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Li S, López DB, Di Capua J, Reid NJ, An T, Som A, Daye D, Walker TG. Predictors for Non-Home Patient Discharge Following Lower Extremity Arterial Interventions. J Vasc Interv Radiol 2022; 33:987-992. [DOI: 10.1016/j.jvir.2022.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/14/2022] [Accepted: 04/22/2022] [Indexed: 10/18/2022] Open
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Dmitrieva NI, Walts AD, Nguyen DP, Grubb A, Zhang X, Wang X, Ping X, Jin H, Yu Z, Yu ZX, Yang D, Schwartzbeck R, Dalgard CL, Kozel BA, Levin MD, Knutsen RH, Liu D, Milner JD, López DB, O'Connell MP, Lee CCR, Myles IA, Hsu AP, Freeman AF, Holland SM, Chen G, Boehm M. Impaired angiogenesis and extracellular matrix metabolism in autosomal-dominant hyper-IgE syndrome. J Clin Invest 2021; 130:4167-4181. [PMID: 32369445 DOI: 10.1172/jci135490] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/09/2019] [Accepted: 04/29/2020] [Indexed: 12/21/2022] Open
Abstract
There are more than 7000 described rare diseases, most lacking specific treatment. Autosomal-dominant hyper-IgE syndrome (AD-HIES, also known as Job's syndrome) is caused by mutations in STAT3. These patients present with immunodeficiency accompanied by severe nonimmunological features, including skeletal, connective tissue, and vascular abnormalities, poor postinfection lung healing, and subsequent pulmonary failure. No specific therapies are available for these abnormalities. Here, we investigated underlying mechanisms in order to identify therapeutic targets. Histological analysis of skin wounds demonstrated delayed granulation tissue formation and vascularization during skin-wound healing in AD-HIES patients. Global gene expression analysis in AD-HIES patient skin fibroblasts identified deficiencies in a STAT3-controlled transcriptional network regulating extracellular matrix (ECM) remodeling and angiogenesis, with hypoxia-inducible factor 1α (HIF-1α) being a major contributor. Consistent with this, histological analysis of skin wounds and coronary arteries from AD-HIES patients showed decreased HIF-1α expression and revealed abnormal organization of the ECM and altered formation of the coronary vasa vasorum. Disease modeling using cell culture and mouse models of angiogenesis and wound healing confirmed these predicted deficiencies and demonstrated therapeutic benefit of HIF-1α-stabilizing drugs. The study provides mechanistic insights into AD-HIES pathophysiology and suggests potential treatment options for this rare disease.
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Affiliation(s)
- Natalia I Dmitrieva
- Laboratory of Cardiovascular Regenerative Medicine, Translational Vascular Medicine Branch
| | - Avram D Walts
- Laboratory of Cardiovascular Regenerative Medicine, Translational Vascular Medicine Branch
| | - Dai Phuong Nguyen
- Laboratory of Cardiovascular Regenerative Medicine, Translational Vascular Medicine Branch
| | - Alex Grubb
- Laboratory of Cardiovascular Regenerative Medicine, Translational Vascular Medicine Branch
| | - Xue Zhang
- Bioinformatics and Systems Biology Core, and
| | - Xujing Wang
- Bioinformatics and Systems Biology Core, and
| | - Xianfeng Ping
- Laboratory of Cardiovascular Regenerative Medicine, Translational Vascular Medicine Branch
| | - Hui Jin
- Laboratory of Cardiovascular Regenerative Medicine, Translational Vascular Medicine Branch
| | - Zhen Yu
- Laboratory of Cardiovascular Regenerative Medicine, Translational Vascular Medicine Branch
| | - Zu-Xi Yu
- Pathology Core, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, Maryland, USA
| | - Dan Yang
- Laboratory of Cardiovascular Regenerative Medicine, Translational Vascular Medicine Branch
| | - Robin Schwartzbeck
- Laboratory of Cardiovascular Regenerative Medicine, Translational Vascular Medicine Branch
| | - Clifton L Dalgard
- Department of Anatomy, Physiology & Genetics.,The American Genome Center, and.,Collaborative Health Initiative Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Beth A Kozel
- Laboratory of Vascular and Matrix Genetics, NHLBI
| | - Mark D Levin
- Laboratory of Vascular and Matrix Genetics, NHLBI
| | | | - Delong Liu
- Laboratory of Vascular and Matrix Genetics, NHLBI
| | - Joshua D Milner
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases (NIAID)
| | - Diego B López
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases (NIAID)
| | - Michael P O'Connell
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases (NIAID)
| | - Chyi-Chia Richard Lee
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute (NCI), and
| | - Ian A Myles
- Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, Maryland, USA
| | - Amy P Hsu
- Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, Maryland, USA
| | - Alexandra F Freeman
- Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, Maryland, USA
| | - Steven M Holland
- Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, Maryland, USA
| | - Guibin Chen
- Laboratory of Cardiovascular Regenerative Medicine, Translational Vascular Medicine Branch
| | - Manfred Boehm
- Laboratory of Cardiovascular Regenerative Medicine, Translational Vascular Medicine Branch
