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Affiliation(s)
- Nicole Trepanowski
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Emily L. Coleman
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Gabriella Melson
- Department of Dermatology, Section of Dermatopathology, Boston University School of Medicine, Boston, Massachusetts
| | - Candice E. Brem
- Department of Dermatology, Section of Dermatopathology, Boston University School of Medicine, Boston, Massachusetts
| | - Christina S. Lam
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
- Correspondence to: Christina S. Lam, MD, Department of Dermatology, Boston University School of Medicine, 609 Albany St, Boston, MA 02118
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Coleman EL, Olamiju B, Leventhal JS. Potentially life‑threatening severe cutaneous adverse reactions associated with tyrosine kinase inhibitors (Review). Oncol Rep 2020; 45:891-898. [PMID: 33650659 DOI: 10.3892/or.2020.7911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 10/21/2020] [Indexed: 11/05/2022] Open
Abstract
Tyrosine kinase inhibitors (TKIs) have emerged as a new frontier of cancer therapy. These agents include inhibitors of epidermal growth factor receptor (EGFR), human epidermal growth factor receptor 2 (HER2), BRAF, mitogen‑activated protein kinase kinase (also referred to as MEK), bcr‑abl, c‑KIT, platelet‑derived growth factor (PDGFR), fibroblast growth factor receptor (FGFR), anaplastic lymphoma kinase (ALK) and vascular endothelial growth factor (VEGF). Along with the evolving applications of TKIs, there has been an increased recognition of the breadth of potential cutaneous toxicities to these agents. In this review, we provide an overview of potentially life‑threatening severe cutaneous adverse reactions (SCARs) that may occur during therapy with TKIs. These toxicities include Stevens‑Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP).
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Affiliation(s)
- Emily L. Coleman
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Shawn E. Cowper
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Stacey M. Stein
- Department of Medicine Medical Oncology, Yale University School of Medicine, New Haven, Connecticut
| | - Jonathan S. Leventhal
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
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Jones IV AR, Coleman EL, Husni NR, Deeney JT, Raval F, Steenkamp D, Dooms H, Nikolajczyk BS, Corkey BE. Type 1 diabetes alters lipid handling and metabolism in human fibroblasts and peripheral blood mononuclear cells. PLoS One 2017; 12:e0188474. [PMID: 29206239 PMCID: PMC5714353 DOI: 10.1371/journal.pone.0188474] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 11/07/2017] [Indexed: 01/05/2023] Open
Abstract
Triggers of the autoimmune response that leads to type 1 diabetes (T1D) remain poorly understood. A possibility is that parallel changes in both T cells and target cells provoke autoimmune attack. We previously documented greater Ca2+ transients in fibroblasts from T1D subjects than non-T1D after exposure to fatty acids (FA) and tumor necrosis factor α (TNFα). These data indicate that metabolic and signal transduction defects present in T1D can be elicited ex vivo in isolated cells. Changes that precede T1D, including inflammation, may activate atypical responses in people that are genetically predisposed to T1D. To identify such cellular differences in T1D, we quantified a panel of metabolic responses in fibroblasts and peripheral blood cells (PBMCs) from age-matched T1D and non-T1D subjects, as models for non-immune and immune cells, respectively. Fibroblasts from T1D subjects accumulated more lipid, had higher LC-CoA levels and converted more FA to CO2, with less mitochondrial proton leak in response to oleate alone or with TNFα, using the latter as a model of inflammation. T1D-PBMCs contained and also accumulated more lipid following FA exposure. In addition, they formed more peroxidized lipid than controls following FA exposure. We conclude that both immune and non-immune cells in T1D subjects differ from controls in terms of responses to FA and TNFα. Our results suggest a differential sensitivity to inflammatory insults and FA that may precede and contribute to T1D by priming both immune cells and their targets for autoimmune reactions.
