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Watson J, Balmforth V, Gray E, Unthank MG. pH-Responsive, Thermoset Polymer Coatings for Active Protection against Aluminum Corrosion. ACS Appl Mater Interfaces 2024; 16:12986-12995. [PMID: 38426266 PMCID: PMC10941078 DOI: 10.1021/acsami.3c14752] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
This paper describes the synthesis and use of multifunctional methacrylic monomers, which contain basic (amine) functional groups, including an example in which an acid-labile tert-butylcarbamate-protected glycine is used to form a novel methacrylic monomer. The "protected" amino acid-derived functional monomer (BOC-Gly-MA) is copolymerized with an epoxide functional methacrylic monomer (GMA), to deliver novel multifunctional polymers, which are processed into powder coatings and used to study filiform corrosion at the surface of an aluminum substrate. The BOC-Gly-MA-containing copolymers were shown to improve a coating's anticorrosion performance, presenting the lowest average filiform corrosion (FFC) track length, total FFC number, and total corroded surface area (CSA) of the coatings investigated. Further to this, a mode of action for the role of BOC-Gly functional polymers in corrosion protection is proposed, supported by both solution and polymer-aluminum interface studies, delivering new insights into the mode of action of pH-responsive polymer coatings.
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Affiliation(s)
- Joseph Watson
- Northumbria
University, Newcastle
upon Tyne NE1 8ST, U.K.
| | - Victoria Balmforth
- AkzoNobel,
Polymer Development Group, Stoneygate Lane, Felling, Tyne & Wear NE10 0JY, U.K.
| | - Elaine Gray
- AkzoNobel,
Polymer Development Group, Stoneygate Lane, Felling, Tyne & Wear NE10 0JY, U.K.
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2
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Jennings I, Lester W, Gray E, Reilly-Stitt C, Gomez K, Williams S, Kitchen S, Walker I. Effect of direct thrombin inhibitors on laboratory measurement of fibrinogen: Potential for errors in clinical decision-making. Int J Lab Hematol 2023; 45:599-602. [PMID: 36793181 DOI: 10.1111/ijlh.14040] [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: 11/21/2022] [Accepted: 02/03/2023] [Indexed: 02/17/2023]
Affiliation(s)
| | - Will Lester
- Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Elaine Gray
- South Mimms Laboratories, Medicines and Healthcare Products Regulatory Agency, Potters Bar, UK
| | | | - Keith Gomez
- Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, UK
| | - Stella Williams
- South Mimms Laboratories, Medicines and Healthcare Products Regulatory Agency, Potters Bar, UK
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3
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Hogwood J, Mulloy B, Lever R, Gray E, Page CP. Pharmacology of Heparin and Related Drugs: An Update. Pharmacol Rev 2023; 75:328-379. [PMID: 36792365 DOI: 10.1124/pharmrev.122.000684] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 02/17/2023] Open
Abstract
Heparin has been used extensively as an antithrombotic and anticoagulant for close to 100 years. This anticoagulant activity is attributed mainly to the pentasaccharide sequence, which potentiates the inhibitory action of antithrombin, a major inhibitor of the coagulation cascade. More recently it has been elucidated that heparin exhibits anti-inflammatory effect via interference of the formation of neutrophil extracellular traps and this may also contribute to heparin's antithrombotic activity. This illustrates that heparin interacts with a broad range of biomolecules, exerting both anticoagulant and nonanticoagulant actions. Since our previous review, there has been an increased interest in these nonanticoagulant effects of heparin, with the beneficial role in patients infected with SARS2-coronavirus a highly topical example. This article provides an update on our previous review with more recent developments and observations made for these novel uses of heparin and an overview of the development status of heparin-based drugs. SIGNIFICANCE STATEMENT: This state-of-the-art review covers recent developments in the use of heparin and heparin-like materials as anticoagulant, now including immunothrombosis observations, and as nonanticoagulant including a role in the treatment of SARS-coronavirus and inflammatory conditions.
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Affiliation(s)
- John Hogwood
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (B.M., E.G., C.P.P.); National Institute for Biological Standards and Control, South Mimms, Hertfordshire, United Kingdom (J.H., E.G.) and School of Pharmacy, University College London, London, United Kingdom (R.L.)
| | - Barbara Mulloy
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (B.M., E.G., C.P.P.); National Institute for Biological Standards and Control, South Mimms, Hertfordshire, United Kingdom (J.H., E.G.) and School of Pharmacy, University College London, London, United Kingdom (R.L.)
| | - Rebeca Lever
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (B.M., E.G., C.P.P.); National Institute for Biological Standards and Control, South Mimms, Hertfordshire, United Kingdom (J.H., E.G.) and School of Pharmacy, University College London, London, United Kingdom (R.L.)
| | - Elaine Gray
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (B.M., E.G., C.P.P.); National Institute for Biological Standards and Control, South Mimms, Hertfordshire, United Kingdom (J.H., E.G.) and School of Pharmacy, University College London, London, United Kingdom (R.L.)
| | - Clive P Page
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (B.M., E.G., C.P.P.); National Institute for Biological Standards and Control, South Mimms, Hertfordshire, United Kingdom (J.H., E.G.) and School of Pharmacy, University College London, London, United Kingdom (R.L.)
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4
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Hogwood J, Gray E, Mulloy B. Heparin, Heparan Sulphate and Sepsis: Potential New Options for Treatment. Pharmaceuticals (Basel) 2023; 16:271. [PMID: 37259415 PMCID: PMC9959362 DOI: 10.3390/ph16020271] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/25/2022] [Revised: 01/22/2023] [Accepted: 02/07/2023] [Indexed: 08/31/2023] Open
Abstract
Sepsis is a life-threatening hyperreaction to infection in which excessive inflammatory and immune responses cause damage to host tissues and organs. The glycosaminoglycan heparan sulphate (HS) is a major component of the cell surface glycocalyx. Cell surface HS modulates several of the mechanisms involved in sepsis such as pathogen interactions with the host cell and neutrophil recruitment and is a target for the pro-inflammatory enzyme heparanase. Heparin, a close structural relative of HS, is used in medicine as a powerful anticoagulant and antithrombotic. Many studies have shown that heparin can influence the course of sepsis-related processes as a result of its structural similarity to HS, including its strong negative charge. The anticoagulant activity of heparin, however, limits its potential in treatment of inflammatory conditions by introducing the risk of bleeding and other adverse side-effects. As the anticoagulant potency of heparin is largely determined by a single well-defined structural feature, it has been possible to develop heparin derivatives and mimetic compounds with reduced anticoagulant activity. Such heparin mimetics may have potential for use as therapeutic agents in the context of sepsis.
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Affiliation(s)
- John Hogwood
- National Institute for Biological Standards and Control, Blanche Lane, South Mimms EN6 3QG, UK
| | - Elaine Gray
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King’s College London, Stamford St., London SE1 9NH, UK
| | - Barbara Mulloy
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King’s College London, Stamford St., London SE1 9NH, UK
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5
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Abed A, Beasly A, Reid A, Calapre L, Millward M, Gray E. EP16.01-002 T Cell Receptor Diversity among Non-Small Cell Lung Cancer Patients Treated with Pembrolizumab Alone or in Combination with Chemotherapy. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.1002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Gormley M, Gray E, Richards C, Gormley A, Richmond RC, Vincent EE, Dudding T, Ness AR, Thomas SJ. An update on oral cavity cancer: epidemiological trends, prevention strategies and novel approaches in diagnosis and prognosis. Community Dent Health 2022; 39:197-205. [PMID: 35852216 DOI: 10.1922/cdh_00032gormley09] [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] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In the UK, the incidence of oral cavity cancer continues to rise, with an increase of around 60% over the past 10 years. Many patients still present with advanced disease, often resulting in locoregional recurrence and poor outcomes, which has not changed significantly for over four decades. Changes in aetiology may also be emerging, given the decline of smoking in developed countries. Therefore, new methods to better target prevention, improve screening and detect recurrence are needed. High-throughput 'omics' technologies appear promising for future individual-level diagnosis and prognosis. However, given this is a relatively rare cancer with significant intra-tumour heterogeneity and variation in patient response, reliable biomarkers have been difficult to elucidate. From a public health perspective, implementing these novel technologies into current services would require substantial practical, financial and ethical considerations. This may be difficult to justify and implement at present, therefore focus remains on early detection using new patient-led follow-up strategies. This paper reviews the latest evidence on epidemiological trends in oral cavity cancer to help identify at risk groups, population-based approaches for prevention, in addition to potential cutting-edge approaches in the diagnosis and prognosis of this disease.
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Affiliation(s)
- M Gormley
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - E Gray
- University of Bristol Dental School, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - C Richards
- Oral Surgery, School of Dentistry, Cardiff University, UK
| | - A Gormley
- University of Bristol Dental School, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - R C Richmond
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - E E Vincent
- Translational Health Sciences, Bristol Medical School, University of Bristol, UK
| | - T Dudding
- University of Bristol Dental School, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - A R Ness
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - S J Thomas
- University of Bristol Dental School, University Hospitals Bristol and Weston NHS Foundation Trust, UK
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7
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Goldsworthy S, McGrail S, Eve A, Webster A, Gray E. PO-1849 Estimating the dose delivered to rectum and bowel in plan of the day adaptive bladder radiotherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03812-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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8
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Crossingham G, Bashaeb M, Gray E, Sabah N, Shearing T, Orim I, Wegbe L. P.57 No Accident: psychological safety and civility in a south west maternity unit. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103353] [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: 11/26/2022]
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9
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Bowyer A, Gray E, Lowe A, Murphy P, Platton S, Riddell A, Chowdary P, Lester W, Jenkins PV. Laboratory coagulation tests and recombinant porcine factor VIII: A United Kingdom Haemophilia Centre Doctors’ Organisation guideline. Haemophilia 2022; 28:515-519. [DOI: 10.1111/hae.14536] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Annette Bowyer
- Department of Coagulation Royal Hallamshire Hospital Sheffield UK
| | - Elaine Gray
- Haemostasis Section National Institute for Biological Standards and Control Potters Bar UK
| | - Anna Lowe
- UK National External Quality Assurance Scheme for Blood Coagulation Sheffield UK
| | - Paul Murphy
- Department of Haematology Newcastle Upon Tyne Hospitals Newcastle upon Tyne UK
| | - Sean Platton
- The Royal London Hospital Haemophilia Centre Barts Health NHS Trust London UK
| | - Anne Riddell
- Katharine Dormandy Haemophilia Centre Royal Free Hospital London UK
| | - Pratima Chowdary
- Katharine Dormandy Haemophilia Centre Royal Free Hospital London UK
| | - Will Lester
- Haemophilia Unit University Hospitals Birmingham Birmingham UK
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10
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Thacker BE, Thorne KJ, Cartwright C, Park J, Glass K, Chea A, Kellman BP, Lewis NE, Wang Z, Di Nardo A, Sharfstein ST, Jeske W, Walenga J, Hogwood J, Gray E, Mulloy B, Esko JD, Glass CA. Multiplex genome editing of mammalian cells for producing recombinant heparin. Metab Eng 2022; 70:155-165. [PMID: 35038554 DOI: 10.1016/j.ymben.2022.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 10/06/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 10/19/2022]
Abstract
Heparin is an essential anticoagulant used for treating and preventing thrombosis. However, the complexity of heparin has hindered the development of a recombinant source, making its supply dependent on a vulnerable animal population. In nature, heparin is produced exclusively in mast cells, which are not suitable for commercial production, but mastocytoma cells are readily grown in culture and make heparan sulfate, a closely related glycosaminoglycan that lacks anticoagulant activity. Using gene expression profiling of mast cells as a guide, a multiplex genome engineering strategy was devised to produce heparan sulfate with high anticoagulant potency and to eliminate contaminating chondroitin sulfate from mastocytoma cells. The heparan sulfate purified from engineered cells grown in chemically defined medium has anticoagulant potency that exceeds porcine-derived heparin and confers anticoagulant activity to the blood of healthy mice. This work demonstrates the feasibility of producing recombinant heparin from mammalian cell culture as an alternative to animal sources.
