1
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Chow S, Lee S, Lin A, Craddock KJ, Smith AC, Tsui H. Diagnosis of systemic mastocytosis with cryptic deletion of TET2 and DNMT3A resulting from unbalanced translocation. Br J Haematol 2024. [PMID: 38702998 DOI: 10.1111/bjh.19501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/20/2024] [Indexed: 05/06/2024]
Abstract
Systemic mastocytosis (SM) is a rare haematological neoplasm associated with the gain of function mutation KIT D816V in 90% of adult patients. Classically, cytogenetic aberrations are not common except in cases of SM associated with another haematological neoplasm. We highlight here an unusual clinical presentation of SM and demonstrate the utility of advanced cytogenetic analysis (optical genome mapping, OGM) in detecting a novel cytogenetic abnormality resulting in an unusual mechanism of DNMT3A and TET2 loss of function.
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Affiliation(s)
- Signy Chow
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Medical Oncology and Hematology, Department of Medicine, Odette Cancer Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Stephanie Lee
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Oncology/Hematology, Department of Medicine, St. Michaels Hospital, Toronto, Ontario, Canada
| | - August Lin
- Biological Sciences Platform, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada
| | - Kenneth J Craddock
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Advanced Diagnostics Platform, Department of Laboratory Medicine and Molecular Diagnostics, Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Adam C Smith
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Advanced Diagnostics Platform, Department of Laboratory Medicine and Molecular Diagnostics, Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Anatomic Pathology, Department of Laboratory Medicine and Molecular Diagnostics, Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Hubert Tsui
- Biological Sciences Platform, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Hematological Pathology, Department of Laboratory Medicine and Molecular Diagnostics, Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Immunology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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2
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England JT, Szuber N, Sirhan S, Dunne T, Cerquozzi S, Hill M, Villeneuve PJA, Ho JM, Sadikovic B, Bhai P, Krishnan N, Dowhanik S, Hillis C, Capo-Chichi JM, Tsui H, Cheung V, Gauthier K, Sibai H, Davidson MB, Bankar A, Kotchetkov R, Gupta V, Maze D. Clinical Features and Long-Term Outcomes of a Pan-Canadian Cohort of Adolescents and Young Adults with Myeloproliferative Neoplasms: A Canadian MPN Group Study. Leukemia 2024; 38:570-578. [PMID: 38321107 DOI: 10.1038/s41375-024-02155-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/27/2023] [Accepted: 01/11/2024] [Indexed: 02/08/2024]
Abstract
Myeloproliferative neoplasms (MPNs) are a group of chronic hematologic malignancies that lead to morbidity and early mortality due to thrombotic complications and progression to acute leukemia. Clinical and mutational risk factors have been demonstrated to predict outcomes in patients with MPNs and are used commonly to guide therapeutic decisions, including allogenic stem cell transplant, in myelofibrosis. Adolescents and young adults (AYA, age ≤45 years) comprise less than 10% of all MPN patients and have unique clinical and therapeutic considerations. The prevalence and clinical impact of somatic mutations implicated in myeloid disease has not been extensively examined in this population. We conducted a retrospective review of patients evaluated at eight Canadian centers for MPN patients diagnosed at ≤45 years of age. In total, 609 patients were included in the study, with median overall survival of 36.8 years. Diagnosis of prefibrotic or overt PMF is associated with the lowest OS and highest risk of AP/BP transformation. Thrombotic complications (24%), including splanchnic circulation thrombosis (9%), were frequent in the cohort. Mutations in addition to those in JAK2/MPL/CALR are uncommon in the initial disease phase in our AYA population (12%); but our data indicate they may be predictive of transformation to post-ET/PV myelofibrosis.
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Affiliation(s)
- James T England
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.
- Division of Medical Oncology & Malignant Hematology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - Natasha Szuber
- Maisonneuve-Rosemont Hospital, University of Montreal, Quebec, QC, Canada
| | - Shireen Sirhan
- Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Tom Dunne
- Division of Hematology, Newfoundland and Labrador Health Services, St. John's, NL, Canada
| | - Sonia Cerquozzi
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Madeleine Hill
- The Ottawa Hospital Research Institute, Ottawa, Ottawa, ON, Canada
| | - Pierre J A Villeneuve
- The Ottawa Hospital Research Institute, Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Jenny M Ho
- Division of Hematology, Department of Medicine, Western University, London Health Sciences Centre, London, ON, Canada
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON, Canada
| | - Pratibha Bhai
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON, Canada
| | - Nupur Krishnan
- Royal Victoria Regional Health Center, Barrie, ON, Canada
| | | | - Chris Hillis
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Jose-Mario Capo-Chichi
- Division of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Hubert Tsui
- Department of Hematopathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Verna Cheung
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Karine Gauthier
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Hassan Sibai
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Marta B Davidson
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Aniket Bankar
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | - Vikas Gupta
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Dawn Maze
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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3
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Bergeron J, Capo-Chichi JM, Tsui H, Mahe E, Berardi P, Minden MD, Brandwein JM, Schuh AC. The Clinical Utility of FLT3 Mutation Testing in Acute Leukemia: A Canadian Consensus. Curr Oncol 2023; 30:10410-10436. [PMID: 38132393 PMCID: PMC10742150 DOI: 10.3390/curroncol30120759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/02/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
FMS-like tyrosine kinase 3 (FLT3) mutations are detected in approximately 20-30% of patients with acute myeloid leukemia (AML), with the presence of a FLT3 internal tandem duplication (FLT3-ITD) mutation being associated with an inferior outcome. Assessment of FLT3 mutational status is now essential to define optimal upfront treatment in both newly diagnosed and relapsed AML, to support post-induction allogeneic hematopoietic stem cell transplantation (alloSCT) decision-making, and to evaluate treatment response via measurable (minimal) residual disease (MRD) evaluation. In view of its importance in AML diagnosis and management, the Canadian Leukemia Study Group/Groupe canadien d'étude sur la leucémie (CLSG/GCEL) undertook the development of a consensus statement on the clinical utility of FLT3 mutation testing, as members reported considerable inter-center variability across Canada with respect to testing availability and timing of use, methodology, and interpretation. The CLSG/GCEL panel identified key clinical and hematopathological questions, including: (1) which patients should be tested for FLT3 mutations, and when?; (2) which is the preferred method for FLT3 mutation testing?; (3) what is the clinical relevance of FLT3-ITD size, insertion site, and number of distinct FLT3-ITDs?; (4) is there a role for FLT3 analysis in MRD assessment?; (5) what is the clinical relevance of the FLT3-ITD allelic burden?; and (6) how should results of FLT3 mutation testing be reported? The panel followed an evidence-based approach, taken together with Canadian clinical and laboratory experience and expertise, to create a consensus document to facilitate a more uniform approach to AML diagnosis and treatment across Canada.
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Affiliation(s)
- Julie Bergeron
- CEMTL Installation Maisonneuve-Rosemont, Institut Universitaire d’Hématologie-Oncologie et de Thérapie Cellulaire, Université de Montréal, Montréal, QC H1T 2M4, Canada
| | - Jose-Mario Capo-Chichi
- Division of Clinical Laboratory Genetics, Department of Laboratory Medicine and Pathobiology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada;
| | - Hubert Tsui
- Division of Hematological Pathology, Department of Laboratory Medicine and Molecular Diagnostics, Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada;
- Department of Laboratory Medicine and Pathobiology, Department of Immunology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Etienne Mahe
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada;
- Division of Hematology and Hematological Malignancies, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Philip Berardi
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital/Eastern Ontario Regional Laboratory Association, Ottawa, ON K1H 8M2, Canada;
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Mark D. Minden
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada; (M.D.M.); (A.C.S.)
- Department of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada
| | - Joseph M. Brandwein
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada;
| | - Andre C. Schuh
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada; (M.D.M.); (A.C.S.)
- Department of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada
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4
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Teichman S, Wang H, Lee CR, Mohtashami M, Foerster E, Han J, Trotman-Grant AC, Winer S, Tsui H, Philpott DJ, Zúñiga-Pflücker JC. Recent Thymic Emigrants Require RBPJ-Dependent Notch Signaling to Transition into Functionally Mature Naive T Cells. J Immunol 2023:263691. [PMID: 37154711 DOI: 10.4049/jimmunol.2300140] [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] [Received: 02/24/2023] [Accepted: 04/18/2023] [Indexed: 05/10/2023]
Abstract
Recent thymic emigrant (RTE) cells are nascent T cells that continue their post-thymic maturation in the periphery and dominate T cell immune responses in early life and in adults having undergone lymphodepletion regimens. However, the events that govern their maturation and their functionality as they transition to mature naive T cells have not been clearly defined. Using RBPJind mice, we were able to identify different stages of RTE maturation and interrogate their immune function using a T cell transfer model of colitis. As CD45RBlo RTE cells mature, they transition through a CD45RBint immature naive T (INT) cell population that is more immunocompetent but shows a bias toward IL-17 production at the expense of IFN-γ. Additionally, the levels of IFN-γ and IL-17 produced in INT cells are highly dependent on whether Notch signals are received during INT cell maturation or during their effector function. IL-17 production by INT cells showed a total requirement for Notch signaling. Loss of Notch signaling at any stage of INT cells resulted in an impaired colitogenic effect of INT cells. RNA sequencing of INT cells that had matured in the absence of Notch signals showed a reduced inflammatory profile compared with Notch-responsive INT cells. Overall, we have elucidated a previously unknown INT cell stage, revealed its intrinsic bias toward IL-17 production, and demonstrated a role for Notch signaling in INT cell peripheral maturation and effector function in the context of a T cell transfer model of colitis.
