1
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Heo E, Jeong Y, Heo KN, Kim H, Kang HR, Park SK, Lee JY. Impact of β-lactam allergies on antibiotic use, clinical outcomes, and economic costs in patients receiving surgical prophylactic antibiotics. J Hosp Infect 2023; 139:249-250. [PMID: 37286106 DOI: 10.1016/j.jhin.2023.05.007] [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: 04/16/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023]
Affiliation(s)
- E Heo
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Y Jeong
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - K N Heo
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - H Kim
- Regional Pharmacovigilance Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - H R Kang
- Regional Pharmacovigilance Center, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - S K Park
- College of Pharmacy, The Catholic University of Korea, Bucheon, Republic of Korea
| | - J Y Lee
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea.
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2
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Wong H, Hooper AW, Kang HR, Lee SJ, Zhao J, Sadhu C, Rawat S, Gray SJ, Hampson DR. CNS-dominant human FMRP isoform rescues seizures, fear, and sleep abnormalities in Fmr1-KO mice. JCI Insight 2023; 8:169650. [PMID: 37288657 PMCID: PMC10393223 DOI: 10.1172/jci.insight.169650] [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: 02/15/2023] [Accepted: 04/18/2023] [Indexed: 06/09/2023] Open
Abstract
Fragile X syndrome is a neurodevelopmental disorder caused by the absence of the mRNA-binding protein fragile X messenger ribonucleoprotein (FMRP). Because FMRP is a highly pleiotropic protein controlling the expression of hundreds of genes, viral vector-mediated gene replacement therapy is viewed as a potential viable treatment to correct the fundamental underlying molecular pathology inherent in the disorder. Here, we studied the safety profile and therapeutic effects of a clinically relevant dose of a self-complementary adeno-associated viral (AAV) vector containing a major human brain isoform of FMRP after intrathecal injection into wild-type and fragile X-KO mice. Analysis of the cellular transduction in the brain indicated primarily neuronal transduction with relatively sparse glial expression, similar to endogenous FMRP expression in untreated wild-type mice. AAV vector-treated KO mice showed recovery from epileptic seizures, normalization of fear conditioning, reversal of slow-wave deficits as measured via electroencephalographic recordings, and restoration of abnormal circadian motor activity and sleep. Further assessment of vector efficacy by tracking and analyzing individual responses demonstrated correlations between the level and distribution of brain transduction and drug response. These preclinical findings further demonstrate the validity of AAV vector-mediated gene therapy for treating the most common genetic cause of cognitive impairment and autism in children.
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Affiliation(s)
- Hayes Wong
- Department of Pharmaceutical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Alexander Wm Hooper
- Department of Pharmaceutical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Hye Ri Kang
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shiron J Lee
- Department of Pharmaceutical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Jiayi Zhao
- Department of Pharmaceutical Sciences, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Steven J Gray
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David R Hampson
- Department of Pharmaceutical Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
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3
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Arnson B, Kang HR, Brooks ED, Gheorghiu D, Ilich E, Courtney D, Everitt JI, Cullen BR, Koeberl DD. Genome editing using Staphylococcus aureus Cas9 in a canine model of glycogen storage disease Ia. Mol Ther Methods Clin Dev 2023; 29:108-119. [PMID: 37021039 PMCID: PMC10068017 DOI: 10.1016/j.omtm.2023.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 04/11/2022] [Accepted: 03/03/2023] [Indexed: 03/11/2023]
Abstract
Glycogen storage disease type Ia (GSD Ia) is the inherited deficiency of glucose-6-phosphatase (G6Pase), associated with life-threatening hypoglycemia and long-term complications, including hepatocellular carcinoma formation. Gene replacement therapy fails to stably reverse G6Pase deficiency. We attempted genome editing using two adeno-associated virus vectors, one that expressed Staphylococcus aureus Cas9 protein and a second containing a donor transgene encoding G6Pase, in a dog model for GSD Ia. We demonstrated donor transgene integration in the liver of three adult-treated dogs accompanied by stable G6Pase expression and correction of hypoglycemia during fasting. Two puppies with GSD Ia were treated by genome editing that achieved donor transgene integration in the liver. Integration frequency ranged from 0.5% to 1% for all dogs. In adult-treated dogs, anti-SaCas9 antibodies were detected before genome editing, reflecting prior exposure to S. aureus. Nuclease activity was low, as reflected by a low percentage of indel formation at the predicted site of SaCas9 cutting that indicated double-stranded breaks followed by non-homologous end-joining. Thus, genome editing can integrate a therapeutic transgene in the liver of a large animal model, either early or later in life, and further development is warranted to provide a more stable treatment for GSD Ia.
