1
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Düchs MJ, Kratzer RF, Vieyra-Garcia P, Strobel B, Schönberger T, Groß P, Aljayyoussi G, Gupta A, Lang I, Klein H, Morilla SM, Hopf S, Park J, Kreuz S, Klugmann M, Igney FH. Riboswitch-controlled IL-12 gene therapy reduces hepatocellular cancer in mice. Front Immunol 2024; 15:1360063. [PMID: 38558809 PMCID: PMC10979303 DOI: 10.3389/fimmu.2024.1360063] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/14/2024] [Indexed: 04/04/2024] Open
Abstract
Hepatocellular carcinoma (HCC) and solid cancers with liver metastases are indications with high unmet medical need. Interleukin-12 (IL-12) is a proinflammatory cytokine with substantial anti-tumor properties, but its therapeutic potential has not been realized due to severe toxicity. Here, we show that orthotopic liver tumors in mice can be treated by targeting hepatocytes via systemic delivery of adeno-associated virus (AAV) vectors carrying the murine IL-12 gene. Controlled cytokine production was achieved in vivo by using the tetracycline-inducible K19 riboswitch. AAV-mediated expression of IL-12 led to STAT4 phosphorylation, interferon-γ (IFNγ) production, infiltration of T cells and, ultimately, tumor regression. By detailed analyses of efficacy and tolerability in healthy and tumor-bearing animals, we could define a safe and efficacious vector dose. As a potential clinical candidate, we characterized vectors carrying the human IL-12 (huIL-12) gene. In mice, bioactive human IL-12 was expressed in a vector dose-dependent manner and could be induced by tetracycline, suggesting tissue-specific AAV vectors with riboswitch-controlled expression of highly potent proinflammatory cytokines as an attractive approach for vector-based cancer immunotherapy.
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Affiliation(s)
- Matthias J. Düchs
- Research Beyond Borders, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Ramona F. Kratzer
- Cancer Immunology and Immune Modulation, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Pablo Vieyra-Garcia
- Cancer Immunology and Immune Modulation, Boehringer Ingelheim RCV GmbH & Co. KG, Vienna, Austria
| | - Benjamin Strobel
- Drug Discovery Sciences, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Tanja Schönberger
- Drug Discovery Sciences, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Peter Groß
- Drug Discovery Sciences, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Ghaith Aljayyoussi
- Drug Discovery Sciences, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Aradhana Gupta
- Nonclinical Drug Safety, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, United States
| | - Isabel Lang
- Research Beyond Borders, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Holger Klein
- Global Computational Biology and Digital Sciences, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Sandra Martinez Morilla
- Cancer Immunology and Immune Modulation, Boehringer Ingelheim RCV GmbH & Co. KG, Ridgefield, CT, United States
| | - Stefan Hopf
- Cancer Immunology and Immune Modulation, Boehringer Ingelheim RCV GmbH & Co. KG, Vienna, Austria
| | - John Park
- Cancer Immunology and Immune Modulation, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Sebastian Kreuz
- Research Beyond Borders, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Matthias Klugmann
- Research Beyond Borders, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Frederik H. Igney
- Cancer Immunology and Immune Modulation, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
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2
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Benza R, Lang I, Matsubara H, Naeije R, Vizza C, Waxman A, Adamson P, Liu Y, Golden G. ARTISAN: A Novel Study of Mean Pulmonary Artery Pressure-Targeted Approach with Early and Rapid Treprostinil Therapy to Reverse Right Ventricular Remodeling in Pulmonary Arterial Hypertension. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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3
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Cecilia V, Ausserhofer T, Lang I, Mascherbauer J, Tschernko E, Dworschak M, Ankersmit H, Moser B. INCREASED SUPAR SERUM CONCENTRATIONS IN PATIENTS WITH LEFT AND RIGHT VENTRICULAR REMODELING DUE TO PRESSURE OVERLOAD IS ASSOCIATED WITH MYOCARDIAL MASS. J Cardiothorac Vasc Anesth 2022. [DOI: 10.1053/j.jvca.2022.09.100] [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: 12/05/2022]
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4
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Di Cosimo S, Pizzamiglio S, Sotiriou C, Ciniselli C, Triulzi T, de Cecco L, El-Abed S, Izquierdo M, de Azambuja E, Saura C, Huober J, Untch M, Lang I, Loi S, Tagliabue E, Rubio I, Vingiani A, Colombo M, Verderio P, Pruneri G. Gene expression profile at week 2 of neoadjuvant therapy course predicts outcome in HER2-positive breast cancer patients: an explorative analysis from NeoALTTO. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01561-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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5
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Koskinas KC, Losdat S, Shibutani H, Ueki Y, Otsuka T, Haener J, Fahrni G, Iglesias JF, Spirk D, Van Geuns RJ, Daemen J, Windecker S, Engstrom T, Lang I, Raber L. Interrelation between baseline plaque characteristics and changes in coronary atherosclerosis with the PCSK9-inhibitor alirocumab: insights from the PACMAN-AMI randomized trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with acute myocardial infarction (AMI) frequently experience recurrent atherothrombotic events, largely attributable to non-culprit lesions with high-risk characteristics. Statins can halt the progression of coronary atherosclerosis, and addition of protein convertase subtilisin/kexin type 9-inhibitors (PCSK9i) results in incremental low-density lipoprotein cholesterol (LDL-C) lowering and atheroma regression.
Purpose
We sought to examine the interrelation between baseline imaging characteristics, on-treatment LDL-C levels, and changes in coronary atherosclerosis as assessed by serial, multi-modality intracoronary imaging in patients with AMI.
Methods
This is a post hoc analysis from the PACMAN-AMI randomized trial. Patients were randomly allocated to biweekly alirocumab 150 mg vs. placebo on top of high-intensity statin initiated within 24h of presentation with AMI, and underwent serial imaging of the two non-infarct-related arteries at baseline and after 52 weeks. The primary endpoint was percent atheroma volume (PAV) by intravascular ultrasound (IVUS). Powered secondary endpoints were maximal lipid core burden index (maxLCBI4mm) by near-infrared spectroscopy (NIRS) and minimum fibrous cap thickness (FCTmin) by optical coherence tomography (OCT).
Results
Of 300 randomized patients (mean age 58.5±9.8 years, 18.7% women, baseline LDL-C 3.94±0.87 mmol/L), IVUS was serially performed in 265 patients (537 arteries). LDL-C levels decreased to 1.92±0.79 mmol/L with placebo and 0.61±0.61 mmol/L with alirocumab (p<0.001). Compared with placebo (statin alone), alirocumab added to statin resulted in greater PAV reduction (−2.13% vs. −0.92%; p<0.001), greater maxLCBI4mm reduction (−79.42 vs. −37.60; p=0.006), and greater increase in FCTmin (62.67 vs. 33.19 μm; p=0.001). Changes in PAV and maxLCBI4mm were inversely related to on-treatment LDL-C levels, and change in FCTmin was positively related to on-treatment LDL-C levels (Figure 1). Across all patients, we found significant, inverse relationships between change in PAV and baseline PAV [slope: −0.072 (95% CI −0.101 to −0.042); p<0.001], between change in maxLCBI4mm and baseline maxLCBI4mm [slope: −0.437 (95% CI −0.505 to −0.369); p<0.001], and between change in FCTmin and baseline FCTmin [slope: −0.436 (95% CI −0.541 to −0.332); p<0.001]; these findings indicate greater PAV and maxLCBI4mm regression in lesions with greater PAV and LCBI4mm at baseline, and greater fibrous cap thickening in lesions with thinner fibrous caps at baseline.
Conclusion
In this study of intensive LDL-C lowering treatment initiated in the acute AMI setting, more favorable plaque changes were observed in patients with lower on-treatment LDL-C levels and in lesions with more adverse baseline plaque characteristics. Whether AMI patients with high-risk plaque features might derive greater clinical benefit from early initiation of intensive LDL-C-lowering therapies requires further investigation.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Sanofi, Regeneron
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Affiliation(s)
- K C Koskinas
- Bern University Hospital, Inselspital , Bern , Switzerland
| | - S Losdat
- CTU Bern, University of Bern , Bern , Switzerland
| | - H Shibutani
- Bern University Hospital, Inselspital , Bern , Switzerland
| | - Y Ueki
- Bern University Hospital, Inselspital , Bern , Switzerland
| | - T Otsuka
- Bern University Hospital, Inselspital , Bern , Switzerland
| | - J Haener
- Bern University Hospital, Inselspital , Bern , Switzerland
| | - G Fahrni
- University Hospital Basel , Basel , Switzerland
| | - J F Iglesias
- Geneva University Hospitals, Cardiology , Geneva , Switzerland
| | - D Spirk
- University of Bern , Bern , Switzerland
| | - R J Van Geuns
- Radboud University Medical Centre , Nijmegen , The Netherlands
| | - J Daemen
- Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - S Windecker
- Bern University Hospital, Inselspital , Bern , Switzerland
| | - T Engstrom
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - I Lang
- Medical University of Vienna , Vienna , Austria
| | - L Raber
- Bern University Hospital, Inselspital , Bern , Switzerland
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6
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Schrutka L, Hagn G, Galli L, Poeschl A, Seidl V, Ondracek A, Bileck A, Lang I, Hengstenberg C, Krychtiuk K, Speidl W, Gerner C, Distelmaier K. Plasma eicosanoid profiling in the course of proprotein convertase subtilisin-kexin type 9 inhibition: insights from a metabolomic analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.3031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Treatment with monoclonal antibodies targeting circulating proprotein convertase subtilisin-kexin type 9 (PCSK9) was found to reduce all-cause mortality in addition to cardiovascular events, suggesting pleiotropic effects. Eicosanoids are bioactive metabolites involved in cardiovascular disease and have not yet been studied in the course of PCSK9 inhibition.
Methods
In this prospective translational single-center study, plasma samples were collected from 64 patients before and after initiation of PCSK9 inhibitor treatment. Metabolomic analyses were performed using liquid chromatography coupled to high-resolution mass spectrometry.
Results
A total of 62 bioactive eicosanoids were detected. Among the metabolites, four were significantly decreased by PCSK9 inhibition after one month and remained stable after 6 months (figure): arachidonic acid (p=0.003), 12,13-DiHOME (p<0.001), 9-HpODE_9.91 (p=0.007) and HpODE_7.71 (p=0.011). Phospholipase A2 levels were reduced by 40% after 1 month (p=0.003) and by additional 50% after 6 months of treatment (p=0.015), but did not correlate with eicosanoids (p=0.057). The change in arachidonic acid levels resulted in a significant increase in the ratio of omega-3 to omega-6 polyunsaturated fatty acids (p=0.002).
Conclusion
PCSK9 inhibition leads to significant changes in the eicosanoid profile already after one month, in particular to a downregulation of arachidonic acid. This discovery complements the presumed pleiotropic effects of PCSK9 inhibition and may provide additional benefit in the treatment of atherosclerotic disease.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Schrutka
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - G Hagn
- University of Vienna, Department of Analytical Chemistry , Vienna , Austria
| | - L Galli
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - A Poeschl
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - V Seidl
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - A Ondracek
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - A Bileck
- University of Vienna, Department of Analytical Chemistry , Vienna , Austria
| | - I Lang
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - C Hengstenberg
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - K Krychtiuk
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - W Speidl
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - C Gerner
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - K Distelmaier
- Medical University of Vienna, Cardiology , Vienna , Austria
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7
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Eyileten C, Jarosz-Popek J, Jakubik D, Gasecka A, Wolska M, Czajka P, Nowak A, Ufnal M, Dizdarevic A, Toma A, Lang I, Postula M, Siller-Matula JM. Increased symmetric dimethyl-arginine is a predictor factor of decreased platelet reactivity and increased bleeding risk in patients with acute coronary syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
One of the promising biomarkers in CVD are asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA), which are products of L-arginine methylation and are both involved in endothelial dysfunction. ADMA, SDMA and L-homoarginine, have emerged as biomarkers linked to cardiovascular outcomes [1].
Purpose
To investigate the association of SDMA with platelet reactivity and bleeding risk in patients with acute coronary syndrome (ACS) treated with potent P2Y12 inhibitors prasugrel and ticagrelor.
Methods
Our prospective observational study enrolled 292 patients with ACS undergoing percuteneus coronary intervention [2]. Plasma concentrations of SDMA were measured during the hospitalization for ACS. Impedance aggregometry was used. The primary study endpoint was the concentration of metabolites and platelet reactivity. The primary clinical outcome endpoint was the incidence of Thrombolysis in Myocardial Infarction (TIMI) bleeding events (major, minor and minimal). The efficacy endpoint was the composite of major adverse cardiac events (MACE: stent thrombosis, myocardial infarction, stroke and cardiac death).
Results
There was an inverse correlation between SDMA serum levels and platelet reactivity (r=−0.25; p<0.000). The ADP+PGE1-induced platelet reactivity was 33% lower among patients with the highest SDMA quartile (4th) as compared to those with the 1–3rd SDMA quartile (8 [0–29] vs 12 [0–126] U; p<0.001). The AA-induced platelet reactivity was 56% lower among patients with the highest SDMA quartile (4th) as compared to those with the 1–3rd SDMA quartile (4 [0–48] vs 9 [0–133]; p<0.001). In a multivariate model, the highest SDMA (4th) quartile was found to be an independent predictor of the lowest ADP+PGE1 and AA induced platelet aggregation (OR: 2.666, 95% CI [1.184–5.999], p=0.018).
Conclusions
Our study shows that high plasma concentration of SDMA, but not ADMA, is independently associated with low platelet reactivity to ADP and AA and is associated with major and minor bleeding events in patients with ACS on potent antiplatelet therapies. Therefore, SDMA might have a potential to be further evaluated as a blood biomarker for individualization of duration and potency of antiplatelet therapies in an ACS population at high risk of bleeding complications.