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Affiliation(s)
- Sintia Teichman
- Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Helen Wang
- Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Christina R Lee
- Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | | | | | - Jianxun Han
- Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Ashton C Trotman-Grant
- Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Shawn Winer
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Hubert Tsui
- Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Immunology, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Division of Hematological Pathology, Department of Laboratory Medicine and Molecular Diagnostics, Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Dana J Philpott
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Juan Carlos Zúñiga-Pflücker
- Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Immunology, University of Toronto, Toronto, ON, Canada
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5
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Kozak RA, Salvant E, Chang V, Oikonomou A, Biondi MJ, Feld JJ, Armstrong S, Wasif S, Mubareka S, Nirmalarajah K, Seth A, Amemiya Y, Wang C, Tsui H. Host Expression Profiling From Diagnostic Coronavirus Disease 2019 Swabs Associates Upper Respiratory Tract Immune Responses With Radiologic Lung Pathology and Clinical Severity. Open Forum Infect Dis 2023; 10:ofad190. [PMID: 37180592 PMCID: PMC10173546 DOI: 10.1093/ofid/ofad190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/11/2023] [Indexed: 05/16/2023] Open
Abstract
Background COVID-19 presents with a breadth of symptomatology including a spectrum of clinical severity requiring intensive care unit (ICU) admission. We investigated the mucosal host gene response at the time of gold standard COVID-19 diagnosis using clinical surplus RNA from upper respiratory tract swabs. Methods Host response was evaluated by RNA-sequencing, and transcriptomic profiles of 44 unvaccinated patients including outpatients and in-patients with varying levels of oxygen supplementation were included. Additionally, chest X-rays were reviewed and scored for patients in each group. Results Host transcriptomics revealed significant changes in the immune and inflammatory response. Patients destined for the ICU were distinguished by the significant upregulation of immune response pathways and inflammatory chemokines, including cxcl2 which has been linked to monocyte subsets associated with COVID-19 related lung damage. In order to temporally associate gene expression profiles in the upper respiratory tract at diagnosis of COVID-19 with lower respiratory tract sequalae, we correlated our findings with chest radiography scoring, showing nasopharygeal or mid-turbinate sampling can be a relevant surrogate for downstream COVID-19 pneumonia/ICU severity. Conclusions This study demonstrates the potential and relevance for ongoing study of the mucosal site of infection of SARS-CoV-2 using a single sampling that remains standard of care in hospital settings. We highlight also the archival value of high quality clinical surplus specimens, especially with rapidly evolving COVID-19 variants and changing public health/vaccination measures.
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Affiliation(s)
- Robert A Kozak
- Correspondence: Hubert Tsui, MD, PhD, FRCPC, Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada (); Robert A. Kozak, PhD, FCCM, Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada ()
| | - Elsa Salvant
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Veronica Chang
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Anastasia Oikonomou
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Mia J Biondi
- School of Nursing, York University, Toronto, Ontario, Canada
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - Jordan J Feld
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - Susan Armstrong
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Sumaiyah Wasif
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Samira Mubareka
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Kuganya Nirmalarajah
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Arun Seth
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Precision Diagnostics and Therapeutics Program, Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Yutaka Amemiya
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Chao Wang
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Hubert Tsui
- Correspondence: Hubert Tsui, MD, PhD, FRCPC, Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada (); Robert A. Kozak, PhD, FCCM, Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada ()
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6
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Ferrone CK, McNaughton AJM, Rashedi I, Ring B, Buckstein R, Tsui H, Rauh MJ. A Lower Frequency of Spliceosome Mutations Distinguishes Clonal Cytopenias of Undetermined Significance From Low-Risk Myelodysplastic Syndromes, Despite Inherent Similarities in Genomic, Laboratory, and Clinical Features. Mod Pathol 2023; 36:100068. [PMID: 36788103 DOI: 10.1016/j.modpat.2022.100068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/23/2022] [Accepted: 12/06/2022] [Indexed: 01/11/2023]
Abstract
Clonal cytopenias of undetermined significance (CCUS) are associated with an increased risk of developing a myelodysplastic syndrome (MDS); however, the mechanism and factors associated with evolution remain unclear. We propose that next-generation sequencing (NGS) of cytopenic cases with equivocal morphologic dysplasia will improve patient clinical care and that serial sequencing of such equivocal cases could identify the factors that predict evolution to MDS. We performed targeted NGS of samples from 193 individuals with confirmed or suspected MDS or MDS/myeloproliferative neoplasm, including sequential investigation for 28 individuals at the time of diagnosis and during follow-up. NGS facilitated the diagnosis of all suspicious cases as myeloid neoplasm (21%), CCUS (34%), or idiopathic cytopenias of undetermined significance (45%) when no variants were detected. We found that there was no significant difference in most measured clinical features or clonal phenotypes, such as cell counts, number of variants, variant allele frequencies, and overall survival, between CCUS and International Prognostic Scoring System-Revised-defined low-risk MDS. However, there was a significant difference in the types of variants between CCUS and low-risk MDS, with a significantly lower number of splicing factor mutations in CCUS cases (P < .001). Moreover, we observed an increased probability of evolution to MDS of individuals with CCUS compared with that in those with idiopathic cytopenias of undetermined significance over the first 5 years (P = .045). Our analyses revealed no conclusive pattern associating clonal expansion or the number of variants with the evolution of CCUS to MDS, perhaps further supporting the similarity of these diseases and the clinical importance of recognizing and formally defining CCUS as a category of precursor myeloid disease state in the next revision of the World Health Organization guidelines.
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Affiliation(s)
- Christina K Ferrone
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - Amy J M McNaughton
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - Iran Rashedi
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Molecular Diagnostics, Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre and Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Brooke Ring
- Department Medicine, Queen's University, Kingston, Ontario, Canada
| | - Rena Buckstein
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Odette Cancer Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Hubert Tsui
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Molecular Diagnostics, Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre and Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Michael J Rauh
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada.
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7
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Suleman A, Tsui H, Ghorab Z, Lam PW, Mozessohn L. EBV-positive diffuse large B-cell lymphoma following alemtuzumab therapy for T-cell prolymphocytic leukemia. Ann Hematol 2023; 102:471-472. [PMID: 36441259 DOI: 10.1007/s00277-022-05060-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Adam Suleman
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Hubert Tsui
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Zeina Ghorab
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Philip W Lam
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Lee Mozessohn
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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8
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Yau K, Enilama O, Levin A, Romney MG, Singer J, Blake P, Perl J, Leis JA, Kozak R, Tsui H, Bolotin S, Tran V, Chan CT, Tam P, Dhruve M, Kandel C, Estrada-Codecido J, Brown T, Siwakoti A, Abe KT, Hu Q, Colwill K, Gingras AC, Oliver MJ, Hladunewich MA. Determining the Longitudinal Serologic Response to COVID-19 Vaccination in the Chronic Kidney Disease Population: A Clinical Research Protocol. Can J Kidney Health Dis 2023; 10:20543581231160511. [PMID: 36950028 PMCID: PMC10028441 DOI: 10.1177/20543581231160511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/13/2023] [Indexed: 03/22/2023] Open
Abstract
Background People living with chronic kidney disease (CKD) have been disproportionately affected by the coronavirus disease 2019 (COVID-19) pandemic, including higher rates of infection, hospitalization, and death. Data on responsiveness to COVID-19 vaccination strategies and immunogenicity are limited, yet required to inform vaccination strategies in this at-risk population. Objective The objective of this study is to characterize the longitudinal serologic response to COVID-19 vaccination. Design This is a prospective observational cohort study. Setting Participating outpatient kidney programs within Ontario and British Columbia. Patients Up to 2500 participants with CKD G3b-5D receiving COVID-19 vaccination, including participants receiving dialysis and kidney transplant recipients (CKD G1T-5T). Measurements The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG antibodies (anti-spike, anti-receptor binding domain, anti-nucleocapsid) will be detected by ELISA (enzyme-linked immunosorbent assay) from serum or dried blood spot testing. In a subset of participants, neutralizing antibodies against novel variants of concern will be evaluated. Peripheral blood mononuclear cells will be collected for exploratory immune profiling of SARS-CoV-2 specific cellular immunity. Methods Participants will be recruited prior to or following any COVID-19 vaccine dose and have blood sampled for serological testing at multiple timepoints: 1, 3, 6, 9, and 12 months post vaccination. When possible, samples will be collected prior to a dose or booster. Participants will remain in the study for at least 1 year following their last COVID-19 vaccine dose. Strengths and limitations The adaptive design of this study allows for planned modification based on emerging evidence or rapid changes in public health policy surrounding vaccination. Limitations include incomplete earlier timepoints for blood collection due to rapid vaccination of the population. Conclusions This large multicenter serologic study of participants living with kidney disease will generate data on the kinetics of SARS-CoV-2 immune response to vaccination across the spectrum of CKD, providing insights into the amplitude and duration of immunity conferred by COVID-19 vaccination and allowing for characterization of factors associated with immune response. The results of this study may be used to inform immunization guidelines and public health recommendations for the 4 million Canadians living with CKD.
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Affiliation(s)
- Kevin Yau
- Division of Nephrology, Department of
Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Nephrology, Department of
Medicine, Unity Health Toronto, ON, Canada
| | - Omosomi Enilama
- Experimental Medicine, Department of
Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Adeera Levin
- Division of Nephrology, Department of
Medicine, The University of British Columbia, Vancouver, BC, Canada
- British Columbia Renal, Vancouver, BC,
Canada
| | - Marc G. Romney
- Department of Pathology and Laboratory
Medicine, St. Paul’s Hospital, Providence Health Care, Vancouver, BC, Canada
| | - Joel Singer
- School of Population and Public Health,
The University of British Columbia, Vancouver, BC, Canada
| | - Peter Blake
- Ontario Renal Network, Toronto, ON,
Canada
- London Health Sciences Centre, London,
ON, Canada
| | - Jeffrey Perl
- Division of Nephrology, Department of
Medicine, Unity Health Toronto, ON, Canada
| | - Jerome A. Leis
- Division of Infectious Diseases,
Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Robert Kozak
- Department of Laboratory Medicine
& Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Hubert Tsui
- Department of Laboratory Medicine
& Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Shelly Bolotin
- Public Health Ontario, Toronto, ON,
Canada
- Dalla Lana School of Public Health,
University of Toronto, Toronto, ON, Canada
| | - Vanessa Tran
- Public Health Ontario, Toronto, ON,
Canada
- Dalla Lana School of Public Health,
University of Toronto, Toronto, ON, Canada
| | - Christopher T. Chan
- Division of Nephrology, Department of
Medicine, University Health Network, Toronto, ON, Canada
| | - Paul Tam
- Division of Nephrology, Scarborough
Health Network, Toronto, ON, Canada
| | - Miten Dhruve
- Division of Nephrology, Michael
Garron Hospital, Toronto, ON, Canada
| | - Christopher Kandel
- Division of Infectious Diseases,
Michael Garron Hospital, Toronto, ON, Canada
| | - Jose Estrada-Codecido
- Division of Nephrology, Department of
Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tyler Brown
- Division of Nephrology, Department of
Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Aswani Siwakoti
- Division of Nephrology, Department of
Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kento T. Abe
- Department of Molecular Genetics,
University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research
Institute, Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada
| | - Queenie Hu
- Lunenfeld-Tanenbaum Research
Institute, Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada
| | - Karen Colwill
- Lunenfeld-Tanenbaum Research
Institute, Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada
| | - Anne-Claude Gingras
- Department of Molecular Genetics,
University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research
Institute, Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada
| | - Matthew J. Oliver
- Division of Nephrology, Department of
Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Ontario Renal Network, Toronto, ON,
Canada
| | - Michelle A. Hladunewich
- Division of Nephrology, Department of
Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Ontario Renal Network, Toronto, ON,
Canada
- Michelle A. Hladunewich, Division of
Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, 2075
Bayview Avenue, D4 Room 474, Toronto, ON M4N 3M5, Canada.