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Affiliation(s)
- Benjamin Arnson
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical School, Durham, NC, USA
- Department of Molecular Genetics & Microbiology, Duke University Medical Center, Durham, NC, USA
| | - Hye Ri Kang
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Elizabeth D. Brooks
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical School, Durham, NC, USA
| | - Dorothy Gheorghiu
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical School, Durham, NC, USA
| | - Ekaterina Ilich
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical School, Durham, NC, USA
| | - David Courtney
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, UK
| | - Jeffrey I. Everitt
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA
| | - Bryan R. Cullen
- Department of Molecular Genetics & Microbiology, Duke University Medical Center, Durham, NC, USA
| | - Dwight D. Koeberl
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical School, Durham, NC, USA
- Department of Molecular Genetics & Microbiology, Duke University Medical Center, Durham, NC, USA
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4
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Maurer M, Magerl M, Betschel S, Aberer W, Ansotegui IJ, Aygören-Pürsün E, Banerji A, Bara NA, Boccon-Gibod I, Bork K, Bouillet L, Boysen HB, Brodszki N, Busse PJ, Bygum A, Caballero T, Cancian M, Castaldo A, Cohn DM, Csuka D, Farkas H, Gompels M, Gower R, Grumach AS, Guidos-Fogelbach G, Hide M, Kang HR, Kaplan AP, Katelaris C, Kiani-Alikhan S, Lei WT, Lockey R, Longhurst H, Lumry WR, MacGinnitie A, Malbran A, Saguer IM, Matta JJ, Nast A, Nguyen D, Nieto-Martinez SA, Pawankar R, Peter J, Porebski G, Prior N, Reshef A, Riedl M, Ritchie B, Sheikh FR, Smith WB, Spaeth PJ, Stobiecki M, Toubi E, Varga LA, Weller K, Zanichelli A, Zhi Y, Zuraw B, Craig T. [Not Available]. ARERUGI = [ALLERGY] 2023; 72:237-272. [PMID: 37225467 DOI: 10.15036/arerugi.72.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Affiliation(s)
- M Maurer
- Institute of Allergology, Charité-Universitätsmedizin, Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology
| | - M Magerl
- Institute of Allergology, Charité-Universitätsmedizin, Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology
| | | | - W Aberer
- Department of Dermatology, Medical University of Graz
| | - I J Ansotegui
- Department of Allergy & Immunology, Hospital Quironsalud Bizkaia
| | - E Aygören-Pürsün
- Center for Children and Adolescents, University Hospital Frankfurt
| | - A Banerji
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital
| | - N A Bara
- Romanian Hereditary Angioedema Expertise Centre, Mediquest Clinical Research Center
| | - I Boccon-Gibod
- National Reference Center for Angioedema (CREAK), Angioedema Center of Reference and Excellence (ACARE), Grenoble Alpes University Hospital
| | - K Bork
- Department of Dermatology, University Medical Center, Johannes Gutenberg University
| | - L Bouillet
- National Reference Center for Angioedema (CREAK), Angioedema Center of Reference and Excellence (ACARE), Grenoble Alpes University Hospital
| | | | - N Brodszki
- Department of Pediatric Immunology, Childrens Hospital, Skåne University Hospital
| | - P J Busse
- Icahn School of Medicine at Mount Sinai
| | - A Bygum
- Clinical Institute, University of Southern Denmark
- Department of Clinical Genetics, Odense University Hospital
| | - T Caballero
- Allergy Department, Hospital Universitario La Paz
| | - M Cancian
- Department of Systems Medicine, University Hospital of Padua
| | | | - D M Cohn
- Department of Vascular Medicine, Amsterdam UMC/University of Amsterdam
| | - D Csuka
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University
| | - H Farkas
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University
| | - M Gompels
- Clinical Immunology, North Bristol NHS Trust
| | - R Gower
- Marycliff Clinical Research, Principle Research Solutions
| | - A S Grumach
- Clinical Immunology, Centro Universitario FMABC
| | | | - M Hide
- Department of Dermatology, Hiroshima Citizens Hospital
- Department of Dermatology, Hiroshima University
| | - H R Kang
- Department of Internal Medicine, Seoul National University College of Medicine
| | - A P Kaplan
