1
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Hedvat J, Lange NW, Scheffert JL, Pereira MR, Salerno DM. Managing the significant drug-drug interaction between isavuconazole and tacrolimus in solid organ transplant recipients. Clin Transplant 2024; 38:e15278. [PMID: 38501290 DOI: 10.1111/ctr.15278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/08/2024] [Accepted: 02/19/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Jessica Hedvat
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York City, New York, USA
| | - Nicholas W Lange
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York City, New York, USA
| | - Jenna L Scheffert
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York City, New York, USA
| | - Marcus R Pereira
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York City, New York, USA
| | - David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York City, New York, USA
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Lange NW, King K, Husain SA, Salerno DM, Tsapepas DS, Hedvat J, Yu M, Mohan S. Obesity is associated with a higher incidence of rejection in patients on belatacept: A pooled analysis from the BENEFIT/BENEFIT-EXT clinical trials. Am J Transplant 2024:S1600-6135(24)00157-6. [PMID: 38387620 DOI: 10.1016/j.ajt.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/25/2024] [Accepted: 02/14/2024] [Indexed: 02/24/2024]
Abstract
Though belatacept is administered with a weight-based dosing schema, there has been higher clearance reported in obese patients. Therefore, we evaluated the association between body mass index (BMI) and transplant outcomes in kidney transplant recipients who were randomized to cyclosporine- or belatacept-based immunosuppression in the BENEFIT and BENEFIT-EXT randomized clinical trials. A total of 666 and 543 patients underwent randomization and transplantation in BENEFIT and BENEFIT-EXT, respectively, of which 1056 had complete data and were included in this analysis. Patients were grouped categorically according to BMI: <25, 25 to <30, and ≥30 kg/m2. BMI did influence both the incidence and severity of acute rejection. Obese patients with BMI >30 kg/m2 in the low intensity belatacept group experienced significantly more rejection at 12 months than did patients with BMI <25 kg/m2 or BMI 25 to <30 kg/m2. In both the moderate intensity belatacept and low intensity belatacept groups, obese patients with BMI >30 kg/m2 experienced significantly more severe acute rejection than did patients with BMI < 25 kg/m2 or BMI 25 to <30 kg/m2. These results suggest that obese kidney transplant recipients are at an increased risk for acute rejection when under belatacept-based immunosuppression when compared to nonobese patients.
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Affiliation(s)
- Nicholas W Lange
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA.
| | - Kristen King
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA; Columbia University Renal Epidemiology Group, New York, New York, USA
| | - Syed Ali Husain
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA; Columbia University Renal Epidemiology Group, New York, New York, USA
| | - David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Demetra S Tsapepas
- Columbia University Renal Epidemiology Group, New York, New York, USA; Division of Transplantation, Department of Surgery, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA; Department of Quality, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jessica Hedvat
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Miko Yu
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA; Columbia University Renal Epidemiology Group, New York, New York, USA
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA; Columbia University Renal Epidemiology Group, New York, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
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Tsapepas D, Ramakrishnan A, Salerno DM, Husain SA, King K, Mohan S. Impact of peri-operative red blood cell transfusions for treatment of anemia on acute rejection in renal transplant recipients. Transfus Apher Sci 2024:103896. [PMID: 38365525 DOI: 10.1016/j.transci.2024.103896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/05/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Anemia occurs before and after kidney transplantation. Determining the impact of perioperative transfusion on post-transplant outcomes can help determine best management of anemia. PROJECT AIM The current study aims to describe clinical outcomes associated with packed red blood cell transfusions in the peri-operative management of anemia after transplantation. DESIGN This was a single-center, retrospective study of adult kidney recipients with anemia at the time of transplantation. 1271 patients were stratified by donor-type due to the potential variability in underlying recipient and transplant characteristics; living donor (n = 698, 62%) or deceased donor (n = 573, 38%). RESULTS Living donor recipients that received blood during the index hospitalization were more likely to experience rejection within 30 days (18% vs. 10%, p = 0.008) and 1 year of transplant (32% vs. 16%, p = 0.038). In multivariate analysis, receiving both blood and darbepoetin (HR: 1.89 [1.20,3.00], p = 0.006), age at transplant (HR: 0.98 [0.97, 0.99], p = 0.02), number of HLA mismatches (HR: 1.17 [1.05,1.30], p = 0.003), and whether the case was a repeat transplant (HR: 2.77 [1.93,3.97], p < 0.01) were significantly associated with hazard of rejection. For deceased donor recipients, there were no differences in acute rejection, graft failure or mortality at 30 days or 1 year. When analyzing hazard of rejection in a multivariate model, treatment received was not found to be significantly associated with rejection. CONCLUSION Our findings suggest there may be a role for more aggressive pre-transplant treatment of anemia for those patients undergoing living donor transplants.
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Affiliation(s)
- Demetra Tsapepas
- Department of Transplant Analytics, New York-Presbyterian Hospital, New York, NY, USA; Department of Transplant Surgery, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Adarsh Ramakrishnan
- Department of Transplant Analytics, New York-Presbyterian Hospital, New York, NY, USA.
| | - David M Salerno
- Department of Pharmacy, New York-Presbyterian Hospital, New York, NY, USA
| | - Syed Ali Husain
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Kristen King
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Chen JK, Salerno DM, Law S, Freniere V, Neunert C. Anticoagulation Stability With Bivalirudin: Positioning the Horse Before the Cart. ASAIO J 2023; 69:e468-e469. [PMID: 37220194 DOI: 10.1097/mat.0000000000001992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Affiliation(s)
- Justin K Chen
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York
- Department of Pharmacy, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York
| | - Sabrina Law
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Victoria Freniere
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York
| | - Cindy Neunert
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
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Freniere V, Salerno DM, Corbo H, Law S, McAllister J, Neunert C, Chen JK. Bivalirudin Compared to Heparin as the Primary Anticoagulant in Pediatric Berlin Heart Recipients. ASAIO J 2023; 69:e205-e211. [PMID: 36943709 DOI: 10.1097/mat.0000000000001921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Bivalirudin has been used in increasing frequency as an alternative to unfractionated heparin (UFH) in pediatric recipients of Berlin Heart EXCOR ventricular assist devices (VAD). This single-center, retrospective review characterizes anticoagulant trends and outcomes in pediatric Berlin Heart VAD recipients implanted between September 1, 2013, and August 31, 2021, anticoagulated with either bivalirudin or UFH. Thirty-one patients were included; 65% who received bivalirudin and 35% who received UFH. The median age was 2.9 years, included 64.5% females, with 61.3% of patients diagnosed with dilated cardiomyopathy and 25.8% of patients with congenital heart disease. Therapeutic anticoagulation was achieved sooner in the bivalirudin group compared to UFH via anti-Xa monitoring (median 5.7 and 69.5 hours, respectively, p < 0.001). Bivalirudin had a greater number of therapeutic values comparatively to UFH (52% and 24%, respectively; p < 0.001) and a superior number of hours in the therapeutic range (67% and 32%, respectively; p < 0.001). Secondary outcomes were similar among the two groups, apart from greater chest tube output (UFH), more frequent events of elevated plasma-free hemoglobin (bivalirudin), and more frequent elevated inflammatory markers postimplant (bivalirudin). Prevalence of pump replacements secondary to significant clot burden and prevalence of stroke was comparable. In this patient cohort, bivalirudin demonstrated greater anticoagulation stability comparatively to UFH. Multicenter collaboration would be necessary to identify whether this further translates into improved patient outcomes.