Acknowledgment
I-COMET research team
Funding Acknowledgement
Type of funding sources: None. Figure 1Table 1
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Affiliation(s)
- C Eyileten
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - J Jarosz-Popek
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - D Jakubik
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - A Gasecka
- Medical University of Warsaw, 1st Chair and Department of Cardiology, Warsaw, Poland
| | - M Wolska
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - P Czajka
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - A Nowak
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - M Ufnal
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - A Dizdarevic
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - A Toma
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - I Lang
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - M Postula
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - J M Siller-Matula
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
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8
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Eyileten C, Jarosz-Popek J, Jakubik D, Wolska M, Fitas A, Czajka P, Nowak A, Ufnal M, Postula M, Toma A, Lang I, Siller-Matula JM. High concentrations of plasma trimethylamine-n-oxide is associated with long-term cardiovascular mortality in patients with acute coronary syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Acute coronary syndrome (ACS) remains a leading cause of mortality worldwide [1]. Patients who experienced ACS are at high risk of future cardiovascular events and death [2–4]. Identification of reliable predictive tools could potentially improve the risk stratification [5]. Numerous studies revealed that intestinal microbial organisms (microbiota) and its metabolites, as TMAO (trimethylamine-N-oxide) may play a pathogenic role in a cardiovascular disease (CVD) and ACS [6]. Elevated concentration of circulating TMAO has been associated with increased risk of CVD and major adverse cardiac events (MACE), including myocardial infarction (MI), stroke, major bleeding and all-cause mortality [7].
Purpose
To investigate the association of liver metabolite TMAO with cardiovascular disease (CV)-related and all-cause mortality in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention.
Methods
Our prospective observational study enrolled 292 patients with ACS. Plasma concentrations of TMAO were measured during the hospitalization for ACS. Observation period lasted 7 years in the median. Adjusted Cox-regression analysis was used for prediction of mortality.
Results
ROC curve analysis revealed that increasing concentrations of TMAO levels assessed at the time point of ACS significantly predicted the risk of CV mortality (c-index=0.78, p<0.001). The cut-off value of >4 μmol/L, labeled as high TMAO level (23% of study population), provided the greatest sum of sensitivity (85%) and specificity (80%) for the prediction of CV mortality and was associated with a positive predictive value of 16% and a negative predictive value of 99%. A multivariate Cox regression model revealed that high TMAO level was a strong and independent predictor of CV death (HR=11.62, 95% CI: 2.26–59.67; p=0.003). High TMAO levels as compared with low TMAO levels were associated with the highest risk of CV death in a subpopulation of patients with diabetes mellitus (27.3% vs 2.6%; p=0.004). Although increasing TMAO levels were also significantly associated with all-cause mortality, their estimates for diagnostic accuracy were low.
Conclusions
High TMAO level is a strong and independent predictor of long-term CV mortality among patients presenting with ACS. TMAO concentration of 4 μmol/L may be a cut-off value for prognosis of ACS patients.
Funding Acknowledgement
Type of funding sources: None. Figure 1. Kaplan-Meier curvesTable 1
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Affiliation(s)
- C Eyileten
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - J Jarosz-Popek
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - D Jakubik
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - M Wolska
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - A Fitas
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - P Czajka
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - A Nowak
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - M Ufnal
- Medical University of Warsaw, Department of Experimental Physiology and Pathophysiology, Laboratory of Centre for Preclinical Rese, Warsaw, Poland
| | - M Postula
- Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharma, Warsaw, Poland
| | - A Toma
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - I Lang
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - J M Siller-Matula
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
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9
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Dona C, Koschutnik M, Nitsche C, Winter MP, Mach M, Andreas M, Bartko P, Kammerlander A, Goliasch G, Lang I, Hengstenberg C, Mascherbauer J. Cerebral protection in TAVR – can we do without? Impact on stroke rate, length of hospital stay and 12-month mortality. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Stroke associated with transcatheter aortic valve replacement (TAVR) is a potentially devastating complication. Until recently, the Sentinel™ Cerebral Protection System (CPS; Boston Scientific) has been the only commercially available device for mechanical prevention of TAVR-related stroke. However, its effectiveness is still undetermined.
Methods
Between January 2019 and August 2020 consecutive patients were randomly assigned to TAVR with or without Sentinel™ in a 1:1 fashion. We defined as primary endpoint clinically detectable cerebrovascular events within 72 hours after TAVR, and as secondary endpoints LOS and 12-month mortality. Logistic and linear regression analyses were used to assess associations of Sentinel™ use with endpoints.
Results
Of 411 patients (80±7 y/o, 47.4% female, EuroSCORE II 6.3±5.9%), Sentinel™ was used in 213 (51.8%), with both filters correctly deployed in 189 (46.0%). 20 (4.9%) cerebrovascular events were recorded, 10 (2.4%) of which were disabling strokes. Sentinel™ reduced cerebrovascular events in univariate analysis by 71% (OR 0.29, 95% CI 0.11–0.82; p=0.02) and after multivariate adjustment by 75% (adj. OR 0.25; 95% CI 0.08–0.80; p=0.02). Sentinel™ use was also significantly associated with shorter LOS (8.4±9.6 versus 6.7±6.1 days; p=0.03) and lower 12-month all-cause mortality (15.7% versus 7.5%, p=0.01).
Conclusions
In the present prospective all-comers TAVR cohort, Sentinel™ significantly 1) reduced cerebrovascular events, 2) shortened LOS, and 3) improved 12-month survival. These data promote the use of a CPS when implanting TAVR valves.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Dona
- Medical University of Vienna, Wien, Austria
| | | | - C Nitsche
- Medical University of Vienna, Wien, Austria
| | - M P Winter
- Medical University of Vienna, Wien, Austria
| | - M Mach
- Medical University of Vienna, Wien, Austria
| | - M Andreas
- Medical University of Vienna, Wien, Austria
| | - P Bartko
- Medical University of Vienna, Wien, Austria
| | | | - G Goliasch
- Medical University of Vienna, Wien, Austria
| | - I Lang
- Medical University of Vienna, Wien, Austria
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10
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Winter M, Bartko P, Krickl A, Gatterer C, Nitsche C, Koschutnik M, Dona C, Spinka G, Siller-Matula J, Lang I, Mascherbauer J, Hengstenberg C, Goliasch G. Adaptive development of concomitant secondary mitral and tricuspid regurgitation after TAVR. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Concomitant secondary atrioventricular regurgitation is frequent in patients with severe aortic stenosis scheduled fortranscatheter aortic valve replacement (TAVR). The future implications of leaving associated valve lesions untreated after TAVR remain unknown. Aim of the present study wasto characterize the evolution of concomitant secondary atrioventricular regurgitations and to evaluate their impact on long-term prognosis.
Methods
We prospectively enrolled 429 consecutive TAVR patients. All patients underwent comprehensive clinical, laboratory, and echocardiographic assessments prior to TAVR, at discharge, and yearly thereafter. All-cause mortality was chosen as primary study endpoint.
Results
At baseline, severe concomitant secondary mitral regurgitation (sMR) was present in 54 (13%) and severe concomitant secondary tricuspid regurgitation (sTR) in 75 patients (17%). After TAVR 59% of patients with severe sMR at baseline experienced sMR regression, whereas analogously sTR regressed in 43% of patients with severe sTR at baseline. Persistence of sTR and sMR were associated with excess mortality after adjustment for our bootstrap-selected confounder model with an adjusted HR of 2.44 (95% CI 1.15–5.20, P=0.021) for sMR and of 2.09 (95% CI 1.20–3.66, P=0.01) for sTR (Figure 1). Furthermore patients showing regression of atrioventricular regurgitation exhibited survival rates indistinguishable to those seen in patients without concomitant atrioventricular regurgitation (sMR: P=0.83; sTR: P=0.74)
Conclusion
Concomitant secondary atrioventricular regurgitation in patients with severe AS is a highly dynamic process with up to half of all patients showing regression of associated valvular regurgitation after TAVR and subsequent favorable post-interventional outcome. Persistent atrioventricular regurgitation is a major determinant of TAVR futility and proposes a window of early sequel intervention.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M.P Winter
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - P.E Bartko
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - A Krickl
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - C Gatterer
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - C Nitsche
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - M Koschutnik
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - C Dona
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - G Spinka
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - J Siller-Matula
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - I Lang
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - J Mascherbauer
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - C Hengstenberg
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - G Goliasch
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
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Shafran I, Probst V, Campean J, Sadushi-Kolici R, Gerges C, Lang I, Skoro-Sajer N. The role of asymmetric dimethylarginine (ADMA) in the follow-up of patients with precapillary pulmonary hypertension (PH). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Asymmetric dimethylarginine (ADMA) interferes with L-arginine in the production of nitric oxide, a key mediator of endothelial cell function. ADMA is elevated in pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) and is associated with unfavorable outcomes.
Aim
To assess the role of ADMA to monitor disease progression of PH patients treated with PAH-specific therapy.
Methods
ADMA was measured by competitive ELISA at baseline (BL) and follow-up (FU). Risk assessment including a clinical assessment, echocardiography, 6-minute walking test, NT-pro-BNP and hemodynamic assessment by right heart catheterization was performed accordingly. Risk was calculated according to the ESC/ERS 2015 guidelines by the SPHAR method.
Results
ADMA samples were collected from 113 patients treated at our institution between 2012 and 2019. 89 (79%) patients had PAH, 15 (13%) were diagnosed with CTEPH and 9 (8%) with group 3 – PH associated with lung disease. 69% were females. 15 (13.3%) patients had a low risk at baseline, 96 (85%) intermediate risk and 2 (1.8%) were high risk patients. 75% received oral medications, 31% received subcutaneous treprostinil. Median baseline ADMA was 0.738umol/l. At BL no significant difference of ADMA plasma levels was found among the different PH types (p=0.063), or between different risk categories (p=0.531).
Change in ADMA plasma levels correlated with change in risk (p=0.002, rs 0.291) and with change in mixed venous saturation (p=0.034, rs −0.205). Change in ADMA plasma levels also correlated with risk at FU (p=0.011, rs 0.240).
Patients categorized as low risk at FU had a median ADMA plasma level decrease of 22%, compared with −3 to 0% ADMA plasma level change in patients with moderate to high risk at FU (p=0.04). Patients who improved their risk category had a median decrease of ADMA plasma level of 23% vs. 2.3% in patients who did not improve (p=0.011). Decrease of ADMA plasma levels was a weak but significant discriminator for improvement of risk in ROC analysis (p=0.032, AUC 0.374).
Conclusion
ADMA plasma levels paralleled the hemodynamic and clinical benefit of PAH-specific treatments in patients with precapillary PH. ADMA could be used as a biomarker for monitoring treatment effects in precapillary PH.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- I Shafran
- Medical University of Vienna, Vienna, Austria
| | - V Probst
- Medical University of Vienna, Vienna, Austria
| | - J Campean
- Medical University of Vienna, Vienna, Austria
| | | | - C Gerges
- Medical University of Vienna, Vienna, Austria
| | - I Lang
- Medical University of Vienna, Vienna, Austria
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12
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Schneider M, Ran H, Pistritto AM, Gerges C, Heidari H, Hengstenberg C, Bergler-Klein J, Lang I, Binder T, Goliasch G. P1739 Diameter of the pulmonary artery in relation to the ascending aorta: a promising parameter for the diagnosis of pulmonary hypertension. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Pulmonary hypertension (PH) is a disease with significant morbidity and mortality. The first imaging modality in the diagnostic algorithm is transthoracic echocardiography (TTE). Despite significant technological advances in recent years, there are still patients with PH who are missed by TTE. The pulmonary artery to ascending aorta ratio (PA/Ao-R) has been evaluated in cardiac magnetic resonance (CMR) and computed tomography (CT) studies. The ratio was able to detect patients with PH, it correlated with hemodynamics, and it was predictive for mortality. We sought to evaluate the diagnostic accuracy of PA/Ao-R measured by TTE in the detection of PH.
Methods
We evaluated consecutive patients who received quasi-simultaneous transthoracic echocardiography and right heart catheterization (RHC) for evaluation of pulmonary hypertension between July 2015 and July 2016.
Results
A total of 84 patients fulfilled the inclusion criteria, 47 were female, mean age was 65 years. Median PA/Ao-R was 0.8 (Q1;Q3 0.69;0.94). Seventy patients had PH (median mean pulmonary artery pressure (mPAP) was 35.5 mmHg, Q1;Q3 27;47). The area under the curve for the diagnosis of PH via PA/Ao-R was 0.853. A cut-off of 1 was chosen for further analysis. Sensitivity for the diagnosis of PH was 100%, specificity was 23%. PA/Ao-R correlated with mPAP (r = 0.65, p < 0.001), and pulmonary vascular resistance (r = 0.68, p < 0.001). In the subgroup of patients with PH, those patients with a PA/Ao-R of ≥1 had significantly (p < 0.001) higher pulmonary pressures than those below, with a mean mPAP of 53 mmHg as compared to 38.5 mmHg.
Conclusion
PA/Ao-R correlates with mPAP. A ratio of ≥1 should prompt suspicion for the presence of PH. PA/Ao-R should be reported in every patient who is evaluated for PH.