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9
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England JT, McNamara CJ, Kennedy JA, Capo-Chichi JM, Huang J, Arruda A, Nye T, Cheung V, Claudio JO, Maze D, Sibai H, Tierens A, Tsui H, Bankar A, Xu W, Stockley T, Gupta V. Clinical and molecular correlates of JAK-inhibitor therapy failure in myelofibrosis: long-term data from a molecularly annotated cohort. Leukemia 2022; 36:1689-1692. [PMID: 35347238 PMCID: PMC9162913 DOI: 10.1038/s41375-022-01544-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/01/2022] [Accepted: 03/09/2022] [Indexed: 11/09/2022]
Affiliation(s)
- James T. England
- grid.415224.40000 0001 2150 066XMedical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario Canada
| | - Caroline J. McNamara
- grid.415224.40000 0001 2150 066XMedical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario Canada
| | - James A. Kennedy
- grid.413104.30000 0000 9743 1587Medical Oncology and Hematology, Sunnybrook Health Sciences Centre, Toronto, Ontario Canada
| | - Jose-Mario Capo-Chichi
- grid.231844.80000 0004 0474 0428Division of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, Toronto, Ontario Canada
| | - Jingyue Huang
- grid.415224.40000 0001 2150 066XBiostatistics, Princess Margaret Cancer Centre, Toronto, Ontario Canada
| | - Andrea Arruda
- grid.415224.40000 0001 2150 066XMedical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario Canada
| | - Taylor Nye
- grid.415224.40000 0001 2150 066XMedical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario Canada
| | - Verna Cheung
- grid.415224.40000 0001 2150 066XMedical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario Canada
| | - Jaime O. Claudio
- grid.415224.40000 0001 2150 066XMedical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario Canada
| | - Dawn Maze
- grid.415224.40000 0001 2150 066XMedical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario Canada
| | - Hassan Sibai
- grid.415224.40000 0001 2150 066XMedical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario Canada
| | - Anne Tierens
- grid.417184.f0000 0001 0661 1177Laboratory Hematology, Toronto General Hospital, Toronto, Ontario Canada
| | - Hubert Tsui
- grid.417184.f0000 0001 0661 1177Laboratory Hematology, Toronto General Hospital, Toronto, Ontario Canada
| | - Aniket Bankar
- grid.415224.40000 0001 2150 066XMedical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario Canada
| | - Wei Xu
- grid.415224.40000 0001 2150 066XBiostatistics, Princess Margaret Cancer Centre, Toronto, Ontario Canada
| | - Tracy Stockley
- grid.231844.80000 0004 0474 0428Division of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario Canada
| | - Vikas Gupta
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
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10
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Spaner DE, Luo Y, Wang G, Gallagher J, Tsui H, Shi Y. Janus kinases restrain chronic lymphocytic leukemia cells in patients on ibrutinib: Results of a phase II trial. Cancer Med 2021; 10:8789-8798. [PMID: 34791813 PMCID: PMC8683523 DOI: 10.1002/cam4.4378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/27/2021] [Accepted: 10/09/2021] [Indexed: 11/06/2022] Open
Abstract
Preclinical observations that killing of chronic lymphocytic leukemia (CLL) cells was dexamethasone (DEX) were enhanced by concomitant inhibition of Bruton's tyrosine kinase and janus kinases (JAKs) motivated a phase II trial to determine if clinical responses to ibrutinib could be deepened by DEX and the JAK inhibitor ruxolitinib. Patients on ibrutinib at 420 mg daily for 2 months or with abnormal serum β2M levels after 6 months or with persistent lymphadenopathy or splenomegaly after 12 months were randomized to receive DEX 40 mg on days 1-4 of a 4-week cycle for six cycles alone (three patients) or with ruxolitinib 15 mg BID on days 1-21 of each cycle (five patients). Ruxolitinib dosing was based on a previous phase I trial. Steroid withdrawal symptoms and significantly decreased serum IgG levels occurred in all patients regardless of their exposure to ruxolitinib. A fatal invasive fungal infection was seen in a patient taking DEX without ruxolitinib. Complete responses anticipated with addition of ruxolitinib were not seen. Gene expression studies suggested ruxolitinib had turned off interferon signaling in CLL cells and turned on genes associated with the activation of NFκB by TNF-α. Ruxolitinib increased blood levels of TNF-α by cycle 3 and decreased the inhibitory cytokine IL-10. These results suggest ruxolitinib releases activating signals for CLL cells that persist in patients on ibrutinib. This inhibitory JAK signaling may contribute to the therapeutic activity of ibrutinib. Thus JAK inhibitors provide no added value with ibrutinib for disease control and should be used with caution in CLL patients. Combining glucocorticoids with ibrutinib may increase the risk of serious infects.
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Affiliation(s)
- David E Spaner
- Biology Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Odette Cancer Center, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Yuxuan Luo
- Biology Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Guizhei Wang
- Biology Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Hubert Tsui
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada.,Division of Hematological Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Yonghong Shi
- Biology Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
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11
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Chow S, Tang K, Al-Abri M, Hall V, Tremblay-Lemay R, Rashedi I, Tsui H, Chan SM. RUNX1 mutations correlate with response to venetoclax combination therapies in relapsed/refractory acute myeloid leukemia. Leuk Res 2021; 111:106735. [PMID: 34735933 DOI: 10.1016/j.leukres.2021.106735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Signy Chow
- Division of Medical Oncology and Hematology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.
| | - Kenny Tang
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, Canada
| | - Mahmood Al-Abri
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, Canada
| | - Victoria Hall
- Transplant Infectious Diseases and Ajmera Transplant Centre, University Health Network, Toronto, Canada
| | - Rosemarie Tremblay-Lemay
- Laboratory Medicine Program, Toronto General Hospital, University Health Network, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Iran Rashedi
- Division of Hematological Pathology, Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Hubert Tsui
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada; Division of Hematological Pathology, Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Steven M Chan
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, Canada
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12
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Brailovski E, Tsui H, Chen YB, Velsher L, Liu J, Buckstein R. Previously unreported WRAP53 gene variants in a patient with dyskeratosis congenita. Ann Hematol 2021; 101:907-909. [PMID: 34599657 DOI: 10.1007/s00277-021-04678-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/22/2021] [Indexed: 12/21/2022]
Affiliation(s)
| | - Hubert Tsui
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Yi-Bin Chen
- Massachusetts General Hospital, Boston, MA, USA
| | - Lea Velsher
- North York General Hospital, Toronto, ON, Canada
| | - Jiajia Liu
- St Michael's Hospital, Toronto, ON, Canada
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13
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Kozak R, Armstrong SM, Salvant E, Ritzker C, Feld J, Biondi MJ, Tsui H. Recognition of Long-COVID-19 Patients in a Canadian Tertiary Hospital Setting: A Retrospective Analysis of Their Clinical and Laboratory Characteristics. Pathogens 2021; 10:pathogens10101246. [PMID: 34684195 PMCID: PMC8537802 DOI: 10.3390/pathogens10101246] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 08/07/2021] [Revised: 09/09/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
A proportion of patients with COVID-19 have symptoms past the acute disease phase, which may affect quality of life. It is important for clinicians to be aware of this "long-COVID-19" syndrome to better diagnose, treat, and prevent it. We reviewed clinical and laboratory characteristics of a COVID-19 cohort in a Toronto, Ontario tertiary care center. Demographic, clinical, and laboratory data were collected, and patients were classified as "long-COVID-19" or "non-long-COVID-19" using consensus criteria. Of 397 patients who tested positive for COVID-19, 223 met inclusion criteria, and 62 (27%) had long-COVID-19. These patients had a similar age distribution compared to non-long-COVID-19 patients overall but were younger in the admitted long COVID-19 group. The long-COVID-19 group had more inpatients compared to the non-long-COVID-19 group (39% vs. 25%) and more frequent supplemental oxygen or mechanical ventilation use. However, long-COVID-19 patients did not differ by duration of mechanical ventilation, length of stay, comorbidities, or values of common laboratory tests ordered. The most frequent symptoms associated with long-COVID-19 were fatigue and weakness, as reported most commonly by the infectious disease, respirology and cardiology disciplines. In conclusion, by retrospective chart review, 27% of COVID-19 patients presenting to a tertiary care center in Toronto, Canada, were found to meet criteria for long-COVID-19. Past medical history and routine laboratory testing at presentation did not predict for long-COVID-19 development.
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Affiliation(s)
- Robert Kozak
- Sunnybrook Health Sciences Centre, Biological Science Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; (R.K.); (S.M.A.); (E.S.); (C.R.)
| | - Susan M. Armstrong
- Sunnybrook Health Sciences Centre, Biological Science Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; (R.K.); (S.M.A.); (E.S.); (C.R.)
| | - Elsa Salvant
- Sunnybrook Health Sciences Centre, Biological Science Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; (R.K.); (S.M.A.); (E.S.); (C.R.)
| | - Claudia Ritzker
- Sunnybrook Health Sciences Centre, Biological Science Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; (R.K.); (S.M.A.); (E.S.); (C.R.)
| | - Jordan Feld
- Toronto Centre for Liver Disease, University Health Network, Toronto, ON M5G 2C4, Canada; (J.F.); (M.J.B.)
| | - Mia J. Biondi
- Toronto Centre for Liver Disease, University Health Network, Toronto, ON M5G 2C4, Canada; (J.F.); (M.J.B.)
| | - Hubert Tsui
- Sunnybrook Health Sciences Centre, Biological Science Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; (R.K.); (S.M.A.); (E.S.); (C.R.)