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Affiliation(s)
| | - David M Salerno
- From the Department of Pharmacy, NewYork-Presbyterian Hospital
| | - Heather Corbo
- From the Department of Pharmacy, NewYork-Presbyterian Hospital
| | - Sabrina Law
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Jennie McAllister
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Cindy Neunert
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Justin K Chen
- From the Department of Pharmacy, NewYork-Presbyterian Hospital
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Sabatino DC, Hedvat J, Salerno DM, Pereira MR, Lange NW. Real world experience with Maribavir for the treatment of cytomegalovirus in solid organ transplant recipients. Clin Transplant 2023; 37:e14929. [PMID: 36740886 DOI: 10.1111/ctr.14929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/14/2022] [Accepted: 02/02/2023] [Indexed: 02/07/2023]
Affiliation(s)
- David C Sabatino
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, New York, USA
| | - Jessica Hedvat
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, New York, USA
| | - David M Salerno
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, New York, USA
| | - Marcus R Pereira
- Columbia University Vagelos College of Physicians and Surgeons, Department of Medicine, New York, New York, USA
| | - Nicholas W Lange
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, New York, USA
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Chen JK, Salerno DM, Corbo H, Mantell BS, Richmond M, Rothkopf A, Lytrivi ID. Immune cell function assay and T lymphocyte counts lack association with rejection or infection in pediatric heart transplant recipients. Clin Transplant 2023; 37:e14858. [PMID: 36372938 DOI: 10.1111/ctr.14858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/31/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Immune cell function assay (ICFA) and CD3 lymphocyte counts have been considered to be useful in discerning the overall intensity of immunosuppression in pediatric orthotopic heart transplant (OHT) recipients. METHODS The aim of this retrospective analysis was to evaluate trends of ICFA and CD3 lymphocyte counts and their association with adverse outcomes post-OHT. RESULTS A total of 381 ICFA and 493 CD3 laboratory values obtained in 78 patients within six months post-OHT were analyzed. There were 14 patients treated for biopsy-proven acute rejection, four of whom had ISHLT grade 2R/3A rejection. In patients with rejection versus those without, CD3 and ICFA values were 122 (IQR 74.5-308) cells/mm2 and 224.5 (IQR 132-343.5) ng/ml compared to 231.8 (IQR 68-421) cells/m2 and 191 (IQR 81.5-333) ng/mL (p = NS for both). Twenty-six patients had at least one detectable cytomegalovirus or Epstein-Barr virus DNAemia within the study timeframe. In patients with viremia versus those without, CD3 and ICFA values were 278.5 (IQR 68-552) cells/mm2 and 130 (IQR 48-284) ng/ml compared to 195 (IQR 74.5-402.5) cells/mm2 and 212 (IQR 89-342) ng/ml (p = NS for both). CONCLUSIONS No association was found between these immune markers and adverse outcomes. In the absence of larger pediatric studies justifying the role of these tests in identifying elevated risk profiles post OHT, we do not recommend their routine use.
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Affiliation(s)
- Justin K Chen
- Department of Pharmacy, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA
| | - Heather Corbo
- Department of Pharmacy, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - Benjamin S Mantell
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Marc Richmond
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Amy Rothkopf
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Irene D Lytrivi
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
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Sabatino DC, Lange NW, Salerno DM, Scheffert J. Elevated posaconazole trough concentrations are not associated with increased risk for posaconazole toxicity in lung transplant recipients. Clin Transplant 2023; 37:e14826. [PMID: 36205935 DOI: 10.1111/ctr.14826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/11/2022] [Accepted: 09/19/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Posaconazole is used for prophylaxis and treatment of invasive fungal infections in lung transplant recipients (LTR). Previous studies have not described the relationship between elevated posaconazole trough concentrations and adverse drug reactions in this population. METHODS This IRB-approved, retrospective cohort study at NewYork-Presbyterian Hospital included LTR who had posaconazole trough concentrations measured. The primary aim of this study was to evaluate elevated posaconazole trough concentrations and changes in liver function tests as well as QTc interval. A secondary aim of this study was to identify patient factors associated with elevated posaconazole trough levels. RESULTS A total of 109 LTR were included. The average age was 58.1 years (IQR, 48-65), the majority were male (56%). A total of 932 trough levels were assessed with a median number of 8 (IQR, 5-15) levels per patient. The median posaconazole trough concentration was 1.7 mg/L (IQR, 1.1-2.5). Hepatotoxicity, as defined by common terminology criteria for adverse events (CTCAE), was observed in 73.4% of subjects, with the majority classified as grade 1 (67.5%). However, there was no correlation between elevated posaconazole levels and aspartate aminotransferase (r = .03), alanine aminotransferase (r = .04), alkaline phosphatase (r = .04), and total bilirubin (r = .02). There was also no correlation between posaconazole trough concentrations and QTc interval (r = .03). CONCLUSION This analysis demonstrates that no correlation exists between whole blood posaconazole levels and hepatotoxicity or QTc prolongation. Based on these results, posaconazole dose reductions may not be warranted for posaconazole levels that are significantly above the therapeutic target to avert risk for hepatotoxicity or QTc prolongation.
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Affiliation(s)
- David C Sabatino
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Nicholas W Lange
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA
| | - David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jenna Scheffert
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA
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Hedvat J, Lange NW, Salerno DM, DeFilippis EM, Kovac D, Corbo H, Chen JK, Choe JY, Lee JH, Anamisis A, Jennings DL, Codispodo G, Shertel T, Brown RS, Pereira MR. COVID-19 therapeutics and outcomes among solid organ transplant recipients during the Omicron BA.1 era. Am J Transplant 2022; 22:2682-2688. [PMID: 35801839 PMCID: PMC9349644 DOI: 10.1111/ajt.17140] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [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: 04/22/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 01/25/2023]
Abstract
Treatment outcomes associated with the use of novel COVID-19 therapeutics in solid organ transplant recipients (SOTR) are not well described in the literature. The objective of this analysis was to characterize 30-day hospitalization and other key secondary endpoints experienced by outpatient SOTR with mild-moderate COVID-19 treated with nirmatrelvir/ritonavir (NR), sotrovimab, or no SARS-CoV-2 specific treatment. This IRB-approved, retrospective study included 154 SOTR with a documented positive SARS-CoV-2 infection between December 16, 2021 and January 19, 2022 (a predominant Omicron BA.1 period in New York City). Patients who received NR (N = 28) or sotrovimab (N = 51) experienced a lower rate of 30-day hospitalization or death as compared to those who received no specific treatment (N = 75) (p = .009). A total of three deaths occurred, all among patients who initially received no specific treatment prior to hospitalization. These results suggest a role for SARS-CoV-2 specific agents in the treatment of SOTR with COVID-19, and that there does not appear to be any difference in effectiveness when comparing NR versus sotrovimab.
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Key Words
- aki, acute kidney injury
- arr, adjusted risk ratio
- bmi, body mass index
- ci, confidence interval
- eua, emergency use authorization
- fda, food and drug administration
- iqr, interquartile range
- mmf, mycophenolate mofetil
- nr, nirmatrelvir/ritonavir
- nyph, newyork-presbyterian hospital
- rrr, relative risk reduction
- scr, serum creatinine
- sotr, solid organ transplant recipient
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Affiliation(s)
- Jessica Hedvat
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA,Jessica Hedvat, Department of Pharmacy, NewYork-Presbyterian Hospital, New York City, NY, USA.
| | - Nicholas W. Lange
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - David M. Salerno
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Ersilia M. DeFilippis
- Division of Cardiology, Department of Medicine Columbia University Irving Medical Center New York City, New York USA
| | - Danielle Kovac
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Heather Corbo
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Justin K. Chen
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Jason Y. Choe
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Jennifer H. Lee
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Anastasia Anamisis
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Douglas L. Jennings
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Giovanna Codispodo
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Tara Shertel
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Robert S. Brown
- Department of Medicine Weill Cornell Medicine New York City, New York USA
| | - Marcus R. Pereira
- Department of Medicine Vagelos College of Physicians and Surgeons New York City, New York USA
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Salerno DM, Lee-Riddle GS, Brar S, Samstein B, Brown RS, Lennon C. Deceased donor liver transplantation in patients on direct oral anticoagulants at the time of transplant surgery: A case series. Liver Transpl 2022; 28:1681-1684. [PMID: 35657735 DOI: 10.1002/lt.26521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/27/2022] [Accepted: 05/17/2022] [Indexed: 01/13/2023]
Affiliation(s)
- David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Grace S Lee-Riddle
- Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Seema Brar
- Department of Anesthesiology, Weill Cornell Medical Center, New York, New York, USA
| | - Benjamin Samstein
- Department of Surgery, Weill Cornell Medical Center, New York, New York, USA
| | - Robert S Brown
- Department of Medicine, Weill Cornell Medical Center, New York, New York, USA
| | - Christine Lennon
- Department of Anesthesiology, Weill Cornell Medical Center, New York, New York, USA
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Lange NW, Salerno DM, Jennings DL, Choe J, Hedvat J, Kovac DB, Scheffert J, Shertel T, Ratner LE, Brown RS, Pereira MR. Nirmatrelvir/ritonavir use: Managing clinically significant drug-drug interactions with transplant immunosuppressants. Am J Transplant 2022; 22:1925-1926. [PMID: 35015924 DOI: 10.1111/ajt.16955] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Nicholas W Lange
- Department of Pharmacy, NewYork-Presbyterian Hospital Pharmacy, New York, New York, USA
| | - David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital Pharmacy, New York, New York, USA
| | - Douglas L Jennings
- Department of Pharmacy, NewYork-Presbyterian Hospital Pharmacy, New York, New York, USA
| | - Jason Choe
- Department of Pharmacy, NewYork-Presbyterian Hospital Pharmacy, New York, New York, USA
| | - Jessica Hedvat
- Department of Pharmacy, NewYork-Presbyterian Hospital Pharmacy, New York, New York, USA
| | - Danielle Bley Kovac
- Department of Pharmacy, NewYork-Presbyterian Hospital Pharmacy, New York, New York, USA
| | - Jenna Scheffert
- Department of Pharmacy, NewYork-Presbyterian Hospital Pharmacy, New York, New York, USA
| | - Tara Shertel
- Department of Pharmacy, NewYork-Presbyterian Hospital Pharmacy, New York, New York, USA
| | - Lloyd E Ratner
- Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Robert S Brown
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Marcus R Pereira
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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Sabatino DC, Hedvat J, Salerno DM, Lange NW. Maribavir does not significantly influence tacrolimus dose requirements in solid organ transplant recipients. Transpl Infect Dis 2022; 24:e13869. [DOI: 10.1111/tid.13869] [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] [Received: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 11/29/2022]
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13
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Salerno DM, Jennings DL, Lange NW, Kovac D, Shertel T, Chen JK, Hedvat J, Scheffert J, Brown RS, Pereira MR. Early clinical experience with nirmatrelvir/ritonavir for the treatment of COVID-19 in solid organ transplant recipients. Am J Transplant 2022; 22:2083-2088. [PMID: 35278260 PMCID: PMC9111190 DOI: 10.1111/ajt.17027] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [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: 01/19/2022] [Revised: 03/06/2022] [Accepted: 03/06/2022] [Indexed: 01/25/2023]
Abstract
Nirmatrelvir/ritonavir (NR) use has not yet been described in solid organ transplant recipients (SOTRs) with mild COVID-19. The objective was to evaluate outcomes among SOTR and describe the drug-drug interaction of NR. This is an IRB-approved, retrospective study of all adult SOTR on a calcineurin inhibitor (CNI) or mammalian target of rapamycin inhibitor who were prescribed NR between December 28, 2021 and January 6, 2022. A total of 25 adult SOTR were included (n = 21 tacrolimus, n = 4 cyclosporine, n = 3 everolimus, n = 1 sirolimus). All patients were instructed to follow the following standardized protocol during treatment with 5 days of NR: hold tacrolimus or mTOR inhibitor or reduce cyclosporine dose to 20% of baseline daily dose. Four patients (16%) were hospitalized by day 30; one for infectious diarrhea and three for symptoms related to COVID-19. No patients died within 30 days of receipt of NR. Median tacrolimus level pre- and post-NR were 7.4 ng/ml (IQR, 6.6-8.6) and 5.2 (IQR, 3.6-8.7), respectively. Four patients experienced a supratherapeutic tacrolimus concentration after restarting tacrolimus post-NR. Our results show the clinically significant interaction between NR and immunosuppressive agents can be reasonably managed with a standardized dosing protocol. Prescribers should carefully re-introduce CNI after the NR course is complete.
