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Nichols GL, Gillingham EL, Macintyre HL, Vardoulakis S, Hajat S, Sarran CE, Amankwaah D, Phalkey R. Coronavirus seasonality, respiratory infections and weather. BMC Infect Dis 2021; 21:1101. [PMID: 34702177 PMCID: PMC8547307 DOI: 10.1186/s12879-021-06785-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/12/2021] [Indexed: 12/23/2022] Open
Abstract
Background The survival of coronaviruses are influenced by weather conditions and seasonal coronaviruses are more common in winter months. We examine the seasonality of respiratory infections in England and Wales and the associations between weather parameters and seasonal coronavirus cases. Methods Respiratory virus disease data for England and Wales between 1989 and 2019 was extracted from the Second-Generation Surveillance System (SGSS) database used for routine surveillance. Seasonal coronaviruses from 2012 to 2019 were compared to daily average weather parameters for the period before the patient’s specimen date with a range of lag periods. Results The seasonal distribution of 985,524 viral infections in England and Wales (1989–2019) showed coronavirus infections had a similar seasonal distribution to influenza A and bocavirus, with a winter peak between weeks 2 to 8. Ninety percent of infections occurred where the daily mean ambient temperatures were below 10 °C; where daily average global radiation exceeded 500 kJ/m2/h; where sunshine was less than 5 h per day; or where relative humidity was above 80%. Coronavirus infections were significantly more common where daily average global radiation was under 300 kJ/m2/h (OR 4.3; CI 3.9–4.6; p < 0.001); where average relative humidity was over 84% (OR 1.9; CI 3.9–4.6; p < 0.001); where average air temperature was below 10 °C (OR 6.7; CI 6.1–7.3; p < 0.001) or where sunshine was below 4 h (OR 2.4; CI 2.2–2.6; p < 0.001) when compared to the distribution of weather values for the same time period. Seasonal coronavirus infections in children under 3 years old were more frequent at the start of an annual epidemic than at the end, suggesting that the size of the susceptible child population may be important in the annual cycle. Conclusions The dynamics of seasonal coronaviruses reflect immunological, weather, social and travel drivers of infection. Evidence from studies on different coronaviruses suggest that low temperature and low radiation/sunlight favour survival. This implies a seasonal increase in SARS-CoV-2 may occur in the UK and countries with a similar climate as a result of an increase in the R0 associated with reduced temperatures and solar radiation. Increased measures to reduce transmission will need to be introduced in winter months for COVID-19. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06785-2.
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Affiliation(s)
- G L Nichols
- Climate Change and Health Group, Centre for Radiation Chemicals and Environmental Hazards, UK Health Security Agency (Formerly Public Health England), Chilton, Oxon, OX11 0RQ, UK. .,European Centre for Environment and Human Health, University of Exeter Medical School, C/O Knowledge Spa RCHT, Truro, Cornwall, TR1 3HD, UK. .,School of Environmental Sciences, UEA, Norwich, NR4 7TJ, UK.
| | - E L Gillingham
- Climate Change and Health Group, Centre for Radiation Chemicals and Environmental Hazards, UK Health Security Agency (Formerly Public Health England), Chilton, Oxon, OX11 0RQ, UK
| | - H L Macintyre
- Climate Change and Health Group, Centre for Radiation Chemicals and Environmental Hazards, UK Health Security Agency (Formerly Public Health England), Chilton, Oxon, OX11 0RQ, UK.,School of Geography Earth and Environmental Sciences, University of Birmingham, Edgbaston, B15 2TT, UK
| | - S Vardoulakis
- European Centre for Environment and Human Health, University of Exeter Medical School, C/O Knowledge Spa RCHT, Truro, Cornwall, TR1 3HD, UK.,National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, 2601, Australia
| | - S Hajat
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
| | - C E Sarran
- Met Office, Fitzroy Road, Exeter, EX1 3PB, UK.,Institute of Health Research, University of Exeter, Saint Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - D Amankwaah
- Climate Change and Health Group, Centre for Radiation Chemicals and Environmental Hazards, UK Health Security Agency (Formerly Public Health England), Chilton, Oxon, OX11 0RQ, UK
| | - R Phalkey
- Climate Change and Health Group, Centre for Radiation Chemicals and Environmental Hazards, UK Health Security Agency (Formerly Public Health England), Chilton, Oxon, OX11 0RQ, UK.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.,Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
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2
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Affiliation(s)
- Gordon L Nichols
- Climate Change Group, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot OX11 0RQ, UK.
| | - Giovanni Lo Iacono
- School of Veterinary Medicine, Department of Veterinary Epidemiology and Public Health, University of Surrey, Surrey, UK
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Djennad A, Lo Iacono G, Sarran C, Lane C, Elson R, Höser C, Lake IR, Colón-González FJ, Kovats S, Semenza JC, Bailey TC, Kessel A, Fleming LE, Nichols GL. Seasonality and the effects of weather on Campylobacter infections. BMC Infect Dis 2019; 19:255. [PMID: 30866826 PMCID: PMC6417031 DOI: 10.1186/s12879-019-3840-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/20/2019] [Indexed: 01/08/2023] Open
Abstract
Background Campylobacteriosis is a major public health concern. The weather factors that influence spatial and seasonal distributions are not fully understood. Methods To investigate the impacts of temperature and rainfall on Campylobacter infections in England and Wales, cases of Campylobacter were linked to local temperature and rainfall at laboratory postcodes in the 30 days before the specimen date. Methods for investigation included a comparative conditional incidence, wavelet, clustering, and time series analyses. Results The increase of Campylobacter infections in the late spring was significantly linked to temperature two weeks before, with an increase in conditional incidence of 0.175 cases per 100,000 per week for weeks 17 to 24; the relationship to temperature was not linear. Generalized structural time series model revealed that changes in temperature accounted for 33.3% of the expected cases of Campylobacteriosis, with an indication of the direction and relevant temperature range. Wavelet analysis showed a strong annual cycle with additional harmonics at four and six months. Cluster analysis showed three clusters of seasonality with geographic similarities representing metropolitan, rural, and other areas. Conclusions The association of Campylobacteriosis with temperature is likely to be indirect. High-resolution spatial temporal linkage of weather parameters and cases is important in improving weather associations with infectious diseases. The primary driver of Campylobacter incidence remains to be determined; other avenues, such as insect contamination of chicken flocks through poor biosecurity should be explored. Electronic supplementary material The online version of this article (10.1186/s12879-019-3840-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Abdelmajid Djennad
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, 61, Colindale Avenue, London, NW9 5EQ, UK.
| | | | | | | | - Richard Elson
- National Infection Service, Public Health England, London, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, London, UK
| | - Christoph Höser
- Institute for Hygiene and Public Health, GeoHealth Centre, University of Bonn, Bonn, Germany
| | | | | | - Sari Kovats
- London School of Hygiene and Tropical Medicine, London, UK
| | - Jan C Semenza
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Anthony Kessel
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, 61, Colindale Avenue, London, NW9 5EQ, UK.,London School of Hygiene and Tropical Medicine, London, UK
| | | | - Gordon L Nichols
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, 61, Colindale Avenue, London, NW9 5EQ, UK.,University of Exeter, Exeter, UK.,University of Thessaly, Larissa, Thessaly, Greece
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Djennad A, Lo Iacono G, Sarran C, Fleming LE, Kessel A, Haines A, Nichols GL. A comparison of weather variables linked to infectious disease patterns using laboratory addresses and patient residence addresses. BMC Infect Dis 2018; 18:198. [PMID: 29703153 DOI: 10.1186/s12879-018-3106-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 04/20/2018] [Indexed: 03/31/2024] Open
Abstract
BACKGROUND To understand the impact of weather on infectious diseases, information on weather parameters at patient locations is needed, but this is not always accessible due to confidentiality or data availability. Weather parameters at nearby locations are often used as a proxy, but the accuracy of this practice is not known. METHODS Daily Campylobacter and Cryptosporidium cases across England and Wales were linked to local temperature and rainfall at the residence postcodes of the patients and at the corresponding postcodes of the laboratory where the patient's specimen was tested. The paired values of daily rainfall and temperature for the laboratory versus residence postcodes were interpolated from weather station data, and the results were analysed for agreement using linear regression. We also assessed potential dependency of the findings on the relative geographic distance between the patient's residence and the laboratory. RESULTS There was significant and strong agreement between the daily values of rainfall and temperature at diagnostic laboratories with the values at the patient residence postcodes for samples containing the pathogens Campylobacter or Cryptosporidium. For rainfall, the R-squared was 0.96 for the former and 0.97 for the latter, and for maximum daily temperature, the R-squared was 0.99 for both. The overall mean distance between the patient residence and the laboratory was 11.9 km; however, the distribution of these distances exhibited a heavy tail, with some rare situations where the distance between the patient residence and the laboratory was larger than 500 km. These large distances impact the distributions of the weather variable discrepancies (i.e. the differences between weather parameters estimated at patient residence postcodes and those at laboratory postcodes), with discrepancies up to ±10 °C for the minimum and maximum temperature and 20 mm for rainfall. Nevertheless, the distributions of discrepancies (estimated separately for minimum and maximum temperature and rainfall), based on the cases where the distance between the patient residence and the laboratory was within 20 km, still exhibited tails somewhat longer than the corresponding exponential fits suggesting modest small scale variations in temperature and rainfall. CONCLUSION The findings confirm that, for the purposes of studying the relationships between meteorological variables and infectious diseases using data based on laboratory postcodes, the weather results are sufficiently similar to justify the use of laboratory postcode as a surrogate for domestic postcode. Exclusion of the small percentage of cases where there is a large distance between the residence and the laboratory could increase the precision of estimates, but there are generally strong associations between daily weather parameters at residence and laboratory.