- Division of Pulmonary, Critical Care, Allergy and Immunology, Medical University of South Carolina
| | - C Katelaris
- Department of Medicine, Campbelltown Hospital and Western Sydney University
| | | | - W T Lei
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Mackay Memorial Hospital
| | - R Lockey
- Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida
| | - H Longhurst
- Department of Immunology, Auckland District Health Board and Department of Medicine, University of Auckland
| | - W R Lumry
- Internal Medicine, Allergy Division, University of Texas Health Science Center
| | - A MacGinnitie
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School
| | - A Malbran
- Unidad de Alergia, Asma e Inmunología Clínica
| | - I M Saguer
- Pediatrics, Haemophilia Centre Rhine Main (HZRM)
| | - J J Matta
- H. Especialidades C.M.N.SXXI, I.M.S.S
| | - A Nast
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine Charité-Universitätsmedizin Berlin, corporate member of Free University of Berlin, Humboldt University of Berlin, and Berlin Institute of Health
| | - D Nguyen
- Respiratory, Allergy and Clinical Immunology Unit, Internal Medicine Department, Vinmec Healthcare System, College of Health Sciences, VinUniversity
| | | | - R Pawankar
- Department of Pediatrics, Nippon Medical School
| | - J Peter
- Division of Allergy and Clinical Immunology, University of Cape Town
- Allergy and Immunology Unit, University of Cape Town Lung Institute
| | - G Porebski
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College
| | - N Prior
- Allergy, Hospital Universitario Severo Ochoa
| | - A Reshef
- Angioderma Center, Barzilai University Medical Center
| | - M Riedl
- Division of Rheumatology, Allergy and Immunology, University of California San Diego
| | - B Ritchie
- Departments of Medicine and Medical Oncology, University of Alberta
| | - F R Sheikh
- Section of Adult Allergy & Immunology, Department of Medicine, King Faisal Specialist Hospital & Research Centre
| | - W B Smith
- Clinical Immunology and Allergy, Royal Adelaide Hospital
| | - P J Spaeth
- Institute of Pharmacology, University of Bern
| | - M Stobiecki
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College
| | - E Toubi
- Division of Allergy and Clinical Immunology, Bnai Zion Medical Center, Affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology
| | - L A Varga
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University
| | - K Weller
- Institute of Allergology, Charité-Universitätsmedizin, Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology
| | - A Zanichelli
- Department of Internal Medicine, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco-University of Milan
| | - Y Zhi
- Department of Allergy and Clinical Immunology, Bejing Union Medical College Hospital & Chinese Academy of Medical Sciences
| | - B Zuraw
- University of California, San Diego
| | - T Craig
- Departments of Medicine and Pediatrics, Penn State University
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5
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Lee JW, Lee SR, Kim MJ, Cho S, Youn SW, Yang MS, Kim SH, Kang HR, Kwon O. Skin manifestations and clinical features of drug reaction with eosinophilia and systemic symptoms (DRESS): A retrospective multicenter study of 125 patients. J Eur Acad Dermatol Venereol 2022; 36:1584-1592. [PMID: 35342995 DOI: 10.1111/jdv.18100] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 01/06/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe adverse drug reaction generally accompanied by skin manifestations as the first and most frequent symptoms. However, skin manifestations and associated clinical features of DRESS have not been fully explored and evaluated. OBJECTIVES This study aimed to describe the skin manifestations of DRESS in detail and analyze their association with demographic characteristics and extra-cutaneous clinical features. METHODS We conducted this retrospective study on patients with DRESS diagnosed between September 2009 and August 2021 at three medical institutes and validated using the RegiSCAR score. Data regarding demographics, skin manifestations, and clinical characteristics were retrieved through thorough chart reviews. RESULTS Among 182 potential cases of DRESS, the validated 