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Affiliation(s)
- David M. Salerno
- Department of PharmacyNewYork‐Presbyterian Hospital PharmacyNew YorkNew YorkUSA
| | - Douglas L. Jennings
- Department of PharmacyNewYork‐Presbyterian Hospital PharmacyNew YorkNew YorkUSA
| | - Nicholas W. Lange
- Department of PharmacyNewYork‐Presbyterian Hospital PharmacyNew YorkNew YorkUSA
| | | | - Tara Shertel
- Department of PharmacyNewYork‐Presbyterian Hospital PharmacyNew YorkNew YorkUSA
| | - Justin K. Chen
- Department of PharmacyNewYork‐Presbyterian Hospital PharmacyNew YorkNew YorkUSA
| | - Jessica Hedvat
- Department of PharmacyNewYork‐Presbyterian Hospital PharmacyNew YorkNew YorkUSA
| | - Jenna Scheffert
- Department of PharmacyNewYork‐Presbyterian Hospital PharmacyNew YorkNew YorkUSA
| | - Robert S. Brown
- Department of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Marcus R. Pereira
- Department of MedicineColumbia University Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
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14
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Hedvat J, Salerno DM, Kovac D, Scheffert JL, Corbo H, Chen J, Choe JY, Jennings DL, Anamisis A, Liu EC, Lee JH, Shertel T, Lange NW. Nitazoxanide treatment for norovirus infection in solid organ transplant recipients. Clin Transplant 2022; 36:e14594. [PMID: 35032413 DOI: 10.1111/ctr.14594] [Citation(s) in RCA: 8] [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: 01/03/2022] [Revised: 01/18/2022] [Accepted: 01/10/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Jessica Hedvat
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, NY
| | - David M Salerno
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, NY
| | - Danielle Kovac
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, NY
| | | | - Heather Corbo
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, NY
| | - Justin Chen
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, NY
| | - Jason Y Choe
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, NY
| | - Douglas L Jennings
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, NY.,Department of Pharmacy Practice, Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, New York, NY
| | | | - Esther C Liu
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, NY
| | - Jennifer H Lee
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, NY
| | - Tara Shertel
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, NY
| | - Nicholas W Lange
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, NY
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15
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Breslin NT, Hedvat J, Salerno DM, Jandovitz N, Patel C, Lee S, Lange NW. Comparing weight-based dosing of tacrolimus XR in obese and non-obese renal transplant recipients. Clin Transplant 2021; 36:e14529. [PMID: 34757669 DOI: 10.1111/ctr.14529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/15/2021] [Accepted: 10/30/2021] [Indexed: 11/30/2022]
Abstract
The recommended initial weight-based dose of extended-release (XR) tacrolimus (Envarsus XR) in kidney transplant recipients (KTR) is 0.14 mg/kg/day. However, no data exist regarding dosing recommendations for obese patients specifically. The aim of this study was to evaluate weight-based dosing requirements in a cohort of obese KTR who were initiated on de novo tacrolimus XR post-transplantation. The primary outcome was weight-based dosing requirements (mg/kg/day) on post-operative day (POD) 7 and 14. Of the 254 KTR, 81 (31%) were obese. The median therapeutic dose on POD7 was 0.1 versus 0.12 vs. 0.14 mg/kg/day in the BMI > 30 kg/m2 , BMI 25-30 kg/m2 , and BMI < 25 kg/m2 , respectively, (p = .0001). This result was similar on POD14; median therapeutic dose was 0.09 versus 0.11 versus 0.15 mg/kg/day in the BMI > 30 kg/m2 , BMI 25-30 kg/m2 , and BMI < 25 kg/m2 , respectively, (p < .001). Therapeutic dose on POD7 and POD14 based on ideal body was similar in all cohorts (p = .238, p = .923, respectively). This finding was supported by a strong linear relationship between ideal body weight (IBW) and therapeutic dose (r = .929). In both obese and non-obese KTR, IBW had a stronger correlation with the therapeutic dose for tacrolimus XR.