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Affiliation(s)
- Albert R. Jones IV
- Obesity Research Center, Evans Department of Medicine, Boston University School of Medicine, Boston, MA, United States of America
| | - Emily L. Coleman
- Yale University School of Medicine, New Haven, CT, United States of America
| | - Nicholas R. Husni
- Obesity Research Center, Evans Department of Medicine, Boston University School of Medicine, Boston, MA, United States of America
| | - Jude T. Deeney
- Obesity Research Center, Evans Department of Medicine, Boston University School of Medicine, Boston, MA, United States of America
| | - Forum Raval
- Department of Microbiology, Boston University School of Medicine, Boston, MA, United States of America
| | - Devin Steenkamp
- Endocrinology Section, Evans Department of Medicine, Boston University School of Medicine, Boston, MA, United States of America
| | - Hans Dooms
- Rheumatology Section, Evans Department of Medicine, Boston University School of Medicine, Boston, MA, United States of America
| | - Barbara S. Nikolajczyk
- Department of Translational Research in Diabetes, University of Kentucky School of Medicine, Lexington, KY, United States of America
- Department of Pharmacology and Nutritional Sciences, University of Kentucky School of Medicine, Lexington, KY, United States of America
| | - Barbara E. Corkey
- Obesity Research Center, Evans Department of Medicine, Boston University School of Medicine, Boston, MA, United States of America
- * E-mail:
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Dingli K, Coleman EL, Vennelle M, Finch SP, Wraith PK, Mackay TW, Douglas NJ. Evaluation of a portable device for diagnosing the sleep apnoea/hypopnoea syndrome. Eur Respir J 2003; 21:253-9. [PMID: 12608438 DOI: 10.1183/09031936.03.00298103] [Citation(s) in RCA: 201] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Waiting times for hospital-based monitoring of the obstructive sleep apnoea/hypopnoea syndrome (OSAHS) are rising. This study tested whether Embletta, a new portable device, may accurately diagnose OSAHS at home. A synchronous comparison to polysomnography was performed in 40 patients and a comparison of home Embletta studies with in-laboratory polysomnography was performed in 61 patients. In the synchronous study, the mean difference (polysomnography-Embletta) in apnoeas+hypopnoeas (A+H) x h(-1) in bed was 2 h(-1). In comparison to the apnoea/ hypopnoea index (AHI) x h(-1) slept, the Embletta (A+H) x h(-1) in bed differed by 8 x h(-1). These data were used to construct diagnostic categories in symptomatic patients from their Embletta results: "OSAHS" (> or = 20 (A+H) x h(-1) in bed), "possible OSAHS" (10-20 (A+H) x h(-1) in bed) or "not OSAHS" (<10 (A+H) x h(-1) in bed). In the home study, the mean difference in (A+H) x h(-1) in bed was 3 x h(-1). In comparison to the polysomnographic AHI x h(-1) slept, the Embletta (A+H) x h(-1) in bed differed by 6 +/- 14 x h(-1). Using the above classification, all nine patients categorised as not OSAHS had AHI < 15 x h(-1) slept on polysomnography and all 23 with OSAHS on Embletta had an AHI > or = 15 on polysomnography, but 18 patients fell into the possible OSAHS category potentially requiring further investigation and 11 home studies failed. Most patients were satisfactorily classified by home Embletta studies but 29 out of 61 required further investigation. The study suggested a 42% saving in diagnostic costs over polysomnography if this approach were adopted.
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Affiliation(s)
- K Dingli
- Sleep Centre, Royal Infirmary NHS Trust, Edinburgh, Scotland, UK
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Kingshott RN, Vennelle M, Coleman EL, Engleman HM, Mackay TW, Douglas NJ. Randomized, double-blind, placebo-controlled crossover trial of modafinil in the treatment of residual excessive daytime sleepiness in the sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 2001; 163:918-23. [PMID: 11282766 DOI: 10.1164/ajrccm.163.4.2005036] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Some patients with the sleep apnea/hypopnea syndrome (SAHS) remain subjectively and objectively sleepy despite using effective continuous positive airway pressure (CPAP) therapy. The aim of this single center study was to determine the efficacy and safety of the novel wake-promoting medication modafinil in the treatment of CPAP-resistant daytime sleepiness. Thirty sleep apneics receiving effective CPAP therapy (objective use, 6.5 +/- 1.1 h/night) received daily single doses of 400 mg modafinil or placebo for 2 wk in a double-blind randomized crossover design. Outcome measures were assessed at baseline and at the end of both 2-wk treatment periods. Treatment periods were separated by a 1-wk washout. Modafinil had no effect on sleepiness as measured by the Epworth Sleepiness Scale or the Multiple Sleep Latency Test (p > 0.1); however, significant improvements in alertness were found with the Maintenance of Wakefulness Test (modafinil 18.3 +/- 3.9 min; placebo, 16.6 +/- 5.0 min; p < 0.02). No significant treatment-related improvements in cognitive performance or quality of life were found with modafinil (all p > 0.05). There was a significant reduction in CPAP use on modafinil compared to placebo (6.3 +/- 1 h/ night; 6.5 +/- 1, p = 0.03). This study suggests that modafinil may improve some aspects of alertness in patients with SAHS who remain sleepy during CPAP therapy, but further studies are required to assess the significance of the reduction in CPAP use.
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Affiliation(s)
- R N Kingshott
- Sleep Center, Respiratory Medicine Unit, The University of Edinburgh, United Kingdom.
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