125 cases were analyzed. A widespread rash extending over more than 50% of the body surface area was observed in 122 patients (97.6%) and typical facial edema was experienced by 67 patients (53.6%). Polymorphous maculopapules were the most common rash morphology (106, 84.8%): specifically, exfoliative (59, 47.2%), urticarial (57, 45.6%), and purpuric forms (39, 31.2%) were common. Mucosal involvement was observed in 41 patients (32.8%). Patients with carboxamide antiepileptics (carbamazepine and oxcarbazepine) experienced more edema (P = .014) and typical facial edema than those with allopurinol (P = .021). The RegiSCAR score was higher in patients with purpura (P < .01). CONCLUSIONS Skin manifestations of DRESS exhibit a wide range of skin lesions and can vary according to the culprit drugs. Early suspicion and prompt intervention are needed to improve prognosis.
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Affiliation(s)
- J W Lee
- Department of Dermatology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - S R Lee
- Department of Dermatology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea.,Department of Dermatology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, Republic of Korea
| | - M J Kim
- Department of Dermatology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - S Cho
- Department of Dermatology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, Republic of Korea
| | - S W Youn
- Department of Dermatology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - M S Yang
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, Republic of Korea
| | - S H Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - H R Kang
- Drug Safety Center, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine.,Institute of Allergy and Clinical Immunology, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - O Kwon
- Department of Dermatology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea.,Laboratory of Cutaneous Aging and Hair Research, Clinical Research Institute, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea.,Institute of Human-Environment Interface Biology, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
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6
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Han S, Gheorghiu DB, Li S, Kang HR, Koeberl D. Minimum Effective Dose to Achieve Biochemical Correction With AAV Vector-Mediated Gene Therapy in Mice With Pompe Disease. Hum Gene Ther 2022; 33:492-498. [PMID: 35102744 DOI: 10.1089/hum.2021.252] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pompe disease is an autosomal recessive lysosomal storage disorder caused by deficiency of acid α-glucosidase (GAA), resulting in skeletal muscle weakness and cardiomyopathy. Muscle weakness progresses despite currently available therapy, which has prompted the development of gene therapy with adeno-associated virus (AAV) type 2 vectors cross-packaged as AAV8 (2/8). Preclinical studies of gene therapy demonstrated that the minimum effective dose for biochemical correction with AAV2/8-LSPhGAA was approximately 2 x 1011 vector genomes (vg)/kg body weight. The current study examined the transduction of AAV2/8-LSPeGFP vector in adult GAA-KO mice with Pompe disease, and correlated that degree of transduction with the biochemical correction achieved by the same dose of AAV2/8-LSPhGAA. The minimum effective dose was found to be approximately 2 x 1011 vg/kg, with all hepatocytes variably transducing at this dose. At this dose, liver GAA significantly increased, while liver glycogen significantly decreased. The 2 x 1011 vg/kg dose was sufficient to significantly decrease diaphragm glycogen. However, the heart, diaphragm, and quadriceps all required a four-fold higher dose to achieve correction of GAA deficiency in association with significant clearance of stored glycogen, which correlated with increased serum GAA activity. These data indicate that AAV2/8-LSPeGFP transduced all hepatocytes when the 2 x 1011 vg/kg dose was administered, which correlated with partial biochemical correction from the equivalent dose of AAV2/8-LSPhGAA. Together these data support the conclusion that substantial transduction of the liver is required to achieve biochemical correction from AAV2/8-LSPhGAA.