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Affiliation(s)
- Nadine T Breslin
- Department of Pharmacy, North Shore University Hospital, Manhasset, New York, USA
| | - Jessica Hedvat
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA
| | - David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Nicholas Jandovitz
- Department of Pharmacy, North Shore University Hospital, Manhasset, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA
| | - Chandni Patel
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Sara Lee
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Nicholas W Lange
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA
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16
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Allamneni C, Vora RS, Bamidele AO, Schwartz RE, Povero D, Salerno DM, Brown RS, Yu RL, Ullah MUD, Lau DTY, Zhang W, Lee A, Kostallari E, Jalan-Sakrikar N, Khanal S, Kostallari E. Hepatology Highlights. Hepatology 2021; 74:1727-1729. [PMID: 34559905 DOI: 10.1002/hep.32146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
| | - Ravi S Vora
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | | | - Robert E Schwartz
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY
| | - Davide Povero
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN
| | - David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY
| | - Robert S Brown
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY
| | | | | | - Daryl T Y Lau
- Liver Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - Amani Lee
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Enis Kostallari
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | | | - Shalil Khanal
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Enis Kostallari
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
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17
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Salerno DM, Thornberg ME, Lange NW, Hedvat J, Robbins H, Brown RS, Jennings D, Scheffert J. Less bleeding associated with apixaban versus other direct acting oral anticoagulation in solid organ transplant recipients. Clin Transplant 2021; 35:e14396. [PMID: 34165845 DOI: 10.1111/ctr.14396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/19/2021] [Accepted: 06/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate outcomes of bleeding and thrombosis resulting from the use of DOACs in a large cohort of SOT recipients. METHODS This was a single center, retrospective cohort study of adult kidney, heart, lung, and liver transplant recipients transplanted between August 2009 and May 2018. Patients were stratified into two groups: those who received apixaban (apixaban group) or those patients receiving either rivaroxaban or dabigatran (non-apixaban group). The primary endpoint was the cumulative incidence of bleeding while receiving DOAC therapy. The secondary endpoints were incidence of major bleeding and thrombosis at any time while receiving DOAC therapy. RESULTS A total of 106 patients were included; 70 patients received apixaban and 36 patients received non-apixaban anticoagulation. Cumulative incidence of any bleeding was lower in the apixaban group compared to the non-apixaban group at both 90 days (4.9% versus 16.1%) and 180 days (11.4% versus 24.9%, P = 0.034). Cumulative incidence of major bleeding (P = 0.686) and thrombosis (P = 0.515) were similar between groups. DOAC dosing congruent with the package insert(s) was associated with a lower risk of thrombosis. CONCLUSION Apixaban-based anticoagulation was associated with a lower cumulative incidence of any bleeding compared to non-apixaban DOACs. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, 10065, USA
| | - Megan E Thornberg
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, 10065, USA
| | - Nicholas W Lange
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, 10065, USA
| | - Jessica Hedvat
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, 10065, USA
| | - Hilary Robbins
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, 10032, USA
| | - Robert S Brown
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, 10065, USA
| | - Douglas Jennings
- Long Island University Department of Pharmacy Practice, New York, 11201, USA
| | - Jenna Scheffert
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, 10065, USA
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18
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Muhammad Khan M, Alejandra Luna-Cuadros M, Lau DTY, Sehrawat TS, Sehrawat O, Schwartz RE, Choi AJ, Brown RS, Parthasarathy G, Kostallari E, Jalan-Sakrikar N, Salerno DM, Allamneni C, Vora RS, Maiers JL. Hepatology Highlights. Hepatology 2021; 73:2085-2088. [PMID: 34145622 DOI: 10.1002/hep.31883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
| | | | - Daryl T Y Lau
- Liver Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - Ojasav Sehrawat
- Department of Internal Medicine, Government Medical College, Chandigarh, India
| | - Robert E Schwartz
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY
| | | | - Robert S Brown
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY
| | | | - Enis Kostallari
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | | | - David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY
| | | | - Ravi S Vora
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | - Jessica L Maiers
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
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19
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Hanif H, Ali MJ, Chen HW, Lau DTY, Parthasarathy G, Schwartz RE, Bamidele AO, Wahid NA, Rosenblatt R, Salerno DM, Brown RS, Buckholz A, Taborda C, Wedd J, Kaplan A, Fortune BE, Jalan-Sakrikar N. Hepatology Highlights. Hepatology 2021; 73:877-880. [PMID: 33728693 DOI: 10.1002/hep.31753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
| | | | | | - Daryl T Y Lau
- Liver CenterBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | | | - Robert E Schwartz
- Division of Gastroenterology and HepatologyWeill Cornell Medical CollegeNew YorkNY
| | | | | | - Russell Rosenblatt
- Division of Gastroenterology and HepatologyWeill Cornell Medical CollegeNew YorkNY
| | - David M Salerno
- Department of PharmacyNewYork-Presbyterian HospitalNew YorkNY
| | - Robert S Brown
- Liver CenterBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | | | | | - Joel Wedd
- Division of Digestive DiseasesEmory University School of MedicineAtlantaGA
| | | | - Brett E Fortune
- Division of Gastroenterology and HepatologyWeill Cornell Medical CollegeNew YorkNY
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20
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Buckholz A, Brown RS, Parthasarathy G, Schwartz RE, Allamneni C, Vora RS, Bamidele AO, Salerno DM, Chen HW, Yang L, Lau DTY, Maiers JL, Jalan-Sakrikar N, Wahid NA, Rosenblatt R. Hepatology Highlights. Hepatology 2021; 73:475-478. [PMID: 33586814 DOI: 10.1002/hep.31717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
| | - Robert S Brown
- Division of Gastroenterology and HepatologyWeill Cornell Medical CollegeNew YorkNY
| | | | - Robert E Schwartz
- Division of Gastroenterology and HepatologyWeill Cornell Medical CollegeNew YorkNY
| | | | - Ravi S Vora
- Division of Digestive DiseasesEmory University School of MedicineAtlantaGA
| | | | - David M Salerno
- Department of PharmacyNewYork-Presbyterian HospitalNew YorkNY
| | | | | | - Daryl T Y Lau
- Liver CenterBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | - Jessica L Maiers
- Division of Gastroenterology and HepatologyMayo ClinicRochesterMN
| | | | | | - Russell Rosenblatt
- Division of Gastroenterology and HepatologyWeill Cornell Medical CollegeNew YorkNY
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21
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Hedvat J, Choe JY, Salerno DM, Scheffert JL, Kovac D, Anamisis A, Shertel TL, Lee JH, Liu EC, Lange NW. Managing the significant drug-drug interaction between tacrolimus and letermovir in solid organ transplant recipients. Clin Transplant 2021; 35:e14213. [PMID: 33438781 DOI: 10.1111/ctr.14213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Jessica Hedvat
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jason Y Choe
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jenna L Scheffert
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Danielle Kovac
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Anastasia Anamisis
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Tara L Shertel
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jennifer H Lee
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Esther C Liu
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Nicholas W Lange
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
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22
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Salerno DM, Kovac D, Corbo H, Jennings DL, Lee J, Choe J, Scheffert J, Hedvat J, Chen J, Tsapepas D, Rosenblatt R, Samstein B, Halazun K, Verna E, Pereira M, Brennan C, Husain SA, Mohan S, Brown RS. SARS-CoV-2 infection increases tacrolimus concentrations in solid-organ transplant recipients. Clin Transplant 2021; 35:e14193. [PMID: 33336440 PMCID: PMC7883259 DOI: 10.1111/ctr.14193] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/05/2020] [Accepted: 12/10/2020] [Indexed: 12/24/2022]
Affiliation(s)
- David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Danielle Kovac
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Heather Corbo
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Douglas L Jennings
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA.,Division of Pharmacy Practice, Long Island University, New York, NY, USA
| | - Jennifer Lee
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jason Choe
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jenna Scheffert
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jessica Hedvat
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Justin Chen
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Demetra Tsapepas
- Department of Transplant Surgery, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Russell Rosenblatt
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA
| | - Benjamin Samstein
- Department of Surgery, Division of Transplant Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Karim Halazun
- Department of Surgery, Division of Transplant Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Elizabeth Verna
- Department of Medicine, Division of Digestive & Liver Diseases, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Marcus Pereira
- Department of Medicine, Division of Infectious Disease, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Corey Brennan
- Department of Transplant Surgery, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Syed A Husain
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, NY, USA.,The Columbia University Renal Epidemiology (CURE) Group, New York, NY, USA
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, NY, USA.,The Columbia University Renal Epidemiology (CURE) Group, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Robert S Brown
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA
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23
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Hedvat J, Poladi N, Salerno DM, Dube GK, Lange NW. An evaluation of PJP prophylaxis and anemia among renal transplant recipients. Transpl Infect Dis 2020; 23:e13543. [PMID: 33280205 DOI: 10.1111/tid.13543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/19/2020] [Accepted: 11/29/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Dapone and atovaquone are therapeutic options for PJP prophylaxis in renal transplant recipients. The objective of this study was to evaluate the incidence of anemia in renal transplant recipients receiving these agents. METHODS This is an IRB-approved, retrospective analysis of adult renal transplant recipients who received either dapsone or atovaquone. The primary endpoint was the change in hemoglobin within 90 days of drug initiation. Other endpoints of interest included incidence and management of anemia at multiple time points post-transplant. Categorical variables were compared with Pearson's chi-squared or Fischer's exact test and continuous data were compared utilizing Wilcoxon rank-sum test. Statistical analyses were performed using Stata 14.2. RESULTS A total of 478 patients were screened for inclusion; 50 patients were evaluated in both the dapsone and atovaquone groups. In the dapsone and atovaquone groups, the median age was 52 and 50.5 years, 44% and 42% were Caucasian, and median time to treatment initiation was 27 and 39 days post-transplant, respectively. All patients receiving dapsone had normal G6PD function. There was no difference in baseline hemoglobin between groups (9.7 g/dL vs 9.8 g/dL, P = .83). The median nadir hemoglobin values were 8.6 g/dL and 9.6 g/dL in the dapsone and atovaquone groups, respectively (P = .047). The median decrease in hemoglobin from baseline to nadir was 1.3 g/dL in dapsone patients and 0.2 g/dL in atovaquone patients (P = .001). Dapsone was discontinued in 46% of patients, whereas atovaquone was discontinued in 18% (P = .001). CONCLUSION Among renal transplant recipients with normal G6PD activity, dapsone is associated with greater hemoglobin reductions and rates of drug discontinuation as compared to atovaquone.