- Correspondence: ; Tel.: +416-480-6100
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14
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Bankar A, Alibhai S, Smith E, Yang D, Malik S, Cheung V, Siddiq N, Claudio J, Arruda A, Tsui H, Capo-Chichi JM, Kennedy JA, McNamara C, Sibai H, Maze D, Xu W, Gupta V. Association of frailty with clinical outcomes in myelofibrosis: a retrospective cohort study. Br J Haematol 2021; 194:557-567. [PMID: 34131896 PMCID: PMC8361997 DOI: 10.1111/bjh.17617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/13/2021] [Indexed: 12/17/2022]
Abstract
There is limited understanding of the impact of frailty on clinical outcomes in patients with myelofibrosis (MF). In this retrospective cohort study on 439 chronic phase MF patients [mean age: 68·7 ± 12 years; median follow-up: 3·4 years (IQR 0·4-8·6)] from 2004 till 2018, we used a 35-variable frailty index (FI) to categorise patient's frailty status as fit (FI < 0·2, reference), prefrail (FI 0·2-0·29) or frail (FI ≥ 0·3). The association of frailty with overall survival (OS) and cumulative JAK inhibitor (JAKi) therapy failure was measured using hazard ratio (HR, 95% CI). In multivariable analysis, prefrail (HR 1·7, 1·1-2·5) and frail patients (HR 2·9, 1·6-5·5), those with higher DIPSS score (HR 2·5, 1·6-3·9) and transfusion dependency (HR 1·9, 1·3-2·9) had shorter OS. In a subset analysis of patients on JAKi treatment (n = 222), frail patients (HR 2·5, 1·1-5·7), patients with higher DIPSS score (HR 1·7, 1·0-3·1) and transfusion dependence (HR 1·7, 1·1-2·7) had higher cumulative incidence of JAKi failure. Age, comorbidities, ECOG performance status, and MPN driver mutations did not impact outcomes. Thus, higher frailty scores are associated with worse OS and increased JAKi failure in MF, and is a superior indicator of fitness in comparison to age, comorbidities, and performance status.
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Affiliation(s)
- Aniket Bankar
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Elliot Smith
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Dongyang Yang
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Sarah Malik
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Verna Cheung
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Nancy Siddiq
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jaime Claudio
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Andrea Arruda
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Hubert Tsui
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | | | | | - Hassan Sibai
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Dawn Maze
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Wei Xu
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Vikas Gupta
- Princess Margaret Cancer Centre, Toronto, ON, Canada
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15
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Shopsowitz KE, Shah K, Tsui H. Lymphoid blasts with aberrant myeloid marker expression and BCR/ABL1: Is it mixed phenotype acute leukemia or B lymphoblastic leukemia? Cytometry B Clin Cytom 2021; 102:73-75. [PMID: 33780164 DOI: 10.1002/cyto.b.22002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/05/2021] [Accepted: 03/16/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Kevin E Shopsowitz
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kalpesh Shah
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Hubert Tsui
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Department of Immunology, University of Toronto, Toronto, Ontario, Canada
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16
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Xia M, Luo TY, Shi Y, Wang G, Tsui H, Harari D, Spaner DE. Effect of Ibrutinib on the IFN Response of Chronic Lymphocytic Leukemia Cells. J Immunol 2020; 205:2629-2639. [PMID: 33067379 DOI: 10.4049/jimmunol.2000478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/11/2020] [Indexed: 01/21/2023]
Abstract
The Bruton's tyrosine kinase (BTK) inhibitor ibrutinib has profound activity in chronic lymphocytic leukemia (CLL) but limited curative potential by itself. Residual signaling pathways that maintain survival of CLL cells might be targeted to improve ibrutinib's therapeutic activity, but the nature of these pathways is unclear. Ongoing activation of IFN receptors in patients on ibrutinib was suggested by the presence of type I and II IFN in blood together with the cycling behavior of IFN-stimulated gene (ISG) products when IFN signaling was blocked intermittently with the JAK inhibitor ruxolitinib. IFN signaling in CLL cells from human patients was not prevented by ibrutinib in vitro or in vivo, but ISG expression was significantly attenuated in vitro. ISGs such as CXCL10 that require concomitant activation of NF-κB were decreased when this pathway was inhibited by ibrutinib. Other ISGs, exemplified by LAG3, were decreased as a result of inhibited protein translation. Effects of IFN on survival remained intact as type I and II IFN-protected CLL cells from ibrutinib in vitro, which could be prevented by ruxolitinib and IFNR blocking Abs. These observations suggest that IFNs may help CLL cells persist and specific targeting of IFN signaling might deepen clinical responses of patients on ibrutinib.
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Affiliation(s)
- Meihui Xia
- Biology Platform, Sunnybrook Research Institute, Toronto, Ontario M4N 3M5, Canada.,Department of Gynecology and Obstetrics, First Hospital, Jilin University, 130021 Changchun, Jilin, China.,Department of Human Anatomy, College of Basic Medical Sciences, Jilin University, 130021 Changchun, Jilin, China
| | - Tina Yuxuan Luo
- Biology Platform, Sunnybrook Research Institute, Toronto, Ontario M4N 3M5, Canada.,Department of Immunology, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Yonghong Shi
- Biology Platform, Sunnybrook Research Institute, Toronto, Ontario M4N 3M5, Canada
| | - Guizhi Wang
- Biology Platform, Sunnybrook Research Institute, Toronto, Ontario M4N 3M5, Canada
| | - Hubert Tsui
- Department of Immunology, University of Toronto, Toronto, Ontario M5S 1A8, Canada.,Division of Hematopathology, Sunnybrook Health Sciences Center, Toronto, Ontario M4C 3E7, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Daniel Harari
- Department of Biomolecular Sciences, Weizmann Institute of Science, 76100 Rehovot, Israel
| | - David E Spaner
- Biology Platform, Sunnybrook Research Institute, Toronto, Ontario M4N 3M5, Canada; .,Department of Immunology, University of Toronto, Toronto, Ontario M5S 1A8, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario M5G 2M9, Canada; and.,Department of Medicine, University of Toronto, Toronto, Ontario M5G 2C4, Canada
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17
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Aguilar-Navarro AG, Meza-León B, Gratzinger D, Juárez-Aguilar FG, Chang Q, Ornatsky O, Tsui H, Esquivel-Gómez R, Hernández-Ramírez A, Xie SZ, Dick JE, Flores-Figueroa E. Human Aging Alters the Spatial Organization between CD34+ Hematopoietic Cells and Adipocytes in Bone Marrow. Stem Cell Reports 2020; 15:317-325. [PMID: 32649902 PMCID: PMC7419665 DOI: 10.1016/j.stemcr.2020.06.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 02/08/2023] Open
Abstract
Age-related clonal hematopoiesis is a major risk factor for myeloid malignancy and myeloid skewing is a hallmark of aging. However, while it is known that non-cell-autonomous components of the microenvironment can also influence this risk, there have been few studies of how the spatial architecture of human bone marrow (BM) changes with aging. Here, we show that BM adiposity increases with age, which correlates with increased density of maturing myeloid cells and CD34+ hematopoietic stem/progenitor cells (HSPCs) and an increased proportion of HSPCs adjacent to adipocytes. However, NGFR+ bone marrow stromal cell (NGFR+ BMSC) density and distance to HSPCs and vessels remained stable. Interestingly, we found that, upon aging, maturing myeloid cell density increases in hematopoietic areas surrounding adipocytes. We propose that increased adjacency to adipocytes in the BM microenvironment may influence myeloid skewing of aging HSPCs, contributing to age-related risk of myeloid malignancies. Aging increases adipose, myeloid, and CD34+ HSPC density in the human bone marrow Human CD34+ HSPC niche is reticular, perivascular, and periadipocytic in aging Aging increases maturing myeloid cell density surrounding adipocytes
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Affiliation(s)
- Alicia G Aguilar-Navarro
- Unidad de Investigación Médica en Enfermedades Oncológicas, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Berenice Meza-León
- Unidad de Investigación Médica en Enfermedades Oncológicas, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Dita Gratzinger
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Fany G Juárez-Aguilar
- Departamento de Patología, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Qing Chang
- Fluidigm Canada Inc., Markham, ON, Canada
| | | | - Hubert Tsui
- Division of Hematopathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ricardo Esquivel-Gómez
- División de Ortopedia, Hospital de Traumatología y Ortopedia Lomas Verdes, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Antonio Hernández-Ramírez
- Unidad de Reemplazo Articular, Hospital de Traumatología y Ortopedia Lomas Verdes, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Stephanie Z Xie
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - John E Dick
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 1A8, Canada.
| | - Eugenia Flores-Figueroa
- Unidad de Investigación Médica en Enfermedades Oncológicas, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
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18
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Spaner DE, McCaw L, Wang G, Tsui H, Shi Y. Persistent janus kinase-signaling in chronic lymphocytic leukemia patients on ibrutinib: Results of a phase I trial. Cancer Med 2019; 8:1540-1550. [PMID: 30843659 PMCID: PMC6488147 DOI: 10.1002/cam4.2042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/20/2019] [Accepted: 02/04/2019] [Indexed: 12/13/2022] Open
Abstract
Methods to deepen clinical responses to ibrutinib are needed to improve outcomes for patients with chronic lymphocytic leukemia (CLL). This study aimed to determine the safety and efficacy of combining a janus kinase (JAK)‐inhibitor with ibrutinib because JAK‐mediated cytokine‐signals support CLL cells and may not be inhibited by ibrutinib. The JAK1/2 inhibitor ruxolitinib was prescribed to 12 CLL patients with abnormal serum beta‐2 microglobulin levels after 6 months or persistent lymphadenopathy or splenomegaly after 12 months on ibrutinib using a 3 + 3 phase 1 trial design (NCT02912754). Ibrutinib was continued at 420 mg daily and ruxolitinib was added at 5, 10, 15, or 20 mg BID for 3 weeks out of five for seven cycles. The break was mandated to avoid anemia and thrombocytopenia observed with ruxolitinib as a single agent in CLL. The combination was well‐tolerated without dose‐limiting toxicities. Cyclic changes in platelets, lymphocytes, and associated chemokines and thrombopoietic factors were observed and partial response criteria were met in 2 of 12 patients. The results suggest that JAK‐signaling helps CLL cells persist in the presence of ibrutinib and ruxolitinib with ibrutinib is well‐tolerated and may be a useful regiment to use in combination therapies for CLL.