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Affiliation(s)
- Bryan E Thacker
- TEGA Therapeutics Inc, 3550 General Atomics Court, G02-102, San Diego, CA, 92121, USA
| | - Kristen J Thorne
- TEGA Therapeutics Inc, 3550 General Atomics Court, G02-102, San Diego, CA, 92121, USA
| | - Colin Cartwright
- TEGA Therapeutics Inc, 3550 General Atomics Court, G02-102, San Diego, CA, 92121, USA
| | - Jeeyoung Park
- TEGA Therapeutics Inc, 3550 General Atomics Court, G02-102, San Diego, CA, 92121, USA
| | - Kimberly Glass
- TEGA Therapeutics Inc, 3550 General Atomics Court, G02-102, San Diego, CA, 92121, USA
| | - Annie Chea
- TEGA Therapeutics Inc, 3550 General Atomics Court, G02-102, San Diego, CA, 92121, USA
| | - Benjamin P Kellman
- Departments of Pediatrics and Bioengineering, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Nathan E Lewis
- Departments of Pediatrics and Bioengineering, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Zhenping Wang
- Department of Dermatology, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Anna Di Nardo
- Department of Dermatology, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Susan T Sharfstein
- College of Nanoscale Science and Engineering, SUNY Polytechnic Institute, 257 Fuller Road, Albany, NY, 12203, USA
| | - Walter Jeske
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, 2160 S 1st Avenue, Maywood, IL, 60153, USA
| | - Jeanine Walenga
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, 2160 S 1st Avenue, Maywood, IL, 60153, USA
| | - John Hogwood
- National Institute for Biological Standards and Control, Blanche Lane, South Mimms, Herts, EN6 3QG, UK
| | - Elaine Gray
- National Institute for Biological Standards and Control, Blanche Lane, South Mimms, Herts, EN6 3QG, UK
| | - Barbara Mulloy
- National Institute for Biological Standards and Control, Blanche Lane, South Mimms, Herts, EN6 3QG, UK
| | - Jeffrey D Esko
- Glycobiology Research and Training Center, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA; Department of Cellular and Molecular Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Charles A Glass
- TEGA Therapeutics Inc, 3550 General Atomics Court, G02-102, San Diego, CA, 92121, USA.
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Tarasek M, Shu Y, Kang D, Tao S, Gray E, Huston J, Hua Y, Yeo D, Bernstein M, Foo T. Average SAR prediction, validation, and evaluation for a compact MR scanner head-sized RF coil. Magn Reson Imaging 2022; 85:168-176. [PMID: 34666159 PMCID: PMC8631045 DOI: 10.1016/j.mri.2021.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/01/2021] [Accepted: 10/12/2021] [Indexed: 01/03/2023]
Abstract
A recently developed compact 3 T (C3T) MRI scanner with high performance gradients [1, 2] has a dedicated radiofrequency (RF) transmit coil that exposes only the head, neck and a small portion of the upper body region during head-first scanning. Due to the unique coil geometry and patient positioning, the established SAR model used for a conventional whole-body scanner cannot be directly translated to the C3T. Here a specific absorption rate (SAR) estimation and validation framework was developed and used to implement a dedicated and accurate SAR prediction model for the C3T. Two different SAR prediction models for the C3T were defined and evaluated: one based on an anatomically derived exposed mass, and one using a fixed anatomical position located caudally to the RF coil to determine the exposed mass. After coil modeling and virtual human body simulation, the designed SAR prediction model was implemented on the C3T and verified with calorimetry and in vivo scan power monitoring. The fixed-demarcation exposed mass model was selected as appropriate exposed mass region to accurately estimate the SAR deposition in the patient on the C3T.
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Affiliation(s)
| | - Y. Shu
- Mayo Clinic, Department of Radiology, Rochester MN U.S
| | - D. Kang
- Mayo Clinic, Department of Radiology, Rochester MN U.S
| | - S. Tao
- Mayo Clinic, Department of Radiology, Jacksonville, FL U.S
| | - E. Gray
- Mayo Clinic, Department of Radiology, Rochester MN U.S
| | - J Huston
- Mayo Clinic, Department of Radiology, Rochester MN U.S
| | - Y Hua
- GE Global Research, Niskayuna NY U.S
| | | | | | - T.K. Foo
- GE Global Research, Niskayuna NY U.S
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12
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Gray E, Figueroa JD, Oikonomidou O, MacPherson I, Urquhart G, Cameron DA, Hall PS. Variation in chemotherapy prescribing rates and mortality in early breast cancer over two decades: a national data linkage study. ESMO Open 2021; 6:100331. [PMID: 34864502 PMCID: PMC8649669 DOI: 10.1016/j.esmoop.2021.100331] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 11/07/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022] Open
Abstract
Background Regional variation in clinical practice may identify differences in care, reveal inequity in access, and explain inequality in outcomes. The study aim was to measure geographical variation in Scotland for adjuvant chemotherapy use and mortality in early-stage breast cancer. Patients and methods In this retrospective cohort study using population cancer registry-based data linkage, patients with surgically treated early breast cancer between 2001 and 2018 were identified from the Scottish Cancer Registry. Geographical regions considered were based on NHS Scotland organisational structure including 14 territorial Health Boards as well as three regional Cancer Networks. Regional variation in the proportion receiving chemotherapy, breast cancer mortality and all-cause mortality was investigated. Inter-regional comparisons of chemotherapy use were adjusted for differences in case mix using logistic regression. Comparison of breast cancer-specific mortality and all-cause mortality used regression with a parametric survival model. Time trends were assessed using moving average plots. Results Chemotherapy use ranged from 35% to 46% of patients across Health Boards without adjustment. Variation reduced between 2001 and 2018. Following adjustment for clinical case mix, variation between cancer networks was within 3 percentage points, but up to 10 percentage points from the national average in some Health Boards. Differences in breast cancer mortality and all-cause mortality between cancer networks were modest, with hazard ratios of between 0.933 (95% confidence interval 0.893-0.975) and 1.041 (1.002-1.082) compared with the national average. Survival improved over the time period studied. Conclusion With adequate case mix adjustment, variation in adjuvant chemotherapy use for early breast cancer in Scotland is small, with a trend towards greater convergence in practice and improved mortality outcomes in more recent cohorts. This suggests very limited regional inequity in access and convergence of clinical practice towards risk-stratified treatment recommendations. Outliers require assessment to understand the reasons for variance. A cohort study including the Scottish population of surgically treated early breast cancer patients from 2001 to 2018. With adequate case mix adjustment, regional variation in adjuvant chemotherapy use was small, but with notable outliers. Over time there was a trend towards greater convergence in practice towards risk-stratified treatment recommendations.
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Affiliation(s)
- E Gray
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - J D Figueroa
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - O Oikonomidou
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK; Edinburgh Cancer Centre, NHS Lothian, Edinburgh, UK
| | - I MacPherson
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK; The Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - D A Cameron
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK; Edinburgh Cancer Centre, NHS Lothian, Edinburgh, UK
| | - P S Hall
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK; Edinburgh Cancer Centre, NHS Lothian, Edinburgh, UK.
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Abed A, Law N, Calapre L, Bowyer S, Millward M, Gray E. 9P HLA-I homozygosity as a predictive biomarker for developing immune related adverse events (irAE) among non-small cell lung cancer (NSCLC) patients treated with single agent immunotherapy. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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14
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Moore GW, Jones PO, Platton S, Hussain N, White D, Thomas W, Rigano J, Pouplard C, Gray E, Devreese KMJ. International multicenter, multiplatform study to validate Taipan snake venom time as a lupus anticoagulant screening test with ecarin time as the confirmatory test: Communication from the ISTH SSC Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibodies. J Thromb Haemost 2021; 19:3177-3192. [PMID: 34192404 DOI: 10.1111/jth.15438] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Received: 05/11/2021] [Revised: 06/08/2021] [Accepted: 06/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lupus anticoagulant (LA) assays are compromised in anticoagulated patients, and existing strategies to overcome the interferences have limitations. The prothrombin-activating Taipan snake venom time (TSVT) screening test and ecarin time (ET) confirmatory test are innately insensitive to vitamin K antagonists (VKA) and direct factor Xa inhibitors (DFXaI). OBJECTIVES Validate standardized TSVT/ET reagents for LA detection, in a multicenter, multiplatform study. PATIENTS/METHODS Six centers from four countries analyzed samples with TSVT/ET from 81 nonanticoagulated patients with LA, patients with established antiphospholipid syndrome (APS), and proven persistent LA who were either not anticoagulated (n = 120) or were anticoagulated with VKAs (n = 180) or DFXaIs (n = 71). Additionally, 339 nonanticoagulated LA-negative patients, and 575 anticoagulated non-APS patients (172 VKA, 403 DFXaI) were tested. Anticoagulant spiking experiments were performed and 112 samples containing potential interferences (i.e., direct thrombin inhibitors) were tested. Results were evaluated against locally derived cutoffs. Imprecision was evaluated. RESULTS Cutoffs were remarkably similar despite use of different analyzers and donor populations. Cutoffs for TSVT ratio, ET ratio, percent correction, and normalized TSVT ratio/ET ratio ranged between 1.08 and 1.10, 1.09 and 1.12, 9.3% and 14.8%, and 1.10 and 1.15, respectively. Coefficients of variation for TSVT and ET ratios were ≤5.0%. TSVT/ET exhibited sensitivity, specificity, and negative and positive predictive values of 78.2%/95.0%/86.3%/91.5%, respectively, with established APS as the LA-positive population, and 86.9%/95.0%/76.8%/97.4%, respectively, with triple-positive APS. Interference was seen with direct thrombin inhibitors, unfractionated heparin, and low molecular weight heparins, but not VKAs or DFXaIs. CONCLUSIONS TSVT/ET are validated for LA detection in nonanticoagulated patients and those on VKAs or DFXaIs.