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Affiliation(s)
- M Schneider
- Medical University of Vienna, Vienna, Austria
| | - H Ran
- Nanjing 1st Hospital, Department of Echocardiography, Nanjing, China
| | - A M Pistritto
- San Paolo Hospital, Emergency Department, Division of Cardiology, Savona, Italy
| | - C Gerges
- Medical University of Vienna, Vienna, Austria
| | - H Heidari
- Medical University of Vienna, Vienna, Austria
| | | | | | - I Lang
- Medical University of Vienna, Vienna, Austria
| | - T Binder
- Medical University of Vienna, Vienna, Austria
| | - G Goliasch
- Medical University of Vienna, Vienna, Austria
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Langleben D, Gaine S, Sitbon O, Channick R, Chin K, Di Scala L, Galiè N, Hoeper M, McLaughlin V, Preiss R, Rubin L, Simonneau G, Tapson V, Ghofrani H, Lang I. THE IMPACT OF TIME FROM DIAGNOSIS AT BASELINE ON LONG-TERM OUTCOME IN THE GRIPHON STUDY: SELEXIPAG IN PULMONARY ARTERIAL HYPERTENSION (PAH). Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Zeymer U, Ludman P, Danchin N, Kala P, Maggioni AP, Weidinger F, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy VK, Nedoshivin A, Petronio AS, Roos-Hesselink J, Wallentin L, Zeymer U, Weidinger F, Zeymer U, Danchin N, Ludman P, Sinnaeve P, Kala P, Ferrari R, Maggioni AP, Goda A, Zelveian P, Weidinger F, Karamfilov K, Motovska Z, Zeymer U, Raungaard B, Marandi T, Shaheen SM, Lidon RM, Karjalainen PP, Kereselidze Z, Alexopoulos D, Becker D, Quinn M, Iakobishvili Z, Al-Farhan H, Sadeghi M, Caporale R, Romeo F, Mirrakhimov E, Serpytis P, Erglis A, Kedev S, Balbi MM, Moore AM, Dudek D, Legutko J, Mimoso J, Tatu-Chitoiu G, Stojkovic S, Shlyakhto E, AlHabib KF, Bunc M, Studencan M, Mourali MS, Bajraktari G, Konte M, Larras F, Lefrancq EF, Mekhaldi S, Laroche C, Maggioni AP, Goda A, Shuka N, Pavli E, Tafaj E, Gishto T, Dibra A, Duka A, Gjana A, Kristo A, Knuti G, Demiraj A, Dado E, Hasimi E, Simoni L, Siqeca M, Sisakian H, Hayrapetyan H, Markosyan S, Galustyan L, Arustamyan N, Kzhdryan H, Pepoyan S, Zirkik A, Von Lewinski D, Paetzold S, Kienzl I, Matyas K, Neunteufl T, Nikfardjam M, Neuhold U, Mihalcz A, Glaser F, Steinwender C, Reiter C, Grund M, Hrncic D, Hoppe U, Hammerer M, Hinterbuchner L, Hengstenberg C, Delle Karth G, Lang I, Weidinger F, Winkler W, Hasun M, Kastner J, Havel C, Derntl M, Oberegger G, Hajos J, Adlbrecht C, Publig T, Leitgeb MC, Wilfing R, Jirak P, Ho CY, Puskas L, Schrutka L, Spinar J, Parenica J, Hlinomaz O, Fendrychova V, Semenka J, Sikora J, Sitar J, Groch L, Rezek M, Novak M, Kramarikova P, Stasek J, Dusek J, Zdrahal P, Polasek R, Karasek J, Seiner J, Sukova N, Varvarovsky I, Lazarák T, Novotny V, Matejka J, Rokyta R, Volovar S, Belohlavek J, Motovska Z, Siranec M, Kamenik M, Kralik R, Raungaard B, Ravkilde J, Jensen SE, Villadsen A, Villefrance K, Schmidt Skov C, Maeng M, Moeller K, Hasan-Ali H, Ahmed TA, Hassan M, ElGuindy A, Farouk Ismail M, Ibrahim Abd El-Aal A, El-sayed Gaafar A, Magdy Hassan H, Ahmed Shafie M, Nabil El-khouly M, Bendary A, Darwish M, Ahmed Y, Amin O, AbdElHakim A, Abosaif K, Kandil H, Galal MAG, El Hefny EE, El Sayed M, Aly K, Mokarrab M, Osman M, Abdelhamid M, Mantawy S, Ali MR, Kaky SD, Khalil VA, Saraya MEA, Talaat A, Nabil M, Mounir WM, Mahmoud K, Aransa A, Kazamel G, Anwar S, Al-Habbaa A, Abd el Monem M, Ismael A, Amin Abu-Sheaishaa M, Abd Rabou MM, Hammouda TMA, Moaaz M, Elkhashab K, Ragab T, Rashwan A, Rmdan A, AbdelRazek G, Ebeid H, Soliman Ghareeb H, Farag N, Zaki M, Seleem M, Torki A, Youssef M, AlLah Nasser NA, Rafaat A, Selim H, Makram MM, Khayyal M, Malasi K, Madkour A, Kolib M, Alkady H, Nagah H, Yossef M, Wafa A, Mahfouz E, Faheem G, Magdy Moris M, Ragab A, Ghazal M, Mabrouk A, Hassan M, El-Masry M, Naseem M, Samir S, Marandi T, Reinmets J, Allvee M, Saar A, Ainla T, Vaide A, Kisseljova M, Pakosta U, Eha J, Lotamois K, Sia J, Myllymaki J, Pinola T, Karjalainen PP, Paana T, Mikkelsson J, Ampio M, Tsivilasvili J, Zurab P, Kereselidze Z, Agladze R, Melia A, Gogoberidze D, Khubua N, Totladze L, Metreveli I, Chikovani A, Eitel I, Pöss J, Werner M, Constantz A, Ahrens C, Zeymer U, Tolksdorf H, Klinger S, Sack S, Heer T, Lekakis J, Kanakakis I, Xenogiannis I, Ermidou K, Makris N, Ntalianis A, Katsaros F, Revi E, Kafkala K, Mihelakis E, Diakakis G, Grammatikopoulos K, Voutsinos D, Alexopoulos D, Xanthopoulou I, Mplani V, Foussas S, Papakonstantinou N, Patsourakos N, Dimopoulos A, Derventzis A, Athanasiou K, Vassilikos VP, Papadopoulos C, Tzikas S, Vogiatzis I, Datsios A, Galitsianos I, Koutsampasopoulos K, Grigoriadis S, Douras A, Baka N, Spathis S, Kyrlidis T, Hatzinikolaou H, Kiss RG, Becker D, Nowotta F, Tóth K, Szabó S, Lakatos C, Jambrik Z, Ruzsa J, Ruzsa Z, Róna S, Toth J, Vargane Kosik A, Toth KSB, Nagy GG, Ondrejkó Z, Körömi Z, Botos B, Pourmoghadas M, Salehi A, Massoumi G, Sadeghi M, Soleimani A, Sarrafzadegan N, Roohafza H, Azarm M, Mirmohammadsadeghi A, Rajabi D, Rahmani Y, Siabani S, Najafi F, Hamzeh B, Karim H, Siabani H, Saleh N, Charehjoo H, Zamzam L, Al-Temimi G, Al-Farhan H, Al-Yassin A, Mohammad A, Ridha A, Al-Saedi G, Atabi N, Sabbar O, Mahmood S, Dakhil Z, Yaseen IF, Almyahi M, Alkenzawi H, Alkinani T, Alyacopy A, Kearney P, Twomey K, Iakobishvili Z, Shlomo N, Beigel R, Caldarola P, Rutigliano D, Sublimi Saponetti L, Locuratolo N, Palumbo V, Scherillo M, Formigli D, Canova P, Musumeci G, Roncali F, Metra M, Lombardi C, Visco E, Rossi L, Meloni L, Montisci R, Pippia V, Marchetti MF, Congia M, Cacace C, Luca G, Boscarelli G, Indolfi C, Ambrosio G, Mongiardo A, Spaccarotella C, De Rosa S, Canino G, Critelli C, Caporale R, Chiappetta D, Battista F, Gabrielli D, Marziali A, Bernabò P, Navazio A, Guerri E, Manca F, Gobbi M, Oreto G, Andò G, Carerj S, Saporito F, Cimmino M, Rigo F, Zuin G, Tuccillo B, Scotto di Uccio F, Irace L, Lorenzoni G, Meloni I, Merella P, Polizzi GM, Pino R, Marzilli M, Morrone D, Caravelli P, Orsini E, Mosa S, Piovaccari G, Santarelli A, Cavazza C, Romeo F, Fedele F, Mancone M, Straito M, Salvi N, Scarparo P, Severino P, Razzini C, Massaro G, Cinque A, Gaudio C, Barillà F, Torromeo C, Porco L, Mei M, Iorio R, Nassiacos D, Barco B, Sinagra G, Falco L, Priolo L, Perkan A, Strana M, Bajraktari G, Percuku L, Berisha G, Mziu B, Beishenkulov M, Abdurashidova T, Toktosunova A, Kaliev K, Serpytis P, Serpytis R, Butkute E, Lizaitis M, Broslavskyte M, Xuereb RG, Moore AM, Mercieca Balbi M, Paris E, Buttigieg L, Musial W, Dobrzycki S, Dubicki A, Kazimierczyk E, Tycinska A, Wojakowski W, Kalanska-Lukasik B, Ochala A, Wanha W, Dworowy S, Sielski J, Janion M, Janion-Sadowska A, Dudek D, Wojtasik-Bakalarz J, Bryniarski L, Peruga JZ, Jonczyk M, Jankowski L, Klecha A, Legutko J, Michalowska J, Brzezinski M, Kozmik T, Kowalczyk T, Adamczuk J, Maliszewski M, Kuziemka P, Plaza P, Jaros A, Pawelec A, Sledz J, Bartus S, Zmuda W, Bogusz M, Wisnicki M, Szastak G, Adamczyk M, Suska M, Czunko P, Opolski G, Kochman J, Tomaniak M, Miernik S, Paczwa K, Witkowski A, Opolski MP, Staruch AD, Kalarus Z, Honisz G, Mencel G, Swierad M, Podolecki T, Marques J, Azevedo P, Pereira MA, Gaspar A, Monteiro S, Goncalves F, Leite L, Mimoso J, Manuel Lopes dos Santos W, Amado J, Pereira D, Silva B, Caires G, Neto M, Rodrigues R, Correia A, Freitas D, Lourenco A, Ferreira F, Sousa F, Portugues J, Calvo L, Almeida F, Alves M, Silva A, Caria R, Seixo F, Militaru C, Ionica E, Tatu-Chitoiu G, Istratoaie O, Florescu M, Lipnitckaia E, Osipova O, Konstantinov S, Bukatov V, Vinokur T, Egorova E, Nefedova E, Levashov S, Gorbunova A, Redkina M, Karaulovskaya N, Bijieva F, Babich N, Smirnova O, Filyanin R, Eseva S, Kutluev A, Chlopenova A, Shtanko A, Kuppar E, Shaekhmurzina E, Ibragimova M, Mullahmetova M, Chepisova M, Kuzminykh M, Betkaraeva M, Namitokov A, Khasanov N, Baleeva L, Galeeva Z, Magamedkerimova F, Ivantsov E, Tavlueva E, Kochergina A, Sedykh D, Kosmachova E, Skibitskiy V, Porodenko N, Namitokov A, Litovka K, Ulbasheva E, Niculina S, Petrova M, Harkov E, Tsybulskaya N, Lobanova A, Chernova A, Kuskaeva A, Kuskaev A, Ruda M, Zateyshchikov D, Gilarov M, Konstantinova E, Koroleva O, Averkova A, Zhukova N, Kalimullin D, Borovkova N, Tokareva A, Buyanova M, Khaisheva L, Pirozhenko A, Novikova T, Yakovlev A, Tyurina T, Lapshin K, Moroshkina N, Kiseleva M, Fedorova S, Krylova L, Duplyakov D, Semenova Y, Rusina A, Ryabov V, Syrkina A, Demianov S, Reitblat O, Artemchuk A, Efremova E, Makeeva E, Menzorov M, Shutov A, Klimova N, Shevchenko I, Elistratova O, Kostyuckova O, Islamov R, Budyak V, Ponomareva E, Ullah Jan U, Alshehri AM, Sedky E, Alsihati Z, Mimish L, Selem A, Malik A, Majeed O, Altnji I, AlShehri M, Aref A, AlHabib K, AlDosary M, Tayel S, Abd AlRahman M, Asfina KN, Abdin Hussein G, Butt M, Markovic Nikolic N, Obradovic S, Djenic N, Brajovic M, Davidovic A, Romanovic R, Novakovic V, Dekleva M, Spasic M, Dzudovic B, Jovic Z, Cvijanovic D, Veljkovic S, Ivanov I, Cankovic M, Jarakovic M, Kovacevic M, Trajkovic M, Mitov V, Jovic A, Hudec M, Gombasky M, Sumbal J, Bohm A, Baranova E, Kovar F, Samos M, Podoba J, Kurray P, Obona T, Remenarikova A, Kollarik B, Verebova D, Kardosova G, Studencan M, Alusik D, Macakova J, Kozlej M, Bayes-Genis A, Sionis A, Garcia Garcia C, Lidon RM, Duran Cambra A, Labata Salvador C, Rueda Sobella F, Sans Rosello J, Vila Perales M, Oliveras Vila T, Ferrer Massot M, Bañeras J, Lekuona I, Zugazabeitia G, Fernandez-Ortiz A, Viana Tejedor A, Ferrera C, Alvarez V, Diaz-Castro O, Agra-Bermejo RM, Gonzalez-Cambeiro C, Gonzalez-Babarro E, Domingo-Del Valle J, Royuela N, Burgos V, Canteli A, Castrillo C, Cobo M, Ruiz M, Abu-Assi E, Garcia Acuna JM. The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry. European Heart Journal - Quality of Care and Clinical Outcomes 2019; 6:100-104. [DOI: 10.1093/ehjqcco/qcz042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 07/24/2019] [Indexed: 12/20/2022]
Abstract
Abstract
Aims
The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.
Methods and results
Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.
Conclusion
The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.
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Affiliation(s)
- Uwe Zeymer
- Hospital of the City of Ludwigshafen, Medical Clinic B and Institute of Heart Attack Research, Ludwigshafen on the Rhine, Germany
| | - Peter Ludman
- Institute of Cardiovascular Sciences, Birmingham University, Birmingham, UK
| | - Nicolas Danchin
- Cardiology Department, Georges Pompidou European Hospital, Paris, France
| | - Petr Kala
- Internal Cardiology Department, University Hospital Brno, Czech Republic
| | - Aldo P Maggioni
- EURObservational Research Programme, ESC, Sophia Antipolis, France
- ANMCO Research Center, Florence, Italy
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Brigham MD, Radeck LP, Mendonca CM, Lang I, Li JW, Kent JD, LaMoreaux B, Mandell BF, Johnson RJ. Gout Severity in Recipients of Kidney Transplant. Transplant Proc 2019; 51:1816-1821. [PMID: 31256872 DOI: 10.1016/j.transproceed.2019.04.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 04/05/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE This retrospective analysis of medical chart data was performed to compare severity and treatment of gout in patients with or without a history of kidney transplantation (KT). METHODS Via an online survey, a panel of board-certified US nephrologists (N = 104) provided the following deidentified chart data for their 3 most recent patients with gout: age, sex, serum uric acid, numbers of swollen or tender joints, visible tophi, gout flare events (prior 12 months), gout drug treatment history, and KT history. The presence of "severe, uncontrolled gout" was defined as: serum uric acid ≥ 7.0 mg/dL, ≥1 tophi and ≥2 flares in the last 12 months, and history of xanthine oxidase inhibitor treatment. RESULTS Twenty-five out of 312 (8.0%) gout patients had a history of KT. Univariate analysis found that patients with gout and history of kidney transplants had: greater prevalence of severe uncontrolled gout (27% vs 8%, P = .007) and tophi (36% vs 17%, P = .030), and higher rates of failure or physician perceived contraindication to allopurinol (44% vs 23%, P = .028). CONCLUSION This study provides preliminary evidence that gout in patients with history of KT is more severe and poses greater challenges to pharmacologic management. Although gout has been linked to worse outcomes among kidney recipients in the literature, there are presently no publications on gout severity among patients with KT in comparison to other patients with gout. Further investigation of disease severity and appropriate, effective treatment options in recipients of kidney transplant with a diagnosis of gout, especially prior to the transplant, is warranted.