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Affiliation(s)
- David E Spaner
- Biology Platform, Sunnybrook Research Institute, Toronto, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Canada.,Sunnybrook Odette Cancer Center, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Department of Immunology, University of Toronto, Toronto, Canada
| | - Lindsay McCaw
- Biology Platform, Sunnybrook Research Institute, Toronto, Canada
| | - Guizhei Wang
- Biology Platform, Sunnybrook Research Institute, Toronto, Canada
| | - Hubert Tsui
- Department of Immunology, University of Toronto, Toronto, Canada.,Division of Hematopathology, Sunnybrook Health Sciences Center, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Yonghong Shi
- Biology Platform, Sunnybrook Research Institute, Toronto, Canada
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Gladka MM, Molenaar B, De Ruiter H, Versteeg D, Tsui H, Lacraz GPA, Van Der Elst S, Huibers MMH, Van Oudenaarden A, Van Rooij E. 239Single-cell sequencing of the healthy and diseased heart reveals Ckap4 as a new modulator of fibroblasts activation. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M M Gladka
- Hubrecht Institute, Molecular Cardiology, Utrecht, Netherlands
| | - B Molenaar
- Hubrecht Institute, Molecular Cardiology, Utrecht, Netherlands
| | - H De Ruiter
- Hubrecht Institute, Molecular Cardiology, Utrecht, Netherlands
| | - D Versteeg
- Hubrecht Institute, Molecular Cardiology, Utrecht, Netherlands
| | - H Tsui
- Hubrecht Institute, Molecular Cardiology, Utrecht, Netherlands
| | - GPA Lacraz
- Hubrecht Institute, Molecular Cardiology, Utrecht, Netherlands
| | - S Van Der Elst
- Hubrecht Institute, Molecular Cardiology, Utrecht, Netherlands
| | - MMH Huibers
- University Medical Center Utrecht, Utrecht, Netherlands
| | | | - E Van Rooij
- Hubrecht Institute, Molecular Cardiology, Utrecht, Netherlands
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20
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Revelo XS, Ghazarian M, Chng MHY, Luck H, Kim JH, Zeng K, Shi SY, Tsai S, Lei H, Kenkel J, Liu CL, Tangsombatvisit S, Tsui H, Sima C, Xiao C, Shen L, Li X, Jin T, Lewis GF, Woo M, Utz PJ, Glogauer M, Engleman E, Winer S, Winer DA. Nucleic Acid-Targeting Pathways Promote Inflammation in Obesity-Related Insulin Resistance. Cell Rep 2016; 16:717-30. [PMID: 27373163 DOI: 10.1016/j.celrep.2016.06.024] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 04/27/2016] [Accepted: 06/03/2016] [Indexed: 12/22/2022] Open
Abstract
Obesity-related inflammation of metabolic tissues, including visceral adipose tissue (VAT) and liver, are key factors in the development of insulin resistance (IR), though many of the contributing mechanisms remain unclear. We show that nucleic-acid-targeting pathways downstream of extracellular trap (ET) formation, unmethylated CpG DNA, or ribonucleic acids drive inflammation in IR. High-fat diet (HFD)-fed mice show increased release of ETs in VAT, decreased systemic clearance of ETs, and increased autoantibodies against conserved nuclear antigens. In HFD-fed mice, this excess of nucleic acids and related protein antigens worsens metabolic parameters through a number of mechanisms, including activation of VAT macrophages and expansion of plasmacytoid dendritic cells (pDCs) in the liver. Consistently, HFD-fed mice lacking critical responders of nucleic acid pathways, Toll-like receptors (TLR)7 and TLR9, show reduced metabolic inflammation and improved glucose homeostasis. Treatment of HFD-fed mice with inhibitors of ET formation or a TLR7/9 antagonist improves metabolic disease. These findings reveal a pathogenic role for nucleic acid targeting as a driver of metabolic inflammation in IR.
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Affiliation(s)
- Xavier S Revelo
- Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Research Institute (TGRI), University Health Network, Toronto, ON M5G 1L7, Canada.
| | - Magar Ghazarian
- Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Research Institute (TGRI), University Health Network, Toronto, ON M5G 1L7, Canada
| | - Melissa Hui Yen Chng
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Helen Luck
- Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Research Institute (TGRI), University Health Network, Toronto, ON M5G 1L7, Canada
| | - Justin H Kim
- Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Research Institute (TGRI), University Health Network, Toronto, ON M5G 1L7, Canada
| | - Kejing Zeng
- Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Research Institute (TGRI), University Health Network, Toronto, ON M5G 1L7, Canada; Department of Endocrinology and Metabolism, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Sally Y Shi
- Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Research Institute (TGRI), University Health Network, Toronto, ON M5G 1L7, Canada
| | - Sue Tsai
- Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Research Institute (TGRI), University Health Network, Toronto, ON M5G 1L7, Canada
| | - Helena Lei
- Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Research Institute (TGRI), University Health Network, Toronto, ON M5G 1L7, Canada
| | - Justin Kenkel
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Chih Long Liu
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Stephanie Tangsombatvisit
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Hubert Tsui
- Department of Pathology, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Corneliu Sima
- Department of Applied Oral Sciences, The Forsyth Institute, Cambridge, MA 02142, USA
| | - Changting Xiao
- Division of Endocrinology and Metabolism, Department of Medicine, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Lei Shen
- Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai 200240, China
| | - Xiaoying Li
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai 200011, China
| | - Tianru Jin
- Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Research Institute (TGRI), University Health Network, Toronto, ON M5G 1L7, Canada
| | - Gary F Lewis
- Division of Endocrinology and Metabolism, Department of Medicine, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Minna Woo
- Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Research Institute (TGRI), University Health Network, Toronto, ON M5G 1L7, Canada; Division of Endocrinology and Metabolism, Department of Medicine, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Paul J Utz
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Michael Glogauer
- Faculty of Dentistry, University of Toronto, Matrix Dynamics Group, Toronto, ON M5G 1G6, Canada
| | - Edgar Engleman
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Shawn Winer
- Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Research Institute (TGRI), University Health Network, Toronto, ON M5G 1L7, Canada; Department of Laboratory Medicine, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Daniel A Winer
- Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Research Institute (TGRI), University Health Network, Toronto, ON M5G 1L7, Canada; Department of Pathology, University Health Network, Toronto, ON M5G 2C4, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada; Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada.
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Maezawa Y, Paltser G, Tsui H, Cheung R, Wu P, Nicholas AP, Dosch HM. 2-Chloroacetamidine, a novel immunomodulator, suppresses antigen-induced mouse airway inflammation. Allergy 2015; 70:1130-8. [PMID: 25969859 DOI: 10.1111/all.12651] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Citrullination is a presently under-recognized posttranslational protein modification catalyzed by PAD enzymes. Immune responses to citrullinated neo-epitopes are identified in a growing number of inflammatory and autoimmune diseases. However, the involvement of hypercitrullination in the pathogenesis of bronchial asthma is still unknown. METHODS As main experimental tool, we examined the effect of 2-chloroacetamidine (2CA), a PAD enzyme inhibitor, on OVA-immunized and airway-challenged BALB/c mice; a commonly used model of allergic airway inflammation. We also measured the effect of 2CA on ex vivo lymphocytes and cell lines. RESULTS In vivo, 2CA dramatically suppressed lung tissue hypercitrullination, inflammatory cell recruitment, and airway-Th2 cytokine secretion. 2CA also suppressed systemic OVA-specific and total IgE production dramatically, effectively preventing de novo and diminishing established disease without measurably impacting general immunocompetence. In vitro, 2CA markedly inhibited the proliferation of mouse and human T cells with cell cycle block and apoptosis during a limited, postactivation phase. CONCLUSIONS 2CA acts as narrow-spectrum immunosuppressant that selectively targets lymphocyte populations involved in active inflammatory tissue lesions. If hypercitrullination is generated in patients with asthma, 2CA may represent a novel disease modulator for human asthmatics/allergic diseases.
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Affiliation(s)
- Y. Maezawa
- The Hospital for Sick Children Research Institute; Neuroscience and Mental Health; University of Toronto; Toronto ON Canada
| | - G. Paltser
- The Hospital for Sick Children Research Institute; Neuroscience and Mental Health; University of Toronto; Toronto ON Canada
| | - H. Tsui
- The Hospital for Sick Children Research Institute; Neuroscience and Mental Health; University of Toronto; Toronto ON Canada
| | - R. Cheung
- The Hospital for Sick Children Research Institute; Neuroscience and Mental Health; University of Toronto; Toronto ON Canada
| | - P. Wu
- The Hospital for Sick Children Research Institute; Neuroscience and Mental Health; University of Toronto; Toronto ON Canada
| | - A. P. Nicholas
- Department of Neurology and Center for Neuroimmunology; University of Alabama at Birmingham; Birmingham AL USA
- Birmingham VA Medical Center; Birmingham AL USA
| | - H.-M. Dosch
- The Hospital for Sick Children Research Institute; Neuroscience and Mental Health; University of Toronto; Toronto ON Canada
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22
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Revelo XS, Tsai S, Lei H, Luck H, Ghazarian M, Tsui H, Shi SY, Schroer S, Luk CT, Lin GHY, Mak TW, Woo M, Winer S, Winer DA. Perforin is a novel immune regulator of obesity-related insulin resistance. Diabetes 2015; 64:90-103. [PMID: 25048196 DOI: 10.2337/db13-1524] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Obesity-related insulin resistance is associated with an influx of pathogenic T cells into visceral adipose tissue (VAT), but the mechanisms regulating lymphocyte balance in such tissues are unknown. Here we describe an important role for the immune cytotoxic effector molecule perforin in regulating this process. Perforin-deficient mice (Prf1(null)) show early increased body weight and adiposity, glucose intolerance, and insulin resistance when placed on high-fat diet (HFD). Regulatory effects of perforin on glucose tolerance are mechanistically linked to the control of T-cell proliferation and cytokine production in inflamed VAT. HFD-fed Prf1(null) mice have increased accumulation of proinflammatory IFN-γ-producing CD4(+) and CD8(+) T cells and M1-polarized macrophages in VAT. CD8(+) T cells from the VAT of Prf1(null) mice have increased proliferation and impaired early apoptosis, suggesting a role for perforin in the regulation of T-cell turnover during HFD feeding. Transfer of CD8(+) T cells from Prf1(null) mice into CD8-deficient mice (CD8(null)) resulted in worsening of metabolic parameters compared with wild-type donors. Improved metabolic parameters in HFD natural killer (NK) cell-deficient mice (NK(null)) ruled out a role for NK cells as a single source of perforin in regulating glucose homeostasis. The findings support the importance of T-cell function in insulin resistance and suggest that modulation of lymphocyte homeostasis in inflamed VAT is one possible avenue for therapeutic intervention.