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Affiliation(s)
- Jessica Hedvat
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Neha Poladi
- Department of Pharmacy, Wake Forest Baptist Health Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Geoffrey K Dube
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Nicholas W Lange
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
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24
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Lange NW, Hedvat J, Tsapepas DS, Salerno DM. Managing the significant interaction between XR tacrolimus and fluconazole in kidney transplant recipients. Clin Transplant 2020; 34:e14001. [PMID: 32564404 DOI: 10.1111/ctr.14001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Nicholas W Lange
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York
| | - Jessica Hedvat
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York
| | - Demetra S Tsapepas
- Department of Transplant Surgery, New York-Presbyterian Hospital, New York, New York
| | - David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York
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25
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Lange NW, Salerno DM, Berger K, Cushing MM, Brown RS. Management of Hepatic Coagulopathy in Bleeding and Nonbleeding Patients: An Evidence-Based Review. J Intensive Care Med 2020; 36:524-541. [PMID: 32079443 DOI: 10.1177/0885066620903027] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Patients with varying degrees of hepatic dysfunction often present with presumed bleeding diathesis based on interpretation of routine measures of coagulation (prothrombin time [PT], international normalized ratio [INR], and activated partial thromboplastin time). However, standard markers of coagulation do not reflect the actual bleeding risk in this population and may lead to inappropriate administration of hemostatic agents and blood products. The concept of "rebalanced hemostasis" explains both the risk of bleeding and clotting seen in patients with liver dysfunction. The role of pharmacologic agents and blood products for prevention of bleeding during high-risk procedures and treatment of clinically significant bleeding remains unclear. Viscoelastic measurements of the clotting cascade provide information about platelets, fibrinogen/fibrin polymerization, coagulation factors, and fibrinolysis that might better represent hemostasis in vivo and may better inform management strategies. Due to the paucity of available data, firm recommendations for the use of blood products and pharmacologic agents in patients with hepatic coagulopathies are lacking, and thus, these products should not be routinely administered. Traditional laboratory tests such as PT/INR should not be the sole determinant of potential interventions. Rather, clinicians should assess factors such as the severity of bleed or bleeding risk of the procedure, the patient's risk of thromboembolism, and the strength of available evidence for specific agents and blood products to guide decision-making.
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Affiliation(s)
- Nicholas W Lange
- Department of Pharmacy, 25065NewYork-Presbyterian Hospital, New York, NY, USA
| | - David M Salerno
- Department of Pharmacy, 25065NewYork-Presbyterian Hospital, New York, NY, USA
| | - Karen Berger
- Department of Pharmacy, 25065NewYork-Presbyterian Hospital, New York, NY, USA
| | - Melissa M Cushing
- Department of Pathology and Laboratory Medicine, 159947Weill Cornell Medicine, New York, NY, USA
- Department of Anesthesiology, 159947Weill Cornell Medicine, New York, NY, USA
| | - Robert S Brown
- Division of Gastroenterology, Department of Medicine, 159947Weill Cornell Medicine, New York, NY, USA
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26
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Lange NW, Salerno DM, Sammons CM, Jesudian AB, Verna EC, Brown RS. Delayed calcineurin inhibitor introduction and renal outcomes in liver transplant recipients receiving basiliximab induction. Clin Transplant 2018; 32:e13415. [DOI: 10.1111/ctr.13415] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/27/2018] [Accepted: 09/22/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Nicholas W. Lange
- Department of Pharmacy; NewYork-Presbyterian Hospital; New York New York
| | - David M. Salerno
- Department of Pharmacy; NewYork-Presbyterian Hospital; New York New York
| | - Chelsea M. Sammons
- Department of Pharmacy; NewYork-Presbyterian Hospital; New York New York
| | - Arun B. Jesudian
- Division of Gastroenterology and Hepatology, Department of Medicine; Weill Cornell Medical College; New York New York
| | - Elizabeth C. Verna
- Center for Liver Disease and Transplantation, Division of Digestive and Liver Diseases, Department of Medicine; Columbia University Irving Medical Center; New York New York
| | - Robert S. Brown
- Division of Gastroenterology and Hepatology, Department of Medicine; Weill Cornell Medical College; New York New York
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27
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Lange NW, Salerno DM, Berger K, Tsapepas DS. Using known drug interactions to manage supratherapeutic calcineurin inhibitor concentrations. Clin Transplant 2017; 31. [PMID: 28856745 DOI: 10.1111/ctr.13098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2017] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To summarize the available body of evidence guiding the management of supratherapeutic concentrations of calcineurin inhibitors (CNI) using cytochrome P450 (CYP450) enzyme inducers. METHODS A nondate restricted literature search within MEDLINE, Embase, and Scopus was performed using the terms "cyclosporine," "tacrolimus," "calcineurin inhibitor," "toxicity," "pharmacokinetics," "carbamazepine," "rifampin," "phenytoin," and "phenobarbital." Additional references were identified from a review of all included citations. All English-language reports that describe the management of supratherapeutic CNI concentrations with interventions targeting metabolic induction using CYP450 enzyme inducers were evaluated. RESULTS A total of 10 publications were identified in which a CYP450 enzyme inducer was utilized intentionally to enhance CNI clearance in the setting of supratherapeutic concentrations; 7 case reports describe the use of phenytoin and 3 case reports describe the use of phenobarbital. Patient demographics, dosing strategies employed, and reported efficacy across this series of publications are heterogeneous; however, both agents appear to be well-tolerated when used in this setting. CONCLUSIONS There is a paucity of published data on the use of CYP450 enzyme inducers for the management of supratherapeutic CNI concentrations. While routine use of this approach cannot be recommended, thorough risk-benefit analyses should be performed in the management of each such clinical scenario.
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Affiliation(s)
- Nicholas W Lange
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Karen Berger
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Demetra S Tsapepas
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA.,Division of Abdominal Transplantation, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
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Sabato LA, Salerno DM, Moretz JD, Jennings DL. Inhaled Pulmonary Vasodilator Therapy for Management of Right Ventricular Dysfunction after Left Ventricular Assist Device Placement and Cardiac Transplantation. Pharmacotherapy 2017; 37:944-955. [DOI: 10.1002/phar.1959] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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)
- Leah A. Sabato
- Heart Failure and Cardiac Transplantation; Department of Pharmacy; UC Health-University of Cincinnati Medical Center; Cincinnati Ohio
| | - David M. Salerno
- Solid Organ Transplantation; Department of Pharmacy; NewYork-Presbyterian Hospital - Weill Cornell Medical Center; New York New York
| | - Jeremy D. Moretz
- Ventricular Assist Devices; Department of Pharmacy; Vanderbilt University Medical Center; Nashville Tennessee
| | - Douglas L. Jennings
- Heart Transplant and Mechanical Circulatory Support; Department of Pharmacy; New York-Presbyterian Hospital - Columbia University Medical Center; New York NY
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Salerno DM, Tsapepas D, Papachristos A, Chang JH, Martin S, Hardy MA, McKeen J. Direct oral anticoagulant considerations in solid organ transplantation: A review. Clin Transplant 2016; 31. [PMID: 27859621 DOI: 10.1111/ctr.12873] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2016] [Indexed: 12/17/2022]
Abstract
For more than 60 years, warfarin was the only oral anticoagulation agent available for use in the United States. In many recent clinical trials, several direct oral anticoagulants (DOACs) demonstrated similar efficacy with an equal or superior safety profile, with some other notable benefits. The DOACs have lower inter- and intrapatient variability, much shorter half-lives, and less known drug-drug and drug-food interactions as compared to warfarin. Despite these demonstrated benefits, the use of DOACs has not gained uniform acceptance because of lack of supportive data in special patient populations, including recipients of solid organ transplants maintained on immunosuppression. This review describes the properties of several novel DOACs including their pharmacology and mechanisms of action as they relate to use among solid organ transplant recipients. We have particularly focused on (i) dosing in patients with impaired renal and hepatic function; (ii) considerations for drug-drug interactions with immunosuppressive medications; and (iii) management of the anticoagulated patients at the time of unplanned surgery. The risks and benefits of the use of DOACs in solid organ transplant recipients should be carefully evaluated prior to the introduction of these agents in this highly distinct patient population.
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Affiliation(s)
- David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Demetra Tsapepas
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA.,Department of Surgery, Division of Abdominal Transplantation, Columbia University Medical Center, New York, NY, USA
| | | | - Jae-Hyung Chang
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, NY, USA
| | - Spencer Martin
- Department of Pharmacy, Hartford Hospital, Hartford, CT, USA
| | - Mark A Hardy
- Department of Surgery, Division of Abdominal Transplantation, Columbia University Medical Center, New York, NY, USA
| | - Jaclyn McKeen
- Department of Pharmacy, Hackensack University Medical Center, Hackensack, NJ, USA
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Abstract
Several types of supraventricular tachyarrhythmias occur commonly during intensive care. The specific type can usually be diagnosed using standard electrocardiographic techniques. Several new drugs have significantly improved the ability to successfully manage these arrhythmias.