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Affiliation(s)
- Abdelmajid Djennad
- Public Health England, London, UK. .,Statistics, Modelling and Economics Department, National Infection Service, Public Health England, 61, Colindale Avenue, London, NW9 5EQ, UK.
| | - Giovanni Lo Iacono
- School of Veterinary Medicine, University of Surrey, Guildford, UK.,Centre for Radiation Chemical and Environmental Hazards, Public Health England, Harwell, Didcot, UK
| | | | - Lora E Fleming
- European Centre for Environment and Human Health, University of Exeter, Exeter, UK
| | | | - Andy Haines
- London School of Hygiene and Tropical Medicine, London, UK
| | - Gordon L Nichols
- Public Health England, London, UK.,Centre for Radiation Chemical and Environmental Hazards, Public Health England, Harwell, Didcot, UK.,European Centre for Environment and Human Health, University of Exeter, Exeter, UK.,University of East Anglia, Norwich, UK
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Semenza JC, Trinanes J, Lohr W, Sudre B, Löfdahl M, Martinez-Urtaza J, Nichols GL, Rocklöv J. Environmental Suitability of Vibrio Infections in a Warming Climate: An Early Warning System. Environ Health Perspect 2017; 125:107004. [PMID: 29017986 PMCID: PMC5933323 DOI: 10.1289/ehp2198] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/12/2017] [Accepted: 08/14/2017] [Indexed: 05/19/2023]
Abstract
BACKGROUND Some Vibrio spp. are pathogenic and ubiquitous in marine waters with low to moderate salinity and thrive with elevated sea surface temperature (SST). OBJECTIVES Our objective was to monitor and project the suitability of marine conditions for Vibrio infections under climate change scenarios. METHODS The European Centre for Disease Prevention and Control (ECDC) developed a platform (the ECDC Vibrio Map Viewer) to monitor the environmental suitability of coastal waters for Vibrio spp. using remotely sensed SST and salinity. A case-crossover study of Swedish cases was conducted to ascertain the relationship between SST and Vibrio infection through a conditional logistic regression. Climate change projections for Vibrio infections were developed for Representative Concentration Pathway (RCP) 4.5 and RCP 8.5. RESULTS The ECDC Vibrio Map Viewer detected environmentally suitable areas for Vibrio spp. in the Baltic Sea in July 2014 that were accompanied by a spike in cases and one death in Sweden. The estimated exposure-response relationship for Vibrio infections at a threshold of 16°C revealed a relative risk (RR)=1.14 (95% CI: 1.02, 1.27; p=0.024) for a lag of 2 wk; the estimated risk increased successively beyond this SST threshold. Climate change projections for SST under the RCP 4.5 and RCP 8.5 scenarios indicate a marked upward trend during the summer months and an increase in the relative risk of these infections in the coming decades. CONCLUSIONS This platform can serve as an early warning system as the risk of further Vibrio infections increases in the 21st century due to climate change. https://doi.org/10.1289/EHP2198.
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Affiliation(s)
- Jan C Semenza
- Scientific Assessment Section, European Centre for Disease Prevention and Control , Stockholm, Sweden
| | - Joaquin Trinanes
- Instituto de Investigaciones Tecnoloxicas, Universidade de Santiago de Compostela , Santiago, Spain
- Physical Oceanography Division, Atlantic Oceanographic and Meteorological Laboratory, National Oceanic and Atmospheric Administration , Miami, Florida, USA
- Cooperative Institute for Marine and Atmospheric Studies, Rosenstiel School of Marine and Atmospheric Sciences, University of Miami , Miami, Florida, USA
| | - Wolfgang Lohr
- Umeå Centre for Global Health Research, Umeå University , Umeå, Sweden
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University , Umeå, Sweden
| | - Bertrand Sudre
- Epidemic Intelligence and Response, European Centre for Disease Prevention and Control , Stockholm, Sweden
| | | | - Jaime Martinez-Urtaza
- The Milner Centre for Evolution, Department of Biology and Biochemistry, University of Bath , Bath, UK
- The Centre for Environment, Fisheries and Aquaculture Science (CEFAS), Weymouth, UK
| | - Gordon L Nichols
- Public Health England , London, UK
- University of Exeter , Exeter, UK
- University of East Anglia , Norwich, UK
| | - Joacim Rocklöv
- Umeå Centre for Global Health Research, Umeå University , Umeå, Sweden
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University , Umeå, Sweden
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6
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Lo Iacono G, Armstrong B, Fleming LE, Elson R, Kovats S, Vardoulakis S, Nichols GL. Challenges in developing methods for quantifying the effects of weather and climate on water-associated diseases: A systematic review. PLoS Negl Trop Dis 2017; 11:e0005659. [PMID: 28604791 PMCID: PMC5481148 DOI: 10.1371/journal.pntd.0005659] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 06/22/2017] [Accepted: 05/23/2017] [Indexed: 11/19/2022] Open
Abstract
Infectious diseases attributable to unsafe water supply, sanitation and hygiene (e.g. Cholera, Leptospirosis, Giardiasis) remain an important cause of morbidity and mortality, especially in low-income countries. Climate and weather factors are known to affect the transmission and distribution of infectious diseases and statistical and mathematical modelling are continuously developing to investigate the impact of weather and climate on water-associated diseases. There have been little critical analyses of the methodological approaches. Our objective is to review and summarize statistical and modelling methods used to investigate the effects of weather and climate on infectious diseases associated with water, in order to identify limitations and knowledge gaps in developing of new methods. We conducted a systematic review of English-language papers published from 2000 to 2015. Search terms included concepts related to water-associated diseases, weather and climate, statistical, epidemiological and modelling methods. We found 102 full text papers that met our criteria and were included in the analysis. The most commonly used methods were grouped in two clusters: process-based models (PBM) and time series and spatial epidemiology (TS-SE). In general, PBM methods were employed when the bio-physical mechanism of the pathogen under study was relatively well known (e.g. Vibrio cholerae); TS-SE tended to be used when the specific environmental mechanisms were unclear (e.g. Campylobacter). Important data and methodological challenges emerged, with implications for surveillance and control of water-associated infections. The most common limitations comprised: non-inclusion of key factors (e.g. biological mechanism, demographic heterogeneity, human behavior), reporting bias, poor data quality, and collinearity in exposures. Furthermore, the methods often did not distinguish among the multiple sources of time-lags (e.g. patient physiology, reporting bias, healthcare access) between environmental drivers/exposures and disease detection. Key areas of future research include: disentangling the complex effects of weather/climate on each exposure-health outcome pathway (e.g. person-to-person vs environment-to-person), and linking weather data to individual cases longitudinally.
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Affiliation(s)
- Giovanni Lo Iacono
- Chemical and Environmental Effects Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, United Kingdom
| | - Ben Armstrong
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lora E. Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, United Kingdom
| | - Richard Elson
- Gastrointestinal Infections, National Infection Service, Public Health England, London, United Kingdom
| | - Sari Kovats
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sotiris Vardoulakis
- Chemical and Environmental Effects Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, United Kingdom
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, United Kingdom
- Institute of Occupational Medicine, Edinburgh, United Kingdom
| | - Gordon L. Nichols
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, United Kingdom
- Gastrointestinal Infections, National Infection Service, Public Health England, London, United Kingdom
- University of East Anglia, Norwich, United Kingdom
- University of Thessaly, Larissa, Thessaly, Greece
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7
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Nichols GL, Freedman J, Pollock KG, Rumble C, Chalmers RM, Chiodini P, Hawkins G, Alexander CL, Godbole G, Williams C, Kirkbride HA, Hamel M, Hawker JI. Cyclospora infection linked to travel to Mexico, June to September 2015. Euro Surveill 2015; 20:30048. [DOI: 10.2807/1560-7917.es.2015.20.43.30048] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 10/28/2015] [Indexed: 11/20/2022] Open
Abstract
Cyclospora cayetanensis was identified in 176 returned travellers from the Riviera Maya region of Mexico between 1 June and 22 September 2015; 79 in the United Kingdom (UK) and 97 in Canada. UK cases completed a food exposure questionnaire. This increase in reported Cyclospora cases highlights risks of gastrointestinal infections through travelling, limitations in Cyclospora surveillance and the need for improved hygiene in the production of food consumed in holiday resorts.
