glutamate cysteine ligase and heme oxygenase 1. Nrf2 knockdown prevented MGO-dependent induction of glutamate cysteine ligase and heme oxygenase 1. The cystine/glutamate antiporter, system xc(-), which is also controlled by Nrf2, was also induced. The increased cystine import (system xc(-)) activity and GCL expression promoted GSH synthesis, leading to increased levels of GSH. The data indicate that MGO can act as both a foe and a friend of the glyoxalase and the Trx/TrxR systems. At low concentrations of MGO (0.3mM), GLO2 is strongly induced, but at high MGO (0.75 mM) concentrations, GLO1 is inhibited and GLO2 is downregulated. The cytosolic Trx/TrxR system is impaired by MGO, where Trx is downregulated yet TrxR is induced, but strong MGO-dependent glycation may explain the loss in TrxR activity. We propose that Nrf2 can be the unifying element to explain the observed upregulation of GSH, GCL, HO1, TrxR1, Trx2, TrxR2, and system xc(-) system activity.
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Affiliation(s)
- A L Dafre
- Biochemistry Department, Federal University of Santa Catarina, Florianópolis, SC, Brazil.
| | - J Goldberg
- Cellular Neurobiology Laboratory, Salk Institute for Biological Studies, La Jolla, CA 92037, USA
| | - T Wang
- Department of Chemistry, Yale University, New Haven, CT 06520, USA
| | - D A Spiegel
- Department of Chemistry, Yale University, New Haven, CT 06520, USA
| | - P Maher
- Cellular Neurobiology Laboratory, Salk Institute for Biological Studies, La Jolla, CA 92037, USA
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Spiegel DA, Nduaguba A, Cherian MN, Monono M, Kelley ET. Deficiencies in the availability of essential musculoskeletal surgical services at 883 health facilities in 24 low- and lower-middle-income countries. World J Surg 2015; 39:1421-32. [PMID: 25663008 DOI: 10.1007/s00268-015-2971-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The sequelae of acute musculoskeletal conditions, especially injuries and infections, are responsible for significant disability in low- and middle-income countries. This study characterizes the availability of selected musculoskeletal surgical services at different tiers of the health system in a convenience sample of 883 health facilities from 24 low- and lower-middle-income countries. METHODS Selected data points from the World Health Organization's (WHO) tool of situational analysis of surgical availability were extracted from the WHO's database in December, 2013. These included infrastructure, physical resources and supplies, interventions, and human resources. For a descriptive analysis, facilities were divided into two groups based on number of beds (<100, 100-300, and >300) and level of facility (primary referral, secondary/tertiary, and Private/NGO/Mission). Statistical comparison was made between public and Private/NGO/Mission facilities based on number of beds (≤100, 100-300, and >300) using a Chi-Square analysis, with statistical significance at p < 0.05. FINDINGS Significant deficiencies were noted in infrastructure, physical resources and supplies, and human resources for the provision of essential orthopedic surgical services at all tiers of the health system. Availability was significantly lower in public versus Private/NGO/Mission facilities for nearly all categories in facilities with ≤100 beds, and in a subset of measures in facilities with between 100 and 300 beds. INTERPRETATION Deficiencies in the availability of orthopedic surgical services were observed at all levels of health facility and were most pronounced at facilities with ≤100 beds in the public sector. Strengthening the delivery of essential surgical services, including orthopedics, at the primary referral level must be prioritized if we are to reduce the burden of death and disability from a variety of emergent health conditions. FUNDING There were no sources of funding.
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Affiliation(s)
- D A Spiegel
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, 2nd Floor Wood Building, 34th Street and Civic Center Blvd, Philadelphia, PA, 19106, USA,
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