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Affiliation(s)
- D M Salerno
- University of Minnesota Medical School-Minneapolis
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31
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So JY, Wahler J, Das Gupta S, Salerno DM, Maehr H, Uskokovic M, Suh N. HES1-mediated inhibition of Notch1 signaling by a Gemini vitamin D analog leads to decreased CD44(+)/CD24(-/low) tumor-initiating subpopulation in basal-like breast cancer. J Steroid Biochem Mol Biol 2015; 148:111-21. [PMID: 25541438 PMCID: PMC4361253 DOI: 10.1016/j.jsbmb.2014.12.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 06/25/2014] [Revised: 12/05/2014] [Accepted: 12/18/2014] [Indexed: 01/05/2023]
Abstract
Tumor-initiating cells (also known as cancer stem cells) are the subpopulation of cells shown to be responsible for tumor initiation, maintenance and recurrence. In breast cancer, CD44(+)/CD24(-/low) cells were identified as tumor-initiating cells. We previously reported that a Gemini vitamin D analog, 1,25-dihydroxy-20R-21(3-hydroxy-3-deuteromethyl-4,4,4-trideuterobutyl)-23-yne-26,27-hexafluoro-cholecalciferol (BXL0124), reduced CD44(+)/CD24(-/low) cells in MCF10DCIS basal-like breast cancer cells. Since Notch has been identified as one of the key signaling pathways involved in breast cancer stem cells, the effect of BXL0124 on the Notch signaling pathway was investigated in breast cancer. The CD44(+)/CD24(-/low) subpopulation of MCF10DCIS cells showed elevated Notch1 signaling and increased cell proliferation compared to the CD44(+)/CD24(high) subpopulation. Treatment with the Gemini vitamin D analog BXL0124 decreased the level of activated Notch1 receptor. In addition, mRNA and protein levels of the Notch ligands, Jagged-1, Jagged-2 and DLL1, were significantly reduced by treatment with BXL0124, which was followed by repression of c-Myc, a key downstream target of Notch signaling. Interestingly, HES1, a known downstream target of Notch signaling, was rapidly induced by treatment with BXL0124. The inhibitory effect of BXL0124 on Notch signaling was reversed by knockdown of HES1. Overexpression of HES1 inhibited Notch1 signaling and reduced the CD44(+)/CD24(-/low) subpopulation, confirming a role of HES1 in Notch1 signaling. In conclusion, the Gemini vitamin D analog, BXL0124, represses the tumor-initiating subpopulation by HES1-mediated inhibition of Notch1 signaling. The present study demonstrates BXL0124 as a potent inhibitor of Notch signaling to target tumor-initiating cells in basal-like breast cancer. This article is part of a Special Issue entitled "17th Vitamin D Workshop".
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MESH Headings
- Apoptosis/drug effects
- Basic Helix-Loop-Helix Transcription Factors/antagonists & inhibitors
- Basic Helix-Loop-Helix Transcription Factors/genetics
- Basic Helix-Loop-Helix Transcription Factors/metabolism
- Blotting, Western
- Breast Neoplasms/drug therapy
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- CD24 Antigen/metabolism
- Calcitriol/analogs & derivatives
- Calcitriol/pharmacology
- Carcinoma, Basal Cell/drug therapy
- Carcinoma, Basal Cell/metabolism
- Carcinoma, Basal Cell/pathology
- Cell Proliferation/drug effects
- Female
- Flow Cytometry
- Homeodomain Proteins/antagonists & inhibitors
- Homeodomain Proteins/genetics
- Homeodomain Proteins/metabolism
- Humans
- Hyaluronan Receptors/metabolism
- Microscopy, Fluorescence
- Neoplastic Stem Cells/drug effects
- Neoplastic Stem Cells/metabolism
- Neoplastic Stem Cells/pathology
- RNA, Messenger/genetics
- RNA, Small Interfering/genetics
- Real-Time Polymerase Chain Reaction
- Receptor, Notch1/antagonists & inhibitors
- Receptor, Notch1/genetics
- Receptor, Notch1/metabolism
- Receptors, Calcitriol/antagonists & inhibitors
- Receptors, Calcitriol/genetics
- Receptors, Calcitriol/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
- Transcription Factor HES-1
- Tumor Cells, Cultured
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Affiliation(s)
- Jae Young So
- Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Joseph Wahler
- Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Soumyasri Das Gupta
- Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - David M Salerno
- Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Hubert Maehr
- Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Milan Uskokovic
- Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Nanjoo Suh
- Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
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So JY, Salerno DM, Maehr H, Uskokovic M, Suh N. Abstract 1248: The Gemini vitamin D analogue BXL0124 inhibits Notch signaling via HES1, resulting in the reduction of CD44+/CD24-/low subpopulation and proliferation of MCF10DCIS cells. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-1248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Activation of Notch signaling is correlated with poor prognosis and decreased survival of breast cancer patients. Recent studies reported that Notch signaling plays an important role for the maintenance of tumor-initiating cells in breast cancer. Using MCF10DCIS.com human breast cancer cells (MCF10DCIS), which contain tumor-initiating subpopulation (CD44+/CD24-/low), we demonstrated that the Gemini vitamin D analog, BXL0124, reduced the tumor-initiating subpopulation in vitro and repressed the growth of MCF10DCIS xenograft tumors in vivo. In the present study, we investigated Notch signaling in CD44+/CD24-/low and CD44+/CD24+ subpopulations of MCF10DCIS cells and determined whether BXL0124 represses tumor-initiating subpopulation of breast cancer by targeting Notch signaling. CD44+/CD24-/low subpopulation showed higher Notch1 activation and cell proliferation than CD44+/CD24+ subpopulation in MCF10DCIS cells. To investigate the effects of BXL0124 on Notch signaling, the protein levels of Notch receptors and their ligands were determined. BXL0124 decreased activated Notch1 (c-Notch1) as well as its ligands, Jagged1, Jagged2 and DLL1. However, total Notch1 was not affected by BXL0124, suggesting that BXL0124 inhibits Notch signaling by decreasing Notch ligands. A downstream target of Notch signaling, cMyc, and cell proliferation were reduced by BXL0124. The inhibition of Notch1 activation by BXL0124 was blocked with knock-down of the vitamin D receptor (VDR), indicating that it is a VDR-dependent event. In a time course study, the effects of BXL0124 on the mRNA expression of Notch1, Notch ligands and downstream targets were investigated. BXL0124 decreased the mRNA levels of Jagged1, Jagged2 and DLL1 starting at 8 h which followed by the repression of cMyc mRNA at 16 h. The mRNA level of a transcriptional repressor HES1, which is a key downstream target of Notch signaling, was rapidly induced by BXL0124 as early as 30 min. To determine the involvement of HES1 in Notch signaling, both knock-down and overexpression of HES1 were performed by using HES1 siRNA and HES1-expression vector, respectively. The inhibition of Notch signaling by BXL0124 was reversed by the knock-down of HES1, while the overexpression of HES1 inhibited Notch activation, reduced CD44+/CD24-/low population and decreased cell proliferation of MCF10DCIS cells. These results suggest that HES1 functions as a repressor of Notch signaling, and BXL0124 inhibits Notch signaling in a HES1-dependent manner. The present study demonstrates that BXL0124 inhibits Notch signaling by rapid induction of HES1 which results in the reduction of CD44+/CD24-/low subpopulation and proliferation of MCF10DCIS cells. Our study suggests the Gemini vitamin D analog, BXL0124, as a potential agent to repress the tumor-initiating subpopulation of breast cancer by targeting Notch signaling.
