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Siddique A, Parekh KR, Huddleston SJ, Shults A, Locke JE, Keshavamurthy S, Schwartz G, Hartwig MG, Whitson BA. A call to action in thoracic transplant surgical training. J Heart Lung Transplant 2023; 42:1627-1631. [PMID: 37268052 DOI: 10.1016/j.healun.2023.05.017] [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: 12/12/2022] [Revised: 05/19/2023] [Accepted: 05/30/2023] [Indexed: 06/04/2023] Open
Abstract
Thoracic organ recovery and implantation is increasing in complexity. Simultaneously the logistic burden and associated cost is rising. An electronic survey distributed to the surgical directors of thoracic transplant programs in the United States indicated dissatisfaction amongst 72% of respondents with current procurement training and 85% of respondents favored a process for certification in thoracic organ transplantation. These responses highlight concerns for the current paradigm of training in thoracic transplantation. We discuss the implications of advancements in organ retrieval and implant for surgical training and propose that the thoracic transplant community might address the need through formalized training in procurement and certification in thoracic transplantation.
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Affiliation(s)
- A Siddique
- University of Nebraska Medical Center, Department of Surgery, Division of Cardiothoracic Surgery, Omaha, Nebraska.
| | - K R Parekh
- University of Iowa Hospitals and Clinics, Department of Cardiothoracic Surgery, Carver College of Medicine, Iowa City, Iowa
| | - S J Huddleston
- University of Minnesota, Department of Surgery, Division of Cardiothoracic Surgery
| | - A Shults
- American Society of Thoracic Surgeons, Arlington, Virginia
| | - J E Locke
- University of Alabama at Birmingham, Department of Surgery, Division of Transplantation, Birmingham, Alabama
| | - S Keshavamurthy
- University of Kentucky College of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Lexington, Kentucky
| | - G Schwartz
- Baylor University Medical Center, Department of Thoracic Surgery, Dallas, Texas
| | - M G Hartwig
- Duke University Health System, Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Durham, North Carolina
| | - B A Whitson
- The Ohio State University Wexner Medical Center, Department of Surgery, Division of Cardiac Surgery, Columbus, Ohio
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Schwartz G, Lutz D, Bell M, Klug M. 39P Longitudinal increases in albumin-adjusted serum calcium predict ovarian cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.057] [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: 11/26/2022] Open
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3
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Levi-Belz Y, Zerach G, Schwartz G, Halperin E. Moral Injury and Suicide Ideation Among Combat Veterans: The Role of Trauma-Related Shame and Collective Hatred. Eur Psychiatry 2022. [PMCID: PMC9568020 DOI: 10.1192/j.eurpsy.2022.2187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Exposure to potentially morally injurious events (PMIEs) among combat veterans has been acknowledged as a significant stressful combat event that may lead to mental health problems, including suicide ideation (SI). Several studies have examined the risk and protective factors that can explain the conditions in which PMIEs may contribute to the development and maintenance of SI. However, the contribution of social-emotional factors has yet to be examined.
Objectives
In the current study, we examined the association between PMIE-Self and SI among combat veterans and explored the mediating role of trauma-related shame and the moderation role of collective hatred in this association.
Methods
A volunteer sample of 336 Israeli combat veterans was recruited, completing self-report questionnaires in a cross-sectional study.
Results
indicated that PMIE-Self was positively associated with SI, and trauma-related shame mediated this association. Moreover, collective hatred moderated both their direct (PMIE -SI) and indirect (PMIE-Shame-SI) association. Notably, collective hatred had an inverse role for each of the associations. Thus, collective hatred was found to comprise both a risk and a protective factor for SI following PMIE-Self.
Conclusions
The current findings highlight the crucial contribution of trauma-related shame and collective hatred to the association between moral injury and suicidality. Moreover, the findings demonstrate that even years after their military service release, combat veterans exposed to PMIEs may still feel consumed by painful memories and maintain premonitions of a foreshortened future. Furthermore, the findings help to better understand the dynamics of collective hatred and the challenge of modifying it.
Disclosure
No significant relationships.
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Leal A, Broyles W, Hashmi Z, Patel N, Patel A, Hernandez O, Schwartz G, Meyer D. Extracorporeal Membrane Oxygenation Dependent COVID19 Hospital Transfers. J Heart Lung Transplant 2021. [PMCID: PMC7979375 DOI: 10.1016/j.healun.2021.01.1292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction The World Health Organization has recorded over 8 Million cases of COVID19 as of October 2020. Despite receiving appropriate lung protective ventilation and medical treatment, some of these patients develop refractory hypoxemia and acute respiratory distress syndrome . Extracorporeal membrane oxygenation has been recognized as a lifesaving therapy for patients with ARDS secondary to COVID19. There are few centers in the United States equipped with the necessary staff and the experience to take care of such critically ill patients. Some patients are too ill to be transferred with conventional mechanical ventilation, and they require interhospital transport while on ECMO. Case Report We have developed a highly specialized ECMO Deployment Team dedicated to the cannulation and transport of COVID19 patients while on venous-venous (VV) ECMO or venous-arterial (VA) ECMO. We use routine bedside ECMO cannulation via bilateral femoral vessels configuration at the outside hospital. The patient is stabilized and transported by air or ground to one of our affiliated hospitals.Here we present a series of five patients who were cannulated by our team at an outside institution and transported while on ECMO support to one of our three system hospitals. Patient ages ranged between 49-64 years old. Four patients required VV ECMO for severe hypoxemia secondary to COVID19 ARDS. One patient required VA ECMO due to viral myocarditis secondary to COVID19. Time on ECMO ranged from 9-33 days. Three of the five patients recovered successfully and were discharged home, rehab or LTAC. One patient is still currently on ECMO and one patient is deceased. There were no reported or documented transmission of COVID19 to the members of the ECMO deployment team. Summary The potential for survival of the critically ill due to COVID19 often demands a higher level of care. However, stable transport to an appropriate institution presents a limiting factor. Our method of a dedicated ECMO Deployment Team appears to provide favorable outcome for these patients.
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Wright R, Kallend D, Raal F, Stoekenbroek R, Koenig W, Leiter L, Landmesser U, Schwartz G, Wijngaard P, Kastelein J, Ray K. Pooled safety and efficacy of inclisiran in patients with statin intolerance (ORION-10 and ORION-11). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Statin-associated side effects prevent a substantial proportion of patients from being adequately treated with statin therapy and achieving adequate LDL-C reductions. Phase 3 trials showed that inclisiran, a new siRNA, durably lowers LDL-C by ≥50% on top of maximally tolerated statin therapy.
Purpose
To evaluate inclisiran's tolerability and LDL-C lowering effects among individuals who were not receiving statin therapy mainly because of statin intolerance.
Methods
The Phase 3 ORION-10 and ORION-11 trials randomized patients with established ASCVD (or risk-equivalents) with LDL-C >70 mg/dl despite maximally tolerated statins to inclisiran or placebo (1:1). Inclisiran sodium 300 mg was administered s.c. at baseline, three months later, then every six months. The primary efficacy endpoints were % change in LDL-C from baseline to Day 510 and time adjusted % change in LDL-C from baseline after Day 90 and up to Day 540. Absolute LDL-C reductions were secondary endpoints. This analysis included individuals who were not on statin therapy at baseline.
Results
The trials included 252 (7.9% of the pooled trial populations; mean age 68; male 62%; lipid-lowering therapy 28%). AE rates and LDL-C reductions are shown in the Table. Overall, 12 (4.7%) patients had myalgia (4.8% in the inclisiran groups, 4.7% in the placebo groups). There were 8 discontinuations in the inclisiran groups (6.5%) and 3 in the placebo groups (2.3%). The placebo-adjusted mean reduction in LDL-C at Day 510 was 45.8%, an absolute reduction of 68.0 mg/dL (p<0.0001).
Conclusion
Among statin intolerant individuals in ORION-10 and 11, inclisiran potently and durably lowered LDL-C with an adverse event profile comparable to placebo. Inclisiran may represent a new and potent therapeutic option for patients with elevated LDL-C unable to tolerate statins.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): The Medicines Company
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Affiliation(s)
- R.S Wright
- Mayo Clinic, Rochester, United States of America
| | - D Kallend
- The Medicines Company, Parsippany, United States of America
| | - F.J Raal
- University of the Witwatersrand, Johannesburg, South Africa
| | - R Stoekenbroek
- The Medicines Company, Parsippany, United States of America
| | - W Koenig
- German Heart Center of Munich, Munich, Germany
| | - L.A Leiter
- University of Toronto, Division of Endocrinology and Metabolism, Toronto, Canada
| | - U Landmesser
- Charite University Hospital, Department of Cardiology, Berlin, Germany
| | - G Schwartz
- University of Colorado Health, Denver, United States of America
| | | | | | - K.K Ray
- Imperial College London, Department of Primary Care and Public Health, London, United Kingdom
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Schwartz G, Leiter LA, Ballantyne CM, Barter PJ, Black DM, Kallend D, Leitersdorf E, McMurray JJV, Nicholls SJ, Olsson AG, Preiss D, Shah PK, Tardif JC, Kittelson J. P6193Dalcetrapib reduces incident diabetes in patients with recent acute coronary syndrome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Among patients with acute coronary syndrome (ACS) who do not have diabetes, incident diabetes is common and associated with an adverse prognosis. Some data suggest that high density lipoprotein (HDL) has favourable effects on beta cell function and that cholesteryl ester transfer protein (CETP) inhibitors reduce incident type 2 diabetes in conjunction with increased HDL cholesterol (HDL-C) concentration. Dalcetrapib is a CETP inhibitor under ongoing evaluation as a potential cardiovascular therapy.