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Di Capua J, Reid NJ, Som A, An T, López DB, So AJ, Di Capua C, Walker GT. The Effect of Preoperative Renal Failure on Outcomes Following Infrainguinal Endovascular Interventions for Peripheral Arterial Disease. J Vasc Interv Radiol 2020; 32:459-465. [PMID: 33386206 DOI: 10.1016/j.jvir.2020.10.020] [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] [Received: 07/26/2020] [Revised: 09/24/2020] [Accepted: 10/19/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To analyze the effect of a patient's renal failure status on acute outcomes after lower extremity endovascular interventions for peripheral artery disease. MATERIALS AND METHODS A retrospective analysis of the American College of Surgery National Surgical Quality Improvement Program database from 2014 to 2017 was conducted. Patients were included based on current procedural terminology codes. They were divided into renal failure cohorts. Six thousand seven hundred and sixty-five patients were included in the analysis, 11.0% of whom had renal failure. A univariate analysis was performed using chi-squared test or Fischer's exact test as appropriate. Multivariate logistic regression models were constructed, while controlling for relevant patient factors, to identify the effect of renal failure on several outcomes of interest after the intervention. A sensitivity analysis was performed with a propensity score-matched cohort. RESULTS Patients with renal failure were more likely to have infrapopliteal interventions (38.0% vs 20.9%), critical limb ischemia with tissue loss (73.5% vs 38.9%), diabetes (70.9% vs 52.3%), preoperative wound infection (59.2% vs 30.7%), mortality (5.1% vs 1.3%), prolonged hospital stay (68.5% vs 46.5%), transfusion after the intervention (13.3% vs 9.1%), reoperation (18.3% vs 9.5%), and readmission (24.9% vs 12.6%), compared to patients without renal failure. The multivariate analysis found renal failure to be significant for mortality (odds ratio [OR] = 4.11, 95% confidence interval [CI] = 2.71-6.24), any complication (OR = 2.03, 95% CI = 1.72-2.39), extended length of stay (OR = 1.53, 95% CI = 1.28-1.83), sepsis (OR = 2.37, 95% CI = 1.60-3.51), readmission (OR = 1.89, 95% CI = 1.57-2.29), reoperation (OR = 1.84, 95% CI = 1.48-2.27), major adverse cardiovascular event (OR = 3.50, 95% CI = 2.54-4.84), and major adverse limb event (OR = 1.97, 95% CI = 1.55-2.51). P value was <.001 unless otherwise noted. CONCLUSIONS Renal failure before the intervention places patients at a significantly elevated risk of morbidity and mortality following endovascular revascularization procedures for peripheral artery disease.
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Affiliation(s)
- John Di Capua
- Division of Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114.
| | | | - Avik Som
- Division of Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114
| | - Thomas An
- Division of Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114
| | - Diego B López
- Division of Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114
| | - Ashley J So
- Department of Internal Medicine, North Shore Medical Center, Salem, MA, 01970
| | | | - Gregory T Walker
- Division of Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114
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López DB, Flores EJ, Miles RC, Wang GX, Glover M, Shepard JAO, Lehman CD, Narayan AK. Assessing Eligibility for Lung Cancer Screening Among Women Undergoing Screening Mammography: Cross-Sectional Survey Results From the National Health Interview Survey. J Am Coll Radiol 2019; 16:1433-1439. [PMID: 31092347 DOI: 10.1016/j.jacr.2019.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/07/2019] [Accepted: 04/08/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Millions of women undergo mammography screening each year, presenting an opportunity for radiologists to identify women eligible for lung cancer screening (LCS) with low-dose chest CT and smoking cessation counseling. The purpose of our study was to estimate the proportion of women eligible for LCS and tobacco cessation counseling among women reporting mammography screening within the previous 2 years using nationally representative cross-sectional survey data. METHODS Women between the ages of 55 and 74 years in the 2015 National Health Interview Survey without history of lung or breast cancer who reported mammography use in the previous 2 years were included. The primary outcome was the weighted proportion of women eligible for LCS. Secondary outcomes included self-reported receipt of LCS and current smoking. Bivariate and multiple variable logistic regression analyses were performed to evaluate the association between primary and secondary outcomes and sociodemographics, accounting for complex survey design elements. RESULTS Among 3,806 women meeting inclusion criteria, 7.1% were eligible for LCS and 9.8% were current smokers. Multivariable analyses demonstrated that LCS-eligible women were more likely to be white, younger, and non-college-educated and have lower household incomes (all P < .001). Among all LCS-eligible women, 58% reported undergoing mammography screening within the previous 2 years. Among LCS-eligible women who underwent screening mammography, 7.9% reported undergoing LCS. CONCLUSIONS The majority of LCS-eligible women received mammography screening but did not receive LCS. Mammography encounters may represent prime opportunities to increase LCS participation among patients already receiving imaging-based screening services.