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Affiliation(s)
- Xavier S Revelo
- Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Sue Tsai
- Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Helena Lei
- Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Helen Luck
- Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Magar Ghazarian
- Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Hubert Tsui
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Sally Y Shi
- Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Stephanie Schroer
- Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Cynthia T Luk
- Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Gloria H Y Lin
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Tak W Mak
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Minna Woo
- Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada Division of Endocrinology and Metabolism, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Shawn Winer
- Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada Department of Pathology, University Health Network, Toronto, Ontario, Canada
| | - Daniel A Winer
- Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada Department of Pathology, University Health Network, Toronto, Ontario, Canada
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Wang Y, Tsui H, Ke Y, Terrar D, Huang CLH, Solaro RJ, Wang X, Lei M. P115Pak1 is required to maintain ventricular Ca2+ homeostasis and electrophysiological stability through SERCA2a regulation in mice. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu082.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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24
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Paltser G, Liu XJ, Yantha J, Winer S, Tsui H, Wu P, Maezawa Y, Cahill LS, Laliberté CL, Ramagopalan SV, DeLuca GC, Sadovnick AD, Astsaturov I, Ebers GC, Henkelman RM, Salter MW, Dosch HM. TRPV1 gates tissue access and sustains pathogenicity in autoimmune encephalitis. Mol Med 2013; 19:149-59. [PMID: 23689362 DOI: 10.2119/molmed.2012.00329] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 05/08/2013] [Indexed: 01/03/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic progressive, demyelinating condition whose therapeutic needs are unmet, and whose pathoetiology is elusive. We report that transient receptor potential vanilloid-1 (TRPV1) expressed in a major sensory neuron subset, controls severity and progression of experimental autoimmune encephalomyelitis (EAE) in mice and likely in primary progressive MS. TRPV1-/- B6 congenics are protected from EAE. Increased survival reflects reduced central nervous systems (CNS) infiltration, despite indistinguishable T cell autoreactivity and pathogenicity in the periphery of TRPV1-sufficient and -deficient mice. The TRPV1+ neurovascular complex defining the blood-CNS barriers promoted invasion of pathogenic lymphocytes without the contribution of TRPV1-dependent neuropeptides such as substance P. In MS patients, we found a selective risk-association of the missense rs877610 TRPV1 single nucleotide polymorphism (SNP) in primary progressive disease. Our findings indicate that TRPV1 is a critical disease modifier in EAE, and we identify a predictor of severe disease course and a novel target for MS therapy.
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Affiliation(s)
- Geoffrey Paltser
- Neuroscience and Mental Health Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
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Moscarello MA, Lei H, Mastronardi FG, Winer S, Tsui H, Li Z, Ackerley C, Zhang L, Raijmakers R, Wood DD. Inhibition of peptidyl-arginine deiminases reverses protein-hypercitrullination and disease in mouse models of multiple sclerosis. Dis Model Mech 2012; 6:467-78. [PMID: 23118341 PMCID: PMC3597028 DOI: 10.1242/dmm.010520] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Multiple sclerosis (MS) is the most common CNS-demyelinating disease of humans, showing clinical and pathological heterogeneity and a general resistance to therapy. We first discovered that abnormal myelin hypercitrullination, even in normal-appearing white matter, by peptidylarginine deiminases (PADs) correlates strongly with disease severity and might have an important role in MS progression. Hypercitrullination is known to promote focal demyelination through reduced myelin compaction. Here we report that 2-chloroacetamidine (2CA), a small-molecule, PAD active-site inhibitor, dramatically attenuates disease at any stage in independent neurodegenerative as well as autoimmune MS mouse models. 2CA reduced PAD activity and protein citrullination to pre-disease status. In the autoimmune models, disease induction uniformly induced spontaneous hypercitrullination with citrulline+ epitopes targeted frequently. 2CA rapidly suppressed T cell autoreactivity, clearing brain and spinal cord infiltrates, through selective removal of newly activated T cells. 2CA essentially prevented disease when administered before disease onset or before autoimmune induction, making hypercitrullination, and specifically PAD enzymes, a therapeutic target in MS models and thus possibly in MS.
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Affiliation(s)
- Mario A Moscarello
- Molecular Structure and Function, The Research Institute, Hospital For Sick Children, Toronto, ON M5G 1X8, Canada.
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Abstract
Obesity-associated insulin resistance is a core element of metabolic syndrome and type 2 diabetes (T2D). Notably, insulin resistance is also a feature of type 1 diabetes (T1D), where findings in the non-obese diabetic mouse model have implicated transient receptor potential vanilloid-1 (TRPV1+) sensory neurons in local islet inflammation and glucose metabolism. Here, we briefly review the role of TRPV1 in non-obese diabetic (NOD) T1D pathogenesis, highlighting commonalities that suggest TRPV1 may contribute to obesity and T2D as well. With the recently discovered importance of adipose infiltrating lymphocytes in the metabolic disturbances of obesity and T2D, sensory innervation of fat may thus play an analogous role to sensory neurons in the islet--modulating neuroendocrine homeostasis and inflammation. In such a scenario, TRPV1+ sensory nerves would provide the pathoaetiological link connecting the shared metabolic and immunologic features of type 1 diabetes and T2D.
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Affiliation(s)
- Hubert Tsui
- The Research Institute, Hospital For Sick Children, University of Toronto, Neuroscience and Mental Health Program, Toronto, ON M5G 1X8, Canada.
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Winer DA, Winer S, Shen L, Wadia PP, Yantha J, Paltser G, Tsui H, Wu P, Davidson MG, Alonso MN, Leong HX, Glassford A, Caimol M, Kenkel JA, Tedder TF, McLaughlin T, Miklos DB, Dosch HM, Engleman EG. B cells promote insulin resistance through modulation of T cells and production of pathogenic IgG antibodies. Nat Med 2011; 17:610-7. [PMID: 21499269 DOI: 10.1038/nm.2353] [Citation(s) in RCA: 732] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 03/04/2011] [Indexed: 02/07/2023]
Abstract
Chronic inflammation characterized by T cell and macrophage infiltration of visceral adipose tissue (VAT) is a hallmark of obesity-associated insulin resistance and glucose intolerance. Here we show a fundamental pathogenic role for B cells in the development of these metabolic abnormalities. B cells accumulate in VAT in diet-induced obese (DIO) mice, and DIO mice lacking B cells are protected from disease despite weight gain. B cell effects on glucose metabolism are mechanistically linked to the activation of proinflammatory macrophages and T cells and to the production of pathogenic IgG antibodies. Treatment with a B cell-depleting CD20 antibody attenuates disease, whereas transfer of IgG from DIO mice rapidly induces insulin resistance and glucose intolerance. Moreover, insulin resistance in obese humans is associated with a unique profile of IgG autoantibodies. These results establish the importance of B cells and adaptive immunity in insulin resistance and suggest new diagnostic and therapeutic modalities for managing the disease.
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Affiliation(s)
- Daniel A Winer
- Department of Pathology, Stanford University, Palo Alto, California, USA.
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Gu J, Lau JTF, Tsui H. Psychological factors in association with uptake of voluntary counselling and testing for HIV among men who have sex with men in Hong Kong. Public Health 2011; 125:275-82. [PMID: 21419466 DOI: 10.1016/j.puhe.2011.01.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To investigate the prevalence and factors associated with uptake of voluntary counselling and testing (VCT) for human immunodeficiency virus (HIV) among men who have sex with men (MSM) in Hong Kong. STUDY DESIGN Cross-sectional study. METHODS A total of 389 MSM were recruited from gay venues. An additional 188 MSM were recruited through the Internet. Data were collected via face-to-face interviews using a self-administered anonymous questionnaire or via an electronic questionnaire accessible via local gay-friendly websites. The associations between independent and dependent variables (VCT uptake in lifetime and in last 12 months) were examined by logistic regression models. RESULTS The prevalence rates for lifetime and 12-month uptake of VCT were 56.5% and 39.4%, respectively. Adjusting for significant background variables, all cognitive variables (attitudes, subjective norms, perceived control and behavioural intention) that were derived from the Theory of Planned Behaviours (TPB) were significantly associated with both lifetime and 12-month uptake of VCT [adjusted odds ratio (AOR) 0.56-4.71, P < 0.05]. Perceived fear of contracting HIV and perceived discrimination towards local MSM were associated with a lower likelihood of 12-month uptake of VCT (AOR 0.63, P < 0.05) and lifetime uptake (AOR 0.65, P < 0.05). In the summary models, variables derived from the TPB (subjective norms, perceived control and behavioural intention) were independently associated with lifetime and 12-month uptake of VCT (OR 0.64-2.78, P < 0.05; OR 2.39-3.21, P < 0.05, respectively). Fear of contracting HIV was associated with VCT uptake in the last 12 months (OR 0.55, P < 0.05). CONCLUSIONS Psychological factors are associated with VCT uptake. The TPB and other health behavioural theories should be taken into account when designing VCT promotion campaigns.