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Affiliation(s)
| | | | | | - Isabel Lang
- Trinity Partners LLC, Waltham, Massachusetts
| | - Justin W Li
- Trinity Partners LLC, Waltham, Massachusetts
| | - Jeffrey D Kent
- Horizon Pharma USA Inc, Medical Affairs, Lake Forest, Illinois
| | - Brian LaMoreaux
- Horizon Pharma USA Inc, Medical Affairs, Lake Forest, Illinois
| | | | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado
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Schwartzberg L, Bhat G, Mezei K, Lang I, Moon YW, Senviratne L, Chawla S, Cobb P, Yang Z. Abstract P1-13-05: Efficacy and safety of eflapegrastim confirmed in reducing severe neutropenia in breast cancer patients treated with myelosuppressive chemotherapy in the second Phase 3 randomized controlled multinational trial compared to pegfilgrastim (RECOVER trial). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-13-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Eflapegrastim is a novel investigational biologic comprised of recombinant human G-CSF covalently linked to the human immunoglobulin G4FC fragment using proprietary LAPSCOVERY™ technology with potentially unique distribution to areas rich in FcRn receptors. RECOVER is the second Phase 3 study to investigate the non-inferiority (NI) of eflapegrastim to pegfilgrastim in patients receiving chemotherapy for breast cancer. The first Phase 3 study, ADVANCE, has demonstrated the non-inferiority of eflapegrastim comparing to pegfilgrastim in the duration of severe neutropenia (DSN) in breast cancer patients receiving docetaxel and cyclophosphamide (TC) and was previously published at ASCO 2018 meeting.
TrialDesign:
Patients with Stage I to Stage IIIA breast cancer from centers in the USA, Canada, Poland, Hungary, South Korea and India were treated on Day 1 of each of four 21-day cycles with adjuvant or neo-adjuvant TC. On Day 2 of each cycle, patients received a single subcutaneous dose of either eflapegrastim 13.2 mg/0.6 mL (equivalent to 3.6 mg G-CSF) or pegfilgrastim (6 mg) in a 1:1 ratio. Patients had CBCs drawn on Day 1 prior to chemotherapy and Days 4-15 daily or until recovery of neutropenia in Cycle 1. CBC was also collected on Days 1, 4, 7, 10 and 15 in Cycles 2-4. The primary endpoint was to demonstrate the non-inferiority of eflapegrastim comparing to pegfilgrastim as measured by the mean DSN in Cycle 1 with NI margin of <0.62 day.
Results:
In a total of 237 intent-to-treat patients (randomized to 118 eflapegrastim; 119 pegfilgrastim), median age was 59 years (range 29 to 88 years); mean (SD) DSN was 0.31 (0.688) days for eflapegrastim and 0.39 (0.949) days for pegfilgrastim, demonstrating the non-inferiority (95% CI of ΔDSN: [-0.292, 0.129]; p<0.0001). Non-inferiority of eflapegrastim for DSN was maintained across all 4 cycles. There were no statistically significant differences in secondary endpoints: time to ANC recovery, depth of ANC nadir and incidence of FN at Cycle 1. The common Grade 3/4 adverse events observed in≥5%of patients were similar across both arms and were mainly hematologic including neutropenia, lymphopenia, anemia and leukopenia. Grade 3/4 bone pain and febrile neutropenia rates were similar across both arms and were less than 5%.
Conclusions:
Eflapegrastim, a novel long acting G-CSF demonstrated non-inferiority to pegfilgrastim in the reduction of DSN in breast cancer patients treated with TC and has validated the results from the first Phase 3 ADVANCE study. Eflapegrastim was safe and well-tolerated with a similar safety profile to pegfilgrastim.
Citation Format: Schwartzberg L, Bhat G, Mezei K, Lang I, Moon YW, Senviratne L, Chawla S, Cobb P, Yang Z. Efficacy and safety of eflapegrastim confirmed in reducing severe neutropenia in breast cancer patients treated with myelosuppressive chemotherapy in the second Phase 3 randomized controlled multinational trial compared to pegfilgrastim (RECOVER trial) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-13-05.
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Affiliation(s)
- L Schwartzberg
- West Cancer Center, Germantown, TN; Spectrum Pharmaceuticals, Irvine, CA; Szabolcs-Szatmar-Bereg Megyei Korhazak es Egyetemi Oktato Korhaz, Onkologiai Osztaly, Nyiregyhaza, Hungary; Orszagos Onkologiai Intezet, "B" Belgyogyaszati Onkologiai Osztaly, Budapest, Hungary; Cha Bundang Medical Center, Seongnam, Republic of Korea; Los Angeles Hematology and Oncology Medical Group, Los Angeles, CA; St Vincent Frontier Cancer Center, Billings, MT
| | - G Bhat
- West Cancer Center, Germantown, TN; Spectrum Pharmaceuticals, Irvine, CA; Szabolcs-Szatmar-Bereg Megyei Korhazak es Egyetemi Oktato Korhaz, Onkologiai Osztaly, Nyiregyhaza, Hungary; Orszagos Onkologiai Intezet, "B" Belgyogyaszati Onkologiai Osztaly, Budapest, Hungary; Cha Bundang Medical Center, Seongnam, Republic of Korea; Los Angeles Hematology and Oncology Medical Group, Los Angeles, CA; St Vincent Frontier Cancer Center, Billings, MT
| | - K Mezei
- West Cancer Center, Germantown, TN; Spectrum Pharmaceuticals, Irvine, CA; Szabolcs-Szatmar-Bereg Megyei Korhazak es Egyetemi Oktato Korhaz, Onkologiai Osztaly, Nyiregyhaza, Hungary; Orszagos Onkologiai Intezet, "B" Belgyogyaszati Onkologiai Osztaly, Budapest, Hungary; Cha Bundang Medical Center, Seongnam, Republic of Korea; Los Angeles Hematology and Oncology Medical Group, Los Angeles, CA; St Vincent Frontier Cancer Center, Billings, MT
| | - I Lang
- West Cancer Center, Germantown, TN; Spectrum Pharmaceuticals, Irvine, CA; Szabolcs-Szatmar-Bereg Megyei Korhazak es Egyetemi Oktato Korhaz, Onkologiai Osztaly, Nyiregyhaza, Hungary; Orszagos Onkologiai Intezet, "B" Belgyogyaszati Onkologiai Osztaly, Budapest, Hungary; Cha Bundang Medical Center, Seongnam, Republic of Korea; Los Angeles Hematology and Oncology Medical Group, Los Angeles, CA; St Vincent Frontier Cancer Center, Billings, MT
| | - YW Moon
- West Cancer Center, Germantown, TN; Spectrum Pharmaceuticals, Irvine, CA; Szabolcs-Szatmar-Bereg Megyei Korhazak es Egyetemi Oktato Korhaz, Onkologiai Osztaly, Nyiregyhaza, Hungary; Orszagos Onkologiai Intezet, "B" Belgyogyaszati Onkologiai Osztaly, Budapest, Hungary; Cha Bundang Medical Center, Seongnam, Republic of Korea; Los Angeles Hematology and Oncology Medical Group, Los Angeles, CA; St Vincent Frontier Cancer Center, Billings, MT
| | - L Senviratne
- West Cancer Center, Germantown, TN; Spectrum Pharmaceuticals, Irvine, CA; Szabolcs-Szatmar-Bereg Megyei Korhazak es Egyetemi Oktato Korhaz, Onkologiai Osztaly, Nyiregyhaza, Hungary; Orszagos Onkologiai Intezet, "B" Belgyogyaszati Onkologiai Osztaly, Budapest, Hungary; Cha Bundang Medical Center, Seongnam, Republic of Korea; Los Angeles Hematology and Oncology Medical Group, Los Angeles, CA; St Vincent Frontier Cancer Center, Billings, MT
| | - S Chawla
- West Cancer Center, Germantown, TN; Spectrum Pharmaceuticals, Irvine, CA; Szabolcs-Szatmar-Bereg Megyei Korhazak es Egyetemi Oktato Korhaz, Onkologiai Osztaly, Nyiregyhaza, Hungary; Orszagos Onkologiai Intezet, "B" Belgyogyaszati Onkologiai Osztaly, Budapest, Hungary; Cha Bundang Medical Center, Seongnam, Republic of Korea; Los Angeles Hematology and Oncology Medical Group, Los Angeles, CA; St Vincent Frontier Cancer Center, Billings, MT
| | - P Cobb
- West Cancer Center, Germantown, TN; Spectrum Pharmaceuticals, Irvine, CA; Szabolcs-Szatmar-Bereg Megyei Korhazak es Egyetemi Oktato Korhaz, Onkologiai Osztaly, Nyiregyhaza, Hungary; Orszagos Onkologiai Intezet, "B" Belgyogyaszati Onkologiai Osztaly, Budapest, Hungary; Cha Bundang Medical Center, Seongnam, Republic of Korea; Los Angeles Hematology and Oncology Medical Group, Los Angeles, CA; St Vincent Frontier Cancer Center, Billings, MT
| | - Z Yang
- West Cancer Center, Germantown, TN; Spectrum Pharmaceuticals, Irvine, CA; Szabolcs-Szatmar-Bereg Megyei Korhazak es Egyetemi Oktato Korhaz, Onkologiai Osztaly, Nyiregyhaza, Hungary; Orszagos Onkologiai Intezet, "B" Belgyogyaszati Onkologiai Osztaly, Budapest, Hungary; Cha Bundang Medical Center, Seongnam, Republic of Korea; Los Angeles Hematology and Oncology Medical Group, Los Angeles, CA; St Vincent Frontier Cancer Center, Billings, MT
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Rothman AMK, Vachiery JL, Howard L, Lang I, Avriel A, Jonas M, Kiely D, Leon M, Ben-Yehuda O, Rubin L. P567Pulmonary artery denervation for the treatment of pulmonary arterial hypertension: preliminary results of the TROPHY 1 Study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p567] [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: 11/15/2022] Open
Affiliation(s)
- A M K Rothman
- Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | | | - L Howard
- Hammersmith Hospital, London, United Kingdom
| | - I Lang
- Medical University of Vienna, Vienna, Austria
| | - A Avriel
- Soroka University Medical Center, Beer Sheva, Israel
| | - M Jonas
- Kaplan Medical Center, Rehovot, Israel
| | - D Kiely
- Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - M Leon
- Cardiovascular Research Foundation, New York, United States of America
| | - O Ben-Yehuda
- Cardiovascular Research Foundation, New York, United States of America
| | - L Rubin
- University of California San Diego, San Diego, United States of America
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Winter MP, Smriti S, Altmann J, Seidl V, Alimohammadi A, Redwan B, Nagel F, Santer D, Podesser B, Sibilia S, Helbich T, Prager G, Ilhan-Mutlu A, Preusser M, Lang I. 1206Endothelial cell-specific deletion of vascular endothelial growth factor receptor 2/kinase insert domain protein receptor and proliferative pulmonary vasculopathy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1206] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M.-P Winter
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - S Smriti
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - J Altmann
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - V Seidl
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - A Alimohammadi
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - B Redwan
- University of Witten/Herdecke, Department of Thoracic Surgery, Helios University Hospital of Wuppertal, Witten, Germany
| | - F Nagel
- Medical University of Vienna, Institute of Biomedical Research, Vienna, Austria
| | - D Santer
- Medical University of Vienna, Institute of Biomedical Research, Vienna, Austria
| | - B Podesser
- Medical University of Vienna, Institute of Biomedical Research, Vienna, Austria
| | - S Sibilia
- Medical University of Vienna, Institute for Cancer Research, Department of Medicine I, Comprehensive Cancer Center,, Vienna, Austria
| | - T Helbich
- Medical University of Vienna, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - G Prager
- Medical University of Vienna, Institute for Cancer Research, Department of Medicine I, Comprehensive Cancer Center,, Vienna, Austria
| | - A Ilhan-Mutlu
- Medical University of Vienna, Institute for Cancer Research, Department of Medicine I, Comprehensive Cancer Center,, Vienna, Austria
| | - M Preusser
- Medical University of Vienna, Institute for Cancer Research, Department of Medicine I, Comprehensive Cancer Center,, Vienna, Austria
| | - I Lang
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
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Schneider M, Aschauer S, Mascherbauer J, Ran H, Binder C, Lang I, Goliasch G, Binder T. P5635Visual assessment of right ventricular function in echocardiography: how good are we? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5635] [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: 11/12/2022] Open
Affiliation(s)
- M Schneider
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - S Aschauer
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - J Mascherbauer
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - H Ran
- Nanjing 1st Hospital, Department of Echocardiography, Nanjing, China People's Republic of
| | - C Binder
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - I Lang
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - G Goliasch
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - T Binder
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
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Panzenboeck A, Sadushi-Kolici R, Plaimauer B, Gritsch H, Turecek P, Lang I. P1621Plasma ADAMTS13 in chronic thromboembolic pulmonary hypertension. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1621] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Panzenboeck
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - R Sadushi-Kolici
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - B Plaimauer
- Baxalta Innovations GmbH, now part of Shire, Vienna, Austria
| | - H Gritsch
- Baxalta Innovations GmbH, now part of Shire, Vienna, Austria
| | - P Turecek
- Baxalta Innovations GmbH, now part of Shire, Vienna, Austria
| | - I Lang
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
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Bartko PE, Pavo N, Perez-Serradilla A, Arfsten H, Neuhold S, Wurm R, Lang I, Strunk G, Dal-Bianco JP, Levine RA, Huelsmann M, Goliasch G. 6162Natural history of functional mitral regurgitation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.6162] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P E Bartko
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - N Pavo
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - A Perez-Serradilla
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - H Arfsten
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - S Neuhold
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - R Wurm
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - I Lang
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - G Strunk
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - J P Dal-Bianco
- Massachusetts General Hospital, Institute for Heart, Vascular and Stroke Care, Boston, United States of America
| | - R A Levine
- Massachusetts General Hospital, Institute for Heart, Vascular and Stroke Care, Boston, United States of America
| | - M Huelsmann
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - G Goliasch
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
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Winter MP, Zbiral M, Kietaibl A, Sulzgruber P, Kastner J, Rosenhek R, Binder T, Lang I, Goliasch G. P6302Normal values for doppler echocardiographic assessment of prosthetic valve function after TAVR - A systematic review and meta-analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6302] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M.-P Winter
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - M Zbiral
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - A Kietaibl
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - P Sulzgruber
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - J Kastner
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - R Rosenhek
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - T Binder
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - I Lang
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - G Goliasch
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
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Galie N, Gaine S, Channick R, Ghofrani HA, Hoeper M, Lang I, McLaughlin V, Preiss R, Rubin L, Shiraga Y, Simonneau G, Sitbon O, Tapson V, Chin K. 3016Long-term survival and safety with selexipag in patients with pulmonary arterial hypertension: results from the GRIPHON study and its open-label extension. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- N Galie
- Bologna University Hospital, Department of Experimental, Diagnostic, and Specialty Medicine, Bologna, Italy
| | - S Gaine
- Mater Misericordiae University Hospital, National Pulmonary Hypertension Unit, Dublin, Ireland
| | - R Channick
- Massachusetts General Hospital, Pulmonary and Critical Care, Boston, United States of America
| | - H A Ghofrani
- University of Giessen and Marburg Lung Center (UGMLC) and German Center of Lung Research, Giessen, Germany; Imperial College London, Department of Medicine, London, United Kingdom
| | - M Hoeper
- Hannover Medical School and German Centre for Lung Research, Department of Respiratory Medicine, Hannover, Germany
| | - I Lang
- Medical University of Vienna, Division of Cardiology, Vienna, Austria
| | - V McLaughlin
- University of Michigan Health System, Department of Internal Medicine, Ann Arbor, United States of America
| | - R Preiss
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - L Rubin
- University of California San Diego, Department of Medicine, San Diego, United States of America
| | - Y Shiraga
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - G Simonneau
- Assistance Publique–Hôpitaux de Paris, Service de Pneumologie, Hôpital Bicêtre and, Laboratoire d'Excellence en Recherche sur le Médicament et Innovation Thérapeutique, Université Paris-Sud, Le Kremlin–Bicêtre; Inserm Unité 999, Le Plessis Robinson, France
| | - O Sitbon
- Assistance Publique–Hôpitaux de Paris, Service de Pneumologie, Hôpital Bicêtre and, Laboratoire d'Excellence en Recherche sur le Médicament et Innovation Thérapeutique, Université Paris-Sud, Le Kremlin–Bicêtre; Inserm Unité 999, Le Plessis Robinson, France
| | - V Tapson
- Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - K Chin
- University of Texas Southwestern Medical Center, Dallas, United States of America
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Huber K, Resch I, Stefenelli T, Lang I, Probst P, Kaindl F, Binder BR. Plasminogen Activator Inhibitor-1 Levels in Patients with Chronic Angina Pectoris with or without Angiographic Evidence of Coronary Sclerosis. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1645042] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryIncreased plasma levels of plasminogen activator inhibitor-1 (PAI-1) have been shown to exist in 40 to 60% of patients with stable coronary artery disease and have been suggested to be responsible for the development of coronary thrombotic complications. However, it is also discussed whether PAI-1 elevation might mainly be due to variables like increased age or to reactive mechanisms caused e.g. by the chest pain itself. To exclude age dependent ui pain related influences, age-matched patients with stable angina pectoris (NHYA II) and angiographically proven coronary artery disease (CAD, n = 16) or without evidence for coronary sclerosis (variant angina, n = 10; angina-like syndrome with normal coronary angiogram, n = 5; non-CAD, n = 15) have been investigated for their plasma PAI-1 activity and t-PA antigen levels. The mean PAI activity in CAD patients (17.5 U/ml) was significantly higher than in non-CAD patients (9.6 U/ml) (p <0.0001). In the CAD patients no significant variation in plasma PAI-1 values could be demonstrated when related to the extent of the disease or to a history of previous myocardial infarction t-PA antigen was also elevated m CAD patients as compared to the non-CAD group (p <0.02). The results suggest therefore a strong correlation between coronary artery disease itself and elevated levels of components of the plasma fibrinolytic system.