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Affiliation(s)
- Gary W Moore
- Department of Haemostasis and Thrombosis, Viapath Analytics, Guy's & St. Thomas' Hospitals, London, UK
- Specialist Haemostasis Unit, Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Faculty of Science and Technology, Middlesex University, London, UK
| | - Paul O Jones
- Department of Haemostasis and Thrombosis, Viapath Analytics, Guy's & St. Thomas' Hospitals, London, UK
| | - Sean Platton
- The Royal London Hospital Haemophilia Centre, Barts Health NHS Trust, London, UK
| | - Nadia Hussain
- Clinical Biochemistry Department, Barts Health NHS Trust, London, UK
| | - Danielle White
- Specialist Haemostasis Unit, Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Will Thomas
- Specialist Haemostasis Unit, Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Joseph Rigano
- Haematology Department, Alfred Health, Melbourne, Vic., Australia
| | - Claire Pouplard
- Department of Hemostasis, University Hospital of Tours, University of Tours, Tours, France
| | - Elaine Gray
- Haemostasis Section, The National Institute for Biological Standards and Control, Potters Bar, UK
| | - Katrien M J Devreese
- Coagulation Laboratory, Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
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15
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Serina P, Gray E, Kocherginsky M, Lo A, Lindquist L, Post L, Heinemann A, Cruz D, Dresden S. 32EMF Validation of the Admission for Geriatric patients in the Emergency Department (AGED) Algorithm. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Maeda Y, Gray E, Figueroa JD, Hall PS, Weller D, Dunlop MG, Din FVN. Risk of missing colorectal cancer with a COVID-adapted diagnostic pathway using quantitative faecal immunochemical testing. BJS Open 2021; 5:zrab056. [PMID: 34228096 PMCID: PMC8259497 DOI: 10.1093/bjsopen/zrab056] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND COVID-19 has brought an unprecedented challenge to healthcare services. The authors' COVID-adapted pathway for suspected bowel cancer combines two quantitative faecal immunochemical tests (qFITs) with a standard CT scan with oral preparation (CT mini-prep). The aim of this study was to estimate the degree of risk mitigation and residual risk of undiagnosed colorectal cancer. METHOD Decision-tree models were developed using a combination of data from the COVID-adapted pathway (April-May 2020), a local audit of qFIT for symptomatic patients performed since 2018, relevant data (prevalence of colorectal cancer and sensitivity and specificity of diagnostic tools) obtained from literature and a local cancer data set, and expert opinion for any missing data. The considered diagnostic scenarios included: single qFIT; two qFITs; single qFIT and CT mini-prep; two qFITs and CT mini-prep (enriched pathway). These were compared to the standard diagnostic pathway (colonoscopy or CT virtual colonoscopy (CTVC)). RESULTS The COVID-adapted pathway included 422 patients, whereas the audit of qFIT included more than 5000 patients. The risk of missing a colorectal cancer, if present, was estimated as high as 20.2 per cent with use of a single qFIT as a triage test. Using both a second qFIT and a CT mini-prep as add-on tests reduced the risk of missed cancer to 6.49 per cent. The trade-off was an increased rate of colonoscopy or CTVC, from 287 for a single qFIT to 418 for the double qFIT and CT mini-prep combination, per 1000 patients. CONCLUSION Triage using qFIT alone could lead to a high rate of missed cancers. This may be reduced using CT mini-prep as an add-on test for triage to colonoscopy or CTVC.
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Affiliation(s)
- Y Maeda
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland
| | - E Gray
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland
| | - J D Figueroa
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland
| | - P S Hall
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland
| | - D Weller
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland
| | - M G Dunlop
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland
| | - F V N Din
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland
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17
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Hook AL, Hogwood J, Gray E, Mulloy B, Merry CLR. High sensitivity analysis of nanogram quantities of glycosaminoglycans using ToF-SIMS. Commun Chem 2021; 4:67. [PMID: 36697531 PMCID: PMC9814553 DOI: 10.1038/s42004-021-00506-1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/07/2021] [Indexed: 01/28/2023] Open
Abstract
Glycosaminoglycans (GAGs) are important biopolymers that differ in the sequence of saccharide units and in post polymerisation alterations at various positions, making these complex molecules challenging to analyse. Here we describe an approach that enables small quantities (<200 ng) of over 400 different GAGs to be analysed within a short time frame (3-4 h). Time of flight secondary ion mass spectrometry (ToF-SIMS) together with multivariate analysis is used to analyse the entire set of GAG samples. Resultant spectra are derived from the whole molecules and do not require pre-digestion. All 6 possible GAG types are successfully discriminated, both alone and in the presence of fibronectin. We also distinguish between pharmaceutical grade heparin, derived from different animal species and from different suppliers, to a sensitivity as low as 0.001 wt%. This approach is likely to be highly beneficial in the quality control of GAGs produced for therapeutic applications and for characterising GAGs within biomaterials or from in vitro cell culture.
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Affiliation(s)
- Andrew L. Hook
- grid.4563.40000 0004 1936 8868Advanced Materials and Healthcare Technology, University of Nottingham, Nottingham, UK
| | - John Hogwood
- grid.70909.370000 0001 2199 6511National Institute for Biological Standards and Control, Potters Bar, UK
| | - Elaine Gray
- grid.70909.370000 0001 2199 6511National Institute for Biological Standards and Control, Potters Bar, UK ,grid.13097.3c0000 0001 2322 6764Institute for Pharmaceutical Science, King’s College London, Franklin-Wilkins Building, Stamford Street, London, UK
| | - Barbara Mulloy
- grid.13097.3c0000 0001 2322 6764Institute for Pharmaceutical Science, King’s College London, Franklin-Wilkins Building, Stamford Street, London, UK
| | - Catherine L. R. Merry
- grid.4563.40000 0004 1936 8868Stem Cell Glycobiology Group, Biodiscovery Institute, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
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18
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Abed A, Calapre L, Lo J, Correia S, Bowyer S, Chopra A, Watson M, Khattak M, Millward M, Gray E. FP12.07 Prognostic Value of HLA-I Homozygosity in Non-Small Cell Lung Cancer Patients Treated with Single Agent Immunotherapy. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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Baxter GC, Selamoglu A, Mackay JW, Bond S, Gray E, Gilbert FJ. A meta-analysis comparing the diagnostic performance of abbreviated MRI and a full diagnostic protocol in breast cancer. Clin Radiol 2021; 76:154.e23-154.e32. [PMID: 33032820 DOI: 10.1016/j.crad.2020.08.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/07/2020] [Indexed: 12/18/2022]
Abstract
AIM To undertake a meta-analysis of the diagnostic performance of abbreviated (ABB) magnetic resonance imaging (MRI) and full diagnostic protocol MRI (FDP-MRI) in breast cancer. MATERIALS AND METHODS This meta-analysis was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Diagnostic Test Accuracy (PRISMA-DTA) guidelines. The PubMed and EMBASE databases were searched through August 2019 for studies comparing the diagnostic performance of ABB-MRI and FDP-MRI in the breast. Studies were reviewed by two authors independently according to eligibility and exclusion criteria and split into two subgroups (screening population studies and studies using cohorts enriched with known cancers) to avoid bias. Quality assessment and bias for diagnostic accuracy was determined with Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). The diagnostic accuracy for each subgroup was pooled using a bivariate random effects model and summary receiver operating characteristic (sROC) curves produced. Sensitivities and specificities were compared using a paired t-test. RESULTS Five screening (62/2,588 cancers/patients) and eight enriched cohort (540/1,432 cancers/patients) studies were included in the meta-analysis. QUADAS-2 assessment showed a low risk of bias in most studies. The pooled sensitivity/specificity/area under the receiver operating characteristic curve (AUC) for screening studies was 0.90/0.92/0.94 for ABB-MRI and 0.92/0.95/0.97 for FDP-MRI. The pooled sensitivity/specificity/AUC for enriched cohort studies was 0.93/0.83/0.94 for ABB-MRI and 0.93/0.84/0.95 for FDP-MRI. There was no significant difference in sensitivity or specificity using ABB-MRI or FDP-MRI (p=0.18 and 0.27, p=0.18 and 0.93, respectively). CONCLUSION The diagnostic performances of the ABB-MRI and FDP-MRI protocols used in either screening or enriched cohorts were comparable. There was a large variation in patient population, study methodology, and abbreviated protocols reported.
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Affiliation(s)
- G C Baxter
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - A Selamoglu
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - J W Mackay
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - S Bond
- National Institute for Health Research, Cambridge Clinical Trials Unit, Cambridge, UK
| | - E Gray
- University of Edinburgh, Edinburgh, UK
| | - F J Gilbert
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK; National Institute for Health Research, Cambridge Clinical Trials Unit, Cambridge, UK.
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20
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Tree JA, Turnbull JE, Buttigieg KR, Elmore MJ, Coombes N, Hogwood J, Mycroft-West CJ, Lima MA, Skidmore MA, Karlsson R, Chen YH, Yang Z, Spalluto CM, Staples KJ, Yates EA, Gray E, Singh D, Wilkinson T, Page CP, Carroll MW. Unfractionated heparin inhibits live wild type SARS-CoV-2 cell infectivity at therapeutically relevant concentrations. Br J Pharmacol 2021. [PMID: 33125711 DOI: 10.1111/bph.v178.310.1111/bph.15304] [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] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND AND PURPOSE Currently, there are no licensed vaccines and limited antivirals for the treatment of COVID-19. Heparin (delivered systemically) is currently used to treat anticoagulant anomalies in COVID-19 patients. Additionally, in the United Kingdom, Brazil and Australia, nebulised unfractionated heparin (UFH) is being trialled in COVID-19 patients as a potential treatment. A systematic comparison of the potential antiviral effect of various heparin preparations on live wild type SARS-CoV-2, in vitro, is needed. EXPERIMENTAL APPROACH Seven different heparin preparations including UFH and low MW heparins (LMWH) of porcine or bovine origin were screened for antiviral activity against live SARS-CoV-2 (Australia/VIC01/2020) using a plaque inhibition assay with Vero E6 cells. Interaction of heparin with spike protein RBD was studied using differential scanning fluorimetry and the inhibition of RBD binding to human ACE2 protein using elisa assays was examined. KEY RESULTS All the UFH preparations had potent antiviral effects, with IC50 values ranging between 25 and 41 μg·ml-1 , whereas LMWHs were less inhibitory by ~150-fold (IC50 range 3.4-7.8 mg·ml-1 ). Mechanistically, we observed that heparin binds and destabilizes the RBD protein and furthermore, we show heparin directly inhibits the binding of RBD to the human ACE2 protein receptor. CONCLUSION AND IMPLICATIONS This comparison of clinically relevant heparins shows that UFH has significantly stronger SARS-CoV-2 antiviral activity compared to LMWHs. UFH acts to directly inhibit binding of spike protein to the human ACE2 protein receptor. Overall, the data strongly support further clinical investigation of UFH as a potential treatment for patients with COVID-19.