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Affiliation(s)
- J Gu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Yantha J, Tsui H, Winer S, Song A, Wu P, Paltser G, Ellis J, Dosch HM. Unexpected acceleration of type 1 diabetes by transgenic expression of B7-H1 in NOD mouse peri-islet glia. Diabetes 2010; 59:2588-96. [PMID: 20522597 PMCID: PMC3279538 DOI: 10.2337/db09-1209] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Autoimmune target tissues in type 1 diabetes include pancreatic β-cells and peri-islet Schwann cells (pSC)--the latter active participants or passive bystanders in pre-diabetic autoimmune progression. To distinguish between these alternatives, we sought to suppress pSC autoimmunity by transgenic expression of the negative costimulatory molecule B7-H1 in NOD pSC. RESEARCH DESIGN AND METHODS A B7-H1 transgene was placed under control of the glial fibrillary acidic protein (GFAP) promoter. Transgenic and wild-type NOD mice were compared for transgene PD-1 affinities, diabetes development, insulitis, and pSC survival. Mechanistic studies included adoptive type 1 diabetes transfer, B7-H1 blockade, and T-cell autoreactivity and sublineage distribution. RESULTS Transgenic and endogenous B7-H1 bound PD-1 with equal affinities. Unexpectedly, the transgene generated islet-selective CD8(+) bias with accelerated rather than suppressed diabetes progression. T-cells of diabetic transgenics transferred type 1 diabetes faster. There were no earlier pSC losses due to conceivable transgene toxicity, but transgenic pSC loss was enhanced by 8 weeks, preceded by elevated GFAP autoreactivity, with high-affinity T-cells targeting the major NOD K(d)-GFAP epitope, p253-261. FoxP3(+) regulatory T- and CD11c(+) dendritic cell pools were unaffected. CONCLUSIONS In contrast with transgenic B7-H1 in NOD mouse β-cells, transgenic B7-H1 in pSC promotes rather than protects from type 1 diabetes. Here, ectopic B7-H1 enhanced the pathogenicity of effector T-cells, demonstrating that pSC can actively impact diabetes progression-likely through modification of intraislet T-cell selection. Although pSC cells emerge as a new candidate for therapeutic targets, caution is warranted with regard to the B7-H1-PD1 axis, where B7-H1 overexpression can lead to accelerated autoimmune disease.
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Affiliation(s)
- Jason Yantha
- Neuroscience and Mental Health Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Departments of Pediatrics and Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Hubert Tsui
- Neuroscience and Mental Health Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Departments of Pediatrics and Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Shawn Winer
- Neuroscience and Mental Health Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Departments of Pediatrics and Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Aihua Song
- Neuroscience and Mental Health Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Departments of Pediatrics and Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Ping Wu
- Neuroscience and Mental Health Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Departments of Pediatrics and Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Geoff Paltser
- Neuroscience and Mental Health Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Departments of Pediatrics and Immunology, University of Toronto, Toronto, Ontario, Canada
| | - James Ellis
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - H.-Michael Dosch
- Neuroscience and Mental Health Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Departments of Pediatrics and Immunology, University of Toronto, Toronto, Ontario, Canada
- Corresponding author: H.-Michael Dosch,
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Tsui H, Chan Y, Tang L, Winer S, Cheung RK, Paltser G, Selvanantham T, Elford AR, Ellis JR, Becker DJ, Ohashi PS, Dosch HM. Targeting of pancreatic glia in type 1 diabetes. Diabetes 2008; 57:918-28. [PMID: 18198358 DOI: 10.2337/db07-0226] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Type 1 diabetes reflects autoimmune destruction of beta-cells and peri-islet Schwann cells (pSCs), but the mechanisms of pSC death and the T-cell epitopes involved remain unclear. RESEARCH DESIGN AND METHODS Primary pSC cultures were generated and used as targets in cytotoxic T-lymphocyte (CTL) assays in NOD mice. Cognate interaction between pSC and CD8(+) T-cells was assessed by transgenic restoration of beta2-microglobulin (beta2m) to pSC in NOD.beta2m(-/-) congenics. I-A(g7) and K(d) epitopes in the pSC antigen glial fibrillary acidic protein (GFAP) were identified by peptide mapping or algorithms, respectively, and the latter tested by immunotherapy. RESULTS pSC cultures did not express major histocompatibility complex (MHC) class II and were lysed by ex vivo CTLs from diabetic NOD mice. In vivo, restoration of MHC class I in GFAP-beta2m transgenics significantly accelerated adoptively transferred diabetes. Target epitopes in the pSC autoantigen GFAP were mapped to residues 79-87 and 253-261 for K(d) and 96-110, 116-130, and 216-230 for I-A(g7). These peptides were recognized spontaneously in NOD spleens as early as 2.5 weeks of age, with proliferative responses peaking around weaning and detectable lifelong. Several were also recognized by T-cells from new-onset type 1 diabetic patients. NOD mouse immunotherapy at 8 weeks with the CD8(+) T-cell epitope, GFAP 79-87 but not 253-261, significantly inhibited type 1 diabetes and was associated with reduced gamma-interferon production to whole protein GFAP. CONCLUSIONS Collectively, these findings elucidate a role for pSC-specific CD8(+) T-cells in islet inflammation and type 1 diabetes pathogenesis, further supporting neuronal involvement in beta-cell demise.
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Affiliation(s)
- Hubert Tsui
- The Hospital for Sick Children, 555 University Ave., 10th Floor Elm Wing, Rm. 10126, Toronto, Ontario, M5G 1X8, Canada
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Chan Y, Yantha J, Tsui H, Winer S, Dosch H. Selective activation of TRPV1+ sensory neurons in the pancreas halts islet autoimmunity and restore normoglycemia in Diabetic Non‐Obese Diabetic (NOD) mice. FASEB J 2008. [DOI: 10.1096/fasebj.22.1_supplement.1074.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yin Chan
- Neurosciences and Mental HealthThe Hospital for Sick ChildrenTorontoCanada
| | - Jason Yantha
- Neurosciences and Mental HealthThe Hospital for Sick ChildrenTorontoCanada
| | - Hubert Tsui
- Neurosciences and Mental HealthThe Hospital for Sick ChildrenTorontoCanada
| | - Shawn Winer
- Neurosciences and Mental HealthThe Hospital for Sick ChildrenTorontoCanada
| | - Hans‐Michael Dosch
- Neurosciences and Mental HealthThe Hospital for Sick ChildrenTorontoCanada
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Tsui H, Razavi R, Chan Y, Yantha J, Dosch HM. ‘Sensing’ autoimmunity in type 1 diabetes. Trends Mol Med 2007; 13:405-13. [PMID: 17900987 DOI: 10.1016/j.molmed.2007.07.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Revised: 07/28/2007] [Accepted: 07/28/2007] [Indexed: 02/08/2023]
Abstract
Type 1 diabetes (T1D) results from autoimmune-mediated loss of insulin-producing beta-cells. Recent findings suggest that the events controlling T1D development are not only immunological, but also neuronal in nature. In the non-obese diabetic (NOD) mouse model of T1D, a mutant sensory neuron channel, TRPV1, initiates chronic, progressive beta-cell stress, inducing islet cell inflammation. This novel mechanism of organ-specific damage requires a permissive, autoimmune-prone host, but ascribes tissue specificity to the local secretory dysfunction of sensory afferent neurons. In NOD mice, normalizing this neuronal function by administration of the neurotransmitter substance P clears islet cell inflammation, reduces insulin resistance and restores normoglycemia. Here, we discuss this neuro-immuno-endocrine model, its implications and the involvement of sensory neurons in other autoimmune disorders. These developments might provide novel neuronal-based therapeutic interventions, particularly in diabetes.
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Affiliation(s)
- Hubert Tsui
- The Hospital for Sick Children, Department of Neuroscience and Mental Health, 555 University Avenue, 10128 Elm Wing Toronto, ON, M5G 1X8, Canada
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Mastronardi FG, Tsui H, Winer S, Wood DD, Selvanantham T, Galligan C, Fish EN, Dosch HM, Moscarello MA. Synergy between paclitaxel plus an exogenous methyl donor in the suppression of murine demyelinating diseases. Mult Scler 2007; 13:596-609. [PMID: 17548438 DOI: 10.1177/1352458506072167] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [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: 12/28/2022]
Abstract
Progressive demyelination in multiple sclerosis (MS) reflects the negative balance between myelin damage and repair due to physical and molecular barriers, such as astrocytic glial scars, between oligodendrocytes and target neurons. In this paper, we show that combination therapy with paclitaxel (Taxol) plus the universal methyl-donor, vitamin B12CN (B12CN), dramatically limits progressive demyelination, and enhances remyelination in several independent, immune and nonimmune, in vivo and in vitro model systems. Combination therapy significantly reduced clinical signs of EAE in SJL mice, as well as the spontaneously demyelinating ND4 transgenic mouse. Astrocytosis was normalised in parallel to ultrastructural and biochemical evidence of remyelination. The combination therapy suppressed T cell expansion, reduced IFN-gamma, while enhancing IFN-beta and STAT-1 expression, STAT-1 phosphorylation and methylation of STAT-1 and MBP in the brain. Paclitaxel/B12CN has nearly identical effects to the previously described combination of IFN-beta/ B12CN, whose clinical usefulness is transient because of IFN-neutralising antibodies, not observed (or expected) with the present drug combination. This report provides a mechanistic foundation for the development of a new therapeutic strategy in humans with MS.
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Affiliation(s)
- F G Mastronardi
- Department of Structural Biology and Biochemistry, The Hospital for Sick Children, University Health Network, Toronto, Ontario, Canada.
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Razavi R, Chan Y, Afifiyan FN, Liu XJ, Wan X, Yantha J, Tsui H, Tang L, Tsai S, Santamaria P, Driver JP, Serreze D, Salter MW, Dosch HM. TRPV1+ sensory neurons control beta cell stress and islet inflammation in autoimmune diabetes. Cell 2007; 127:1123-35. [PMID: 17174891 DOI: 10.1016/j.cell.2006.10.038] [Citation(s) in RCA: 253] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Revised: 08/22/2006] [Accepted: 10/03/2006] [Indexed: 11/26/2022]
Abstract
In type 1 diabetes, T cell-mediated death of pancreatic beta cells produces insulin deficiency. However, what attracts or restricts broadly autoreactive lymphocyte pools to the pancreas remains unclear. We report that TRPV1(+) pancreatic sensory neurons control islet inflammation and insulin resistance. Eliminating these neurons in diabetes-prone NOD mice prevents insulitis and diabetes, despite systemic persistence of pathogenic T cell pools. Insulin resistance and beta cell stress of prediabetic NOD mice are prevented when TRPV1(+) neurons are eliminated. TRPV1(NOD), localized to the Idd4.1 diabetes-risk locus, is a hypofunctional mutant, mediating depressed neurogenic inflammation. Delivering the neuropeptide substance P by intra-arterial injection into the NOD pancreas reverses abnormal insulin resistance, insulitis, and diabetes for weeks. Concordantly, insulin sensitivity is enhanced in trpv1(-/-) mice, whereas insulitis/diabetes-resistant NODxB6Idd4-congenic mice, carrying wild-type TRPV1, show restored TRPV1 function and insulin sensitivity. Our data uncover a fundamental role for insulin-responsive TRPV1(+) sensory neurons in beta cell function and diabetes pathoetiology.