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Affiliation(s)
- K Huber
- The Department of Cardiology, University of Vienna, Vienna, Austria
- The Laboratory for Clinical and Experimental Physiology, Department of Medical Physiology, University of Vienna, Vienna, Austria
| | - I Resch
- The Laboratory for Clinical and Experimental Physiology, Department of Medical Physiology, University of Vienna, Vienna, Austria
| | - Th Stefenelli
- The Department of Cardiology, University of Vienna, Vienna, Austria
| | - I Lang
- The Department of Cardiology, University of Vienna, Vienna, Austria
| | - P Probst
- The Department of Cardiology, University of Vienna, Vienna, Austria
| | - F Kaindl
- The Department of Cardiology, University of Vienna, Vienna, Austria
| | - B R Binder
- The Laboratory for Clinical and Experimental Physiology, Department of Medical Physiology, University of Vienna, Vienna, Austria
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25
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Chiritescu G, Dumon K, Mercadé TM, Lang I, Vivas CS, Papai Z, Janssens J, Hendrickx K, Pracht M, Van den Eynde M, Taïeb J, Moons V, Geboes K, Van Laethem J, Greil R, Cervantes A, Vergauwe P, Ferrante M, Vanderstraeten E, Fridrik M, Wöll E, Limón M, Rivera F, Sagaert X, Tejpar S, Van Cutsem E. A two arm phase II study of FOLFIRI in combination with standard or escalating dose of cetuximab as first line treatment for metastatic colorectal cancer: Everest 2 final results. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy149.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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26
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Panzenboeck A, Sadushi-Kolici R, Plaimauer B, Gritsch H, Turecek PL, Lang I. P163Plasma ADAMTS13 activity in chronic thromboembolic pulmonary hypertension. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.123] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Panzenboeck
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - R Sadushi-Kolici
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - B Plaimauer
- Baxalta Innovations GmbH, now part of Shire, Vienna, Austria
| | - H Gritsch
- Baxalta Innovations GmbH, now part of Shire, Vienna, Austria
| | - P L Turecek
- Baxalta Innovations GmbH, now part of Shire, Vienna, Austria
| | - I Lang
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
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27
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Altmann J, Seidl V, Saito T, Rabinovitch M, Lang I. P378Circulating B cell phenotypes in chronic thromboembolic pulmonary hypertension. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.287] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Altmann
- Medical University of Vienna, Department of Internal Medicine II, Cardiology, Vienna, Austria
| | - V Seidl
- Medical University of Vienna, Department of Internal Medicine II, Cardiology, Vienna, Austria
| | - T Saito
- Stanford School of Medicine, Department of Pediatrics, Vera Moulton Wall Center for Pulmonary Vascular Diseases, Stanford, United States of America
| | - M Rabinovitch
- Stanford School of Medicine, Department of Pediatrics, Vera Moulton Wall Center for Pulmonary Vascular Diseases, Stanford, United States of America
| | - I Lang
- Medical University of Vienna, Department of Internal Medicine II, Cardiology, Vienna, Austria
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28
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Ghofrani A, Hoeper MM, McLaughlin V, Channick R, Chin K, Delcroix M, Gaine S, Jansa P, Lang I, Mehta S, Pulido T, Sastry BKS, Simonneau G, Sitbon O, De Souza R, Torbicki A, Tapson V, Perchenet L, Preiss R, Verweij P, Rubin L, Galie N. Pulmonary arterial hypertension-related morbidity is prognostic for survival: Insights from the SERAPHIN and GRIPHON studies. Pneumologie 2018. [DOI: 10.1055/s-0037-1619325] [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: 10/28/2022]
Affiliation(s)
- A Ghofrani
- Med. Klinik II/V, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - MM Hoeper
- Klinik für Pneumologie, Zentrum für Innere Medizin, Medizinische Hochschule Hannover
| | - V McLaughlin
- Health System Division of Cardiovascular Medicine, University of Michigan
| | - R Channick
- Massachusetts General Hospital; Harvard Medical School
| | - K Chin
- UT Southwestern Medical Center, Dallas, Texas
| | | | - S Gaine
- Mater Misericordiae Hospital, Dublin, Ireland
| | | | - I Lang
- Abteilung für Kardiologie, Universitätsklinik für Innere Medizin II, Wien
| | - S Mehta
- Lhsc University Hospital, London, Ontario, Canada
| | - T Pulido
- Ignacio Chávez National Heart Institute, Mexico City
| | | | | | - O Sitbon
- Service de Pneumologie, Hôpital Bicêtre, Univ. Paris-Sud
| | - R De Souza
- Incor Heart Institute, University of Sao Paulo
| | | | - V Tapson
- Cedars-Sinai Medical Center, Los Angeles, California
| | - L Perchenet
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - R Preiss
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - P Verweij
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - L Rubin
- Division of Pulmonary and Critical Care Medicine University of California; San Diego Medical School
| | - N Galie
- Istituto DI Malattie Dell'apparato Cardiovascolare, Università DI Bologna, Italy
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Hall A, Lang I, Endacott R, Burrows L, Goodwin V. An exploratory qualitative study examining the experiences of people with dementia receiving physiotherapy. Physiotherapy 2017. [DOI: 10.1016/j.physio.2017.11.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Moser B, Jaksch P, Taghavi S, Muraközy G, Lang G, Hager H, Krenn C, Roth G, Faybik P, Bacher A, Aigner C, Matilla J, Hacker P, Lang I, Klepetko W. F-027LUNG TRANSPLANTATION FOR IDIOPATHIC PULMONARY ARTERIAL HYPERTENSION ON INTRAOPERATIVE AND POSTOPERATIVELY PROLONGED EXTRACORPOREAL MEMBRANE OXYGENATION PROVIDES OPTIMALLY CONTROLLED REPERFUSION AND EXCELLENT OUTCOME. Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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31
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Lambertini M, Campbell C, Bines J, Korde L, Izquierdo Delso M, Fumagalli D, Pritchard K, Wolff A, Jackisch C, Lang I, Untch M, Smith I, Boyle F, Xu B, Barrios C, Baselga J, Moreno-Aspitia A, Piccart M, Gelber R, De Azambuja E. Adjuvant anti-HER2 therapy, treatment-induced amenorrhea (TIA) and survival in premenopausal patients (pts) with HER2-positive (HER2+) early breast cancer (EBC): Analysis from the ALTTO trial (BIG 2-06). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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32
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Mohammad M, Koul S, Egerstedt A, Smith J, Noc M, Lang I, Holzer M, Clemmensen P, Jensen U, Engstrom T, Arheden H, Metzler B, Erlinge D. P5541A proteomic analysis of 131 biomarkers in relation to infarct size and long-term ejection fraction assessed by CMR in patients with ST-segment elevation myocardial infarction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5541] [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: 11/13/2022] Open
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33
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Mohammad M, Koul S, Noc M, Lang I, Holzer M, Clemmensen P, Jensen U, Lindahl B, Engstrom T, Arheden H, Metzler B, Erlinge D. P2124High sensitivity troponin T is a stronger predictor than early infarct size determined by CMR for long-term ejection fraction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2124] [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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34
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Adiwijaya BS, Kim J, Lang I, Csõszi T, Cubillo A, Chen JS, Wong M, Park JO, Kim JS, Rau KM, Melichar B, Gallego JB, Fitzgerald J, Belanger B, Molnar I, Ma WW. Population Pharmacokinetics of Liposomal Irinotecan in Patients With Cancer. Clin Pharmacol Ther 2017; 102:997-1005. [PMID: 28445610 PMCID: PMC5697569 DOI: 10.1002/cpt.720] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 03/29/2017] [Accepted: 04/19/2017] [Indexed: 12/18/2022]
Abstract
Nanoliposomal irinotecan (nal‐IRI) is a liposomal formulation of irinotecan with a longer half‐life (t1/2), higher plasma total irinotecan (tIRI), and lower SN‐38 maximum concentration (Cmax) compared with nonliposomal irinotecan. Population pharmacokinetic (PK) analysis of nal‐IRI was performed for tIRI and total SN‐38 (tSN38) using patient samples from six studies. PK‐safety association was evaluated for neutropenia and diarrhea in 353 patients. PK‐efficacy association was evaluated from a phase III study in pancreatic cancer NAPOLI1. Efficacy was associated with longer duration of unencapsulated SN‐38 (uSN38) above a threshold and higher Cavg of tIRI, tSN38, and uSN38. Neutropenia was associated with uSN38 Cmax and diarrhea with tIRI Cmax. Baseline predictive factors were race, body surface area, and bilirubin. Analysis identified PK factors associated with efficacy, safety, and predictive baseline factors. The results support the benefit of nal‐IRI dose of 70 mg/m2 (free‐base; equivalent to 80 mg/m2 salt base) Q2W over 100 mg/m2 Q3W.
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Affiliation(s)
- B S Adiwijaya
- Merrimack Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | - J Kim
- Merrimack Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | - I Lang
- National Institute of Oncology, Budapest, Hungary
| | - T Csõszi
- JNSZ Megyei Hetényi Géza Kórház Rendelöintézet, Szolnok, Hungary
| | - A Cubillo
- Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - J-S Chen
- Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
| | - M Wong
- Westmead Hospital, Westmead, Australia
| | - J O Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - J S Kim
- Korea University Guro Hospital, Seoul, South Korea
| | - K M Rau
- Chang Gung Memorial Hospital Kaohsiung Branch, Kaohsiung, Taiwan
| | - B Melichar
- Onkologicka Klinika, Lekarska Fakulta Univerzity Palackeho a Fakultni Nemocnice, Olomouc, Czech Republic
| | | | - J Fitzgerald
- Merrimack Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | - B Belanger
- Merrimack Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | - I Molnar
- Merrimack Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | - W W Ma
- Mayo Clinic, Rochester, Minnesota, USA
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35
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Alqahtani FF, Messina F, Kruger E, Gill H, Ellis M, Lang I, Broadley P, Offiah AC. Evaluation of a semi-automated software program for the identification of vertebral fractures in children. Clin Radiol 2017; 72:904.e11-904.e20. [PMID: 28506798 DOI: 10.1016/j.crad.2017.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/24/2017] [Accepted: 04/11/2017] [Indexed: 11/19/2022]
Abstract
AIM To assess observer reliability and diagnostic accuracy in children, of a semi-automated six-point technique developed for vertebral fracture (VF) diagnosis in adults, which records percentage loss of vertebral body height. MATERIALS AND METHODS Using a semi-automated software program, five observers independently assessed T4 to L4 from the lateral spine radiographs of 137 children and adolescents for VF. A previous consensus read by three paediatric radiologists using a simplified algorithm-based qualitative technique (i.e., no software involved) served as the reference standard. RESULTS Of a total of 1,781 vertebrae, 1,187 (67%) were adequately visualised according to three or more observers. Interobserver agreement in vertebral readability for each vertebral level for five observers ranged from 0.05 to 0.47 (95% CI: -0.19, 0.76). Intra-observer agreement using the intraclass correlation coefficient (ICC) ranged from 0.25 to 0.61. The overall sensitivity and specificity were 18% (95% CI: 14-22) and 97% (95% CI: 97-98), respectively. CONCLUSION In contrast to adults, the six-point technique assessing anterior, middle, and posterior vertebral height ratios is neither satisfactorily reliable nor sensitive for VF diagnosis in children. Training of the software on paediatric images is required in order to develop a paediatric standard that incorporates not only specific vertebral body height ratios but also the age-related physiological changes in vertebral shape that occur throughout childhood.