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Affiliation(s)
- Sangoh Han
- Duke University Department of Pediatrics, 200759, Pediatrics, 905 LaSalle St., GSRBI RM 4048, Durham, North Carolina, United States, 27710;
| | - Dorothy Brooke Gheorghiu
- Duke University Medical Center, 22957, Pediatric Medical Genetics, 905 S Lasalle St, Durham, North Carolina, United States, 27710-4699;
| | - Songtao Li
- Duke University School of Medicine, 12277, Pediatrics, Durham, North Carolina, United States;
| | - Hye Ri Kang
- UT Southwestern, 12334, Pediatrics, Dallas, Texas, United States;
| | - Dwight Koeberl
- Duke University School of Medicine, 12277, Pediatrics, DUMC 103856, Durham, North Carolina, United States, 27710;
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Kim KW, Chung S, Lee SY, Yoon SS, Kang HR. Successful Infusion of Obinutuzumab by Desensitization: A Case of Anaphylactic Shock During Desensitization. J Investig Allergol Clin Immunol 2020; 30:457-459. [PMID: 32376522 DOI: 10.18176/jiaci.0581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- K W Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - S Chung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - S Y Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
| | - S S Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - H R Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.,Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea
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Lee SY, Kang DY, Kim JY, Yoon SH, Choi YH, Lee W, Cho SH, Kang HR. Incidence and Risk Factors of Immediate Hypersensitivity Reactions Associated With Low-Osmolar Iodinated Contrast Media: A Longitudinal Study Based on a Real-Time Monitoring System. J Investig Allergol Clin Immunol 2019; 29:444-450. [PMID: 30676320 DOI: 10.18176/jiaci.0374] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES We investigated the incidence of immediate hypersensitivity reaction (HSR) caused by different types of low-osmolar contrast media (LOCM) and cumulative exposure to LOCM. METHODS This cohort study included all consecutive patients who underwent LOCM-enhanced computed tomography from 2012 through 2014. We assessed 5 LOCM (iobitridol, iohexol, iomeprol, iopamidol, and iopromide). All patients were monitored for adverse events, and new symptoms and signs were recorded in real time using the Contrast Safety Monitoring and Management System (CoSM2oS). RESULTS The overall incidence of immediate HSR to LOCM was 0.97% (2004 events resulting from 205 726 exposures). Incidence differed significantly depending on whether the patient had a previous history of HSR to LOCM (0.80% in patients with no history and 16.99% in patients with a positive history of HSR to LOCM, P=.001). The incidence of HSR to individual LOCM ranged from 0.72% (iohexol) to 1.34% (iomeprol), although there were no significant differences across the 5 LOCM. A longitudinal analysis demonstrated that the incidence of HSR increased gradually with more frequent previous exposure to LOCM (HR=2.006 [95%CI, 1.517-2.653], P<.001). However, this cumulative increase in risk was observed in patients who had experienced HSR to LOCM, but not in those who had not. CONCLUSION The incidence of HSR did not differ significantly across the 5 LOCM assessed in the study. Repeated exposure to LOCM did not increase the risk of HSR among patients who had never experienced HSR to LOCM.