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Affiliation(s)
- Gordon L Nichols
- National Infection Service, Public Health England, London, United Kingdom
| | - Joanne Freedman
- National Infection Service, Public Health England, London, United Kingdom
| | | | - Caroline Rumble
- National Infection Service, Public Health England, London, United Kingdom
| | - Rachel M Chalmers
- Cryptosporidium Reference Unit, Public Health Wales, Swansea, United Kingdom
| | - Peter Chiodini
- PHE National Parasitology Reference Laboratory, Hospital for Tropical Diseases, London, United Kingdom
| | | | - Claire L Alexander
- Scottish Parasite Diagnostic and Reference Laboratory, Glasgow, United Kingdom
| | - Gauri Godbole
- National Infection Service, Public Health England, London, United Kingdom
- PHE National Parasitology Reference Laboratory, Hospital for Tropical Diseases, London, United Kingdom
| | | | - Hilary A Kirkbride
- National Infection Service, Public Health England, London, United Kingdom
| | | | - Jeremy I Hawker
- National Infection Service, Public Health England, London, United Kingdom
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8
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Chen L, Zhao Y, Halliday GC, Berry P, Rousseau RF, Middleton SA, Nichols GL, Del Bello F, Piergentili A, Newell DR, Lunec J, Tweddle DA. Structurally diverse MDM2-p53 antagonists act as modulators of MDR-1 function in neuroblastoma. Br J Cancer 2014; 111:716-25. [PMID: 24921920 PMCID: PMC4134492 DOI: 10.1038/bjc.2014.325] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 05/09/2014] [Accepted: 05/13/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND A frequent mechanism of acquired multidrug resistance in human cancers is overexpression of ATP-binding cassette transporters such as the Multi-Drug Resistance Protein 1 (MDR-1). Nutlin-3, an MDM2-p53 antagonist, has previously been reported to be a competitive MDR-1 inhibitor. METHODS This study assessed whether the structurally diverse MDM2-p53 antagonists, MI-63, NDD0005, and RG7388 are also able to modulate MDR-1 function, particularly in p53 mutant neuroblastoma cells, using XTT-based cell viability assays, western blotting, and liquid chromatography-mass spectrometry analysis. RESULTS Verapamil and the MDM2-p53 antagonists potentiated vincristine-mediated growth inhibition in a concentration-dependent manner when used in combination with high MDR-1-expressing p53 mutant neuroblastoma cell lines at concentrations that did not affect the viability of cells when given alone. Liquid chromatography-mass spectrometry analyses showed that verapamil, Nutlin-3, MI-63 and NDD0005, but not RG7388, led to increased intracellular levels of vincristine in high MDR-1-expressing cell lines. CONCLUSIONS These results show that in addition to Nutlin-3, other structurally unrelated MDM2-p53 antagonists can also act as MDR-1 inhibitors and reverse MDR-1-mediated multidrug resistance in neuroblastoma cell lines in a p53-independent manner. These findings are important for future clinical trial design with MDM2-p53 antagonists when used in combination with agents that are MDR-1 substrates.
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Affiliation(s)
- L Chen
- Newcastle Cancer Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Y Zhao
- Newcastle Cancer Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - G C Halliday
- Newcastle Cancer Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - P Berry
- Newcastle Cancer Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - R F Rousseau
- Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - S A Middleton
- Hoffmann-La Roche Inc., 340 Kingsland Street, Nutley, NJ 07110, USA
| | - G L Nichols
- Hoffmann-La Roche Inc., 340 Kingsland Street, Nutley, NJ 07110, USA
| | - F Del Bello
- Medicinal Chemistry Unit, School of Pharmacy, University of Camerino, via S. Agostino 1, Camerino 62032, Italy
| | - A Piergentili
- Medicinal Chemistry Unit, School of Pharmacy, University of Camerino, via S. Agostino 1, Camerino 62032, Italy
| | - D R Newell
- Newcastle Cancer Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - J Lunec
- Newcastle Cancer Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - D A Tweddle
- Newcastle Cancer Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
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9
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Oliver DM, van Niekerk M, Kay D, Heathwaite AL, Porter J, Fleming LE, Kinzelman JL, Connolly E, Cummins A, McPhail C, Rahman A, Thairs T, de Roda Husman AM, Hanley ND, Dunhill I, Globevnik L, Harwood VJ, Hodgson CJ, Lees DN, Nichols GL, Nocker A, Schets C, Quilliam RS. Opportunities and limitations of molecular methods for quantifying microbial compliance parameters in EU bathing waters. Environ Int 2014; 64:124-8. [PMID: 24394589 DOI: 10.1016/j.envint.2013.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 12/17/2013] [Accepted: 12/18/2013] [Indexed: 05/11/2023]
Abstract
The debate over the suitability of molecular biological methods for the enumeration of regulatory microbial parameters (e.g. Faecal Indicator Organisms [FIOs]) in bathing waters versus the use of traditional culture-based methods is of current interest to regulators and the science community. Culture-based methods require a 24-48hour turn-around time from receipt at the laboratory to reporting, whilst quantitative molecular tools provide a more rapid assay (approximately 2-3h). Traditional culturing methods are therefore often viewed as slow and 'out-dated', although they still deliver an internationally 'accepted' evidence-base. In contrast, molecular tools have the potential for rapid analysis and their operational utility and associated limitations and uncertainties should be assessed in light of their use for regulatory monitoring. Here we report on the recommendations from a series of international workshops, chaired by a UK Working Group (WG) comprised of scientists, regulators, policy makers and other stakeholders, which explored and interrogated both molecular (principally quantitative polymerase chain reaction [qPCR]) and culture-based tools for FIO monitoring under the European Bathing Water Directive. Through detailed analysis of policy implications, regulatory barriers, stakeholder engagement, and the needs of the end-user, the WG identified a series of key concerns that require critical appraisal before a potential shift from culture-based approaches to the employment of molecular biological methods for bathing water regulation could be justified.
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Affiliation(s)
- David M Oliver
- Biological & Environmental Sciences, School of Natural Sciences, University of Stirling, Stirling FK9 4LA, UK.
| | - Melanie van Niekerk
- Biological & Environmental Sciences, School of Natural Sciences, University of Stirling, Stirling FK9 4LA, UK
| | - David Kay
- Centre for Research into Environment & Health, Aberystwyth University, Wales SA48 8HU, UK
| | | | - Jonathan Porter
- National Laboratory Service, Environment Agency, Starcross, Devon EX6 8FD, UK
| | - Lora E Fleming
- European Centre for Environment & Human Health, University of Exeter Medical School, Truro, Cornwall TR1 3HD, UK
| | - Julie L Kinzelman
- City of Racine Health Department Laboratory, 730 Washington Avenue, Racine, WI 53403, USA
| | - Elaine Connolly
- Department for Environment Food and Rural Affairs, Nobel House, London SW1P 3JR, UK
| | - Andy Cummins
- Surfers Against Sewage, Wheal Kitty Workshops, St Agnes, Cornwall TR5 0RD, UK
| | - Calum McPhail
- Scottish Environment Protection Agency, Eurocentral, North Lanarkshire ML1 4WQ, UK
| | - Amanna Rahman
- Environment Agency, Horizon House, Bristol BS1 5AH, UK
| | - Ted Thairs
- UK Water Industry Research Ltd, 1 Queen Anne's Gate, London SW1H 9BT, UK
| | - Ana Maria de Roda Husman
- Laboratory for Zoonoses & Environmental Microbiology, National Institute for Public Health (RIVM), Centre for Infectious Disease Control, 3720 BA Bilthoven, The Netherlands
| | - Nick D Hanley
- Department of Economics, University of Stirling, Stirling FK9 4LA, UK
| | - Ian Dunhill
- Environment Agency, Oving Road, Chichester, West Sussex PO20 2AG, UK
| | - Lidija Globevnik
- European Environment Agency, European Topic Center for Inland, Coastal and Marine Water, Institute for Water of Republic of Slovenia, Slovenia
| | - Valerie J Harwood
- Department of Integrative Biology, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, USA
| | - Chris J Hodgson
- Rothamsted Research, North Wyke, Okehampton, Devon EX20 2SB, UK
| | - David N Lees
- Centre for Environment, Fisheries and Aquaculture Science, Weymouth Laboratory, Weymouth, Dorset DT4 8UB, UK
| | | | - Andreas Nocker
- Cranfield Water Science Institute, School of Applied Sciences, Cranfield University, MK43 0AL, UK
| | - Ciska Schets
- Laboratory for Zoonoses & Environmental Microbiology, National Institute for Public Health (RIVM), Centre for Infectious Disease Control, 3720 BA Bilthoven, The Netherlands
| | - Richard S Quilliam
- Biological & Environmental Sciences, School of Natural Sciences, University of Stirling, Stirling FK9 4LA, UK
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Puleston RL, Mallaghan CM, Modha DE, Hunter PR, Nguyen-Van-Tam JS, Regan CM, Nichols GL, Chalmers RM. The first recorded outbreak of cryptosporidiosis due to Cryptosporidium cuniculus (formerly rabbit genotype), following a water quality incident. J Water Health 2014; 12:41-50. [PMID: 24642431 DOI: 10.2166/wh.2013.097] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We report the first identified outbreak of cryptosporidiosis with Cryptosporidium cuniculus following a water quality incident in Northamptonshire, UK. A standardised, enhanced Cryptosporidium exposure questionnaire was administered to all cases of cryptosporidiosis after the incident. Stool samples, water testing, microscopy slides and rabbit gut contents positive for Cryptosporidium were typed at the Cryptosporidium Reference Unit, Singleton Hospital, Swansea. Twenty-three people were microbiologically linked to the incident although other evidence suggests an excess of 422 cases of cryptosporidiosis above baseline. Most were adult females; unusually for cryptosporidiosis there were no affected children identified under the age of 5 years. Water consumption was possibly higher than in national drinking water consumption patterns. Diarrhoea duration was negatively correlated to distance from the water treatment works where the contamination occurred. Oocyst counts were highest in water storage facilities. This outbreak is the first caused by C. cuniculus infection to have been noted and it has conclusively demonstrated that this species can be a human pathogen. Although symptomatically similar to cryptosporidiosis from C. parvum or C. hominis, this outbreak has revealed some differences, in particular no children under 5 were identified and females were over-represented. These dissimilarities are unexplained although we postulate possible explanations.