Purpose
We compared the effect of treatment with dalcetrapib or placebo on incident diabetes in patients with recent acute coronary syndrome (ACS).
Methods
In the dal-OUTCOMES trial, 15,871 patients were randomly assigned to treatment with dalcetrapib 600 mg or placebo daily, beginning 4–12 weeks after ACS. Absence of diabetes at baseline was based upon medical history, no use of diabetes medication, haemoglobin A1c <6.5%, and plasma glucose level <7 mmol/L (if measured under fasting conditions) or <11.1 mmol/L (if measured under non-fasting conditions). Among these patients, incident diabetes after randomization was defined by any diabetes-related adverse event, use of a diabetes medication, HbA1c ≥6.5%, or two measurements of plasma glucose ≥7 mmol/L (fasting) or ≥11.1 mmol/L (non-fasting). The association of incident diabetes with baseline and on-treatment HDL-C was determined.
Results
At baseline, 10621 patients (67% of the trial cohort) did not have diabetes and formed the analysis cohort. Over median follow-up of 31 months, incident diabetes was identified in 392 of 5314 patients (7.4%) assigned to dalcetrapib and 505 of 5307 (9.5%) assigned to placebo (odds ratio [OR] 0.76; 95% confidence interval [CI] 0.66–0.87; P<0.001). This corresponds to an absolute reduction in incident diabetes of 2.1%, and a need to treat 47 patients (for 31 months) to prevent 1 case of diabetes. Kaplan-Meier estimates of the cumulative incidence of diabetes are shown in the Figure. Across both treatment groups, incident diabetes was inversely associated with baseline HDL-C (OR 0.98 for 1 mg/dL increase in baseline HDL-C; 95% CI 0.97–0.98, P<0.001). In the dalcetrapib group, there was a further inverse association of incident diabetes with the change in HDL-C on assigned treatment (OR 0.98 for 1 mg/dL increase in HDL-C from baseline; 95% CI 0.97–0.99, P=0.002). Dalcetrapib was safe and generally well-tolerated in the trial.
Conclusions
In patients with recent ACS who do not have diabetes at baseline, incident diabetes is common. Dalcetrapib treatment reduced the relative risk of incident diabetes by 24% and the absolute risk by 2.1% over a median of 31 months. The reduction in incident diabetes with dalcetrapib was associated with increased HDL-C on treatment.
Acknowledgement/Funding
The dal-OUTCOMES trial was funded by F. Hoffmann LaRoche
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Affiliation(s)
- G Schwartz
- University of Colorado School of Medicine and Rocky Mountain Regional VA Medical Center, Aurora, United States of America
| | | | - C M Ballantyne
- Baylor College of Medicine, Houston, United States of America
| | - P J Barter
- University of New South Wales, Sydney, Australia
| | - D M Black
- Dalcor Pharmaceuticals, Montreal, Canada
| | - D Kallend
- The Medicines Company, zurich, Switzerland
| | | | | | | | | | - D Preiss
- University of Oxford, Oxford, United Kingdom
| | - P K Shah
- Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - J C Tardif
- Montreal Heart Institute, Montreal, Canada
| | - J Kittelson
- University of Colorado, Aurora, United States of America
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Schwartz G, Szarek M, Li QH, Chiang CE, Diaz R, Hagstrom E, Huo Y, Jukema JW, Lecorps G, Moryusef A, Pordy R, White HD, Yusoff K, Zeiher AM, Steg PG. P1226Very low achieved low-density lipoprotein cholesterol level with alirocumab treatment after acute coronary syndrome: ODYSSEY OUTCOMES. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Recent guidelines for cholesterol management recognize uncertainty regarding long-term efficacy and safety of prolonged very low levels of LDL-C on treatment with a PCSK9 inhibitor, including risk of new-onset diabetes. ODYSSEY OUTCOMES used a treat-to-target approach to demonstrate reduction of coronary heart disease death, non-fatal myocardial infarction, ischaemic stroke, or unstable angina (MACE) with the PCSK9 inhibitor alirocumab (ALI) vs placebo (PBO) in 18,924 patients with recent acute coronary syndrome and elevated LDL-C despite intensive statin therapy. ALI was blindly adjusted (75 or 150 mg dose) to target LDL-C 0.6–1.3 mmol/L (25–50 mg/dL). To avoid sustained very low LDL-C, blind substitution of PBO for ALI was intended if 2 consecutive LDL-C levels were <0.39 mmol/L (15 mg/dL). Patients were followed for median of 2.8 years (maximum of 5 years).
Purpose
We report the efficacy and safety of ALI in patients who reached very low LDL-C (consecutively <0.39 mmol/L), compared with matched patients from the PBO group.
Methods
Of 9462 patients randomized to receive ALI, 730 (7.7%) reached very low LDL-C and had substitution of PBO a median 8.3 months after randomization. Using propensity score matching, they were compared (3:1) with 2152 patients initially assigned to PBO. Propensity score matching was also used to compare the incidence of new-onset diabetes in 525 patients without diabetes at baseline who had very low LDL-C levels on ALI with 1675 matched patients in the PBO group. Neurocognitive events and haemorrhagic stroke were also evaluated in relation to very low LDL-C.
Results
Overall, ALI reduced the incidence of MACE (9.5% vs 11.1%; HR 0.85, 95% CI 0.78–0.93; P<0.001). Characteristics used in propensity score matching (and associated with very low LDL-C on ALI) included sex (male), diabetes (present), baseline LDL-C and lipoprotein(a) (lower), region (Asia), statin treatment, smoking, hypertension, and body mass index. Despite being switched to PBO, patients with very low LDL-C on ALI had fewer MACE than matched patients from the PBO group (6.4% vs 8.5%; HR 0.71, 95% CI 0.52–0.98; P=0.039; Figure). Very low LDL-C on ALI was not associated with risk of new-onset diabetes, compared with matched patients from the PBO group (15.1% vs 13.0%; HR 1.10, 95% CI 0.85–1.43; P=0.46). There was no association of very low LDL-C on ALI with neurocognitive events or haemorrhagic stroke.
Conclusions
The overall efficacy of ALI on cardiovascular outcomes was not diminished by the patients who had blinded substitution of PBO for sustained very low LDL-C. Despite a short duration of active treatment, these patients had fewer MACE than matched controls from the PBO group. No adverse consequence of very low LDL-C was identified. However, because patients with sustained very low LDL-C were switched to PBO, the long-term safety of more prolonged very low LDL-C, including risk of new-onset diabetes, deserves further study.