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Affiliation(s)
- Julia A Tree
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - Jeremy E Turnbull
- Department of Biochemistry and Systems Biology, Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, UK
- Copenhagen Center for Glycomics, Department of Cellular & Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Karen R Buttigieg
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - Michael J Elmore
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - Naomi Coombes
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - John Hogwood
- Haemostasis Section, Biotherapeutics, National Institute for Biological Standards and Control (NIBSC), Potters Bar, UK
| | - Courtney J Mycroft-West
- Molecular & Structural Biosciences, School of Life Sciences, Keele University, Newcastle-Under-Lyme, UK
| | - Marcelo A Lima
- Molecular & Structural Biosciences, School of Life Sciences, Keele University, Newcastle-Under-Lyme, UK
| | - Mark A Skidmore
- Molecular & Structural Biosciences, School of Life Sciences, Keele University, Newcastle-Under-Lyme, UK
| | - Richard Karlsson
- Copenhagen Center for Glycomics, Department of Cellular & Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Yen-Hsi Chen
- Copenhagen Center for Glycomics, Department of Cellular & Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Zhang Yang
- Copenhagen Center for Glycomics, Department of Cellular & Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Karl J Staples
- Department of Respiratory Medicine, University of Southampton, Southampton, UK
| | - Edwin A Yates
- Department of Biochemistry and Systems Biology, Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, UK
| | - Elaine Gray
- Haemostasis Section, Biotherapeutics, National Institute for Biological Standards and Control (NIBSC), Potters Bar, UK
- Sackler Institute of Pulmonary Pharmacology, King's College London, London, UK
| | - Dave Singh
- Medicines Evaluation Unit, University of Manchester, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - Tom Wilkinson
- Department of Respiratory Medicine, University of Southampton, Southampton, UK
| | - Clive P Page
- Sackler Institute of Pulmonary Pharmacology, King's College London, London, UK
| | - Miles W Carroll
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
- Nuffield Department of Medicine, Wellcome Trust Centre for Human Genetics, Oxford University, Oxford, UK
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21
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Gray E, Hogwood J, Dougall T, Rigsby P, Matejtschuk P, Terao E. Calibration of the WHO 5th IS for Blood Coagulation Factor IX, Concentrate and Ph. Eur. Human Coagulation Factor IX Concentrate Biological Reference Preparation Batch 3 and investigation of the suitability of an IS as potency standard for purified full-length recombinant FIX. Pharmeur Bio Sci Notes 2021; 2021:26-68. [PMID: 33783349] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A joint World Health Organization (WHO) - European Directorate for the Quality of Medicines & HealthCare (EDQM) study was run to calibrate the WHO 5th International Standard (IS) for Blood Coagulation Factor IX (FIX), Concentrate, and European Pharmacopoeia (Ph. Eur.) Human Coagulation Factor IX concentrate Biological Reference Preparation (BRP) Batch 3. The suitability of the 4th IS as a potency standard for purified full-length recombinant FIX (rFIX) was also investigated. Forty-nine laboratories contributed data for the calibration of 2 plasma-derived FIX candidates, relative to the 4th IS, from clotting and chromogenic assays. The intra-laboratory variability was reasonably low; the inter-laboratory variation was lower for sample B (14/148) than for sample C (14/162). Although there were no discrepancies between clotting and chromogenic assays, a significantly lower potency was obtained for sample C with clotting assays when buffer rather than FIX-deficient plasma was used as pre-diluent. A significant assay discrepancy was observed with estimates for the 4th IS for Blood Coagulation Factors FII, VII, IX, X, Plasma against the 4th IS, resulting in a clotting to chromogenic activity ratio of 1.11. The study also investigated the comparability of the plasma-derived concentrate standard with the rFIX products and considered the establishment of an IS for rFIX. The 3 rFIX products currently licensed were represented in this study. Data from 49 laboratories for 2 rFIX candidates were received, with additional results for another full-length rFIX test sample returned by 6 laboratories. The intra-laboratory variability when the rFIX samples were assayed against the 4th IS was acceptably low. Although the full-length rFIX could be assayed against the plasma-derived 4th IS and provided statistically valid results, there were large discrepancies among the clotting assays using different APTT reagents. The inter-laboratory variability of the chromogenic assays was similarly high. There were also significant clotting and chromogenic assay discrepancies. The data from the present study indicate that a recombinant standard for rFIX products will minimise assay discrepancies and improve inter-laboratory agreement. However, they also underline that the value assignment of the 1st rFIX IS needs careful consideration. The Expert Committee on Biological Standardization (ECBS) of WHO was therefore not requested to consider the establishment of an IS for rFIX. In order to ensure continued harmonised standards, sample B (14/148) was established as the WHO 5th IS for Blood Coagulation Factor IX, Concentrate, and as Ph. Eur. Human Coagulation Factor IX, concentrate BRP Batch 3 with the functional activity of 10.5 IU/ampoule.
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Affiliation(s)
- E Gray
- National Institute for Biological Standards and Control (NIBSC), Haemostasis Section, Potters Bar, EN6 3QG, UK
| | - J Hogwood
- National Institute for Biological Standards and Control (NIBSC), Haemostasis Section, Potters Bar, EN6 3QG, UK
| | - T Dougall
- National Institute for Biological Standards and Control (NIBSC), Biostatistics Section, Potters Bar, EN6 3QG, UK
| | - P Rigsby
- National Institute for Biological Standards and Control (NIBSC), Biostatistics Section, Potters Bar, EN6 3QG, UK
| | - P Matejtschuk
- National Institute for Biological Standards and Control (NIBSC), Standardisation Science Technology, Potters Bar, EN6 3QG, UK
| | - E Terao
- European Directorate for the Quality of Medicines & HealthCare (EDQM), Department of Biological Standardisation, OMCL Network & HealthCare (DBO), Council of Europe, Strasbourg, France
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22
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Gray E, Skinner M, Hale L, Bunton R. Preparation and Support for Physical Activity Engagement Following CABG Surgery: A Survey of Current Practice in New Zealand. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Abed A, Calapre L, Lo J, Correia M, Bowyer S, Chopra A, Watson M, Khattak A, Millward M, Gray E. TS01.07 Genomic HLA as a Predictive Biomarker for Survival Among Non-Small Cell Lung Cancer Patient Treated with Single Agent Immunotherapy. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2020.10.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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24
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Tree JA, Turnbull JE, Buttigieg KR, Elmore MJ, Coombes N, Hogwood J, Mycroft-West CJ, Lima MA, Skidmore MA, Karlsson R, Chen YH, Yang Z, Spalluto CM, Staples KJ, Yates EA, Gray E, Singh D, Wilkinson T, Page CP, Carroll MW. Unfractionated heparin inhibits live wild type SARS-CoV-2 cell infectivity at therapeutically relevant concentrations. Br J Pharmacol 2020; 178:626-635. [PMID: 33125711 PMCID: PMC9328389 DOI: 10.1111/bph.15304] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [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: 07/13/2020] [Revised: 10/08/2020] [Accepted: 10/18/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND PURPOSE Currently, there are no licensed vaccines and limited antivirals for the treatment of COVID-19. Heparin (delivered systemically) is currently used to treat anticoagulant anomalies in COVID-19 patients. Additionally, in the United Kingdom, Brazil and Australia, nebulised unfractionated heparin (UFH) is being trialled in COVID-19 patients as a potential treatment. A systematic comparison of the potential antiviral effect of various heparin preparations on live wild type SARS-CoV-2, in vitro, is needed. EXPERIMENTAL APPROACH Seven different heparin preparations including UFH and low MW heparins (LMWH) of porcine or bovine origin were screened for antiviral activity against live SARS-CoV-2 (Australia/VIC01/2020) using a plaque inhibition assay with Vero E6 cells. Interaction of heparin with spike protein RBD was studied using differential scanning fluorimetry and the inhibition of RBD binding to human ACE2 protein using elisa assays was examined. KEY RESULTS All the UFH preparations had potent antiviral effects, with IC50 values ranging between 25 and 41 μg·ml-1 , whereas LMWHs were less inhibitory by ~150-fold (IC50 range 3.4-7.8 mg·ml-1 ). Mechanistically, we observed that heparin binds and destabilizes the RBD protein and furthermore, we show heparin directly inhibits the binding of RBD to the human ACE2 protein receptor. CONCLUSION AND IMPLICATIONS This comparison of clinically relevant heparins shows that UFH has significantly stronger SARS-CoV-2 antiviral activity compared to LMWHs. UFH acts to directly inhibit binding of spike protein to the human ACE2 protein receptor. Overall, the data strongly support further clinical investigation of UFH as a potential treatment for patients with COVID-19.
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Affiliation(s)
- Julia A Tree
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - Jeremy E Turnbull
- Department of Biochemistry and Systems Biology, Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, UK.,Copenhagen Center for Glycomics, Department of Cellular & Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Karen R Buttigieg
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - Michael J Elmore
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - Naomi Coombes
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - John Hogwood
- Haemostasis Section, Biotherapeutics, National Institute for Biological Standards and Control (NIBSC), Potters Bar, UK
| | - Courtney J Mycroft-West
- Molecular & Structural Biosciences, School of Life Sciences, Keele University, Newcastle-Under-Lyme, UK
| | - Marcelo A Lima
- Molecular & Structural Biosciences, School of Life Sciences, Keele University, Newcastle-Under-Lyme, UK
| | - Mark A Skidmore
- Molecular & Structural Biosciences, School of Life Sciences, Keele University, Newcastle-Under-Lyme, UK
| | - Richard Karlsson
- Copenhagen Center for Glycomics, Department of Cellular & Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Yen-Hsi Chen
- Copenhagen Center for Glycomics, Department of Cellular & Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Zhang Yang
- Copenhagen Center for Glycomics, Department of Cellular & Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Karl J Staples
- Department of Respiratory Medicine, University of Southampton, Southampton, UK
| | - Edwin A Yates
- Department of Biochemistry and Systems Biology, Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, UK
| | - Elaine Gray
- Haemostasis Section, Biotherapeutics, National Institute for Biological Standards and Control (NIBSC), Potters Bar, UK.,Sackler Institute of Pulmonary Pharmacology, King's College London, London, UK
| | - Dave Singh
- Medicines Evaluation Unit, University of Manchester, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - Tom Wilkinson
- Department of Respiratory Medicine, University of Southampton, Southampton, UK
| | - Clive P Page
- Sackler Institute of Pulmonary Pharmacology, King's College London, London, UK
| | - Miles W Carroll
- National Infection Service, Public Health England, Porton Down, Salisbury, UK.,Nuffield Department of Medicine, Wellcome Trust Centre for Human Genetics, Oxford University, Oxford, UK
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25
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Wilmot HV, Gray E. Enabling accurate measurement of activated factor XI (FXIa) in therapeutic immunoglobulin products. Vox Sang 2020; 116:656-664. [PMID: 33277936 PMCID: PMC8359487 DOI: 10.1111/vox.13046] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/05/2020] [Accepted: 11/16/2020] [Indexed: 11/29/2022]
Abstract
Background and objectives In 2010, an intravenous immunoglobulin (IVIG) product was removed from the market due to an association with serious thromboembolic events. Investigations revealed that factor XIa (FXIa) was present as a process‐related impurity. This study investigated the ability of two commercial FXIa assays to measure FXIa in immunoglobulin preparations and conducted a survey of FXIa activity in marketed immunoglobulin products. Materials and methods Factor XIa assays were modified to include spiking of samples with FXIa before testing. An immunoglobulin product and its excipient were used to assess the ability of the assays to recover the spiked FXIa levels. Results The Biophen FXIa assay required a high pre‐dilution of the sample to obtain statistically valid results and complete FXIa recovery. The ROX FXIa assay was more sensitive, giving statistically valid results at a lower sample pre‐dilution and FXIa spike level. This modified ROX FXIa assay was used to assay 17 lots of immunoglobulin products for FXIa. Two product lots had measurable FXIa levels without the need for spiking. A further 3 lots produced detectable but not statistically valid FXIa results when left unspiked. Spiking produced statistically valid assays and recoveries above 100%, demonstrating inherent FXIa. Conclusion This study shows marketed immunoglobulin products can contain detectable levels of FXIa. Spiking brings the FXIa levels into the quantifiable range of the assay, allowing measurement of inherent FXIa. Accurate measurement is important to inform on ‘safe’ levels of FXIa in these products and allow future safety guidelines to be set.