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Affiliation(s)
- Richard L Puleston
- Epidemiology and Public Health, School of Community Health Sciences, University of Nottingham/Health Protection Agency East Midlands, Nottingham, NG5 1PB, UK E-mail:
| | | | - Deborah E Modha
- Health Protection Agency East Midlands, Leicester, LE3 8TB, UK
| | - Paul R Hunter
- Norwich School of Medicine, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Jonathan S Nguyen-Van-Tam
- Epidemiology and Public Health, School of Community Health Sciences, University of Nottingham/Health Protection Agency East Midlands, Nottingham, NG5 1PB, UK E-mail:
| | | | - Gordon L Nichols
- Gastrointestinal, Emerging and Zoonotic Infections Department, Health Protection Agency Colindale, London, NW9 5EQ, UK
| | - Rachel M Chalmers
- Cryptosporidium Reference Unit, Public Health Wales Microbiology, Singleton Hospital, Swansea, SA2 8QA, UK
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Launders NJ, Nichols GL, Cartwright R, Lawrence J, Jones J, Hadjichristodoulou C. Self-reported stomach upset in travellers on cruise-based and land-based package holidays. PLoS One 2014; 9:e83425. [PMID: 24427271 PMCID: PMC3888385 DOI: 10.1371/journal.pone.0083425] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 11/04/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND International travellers are at a risk of infectious diseases not seen in their home country. Stomach upsets are common in travellers, including on cruise ships. This study compares the incidence of stomach upsets on land- and cruise-based holidays. METHODS A major British tour operator has administered a Customer Satisfaction Questionnaire (CSQ) to UK resident travellers aged 16 or more on return flights from their holiday abroad over many years. Data extracted from the CSQ was used to measure self-reported stomach upset in returning travellers. RESULTS From summer 2000 through winter 2008, 6,863,092 questionnaires were completed; 6.6% were from cruise passengers. A higher percentage of land-based holiday-makers (7.2%) reported stomach upset in comparison to 4.8% of cruise passengers (RR = 1.5, p<0.0005). Reported stomach upset on cruises declined over the study period (7.1% in 2000 to 3.1% in 2008, p<0.0005). Over 25% of travellers on land-based holidays to Egypt and the Dominican Republic reported stomach upset. In comparison, the highest proportion of stomach upset in cruise ship travellers were reported following cruises departing from Egypt (14.8%) and Turkey (8.8%). CONCLUSIONS In this large study of self-reported illness both demographic and holiday choice factors were shown to play a part in determining the likelihood of developing stomach upset while abroad. There is a lower cumulative incidence and declining rates of stomach upset in cruise passengers which suggest that the cruise industry has adopted operations (e.g. hygiene standards) that have reduced illness over recent years.
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Affiliation(s)
- Naomi J. Launders
- Gastrointestinal, Emerging and Zoonotic Infections Department, Public Health England, London, United Kingdom
- EU Shipsan Trainet Project, Public Health Program, European Agency for Health and Consumers, Luxembourg, Luxembourg
| | - Gordon L. Nichols
- Gastrointestinal, Emerging and Zoonotic Infections Department, Public Health England, London, United Kingdom
- EU Shipsan Trainet Project, Public Health Program, European Agency for Health and Consumers, Luxembourg, Luxembourg
- Department of Hygiene and epidemiology, Medical Faculty, University of Thessaly, Larissa, Greece
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | | | - Joanne Lawrence
- Travel and Migrant Health Section, Public Health England, London, United Kingdom
| | - Jane Jones
- Travel and Migrant Health Section, Public Health England, London, United Kingdom
| | - Christos Hadjichristodoulou
- EU Shipsan Trainet Project, Public Health Program, European Agency for Health and Consumers, Luxembourg, Luxembourg
- Department of Hygiene and epidemiology, Medical Faculty, University of Thessaly, Larissa, Greece
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12
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Nichols GL, Richardson JF, Sheppard SK, Lane C, Sarran C. Campylobacter epidemiology: a descriptive study reviewing 1 million cases in England and Wales between 1989 and 2011. BMJ Open 2012; 2:bmjopen-2012-001179. [PMID: 22798256 PMCID: PMC3400078 DOI: 10.1136/bmjopen-2012-001179] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To review Campylobacter cases in England and Wales over 2 decades and examine the main factors/mechanisms driving the changing epidemiology. DESIGN A descriptive study of Campylobacter patients between 1989 and 2011. Cases over 3 years were linked anonymously to postcode, population density, deprivation indices and census data. Cases over 5 years were anonymously linked to local weather exposure estimates. SETTING Patients were from general practice, hospital and environmental health investigations through primary diagnostic laboratories across England and Wales. PARTICIPANTS There were 1 109 406 cases. OUTCOME MEASURES Description of changes in Campylobacter epidemiology over 23 years and how the main drivers may influence these. RESULTS There was an increase in Campylobacter cases over the past 23 years, with the largest increase in people over 50 years. Changes in the underlying population have contributed to this, including the impacts of population increases after World War I, World War II and the 'baby boom' of the 1960s. A recent increase in risk or ascertainment within this population has caused an increase in cases in all age groups from 2004 to 2011. The seasonal increase in cases between weeks 18 (Early May) and 22 (Early June) was consistent across ages, years and regions and was most marked in children and in more rural regions. Campylobacter prevalence by week in each region correlated with temperature 2 weeks before. There were higher prevalences in areas with a low population density, low deprivation and lower percentage of people of ethnic origin. Data from sero-phage and multilocus sequence typing show a few common types and many uncommon types. CONCLUSIONS The drivers/mechanisms influencing seasonality, age distribution, population density, socioeconomic and long-term differences are diverse and their relative contributions remain to be established. Surveillance and typing provide insights into Campylobacter epidemiology and sources of infection, providing a sound basis for targeted interventions.
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Affiliation(s)
- Gordon L Nichols
- HPA Colindale, Health Protection Agency, London, UK
- University of Thessaly, Larissa, Greece
- University of East Anglia, Norwich, UK
| | | | - Samuel K Sheppard
- Department of Zoology, University of Oxford, Oxford, UK
- Institute of Life Science, College of Medicine, Swansea University, Swansea, UK
| | - Chris Lane
- HPA Colindale, Health Protection Agency, London, UK
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Hunter PR, de Sylor MA, Risebro HL, Nichols GL, Kay D, Hartemann P. Quantitative microbial risk assessment of cryptosporidiosis and giardiasis from very small private water supplies. Risk Anal 2011; 31:228-236. [PMID: 20880218 DOI: 10.1111/j.1539-6924.2010.01499.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This article reports a quantitative microbial risk assessment of the risk of Giardia and Cryptosporidium in very small private water supplies. Both pathogens have been implicated in causing outbreaks of waterborne disease associated with such supplies, though the risk of endemic disease is not known. For exposure assessments, we used existing data to derive regression equations describing the relationships between the concentration of these pathogens and Escherichia coli in private water supplies. Pathogen concentrations were then estimated using national surveillance data of E. coli in private water supplies in England and France. The estimated risk of infection was very high with the median annual risk being of the order of 25-28% for Cryptosporidium and 0.4% to 0.7% for Giardia, though, in the poorer quality supplies the risk could be much higher. These risks are substantially greater than for public water supplies and well above the risk considered tolerable. The observation that observed infection rates are generally much lower may indicate increased immunity in people regularly consuming water from private supplies. However, this increased immunity is presumed to derive from increased disease risk in young children, the group most at risk from severe disease.
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Affiliation(s)
- Paul R Hunter
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, NR4 7TJ, UK.