Acknowledgement/Funding
Funded by Sanofi and Regeneron Pharmaceuticals
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Affiliation(s)
- G Schwartz
- University of Colorado School of Medicine and Rocky Mountain Regional VA Medical Center, Aurora, United States of America
| | - M Szarek
- SUNY Downstate Medical Center, Brooklyn, United States of America
| | - Q H Li
- Regeneron Pharmaceuticals, Tarrytown, United States of America
| | - C E Chiang
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - R Diaz
- Estudios Cardiologicos Latinoamerica (ECLA), Rosario, Argentina
| | | | - Y Huo
- Peking University First Hospital, Beijing, China
| | - J W Jukema
- Leiden University Medical Center, Leiden, Netherlands (The)
| | | | - A Moryusef
- Sanofi, Bridgewater, United States of America
| | - R Pordy
- Regeneron Pharmaceuticals, Tarrytown, United States of America
| | - H D White
- Auckland City Hospital, Auckland, New Zealand
| | - K Yusoff
- Batu Caves and UCSI University, Kuala Lumpur, Malaysia
| | - A M Zeiher
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - P G Steg
- Hospital Bichat-Claude Bernard, Paris, France
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Rothman J, Schwartz G, Surriga O, Ambrosini G. Suppression of KRAS-G12D and BRAF-V600E oncogene transcription with PNA-conjugates. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Garcha P, Nisar T, Jamil A, Edens M, Flores V, Felius J, Schwartz G, Mason D. Single-Center Study Evaluating the Impact of Sarcopenia on Outcomes after Lung Transplantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.842] [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: 10/27/2022] Open
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10
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Koff A, Klein M, Dickson M, Antonescu C, Qin LX, Dooley S, Schwartz G, Crago A, Singer S, Tap W. Senescence after growth arrest: A mechanism by which CDK4/6 inhibitors can mediate their activity suppressing tumor progression. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy046.011] [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: 11/14/2022] Open
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11
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Vinh T, Schwartz G, Moll M. Identification of 2-Ethyl-Hexanoic (2-Ethyl-Caproic) Acid in Beer. Journal of the American Society of Brewing Chemists 2018. [DOI: 10.1094/asbcj-39-0044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- That Vinh
- TEPRAL, 2 Rue Gabriel Bour, F-54250, Champigneulles, France
| | | | - Manfred Moll
- TEPRAL, 2 Rue Gabriel Bour, F-54250, Champigneulles, France
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White H, Steg P, Szarek M, Bhatt D, Bittner V, Diaz R, Edelberg J, Goodman S, Hantoin C, Harrington R, Jukema J, Lecorps G, Moryusef A, Pordy R, Roe M, Zeiher A, Schwartz G. Cardiovascular Outcomes With Alirocumab After Acute Coronary Syndrome: Results of the Odyssey Outcomes Trial. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.585] [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: 10/28/2022]
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13
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Rosenblatt R, Mock A, Garcha P, Huang H, Ausloos K, Aguilar P, Schwartz G, Mason D. Value of Portable Perfusion Scans in the Immediate Post-Operative Period Following Lung Transplantation. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1152] [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: 11/29/2022] Open
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14
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Oleksyn D, Zhao J, Vosoughi A, Zhao JC, Misra R, Pentland AP, Ryan D, Anolik J, Ritchlin C, Looney J, Anandarajah AP, Schwartz G, Calvi LM, Georger M, Mohan C, Sanz I, Chen L. PKK deficiency in B cells prevents lupus development in Sle lupus mice. Immunol Lett 2017; 185:1-11. [PMID: 28274793 DOI: 10.1016/j.imlet.2017.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 02/27/2017] [Accepted: 03/01/2017] [Indexed: 12/25/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by the production of autoantibodies that can result in damage to multiple organs. It is well documented that B cells play a critical role in the development of the disease. We previously showed that protein kinase C associated kinase (PKK) is required for B1 cell development as well as for the survival of recirculating mature B cells and B-lymphoma cells. Here, we investigated the role of PKK in lupus development in a lupus mouse model. We demonstrate that the conditional deletion of PKK in B cells prevents lupus development in Sle1Sle3 mice. The loss of PKK in Sle mice resulted in the amelioration of multiple classical lupus-associated phenotypes and histologic features of lupus nephritis, including marked reduction in the levels of serum autoantibodies, proteinuria, spleen size, peritoneal B-1 cell population and the number of activated CD4 T cells. In addition, the abundance of autoreactive plasma cells normally seen in Sle lupus mice was also significantly decreased in the PKK-deficient Sle mice. Sle B cells deficient in PKK display defective proliferation responses to BCR and LPS stimulation. Consistently, B cell receptor-mediated NF-κB activation, which is required for the survival of activated B cells, was impaired in the PKK-deficient B cells. Taken together, our work uncovers a critical role of PKK in lupus development and suggests that targeting the PKK-mediated pathway may represent a promising therapeutic strategy for lupus treatment.
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Affiliation(s)
- D Oleksyn
- Division of Allergy/Immunology and Rheumatology, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, United States
| | - J Zhao
- Department of Biomedical Genetics, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, United States
| | - A Vosoughi
- Division of Allergy/Immunology and Rheumatology, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, United States
| | - J C Zhao
- Department of Biology, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, United States
| | - R Misra
- Department of Pediatrics, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, United States
| | - A P Pentland
- Department of Dermatology, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, United States
| | - D Ryan
- Department of Pathology, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, United States
| | - J Anolik
- Division of Allergy/Immunology and Rheumatology, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, United States
| | - C Ritchlin
- Division of Allergy/Immunology and Rheumatology, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, United States
| | - J Looney
- Division of Allergy/Immunology and Rheumatology, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, United States
| | - A P Anandarajah
- Division of Allergy/Immunology and Rheumatology, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, United States
| | - G Schwartz
- Department of Pediatrics, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, United States
| | - L M Calvi
- Department of Medicine, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, United States
| | - M Georger
- Department of Medicine, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, United States
| | - C Mohan
- Department Biomedical Engineering, University of Houston, Houston, TX 77204, United States
| | - I Sanz
- Division of Allergy/Immunology and Rheumatology, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, United States
| | - L Chen
- Division of Allergy/Immunology and Rheumatology, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, United States; Department of Dermatology, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, United States.
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Anikster Y, Haack TB, Vilboux T, Pode-Shakked B, Thöny B, Shen N, Guarani V, Meissner T, Mayatepek E, Trefz FK, Marek-Yagel D, Martinez A, Huttlin EL, Paulo JA, Berutti R, Benoist JF, Imbard A, Dorboz I, Heimer G, Landau Y, Ziv-Strasser L, Malicdan MCV, Gemperle-Britschgi C, Cremer K, Engels H, Meili D, Keller I, Bruggmann R, Strom TM, Meitinger T, Mullikin JC, Schwartz G, Ben-Zeev B, Gahl WA, Harper JW, Blau N, Hoffmann GF, Prokisch H, Opladen T, Schiff M. Biallelic Mutations in DNAJC12 Cause Hyperphenylalaninemia, Dystonia, and Intellectual Disability. Am J Hum Genet 2017; 100:257-266. [PMID: 28132689 PMCID: PMC5294665 DOI: 10.1016/j.ajhg.2017.01.002] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 12/22/2016] [Indexed: 01/19/2023] Open
Abstract
Phenylketonuria (PKU, phenylalanine hydroxylase deficiency), an inborn error of metabolism, can be detected through newborn screening for hyperphenylalaninemia (HPA). Most individuals with HPA harbor mutations in the gene encoding phenylalanine hydroxylase (PAH), and a small proportion (2%) exhibit tetrahydrobiopterin (BH4) deficiency with additional neurotransmitter (dopamine and serotonin) deficiency. Here we report six individuals from four unrelated families with HPA who exhibited progressive neurodevelopmental delay, dystonia, and a unique profile of neurotransmitter deficiencies without mutations in PAH or BH4 metabolism disorder-related genes. In these six affected individuals, whole-exome sequencing (WES) identified biallelic mutations in DNAJC12, which encodes a heat shock co-chaperone family member that interacts with phenylalanine, tyrosine, and tryptophan hydroxylases catalyzing the BH4-activated conversion of phenylalanine into tyrosine, tyrosine into L-dopa (the precursor of dopamine), and tryptophan into 5-hydroxytryptophan (the precursor of serotonin), respectively. DNAJC12 was undetectable in fibroblasts from the individuals with null mutations. PAH enzyme activity was reduced in the presence of DNAJC12 mutations. Early treatment with BH4 and/or neurotransmitter precursors had dramatic beneficial effects and resulted in the prevention of neurodevelopmental delay in the one individual treated before symptom onset. Thus, DNAJC12 deficiency is a preventable and treatable cause of intellectual disability that should be considered in the early differential diagnosis when screening results are positive for HPA. Sequencing of DNAJC12 may resolve any uncertainty and should be considered in all children with unresolved HPA.
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Affiliation(s)
- Yair Anikster
- Metabolic Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer 52621, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; The Wohl Institute for Translational Medicine, Sheba Medical Center, Tel Hashomer 52621, Israel.