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Affiliation(s)
| | - Efrén J Flores
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Randy C Miles
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gary X Wang
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - McKinley Glover
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Massachusetts General Physicians Organization, Boston, Massachusetts
| | - Jo-Anne O Shepard
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Constance D Lehman
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anand K Narayan
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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Affiliation(s)
- David C. Chang
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Diego B. López
- Francis Weld Peabody Society, Harvard Medical School, Boston, Massachusetts
| | - George Molina
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
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Zhang Y, Ma CA, Lawrence MG, Break TJ, O'Connell MP, Lyons JJ, López DB, Barber JS, Zhao Y, Barber DL, Freeman AF, Holland SM, Lionakis MS, Milner JD. PD-L1 up-regulation restrains Th17 cell differentiation in STAT3 loss- and STAT1 gain-of-function patients. J Exp Med 2017; 214:2523-2533. [PMID: 28710273 PMCID: PMC5584116 DOI: 10.1084/jem.20161427] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 03/10/2017] [Accepted: 06/19/2017] [Indexed: 01/05/2023] Open
Abstract
Zhang et al. show that hyperphosphorylated STAT1 in patients with STAT1 gain-of-function and STAT3 loss-of-function is caused by impaired SOCS3 expression and leads to upregulation of PD-L1 and defects in Th17 cell differentiation that underlie susceptibility to chronic mucocutaneous candidiasis in these patients. Patients with hypomorphic mutations in STAT3 and patients with hypermorphic mutations in STAT1 share several clinical and cellular phenotypes suggesting overlapping pathophysiologic mechanisms. We, therefore, examined cytokine signaling and CD4+ T cell differentiation in these cohorts to characterize common pathways. As expected, differentiation of Th17 cells was impaired in both cohorts. We found that STAT1 was hyperphosphorylated in response to cytokine stimulation in both cohorts and that STAT1-dependent PD-L1 up-regulation—known to inhibit Th17 differentiation in mouse models—was markedly enhanced as well. Overexpression of SOCS3 strongly inhibited phosphorylation of STAT1 and PD-L1 up-regulation, suggesting that diminished SOCS3 expression may lead to the observed effects. Defects in Th17 differentiation could be partially overcome in vitro via PD-L1 inhibition and in a mouse model of STAT3 loss-of-function by crossing them with PD-1 knockout mice. PD-L1 may be a potential therapeutic target in several genetic diseases of immune deficiency affecting cytokine signaling.
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Affiliation(s)
- Yuan Zhang
- Genetics and Pathogenesis of Allergy Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Chi A Ma
- Genetics and Pathogenesis of Allergy Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | | | - Timothy J Break
- Fungal Pathogenesis Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Michael P O'Connell
- Genetics and Pathogenesis of Allergy Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Jonathan J Lyons
- Genetics and Pathogenesis of Allergy Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | | | | | - Yongge Zhao
- Laboratory of Genome Integrity, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Daniel L Barber
- T-Lymphocyte Biology Unit, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Alexandra F Freeman
- Immunopathogenesis Section, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Steven M Holland
- Immunopathogenesis Section, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Michail S Lionakis
- Fungal Pathogenesis Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Joshua D Milner
- Genetics and Pathogenesis of Allergy Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD
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López DB, Loehrer AP, Chang DC. Impact of Income Inequality on the Nation's Health. J Am Coll Surg 2016; 223:587-94. [DOI: 10.1016/j.jamcollsurg.2016.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/01/2016] [Accepted: 07/01/2016] [Indexed: 01/11/2023]
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