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14
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Little CL, Pires SM, Gillespie IA, Grant K, Nichols GL. Attribution of Human Listeria monocytogenes Infections in England and Wales to Ready-to-Eat Food Sources Placed on the Market: Adaptation of the Hald Salmonella Source Attribution Model. Foodborne Pathog Dis 2010; 7:749-56. [DOI: 10.1089/fpd.2009.0439] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christine L. Little
- Department of Gastrointestinal, Emerging and Zoonotic Infections, Health Protection Agency Centre for Infections, London, United Kingdom
| | - Sara M. Pires
- Department of Microbiology and Risk Assessment, National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - Iain A. Gillespie
- Department of Gastrointestinal, Emerging and Zoonotic Infections, Health Protection Agency Centre for Infections, London, United Kingdom
| | - Kathie Grant
- Department of Gastrointestinal, Emerging and Zoonotic Infections, Health Protection Agency Centre for Infections, London, United Kingdom
| | - Gordon L. Nichols
- Department of Gastrointestinal, Emerging and Zoonotic Infections, Health Protection Agency Centre for Infections, London, United Kingdom
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15
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Papadopoulos KP, Noguera-Irizarry W, Wiebe L, Hesdorffer CS, Garvin J, Nichols GL, Vahdat LH, Lo KMS, Skerrett D, Bernstein D, Sharpe E, Savage DG. Pilot study of tandem high-dose chemotherapy and autologous stem cell transplantation with a novel combination of regimens in patients with poor risk lymphoma. Bone Marrow Transplant 2005; 36:491-7. [PMID: 16044139 DOI: 10.1038/sj.bmt.1705103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In an effort to improve the outcome of poor-risk lymphoma patients, we evaluated a novel regimen of tandem high-dose chemotherapy (THDC) with autologous stem cell transplantation. A total of 41 patients (median age 40 years, range 15-68 years) with poor-risk non-Hodgkin's lymphoma and Hodgkin's disease were enrolled. THDC consisted of melphalan (180 mg/m2) and escalating dose mitoxantrone (30-50 mg/m2) (MMt) for the first conditioning regimen, and thiotepa (500 mg/m2), carboplatin (800 mg/m2), and escalating dose etoposide phosphate (400-850 mg/m2), (ETCb) as the second regimen. In all, 31 patients (76%) completed both transplants, with a median time between transplants of 55 days (range 26-120). The maximum tolerated dose was determined as 40 mg/m2 for mitoxantrone and 550 mg/m2 for etoposide phosphate. The overall toxic death rate was 12%. Following high-dose chemotherapy, 10 of 24 evaluable patients (42%) were in CR. The two-year overall survival and event-free survival is 67% (95% CI, 52-81%) and 45%, (95% CI, 29-61%) for the 41 patients enrolled; and 69% (95% CI, 525-586%) and 48% (95% CI, 30-67%) for the 31 patients completing both transplants. This THDC regimen is feasible but with notable toxicity in heavily pretreated patients; its role in the current treatment of high-risk lymphoma remains to be determined.
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Abstract
Outbreaks of cryptosporidiosis have been linked to weather patterns such as heavy precipitation. However, outbreaks only account for a small percentage of all cryptosporidiosis cases and so the causes of the majority of cases are uncertain. This study assessed the role of environmental factors in all cases of cryptosporidiosis by using ordinary least-squares regression to examine the relationship between the monthly cryptosporidiosis rate, and the weather and river flows in England and Wales between 1989 and 1996. Between April and July the cryptosporidiosis rate was positively related to maximum river flow in the current month. Between August and November cryptosporidiosis was also positively linked to maximum river flows in the current month but only after accounting for the previous month's temperature, precipitation and monthly cryptosporidiosis rate. No associations were found between December and March. Through an understanding of the environmental processes at work, these relationships are all consistent with an animal to human transmission pathway especially as the relationships vary throughout the year. This study therefore indicates the importance of an animal to human transmission pathway for all cases of cryptosporidiosis.
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Affiliation(s)
- Iain R Lake
- School of Environmental Sciences, University of East Anglia. Norwich NR4 7TJ, UK.
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17
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Abstract
An annual increase in Campylobacter infection in England and Wales begins in May and reaches a maximum in early June. This increase occurs in all age groups and is seen in all geographic areas. Examination of risk factors that might explain this seasonal increase identifies flies as a potential source of infection. The observed pattern of infection is hypothesized to reflect an annual epidemic caused by direct or indirect contamination of people by small quantities of infected material carried by flies that have been in contact with feces. The local pattern of human illness appears random, while having a defined geographic and temporal distribution that is a function of the growth kinetics of one or more fly species. The hypothesis provides an explanation for the seasonal distribution of Campylobacter infections seen around the world.
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Affiliation(s)
- Gordon L Nichols
- Environmental and Enteric Diseases Department, Communicable Disease Surveillance Centre, Health Protection Agency Centre for Infections, 61 Colindale Ave., London NW9 5EQ, UK.
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18
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Said B, Wright F, Nichols GL, Reacher M, Rutter M. Outbreaks of infectious disease associated with private drinking water supplies in England and Wales 1970-2000. Epidemiol Infect 2003; 130:469-79. [PMID: 12825731 PMCID: PMC2869983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
In England and Wales over the last 30 years there have been 25 reported outbreaks of infection, associated with private water supplies (PWS). The majority (16 outbreaks) were reported after the introduction of enhanced surveillance. Although PWS only serve 0.5% of the population, 36% of drinking water outbreaks are associated with PWS. The main pathogen, campylobacter, was implicated in 13 (52%) outbreaks. Most reported outbreaks (88%) occurred in commercial or Category Two supplies, which potentially affect larger populations. The main factors implicated in these outbreaks are temporary or transient populations, treatment (lack or failure), the presence of animals and heavy rains. The public health problem associated with PWS could be prevented by the identification and understanding of risk factors, by the proper protection of water sources and adequate treatment and maintenance. This could be facilitated through the introduction of a risk assessment as part of a scheme for PWS.
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Affiliation(s)
- B Said
- Environmental Surveillance Unit, CDSC, Public Health Laboratory Service, 61 Colindale Avenue, London NW9 5EQ
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Abstract
In 2000, an unusual increase of morbidity and mortality among illegal injecting drug users in the UK and Ireland was reported and Clostridium novyi was identified as the likely source of the serious infection, although infections due to C. botulinum and Bacillus cereus were also reported. Because heroin was a possibile source of infection, this study investigated the microflora of heroin samples seized in England during 2000 and 2002. Two methods were developed for the examination of the microflora of heroin. The first consisted of suspension of the drug in maximum recovery diluent (MRD) which was inoculated directly into Clostridium Botulinum Isolation Cooked Meat Broth (CBI). The second method rendered the heroin soluble in citric acid, concentrated particulate material (and bacterial cells) by filtration and removed heroin residues by washing with citric acid and phosphate-buffered saline before placing the filter in CBI broth. Duplicate CBI broths from both methods were incubated without heating and after heating at 60 degrees C for 30 min. Subcultures were made after incubation for 7 and 14 days on to eight different solid media. The methods were evaluated with heroin samples spiked with either C. botulinum or C. novyi spore suspensions; recovery of 10 spores in the original sample was demonstrated. Fifty-eight heroin samples were tested by citric acid solubilisation and 34 by the MRD suspension technique. Fifteen different gram-positive species of four genera were recognised. No fungi were isolated. Aerobic endospore-forming bacteria (Bacillus spp. and Paenibacillus macerans) were the predominant microflora isolated and at least one species was isolated from each sample. B. cereus was the most common species and was isolated from 95% of all samples, with B. licheniformis isolated from 40%. Between one and five samples yielded cultures of B. coagulans, B. laterosporus, B. pumilus, B. subtilis and P. macerans. Staphylococcus spp. were isolated from 23 (40%) samples; S. warneri and S. epidermidis were the most common and were cultured from 13 (22%) and 6 (10%) samples respectively. One or two samples yielded cultures of S. aureus, S. capitis and S. haemolyticus. The remainder of the flora detected comprised two samples contaminated with C. perfringens and two samples with either C. sordellii or C. tertium. Multiple bacterial species were isolated from 43 (74%) samples, a single species from the remaining 15. In 13 samples B. cereus alone was isolated, in one B. subtilis alone and in one sample B. pumilus alone. C. botulinum and C. novyi were not isolated from any of the heroin samples. Recommendations for the optimal examination of the microflora of heroin are given.