| | - Tobias B Haack
- Institute of Human Genetics, Technische Universität München, Trogerstr. 32, Munich 81675, Germany; Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg 85764, Germany
| | - Thierry Vilboux
- Medical Genetics Branch, National Human Genome Research Institute, NIH, Bethesda, MD 20892-1851, USA; Division of Medical Genomics, Inova Translational Medicine Institute, Falls Church, VA 22042, USA
| | - Ben Pode-Shakked
- Metabolic Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer 52621, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; Dr. Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer 52621, Israel
| | - Beat Thöny
- Division of Metabolism, Clinical Chemistry and Biochemistry, Division of Metabolism, Department of Pediatrics, University of Zürich, Zürich 8032, Switzerland
| | - Nan Shen
- Division of Neuropediatrics and Metabolic Medicine, University Children's Hospital, Heidelberg 69120, Germany
| | - Virginia Guarani
- Department of Cell Biology, Harvard Medical School, Boston, MA 02115, USA
| | - Thomas Meissner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Duesseldorf 40225, Germany
| | - Ertan Mayatepek
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Duesseldorf 40225, Germany
| | - Friedrich K Trefz
- Division of Neuropediatrics and Metabolic Medicine, University Children's Hospital, Heidelberg 69120, Germany
| | - Dina Marek-Yagel
- Metabolic Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer 52621, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; The Wohl Institute for Translational Medicine, Sheba Medical Center, Tel Hashomer 52621, Israel
| | - Aurora Martinez
- Department of Biomedicine and K.G. Jebsen Centre for Neuropsychiatric Disorders, University of Bergen, Bergen 5009, Norway
| | - Edward L Huttlin
- Department of Cell Biology, Harvard Medical School, Boston, MA 02115, USA
| | - Joao A Paulo
- Department of Cell Biology, Harvard Medical School, Boston, MA 02115, USA
| | - Riccardo Berutti
- Institute of Human Genetics, Technische Universität München, Trogerstr. 32, Munich 81675, Germany; Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg 85764, Germany
| | - Jean-François Benoist
- Department of Biochemistry, Robert-Debré University Hospital, APHP, Paris 75019, France
| | - Apolline Imbard
- Department of Biochemistry, Robert-Debré University Hospital, APHP, Paris 75019, France
| | - Imen Dorboz
- UMR1141, PROTECT, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris 75019, France
| | - Gali Heimer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; Dr. Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer 52621, Israel; Pediatric Neurology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer 52621, Israel
| | - Yuval Landau
- Metabolic Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer 52621, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Limor Ziv-Strasser
- Sheba Cancer Research Center, Sheba Medical Center, Tel Hashomer 52621, Israel
| | - May Christine V Malicdan
- Medical Genetics Branch, National Human Genome Research Institute, NIH, Bethesda, MD 20892-1851, USA; Division of Medical Genomics, Inova Translational Medicine Institute, Falls Church, VA 22042, USA; NIH Undiagnosed Diseases Program, Common Fund, Office of the Director, NIH, Bethesda, MD 20892, USA
| | - Corinne Gemperle-Britschgi
- Division of Metabolism, Clinical Chemistry and Biochemistry, Division of Metabolism, Department of Pediatrics, University of Zürich, Zürich 8032, Switzerland
| | - Kirsten Cremer
- Institute of Human Genetics, University of Bonn, Bonn 53127, Germany
| | - Hartmut Engels
- Institute of Human Genetics, University of Bonn, Bonn 53127, Germany
| | - David Meili
- Division of Metabolism, Clinical Chemistry and Biochemistry, Division of Metabolism, Department of Pediatrics, University of Zürich, Zürich 8032, Switzerland
| | - Irene Keller
- Interfaculty Bioinformatics Unit and Swiss Institute of Bioinformatics, University of Bern, Berne 3012, Switzerland; Department of Clinical Research, University of Bern, Berne 3012, Switzerland
| | - Rémy Bruggmann
- Interfaculty Bioinformatics Unit and Swiss Institute of Bioinformatics, University of Bern, Berne 3012, Switzerland
| | - Tim M Strom
- Institute of Human Genetics, Technische Universität München, Trogerstr. 32, Munich 81675, Germany; Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg 85764, Germany
| | - Thomas Meitinger
- Institute of Human Genetics, Technische Universität München, Trogerstr. 32, Munich 81675, Germany; Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg 85764, Germany
| | - James C Mullikin
- NIH Intramural Sequencing Center (NISC), National Human Genome Research Institute, NIH, Bethesda, MD 20892-9400, USA
| | - Gerard Schwartz
- Metabolic Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer 52621, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Bruria Ben-Zeev
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; Pediatric Neurology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer 52621, Israel
| | - William A Gahl
- NIH Undiagnosed Diseases Program, Common Fund, Office of the Director, NIH, Bethesda, MD 20892, USA
| | - J Wade Harper
- Department of Cell Biology, Harvard Medical School, Boston, MA 02115, USA
| | - Nenad Blau
- Division of Neuropediatrics and Metabolic Medicine, University Children's Hospital, Heidelberg 69120, Germany
| | - Georg F Hoffmann
- Division of Neuropediatrics and Metabolic Medicine, University Children's Hospital, Heidelberg 69120, Germany
| | - Holger Prokisch
- Institute of Human Genetics, Technische Universität München, Trogerstr. 32, Munich 81675, Germany; Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg 85764, Germany
| | - Thomas Opladen
- Division of Neuropediatrics and Metabolic Medicine, University Children's Hospital, Heidelberg 69120, Germany
| | - Manuel Schiff
- UMR1141, PROTECT, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris 75019, France; Reference Center for Inborn Errors of Metabolism, Robert Debré University Hospital, APHP, Paris 75019, France.
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Tap W, Jones R, Chmielowski B, Elias A, Adkins D, Van Tine B, Agulnik M, Cooney M, Livingston M, Pennock G, Qin A, Shahir A, Ilaria R, Conti I, Schwartz G. A randomized phase 1b/2 study evaluating the safety and efficacy of doxorubicin (dox) with or without olaratumab (IMC-3G3), a human anti–platelet-derived growth factor &agr; (pdgfr&agr;) monoclonal antibody, in advanced soft tissue sarcoma (sts). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw343.01] [Citation(s) in RCA: 2] [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: 11/13/2022] Open
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Schwartz G, Adkins D, Heist R, Werner T, Abbott M, Barber S, Slusarz K, Agarwal N, Neuteboom S, Faltaos D, Chen I, Christensen J, Chao R, Bauer T. 370 A first-in-human phase 1/1b study of receptor tyrosine kinase (RTK) inhibitor, MGCD, in patients with advanced solid tumors. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30233-7] [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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Schwartz G. The Development of CDK4 Inhibitors for Cancer Therapy. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv083.2] [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: 11/14/2022] Open
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Brewer NT, Defrank JT, Chiu WK, Ibrahim JG, Walko CM, Rubin P, Olajide OA, Moore SG, Raab RE, Carrizosa DR, Corso SW, Schwartz G, Peppercorn JM, McLeod HL, Carey LA, Irvin WJ. Patients' understanding of how genotype variation affects benefits of tamoxifen therapy for breast cancer. Public Health Genomics 2014; 17:43-7. [PMID: 24457521 DOI: 10.1159/000356565] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/10/2013] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND CYP2D6 is a critical enzyme in the metabolism of tamoxifen and potentially a key determinant in breast cancer outcomes. Our study examined patients' beliefs about how the CYP2D6 genotype would affect their prognoses. METHODS Women enrolled in a pharmacogenomic clinical trial and on tamoxifen for prevention or treatment of breast cancer underwent CYP2D6 genotyping (EM = extensive, IM = intermediate, PM = poor metabolizing alleles). The informed consent said that the purpose of the trial was to examine effects of dose adjustment based on genotype, but that clinical benefits were uncertain. Our embedded sub-study surveyed 320 patients prior to receiving their genotypes. We experimentally manipulated 6 vignettes to describe hypothetical tamoxifen treatment (no or yes) and hypothetical genotype (EM, IM or PM). For each vignette, women gave their perceived recurrence risk (RR; 0-100%). RESULTS Women believed that genotype would not affect their RR if they did not take tamoxifen (p = 0.06). However, women believed that if prescribed tamoxifen, genotype would affect their RR (22% if EM, 30% if IM and 40% if PM, p < 0.001). CONCLUSION Women believed that extensive tamoxifen metabolizers had better prognoses, despite study materials stating uncertainty about any benefit. The rapidly changing nature of genomic science calls for caution when communicating clinical utility.
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Affiliation(s)
- N T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, N.C., USA
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Parameswaran R, Lunning M, Mantha S, Devlin S, Hamilton A, Schwartz G, Soff G. Romiplostim for management of chemotherapy-induced thrombocytopenia. Support Care Cancer 2014; 22:1217-22. [DOI: 10.1007/s00520-013-2074-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 11/25/2013] [Indexed: 11/30/2022]
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Barlin J, Zhou Q, Leitao M, Bisogna M, Olvera N, Hensley M, Schwartz G, Boyd J, Qin L, Levine D. Uterine leiomyosarcomas have reproducible molecular subtypes that correlate with survival. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.425] [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: 11/24/2022]
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Pode-Shakked B, Shemer-Meiri L, Harmelin A, Stettner N, Brenner O, Abraham S, Schwartz G, Anikster Y. Man made disease: clinical manifestations of low phenylalanine levels in an inadequately treated phenylketonuria patient and mouse study. Mol Genet Metab 2013; 110 Suppl:S66-70. [PMID: 24206931 DOI: 10.1016/j.ymgme.2013.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 10/07/2013] [Accepted: 10/08/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Phenylalanine (Phe) deficiency and its clinical manifestations have been previously described mostly as sporadic case reports dating back to the 1960's and 1970's. In these reports, low plasma Phe levels were associated with listlessness, eczematous eruptions and failure to gain weight, most often in infants in their first year of life. CASE REPORT Herein we describe a 9 month old female patient with known phenylketonuria, who presented with an unusual constellation of symptoms, including severe erythema and desquamation, alopecia, keratomalacia, corneal perforation, failure to thrive and prolonged diarrhea. The diagnostic possibilities of acrodermatitis enteropathica and vitamin deficiencies were ruled out, and further investigation into her medical history led to the conclusion that during the weeks preceding the hospitalization, the patient's diet consisted of the phenylalanine-free medical formula alone, without the addition of a standard infant formula or food as recommended. Subsequently, dietary control of the blood phenylalanine levels brought swift and marked resolution of the dermatological lesions, with renewal of hair growth. OBJECTIVE Following this experience, and due to the relative paucity of data regarding the clinical manifestations of low serum phenylalanine levels in humans and their putative pathogenetic mechanisms, we sought to further investigate the effects of a phenylalanine-free diet in a mouse study. MATERIALS AND METHODS For this purpose, twenty mice were randomly allocated to receive either a phenylalanine-deficient diet (n=10) or a normal diet (n=10). Weight was measured weekly, and laboratory tests were obtained including complete blood count, electrolyte studies, and phenylalanine and tyrosine levels. Finally, necropsies and histopathological examinations of different tissues were performed in selected mice, either early after diet initiation, late after diet initiation or following re-introduction of normal diets. The study was then repeated in additional two groups of mice, for a period of up to thirteen weeks, with a total of 63 mice. RESULTS Gross lesions noted on necropsy in the Phe-deficient mice included scruffy coat, tendency toward weight loss, a reduction in thymic mass, and most notably severe gastric dilation, all of which were not seen in the controls. Histologic findings included thymic depletion, hepatocellular vacuolation, and exocrine pancreatic atrophy. No histopathological lesions were evident in the brain, nor were significant lesions in the eyes. CONCLUSIONS Diagnosis of the iatrogenic condition of phenylalanine deficiency, which manifests in gastrointestinal, dermatological and ocular findings, requires a high index of suspicion. Mice fed a phenylalanine-deficient diet display to some extent similar organ involvement, although no eye abnormalities were evident.