Citation Format: Jae Young So, David M. Salerno, Hubert Maehr, Milan Uskokovic, Nanjoo Suh. The Gemini vitamin D analogue BXL0124 inhibits Notch signaling via HES1, resulting in the reduction of CD44+/CD24-/low subpopulation and proliferation of MCF10DCIS cells. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1248. doi:10.1158/1538-7445.AM2014-1248
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Affiliation(s)
- Jae Young So
- Rutgers, the State University of New Jersey, Piscataway, NJ
| | | | - Hubert Maehr
- Rutgers, the State University of New Jersey, Piscataway, NJ
| | | | - Nanjoo Suh
- Rutgers, the State University of New Jersey, Piscataway, NJ
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Salerno DM, Murakami MM, Johnston RB, Keyler DE, Pentel PR. Reversal of flecainide-induced ventricular arrhythmia by hypertonic sodium bicarbonate in dogs. Am J Emerg Med 1995; 13:285-93. [PMID: 7755819 DOI: 10.1016/0735-6757(95)90201-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Flecainide occasionally produces incessant ventricular tachycardia that is difficult to treat. Reports of uncontrolled clinical studies have suggested a therapeutic role for hypertonic sodium bicarbonate (NaHCO3). To test this observation, spontaneous and pacing-induced arrhythmia canine models were designed. In the spontaneous model, flecainide was infused at 0.5 mg/kg/min until ventricular tachycardia occurred spontaneously. In the pacing-induced model, flecainide was infused at 1.0 mg/kg/min load (0.5 mg/kg/min maintenance) stepwise until the QRS was widened 50%, 75%, and 100%, with programmed ventricular stimulation at each step until ventricular arrhythmia was induced. Dogs who developed spontaneous arrhythmia were treated blindly with three doses of either NaHCO3 (3 mEq/kg/dose, with 1 minute between doses) or normal saline. Dogs who were induced in the second model were treated with the same three doses, 10 minutes apart, with programmed stimulation between each dose. Before unblinding in both protocols, dogs were classified as "responders" or "nonresponders" to therapy. In the spontaneous model, of 14 dogs with spontaneous ventricular tachycardia, all 7 dogs treated with NaHCO3 showed response, compared with only 1 of 7 dogs treated with saline (P < .01). Ventricular QRS complexes/min were reduced by NaHCO3 in that protocol. In the induced arrhythmia protocol, of 14 dogs with inducible arrhythmia, 6 of 7 responded to NaHCO3, and 1 of 7 responded to placebo (P < .05). In both protocols, arterial pH and the serum sodium concentration were increased by NaHCO3 but not by normal saline control treatment. QRS interval duration was shortened by NaHCO3 therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D M Salerno
- Division of Cardiology, Hennepin County Medical Center, University of Minnesota, Minneapolis, USA
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34
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Crow RS, Hannan P, Jacobs D, Hedquist L, Salerno DM. Relationship between
Seismocardiogram and
Echocardiogram for Events in
the Cardiac Cycle. ACTA ACUST UNITED AC 1994. [DOI: 10.1159/000470156] [Citation(s) in RCA: 103] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Cocaine can cause myocardial ischemia or infarction. The incidence of these events, and the influence of specific dosing routes or regimens on their occurrence is not established. In the current study, we obtained frequent 12-lead electrocardiograms (ECGs) and continuous 2 or 3 channel ECGs from 20 subjects participating in a behavioral study of smoked cocaine. Subjects received 10 or 11 doses of cocaine 0.4 mg/kg per dose, or 10 doses of 35 mg per dose at 30 min intervals (range 233-408 mg total dose per session). ECGs were also recorded on control days on which subjects received no cocaine. The mean peak plasma cocaine concentration on cocaine days was 640 +/- 262 ng/ml. There were no changes in digitized ST segment amplitude on 12-lead ECGs obtained during cocaine administration (P = 0.098). Of 17 subjects who had technically satisfactory continuous ECGs, four had significant ST segment depression (> 1 mm below the PR segment); two on cocaine days and two on control days (P > 0.5). One subject had frequent premature beats on both cocaine and control days. One subject had an asymptomatic run of 4 ventricular beats 30 s after cocaine administration that could have been due to cocaine. All episodes of ST depression or premature beats were asymptomatic. No evidence of either symptomatic or subclinical cardiac ischemia related to cocaine administration was found. Thus no clinically important adverse events were found as a result of smoked cocaine administered by this dosing regimen to healthy males with a history of heavy cocaine use. Additional study with larger numbers of subjects will be helpful in further assessing the safety of administering smoked cocaine to research subjects.
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Affiliation(s)
- P R Pentel
- Division of Clinical Pharmacology and Toxicology, Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis 55415
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36
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Roberts SA, Diaz C, Nolan PE, Salerno DM, Stapczynski JS, Zbrozek AS, Ritz EG, Bauman JL, Vlasses PH. Effectiveness and costs of digoxin treatment for atrial fibrillation and flutter. Am J Cardiol 1993; 72:567-73. [PMID: 8362772 DOI: 10.1016/0002-9149(93)90353-e] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.5] [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: 01/30/2023]
Abstract
Clinical outcomes and costs associated with the use of digoxin in atrial fibrillation and flutter were evaluated in a prospective, observational study at 18 academic medical centers in the United States. Data were collected on 115 patients (aged > 18 years) with atrial fibrillation or flutter who were treated with digoxin for rapid ventricular rate (> or = 120 beats/min). The median time to ventricular rate control (i.e., resting ventricular rate < 100 beats/min, decrease in ventricular rate of > 20%, or sinus rhythm) was 11.6 hours from the first dose of digoxin for all evaluable patients (n = 105) and 9.5 hours for those only receiving digoxin (n = 64). Before ventricular rate control, the mean +/- SD dose of digoxin administered was 0.80 +/- 0.74 mg, and a mean of 1.4 +/- 1.8 serum digoxin concentrations were ordered per patient. Concomitant beta-blocker or calcium antagonist therapy was instituted in 47 patients (41%); in 19 of these, combination therapy was initiated within 2 hours. Adenosine was administered to 13 patients (11%). Patients spent a median of 4 days (range 1 to 25) in the hospital; 28% spent time in a coronary/intensive care unit and 79% in a telemetry bed. Loss of control (i.e., resting ventricular rate returned to > 120 beats/min) occurred at least once in 50% of patients and was associated with a longer hospital stay (p < 0.05). Based on 1991 data, the estimated mean hospital bed cost for patients with atrial fibrillation or flutter was $3,169 +/- $3,174.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S A Roberts
- Chicago College of Pharmacy, University of Illinois
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37
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Salerno DM, Katz A, Dunbar DN, Fjeldos-Sperbeck K. Serum electrolytes and catecholamines after cardioversion from ventricular tachycardia and atrial fibrillation. Pacing Clin Electrophysiol 1993; 16:1862-71. [PMID: 7692419 DOI: 10.1111/j.1540-8159.1993.tb01821.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [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: 01/26/2023]
Abstract
We have observed hypokalemia after cardioversion from spontaneous out-of-hospital ventricular fibrillation and induced ventricular tachycardia. To test the hypothesis that the hormone response to the hemodynamic stress of the arrhythmia initiated the change in potassium, we compared the electrolytes and hormones in three groups of patients. We observed a decrease in serum potassium and magnesium after cardioversion from ventricular tachycardia induced by programmed stimulation, but not after normal programmed stimulation of the ventricle or after cardioversion from stable atrial fibrillation. These changes were preceded first by a rise in norepinephrine and epinephrine, then a rise in glucose, followed by a rise in insulin. The stimulus for these changes was probably the hypotension associated with ventricular tachycardia. The sequence of changes suggests that the decrease of potassium and magnesium after ventricular tachycardia was due to a shift of the electrolytes into cells, related to the insulin-mediated movement of glucose from the blood into cells.
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Affiliation(s)
- D M Salerno
- Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis
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Abstract
Although quinidine, the oldest class I antiarrhythmic drug, has been available for several decades, recent reports have emphasized the possibility of dangerous side effects. Quinidine often successfully maintains sinus rhythm in patients with intermittent atrial fibrillation, suppresses sustained ventricular tachycardia in some patients, and minimally depresses left ventricular function. However, it can cause nonfatal and, occasionally, even fatal proarrhythmic complications. Therefore, it must be administered with caution in appropriately selected patients.
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Affiliation(s)
- D M Salerno
- University of Minnesota Medical School, Minneapolis
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40
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Salerno DM, Zanetti JM, Poliac LC, Crow RS, Hannan PJ, Wang K, Goldenberg IF, Van Tassel RA. Exercise Seismocardiography
for Detection of Coronary
Artery Disease. ACTA ACUST UNITED AC 1992. [DOI: 10.1159/000470383] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Bank AJ, Sharkey SW, Goldsmith SR, Salerno DM, Asinger RW. Atypical systolic clicks produced by prolapsing mitral valve masses. Am J Cardiol 1992; 69:1491-4. [PMID: 1590244 DOI: 10.1016/0002-9149(92)90910-q] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- A J Bank
- Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
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Abstract
The Cardiac Arrhythmia Suppression Trial (CAST) was a study designed to test the hypothesis that suppression of ventricular premature complexes after a myocardial infarction would improve survival. Preliminary results showed that suppression of ventricular premature complexes with encainide and flecainide worsened survival, and the CAST continued as the CAST-II with moricizine compared with its placebo. The protocol for the CAST-II was changed to attempt to enroll patients more likely to experience serious arrhythmias. The enrollment time was narrowed to 4 to 90 days after myocardial infarction; the qualifying ejection fraction was lowered to less than or equal to 0.40; a higher dose of moricizine could be used; early titration itself was double-blind with a placebo, and the definition of disqualifying ventricular tachycardia was changed to allow patients with more serious arrhythmias to be entered into the trial. The Cardiac Arrhythmia Suppression Trial-II was subsequently terminated prematurely because 1) patients treated with moricizine had an excessive cardiac mortality rate during the 1st 2 weeks of exposure to the drug, and 2) there appeared to be little chance of showing a long-term survival benefit from treatment with moricizine. This report outlines the rationale behind the Cardiac Arrhythmia Suppression Trial and the reasons for selection of the drugs used in the CAST and CAST-II.
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Affiliation(s)
- H L Greene
- Department of Medicine, University of Washington, Seattle
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Abstract
Seismocardiography is a new noninvasive technique for recording cardiac vibrations. Changes in the recorded waves have been correlated with acute and chronic changes in left ventricular function. In this report, we describe a patient who developed ischemia induced by coronary angiography in the cardiac catheterization laboratory. The patient's seismocardiogram showed distinct changes during the ischemic episode that actually preceded the onset of symptoms and resolved after nitroglycerin therapy. The patient's seismocardiographic recordings were significantly different from the recordings from five control individuals. This observation suggests that seismocardiography may be helpful for monitoring left ventricular function during episodes of myocardial ischemia.