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Affiliation(s)
| | | | | | - G L Nichols
- PHLS Food Safety Microbiology Laboratory, Central Public Health Laboratory and *Environmental Surveillance Unit, Communicable Disease Surveillance Centre, 61 Colindale Ave, London NW9 5HT, †Birkenhead & Wallasey Primary Care Trust, St Catherine's Hospital, Birkenhead, Merseyside CH42 0LP, ‡Communicable Disease Surveillance Centre (North West), Chester CH1 4EF, §South Sefton Primary Care Trust, Burlington House, Crosby Road North, Waterloo, Liverpool L22 0QB and ||Department of Public Health North West Region, Millennium Park, Birchwood, Warrington WA3 7QN
| | - M A Bellis
- PHLS Food Safety Microbiology Laboratory, Central Public Health Laboratory and *Environmental Surveillance Unit, Communicable Disease Surveillance Centre, 61 Colindale Ave, London NW9 5HT, †Birkenhead & Wallasey Primary Care Trust, St Catherine's Hospital, Birkenhead, Merseyside CH42 0LP, ‡Communicable Disease Surveillance Centre (North West), Chester CH1 4EF, §South Sefton Primary Care Trust, Burlington House, Crosby Road North, Waterloo, Liverpool L22 0QB and ||Department of Public Health North West Region, Millennium Park, Birchwood, Warrington WA3 7QN
| | - Q Syed
- PHLS Food Safety Microbiology Laboratory, Central Public Health Laboratory and *Environmental Surveillance Unit, Communicable Disease Surveillance Centre, 61 Colindale Ave, London NW9 5HT, †Birkenhead & Wallasey Primary Care Trust, St Catherine's Hospital, Birkenhead, Merseyside CH42 0LP, ‡Communicable Disease Surveillance Centre (North West), Chester CH1 4EF, §South Sefton Primary Care Trust, Burlington House, Crosby Road North, Waterloo, Liverpool L22 0QB and ||Department of Public Health North West Region, Millennium Park, Birchwood, Warrington WA3 7QN
| | - R P M Thomson
- PHLS Food Safety Microbiology Laboratory, Central Public Health Laboratory and *Environmental Surveillance Unit, Communicable Disease Surveillance Centre, 61 Colindale Ave, London NW9 5HT, †Birkenhead & Wallasey Primary Care Trust, St Catherine's Hospital, Birkenhead, Merseyside CH42 0LP, ‡Communicable Disease Surveillance Centre (North West), Chester CH1 4EF, §South Sefton Primary Care Trust, Burlington House, Crosby Road North, Waterloo, Liverpool L22 0QB and ||Department of Public Health North West Region, Millennium Park, Birchwood, Warrington WA3 7QN
| | - J R Ashton
- PHLS Food Safety Microbiology Laboratory, Central Public Health Laboratory and *Environmental Surveillance Unit, Communicable Disease Surveillance Centre, 61 Colindale Ave, London NW9 5HT, †Birkenhead & Wallasey Primary Care Trust, St Catherine's Hospital, Birkenhead, Merseyside CH42 0LP, ‡Communicable Disease Surveillance Centre (North West), Chester CH1 4EF, §South Sefton Primary Care Trust, Burlington House, Crosby Road North, Waterloo, Liverpool L22 0QB and ||Department of Public Health North West Region, Millennium Park, Birchwood, Warrington WA3 7QN
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Pedraza-Díaz S, Amar CF, McLauchlin J, Nichols GL, Cotton KM, Godwin P, Iversen AM, Milne L, Mulla JR, Nye K, Panigrahl H, Venn SR, Wiggins R, Williams M, Youngs ER. Cryptosporidium meleagridis from humans: molecular analysis and description of affected patients. J Infect 2001; 42:243-50. [PMID: 11545566 DOI: 10.1053/jinf.2001.0839] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To genetically characterize an unusual genotype of Cryptosporidium from the stools of humans with diarrhoea and to identify risk factors in the affected patients. METHODS DNA was extracted from human faeces where Cryptosporidium oocysts were detected by light microscopy. Cryptosporidial gene fragments from six different loci were analysed by PCR alone, PCR/RFLP and by DNA sequencing. Oocysts were characterized by light and immunofluorescence microscopy and epidemiological data was collected from the affected patients. RESULTS Analysis of the Cryptosporidium oocyst wall protein (COWP) gene amplified from > 2000 human faecal samples identified 19 patients all of which produced an unusual RFLP profile. Subsequent DNA sequence analysis of this and an additional four genetic loci (including 18S rRNA sequences) confirmed these as a homogeneous group which was genetically distinct from Cryptosporidium parvum. The isolates were identified as Cryptosporidium meleagridis since the gene sequences were identical to those from this species recovered from birds. Conventional microscopy showed oocysts indistinguishable from C. parvum and reacted strongly with two different commercially available anti-oocyst monoclonal antibodies. None of the patients showed risk factors unusual for cryptosporidiosis; however, ten of the cases occurred during the summer/autumn, six had a history of foreign travel, four were co-infected with Giardia, two were HIV positive, and six were without identifiable immunocompromising factors. CONCLUSIONS This study further confirms that C. meleagridis, in addition to C. parvum, is involved in human disease. The study also highlights the lack of basic information on the host range of this genus of parasites, the complexity of the transmission routes involved in human cryptosporidiosis, and the value of molecular techniques in identify hitherto unrecognised differences in Cryptosporidium from human faeces.
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Affiliation(s)
- S Pedraza-Díaz
- Food Safety Microbiology Laboratory, Division of Gastrointestinal Infections, PHLS Central Public Health Laboratory, 61 Colindale Avenue, London, NW9 5HT, UK
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21
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Cohen P, Nichols GL, Banks HH. Fluoride treatment of bone rarefaction in multiple myeloma and osteoporosis. A review. Clin Orthop Relat Res 2001; 64:221-49. [PMID: 4893445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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22
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Pedraza-Díaz S, Amar C, Nichols GL, McLauchlin J. Nested polymerase chain reaction for amplification of the Cryptosporidium oocyst wall protein gene. Emerg Infect Dis 2001; 7:49-56. [PMID: 11266294 PMCID: PMC2631669 DOI: 10.3201/eid0701.700049] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We developed a sensitive nested polymerase chain reaction procedure for the Cryptosporidium oocyst wall protein (COWP) gene. Amplification and genotyping were successful in 95.2% of 1,680 fecal samples, 77.6% by the unnested and 17.6% by the nested COWP procedure. The COWP gene was amplified from 2,128 fecal samples: 71 from livestock animals and 2,057 from humans. This series included 706 cases from seven drinking water-associated outbreaks and 51 cases from five swimming pool-associated outbreaks, as well as 1,300 sporadic cases.
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McLauchlin J, Amar C, Pedraza-Díaz S, Nichols GL. Molecular epidemiological analysis of Cryptosporidium spp. in the United Kingdom: results of genotyping Cryptosporidium spp. in 1,705 fecal samples from humans and 105 fecal samples from livestock animals. J Clin Microbiol 2000; 38:3984-90. [PMID: 11060056 PMCID: PMC87529 DOI: 10.1128/jcm.38.11.3984-3990.2000] [Citation(s) in RCA: 267] [Impact Index Per Article: 11.1] [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: 05/16/2000] [Accepted: 09/05/2000] [Indexed: 11/20/2022] Open
Abstract
Cryptosporidium present in 1,705 fecal samples from humans and 105 from livestock animals were analyzed by PCR-restriction fragment length polymorphism of the Cryptosporidium oocyst wall protein. Overall, genotype 1 (human exclusive type) was detected in 37.8% of the samples from humans, genotype 2 (broad host range) was detected in 61.5%, a third genotype designated genotype 3 (Cryptosporidium meleagridis) was detected in 0.3%, and both genotypes 1 and 2 were recovered from 0.4%. All samples from livestock yielded genotype 2. Among 469 patients infected during eight drinking water-related outbreaks, five outbreaks were predominantly due to genotype 1, and three were due to genotype 2. Fifty-four samples were collected from patients involved with five swimming pool-associated outbreaks: two outbreaks were due to genotype 1, one was due to genotype 2, and the remaining two involved both genotypes 1 and 2. Among 26 family outbreaks and 1 children's nursery outbreak (2 to 3 members per group), the same genotype was recovered from the different members of each outbreak: 13 were due to genotype 1, and 14 were due to genotype 2. In eighteen patients reporting contact with animals and/or farms, genotype 1 was recovered from one patient and genotype 2 was recovered from the remaining 17. Among the sporadic cases, there were distinct geographical and temporal variations in the distribution of the genotypes. The spring peak in cases was due to genotype 2. Genotype 1 was significantly more common in patients infected during the late-summer-autumn peak and in those with a history of foreign travel.
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Affiliation(s)
- J McLauchlin
- Food Safety Microbiology Laboratory, Division of Gastrointestinal Infections, PHLS Central Public Health Laboratory, London NW9 5HT, United Kingdom.
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Abstract
Results from statutory testing of private water supplies in nine Public Health Laboratories in England were compiled, and the effects of supply class, source, treatment and location on water quality were examined. A total of 6551 samples from 2911 supplies was examined, over a 2-year period, of which 1342 (21%) samples, and 949 (33%) supplies on at least one occasion, failed current regulations for Escherichia coli. Total coliforms, including E. coli, were detected in 1751 (27%) samples from 1215 (42%) supplies. The percentage of samples positive for E. coli was highest in summer and autumn, and lowest in winter. Samples taken from larger supplies and from boreholes were less frequently contaminated than those from other sources. Chlorination, filtration or UV light treatment improved the bacteriological quality of supplies, but still resulted in a low level of compliance with the regulations. The public health implications of the study are discussed.
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Affiliation(s)
- M Rutter
- CDSC, Public Health Laboratory Service, London
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Abstract
Pathogenic protozoa are commonly transmitted to food in developing countries, but food-borne outbreaks of infection are relatively rare in developed countries. The main protozoa of concern in developed countries are Toxoplasma, Cryptosporidium and Giardia, and these can be a problem in immunocompromised people. Other protozoa such as Entamoeba histolytica, Cyclospora cayetanensis and Sarcocystis can be a food-borne problem in non-industrialised countries. C. cayetanensis has emerged as a food-borne pathogen in foods imported into North America from South America. Microsporidia may be food-borne, although evidence for this is not yet available. The measures needed to prevent food-borne protozoa causing disease require clear assessments of the risks of contamination and the effectiveness of processes to inactivate them. The globalisation of food production can allow new routes of transmission, and advances in diagnostic detection methods and surveillance systems have extended the range of protozoa that may be linked to food.