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Affiliation(s)
- Ben Pode-Shakked
- Metabolic Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
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Vale N, Nordmann AJ, Schwartz GG, Lemos JD, Colivicchi F, Hartog FD, Ostadal P, Macin SM, Liem AH, Mills E, Bhatnagar N, Bucher HC, briel M, Vale N, Nordmann A, Schwartz G, De Lemos J, Colivicchi F, Den HF, Ostadal P, Macin S, Liem A, Mills E, Bhatnagar N, Bugheb H, Briel M. Estatinas para el síndrome coronario agudo. Revista Médica Clínica Las Condes 2012. [DOI: 10.1016/s0716-8640(12)70381-4] [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: 11/26/2022] Open
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Teicher B, Sotomayor E, Robinson M, Dupuis N, Schwartz G, Frei E. Tumor oxygenation and radiosensitization by pentoxifylline and a perflubron emulsion carbogen breathing. Int J Oncol 2012; 2:13-21. [PMID: 21573510 DOI: 10.3892/ijo.2.1.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Oxygen tension measurements were made in three tumors: (i) the murine FSaII fibrosarcoma, (ii) the rat 9L gliosarcoma and (iii) the rat 13672 mammary adenocarcinoma using a pO2 histograph. Tumor oxygenation measurements were made while the animals breathed air or breathed carbogen (95% oxygen/5% carbon dioxide). Pentoxifylline or a perflubron emulsion was administered to the animals and tumor oxygen measurements were repeated under both breathing conditions. Both pentoxifylline and the perflubron emulsion improved the oxygenation of the FSaII fibrosarcoma under air breathing conditions but did not alter the oxygen profiles of either rat tumor compared with air breathing alone. Carbogen breathing increased the oxygenation of all tumors. Pentoxifylline administration did not change the oxygen profiles of the tumors under carbogen breathing conditions but administration of the perflubron emulsion increased the oxygenation of all three tumors under carbogen breathing conditions compared with carbogen breathing alone. Co-administration of pentoxifylline and the perflubron emulsion enhanced the radiation response of the Lewis lung tumor to daily fractionated radiation under air breathing conditions with a dose modifying factor of 1.65 and under carbogen breathing conditions with a dose modifying factor of 2.25. Over a range of perflubron emulsion doses, pentoxifylline increased the growth delay of the Lewis lung tumor in a constant manner. These results indicate that pentoxifylline and the perflubron emulsion have the largest impact on the oxygenation of more hypoxic tumors and that administration of the perflubron emulsion/carbogen breathing is the most effective means of increasing tumor oxygenation and radiation response.
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Teicher B, Dupuis N, Kusumoto T, Liu M, Liu F, Menon K, Schwartz G, Frei E. Decreased tumor oxygenation after cyclophosphamide, reoxygenation and therapeutic enhancement with a perflubron emulsion carbogen breathing. Int J Oncol 2012; 3:197-203. [PMID: 21573348 DOI: 10.3892/ijo.3.2.197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Oxygen profiles of the rat mammary 13672 carcinoma were determined using a pO2 histograph prior to treatment and 24 h and 48 h after i.p. administration of a single dose of cyclophosphamide (300 mg/kg). The tumors were severely hypoxic at 24 h post the administration of cyclophosphamide. There was little increase in oxygenation of the tumors at 48 h post therapy compared with 24 h post therapy indicating that reoxygenation after cyclophosphamide was occurring very slowly in this tumor. Carbogen breathing improved the oxygenation of the tumors under each of the conditions studied. Administration of the perflubron emulsion (8 ml/kg) produced little or no change in the oxygenation of the tumors under normal air breathing conditions. However, the addition of carbogen breathing to administration of the perflubron emulsion increased the oxygenation of the tumors to levels equal to or greater than carbogen breathing at the mean/median pO2's. Perhaps most significantly, administration of the perflubron emulsion with carbogen breathing increased the oxygenation of the most hypoxic regions of the tumors but carbogen breathing alone did not. The growth delay of the Lewis lung carcinoma increased with increasing dose.of the perflubron emulsion along with cyclophosphamide (3 x 150 mg/kg) and carbogen breathing (6 h). This combination treatment was most effective when the cyclophosphamide was prepared in the perflubron emulsion. The number of lung metastases decreased in a manner parallel with increased efficacy of the treatment toward the primary tumor.
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Affiliation(s)
- B Teicher
- JOINT CTR RADIAT THERAPY,BOSTON,MA 02115
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Naing A, Aghajanian C, Raymond E, Olmos D, Schwartz G, Oelmann E, Grinsted L, Burke W, Taylor R, Kaye S, Kurzrock R, Banerji U. Safety, tolerability, pharmacokinetics and pharmacodynamics of AZD8055 in advanced solid tumours and lymphoma. Br J Cancer 2012; 107:1093-9. [PMID: 22935583 PMCID: PMC3461162 DOI: 10.1038/bjc.2012.368] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: This study assessed the safety, tolerability, pharmacokinetics and pharmacodynamics of the first-in-class dual mammalian target of rapamycin complex (mTORC)1/mTORC2 inhibitor, AZD8055. Methods: Patients with advanced solid malignancies or lymphomas were recruited into this phase I, open-label, dose-escalation study of AZD8055 starting at 10 mg twice-daily oral dosing (BID). Results: Forty-nine patients received AZD8055. Dose-limiting toxicities were reported at 40 mg (n=1), 90 mg (n=1) and 120 mg (n=3) BID; all were grade 3 rises in transaminases, reversible in all patients, apart from one who had liver metastases. The maximum tolerated dose was defined as 90 mg BID. The most frequent adverse events assessed to be related to AZD8055 were increased alanine aminotransferase (22%), increased aspartate aminotransferase (22%) and fatigue (16%). AZD8055 was rapidly absorbed (median tmax ∼0.5 h) and exposure increased with increasing doses. Seven patients had stable disease for ⩾4 months. Partial metabolic responses, assessed by fluorodeoxyglucose positron emission tomography, were observed at ⩾40 mg BID (n=8 at day 35). Conclusion: The maximum tolerated dose for AZD8055 is 90 mg BID. Apart from elevated transaminases, which occurred at most dose levels, the drug had an acceptable toxicity profile; however, no RECIST responses were seen.
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Affiliation(s)
- A Naing
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Baldwin A, Rand W, Schwartz G. P01.56. Does practicing Reiki alter the electromagnetic field of heart and hands of practitioners? BMC Complement Altern Med 2012. [PMCID: PMC3373879 DOI: 10.1186/1472-6882-12-s1-p56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Barlin J, Leitao M, Qin L, Bisogna M, Olvera N, Shih K, Hensley M, Schwartz G, Boyd J, Levine D. Uterine leiomyosarcomas are driven by cell cycle deregulation. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.329] [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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Mita AC, Papadopoulos K, de Jonge MJA, Schwartz G, Verweij J, Mita MM, Ricart A, Chu QSC, Tolcher AW, Wood L, McCarthy S, Hamilton M, Iwata K, Wacker B, Witt K, Rowinsky EK. Erlotinib 'dosing-to-rash': a phase II intrapatient dose escalation and pharmacologic study of erlotinib in previously treated advanced non-small cell lung cancer. Br J Cancer 2011; 105:938-44. [PMID: 21878940 PMCID: PMC3185947 DOI: 10.1038/bjc.2011.332] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/22/2011] [Accepted: 08/01/2011] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND To evaluate the anticancer activity of erlotinib in patients with previously treated, advanced non-small cell lung cancer (NSCLC) whose dose is increased to that associated with a maximal level of tolerable skin toxicity (i.e., target rash (TR)); to characterise the pharmacokinetics (PK) and pharmacodynamics (PD) of higher doses of erlotinib. METHODS Patients initially received erlotinib 150 mg per day. The dose was successively increased in each patient to that associated with a TR. Anticancer activity was evaluated. Plasma, skin, and hair were sampled for PK and PD studies. RESULTS Erlotinib dose escalation to 200-475 mg per day was feasible in 38 (90%) of 42 patients. Twenty-four (57%) patients developed a TR, but 19 (79%) did so at 150 mg per day. Five (12%) patients, all of whom developed a TR, had a partial response. Median progression-free survival (PFS) was 2.3 months (95% CI: 1.61, 4.14); median PFS was 3.5 months and 1.9 months, respectively, for patients who did and did not experience a TR (hazard ratio, 0.51; P=0.051). Neither rash severity nor response correlated with erlotinib exposure. CONCLUSION Intrapatient dose escalation of erlotinib does not appreciably increase the propensity to experience a maximal level of tolerable skin toxicity, or appear to increase the anticancer activity of erlotinib in NSCLC.
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Affiliation(s)
- A C Mita
- Institute for Drug Development, Cancer Therapy and Research Center, University of Texas Health Science Center, 4th Floor, 7979 Wurzbach Road, Zeller Building, San Antonio, TX 78229, USA.