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Affiliation(s)
- S Y Lee
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.,Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - D Y Kang
- Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea
| | - J Y Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - S H Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Y H Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - W Lee
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - S H Cho
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.,Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea
| | - H R Kang
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.,Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea
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9
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Kim S, Lee CH, Jin KN, Cho SH, Kang HR. Severe Asthma Phenotypes Classified by Site of Airway Involvement and Remodeling via Chest CT Scan. J Investig Allergol Clin Immunol 2018; 28:312-320. [PMID: 29667580 DOI: 10.18176/jiaci.0265] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES This study aimed to establish a system that can classify severe asthma on the basis of airway remodeling patterns visualizedusing computed tomography (CT) images and to evaluate the clinical characteristics of individual image-based subtypes. METHODS Chest CT images from severe asthma patients were retrospectively evaluated to classify phenotypes by site of airway involvement and remodeling. The association between radiologic subtypes and clinical characteristics was assessed. RESULTS Of 91 patients with severe asthma, 74 (81.3%) exhibited abnormal radiologic findings, including bronchial wall thickening (BT), mucus plugging (MP), and bronchiectasis (BE). The severity of BT and the extent of MP were independently associated with peripheral blood eosinophil count (P=.012, r2=0.112) and sputum eosinophil count (P=.022, r2=0.090), respectively. The large-to-medium airway remodeling type, which showed diffuse BT combined with MP and BE, accounted for 44% of patients and revealed higher peripheral blood eosinophil counts than other types. In the small airway remodeling type, which accounted for 6.6% of patients, we observed a higher rate of fixed airflow obstruction, along with a predominance of males and smokers and more frequent use of controller medication than other phenotypes. In 26% of patients with severe asthma, no prominent airway remodeling was observed (near-normal type); the near-normal type required oral corticosteroids less frequently than the large-to-medium airway and small airway remodeling types. CONCLUSIONS Depending on the site of airway involvement and remodeling pattern, 3 different structural types can be distinguished in chest CT findings from patients with severe asthma. Remodeling in large-to-medium sized airways revealed an association with systemic eosinophilic inflammation in patients with severe asthma.
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Affiliation(s)
- S Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - C H Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - K N Jin
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - S H Cho
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - H R Kang
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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10
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Kang HR, Hwang SJ, Kim JW. Effect of Trypan Blue on the Survival of Cultured Trabecular Meshwork Cells. J Korean Ophthalmol Soc 2017. [DOI: 10.3341/jkos.2017.58.3.327] [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: 11/23/2022]
Affiliation(s)
- Hye Ri Kang
- Department of Ophthalmology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Seok Jin Hwang
- Department of Ophthalmology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jae Woo Kim
- Department of Ophthalmology, Catholic University of Daegu School of Medicine, Daegu, Korea
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11
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Kang HR, Lee JH, Kim JW. The Effect of Anti-inflammatory Agents on the Permeability of Trabecular Meshwork Cell Monolayers. J Korean Ophthalmol Soc 2017. [DOI: 10.3341/jkos.2017.58.10.1155] [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: 11/23/2022]
Affiliation(s)
- Hye Ri Kang
- Department of Ophthalmology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | | | - Jae Woo Kim
- Department of Ophthalmology, Catholic University of Daegu School of Medicine, Daegu, Korea
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12
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Lim KH, Kim JY, Kang MG, Park HK, Kang HR. Two cases of cytarabine syndrome successfully resolved by desensitization. J Investig Allergol Clin Immunol 2015; 25:80-82. [PMID: 25898709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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13