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Affiliation(s)
- Helen V Wilmot
- Haemostasis Section, Biotherapeutics, National Institute for Biological Standards and Control (NIBSC), South Mimms, Hertfordshire, UK
| | - Elaine Gray
- Haemostasis Section, Biotherapeutics, National Institute for Biological Standards and Control (NIBSC), South Mimms, Hertfordshire, UK
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26
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Baker P, Platton S, Gibson C, Gray E, Jennings I, Murphy P, Laffan M. Guidelines on the laboratory aspects of assays used in haemostasis and thrombosis. Br J Haematol 2020; 191:347-362. [PMID: 32537743 DOI: 10.1111/bjh.16776] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Peter Baker
- Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sean Platton
- Haemophilia Centre, Barts Health NHS Trust, London, UK
| | - Claire Gibson
- Specialist Haemostasis, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Elaine Gray
- Haemostasis Section, Biotherapeutics Group, National Institute for Biological Standards and Controls, Hertfordshire, UK
| | | | - Paul Murphy
- Department of Haematology, the Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mike Laffan
- Centre for Haematology, Imperial College and Hammersmith Hospital, London, UK
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27
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Abed A, Calapre L, Lo J, Correia S, Bowyer S, Chopra A, Watson M, Khattak M, Millward M, Gray E. 301MO Genomic HLA as a predictive biomarker for survival among non-small cell lung cancer patient treated with single agent immunotherapy. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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28
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Cleary SJ, Pitchford SC, Amison RT, Carrington R, Robaina Cabrera CL, Magnen M, Looney MR, Gray E, Page CP. Animal models of mechanisms of SARS-CoV-2 infection and COVID-19 pathology. Br J Pharmacol 2020; 177:4851-4865. [PMID: 32462701 PMCID: PMC7283621 DOI: 10.1111/bph.15143] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/15/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2 infections has led to a substantial unmet need for treatments, many of which will require testing in appropriate animal models of this disease. Vaccine trials are already underway, but there remains an urgent need to find other therapeutic approaches to either target SARS-CoV-2 or the complications arising from viral infection, particularly the dysregulated immune response and systemic complications which have been associated with progression to severe COVID-19. At the time of writing, in vivo studies of SARS-CoV-2 infection have been described using macaques, cats, ferrets, hamsters, and transgenic mice expressing human angiotensin I converting enzyme 2 (ACE2). These infection models have already been useful for studies of transmission and immunity, but to date only partly model the mechanisms involved in human severe COVID-19. There is therefore an urgent need for development of animal models for improved evaluation of efficacy of drugs identified as having potential in the treatment of severe COVID-19. These models need to reproduce the key mechanisms of COVID-19 severe acute respiratory distress syndrome and the immunopathology and systemic sequelae associated with this disease. Here, we review the current models of SARS-CoV-2 infection and COVID-19-related disease mechanisms and suggest ways in which animal models can be adapted to increase their usefulness in research into COVID-19 pathogenesis and for assessing potential treatments. LINKED ARTICLES: This article is part of a themed issue on The Pharmacology of COVID-19. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v177.21/issuetoc.
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Affiliation(s)
| | - Simon C. Pitchford
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, School of Cancer and Pharmaceutical SciencesKing's College LondonLondonUK
| | - Richard T. Amison
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, School of Cancer and Pharmaceutical SciencesKing's College LondonLondonUK
| | - Robert Carrington
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, School of Cancer and Pharmaceutical SciencesKing's College LondonLondonUK
- Covance Laboratories LimitedHuntingdonUK
| | - C. Lorena Robaina Cabrera
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, School of Cancer and Pharmaceutical SciencesKing's College LondonLondonUK
| | | | | | - Elaine Gray
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, School of Cancer and Pharmaceutical SciencesKing's College LondonLondonUK
- National Institute for Biological Standards and ControlHertsUK
| | - Clive P. Page
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, School of Cancer and Pharmaceutical SciencesKing's College LondonLondonUK
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Ovanesov MV, Williams SC, Nübling C, Dodt J, Hilger A, Maryuningsih Y, Gray E. Summary of the WHO hearing on the development of product-specific reference materials for coagulation factor VIII and factor IX products. Biologicals 2020; 67:88-93. [DOI: 10.1016/j.biologicals.2020.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 11/26/2022] Open
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Wilmot HV, Rakowski K, Gray E. The traceability of commercial plasma calibrators to the plasma International Standards for factor VIII and factor IX. Int J Lab Hematol 2020; 42:810-818. [PMID: 32638532 PMCID: PMC7754292 DOI: 10.1111/ijlh.13277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 01/19/2023]
Abstract
Accurate measurement of coagulation factors is essential, especially for diagnosis of deficiency. Clinical laboratories use commercially available plasma calibrators, which should be traceable to the relevant plasma International Standard (IS). This study assessed the relationship between the plasma IS for factors IX (FIX) and VIII (FVIII) and some commonly used commercial calibrators. Calibrators from seven manufacturers were assayed for FIX and FVIII activity by one‐stage clotting assay (OSCA) using different activated partial thromboplastin time (APTT) reagents and deficient plasmas, or chromogenic assay (CA). Results were calculated relative to the 4th IS Factors II,VII,IX,X, Plasma or the 6th IS Factor VIII/VWF, Plasma. Results for each calibrator were similar across the APTT reagents and deficient plasmas used. All calibrators showed a recovery of 90%‐111% of the manufacturers’ values, except calibrator C, which had recovery of around 85%. CA gave similar results, with good recovery for all but calibrator C. Similar low recoveries for OSCA and CA were found for a different lot of calibrator C and for a different calibrator product from manufacturer C. When all calibrators from manufacturer C were assayed by OSCA using the manufacturer's own deficient plasmas and APTT reagents, the mean recovery was still below 90%. Overall, there was good traceability of the international unit between the IS and commercial calibrator plasmas. Calibrators from one manufacturer consistently yielded lower than expected values for FIX and FVIII. This could lead to an over‐estimation of the coagulation factor content in patient samples and demonstrates the importance of careful choice of calibrator.
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Affiliation(s)
- Helen V Wilmot
- Haemostasis Section, Biotherapeutics Group, National Institute for Biological Standards and Control (NIBSC), Potters Bar, Hertfordshire, United Kingdom
| | - Kajetan Rakowski
- Haemostasis Section, Biotherapeutics Group, National Institute for Biological Standards and Control (NIBSC), Potters Bar, Hertfordshire, United Kingdom
| | - Elaine Gray
- Haemostasis Section, Biotherapeutics Group, National Institute for Biological Standards and Control (NIBSC), Potters Bar, Hertfordshire, United Kingdom
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Affiliation(s)
- Elaine Gray
- National Institute for Biological Standards and Control, Potters Bar, United Kingdom.,Institute of Pharmaceutical Science, King's College London, London, United Kingdom
| | - David A Keire
- Division of Pharmaceutical Analysis, Office of Testing and Research, Center for Drug Evaluation and Research, United States Food and Drug Administration, St Louis, MO, United States
| | - Barbara Mulloy
- Institute of Pharmaceutical Science, King's College London, London, United Kingdom
| | - Timothy R Rudd
- National Institute for Biological Standards and Control, Potters Bar, United Kingdom
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Hogwood J, Pitchford S, Mulloy B, Page C, Gray E. Heparin and non-anticoagulant heparin attenuate histone-induced inflammatory responses in whole blood. PLoS One 2020; 15:e0233644. [PMID: 32469940 PMCID: PMC7259574 DOI: 10.1371/journal.pone.0233644] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/09/2020] [Indexed: 12/23/2022] Open
Abstract
Cytotoxic and pro-inflammatory histones are present in neutrophil extracellular traps (NETs) and are elevated in blood in several inflammatory conditions, sepsis being a major example. Compounds which can attenuate activities of histones are therefore of interest, with heparin being one such material that has previously been shown to bind to histones. Heparin, a successful anticoagulant for nearly a century, has been shown experimentally to bind to histones and exhibit a protective effect in inflammatory conditions. In the present study carried out in whole blood, heparin and selectively desulfated heparin reduced histone induced inflammatory markers such as interleukin 6 (IL 6), interleukin 8 (IL 8) and tissue factor and C3a, a complement component. The selectively desulfated heparins, with reduced anticoagulant activities, retained a high degree of effectiveness as an anti-histone agent, whereas fully desulfated heparin was found to be ineffective. The results from this study indicate that the presence of sulfate and other specific structural features are required for heparin to attenuate the inflammatory action of histones in whole blood.
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Affiliation(s)
- John Hogwood
- National Institute for Biological Standards and Control, South Mimms, Ridge, Herts, United Kingdom
- Sacker Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King’s College London, London, United Kingdom
- * E-mail:
| | - Simon Pitchford
- Sacker Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King’s College London, London, United Kingdom
| | - Barbara Mulloy
- Sacker Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King’s College London, London, United Kingdom
| | - Clive Page
- Sacker Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King’s College London, London, United Kingdom
| | - Elaine Gray
- National Institute for Biological Standards and Control, South Mimms, Ridge, Herts, United Kingdom
- Sacker Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King’s College London, London, United Kingdom
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Abstract
INTRODUCTION Many recombinant and modified FIX products have been, and continue to be, developed with the aim of improving treatment for patients with haemophilia B. One such new product is dalcinonacog alfa, a recombinant FIX with modifications to provide improved features such as subcutaneous administration. AIM In view of previously observed assay discrepancies with modified FIX therapeutics, the aim of this study was to assess potential discrepancies in potency measurement of dalcinonacog alfa between and within different assay methods. METHODS Potency of dalcinonacog alfa was measured against the 5th International Standard (IS) for FIX Concentrate and the 4th IS for FIX Plasma by One-Stage Clotting Assay, using 9 different APTT reagents and 2 commercially available FIX chromogenic kits. Plasma-derived concentrate and recombinant FIX samples were also included for comparison in every assay. RESULTS Substantial discrepancies were observed when assaying dalcinonacog alfa using the one-stage clotting assay against both standards. No statistically valid results were obtained when testing dalcinonacog alfa using either chromogenic kit. Increasing the incubation time with the activation reagent in both chromogenic kits resulted in valid assays and increased the potency to become more in line with potencies by one-stage clotting assays. Increasing the incubation time in the chromogenic kits had no effect on the potencies of the plasma-derived or recombinant samples. However, incubation time influenced in the one-stage clotting assay using Dapttin. CONCLUSIONS Within and between assay method discrepancy was found when assaying dalcinonacog alfa. Methods for potency labelling and clinical monitoring should be given careful consideration.