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Brewer NT, Walko CM, Chiu WK, Dressler LG, Yuen A, Rubin P, Olajide OA, Moore SG, Raab RE, Carrizosa DR, Corso SW, Schwartz G, Peppercorn JM, McLeod HL, Carey LA, Irvin WJ. Patients' understanding of how genotype variation affects benefits of tamoxifen therapy for breast cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.6029] [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: 11/20/2022] Open
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Stinchcombe T, Socinski MA, Moore DT, Gettinger SN, Decker RH, Petty WJ, Blackstock AW, Schwartz G, Lankford S, Morris DE. Phase I/II trial of bevacizumab (B) and erlotinib (E) with induction (IND) and concurrent (CON) carboplatin (Cb)/paclitaxel (P) and 74 Gy of thoracic conformal radiotherapy (TCRT) in stage III non-small cell lung cancer (NSCLC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.7016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lawrence J, Lovelace J, Akman SA, Melin SA, Case LD, Schwartz G. Oral paricalcitol (19-nor-1,25-Dihydroxyvitamn D2) in women with metastatic breast cancer receiving taxanes or ixabepilone: A feasibility trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Irvin WJ, Weck KE, Walko CM, Chiu WK, Rubin P, Olajide OA, Moore SG, Raab RE, Carrizosa DR, Corso SW, Schwartz G, Anderson SM, Friedman KJ, Dees EC, Flockhart D, Peppercorn JM, McLeod HL, Evans JP, Carey LA. Comprehensive CYP2D6 genotyping in a multiracial population shows differences in allele frequencies between races. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e11095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Razi S, Li X, Park K, Schwartz G, Belsley S, Connery C, Bhora F. Anti-Tumor Activity Of Cisplatin And Paclitaxel Is Significantly Enhanced By A Novel Pro-Apoptotic Agent In Non-Small Cell Lung Cancer. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.757] [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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Park K, Razi S, Schwartz G, Belsley S, Todd G, Connery C, Bhora F. Timely Tracheobronchial Stenting Provides Significant Cost-Savings In Malignant Central Airway Obstruction. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.285] [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: 11/24/2022]
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Witkiewicz AK, Kline J, Freydin B, Apanasovich T, Schwartz G, Knudsen E. Abstract P1-15-02: Impact of Retinoblastoma (RB) Tumor Suppressor Pathway on Ductal Carcinoma In Situ (DCIS) Recurrence. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p1-15-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The retinoblastoma (RB) tumor suppressor is functionally inactivated at high frequency in human malignancies including breast cancer. By immunohistochemistry loss of RB function is associated with p16ink4a overexpression and high Ki67 proliferation index.We have previously shown that loss of RB results in dramatic upregulation of genes associated with tumorigenesis and is a key determinant of therapeutic response in invasive breast carcinoma. Recently publish data indicate that RB pathway dysregulation plays an important role in DCIS progression to invasive carcinoma. The aim of this study was to evaluate the expression p16ink4a and Ki67 (indicative of RB loss) in a large cohort of DCIS patients treated at one institution with wide-excision and close follow-up. Material and Methods
149 DCIS patients were included in the study. Expression of p16ink4a and Ki67 was assessed by employing a standard immunoperoxidase method with ani-p16ink4a (MTM Laboratories Westborough, MA) and anti-Ki67 (AbCam Cambridge, MA) antibodies. The p16ink4a staining in DCIS epithelium was scored semi-quantitatively as negative (0; no staining), weak (1;staining in less than 25% of cells), moderate (2; defined as staining in 25-75% of cells) and strong (3; >75% of cells staining). For statistical analysis, the original p16ink4a scores (0, 1, 2, 3) were dichotomized as low (0,1) vs. high (2-3) and original ki67 scores were dichotomized as low (<= 10%) vs. high (> 10%). Stromal p16 staining was scored as absent or present.
Association between p16ink4a and Ki67 and nuclear grade, necrosis, hormone receptor and Her2 expression as well as recurrence was assessed using Fisher's exact test. The Cox proportional hazard model was used for analyses of time to recurrence. Results
There was a statistically significant association between high p16ink4a and Ki67 expression in DCIS epithelium and triple negative as well as Her2 positive DCIS subtypes. Significant association was detected between high expression of p16 and Ki67 in DCIS epithelium and DCIS recurrence (p=0.005). Stromal expression of p16 was the strongest predictor of DCIS recurrence (p < 0.0001). In multivariate Cox model DCIS cases with high expression of p16 and Ki67 in epithelium and stromal p16 expression had the shortest time to recurrence.
Conclusion
RB pathway dysregulation in DCIS epithelium as well as stromal expression of p16ink4a indicative of senescence are associated with DCIS recurrence.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-15-02.
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Affiliation(s)
- AK Witkiewicz
- Thomas Jefferson University, Philadelphia, PA; Kimmel Cancer Center, Philadelphia, PA
| | - J Kline
- Thomas Jefferson University, Philadelphia, PA; Kimmel Cancer Center, Philadelphia, PA
| | - B Freydin
- Thomas Jefferson University, Philadelphia, PA; Kimmel Cancer Center, Philadelphia, PA
| | - T Apanasovich
- Thomas Jefferson University, Philadelphia, PA; Kimmel Cancer Center, Philadelphia, PA
| | - G Schwartz
- Thomas Jefferson University, Philadelphia, PA; Kimmel Cancer Center, Philadelphia, PA
| | - E. Knudsen
- Thomas Jefferson University, Philadelphia, PA; Kimmel Cancer Center, Philadelphia, PA
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Stinchcombe T, Bradford DS, Lee CB, Moore DT, Bakri KM, Taylor MA, Crane JM, Schwartz G, Hensing TA, Socinski MA. Preliminary results of a randomized phase II trial of first-line treatment of gemcitabine (G) versus erlotinib (E) versus gemcitabine and erlotinib (GE) in patients 70 years or older with advanced non-small cell lung cancer (NSCLC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.7576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Razi S, Schwartz G, Boone D, Li X, Belsley S, Connery C, Todd G, Bhora F. Flaxseed Protects Against the Inflammatory Phase of Lung Ischemia Reperfusion Injury in a Murine Model. J Surg Res 2010. [DOI: 10.1016/j.jss.2009.11.513] [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: 11/29/2022]
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Burstein H, Sun Y, Dirix L, Jiang Z, Paridaens R, Tan A, Awada A, Ranade A, Jiao S, Schwartz G, Powell C, Turnbull K, Vermette J, Zacharchuk C, Badwe R. Gastrointestinal and Cardiovascular Safety Profiles of Neratinib Monotherapy in Patients with Advanced ErbB2-Positive Breast Cancer. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-5096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In a phase 2 study, oral neratinib was administered to patients (pts) with advanced breast cancer in 2 cohorts, those with prior trastuzumab treatment (prior T, n=66) and those with no prior trastuzumab treatment (no prior T, n=70). Neratinib demonstrated robust antitumor activity with objective response rates of 26% and 51%, respectively, and was generally tolerable (Burstein et al. Cancer Res 2009;69:72S). Diarrhea, all grades, occurred in 89% of total pts. Characteristics of the diarrhea and left ventricular ejection fraction (LVEF) measurements are described. Methods: Pts were required to have ErbB2 gene amplification in tumor tissue as measured by fluorescence in situ hybridization by independent assessment. Serial LVEF measurements were made with a multigated acquisition scan or echocardiogram. Pts were ineligible if baseline LVEF was <50%. Adverse events were graded based on the NCI Common Terminology Criteria, v 3.0. Pts received oral neratinib 240 mg daily. Results: Data collected by 18 Mar 2009 are reported; the median (range) duration of neratinib treatment was 4.5 (0.2-23.5) months for pts with prior T and 7.8 (0.5-24.2) months for pts with no prior T. Diarrhea, all grades occurred in 93% of the total population (prior T: 97%, no prior T: 89%); grade 3-4 diarrhea occurred in 21% of the total population (prior T: 30%, no prior T: 13%). Median times of onset were 2 and 3 days after first dose of neratinib, respectively, and median durations of diarrhea were 7 and 5 days. In study week 1, 86% and 73% of pts with prior T and no prior T, respectively, had diarrhea; this decreased to 12-14% in months 3 and 4 (Table). Diarrhea was the cause of dose interruptions in 36% of pts with prior T and 11% of pts with no prior T and of dose reductions in 30% of pts with prior T and 5% of pts with no prior T; only 1 pt (prior T) discontinued treatment due to diarrhea. Pts used anti-diarrheal medications for supportive therapy (prior T: 91%, no prior T: 67%). For LVEF measurements, there was little variation from baseline in most pts during the study. Four pts had at least 1 LVEF measurement <50% (2 of these pts had measurements within the institutional range of normal). None had congestive heart failure. One of these pts had grade 3 atrioventricular block and grade 3 bradycardia, which were considered unrelated to neratinib. Discussion: Neratinib treatment was not associated with clinically significant cardiotoxicity. Pts who developed diarrhea with neratinib monotherapy had early onset, but frequency and severity decreased with time on study. Despite the high frequency of diarrhea with neratinib treatment, it was readily managed with supportive therapy and dose interruptions and/or reductions.Time Course of Diarrhea in ErbB2-Positive Breast Cancer Patients Treated With NeratinibStudy PeriodPrior T: No. on StudyPrior T: % With Diarrhea, All Grades*Prior T: % With Diarrhea, Gr 3-4*No Prior T: No. on StudyNo Prior T: % With Diarrhea, All Grades*No Prior T: % With Diarrhea, Gr 3-4*Week 166861770737Week 2-466611170436Month 260331066152Month 34713060120Month 44312058140*For pts with multiple toxicity grades in a period, the maximum grade was reported.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5096.