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Kang HR, Yim EY, Oh SY, Chang YS, Kim YK, Cho SH, Min KU, Kim YY. Normal C1 inhibitor mRNA expression level in type I hereditary angioedema patients: newly found C1 inhibitor gene mutations. Allergy 2006; 61:260-4. [PMID: 16409206 DOI: 10.1111/j.1398-9995.2006.01010.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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: 11/29/2022]
Abstract
BACKGROUND C1 esterase inhibitor (C1INH) plays a key role in the classical pathway of the complement cascade. Mutations in this gene cause a decreased level of antigenic (type I hereditary angioedema, HAE) or functional (type II HAE) C1INH. OBJECTIVE To find novel mutations in C1INH and evaluate the expression of C1INH gene in HAE patients. METHODS Direct sequencing mutation analysis was performed for genomic DNA from three unrelated families (14 HAE patients and 18 family members). Genomic DNA from one family was also analyzed for larger genomic rearrangements, using Southern blotting analysis. We used real-time quantitative polymerase chain reaction (PCR) to evaluate C1INH mRNA expression level. RESULTS Four mutations in exons (2,311 T-->C, 14,034 G-->A, 16,830 G-->A, and 16,979-16,980 G insertion) and four in introns (738 G-->A, 8,531 A-->G, 14,254 A-->G, and 14,337-14,378 TT deletion) were found. Interestingly, all of the nine patients in one family share the same mutation of Gly345Arg (14,034 G-->A) in the seventh exon. In another family, a single base mutation near the splice site (14,254 A-->G) was found in all of the three patients. In the last family, although a significant mutation was not found by direct sequencing, patients showed an abnormal 16 kb fragment in addition to the normal allele (21 kb Bcl I fragment). The C1INH mRNA expression of HAE patients in two families was not significantly different compared with that of normal controls. CONCLUSION The two novel exonal mutations (G-->A and A-->G) and one large gene deletion were associated with the clinical phenotypes of HAE. Considering the normal C1INH mRNA levels but below normal protein levels in two families, their phenotypes would be associated with the post-translational defect.
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Affiliation(s)
- H R Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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14
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Lee MK, Kim JH, Kang HR, Rho HJ, Nam EJ, Kim SW, Kang YM, Lee JM, Kim NS. Systemic lupus erythematosus complicated with cerebral venous sinus thrombosis : a report of two cases. J Korean Med Sci 2001; 16:351-4. [PMID: 11410699 PMCID: PMC3054746 DOI: 10.3346/jkms.2001.16.3.351] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A rare manifestation of systemic lupus erythematosus (SLE) is cerebral venous sinus thrombosis (CVST), in which early diagnosis and aggressive therapy are of prime importance for favorable outcome. The pathogenesis of CVST is largely unknown, but it is thought to be caused by cerebral vasculitis, antiphospholipid antibodies or other conditions associated with enhanced coagulability. We describe two cases of SLE with CVST which were not associated with antiphospholipid antibodies. Both cases were treated with immunosuppressants (intravenous methylprednisolone and cyclophosphamide pulse therapy) and anticoagulant drugs (heparin and subsequent maintenance therapy with warfarin). There was a marked improvement of neurologic symptoms with the disappearance of thrombus in a follow-up MRI. The possibility of CVST should be considered in any patients with SLE who show neuropsychiatric manifestations.
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Affiliation(s)
- M K Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Taegu, Korea
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Abstract
Myelodysplastic syndromes (MDS) are a group of refractory anemias resulting from a clonal stem cell disorder often associated with cytogenetic abnormalities. There is increasing recognition of immunological abnormalities in patients with MDS, including defective B- and T-cell function, hyper- or hypogammaglobulinemia and monoclonal gammopathy. MDS have been associated with Sjögren's syndrome, polymyalgia rheumatica, relapsing polychondritis and systemic lupus erythematosus. Although there may be various rheumatologic features, including acute arthritis in MDS, chronic inflammatory arthritis is uncommonly combined. There have been a few reports that described cases of rheumatoid arthritis (RA) concurrent with MDS, but advanced rheumatoid arthritis with typical joint deformities has rarely been reported. We report a case of rheumatoid arthritis with atlantoaxial subluxation combined with refractory anemia in a 31-year-old woman.
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Affiliation(s)
- E J Nam
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Taegu, Korea
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