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Affiliation(s)
- F F Alqahtani
- Academic Unit of Child Health, University of Sheffield, Sheffield, UK; Department of Radiological Sciences, College of Applied Medical Sciences, Najran University, Najran, Saudi Arabia.
| | - F Messina
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - E Kruger
- Radiology Department, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - H Gill
- Sheffield Medical School, University of Sheffield, Sheffield, UK
| | - M Ellis
- Sheffield Medical School, University of Sheffield, Sheffield, UK
| | - I Lang
- Radiology Department, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - P Broadley
- Radiology Department, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - A C Offiah
- Academic Unit of Child Health, University of Sheffield, Sheffield, UK; Radiology Department, Sheffield Children's NHS Foundation Trust, Sheffield, UK
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36
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Duchnowska R, Sperinde J, Czartoryska-Arlukowicz B, Mysliwiec P, Winslow J, Radecka B, Petropoulos C, Demlova R, Orlikowska M, Kowalczyk A, Lang I, Ziólkowska B, Debska-Szmich S, Merdalska M, Grela-Wojewoda A, Zawrocki A, Biernat W, Huang W, Jassem J. Abstract P2-05-21: Predictive value of quantitative HER2 and HER3 levels combined with downstream signaling markers in HER2-positive advanced breast cancer patients treated with lapatinib. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-05-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Clinical correlates of lapatinib resistance have not been well defined. Previous studies implicated genes regulated by the estrogen receptor (ER) and activation or mutation of proteins downstream from HER family receptors. In the current study, HER2 and HER3 expression levels were quantitatively measured using a VeraTag® fluorescence-based assay, in addition to seven downstream signaling proteins determined by IHC. All biomarkers were correlated with overall survival (OS) in patients treated with lapatinib.
Methods: Formalin-fixed, paraffin-embedded samples were obtained from the primary tumor of 191 patients treated with lapatinib plus capecitabine following progression on trastuzumab. The HERmark® Breast Cancer Assay (Monogram Biosciences, South San Francisco) was used to quantify HER2 protein expression levels. HER3 protein expression was quantified using the VeraTag® technology (Monogram Biosciences). Expression of ER, PTEN, Cyclin E, HIF-2alpha, p-p70S6K, p-AMPK and p-MAPK were determined by IHC (Duchnowska et al., Oncotarget 2016; 7:550). OS analyses of HER2 and HER3 were stratified by key clinical variables, including stage and presence of a brain metastasis prior to lapatinib-based therapy.
Results: Among the downstream signaling molecules, HIF-2alpha (r = -0.23; p = 0.047) and ER (r = -0.27; p = 0.005) were negatively correlated with HER2 expression after adjustment for multiple testing. PTEN appeared to correlate with HER3, but was not significant after adjustment for multiple testing. OS was significantly shorter for both those below the cut-off level of positivity by the HERmark assay (HR = 1.8; p = 0.029), and those with above median HER2 levels (HR = 1.7; p = 0.009), as compared to cases with in between levels. The relationship between HER2 and OS is also captured by a U-shaped, parabolic function in HER2 (p = 0.005). Elevated HER3 showed a trend toward a correlation with longer OS (HR = 0.66/log; p = 0.16), somewhat stronger in the ER-negative subset (HR = 0.55/log; p = 0.085) and in the subset with above-median HER2 (0.48/log; p = 0.10), where inhibiting HER2 activation of HER3 may be more important. In multivariate Cox models, HER2 (parabola, intermediate HER2 best, p = 0.001), presence of brain metastases (HR = 2; p < 0.001), ER (HR = 0.60; p = 0.009) and either p-p70S6K (HR = 0.66; p = 0.018) or p-AMPK (HR = 0.67; p = 0.022) were significantly associated with OS (p-p70S6K and p-AMPK were mutually correlated).
Conclusions: Patients with moderately increased HER2 levels may have best outcomes while receiving lapatinib following progression on trastuzumab. This supports recent findings of a less benefit from lapatinib in patients with high HER2 expression (Nunciforo et al., SABCS 2015, P3-07-08). HER3 levels do not seem to substantially impact the prognosis. Further studies are warranted to explore the predictive utility of quantitative HER2 and HER3 in guiding HER2-directed therapies.
Citation Format: Duchnowska R, Sperinde J, Czartoryska-Arlukowicz B, Mysliwiec P, Winslow J, Radecka B, Petropoulos C, Demlova R, Orlikowska M, Kowalczyk A, Lang I, Ziólkowska B, Debska-Szmich S, Merdalska M, Grela-Wojewoda A, Zawrocki A, Biernat W, Huang W, Jassem J. Predictive value of quantitative HER2 and HER3 levels combined with downstream signaling markers in HER2-positive advanced breast cancer patients treated with lapatinib [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-05-21.
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Affiliation(s)
- R Duchnowska
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - J Sperinde
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - B Czartoryska-Arlukowicz
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - P Mysliwiec
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - J Winslow
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - B Radecka
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - C Petropoulos
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - R Demlova
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - M Orlikowska
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - A Kowalczyk
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - I Lang
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - B Ziólkowska
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - S Debska-Szmich
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - M Merdalska
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - A Grela-Wojewoda
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - A Zawrocki
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - W Biernat
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - W Huang
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - J Jassem
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
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Coghlan G, Gaine S, Channick R, Scala LD, Galiè N, Ghofrani HA, Hoeper MM, Lang I, McLaughlin V, Preiss R, Rubin LJ, Simonneau G, Sitbon O, Tapson VF, Chin K. S109 Targeting the prostacyclin pathway in the treatment of connective tissue disease associated pulmonary arterial hypertension (pah): insights from the randomised controlled griphon trial with selexipag. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hachulla E, Gaine S, Channick R, Discala L, Galiè N, Ghofrani H, Hoeper M, Lang I, Mclaughlin V, Preiss R, Rubin L, Simonneau G, Sitbon O, Tapson V, Chin K. Cibler la voie de la prostacycline dans le traitement des HTAP associées aux connectivites : expérience de Griphon – étude contrôlée, randomisée avec le selexipag. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Loegl J, Hiden U, Nussbaumer E, Schliefsteiner C, Cvitic S, Lang I, Wadsack C, Huppertz B, Desoye G. Hofbauer cells of M2a, M2b and M2c polarization may regulate feto-placental angiogenesis. Reproduction 2016; 152:447-55. [DOI: 10.1530/rep-16-0159] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 08/17/2016] [Indexed: 12/21/2022]
Abstract
The human placenta comprises a special type of tissue macrophages, the Hofbauer cells (HBC), which exhibit M2 macrophage phenotype. Several subtypes of M2-polarized macrophages (M2a, M2b and M2c) exist in almost all tissues. Macrophage polarization depends on the way of macrophage activation and leads to the expression of specific cell surface markers and the acquisition of specific functions, including tissue remodeling and the promotion of angiogenesis. The placenta is a highly vascularized and rapidly growing organ, suggesting a role of HBC in feto-placental angiogenesis. We here aimed to characterize the specific polarization and phenotype of HBC and investigated the role of HBC in feto-placental angiogenesis. Therefore, HBC were isolated from third trimester placentas and their phenotype was determined by the presence of cell surface markers (FACS analysis) and secretion of cytokines (ELISA). HBC conditioned medium (CM) was analyzed for pro-angiogenic factors, and the effect of HBC CM on angiogenesis, proliferation and chemoattraction of isolated primary feto-placental endothelial cells (fpEC) was determined in vitro. Our results revealed that isolated HBC possess an M2 polarization, with M2a, M2b and M2c characteristics. HBC secreted the pro-angiogenic molecules VEGF and FGF2. Furthermore, HBC CM stimulated the in vitro angiogenesis of fpEC. However, compared with control medium, chemoattraction of fpEC toward HBC CM was reduced. Proliferation of fpEC was not affected by HBC CM. These findings demonstrate a paracrine regulation of feto-placental angiogenesis by HBC in vitro. Based on our collective results, we propose that the changes in HBC number or phenotype may affect feto-placental angiogenesis.
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Hall A, Goodwin V, Lang I, Endacott R. Physiotherapy interventions for people with dementia and a hip fracture – a scoping review of the literature. Physiotherapy 2016. [DOI: 10.1016/j.physio.2016.10.225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wilkens H, Konstantinides S, Lang I, Bunck AC, Gerges M, Gerhardt F, Grgic A, Grohé C, Guth S, Held M, Hinrichs J, Hoeper MM, Klepetko W, Kramm T, Krüger U, Lankeit M, Meyer BC, Olsson KM, Schäfers HJ, Schmidt M, Seyfarth HJ, Ulrich S, Wiedenroth CB, Mayer E. [Chronic thromboembolic pulmonary hypertension: Recommendations of the Cologne Consensus Conference 2016]. Dtsch Med Wochenschr 2016; 141:S62-S69. [PMID: 27760452 DOI: 10.1055/s-0042-114529] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The 2015 European Guidelines on Pulmonary Hypertension did not cover only pulmonary arterial hypertension (PAH), but also other significant subgroups of pulmonary hypertension (PH). In June 2016, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany to discuss open and controversial issues surrounding the practical implementation of the European Guidelines. Several working groups were initiated, one of which was dedicated to the diagnosis and treatment of chronic thromboembolic pulmonary hypertension (CTEPH). In every patient with PH of unknown cause CTEPH should be excluded. The primary treatment option is surgical pulmonary endarterectomy (PEA) in a specialized multidisciplinary CTEPH center. Inoperable patients or patients with persistent or recurrent CTEPH after PEA are candidates for targeted drug therapy. For balloon pulmonary angioplasty (BPA), there is currently only limited experience. This option - as PEA - is reserved to specialized centers with expertise for this treatment method. In addition, a brief overview is given on pulmonary artery sarcoma, since its surgical treatment is often analogous to PEA. The recommendations of this working group are summarized in the present paper.
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Langleben D, Beghetti M, Channick R, Chin K, DiScala L, Gaine S, Ghofrani H, Hoeper M, Lang I, McLaughlin V, Preiss R, Rubin L, Simonneau G, Sitbon O, Tapson V, Galiè N. SELEXIPAG FOR PULMONARY ARTERIAL HYPERTENSION ASSOCIATED WITH CONGENITAL HEART DISEASE (PAH-CHD) AFTER DEFECT CORRECTION: INSIGHTS FROM THE RANDOMISED CONTROLLED GRIPHON STUDY. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Waller C, Blakeley C, Pennella E, Bronchud M, Berzoy O, Voitko N, Adamchuk H, Zautashvili Z, Vinnyk Y, Nemsadze G, Dzagnidze G, Shparyk Y, Lytvyn I, Rusyn A, Popov V, Lang I, Sharma R, Baczkowski M, Kothekar M, Barve A. Phase 3 efficacy and safety trial of proposed pegfilgrastim biosimilar MYL-1401H vs EU-neulasta® in the prophylaxis of chemotherapy-induced neutropenia. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw390.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Adiotomre E, Summers L, Allison A, Walters SJ, Digby M, Broadley P, Lang I, Morrison G, Bishop N, Arundel P, Offiah AC. Diagnostic accuracy of DXA compared to conventional spine radiographs for the detection of vertebral fractures in children. Eur Radiol 2016; 27:2188-2199. [PMID: 27655305 PMCID: PMC5374187 DOI: 10.1007/s00330-016-4556-3] [Citation(s) in RCA: 16] [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: 03/15/2016] [Revised: 07/05/2016] [Accepted: 08/09/2016] [Indexed: 10/26/2022]
Abstract
OBJECTIVES In children, radiography is performed to diagnose vertebral fractures and dual energy x-ray absorptiometry (DXA) to assess bone density. In adults, DXA assesses both. We aimed to establish whether DXA can replace spine radiographs in assessment of paediatric vertebral fractures. METHODS Prospectively, lateral spine radiographs and lateral spine DXA of 250 children performed on the same day were independently scored by three radiologists using the simplified algorithm-based qualitative technique and blinded to results of the other modality. Consensus radiograph read and second read of 100 random images were performed. Diagnostic accuracy, inter/intraobserver and intermodality agreements, patient/carer experience and radiation dose were assessed. RESULTS Average sensitivity and specificity (95 % confidence interval) in diagnosing one or more vertebral fractures requiring treatment was 70 % (58-82 %) and 97 % (94-100 %) respectively for DXA and 74 % (55-93 %) and 96 % (95-98 %) for radiographs. Fleiss' kappa for interobserver and average kappa for intraobserver reliability were 0.371 and 0.631 respectively for DXA and 0.418 and 0.621 for radiographs. Average effective dose was 41.9 μSv for DXA and 232.7 μSv for radiographs. Image quality was similar. CONCLUSION Given comparable image quality and non-inferior diagnostic accuracy, lateral spine DXA should replace conventional radiographs for assessment of vertebral fractures in children. KEY POINTS • Vertebral fracture diagnostic accuracy of lateral spine DXA is non-inferior to radiographs. • The rate of unreadable vertebrae for DXA is lower than for radiographs. • Effective dose of DXA is significantly lower than radiographs. • Children prefer DXA to radiographs. • Given the above, DXA should replace radiographs for paediatric vertebral fracture assessment.