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Affiliation(s)
- G L Nichols
- Environmental Surveillance Unit, Communicable Disease Surveillance Centre, London, UK
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McLauchlin J, Pedraza-Díaz S, Amar-Hoetzeneder C, Nichols GL. Genetic characterization of Cryptosporidium strains from 218 patients with diarrhea diagnosed as having sporadic cryptosporidiosis. J Clin Microbiol 1999; 37:3153-8. [PMID: 10488169 PMCID: PMC85515 DOI: 10.1128/jcm.37.10.3153-3158.1999] [Citation(s) in RCA: 154] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Samples of whole feces in which Cryptosporidium oocysts were recognized by hospital laboratories were collected from 218 patients with diarrhea. All samples were reexamined by light microscopy, and oocysts were detected in 211 samples. A simple and rapid procedure for the extraction of DNA from whole feces was developed, and this was used to amplify fragments of the Cryptosporidium outer wall protein (COWP), the thrombospondin-related adhesive protein C1 (TRAP-C1), and the 18S rRNA genes by PCR. For seven samples oocysts were not detected by microscopy and DNA failed to be amplified by the three PCR procedures. Among the 211 samples "positive" by microscopy, the sensitivities of PCRs for the 18S rRNA, COWP, and TRAP-C1 gene fragments were 97, 91, and 66%, respectively. The sensitivities of all three PCR procedures increased with increasing numbers of oocysts as observed by microscopy. Two genotypes of the COWP and TRAP-C1 genes can be detected by PCR-restriction fragment length polymorphism analysis. With this series of samples, the same genotypes of the COWP and TRAP-C1 genes always segregated together. A combined genotyping data set was produced for isolates from 194 samples: 74 (38%) were genotype 1 and 120 (62%) were genotype 2. Genotype 2 was detected in a significantly greater proportion of the samples with small numbers of oocysts, and genotype 1 was detected in a significantly greater proportion of the samples with larger numbers of oocysts. There were no significant differences in the distribution of the genotypes by patient sex and age. The distribution of the genotypes was significantly different both in patients with a history of foreign travel and in those from different regions in England.
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Affiliation(s)
- J McLauchlin
- Food Hygiene Laboratory, Division of Gastrointestinal Infections, PHLS Central Public Health Laboratory, London NW9 5HT, United Kingdom.
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Nichols GL, Little CL, Mithani V, de Louvois J. The microbiological quality of cooked rice from restaurants and take-away premises in the United Kingdom. J Food Prot 1999; 62:877-82. [PMID: 10456740 DOI: 10.4315/0362-028x-62.8.877] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The microbiological quality of 4,162 samples of cooked rice from restaurants and take-away premises in the United Kingdom was examined, including ready-to-eat rice purchased at point-of-sale and rice that was stored precooked for reheating on demand. The majority of point-of-sale cooked rice samples (1,855 of 1,972; 94%) were of acceptable microbiological quality, but 15 (1%) samples were of unacceptable quality (Bacillus spp. and B. cereus, > or = 10(5) CFU/g; Escherichia coli, > or = 10(4) CFU/g), indicating a potential risk to health. The prevalence of Bacillus spp., B. cereus, and E. coli was significantly greater in precooked stored rice than in point-of-sale cooked rice (P < 0.005 to 0.0005). Bacillus spp. (> or = 10(4) CFU/g), B. cereus (> or = 10(4) CFU/g), and E. coli (> or = 10(2) CFU/g) were present in 7%, 2%, and 9% of precooked stored samples, respectively, compared to 2%, 0.5%, and 1%, respectively in point-of-sale samples. Although final heating at the point of sale reduces the levels of microorganisms present in rice it will not inactivate the B. cereus emetic toxin if present. Rice from Indian premises was of poorer microbiological quality than that from Chinese and other premises. Although most point-of-sale cooked rice samples (94%) were of an acceptable microbiological quality, evidence from this study indicates that the microbiological quality of cooked rice sold from certain outlets in the UK is of concern.
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Affiliation(s)
- G L Nichols
- Environmental Surveillance Unit, Public Health Laboratory Service, Communicable Disease Surveillance Centre, London, UK.
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Papadopoulos KP, Murty VV, Lin N, Matsushima A, Riemer E, Rao PH, Nichols GL. Translocation (4;15)(p16;q24): a novel reciprocal translocation in a patient with BCR/ABL negative myeloproliferative syndrome progressing to blastic phase. Cancer Genet Cytogenet 1999; 111:18-20. [PMID: 10326585 DOI: 10.1016/s0165-4608(98)00214-3] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A patient with BCR/ABL negative myeloproliferative syndrome with a 46,XY,del(3)(q21), t(4;15)(p16;q24) karyotype is described. Fluorescence in situ hybridization performed with chromosomes 4 and 15 painting probes confirmed a novel reciprocal (4;15) translocation. The absence of crkl tyrosine phosphorylation, no activation of the abl kinase as measured by autophosphorylation, and a normal-size abl transcript suggest an alternative mechanism for leukemogenesis to that operative in Ph positive BCR/ABL positive chronic myeloid leukemia. A number of genes potentially relevant to tumorigenesis, some involving the ras signaling pathway, map to the 4p16 and 15q24 chromosome regions.
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Affiliation(s)
- K P Papadopoulos
- Department of Medicine, College of Physicians and Surgeons of Columbia University, New York, New York, USA
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Chai SK, Nichols GL, Rothman P. Constitutive activation of JAKs and STATs in BCR-Abl-expressing cell lines and peripheral blood cells derived from leukemic patients. J Immunol 1997; 159:4720-8. [PMID: 9366395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
An important step in the oncogenic transformation of hemopoietic cells and the subsequent development of leukemia is the proliferation of tumor cells in the absence of exogenous growth factors. In most cases of chronic myelocytic leukemia and in some cases of acute myelocytic leukemia and acute lymphocytic leukemia, the bcr-abl oncogene is involved in this process. Although the BCR-Abl oncoprotein demonstrates enhanced tyrosine kinase activity in leukemic cells, the mechanism by which this leads to growth factor independence remains poorly defined. One proposed mechanism is the activation of cytokine signal transduction pathways, possibly by an autocrine loop involving IL-3 and/or granulocyte-macrophage CSF. Examination of several different cell lines expressing BCR-Abl demonstrates that some of these cells have constitutive activation of the JAK/STAT signaling pathway. We have found the constitutive activation of STAT5 in most, but not all, cell lines expressing BCR-Abl. This constitutive activation of STAT5 is variably associated with a corresponding activation of JAK kinases. Ab blocking studies show that the activation of STAT5 in these cell lines cannot be attributed to the activation of an IL-3/granulocyte-macrophage CSF-driven autocrine loop. Interestingly, samples of peripheral blood cells derived from patients with acute myelocytic leukemia and chronic myelocytic leukemia, which express BCR-Abl, demonstrate constitutive activation of STAT family members. These studies suggest that in a variety of leukemic states, BCR-Abl may use a bypass mechanism to activate cytokine signal transduction pathways.
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MESH Headings
- Animals
- DNA-Binding Proteins/blood
- DNA-Binding Proteins/metabolism
- Enzyme Activation
- Fusion Proteins, bcr-abl/biosynthesis
- Fusion Proteins, bcr-abl/blood
- Granulocyte-Macrophage Colony-Stimulating Factor/antagonists & inhibitors
- Granulocyte-Macrophage Colony-Stimulating Factor/metabolism
- Humans
- Interferon-gamma/blood
- Interleukin-3/antagonists & inhibitors
- Interleukin-3/metabolism
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/enzymology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism
- Leukemia, Myeloid, Acute/enzymology
- Leukemia, Myeloid, Acute/metabolism
- Mice
- Milk Proteins
- Protein-Tyrosine Kinases/blood
- Protein-Tyrosine Kinases/metabolism
- STAT1 Transcription Factor
- STAT5 Transcription Factor
- Signal Transduction
- Trans-Activators/blood
- Trans-Activators/metabolism
- Tumor Cells, Cultured
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Affiliation(s)
- S K Chai
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York 10032, USA
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Chai SK, Nichols GL, Rothman P. Constitutive activation of JAKs and STATs in BCR-Abl-expressing cell lines and peripheral blood cells derived from leukemic patients. The Journal of Immunology 1997. [DOI: 10.4049/jimmunol.159.10.4720] [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] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
An important step in the oncogenic transformation of hemopoietic cells and the subsequent development of leukemia is the proliferation of tumor cells in the absence of exogenous growth factors. In most cases of chronic myelocytic leukemia and in some cases of acute myelocytic leukemia and acute lymphocytic leukemia, the bcr-abl oncogene is involved in this process. Although the BCR-Abl oncoprotein demonstrates enhanced tyrosine kinase activity in leukemic cells, the mechanism by which this leads to growth factor independence remains poorly defined. One proposed mechanism is the activation of cytokine signal transduction pathways, possibly by an autocrine loop involving IL-3 and/or granulocyte-macrophage CSF. Examination of several different cell lines expressing BCR-Abl demonstrates that some of these cells have constitutive activation of the JAK/STAT signaling pathway. We have found the constitutive activation of STAT5 in most, but not all, cell lines expressing BCR-Abl. This constitutive activation of STAT5 is variably associated with a corresponding activation of JAK kinases. Ab blocking studies show that the activation of STAT5 in these cell lines cannot be attributed to the activation of an IL-3/granulocyte-macrophage CSF-driven autocrine loop. Interestingly, samples of peripheral blood cells derived from patients with acute myelocytic leukemia and chronic myelocytic leukemia, which express BCR-Abl, demonstrate constitutive activation of STAT family members. These studies suggest that in a variety of leukemic states, BCR-Abl may use a bypass mechanism to activate cytokine signal transduction pathways.