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Affiliation(s)
- Rozita Razavi
- Neurosciences and Mental Health Program, The Hospital for Sick Children, Research Institute, University of Toronto, Toronto, ON, Canada, M5G 1X8
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Abstract
Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache and the cause is usually cerebrospinal fluid leaks in spine level. Most patients with SIH have a benign course. Epidural blood patch (EBP) is the treatment of choice when initial conservative managements are ineffective. We reported a patient with SIH diagnosed by using magnetic resonance imaging and radionuclide cisternography. Acute rebound intracranial hypertension developed after EBP and was successfully treated with intravenous osmotic agent.
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Affiliation(s)
- H Tsui
- Department of Neurology, E-Da Hospital, I-Shou University, Kaohsiung County, Taiwan
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Abstract
STUDY OBJECTIVE To report the evolution in perceptions and behaviours of the general public in response to the severe acute respiratory syndrome (SARS) epidemic in Hong Kong. DESIGN Ten similar and sequential telephone surveys were conducted during outbreak of SARS, which are classified as belonging to the first and second phases of the epidemic. SETTING Hong Kong, China. PARTICIPANTS 1397 Hong Kong residents between 18 and 60 years of age. MAIN OUTCOME MEASURES Perceptions and behaviours to SARS and its prevention. RESULTS Most of the respondents believed that SARS could be transmitted via direct body contact and droplets. About half of respondents believed that SARS was curable, which increased in the initial phase and decreased in the second phase. Perceived chance of infection was low (9%) but fear of infection in public places was high (48%). Perceived efficacy of hygiene measures (wearing a mask: 82%, hand washing: 93%, and home disinfection: 75%) remained high in both phases and the perceived efficacy of avoiding crowded place, and using public transportation, etc, increased initially and decreased in the second phase. In parallel, use of the three hygiene measures increased significantly in the first phase and remained high for wearing a mask and washing hands in the second phase. Percentages of people avoiding crowded place and public transportation significantly increased initially and decreased in the second phase. CONCLUSION SARS related perceptions and behaviours evolved rapidly during the epidemic and Hong Kong residents quickly adopted appropriate SARS prevention measures. Timely dissemination of information seems effective in public health crises management.
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Affiliation(s)
- J T F Lau
- Centre for Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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Affiliation(s)
- Hubert Tsui
- The Hospital For Sick Children, Research Institute, Departments of Pediatrics & Immunology, University of Toronto, Toronto, ON, Canada
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Song A, Winer S, Tsui H, Sampson A, Pasceri P, Ellis J, Elliott JF, Dosch HM. Deviation of islet autoreactivity to cryptic epitopes protects NOD mice from diabetes. Eur J Immunol 2003; 33:546-55. [PMID: 12645954 DOI: 10.1002/immu.200310031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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: 11/12/2022]
Abstract
To better understand loss of self-tolerance in diabetes-prone NOD mice, we are generating ICA69 transgenes under control of the tetracycline-regulated tet07 minimal promoter. In vitro pilot studies showed leaky transgene expression, but addition of beta-globin genomic insulator flanks prevented leakage and dramatically enhanced transgene expression even in transient transfection, with excellent suppression by Doxycycline. In vivo, the accidental loss of insulator flanks during transgene insertion in one transgenic NOD founder, tet1, re-established leakiness with high level, exclusive ICA69-transgene expression in stromal elements of thymus and spleen. This led to persistent deletion of T cells targeting the immunodominant ICA69 epitope, Tep69, but emergence of T cell pools targeting cryptic ICA69 epitopes not normally generated in sufficient density to select and maintain ICA69-autoreactive T cells. This subtle modification of T cell repertoires reduced insulitis, and protected from diabetes in transgenics and in wild-type mice carrying irradiated tet1 thymus grafts. The low pathogenicity of T cells targeting cryptic epitopes likely reflects the fact that the major ICA69 determinant presented in the islet milieu remains Tep69, while cryptic epitopes are under-represented. Deviation of T cell autoreactivity from major to cryptic target epitopes in tet1 mice provides a fortuitous model to explain previously observed diabetes protection by immunotherapy or autoantigen transgenes despite apparent failure to achieve tolerance to the full length islet antigens.
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Affiliation(s)
- Aihua Song
- The Hospital For Sick Children, University of Toronto, Toronto, ON, Canada
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Winer S, Tsui H, Lau A, Song A, Li X, Cheung RK, Sampson A, Afifiyan F, Elford A, Jackowski G, Becker DJ, Santamaria P, Ohashi P, Dosch HM. Autoimmune islet destruction in spontaneous type 1 diabetes is not beta-cell exclusive. Nat Med 2003; 9:198-205. [PMID: 12539039 DOI: 10.1038/nm818] [Citation(s) in RCA: 160] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2002] [Accepted: 12/19/2002] [Indexed: 11/09/2022]
Abstract
Pancreatic islets of Langerhans are enveloped by peri-islet Schwann cells (pSC), which express glial fibrillary acidic protein (GFAP) and S100beta. pSC-autoreactive T- and B-cell responses arise in 3- to 4-week-old diabetes-prone non-obese diabetic (NOD) mice, followed by progressive pSC destruction before detectable beta-cell death. Humans with probable prediabetes generate similar autoreactivities, and autoantibodies in islet-cell autoantibody (lCA) -positive sera co-localize to pSC. Moreover, GFAP-specific NOD T-cell lines transferred pathogenic peri-insulitis to NOD/severe combined immunodeficient (NOD/SCID) mice, and immunotherapy with GFAP or S100beta prevented diabetes. pSC survived in rat insulin promoter Iymphocytic choriomeningitis virus (rip-LCMV) glycoprotein/CD8+ T-cell receptor(gp) double-transgenic mice with virus-induced diabetes, suggesting that pSC death is not an obligate consequence of local inflammation and beta-cell destruction. However, pSC were deleted in spontaneously diabetic NOD mice carrying the CD8+/8.3 T-cell receptor transgene, a T cell receptor commonly expressed in earliest islet infiltrates. Autoimmune targeting of pancreatic nervous system tissue elements seems to be an integral, early part of natural type 1 diabetes.
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Affiliation(s)
- Shawn Winer
- Hospital For Sick Children, Research Institute and Department of Pediatrics and Immunology, University of Toronto, Toronto, Ontario, Canada
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Winer S, Astsaturov I, Cheung R, Tsui H, Song A, Gaedigk R, Winer D, Sampson A, McKerlie C, Bookman A, Dosch HM. Primary Sjögren's syndrome and deficiency of ICA69. Lancet 2002; 360:1063-9. [PMID: 12383988 DOI: 10.1016/s0140-6736(02)11144-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Sjögren's syndrome is a common (about 1% of the population) autoimmune disease of salivary and lacrimal glands. Its cause and pathogenesis are poorly understood, and treatments are mostly for symptoms of the disease. ICA69 is a self-antigen expressed in brain, pancreas, salivary, and lacrimal glands. NOD-strain mice are an animal model of spontaneous Sjögren's syndrome. We aimed to assess the role of ICA69 in autoimmunity against Sjögren's syndrome. METHODS We inactivated the genomic ICA69 locus, generated NOD congenic mice that were deficient in ICA69, and assessed development of Sjögren's syndrome. ICA69 autoimmunity was investigated in controls and in patients with primary Sjögren's syndrome or systemic lupus erythematosus, and in various NOD mice, some of which were given an ICA69-directed prototype peptide vaccine. FINDINGS Disruption of the ICA69 locus prevented lacrimal gland disease and greatly reduced salivary gland disease in NOD mice. In healthy NOD mice, ICA69-specific T cells accumulated in lymph nodes that drain salivary tissue. T-cell and B-cell autoreactivity against ICA69 was much the same in patients with primary Sjögren's syndrome, but not in those with systemic lupus erythematosus or in healthy controls. Immunotherapy with a high-affinity mimicry peptide targeting ICA69-specific T-cells reduced established Sjögren's syndrome in wild-type NOD mice in the long term. INTERPRETATION ICA69 is a new autoantigen in primary Sjögren's syndrome that has an important role in progression of disease and could be of diagnostic value. Immunotherapy of primary Sjögren's syndrome is promising, since autoimmunity in NOD mice with Sjögren's syndrome seems to be uniquely susceptible to such treatment even late in disease.
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Affiliation(s)
- Shawn Winer
- Hospital for Sick Children, Research Institute, ON, Toronto, Canada
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Matsuno H, Matsushita I, Okada C, Suzuki M, Tsuji H, Ochiai H, Tsui H. Role of lymphocytes in collagen induced arthritis. J Rheumatol 1991; 18:1344-9. [PMID: 1757936] [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: 12/28/2022]
Abstract
We investigated the time related changes of lymphocyte subsets in the blood, regional lymph node and thymus during the development of collagen induced arthritis in mice. Flow cytometric analysis showed that Lyt2+ T, but not L3T4+ T cells in the blood or regional lymph node, was significantly reduced throughout the observation. The number of Lyt2+ T cells was decreased in lymph nodes of collagen immunized vs adjuvant controls while B cells were increased and L3T4+ T cells were not different. These might act as a potential factor for the onset of collagen induced arthritis. The reduction of Lyt2+ cells was not influenced by thymic T cell maturation; it is conceivable that the main immune organ is the regional lymph node.
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Affiliation(s)
- H Matsuno
- Department of Orthopaedics and Rheumatology, Toyama Medical and Pharmaceutical University, Japan
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