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Affiliation(s)
- D M Salerno
- Department of Medicine, University of Minnesota, Hennepin County Medical Center, Minneapolis
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45
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Denes P, Gillis AM, Pawitan Y, Kammerling JM, Wilhelmsen L, Salerno DM. Prevalence, characteristics and significance of ventricular premature complexes and ventricular tachycardia detected by 24-hour continuous electrocardiographic recording in the Cardiac Arrhythmia Suppression Trial. CAST Investigators. Am J Cardiol 1991; 68:887-96. [PMID: 1718158 DOI: 10.1016/0002-9149(91)90404-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.5] [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: 12/28/2022]
Abstract
The prevalence, characteristics and significance of ventricular arrhythmias detected by ambulatory electrocardiography were evaluated in 1,498 patients who were randomized to encainide, flecainide or placebo in the Cardiac Arrhythmia Suppression Trial. The mean ventricular premature complex (VPC) frequency at baseline was 133 +/- 257 VPCs/hour. Nonsustained ventricular tachycardia (VT) (rate greater than or equal to 120 beats/min) was present in 22% of patients. Accelerated idioventricular rhythm (rate less than 120 beats/min) occurred in 22% of subjects. There were 63 deaths/resuscitated cardiac arrests in the active treatment (encainide/flecainide) group and 26 in the placebo group. In the treatment group mortality increased with increasing VPC frequency, (p = 0.006), whereas in the placebo group such a relation was not present. Mortality/resuscitated cardiac arrest increased in patients with greater than or equal to 2 VT episodes than in those with less than or equal to 1 episode in the active treatment group (p = 0.04). There was no significant association between VT and mortality/resuscitated cardiac arrest in the placebo group. The presence of accelerated idioventricular rhythm was not associated with increased mortality/resuscitated cardiac arrest in either the active treatment or placebo groups. However, mortality was lower in patients with accelerated idioventricular rhythm rates less than 100 beats/min than in those with rates greater than or equal to 100 beats/min (p = 0.05). Thus, in the Cardiac Arrhythmia Suppression Trial the previously described association between mortality/resuscitated cardiac arrest and ventricular arrhythmias (VPC and VT) were only observed in the active treatment group. In addition, based on the results obtained in this highly selected population, it is suggested that the definition of accelerated idioventricular rhythm should be a rate less than 100 beats/min, and at a rate greater than or equal to 100 beats/min it should be categorized as VT.
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Affiliation(s)
- P Denes
- St. Paul-Ramsey Medical Center, Minnesota
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46
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Salerno DM, Zanetti JM, Green LA, Mooney MR, Madison JD, Van Tassel RA. Seismocardiographic changes associated with obstruction of coronary blood flow during balloon angioplasty. Am J Cardiol 1991; 68:201-7. [PMID: 2063782 DOI: 10.1016/0002-9149(91)90744-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.3] [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: 12/30/2022]
Abstract
Seismocardiography, a new noninvasive technique, detects low-frequency cardiac vibrations on the chest wall during ventricular contraction and during both early and late ventricular filling. To evaluate the ability of seismocardiography to detect ischemia caused by decreased coronary blood flow, 35 patients were studied during coronary angioplasty. Seismocardiograms and electrocardiograms were recorded twice at baseline, with the catheter across the lesion before first inflation (n = 15), every 30 seconds during the first inflation, 1 and 2 minutes after the first inflation and greater than or equal to 5 minutes after the final inflation. For comparison, sequential seismocardiograms were also obtained from 15 healthy volunteers. Electrocardiograms were blindly scored for ST change from baseline (0 = none, 1 = 0.5 mm ST depression, 2 = greater than or equal to 1.0 mm ST depression, 3 = ST elevation). Seismocardiograms were blindly scored for change from baseline (0 = none, 1 = mild, 2 = moderate, 3 = marked) for both the systolic and diastolic waves. The average maximal systolic seismocardiographic score was 2.5 +/- 0.8 for patients who had undergone angioplasty and 1.0 +/- 0.9 for volunteers (p less than 0.001). The average maximal diastolic seismocardiographic score was 2.3 +/- 0.8 for angioplasty patients and 0.7 +/- 0.9 for volunteers (p less than 0.001). The percentage of angioplasty patients with electrocardiographic, systolic and diastolic seismocardiographic scores greater than or equal to 2 was, respectively: 0, 11 and 14% at second baseline; 23, 67 and 53% with catheter across the lesion; 44, 75 and 59% after 30 seconds of inflation; 42, 71 and 61% after 60 seconds of inflation; 23, 74 and 61% after 1 minute of deflation; and 0, 71 and 47% 5 minutes after final inflation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D M Salerno
- Hennepin County Medical Center, Cardiology Division, Minneapolis, Minnesota 55415
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47
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Keyler DE, Salerno DM, Murakami MM, Ruth G, Pentel PR. Rapid administration of high-dose human antibody Fab fragments to dogs: pharmacokinetics and toxicity. Fundam Appl Toxicol 1991; 17:83-91. [PMID: 1916083 DOI: 10.1016/0272-0590(91)90241-u] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The treatment of drug overdose with drug-specific antibody fragments may require very high antibody doses. To address the feasibility of this therapy, we studied the pharmacokinetics and toxicity of high-dose human nonspecific Fab fragments in beagles. Three dogs received 5.3 g/kg Fab iv over 1 hr. Because nephrotoxicity was observed, three subsequent dogs received 3.2 g/kg. The fraction of the Fab dose excreted in urine (10 +/- 6%) was lower than reported values for either high or low doses of Fab in other species. The terminal serum elimination half-life (42 hr for the higher and 48 hr for the lower dose) was also longer than reported values for other species, due to lower renal and nonrenal Fab clearance. Fab administration was tolerated without adverse hemodynamic effects. One of three dogs at each dose developed transient oliguria. All dogs developed a transient but marked increase in the serum creatinine concentration. At 2 weeks creatinine clearance had returned to normal. Urinary protein and albumin excretion at 2 weeks were within the normal range for dogs but were increased over their baseline values. The histology of all organs was normal at 3 weeks by light microscopy, and renal histology by electron microscopy was also normal. The mechanism of Fab nephrotoxicity, not observed previously with high-dose Fab in rats or lower doses of Fab in other species including dogs, is not clear. These data suggest that further study of the potential toxicity of high-dose Fab, and its reversibility, is needed to assess the feasibility of treating drug overdose with this antibody fragment.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D E Keyler
- Department of Medicine, University of Minnesota Medical School, Minneapolis 55415
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48
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Salerno DM, Euinger A, Hodges M. The electrocardiographic effects of encainide, flecainide, and moricizine in a subgroup of the cardiac arrhythmia suppression trial. J Am Coll Cardiol 1991. [DOI: 10.1016/0735-1097(91)91191-g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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49
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Crow R, Salerno DM, Hunnan P, Zanetti JM. Seismocardiography for measurement of left ventricular performance at rest and immediately post exercise. J Am Coll Cardiol 1991. [DOI: 10.1016/0735-1097(91)92374-u] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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50
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Salerno DM, Fifield J, Farmer C, Hodges M. Pirmenol: an antiarrhythmic drug with unique electrocardiographic features--a double-blind placebo-controlled comparison with quinidine. Clin Cardiol 1991; 14:25-32. [PMID: 2019027 DOI: 10.1002/clc.4960140107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 12/29/2022] Open
Abstract
Previous reports have stated that pirmenol is a Class IA antiarrhythmic drug that prolongs the QT interval, but did not use computerized electrocardiography. We randomized 18 patients with frequent ventricular ectopic depolarizations to pirmenol (8 patients) or quinidine (10 patients). Pirmenol was effective and tolerated for suppression of arrhythmia in all 7 patients treated (1 patient withdrew for personal reasons) but quinidine was effective and tolerated for 4 weeks in only 5 of 10 patients (p less than 0.05). Using computerized 12-lead electrocardiography, the mean change in PR interval from placebo to treatment was 5 +/- 18 ms for quinidine and 5 +/- 11 ms for pirmenol (p = NS). The mean change in QRS interval was 5 +/- 14 ms for quinidine and 10 +/- 5 ms for pirmenol (p = NS). The mean change in QT interval was 46 +/- 30 ms for quinidine and 8 +/- 9 ms for pirmenol (p less than 0.01) and the mean change in JT interval was 41 +/- 36 ms for quinidine and -2 +/- 10 ms for pirmenol (p less than 0.01). After the double-blind phase, 4 quinidine patients had computerized electrocardiographic intervals measured on pirmenol; the above findings were confirmed. These electrocardiographic features of pirmenol clearly distinguish it from quinidine, the prototype Class IA drug. However, pirmenol has minimal effect on the PR and QRS intervals, and thus does not appear to be a Class IC drug either. Although its electrocardiographic features are closest to Class IB, its electrophysiology in isolated cells and its antiarrhythmic and side effect profile are atypical for a IB agent.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D M Salerno
- Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis 55415
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