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Affiliation(s)
- Stella C Williams
- The National Institute for Biological Standards and Control, Potter Bar, UK
| | - Elaine Gray
- The National Institute for Biological Standards and Control, Potter Bar, UK
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Jenkins PV, Bowyer A, Burgess C, Gray E, Kitchen S, Murphy P, Platton S, Riddell A, Chowdary P, Lester W. Laboratory coagulation tests and emicizumab treatment A United Kingdom Haemophilia Centre Doctors' Organisation guideline. Haemophilia 2019; 26:151-155. [DOI: 10.1111/hae.13903] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/21/2019] [Accepted: 11/25/2019] [Indexed: 12/16/2022]
Affiliation(s)
- P. Vincent Jenkins
- Haemostasis and Thrombosis Haematology Department University Hospital of Wales Cardiff UK
| | - Annette Bowyer
- Department of Coagulation Royal Hallamshire Hospital Sheffield UK
| | - Clive Burgess
- Coagulation Laboratory Great Ormond Street Hospital for Children NHS Trust London UK
| | - Elaine Gray
- Haemostasis Section National Institute for Biological Standards and Control Potters Bar UK
| | - Steve Kitchen
- Department of Coagulation Royal Hallamshire Hospital Sheffield UK
| | - Paul Murphy
- Department of Haematology Newcastle Upon Tyne Hospitals Newcastle upon Tyne Newcastle upon Tyne UK
| | - Sean Platton
- The Royal London Hospital Haemophilia Centre Royal London Hospital London UK
| | - Anne Riddell
- Katharine Dormandy Haemophilia Centre Royal Free Hospital London UK
| | - Pratima Chowdary
- Katharine Dormandy Haemophilia Centre Royal Free Hospital London UK
| | - Will Lester
- Haemophilia Unit University Hospitals Birmingham Birmingham UK
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Gray E, Kitchen S, Bowyer A, Chowdary P, Jenkins PV, Murphy P, Platton S, Riddell A, Lester W. Laboratory measurement of factor replacement therapies in the treatment of congenital haemophilia: A United Kingdom Haemophilia Centre Doctors’ Organisation guideline. Haemophilia 2019; 26:6-16. [DOI: 10.1111/hae.13907] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Elaine Gray
- Haemostasis Section, Biotherapeutics Group National Institute for Biological Standards and Control Potters Bar UK
| | - Steve Kitchen
- Department of Coagulation Royal Hallamshire Hospital Sheffield UK
| | - Annette Bowyer
- Department of Coagulation Royal Hallamshire Hospital Sheffield UK
| | - Pratima Chowdary
- Katharine Dormandy Haemophilia and Thrombosis Centre Royal Free Hospital London UK
| | - P. Vincent Jenkins
- Haematology Department Haemostasis Laboratory University Hospital of Wales Cardiff UK
| | - Paul Murphy
- Haemostasis Department Newcastle Upon Tyne Hospitals Newcastle upon Tyne UK
| | - Sean Platton
- The Royal London Hospital Haemophilia Centre The Royal London Hospital London UK
| | - Anne Riddell
- Katharine Dormandy Haemophilia and Thrombosis Centre Royal Free Hospital London UK
| | - Will Lester
- Haemophilia Unit University Hospitals Birmingham Birmingham UK
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Pauly B, Brown M, Evans J, Gray E, Schiff R, Ivsins A, Krysowaty B, Vallance K, Stockwell T. "There is a Place": impacts of managed alcohol programs for people experiencing severe alcohol dependence and homelessness. Harm Reduct J 2019; 16:70. [PMID: 31842903 PMCID: PMC6916004 DOI: 10.1186/s12954-019-0332-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 09/29/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The twin problems of severe alcohol dependence and homelessness are associated with precarious living and multiple acute, social and chronic harms. While much attention has been focused on harm reduction services for illicit drug use, there has been less attention to harm reduction for this group. Managed alcohol programs (MAPs) are harm reduction interventions that aim to reduce the harms of severe alcohol use, poverty and homelessness. MAPs typically provide accommodation, health and social supports alongside regularly administered sources of beverage alcohol to stabilize drinking patterns and replace use of non-beverage alcohol (NBA). METHODS We examined impacts of MAPs in reducing harms and risks associated with substance use and homelessness. Using case study methodology, data were collected from five MAPs in five Canadian cities with each program constituting a case. In total, 53 program participants, 4 past participants and 50 program staff were interviewed. We used situational analysis to produce a series of "messy", "ordered" and "social arenas" maps that provide insight into the social worlds of participants and the impact of MAPs. RESULTS Prior to entering a MAP, participants were often in a revolving world of cycling through multiple arenas (health, justice, housing and shelters) where abstinence from alcohol is often required in order to receive assistance. Residents described living in a street-based survival world characterized by criminalization, unmet health needs, stigma and unsafe spaces for drinking and a world punctuated by multiple losses and disconnections. MAPs disrupt these patterns by providing a harm reduction world in which obtaining accommodation and supports are not contingent on sobriety. MAPs represent a new arena that focuses on reducing harms through provision of safer spaces and supply of alcohol, with opportunities for reconnection with family and friends and for Indigenous participants, Indigenous traditions and cultures. Thus, MAPs are safer spaces but also potentially spaces for healing. CONCLUSIONS In a landscape of limited alcohol harm reduction options, MAPs create a new arena for people experiencing severe alcohol dependence and homelessness. While MAPs reduce precarity for participants, programs themselves remain precarious due to ongoing challenges related to lack of understanding of alcohol harm reduction and insecure program funding.
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Affiliation(s)
- B. Pauly
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Ave, Victoria, BC V8P 5C2 Canada
- School of Nursing, University of Victoria, HSD Building A402A, Victoria, BC V8P 5C2 Canada
| | - M. Brown
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Ave, Victoria, BC V8P 5C2 Canada
- School of Nursing, University of Victoria, HSD Building A402A, Victoria, BC V8P 5C2 Canada
| | - J. Evans
- Department of Earth and Atmospheric Sciences, University of Alberta, 1-26 Earth Sciences Building, Edmonton, AB T6G 2E9 Canada
| | - E. Gray
- School of Social Work, MacEwan University, 9-505 Robbins Building, Box 1796, 10700-104 Avenue, Edmonton, AB T5J 2P2 Canada
| | - R. Schiff
- Department of Health Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1 Canada
| | - A. Ivsins
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Ave, Victoria, BC V8P 5C2 Canada
| | - B. Krysowaty
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Ave, Victoria, BC V8P 5C2 Canada
| | - K. Vallance
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Ave, Victoria, BC V8P 5C2 Canada
| | - T. Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Ave, Victoria, BC V8P 5C2 Canada
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Reither J, Gray E, Durdle A, Conlan X, van Oorschot R, Szkuta B. Background DNA on flooring: The effect of cleaning. Forensic Science International: Genetics Supplement Series 2019. [DOI: 10.1016/j.fsigss.2019.10.178] [Citation(s) in RCA: 4] [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: 01/30/2023]
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Abed A, Khattak A, Millward M, Chopra A, Gray E. Genomic HLA heterozygosity as a predictive marker for survival in lung cancer patients post immunotherapy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz446.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bishop DVM, Brookman-Byrne A, Gratton N, Gray E, Holt G, Morgan L, Morris S, Paine E, Thornton H, Thompson PA. Language phenotypes in children with sex chromosome trisomies. Wellcome Open Res 2019; 3:143. [PMID: 30815537 PMCID: PMC6376256 DOI: 10.12688/wellcomeopenres.14904.2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2019] [Indexed: 01/25/2023] Open
Abstract
Background Sex chromosome trisomies (47,XXX, 47,XXY and 47,XYY) are known to be a risk factor for language disorder, but it is hard to predict outcomes, because many cases are identified only when problems are found. Methods We recruited children aged 5-16 years with all three types of trisomy, and divided them into a High Bias group, identified in the course of investigations for neurodevelopmental problems, and a Low Bias group, identified via prenatal screening or other medical investigations. Children from a twin sample were used to compare pattern and severity of language problems: they were subdivided according to parental concerns about language/history of speech-language therapy into a No Concerns group (N = 118) and a Language Concerns group (N = 57). Children were assessed on a psychometric battery and a standardized parent checklist. After excluding children with intellectual disability, autism or hearing problems, the sample included 28 XXX, 18 XXY and 14 XYY Low Bias cases and 7 XXX, 13 XXY and 17 XYY High Bias cases. Results Variation within each trisomy group was substantial: within the Low Bias group, overall language scores were depressed relative to normative data, but around one third had no evidence of problems. There was no effect of trisomy type, and the test profile was similar to the Language Concerns comparison group. The rate of problems was much greater in the High Bias children with trisomies. Conclusions When advising parents after discovery of a trisomy, it is important to emphasise that, though there is an increased risk of language problems, there is a very wide range of outcomes. Severe language problems are more common in those identified via genetic testing for neurodevelopmental problems but these are not characteristic of children identified on prenatal screening.