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Affiliation(s)
- S K Chai
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York 10032, USA
| | - G L Nichols
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York 10032, USA
| | - P Rothman
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York 10032, USA
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Abstract
BACKGROUND Fine needle aspiration biopsy (FNAB) affords a less expensive, less morbid approach to masses within the complex anatomy of the mediastinum as opposed to surgical biopsy. Given the current state of computed tomography guidance and the available cell block preparations and ancillary studies, definitive diagnosis of mediastinal tumors is possible. CASE A 19-year-old male presented with weight loss and muscle weakness. Computed tomography revealed an anterior superior mediastinal mass with attachment to the posterior sternum and anterior aorta. FNAB yielded hyperchromatic cells with densely clumped chromatin and prominent nucleoli. These were present as single cells and clusters. Cell block preparations were studied with immunoperoxidase methods and were strongly positive for chromogranin and glucagon, supporting the diagnosis of carcinoid tumor. Surgical excision yielded a 7-cm, unencapsulated, red-brown tumor with medium-sized cells with oval to round nuclei, scant and granular cytoplasm and coarse "salt and pepper" chromatin with prominent nucleoli. The cells were arranged in islands and bands and were associated with prominent capillaries and dense, collagenous septae. Immunoperoxidase and electron microscopy demonstrated numerous intracytoplasmic, nonspecific neurosecretory granules and positivity for somatostatin, synaptophysin, cytokeratin and chromogranin. CONCLUSION FNAB affords an accurate and timely diagnosis of an anterior mediastinal tumor without the necessity for open biopsy and also offers accurate surgical planning and decreased morbidity.
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Affiliation(s)
- G L Nichols
- Department of Pathology, North Carolina Baptist Hospital/Bowman Gray School of Medicine, Winston-Salem 27157, USA
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MESH Headings
- Blast Crisis
- Bone Marrow Transplantation
- Cell Division/drug effects
- Cell Line
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Oligonucleotides, Antisense/therapeutic use
- Polymerase Chain Reaction
- Sensitivity and Specificity
- Tumor Cells, Cultured
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Affiliation(s)
- G L Nichols
- Columbia University College of Physicians and Surgeons, New York, New York 10032, USA
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Nichols GL, Raines MA, Vera JC, Lacomis L, Tempst P, Golde DW. Identification of CRKL as the constitutively phosphorylated 39-kD tyrosine phosphoprotein in chronic myelogenous leukemia cells. Blood 1994; 84:2912-8. [PMID: 7524758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Chronic myelogenous leukemia (CML) is characterized by the presence of the Philadelphia (Ph) chromosome in clonally derived hematopoietic precursors and their progeny. The Ph chromosome arises from a translocation that deregulates the c-ABL protein tyrosine kinase, giving it transforming potential and increased kinase activity. We observed a unique 39-kD tyrosine phosphoprotein (pp39), previously reported in blastic CML cell lines, in neutrophils from 50 cases of chronic phase CML. This protein was prominently and constitutively tyrosine-phosphorylated in CML neutrophils and was not phosphorylated in normal neutrophils. Stimulation of normal neutrophils with cytokines and agonists did not induce tyrosine phosphorylation of proteins migrating in the region of pp39, and the phosphorylation state of pp39 in CML neutrophils was not affected by kinase inhibitors known to downregulate the ABL kinase. The pp39 was not phosphorylated in hematopoietic cells from healthy donors or from patients with Ph chromosome-negative myeloproliferative disorders. Using micro amino acid sequencing of purified preparations of pp39, we identified pp39 as CRKL protein, which is consistent with recent immunologic studies in the blastic K562 cell line. Immunoblotting with anti-CRKL antibodies showed the presence of CRKL protein in CML cells and cell lines as well as in antiphosphotyrosine immunoprecipitates from CML cells. Our results suggest that pp39 CRKL in CML neutrophils may be stably tyrosine-phosphorylated by the BCR/ABL kinase at an early stage of myeloid differentiation when the ABL kinase is active. CRK, CRKL, and other SH2 (SRC homology domain)/SH3-containing proteins function as adaptor molecules in nonreceptor tyrosine kinase signalling pathways. Although the CRKL protein is present in normal neutrophils, it is not tyrosine-phosphorylated, and the inability to induce such phosphorylation in normal neutrophils suggests a special role of this phosphoprotein in the pathogenesis of CML. Constitutive phosphorylation of CRKL is unique to CML, indicating that it may be a useful target for therapeutic intervention.
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Affiliation(s)
- G L Nichols
- Division of Hematologic Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
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Nichols GL. Update on biologic agents in home care of the cancer client. Home Healthc Nurse 1993; 11:30-2. [PMID: 7693617 DOI: 10.1097/00004045-199309000-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Nichols GL, McLauchlin J, Samuel D. A technique for typing Cryptosporidium isolates. J Protozool 1991; 38:237S-240S. [PMID: 1818185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Antigens extracted from Cryptosporidium oocysts, which had been purified from faeces or chick egg culture, were electrophoresed in sodium dodecyl sulfate-polyacrylamide gels, and blotted onto nitrocellulose membranes. A Cryptosporidium genus-specific monoclonal antibody MAb-C1 bound to multiple bands using several detection techniques, and these corresponded to bands detected using immune rabbit antisera. Using a detection system with fluorescein isothiocyanate (FITC)-labelled MAb-C1 and alkaline phosphatase-labelled anti-FITC, bands were detected between 50 and 300 kDa. Blots were examined directly and by using a laser scanner. The system was shown to be specific for Cryptosporidium spp., giving no staining with a variety of other pathogens, and with negative samples. The oocyst antigen which bound MAb-C1 was stable, and banding patterns were not significantly affected by pretreatment of oocysts with proteinase K, trypsin, formalin, or sodium hypochlorite, methods commonly used during preparation and storage of C. parvum oocysts. However, banding was reduced with potassium dichromate. Of 76 samples containing Cryptosporidium oocysts, 53 showed one or more MAb-C1 staining bands. Cryptosporidium baileyi and C. parvum could be clearly differentiated by their banding patterns, indicating that the system will distinguish between species. Some isolates, including a single isolate of C. muris, produced weak bands which made interpretation difficult. The technique showed differences between isolates of C. parvum, with two different banding types found in human isolates, and other banding types seen in calf and lamb isolates. This method provides a useful way of characterising isolates which may be new species.
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Affiliation(s)
- G L Nichols
- Public Health Laboratory, Royal Sussex County Hospital, Brighton, England
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Abstract
During the period 1970 to 1987, 11 patients with small cell carcinoma of the esophagus were treated at Memorial Sloan-Kettering Cancer Center, New York. This rare tumor was responsible for 1.1% of all patients with esophageal tumors seen on the inpatient services during that period. Using a clinical staging system similar to that employed in small cell cancer of the lung, eight of 11 patients had extensive disease. Although responses were seen to multidrug combination chemotherapy regimens used alone or with sequential radiation, the overall prognosis for small cell esophageal cancer was poor, with a median survival of 7.5 months. Only one patient lived for greater than 2 years.
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Affiliation(s)
- G L Nichols
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
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Nichols GL. The People's First Social Welfare Institution for the Aged: a Chinese nursing home. J Am Health Care Assoc 1984; 10:88-91. [PMID: 10266593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Nichols GL. The non-proprietary facility and the future. J Am Health Care Assoc 1983; 9:15, 20. [PMID: 10309822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Nichols GL. Who will pay if the Feds don't? J Am Health Care Assoc 1982; 8:2-4. [PMID: 10309725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Solomon PR, Nichols GL, Kiernan JM, Kamer RS, Kaplan LJ. Differential effects of lesions in medial and dorsal raphe of the rat: latent inhibition and septohippocampal serotonin levels. J Comp Physiol Psychol 1980; 94:145-54. [PMID: 7372849 DOI: 10.1037/h0077655] [Citation(s) in RCA: 111] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Rats received either 0 or 30 preexposures to a tone which was later used as a conditioned stimulus (CS) in a two-way avoidance task. Tone preexposure resulted in retarded conditioning in normal animals and animals with dorsal raphe lesions. This latent inhibition effect, however, was not present in animals with medial raphe lesions. The failure of CS preexposure to retard conditioning in animals with medial raphe lesions was not due to differences in auditory sensitivity or shock reactivity. Biochemical analysis indicated that whereas medial raphe lesions significantly reduced serotonin in the septohippocampal complex, dorsal raphe lesions had no such effect. The results are discussed in terms of the differing roles of the mesolimbic and mesostriatal serotonergic systems in learning to ignore irrelevant stimuli.
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Abstract
The dynamics of segment shortening have been measured in the central regions of isolated papillary muscles during muscle isometric and after-loaded isotonic contractions. Segment lengths are inferred from muscle cross-sectional area using an assumption that the segments remain isovolumic. Area is assessed with a magnetic induction technique. Infused microspheres have been used as visual markers to corroborate the segment length measurement. The results confirm the existence of major segmental shortening during muscle isometric conditions. However, the time course of shortening is not the same as that of force development. Rather, the segments remain shortened until after force has fallen significantly from its peak value. This behavior appears in the force-segment length plane as counterclockwise loops. The relationship of peak force to segment length has been determined and found to depend on the mechanical conditions under which the muscle is equilibrated. These results demonstrate the utility of the new technique and indicate central segment behavior that is substantially different from that observed for the whole muscle.
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Abstract
Urines from patients with symptoms of urinary tract infection yielded mixed growths of different colony types of Escherichia coli. The different colony types were found to be variants of single infecting strains caused by mutation or by phase action. It is suggested that care should be exercised in the interpretation of apparently mixed growths from urine.
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