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Affiliation(s)
- E Adiotomre
- Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Rd, Sheffield, South Yorkshire, S10 2JF, UK.,Radiology Department, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK
| | - L Summers
- Sheffield Medical School, University of Sheffield, Beech Hill Rd, Sheffield, South Yorkshire, S10 2RX, UK
| | - A Allison
- School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield, South Yorkshire, S1 4DA, UK
| | - S J Walters
- School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield, South Yorkshire, S1 4DA, UK
| | - M Digby
- Sheffield Medical School, University of Sheffield, Beech Hill Rd, Sheffield, South Yorkshire, S10 2RX, UK
| | - P Broadley
- Radiology Department, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK
| | - I Lang
- Radiology Department, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK
| | - G Morrison
- Medical Physics, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Rd, Sheffield, South Yorkshire, S10 2JF, UK
| | - N Bishop
- Academic Unit of Child Health, University of Sheffield, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK
| | - P Arundel
- Academic Unit of Child Health, University of Sheffield, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK
| | - A C Offiah
- Radiology Department, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK. .,Academic Unit of Child Health, University of Sheffield, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK.
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Lourida I, Abbott R, Lang I, Rogers M, Kent B, Thompson-Coon J. OP27 Dissemination and implementation in dementia care practice: a systematic scoping review. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Thompson Coon J, Abbott R, Coxon G, Day J, Lang I, Lourida I, Pearson M, Reed N, Rogers M, Stein K, Sugavanam P, Whear R. OP68 Implementing and disseminating best practice in the care home setting: A systematic scoping review. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Jerusalem G, Mariani G, Ciruelos EM, Martin M, Tjan-Heijnen VCG, Neven P, Gavila JG, Michelotti A, Montemurro F, Generali D, Simoncini E, Lang I, Mardiak J, Naume B, Camozzi M, Lorizzo K, Bianchetti S, Conte P. Safety of everolimus plus exemestane in patients with hormone-receptor-positive, HER2-negative locally advanced or metastatic breast cancer progressing on prior non-steroidal aromatase inhibitors: primary results of a phase IIIb, open-label, single-arm, expanded-access multicenter trial (BALLET). Ann Oncol 2016; 27:1719-25. [PMID: 27358383 DOI: 10.1093/annonc/mdw249] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [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: 02/05/2016] [Accepted: 06/13/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This European phase IIIb, expanded-access multicenter trial evaluated the safety of EVE plus EXE in a patient population similar to BOLERO-2. PATIENTS AND METHODS Post-menopausal women aged ≥18 years with hormone receptor-positive, human epidermal growth factor-receptor-2-negative advanced breast cancer (ABC) recurring/progressing during/after prior non-steroidal aromatase inhibitors were enrolled. The primary objective was safety of EVE plus EXE based on frequency of adverse events (AEs), and serious AEs (SAEs). The secondary objective was to evaluate AEs of grade 3/4 severity. RESULTS The median treatment duration was 5.1 months [95% confidence interval (CI) 4.8-5.6] for EVE and 5.3 months (95% CI 4.8-5.6) for EXE. Overall, 2131 patients were included in the analysis; 81.8% of patients experienced EVE- or EXE-related or EVE/EXE-related AEs (investigator assessed); 27.2% were of grade 3/4 severity. The most frequently reported non-hematologic AEs were (overall %, % EVE-related) stomatitis (52.8%; 50.8%) and asthenia (22.8%; 14.6%). The most frequently reported hematologic AEs were (overall %, % EVE-related) anemia (14.4%; 8.1%) and thrombocytopenia (5.9%; 4.6%). AE-related treatment discontinuations were higher in elderly (≥70 years) versus non-elderly patients (23.8% versus 13.0%). The incidence of EVE-related AEs in both elderly and non-elderly patients appeared to be lower in first-line ABC versus later lines. The incidence of AEs (including stomatitis/pneumonitis) was independent of BMI status (post hoc analysis). Overall, 8.5% of patients experienced at least one EVE-related SAE. Of the 121 on-treatment deaths (5.7%), 66 (3.1%) deaths were due to disease progression and 46 (2.2%) due to AEs; 4 deaths were suspected to be EVE-related. CONCLUSIONS This is the largest ever reported safety dataset on a general patient population presenting ABC treated with EVE plus EXE and included a sizeable elderly subset. Although the patients were more heavily pretreated, the safety profile of EVE plus EXE in BALLET was consistent with BOLERO-2. CLINICAL TRIAL REGISTRATION EudraCT Number: 2012-000073-23.
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Affiliation(s)
- G Jerusalem
- Department of Medical Oncology, CHU Sart Tilman Liege and Liege University, Domaine Universitaire du Sart Tilman, Liege, Belgium
| | - G Mariani
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - E M Ciruelos
- Medical Oncology Department, Breast Cancer Unit, University Hospital 12 de Octubre, Madrid, Spain
| | - M Martin
- Instituto de Investigación Sanitaria Gregorio Marañón, Univesidad Complutense, Madrid, Spain
| | - V C G Tjan-Heijnen
- Department of Medical Oncology, GROW, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P Neven
- KULeuven (University of Leuven), Department of Oncology, Multidisciplinary Breast Center, University Hospitals Leuven, Belgium
| | - J G Gavila
- Medical Oncology Unit of Fundacion Instituto Valenciano De Oncologia, Valencia, Spain
| | - A Michelotti
- UO Oncologia Medica I, Azienda Ospedaliera Universitaria Pisana, Santa Chiara Hospital, Pisa, Italy
| | - F Montemurro
- Unit of Investigative Clinical Oncology (INCO), Fondazione del Piemonte per l'Oncologia, Institute of Candiolo Cancer Center (IRCCs), Candiolo, Torino, Italy
| | - D Generali
- Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - E Simoncini
- Breast Unit, Azienda Ospedaliera Spedali Civili, Brescia, Italy
| | - I Lang
- Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Budapest, Hungary
| | - J Mardiak
- Narodny Onkologicky Ustav Klenova 1, Bratislava, Slovakia
| | - B Naume
- Department of Oncology, Oslo University Hospital, Oslo, Norway K.G. Jebsen Center for Breast Cancer Research, Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - M Camozzi
- Novartis Farma S.p.A., Origgio, VA, Italy
| | - K Lorizzo
- Novartis Farma S.p.A., Origgio, VA, Italy
| | | | - P Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy Medical Oncology 2, Istituto Oncologico Veneto, Padova, Italy
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Bell T, Crown JP, Lang I, Bhattacharyya H, Zanotti G, Randolph S, Kim S, Huang X, Huang Bartlett C, Finn RS, Slamon D. Impact of palbociclib plus letrozole on pain severity and pain interference with daily activities in patients with estrogen receptor-positive/human epidermal growth factor receptor 2-negative advanced breast cancer as first-line treatment. Curr Med Res Opin 2016; 32:959-65. [PMID: 26894413 DOI: 10.1185/03007995.2016.1157060] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Palbociclib is a recently approved drug for use in combination with letrozole as initial endocrine-based therapy for the treatment of postmenopausal women with advanced estrogen receptor-positive/human epidermal growth factor receptor 2-negative (ER+/HER2-) breast cancer. This report assesses the impact of palbociclib in combination with letrozole versus letrozole alone on patient-reported outcomes of pain. Methods Palbociclib was evaluated in an open-label, randomized, phase II study (PALOMA-1/TRIO-18) among postmenopausal women with advanced ER+/HER2- breast cancer who had not received prior systemic treatment for their advanced disease. Patients received continuous oral letrozole 2.5 mg daily alone or the same letrozole dose and schedule plus oral palbociclib 125 mg, given once daily for 3 weeks followed by 1 week off over repeated 28-day cycles. The primary study endpoint was investigator-assessed progression-free survival in the intent-to-treat population, and these results have recently been published (Finn et al., Lancet Oncol 2015;16:25-35). One of the key secondary endpoints was the evaluation of pain, as measured using the Brief Pain Inventory (BPI) patient-reported outcome tool. The BPI was administered at baseline and on day 1 of every cycle thereafter until disease progression and/or treatment discontinuation. Clinical trial registration This study is registered with ClinicalTrials.gov (NCT00721409). Results There were no statistically significant differences in Pain Severity or Pain Interference scores of the BPI between the two treatment groups for the overall population or among those with any bone disease at baseline. A limitation of the study is that results were not adjusted for the concomitant use of opioids or other medications used to control pain. Conclusions The addition of palbociclib to letrozole was associated with increased efficacy without negatively impacting pain severity or pain interference with daily activities.
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Affiliation(s)
- T Bell
- a Pfizer Inc. , New York , NY , USA
| | - J P Crown
- b St. Vincent's University Hospital , Dublin , Ireland
| | - I Lang
- c Orszagos Onkologiai Intezet, Kemoterapia B , Budapest , Hungary
| | | | | | | | - S Kim
- d Pfizer Inc. , San Diego , CA , USA
| | - X Huang
- d Pfizer Inc. , San Diego , CA , USA
| | | | - R S Finn
- e David Geffen School of Medicine at UCLA , Los Angeles , CA , USA
| | - D Slamon
- e David Geffen School of Medicine at UCLA , Los Angeles , CA , USA
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Tapson V, Channick R, Chin K, Di Scala L, Farber H, Gaine S, Galiè N, Ghofrani H, Lang I, McLaughlin V, Preiss R, Rubin L, Simonneau G, Sitbon O, Hoeper M. Anticoagulant Therapy Is Not Associated with Long Term Outcome in Patients with Pulmonary Arterial Hypertension (PAH): Insights from the GRIPHON Study. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Isaacs C, O'Regan R, Xu B, Masuda N, Arena F, Yap YS, Papai Z, Lang I, Armstrong A, Lerzo G, White M, Shen K, Zhang Y, Jappe A, Pacaud LB, Taran T, Ozguroglu M. Abstract P4-13-12: Everolimus plus trastuzumab and vinorelbine for trastuzumab-resistant, taxane-pretreated, HER2+ advanced breast cancer: Overall survival results from BOLERO-3. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p4-13-12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
PI3K/AKT/mTOR pathway activation due to PTEN loss may lead to trastuzumab (TRAS) resistance. mTOR inhibition has been shown to restore TRAS sensitivity in PTEN-deficient tumors. This provided the rationale for the BOLERO-3 trial which evaluated the combination of everolimus (EVE), an mTOR inhibitor, plus TRAS and a taxane in HER2+ advanced breast cancer (ABC). The addition of EVE to TRAS plus vinorelbine (VNB) led to a statistically significant prolongation of 1.2 months in median progression free survival (PFS) vs TRAS plus VNB in patients with TRAS-resistant and taxane-pretreated, HER2+ ABC (7.0 months vs 5.78 months; hazard ratio, 0.78; p=0.0067). The final overall survival (OS) analysis from this study is presented here.
Materials and methods
BOLERO-3 is a randomized, double-blind, placebo-controlled, phase 3 trial. Women with HER2+ ABC progressing on prior TRAS and taxane therapy were randomized (1:1) to receive either daily EVE (5 mg) or PBO plus weekly TRAS (2 mg/kg) and VNB (25 mg/m2), in 3-week cycles, stratified by previous lapatinib use. The primary endpoint was PFS by local investigator assessment. Overall survival was a key secondary endpoint.
Results
Overall, 569 patients were enrolled; 284 patients received EVE and 285 patients received PBO. As of April 1, 2015, after a median follow-up of 44.7 months, 388 deaths had occurred, 191 (67.3%) in the EVE arm and 197 (69.1%) in the PBO arm. The median OS in the EVE arm vs PBO arm was 23.5 months vs 24.1 months (HR = 0.96; 95% CI, 0.79-1.17; p = 0.3392). In the HR+ subgroup, the median OS with EVE was 23.5 months (vs 25.5 months with PBO; HR = 1.03; 95% CI, 0.79-1.35); in the HR subgroup, the median OS with EVE was 22.9 months (vs 23.1 months with PBO; HR = 0.86; 95% CI, 0.64-1.17). AEs leading to treatment discontinuation were reported in 81 (28.9%) vs 46 (16.3%) patients in the EVE vs PBO arms. Serious adverse events (SAEs) were reported in 122 (43.6%) vs 58 (20.6%) patients in the EVE vs PBO arms. Overall, 14 on-treatment deaths were observed, 7 (2.5%) in the EVE arm and 7 (2.5%) in the PBO arm; on-treatment deaths due to AEs were balanced between treatment arms (0.7% in each treatment arm). Types of post-progression therapies were balanced across both treatment arms.
Conclusions
In BOLERO-3, EVE showed a statistically significant prolongation of PFS. OS was similar in both treatment arms. The safety profile of EVE was comparable to that observed previously with EVE in breast cancer. (Funded by Novartis; BOLERO-3 ClinicalTrials.gov number, NCT01007942.)
Citation Format: Isaacs C, O'Regan R, Xu B, Masuda N, Arena F, Yap Y-S, Papai Z, Lang I, Armstrong A, Lerzo G, White M, Shen K, Zhang Y, Jappe A, Pacaud LB, Taran T, Ozguroglu M. Everolimus plus trastuzumab and vinorelbine for trastuzumab-resistant, taxane-pretreated, HER2+ advanced breast cancer: Overall survival results from BOLERO-3. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-13-12.