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Affiliation(s)
- Dorothy V. M. Bishop
- Department of Experimental Psychology, University of Oxford, Oxford, Oxon, OX2 6GG, UK
| | - Annie Brookman-Byrne
- Department of Experimental Psychology, University of Oxford, Oxford, Oxon, OX2 6GG, UK
| | - Nikki Gratton
- Department of Experimental Psychology, University of Oxford, Oxford, Oxon, OX2 6GG, UK
| | - Elaine Gray
- Department of Experimental Psychology, University of Oxford, Oxford, Oxon, OX2 6GG, UK
| | - Georgina Holt
- Department of Experimental Psychology, University of Oxford, Oxford, Oxon, OX2 6GG, UK
| | - Louise Morgan
- Department of Experimental Psychology, University of Oxford, Oxford, Oxon, OX2 6GG, UK
| | - Sarah Morris
- Department of Experimental Psychology, University of Oxford, Oxford, Oxon, OX2 6GG, UK
| | - Eleanor Paine
- Department of Experimental Psychology, University of Oxford, Oxford, Oxon, OX2 6GG, UK
| | - Holly Thornton
- Department of Experimental Psychology, University of Oxford, Oxford, Oxon, OX2 6GG, UK
| | - Paul A. Thompson
- Department of Experimental Psychology, University of Oxford, Oxford, Oxon, OX2 6GG, UK
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McKetton L, Venkatraghavan L, Rosen C, Mandell DM, Sam K, Sobczyk O, Poublanc J, Gray E, Crawley A, Duffin J, Fisher JA, Mikulis DJ. Improved White Matter Cerebrovascular Reactivity after Revascularization in Patients with Steno-Occlusive Disease. AJNR Am J Neuroradiol 2018; 40:45-50. [PMID: 30573457 DOI: 10.3174/ajnr.a5912] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/08/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE One feature that patients with steno-occlusive cerebrovascular disease have in common is the presence of white matter (WM) lesions on MRI. The purpose of this study was to evaluate the effect of direct surgical revascularization on impaired WM cerebrovascular reactivity in patients with steno-occlusive disease. MATERIALS AND METHODS We recruited 35 patients with steno-occlusive disease, Moyamoya disease (n = 24), Moyamoya syndrome (n = 3), atherosclerosis (n = 6), vasculitis (n = 1), and idiopathic stenosis (n = 1), who underwent unilateral brain revascularization using a direct superficial temporal artery-to-MCA bypass (19 women; mean age, 45.8 ± 16.5 years). WM cerebrovascular reactivity was measured preoperatively and postoperatively using blood oxygen level-dependent (BOLD) MR imaging during iso-oxic hypercapnic changes in end-tidal carbon dioxide and was expressed as %Δ BOLD MR signal intensity per millimeter end-tidal partial pressure of CO2. RESULTS WM cerebrovascular reactivity significantly improved after direct unilateral superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass in the revascularized hemisphere in the MCA territory (mean ± SD, -0.0005 ± 0.053 to 0.053 ± 0.046 %BOLD/mm Hg; P < .0001) and in the anterior cerebral artery territory (mean, 0.0015 ± 0.059 to 0.021 ± 0.052 %BOLD/mm Hg; P = .005). There was no difference in WM cerebrovascular reactivity in the ipsilateral posterior cerebral artery territory nor in the vascular territories of the nonrevascularized hemisphere (P < .05). CONCLUSIONS Cerebral revascularization surgery is an effective treatment for reversing preoperative cerebrovascular reactivity deficits in WM. In addition, direct-STA-MCA bypass may prevent recurrence of preoperative symptoms.
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Affiliation(s)
- L McKetton
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - L Venkatraghavan
- Department of Anesthesia and Pain Management (L.V., J.A.F.), University Health Network, Toronto, Ontario, Canada
| | - C Rosen
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - D M Mandell
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - K Sam
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.).,Russell H. Morgan Department of Radiology and Radiological Science (K.S.), John Hopkins School of Medicine, Baltimore, Maryland
| | - O Sobczyk
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - J Poublanc
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - E Gray
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - A Crawley
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - J Duffin
- Department of Physiology (J.D., J.A.F.).,Institute of Medical Sciences (J.D., J.A.F., D.J.M.), University of Toronto, Toronto, Ontario, Canada
| | - J A Fisher
- Department of Anesthesia and Pain Management (L.V., J.A.F.), University Health Network, Toronto, Ontario, Canada.,Department of Physiology (J.D., J.A.F.).,Institute of Medical Sciences (J.D., J.A.F., D.J.M.), University of Toronto, Toronto, Ontario, Canada
| | - D J Mikulis
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.) .,Institute of Medical Sciences (J.D., J.A.F., D.J.M.), University of Toronto, Toronto, Ontario, Canada
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Bishop DVM, Brookman-Byrne A, Gratton N, Gray E, Holt G, Morgan L, Morris S, Paine E, Thornton H, Thompson PA. Language phenotypes in children with sex chromosome trisomies. Wellcome Open Res 2018; 3:143. [PMID: 30815537 PMCID: PMC6376256 DOI: 10.12688/wellcomeopenres.14904.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2018] [Indexed: 12/13/2022] Open
Abstract
Background: Sex chromosome trisomies (47,XXX, 47,XXY and 47,XYY) are known to be a risk factor for language disorder, but typical outcomes are hard to estimate, because many cases are identified only when problems are found. Methods: We recruited children aged 5-16 years with all three types of trisomy, and divided them into a High Bias group, identified in the course of investigations for neurodevelopmental problems, and a Low Bias group, identified via prenatal screening or other medical investigations. Children from a twin sample were used to compare the pattern and severity of language problems: they were subdivided according to parental concerns about language/history of speech-language therapy into a No Concerns group (N = 132) and a Language Concerns group (N = 41). Children were individually assessed on a psychometric battery, and a standardized parent checklist. After excluding children with intellectual disability, autism or hearing problems, psychometric data were available for 31 XXX, 20 XXY and 19 XYY Low Bias cases and 13 XXX, 25 XXY and 32 XYY High Bias cases. Results: Variation within each trisomy group was substantial: within the Low Bias group, overall language scores were depressed relative to normative data, but around one-third had no evidence of problems. There was no effect of trisomy type, and the test profile was similar to the Language Concerns comparison group. The rate of problems was much greater in the High Bias children with trisomies. Conclusions: When advising parents after discovery of a trisomy, it is important to emphasise that, though there is an increased risk of language problems, there is a very wide range of outcomes. Severe language problems are more common in those identified via genetic testing for neurodevelopmental problems but these are not typical of children identified on prenatal screening.
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Affiliation(s)
- Dorothy V. M. Bishop
- Department of Experimental Psychology, University of Oxford, Oxford, Oxon, OX2 6GG, UK
| | - Annie Brookman-Byrne
- Department of Experimental Psychology, University of Oxford, Oxford, Oxon, OX2 6GG, UK
| | - Nikki Gratton
- Department of Experimental Psychology, University of Oxford, Oxford, Oxon, OX2 6GG, UK
| | - Elaine Gray
- Department of Experimental Psychology, University of Oxford, Oxford, Oxon, OX2 6GG, UK
| | - Georgina Holt
- Department of Experimental Psychology, University of Oxford, Oxford, Oxon, OX2 6GG, UK
| | - Louise Morgan
- Department of Experimental Psychology, University of Oxford, Oxford, Oxon, OX2 6GG, UK
| | - Sarah Morris
- Department of Experimental Psychology, University of Oxford, Oxford, Oxon, OX2 6GG, UK
| | - Eleanor Paine
- Department of Experimental Psychology, University of Oxford, Oxford, Oxon, OX2 6GG, UK
| | - Holly Thornton
- Department of Experimental Psychology, University of Oxford, Oxford, Oxon, OX2 6GG, UK
| | - Paul A. Thompson
- Department of Experimental Psychology, University of Oxford, Oxford, Oxon, OX2 6GG, UK
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Gray E, Walker D, Heath A, Barrowcliffe TW. Collaborative Study on Assays of Activated FIX (FIXa) On Behalf of the Factor VIII and Factor IX Subcommittee of the ISTH. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1650715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryA collaborative study has been organised by NIBSC to examine the performance of FIXa assays between laboratories, and to investigate the need for a standard. Ampoules of 3 materials, one monocomponent concentrate (coded C) and 2 different preparations of purified human FIXa (one proposed reference preparation, coded A and a test material coded B), have been assayed in 11 laboratories for FIXa using either the NIBSC method or a local method, with local standards (if available, coded D) to determine their potencies. The data showed high between assay variability; with the exception of one laboratory, most of the between assay variation expressed as %geometric coefficients of variation (gcv) were over 15%The interlaboratory gcv when preparation B was assayed against the local standard was over 1700%, suggesting that most of the local standards are poorly calibrated. The %gcv was improved to 80% when reference A was used as the standard. These data clearly show that an international reference standard for FIXa would help to standardise FIXa preparations and would also improve in house assays for FIXa. However, an accelerated degradation study has shown that reference A is not suitable as a long term standard and another material with suitable stabilisers has to be established as an international standard for FIXa.
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Affiliation(s)
- Elaine Gray
- The National Institute for Biological Standards and Contro’ Potters Bar, Hertfordshire, UK
| | - Dawn Walker
- The National Institute for Biological Standards and Contro’ Potters Bar, Hertfordshire, UK
| | - Alan Heath
- The National Institute for Biological Standards and Contro’ Potters Bar, Hertfordshire, UK
| | - Trevor W Barrowcliffe
- The National Institute for Biological Standards and Contro’ Potters Bar, Hertfordshire, UK
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Wilmot HV, Gray E. Potency estimates for recombinant factor IX in the one-stage clotting assay are influenced by more than just the choice of activated partial thromboplastin time reagent. Haemophilia 2018; 24:e363-e368. [PMID: 30051554 DOI: 10.1111/hae.13556] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2018] [Indexed: 01/31/2023]
Abstract
The activated partial thromboplastin time (APTT) one-stage clotting (OSC) assay is used to potency label factor IX (FIX) therapeutics and to monitor the treatment of deficient patients. Studies have highlighted differences in potency estimates for FIX therapeutics depending on what activator type the APTT reagent contains. During the study to replace the 4th International Standard (IS) for FIX Concentrate, it was noted that for the recombinant FIX (rFIX) candidates, a potency difference of 20% was obtained by some between laboratories using the reagent DAPTTIN. This study was designed to investigate this discrepancy. Two plasma-derived (pdFIX) and 2 rFIX materials were assayed against the 4th IS for FIX concentrate (07/182) using the OSC assay. Three different APTT reagents were used (DAPTTIN, SynthAFax and SynthASil), plus 4 different activation times. The pdFIX samples were not affected by activation time or APTT reagent, with expected potencies recovered in all assays and at all activation times. For rFIX, expected potencies were recovered using SynthASil, but SynthAFax generated potencies around 20% lower. This was consistent across the activation times. For DAPTTIN, potencies for rFIX dropped progressively and by up to 30% as activation time increased from 120 to 300 seconds. This study demonstrates that activation time as well as choice of APTT reagent can result in discrepancies in the potency estimation of rFIX. These factors should be taken into account when assaying rFIX.
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Affiliation(s)
- Helen V Wilmot
- Haemostasis Section, Biotherapeutics Division, National Institute for Biological Standards and Control, Potters Bar, UK
| | - Elaine Gray
- Haemostasis Section, Biotherapeutics Division, National Institute for Biological Standards and Control, Potters Bar, UK
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Gray E, Tubbs J, Thomas S, Oates A, Boisclair M, Kemball-Cook G, Barrowcliffe TW. Measurement of Activated Factor IX in Factor IX Concentrates: Correlation with In Vivo Thrombogenicity. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1653839] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryCurrent in vitro tests for thrombogenicity of FIX concentrates used for prothrombin complex concentrates (PCCs), are of little value when applied to high purity FIX (HP FIXs). In the present study, we have developed a chromogenic assay for activated FIX (FIXa) and evaluated its ability to predict in vivo thrombogenic potential of HP FIXs in a modified Wessler stasis model. Among the HP FIXs, only 1 out of 7 products had no detectable FIXa; this product also showed no in vivo thrombogenicity. In the other 6 products, FIXa content ranged from 0.15–1.2 U/1000 iu FIX, and all showed some evidence of in vivo thrombogenicity, with mean thrombus scores ranging from 0.25–4. There was a significant positive correlation (r = 0.55, p <0.02) between FIXa levels and in vivo thrombogenicity of HP FIXs. NAPTT data were not significantly correlated with the in vivo results and the TFCT also showed no direct correlation with the mean thrombus score. These results indicate that HP FIXs may still carry a small residual thrombotic risk and measurement of FIXa content of these products may be a better predictor of thrombogenicity than the current in vitro tests.