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Affiliation(s)
| | - Y. Sun
- 2Cancer Hospital, Chinese Academy of Medical Sciences, China
| | - L. Dirix
- 3Oncology Center AZ St. Augustinus, Belgium
| | - Z. Jiang
- 4307 Hospital of Chinese People's Liberation Army, China
| | | | - A. Tan
- 6Cancer Institute of New Jersey, NJ,
| | | | - A. Ranade
- 8Deenanath Mangeshkar Hospital, India
| | - S. Jiao
- 9Chinese People's Liberation Army General Hospital, China
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Schwartz G, Borges V, Weiselberg L, Elias A, Budman D. Lapatinib Restores Endocrine Sensitivity in Selected Patients with Estrogen Receptor (ER) Positive Metastatic Breast Cancer. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-3089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:Breast cancer cell lines achieve a state of resistance to antiestrogens and to estrogen withdrawal or aromatase inhibitors by utilizing other growth factor pathways to transactivate ERα and undergo estrogen-independent growth. Breast cancer cell lines consistently overexpress the epidermal growth factor family of receptors (ErbB) and/or the epidermal growth factor (EGF) ligands when they achieve endocrine-independent growth. Our hypothesis is that the ErbB family of receptors is the dominant pathway utilized by breast cancers in our patients with endocrine-resistant tumors. Because ErbB2 is the dominant partner in ErbB heterodimerization, a tyrosine kinase inhibitor with ErbB2 activity such as lapatinib would be the preferred agent to block transactivation of ERα. Lapatinib has minimal activity as a single agent against ErbB2 unamplified cancers, and any clinical benefit from the combination of lapatinib and endocrine therapy indicates evidence of an interaction between the ER and ErbB pathways.Materials and Methods:Patients with hormone receptor positive, metastatic breast carcinoma with an initial clinical benefit from any line of endocrine therapy, were enrolled within six weeks of documentation of clinical progression on endocrine therapy. Subjects had an ECOG performance status of 0-2, adequate organ function, and recovery from prior cancer treatment. They were continued on the same endocrine therapy, with the addition of lapatinib at 1500 mg once daily. Patients were restaged at 14 and 26 weeks, and those with stable disease or better at 26 weeks were eligible to continue the combination of lapatinib and endocrine therapy until disease progression.Results:Twenty one patients have been enrolled to date. The median age is 60 (range 39-77), one patient has ErbB2 amplified disease, one patient has borderline amplification, and 19 patients are unamplified for ErbB2. Fifteen patients were treated with aromatase inhibitors, while six patients used antiestrogens. Ten patients had bone only metastatic disease, and only three patients had visceral metastases at enrollment. The treatment was well-tolerated; four patients had Grade 3 diarrhea, there were five episodes of diarrhea-related Grade 3 electrolyte abnormalities, and one patient went off study due to a reversible Grade 3 elevation in ALT. Seven of sixteen evaluable patients had stable disease at 26 weeks. The median time to disease progression is 179 days (range 94-513 days), and four patients remain on study free of disease progression. The use of, or duration of prior tamoxifen treatment was not predictive of progression-free survival on study.Conclusions:In a highly selected group of patients with metastatic breast cancer, the addition of lapatinib to the endocrine agent on which the cancer had just progressed maintained the duration of response by an average of six months. This demonstrates a favorable interaction between lapatinib and both aromatase inhibitors and antiestrogens in patients with newly acquired endocrine resistance. Accrual to this study is continuing.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3089.
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Affiliation(s)
| | - V. Borges
- 2University of Colorado Health Science Center, CO,
| | | | - A. Elias
- 2University of Colorado Health Science Center, CO,
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Ku G, Yuan J, Schroeder S, Page D, Panageas K, Carvajal R, Chapman P, Schwartz G, Allison J, Wolchok J. PP60 Correlation of absolute lymphocyte count with clinical benefit and overall survival: results of compassionate-use trial of ipilimumab in advanced melanoma at Memorial Sloan-Kettering Cancer Center. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)72180-9] [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: 11/17/2022] Open
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Tse A, Yazji S, Naing A, Matthews D, Schwartz G, Lawhorn K, Kurzrock R. 395 POSTER Phase I study of XL844, a novel Chk1 and Chk2 kinase inhibitor, in combination with gemcitabine in patients with advanced malignancies. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)72329-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Bercovich D, Elimelech A, Yardeni T, Korem S, Zlotogora J, Gal N, Goldstein N, Vilensky B, Segev R, Avraham S, Loewenthal R, Schwartz G, Anikster Y. A Mutation Analysis of the Phenylalanine Hydroxylase (PAH) Gene in the Israeli Population. Ann Hum Genet 2008; 72:305-9. [DOI: 10.1111/j.1469-1809.2007.00425.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Moser K, Biglan KM, Ross CA, Langbehn DR, Aylward E, Stout JC, Queller S, Carlozzi N, Duff K, Beglinger LJ, Paulsen JS, Tomusk A, Lifer S, Hastings S, Dawson J, Walker B, Whitlock K, Johnson S, Pacifici R, Hersch S, Dorsey ER, Katz R, Tempkin T, Wheelock V, Schwartz G, Corey-Bloom J, Mattis P, Feigin A, Young P, McArthur DL, Perlman S, Higginson C, Carr L, Sigvardt K, Chirieac MC, Shinaman A, Shoulson I, Kane AE, Peavy GM, Goldstein JL, Jacobson MW, Lessig S, Wasserman L, Kayson EP, Tang C, Zgaljardic D, Ma Y, Dhawan V, Guttman M, Eidelberg D, Peng S, Kingsley P, Rosas HD, Gevorkian S, Oakes D, Matson W, Massood T, Latourelle J, Mysore JS, Fossale E, Gillis T, Gusella JF, MacDonald ME, Myers RH, Yastrubetskaya O, Preston J, Chiu E, Goh A, Oster E, Bausch J, Kayson E, Quaid K, Sims S, Swenson M, Harrison J, Moskowitz C, Stepanov N, Suter G, Westphal B, Johnson SA, Langbehn D, Paulsen J, Nopoulos P, Beglinger L, Johnson H, Magnotta V, Pierson R, Lipe H, Bird TD, McCusker EA, Lownie A, Lechich AJ, Montas S, Duckett A, Klager J, Sandler S, Pae A, Apostol BL, Simmons DA, Zuccato C, Illes K, Pallos J, Casale M, Kathuria S, Cattaneo E, Marsh JL, Thompson LM, Patzke H, Chesworth R, Li Z, Rahil G, Wang J, Smith J, Huet FL, Shapiro G, Leit S, Beaulieu P, Raeppel F, Fournel M, Sainte-Croix H, Nolan SJ, Albayya FP, Barbier A, Besterman J, Ahlijanian MK, Deziel R, Aubeeluck A, Buchanan H, Ross C, Biglan K, Landwehrmeyer B, Whitlock KB, Carlozzi NE, Mickes L, Lee J, Kim RY, Toro B, Fine E, Cahill T, Johnson D, Goldstein J, Peavy G, Jacobson M, Goodman LV, Como PG, Cha JH, Beck C, Adams M, Chadwick G, Blieck EA, McCallum C, Deuel L, Clarke A, Stewart R, Adams WH, Paulson H, Fiedorowicz JG, Hanson JM, Ramza N, Priller J, Ecker D. Inaugural Huntington Disease Clinical Research Symposium Organized by the Huntington Study Group. Neurotherapeutics 2008. [DOI: 10.1016/j.nurt.2007.10.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Bercovich D, Elimelech A, Zlotogora J, Korem S, Yardeni T, Gal N, Goldstein N, Vilensky B, Segev R, Avraham S, Loewenthal R, Schwartz G, Anikster Y. Genotype-phenotype correlations analysis of mutations in the phenylalanine hydroxylase (PAH) gene. J Hum Genet 2008; 53:407-418. [PMID: 18299955 DOI: 10.1007/s10038-008-0264-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2007] [Accepted: 01/28/2008] [Indexed: 10/22/2022]
Abstract
The aims of our research were to define the genotype-phenotype correlations of mutations in the phenylalanine hydroxylase (PAH) gene that cause phenylketonuria (PKU) among the Israeli population. The mutation spectrum of the PAH gene in PKU patients in Israel is described, along with a discussion on genotype-phenotype correlations. By using polymerase chain reaction/denaturing high-performance liquid chromatography (PCR/dHPLC) and DNA sequencing, we screened all exons of the PAH gene in 180 unrelated patients with four different PKU phenotypes [classic PKU, moderate PKU, mild PKU, and mild hyperphenylalaninemia (MHP)]. In 63.2% of patient genotypes, the metabolic phenotype could be predicted, though evidence is also found for both phenotypic inconsistencies among subjects with more than one type of mutation in the PAH gene. Data analysis revealed that about 25% of patients could participate in the future in (6R)-L: -erythro-5, 6, 7, 8-tetrahydrobiopterin (BH4) treatment trials according to their mutation genotypes. This study enables us to construct a national database in Israel that will serve as a valuable tool for genetic counseling and a prognostic evaluation of future cases of PKU.