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Affiliation(s)
- C Isaacs
- Lombardi Comprehensive, Cancer Center, Georgetown, University, Washington, DC, DC; University of Wisconsin, Madison, Wisconsin; Cancer Hospital, and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; NHO Osaka National Hospital, Chuou-ku, Osaka, Japan; NYU Langone Arena Oncology, Lake Success, NY; National Cancer Centre Singapore, Singapore; Military Hospital, Budapest, Hungary; Orszagos Onkologiai Intezet, Budapest, Hungary; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Sanatorio de la Providencia, Buenos Aires, Argentina; Monash Medical Center, Moorabbin Hospital, Bentleigh East, VIC, Australia; Cabrini Brighton Hospital, Brighton, VIC, Australia; Comprehensive Breast Health Center, RuiJin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China; Novartis Pharmaceuticals Corporation, East Hanover; Novartis Pharma AG, Basel, Switzerland; Istanbul University, Istanbul, Turkey
| | - R O'Regan
- Lombardi Comprehensive, Cancer Center, Georgetown, University, Washington, DC, DC; University of Wisconsin, Madison, Wisconsin; Cancer Hospital, and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; NHO Osaka National Hospital, Chuou-ku, Osaka, Japan; NYU Langone Arena Oncology, Lake Success, NY; National Cancer Centre Singapore, Singapore; Military Hospital, Budapest, Hungary; Orszagos Onkologiai Intezet, Budapest, Hungary; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Sanatorio de la Providencia, Buenos Aires, Argentina; Monash Medical Center, Moorabbin Hospital, Bentleigh East, VIC, Australia; Cabrini Brighton Hospital, Brighton, VIC, Australia; Comprehensive Breast Health Center, RuiJin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China; Novartis Pharmaceuticals Corporation, East Hanover; Novartis Pharma AG, Basel, Switzerland; Istanbul University, Istanbul, Turkey
| | - B Xu
- Lombardi Comprehensive, Cancer Center, Georgetown, University, Washington, DC, DC; University of Wisconsin, Madison, Wisconsin; Cancer Hospital, and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; NHO Osaka National Hospital, Chuou-ku, Osaka, Japan; NYU Langone Arena Oncology, Lake Success, NY; National Cancer Centre Singapore, Singapore; Military Hospital, Budapest, Hungary; Orszagos Onkologiai Intezet, Budapest, Hungary; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Sanatorio de la Providencia, Buenos Aires, Argentina; Monash Medical Center, Moorabbin Hospital, Bentleigh East, VIC, Australia; Cabrini Brighton Hospital, Brighton, VIC, Australia; Comprehensive Breast Health Center, RuiJin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China; Novartis Pharmaceuticals Corporation, East Hanover; Novartis Pharma AG, Basel, Switzerland; Istanbul University, Istanbul, Turkey
| | - N Masuda
- Lombardi Comprehensive, Cancer Center, Georgetown, University, Washington, DC, DC; University of Wisconsin, Madison, Wisconsin; Cancer Hospital, and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; NHO Osaka National Hospital, Chuou-ku, Osaka, Japan; NYU Langone Arena Oncology, Lake Success, NY; National Cancer Centre Singapore, Singapore; Military Hospital, Budapest, Hungary; Orszagos Onkologiai Intezet, Budapest, Hungary; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Sanatorio de la Providencia, Buenos Aires, Argentina; Monash Medical Center, Moorabbin Hospital, Bentleigh East, VIC, Australia; Cabrini Brighton Hospital, Brighton, VIC, Australia; Comprehensive Breast Health Center, RuiJin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China; Novartis Pharmaceuticals Corporation, East Hanover; Novartis Pharma AG, Basel, Switzerland; Istanbul University, Istanbul, Turkey
| | - F Arena
- Lombardi Comprehensive, Cancer Center, Georgetown, University, Washington, DC, DC; University of Wisconsin, Madison, Wisconsin; Cancer Hospital, and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; NHO Osaka National Hospital, Chuou-ku, Osaka, Japan; NYU Langone Arena Oncology, Lake Success, NY; National Cancer Centre Singapore, Singapore; Military Hospital, Budapest, Hungary; Orszagos Onkologiai Intezet, Budapest, Hungary; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Sanatorio de la Providencia, Buenos Aires, Argentina; Monash Medical Center, Moorabbin Hospital, Bentleigh East, VIC, Australia; Cabrini Brighton Hospital, Brighton, VIC, Australia; Comprehensive Breast Health Center, RuiJin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China; Novartis Pharmaceuticals Corporation, East Hanover; Novartis Pharma AG, Basel, Switzerland; Istanbul University, Istanbul, Turkey
| | - Y-S Yap
- Lombardi Comprehensive, Cancer Center, Georgetown, University, Washington, DC, DC; University of Wisconsin, Madison, Wisconsin; Cancer Hospital, and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; NHO Osaka National Hospital, Chuou-ku, Osaka, Japan; NYU Langone Arena Oncology, Lake Success, NY; National Cancer Centre Singapore, Singapore; Military Hospital, Budapest, Hungary; Orszagos Onkologiai Intezet, Budapest, Hungary; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Sanatorio de la Providencia, Buenos Aires, Argentina; Monash Medical Center, Moorabbin Hospital, Bentleigh East, VIC, Australia; Cabrini Brighton Hospital, Brighton, VIC, Australia; Comprehensive Breast Health Center, RuiJin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China; Novartis Pharmaceuticals Corporation, East Hanover; Novartis Pharma AG, Basel, Switzerland; Istanbul University, Istanbul, Turkey
| | - Z Papai
- Lombardi Comprehensive, Cancer Center, Georgetown, University, Washington, DC, DC; University of Wisconsin, Madison, Wisconsin; Cancer Hospital, and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; NHO Osaka National Hospital, Chuou-ku, Osaka, Japan; NYU Langone Arena Oncology, Lake Success, NY; National Cancer Centre Singapore, Singapore; Military Hospital, Budapest, Hungary; Orszagos Onkologiai Intezet, Budapest, Hungary; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Sanatorio de la Providencia, Buenos Aires, Argentina; Monash Medical Center, Moorabbin Hospital, Bentleigh East, VIC, Australia; Cabrini Brighton Hospital, Brighton, VIC, Australia; Comprehensive Breast Health Center, RuiJin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China; Novartis Pharmaceuticals Corporation, East Hanover; Novartis Pharma AG, Basel, Switzerland; Istanbul University, Istanbul, Turkey
| | - I Lang
- Lombardi Comprehensive, Cancer Center, Georgetown, University, Washington, DC, DC; University of Wisconsin, Madison, Wisconsin; Cancer Hospital, and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; NHO Osaka National Hospital, Chuou-ku, Osaka, Japan; NYU Langone Arena Oncology, Lake Success, NY; National Cancer Centre Singapore, Singapore; Military Hospital, Budapest, Hungary; Orszagos Onkologiai Intezet, Budapest, Hungary; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Sanatorio de la Providencia, Buenos Aires, Argentina; Monash Medical Center, Moorabbin Hospital, Bentleigh East, VIC, Australia; Cabrini Brighton Hospital, Brighton, VIC, Australia; Comprehensive Breast Health Center, RuiJin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China; Novartis Pharmaceuticals Corporation, East Hanover; Novartis Pharma AG, Basel, Switzerland; Istanbul University, Istanbul, Turkey
| | - A Armstrong
- Lombardi Comprehensive, Cancer Center, Georgetown, University, Washington, DC, DC; University of Wisconsin, Madison, Wisconsin; Cancer Hospital, and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; NHO Osaka National Hospital, Chuou-ku, Osaka, Japan; NYU Langone Arena Oncology, Lake Success, NY; National Cancer Centre Singapore, Singapore; Military Hospital, Budapest, Hungary; Orszagos Onkologiai Intezet, Budapest, Hungary; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Sanatorio de la Providencia, Buenos Aires, Argentina; Monash Medical Center, Moorabbin Hospital, Bentleigh East, VIC, Australia; Cabrini Brighton Hospital, Brighton, VIC, Australia; Comprehensive Breast Health Center, RuiJin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China; Novartis Pharmaceuticals Corporation, East Hanover; Novartis Pharma AG, Basel, Switzerland; Istanbul University, Istanbul, Turkey
| | - G Lerzo
- Lombardi Comprehensive, Cancer Center, Georgetown, University, Washington, DC, DC; University of Wisconsin, Madison, Wisconsin; Cancer Hospital, and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; NHO Osaka National Hospital, Chuou-ku, Osaka, Japan; NYU Langone Arena Oncology, Lake Success, NY; National Cancer Centre Singapore, Singapore; Military Hospital, Budapest, Hungary; Orszagos Onkologiai Intezet, Budapest, Hungary; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Sanatorio de la Providencia, Buenos Aires, Argentina; Monash Medical Center, Moorabbin Hospital, Bentleigh East, VIC, Australia; Cabrini Brighton Hospital, Brighton, VIC, Australia; Comprehensive Breast Health Center, RuiJin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China; Novartis Pharmaceuticals Corporation, East Hanover; Novartis Pharma AG, Basel, Switzerland; Istanbul University, Istanbul, Turkey
| | - M White
- Lombardi Comprehensive, Cancer Center, Georgetown, University, Washington, DC, DC; University of Wisconsin, Madison, Wisconsin; Cancer Hospital, and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; NHO Osaka National Hospital, Chuou-ku, Osaka, Japan; NYU Langone Arena Oncology, Lake Success, NY; National Cancer Centre Singapore, Singapore; Military Hospital, Budapest, Hungary; Orszagos Onkologiai Intezet, Budapest, Hungary; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Sanatorio de la Providencia, Buenos Aires, Argentina; Monash Medical Center, Moorabbin Hospital, Bentleigh East, VIC, Australia; Cabrini Brighton Hospital, Brighton, VIC, Australia; Comprehensive Breast Health Center, RuiJin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China; Novartis Pharmaceuticals Corporation, East Hanover; Novartis Pharma AG, Basel, Switzerland; Istanbul University, Istanbul, Turkey
| | - K Shen
- Lombardi Comprehensive, Cancer Center, Georgetown, University, Washington, DC, DC; University of Wisconsin, Madison, Wisconsin; Cancer Hospital, and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; NHO Osaka National Hospital, Chuou-ku, Osaka, Japan; NYU Langone Arena Oncology, Lake Success, NY; National Cancer Centre Singapore, Singapore; Military Hospital, Budapest, Hungary; Orszagos Onkologiai Intezet, Budapest, Hungary; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Sanatorio de la Providencia, Buenos Aires, Argentina; Monash Medical Center, Moorabbin Hospital, Bentleigh East, VIC, Australia; Cabrini Brighton Hospital, Brighton, VIC, Australia; Comprehensive Breast Health Center, RuiJin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China; Novartis Pharmaceuticals Corporation, East Hanover; Novartis Pharma AG, Basel, Switzerland; Istanbul University, Istanbul, Turkey
| | - Y Zhang
- Lombardi Comprehensive, Cancer Center, Georgetown, University, Washington, DC, DC; University of Wisconsin, Madison, Wisconsin; Cancer Hospital, and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; NHO Osaka National Hospital, Chuou-ku, Osaka, Japan; NYU Langone Arena Oncology, Lake Success, NY; National Cancer Centre Singapore, Singapore; Military Hospital, Budapest, Hungary; Orszagos Onkologiai Intezet, Budapest, Hungary; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Sanatorio de la Providencia, Buenos Aires, Argentina; Monash Medical Center, Moorabbin Hospital, Bentleigh East, VIC, Australia; Cabrini Brighton Hospital, Brighton, VIC, Australia; Comprehensive Breast Health Center, RuiJin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China; Novartis Pharmaceuticals Corporation, East Hanover; Novartis Pharma AG, Basel, Switzerland; Istanbul University, Istanbul, Turkey
| | - A Jappe
- Lombardi Comprehensive, Cancer Center, Georgetown, University, Washington, DC, DC; University of Wisconsin, Madison, Wisconsin; Cancer Hospital, and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; NHO Osaka National Hospital, Chuou-ku, Osaka, Japan; NYU Langone Arena Oncology, Lake Success, NY; National Cancer Centre Singapore, Singapore; Military Hospital, Budapest, Hungary; Orszagos Onkologiai Intezet, Budapest, Hungary; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Sanatorio de la Providencia, Buenos Aires, Argentina; Monash Medical Center, Moorabbin Hospital, Bentleigh East, VIC, Australia; Cabrini Brighton Hospital, Brighton, VIC, Australia; Comprehensive Breast Health Center, RuiJin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China; Novartis Pharmaceuticals Corporation, East Hanover; Novartis Pharma AG, Basel, Switzerland; Istanbul University, Istanbul, Turkey
| | - LB Pacaud
- Lombardi Comprehensive, Cancer Center, Georgetown, University, Washington, DC, DC; University of Wisconsin, Madison, Wisconsin; Cancer Hospital, and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; NHO Osaka National Hospital, Chuou-ku, Osaka, Japan; NYU Langone Arena Oncology, Lake Success, NY; National Cancer Centre Singapore, Singapore; Military Hospital, Budapest, Hungary; Orszagos Onkologiai Intezet, Budapest, Hungary; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Sanatorio de la Providencia, Buenos Aires, Argentina; Monash Medical Center, Moorabbin Hospital, Bentleigh East, VIC, Australia; Cabrini Brighton Hospital, Brighton, VIC, Australia; Comprehensive Breast Health Center, RuiJin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China; Novartis Pharmaceuticals Corporation, East Hanover; Novartis Pharma AG, Basel, Switzerland; Istanbul University, Istanbul, Turkey
| | - T Taran
- Lombardi Comprehensive, Cancer Center, Georgetown, University, Washington, DC, DC; University of Wisconsin, Madison, Wisconsin; Cancer Hospital, and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; NHO Osaka National Hospital, Chuou-ku, Osaka, Japan; NYU Langone Arena Oncology, Lake Success, NY; National Cancer Centre Singapore, Singapore; Military Hospital, Budapest, Hungary; Orszagos Onkologiai Intezet, Budapest, Hungary; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Sanatorio de la Providencia, Buenos Aires, Argentina; Monash Medical Center, Moorabbin Hospital, Bentleigh East, VIC, Australia; Cabrini Brighton Hospital, Brighton, VIC, Australia; Comprehensive Breast Health Center, RuiJin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China; Novartis Pharmaceuticals Corporation, East Hanover; Novartis Pharma AG, Basel, Switzerland; Istanbul University, Istanbul, Turkey
| | - M Ozguroglu
- Lombardi Comprehensive, Cancer Center, Georgetown, University, Washington, DC, DC; University of Wisconsin, Madison, Wisconsin; Cancer Hospital, and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; NHO Osaka National Hospital, Chuou-ku, Osaka, Japan; NYU Langone Arena Oncology, Lake Success, NY; National Cancer Centre Singapore, Singapore; Military Hospital, Budapest, Hungary; Orszagos Onkologiai Intezet, Budapest, Hungary; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Sanatorio de la Providencia, Buenos Aires, Argentina; Monash Medical Center, Moorabbin Hospital, Bentleigh East, VIC, Australia; Cabrini Brighton Hospital, Brighton, VIC, Australia; Comprehensive Breast Health Center, RuiJin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China; Novartis Pharmaceuticals Corporation, East Hanover; Novartis Pharma AG, Basel, Switzerland; Istanbul University, Istanbul, Turkey
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