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Affiliation(s)
- Elaine Gray
- The Division of Haematology, NIBSC, South Mimms, Potters Bar, Hertfordshire, UK
| | - Jill Tubbs
- The Division of Haematology, NIBSC, South Mimms, Potters Bar, Hertfordshire, UK
| | - S Thomas
- The Division of Haematology, NIBSC, South Mimms, Potters Bar, Hertfordshire, UK
| | - A Oates
- Bioplasma Division, CSL Ltd., Broadmeadows, Victoria, Australia
| | - M Boisclair
- Department of Haematology, Charing Cross and Westminster Medical School, London, UK
| | - G Kemball-Cook
- The Division of Haematology, NIBSC, South Mimms, Potters Bar, Hertfordshire, UK
| | - T W Barrowcliffe
- The Division of Haematology, NIBSC, South Mimms, Potters Bar, Hertfordshire, UK
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Gray E, Heath AB, Mulloy B, Spiese JM, Barrowcliffe TW. A Collaborative Study of Proposed European Pharmacopoeia Reference Preparations of Low Molecular Mass Heparin. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1649843] [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: 10/28/2022]
Abstract
SummaryA European collaborative study, in which 16 laboratories participated, was carried out to assess the performance of the European Pharmacopoeia (EP) monograph methods for anticoagulant activities (anti-Xa and anti-IIa assays) of low molecular mass (EMM) heparin and to assess the suitability of six candidate materials as the EP working standard for LMM heparin. There was good interlaboratory agreement for both types of assays as indicated by most gcv’s being less than 10%, indicating acceptable performance of the EP assay methods. All the candidate preparations gave dose-response curves parallel to the 1st International Standard for Low Molecular Weight heparin and to each other. All preparations, possibly with the exception of E and F, gave similar performance as measured by interlaboratory agreement and would be suitable as working standards. Based on these data, preparations A, B, C and D have been established by the EP as official EP Biological Reference Preparations and they will be issued as successive batches.
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Affiliation(s)
- E Gray
- The National Institute for Biological Standards and Control, South MImms, Potters Bar, Hertfordshire, UK
| | - A B Heath
- The National Institute for Biological Standards and Control, South MImms, Potters Bar, Hertfordshire, UK
| | - B Mulloy
- The National Institute for Biological Standards and Control, South MImms, Potters Bar, Hertfordshire, UK
| | - J-M Spiese
- The European Pharmacopoeia Commission, Strasbourg, France
| | - T W Barrowcliffe
- The National Institute for Biological Standards and Control, South MImms, Potters Bar, Hertfordshire, UK
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Abstract
SummaryThe effect of systemic interleukin-1 (IL-1) on venous endothelium in the presence and absence of stasis has been studied by scanning electron microscopy (SEM). Recombinant human IL-1β at a concentration of 1 εg/kg or saline was injected intravenously into rabbits and allowed to circulate for 0.5 or 4.0 h after which complete stasis was induced for 1 h in an isolated segment of each jugular vein. One vein segment was then excised and the contents examined macroscopically for thrombi, while the other segment was fixed for SEM examination. When examined by SEM the endothelium from rabbits injected with IL-1β was perturbed with increased surface microvilli, blebs and gaps at cell junctions when compared with saline controls. Fibrin deposition was also observed after IL-1β, as was the adherence of essentially non-activated platelets to intact endothelium. However, macroscopic thrombi were not formed in isolated vein segments. We conclude that although fibrin strands and platelets were deposited on the endothelium, IL-1 is not a sufficiently powerful procoagulant stimulus to lead to an occlusive thrombus in acute experiments.
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Affiliation(s)
- R E Merton
- The National Institute for Biological Standards and Control, South Mimms, Potters Bar, Hertfordshire, UK
| | - D Hockley
- The National Institute for Biological Standards and Control, South Mimms, Potters Bar, Hertfordshire, UK
| | - E Gray
- The National Institute for Biological Standards and Control, South Mimms, Potters Bar, Hertfordshire, UK
| | - S Poole
- The National Institute for Biological Standards and Control, South Mimms, Potters Bar, Hertfordshire, UK
| | - D P Thomas
- The National Institute for Biological Standards and Control, South Mimms, Potters Bar, Hertfordshire, UK
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Abstract
SummaryWe have examined the effect in impairing thrombus formation of a preparation of dermatan sulphate (DS) alone and DS plus small amounts of unfractionated heparin (UFH). In rabbits given a dose of 150 μg/kg of DS alone, there was minimal reduction in serum-induced stasis thrombosis (Wessler model), with an overall score of 92.5% (100% = no impairment of thrombus formation). When the same dose of DS containing UFH was given (two different subgroups given DS containing 0.25 and 2.5% heparin by dry weight, respectively), the overall thrombus score was reduced to 60% (P <0.003), with no significant difference between the two subgroups. To achieve a comparable result with DS alone, a dose of 1 mg/kg was required. We conclude that very small amounts of UFH significantly enhance the antithrombotic action of DS, by a mechanism that has yet to be determined.
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Affiliation(s)
- D P Thomas
- The Division of Haematology, National Institute for Biological Standards and Control, Potters Bar, Hertfordshire, U.K
| | - E Gray
- The Division of Haematology, National Institute for Biological Standards and Control, Potters Bar, Hertfordshire, U.K
| | - R E Merton
- The Division of Haematology, National Institute for Biological Standards and Control, Potters Bar, Hertfordshire, U.K
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Ryn-McKenna JV, Gray E, Weber E, Ofosu FA, Buchanan MR. Effects of Sulfated Polysaccharides on Inhibition of Thrombus Formation initiated by Different Stimuli. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1646517] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryTo test the possibility that different doses of heparin or other sulfated polysaccharides are required to inhibit thrombosis initiated by different stimuli, we compared the effects of heparin (HEP), pentosan polysulfate (SP54) and dermatan sulfate (DS) on the inhibition of thrombus formation induced by either I) tissue thromboplastin; II) thrombin; or III) factor Xa. Inhibition of thrombus formation induced by the stimuli was measured in a rabbit jugular vein hypercoagulation/stasis model. First, we determined the minimum dose of each sulfated polysaccharide which inhibited tissue thromboplastin-induced thrombus formation by ∼75%, and then compared the relative effectiveness of this dose to prevent thrombus formation initiated with the other two stimuli. HEP and SP54 were less effective when thrombin was the thrombogenic stimulus, while DS was more effective. HEP was the most effective agent when factor Xa was the stimulus. We conclude that the antithrombotic effectiveness of a given dose of a sulfated polysaccharide may vary depending on the stimulus which initiates thrombus formation.
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Affiliation(s)
- J Van Ryn-McKenna
- The Department of Pathology, McMaster University Medical Centre and the Canadian Red Cross Blood Transfusion Service, Hamilton, Ontario, Canada
| | - E Gray
- The Department of Pathology, McMaster University Medical Centre and the Canadian Red Cross Blood Transfusion Service, Hamilton, Ontario, Canada
| | - E Weber
- The Department of Pathology, McMaster University Medical Centre and the Canadian Red Cross Blood Transfusion Service, Hamilton, Ontario, Canada
| | - F A Ofosu
- The Department of Pathology, McMaster University Medical Centre and the Canadian Red Cross Blood Transfusion Service, Hamilton, Ontario, Canada
| | - M R Buchanan
- The Department of Pathology, McMaster University Medical Centre and the Canadian Red Cross Blood Transfusion Service, Hamilton, Ontario, Canada
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Barrowcliffe TW, Gray E, Merton RE, Dawes J, Jennings CA, Hubbard AR, Thomas DP. Anticoagulant Activities of Pentosan Polysulphate (Hémoclar) Due to Release of Hepatic Triglyceride Lipase (HTGL). Thromb Haemost 2018. [DOI: 10.1055/s-0038-1661640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummarySubcutaneous injections of 50 mg pentosan poly sulphate (Hemoclar) were given to normal volunteers and the effects on anti-Factor Xa activity, thrombin generation and lipase release measured. Concentrations of pentosan polysulphate were measured by a competitive binding assay and the mean peak level found to be 1.6 μg/ml. Anti-Xa clotting activity rose to 0.034 iu/ml and thrombin generation induced by lipid peroxides was inhibited by approximately 50%. Neither of these effects could be accounted for by the direct action of pentosan polysulphate at the concentrations measured. Pentosan poly sulphate was very effective in releasing lipase, approximately 70-80% of the total enzyme activity being due to hepatic triglyceride lipase (HTGL). In vitro addition of purified HTGL to plasma markedly enhanced anti-Xa clotting activity, and caused a 70% inhibition of lipid peroxide induced thrombin generation. Anti-Xa activity of postinjection plasma was increased rather than neutralised by addition of polybrene, and this effect could be mimicked by addition of polybrene to plasma containing pentosan polysulphate and purified HTGL. It is concluded that, when given in low doses subcutaneously, pentosan polysulphate acts as an indirect anticoagulant, its major effects being due to release of HTGL.
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Affiliation(s)
- T W Barrowcliffe
- The National Institute for Biological Standards and Control, London, UK
| | - E Gray
- The National Institute for Biological Standards and Control, London, UK
| | - R E Merton
- The National Institute for Biological Standards and Control, London, UK
| | - J Dawes
- The MRC/SNBTS Blood Components Assay Group, Edinburgh, UK
| | - C A Jennings
- The National Institute for Biological Standards and Control, London, UK
| | - A R Hubbard
- The National Institute for Biological Standards and Control, London, UK
| | - D P Thomas
- The National Institute for Biological Standards and Control, London, UK
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Barrowcliffe TW, Gray E, Kerry PJ, Gutteridge JMC. Triglyceride-Rich Lipoproteins Are Responsible for Thrombin Generation Induced by Lipid Peroxides. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1661124] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryPrevious studies have shown that lipid peroxides promote thrombin generation in platelet-poor plasma. In the present study, it has been shown that triglyceride-rich lipoproteins, especially chylomicra of dietary origin, are responsible for this procoagulant activity. The generation of thrombin by lipid peroxides is also enhanced by their inhibitory action on antithrombin III. These results suggest a possible new relationship between dietary fat, lipid peroxidation and thrombus formation.
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Affiliation(s)
- T W Barrowcliffe
- The National Institute for Biological Standards and Control, Hampstead, London, U.K
| | - E Gray
- The National Institute for Biological Standards and Control, Hampstead, London, U.K
| | - P J Kerry
- The National Institute for Biological Standards and Control, Hampstead, London, U.K
| | - J M C Gutteridge
- The National Institute for Biological Standards and Control, Hampstead, London, U.K
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