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Affiliation(s)
- Dani Bercovich
- MIGAL, Galilee Technology Center, Human Molecular Genetics and Pharmacogenetics Laboratory, Kiryat Shmona, Israel. .,Tel-Hai Academic College, Upper Galilee, Israel.
| | - Arava Elimelech
- MIGAL, Galilee Technology Center, Human Molecular Genetics and Pharmacogenetics Laboratory, Kiryat Shmona, Israel
| | - Joel Zlotogora
- Department of Genetic Community, Public Health Services, Health Ministry and Hebrew University, Jerusalem, Israel
| | - Sigal Korem
- MIGAL, Galilee Technology Center, Human Molecular Genetics and Pharmacogenetics Laboratory, Kiryat Shmona, Israel.,Tel-Hai Academic College, Upper Galilee, Israel
| | - Tal Yardeni
- MIGAL, Galilee Technology Center, Human Molecular Genetics and Pharmacogenetics Laboratory, Kiryat Shmona, Israel
| | - Nurit Gal
- Metabolic Disease Unit, Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Nurit Goldstein
- Metabolic Disease Unit, Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Bela Vilensky
- Metabolic Disease Unit, Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Roni Segev
- Metabolic Disease Unit, Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Smadar Avraham
- Metabolic Disease Unit, Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ron Loewenthal
- Tissue Typing Unit and Safra Children Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gerard Schwartz
- Metabolic Disease Unit, Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Yair Anikster
- Metabolic Disease Unit, Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Fiocco AJ, Nair NPV, Schwartz G, Kin FNY, Joober R, Poirier J, Lupien SJ. Influence of genetic polymorphisms in the apolipoprotein (APOE) and the butyrylcholinesterase (BCHE) gene on stress markers in older adults: a 3-year study. Neurobiol Aging 2007; 30:1001-5. [PMID: 17996334 DOI: 10.1016/j.neurobiolaging.2007.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Revised: 06/26/2007] [Accepted: 09/18/2007] [Indexed: 11/19/2022]
Abstract
The present study examined the influence of genetic polymorphisms in the apolipoprotein (APOE) and the butyrylcholinesterase (BCHE) gene on GC secretion, cognition and personality in 66 healthy older adults. These particular variables were chosen given that they have been shown to be associated with human stress (i.e.stress markers). Measures included basal serum GC levels and cognitive scores on declarative memory obtained annually over 3 years. Also, self-esteem, neuroticism and depression were evaluated. Results showed that participants with the APOE E4-BCHE K variant (E4-K group) present increased basal levels of GCs and poorer cognitive performance when compared to non-carriers of these variants. In addition, the E4-K group reported lower self-esteem and higher levels of depression. These findings may indicate a genotype effect on markers of stress and cognitive integrity years before symptoms of dementia are apparent.
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Affiliation(s)
- A J Fiocco
- Douglas Hospital Research Centre, Verdun, Quebec H4H 1R3, Canada
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Jhawer MP, Qin L, Gerdes H, Klimstra D, Schattner M, Viale A, Gonen M, Schwartz G, Kelsen D, Shah M. Evaluation of the feasibility of expression microarray analysis in endoscopically obtained biopsies of gastric carcinoma and their clinical applicability. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.21164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
21164 Background: The feasibility of extracting high quality RNA for expression microarray analysis from endoscopic biopsy in gastric carcinoma has not been previously established. Methods: Patients with histologically confirmed locally advanced gastric or gastroesophageal junction adenocarcinoma were screened for enrollment in an NCI-sponsored trial of neoadjuvant irinotecan and cisplatin chemotherapy (NC1–5917). All patients underwent a repeat endoscopic biopsy for the procurement of fresh tumor tissue. Gross microdissection was performed to enrich the sample to at least 80% malignancy. RNA was isolated from the tumor specimens using RNeasy columns (Qiagen) and its quality verified by RNA 6000 NanoAssay and Bioanalyzer 2100 (Agilent). Gene expression profiling was performed on Human Genome U133A GeneChip (Affymetrix) which contained 22,215 oligonucleotide-base probe-sets. Differential gene expression profiles for Lauren's classification were assessed using empirical Bayes t test, a threshold p < 0.001 was considered statistically significant. Results: Of 36 patients with previous biopsy confirmed gastric cancer, repeat endoscopic biopsy identified carcinoma in 28 patients (78%, 95%CI 61–90%). Adequate RNA for microarray analysis was obtained from 21 patients-representing 58% of those who presented for the procedure and 75% in whom endoscopic biopsies confirmed malignancy. This yield improved with increasing number of samples taken. Lauren's classification was available on 26 patients who underwent resection. From the total 54,613 gene probe-sets on the arrays, comparison of the expression profiles of diffuse-type and intestinal-type identified 167 genes that were differentially expressed. Diffuse gastric cancer demonstrated altered expression of genes related to cell-matrix interaction whereas intestinal gastric cancer expression analysis showed enhancement of cell growth. Conclusions: Endoscopic biopsy for expression analysis of gastric cancer is feasible with increasing yield with each core taken. Expression analysis at the time of endoscopic biopsy can differentiate Lauren's histology, a characteristic not routinely evaluable by pathologic review. No significant financial relationships to disclose.
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Keohan M, D'Adamo D, Qin L, Saulle M, Caltieri L, Schuetze S, Wright JJ, Schwartz G, Maki R. Analysis of toxicity in a phase II study of sorafenib in soft tissue sarcoma (STS). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.10061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10061 Background: Sorafenib (BAY 43–9006) is an oral multi-targeted kinase inhibitor. Sorafenib causes dermatologic toxicity and hypertension, although the mechanisms are poorly understood. We observed significant toxicity requiring dose reductions in our phase II study of sorafenib in STS. Methods: 120 patients (40 M, 80 F; median age, 55 years) were treated between 10/05 and 12/06; accrual continues. All patients initially received sorafenib 400 mg BID. 118/120 registered patients were evaluable for toxicity. Clinical and laboratory variables were analyzed for association with dose reduction, using Kruskal-Wallis rank sum test for continuous variables and Fisher exact test for categorical variables. Variables significant at the p=0.05 level were further analyzed with a multivariate logistic regression model for their effects on dose reduction. Results: 53% of patients (63/118) required dose reductions, 53/63 for grade 2 or greater skin toxicity. Most common grade 3–4 drug-related toxicities included lymphopenia (14%), rash (12%), and hand-foot skin reaction (10%). Sex, height, weight, BSA and serum creatinine (Cr) were significantly associated with dose reduction by univariate analysis. Adjusting for sex and/or low serum Cr, BSA was not significantly associated with dose reduction. Sex and low serum Cr were borderline statistically significant predictors of dose reductions when both variables were included in a multivariate model. Only female sex remained a significant predictor when eliminating one outlier with BSA 2.83 (p=0.04). Conclusions: Female gender appears associated with skin toxicity, requiring dose reductions. Based on this multivariate analysis, a starting dose of 400 mg oral daily in women may limit side effects. Correlation with trough serum sorafenib levels is pending. This study is funded in part by NCI Grant P01-CA47179. No significant financial relationships to disclose.
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Affiliation(s)
- M. Keohan
- Memor Sloan Kettering Cancer Ctr, New York, NY; University of Michigan Cancer Center, Ann Arbor, MI; National Cancer Institute, Rockville, MD
| | - D. D'Adamo
- Memor Sloan Kettering Cancer Ctr, New York, NY; University of Michigan Cancer Center, Ann Arbor, MI; National Cancer Institute, Rockville, MD
| | - L. Qin
- Memor Sloan Kettering Cancer Ctr, New York, NY; University of Michigan Cancer Center, Ann Arbor, MI; National Cancer Institute, Rockville, MD
| | - M. Saulle
- Memor Sloan Kettering Cancer Ctr, New York, NY; University of Michigan Cancer Center, Ann Arbor, MI; National Cancer Institute, Rockville, MD
| | - L. Caltieri
- Memor Sloan Kettering Cancer Ctr, New York, NY; University of Michigan Cancer Center, Ann Arbor, MI; National Cancer Institute, Rockville, MD
| | - S. Schuetze
- Memor Sloan Kettering Cancer Ctr, New York, NY; University of Michigan Cancer Center, Ann Arbor, MI; National Cancer Institute, Rockville, MD
| | - J. J. Wright
- Memor Sloan Kettering Cancer Ctr, New York, NY; University of Michigan Cancer Center, Ann Arbor, MI; National Cancer Institute, Rockville, MD
| | - G. Schwartz
- Memor Sloan Kettering Cancer Ctr, New York, NY; University of Michigan Cancer Center, Ann Arbor, MI; National Cancer Institute, Rockville, MD
| | - R. Maki
- Memor Sloan Kettering Cancer Ctr, New York, NY; University of Michigan Cancer Center, Ann Arbor, MI; National Cancer Institute, Rockville, MD
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