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Arif S, Gibson VB, Nguyen V, Bingley PJ, Todd JA, Guy C, Dunger DB, Dayan CM, Powrie J, Lorenc A, Peakman M. β-cell specific T-lymphocyte response has a distinct inflammatory phenotype in children with Type 1 diabetes compared with adults. Diabet Med 2017; 34:419-425. [PMID: 27151105 DOI: 10.1111/dme.13153] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 12/31/2022]
Abstract
AIM To examine the hypothesis that the quality, magnitude and breadth of helper T-lymphocyte responses to β cells differ in Type 1 diabetes according to diagnosis in childhood or adulthood. METHODS We studied helper T-lymphocyte reactivity against β-cell autoantigens by measuring production of the pro-inflammatory cytokine interferon-γ and the anti-inflammatory cytokine interleukin-10, using enzyme-linked immunospot assays in 61 people with Type 1 diabetes (within 3 months of diagnosis, positive for HLA DRB1*0301 and/or *0401), of whom 33 were children/adolescents, and a further 91 were unaffected siblings. RESULTS Interferon-γ responses were significantly more frequent in children with Type 1 diabetes compared with adults (85 vs 61%; P = 0.04). Insulin and proinsulin peptides were preferentially targeted in children (P = 0.0001 and P = 0.04, respectively) and the breadth of the interferon-γ response was also greater, with 70% of children having an interferon-γ response to three or more peptides compared with 14% of adults (P < 0.0001). Islet β-cell antigen-specific interleukin-10 responses were similar in children and adults in terms of frequency, breadth and magnitude, with the exception of responses to glutamic acid decarboxylase 65, which were significantly less frequent in adults. CONCLUSIONS At diagnosis of Type 1 diabetes, pro-inflammatory autoreactivity is significantly more prevalent, focuses on a wider range of targets, and is more focused on insulin/proinsulin in children than adults. We interpret this as indicating a more aggressive immunological response in the younger age group that is especially characterized by loss of tolerance to proinsulin. These findings highlight the existence of age-related heterogeneity in Type 1 diabetes pathogenesis that could have relevance to the development of immune-based therapies.
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Affiliation(s)
- S Arif
- Department of Immunobiology, King's College London, London
- JDRF Centre for Diabetes Genes, Autoimmunity and Prevention, University of Cambridge, Cambridge, UK
| | - V B Gibson
- Department of Immunobiology, King's College London, London
| | - V Nguyen
- Department of Immunobiology, King's College London, London
| | - P J Bingley
- School of Clinical Sciences, University of Bristol, Bristol, UK
- JDRF Centre for Diabetes Genes, Autoimmunity and Prevention, University of Cambridge, Cambridge, UK
| | - J A Todd
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- JDRF Centre for Diabetes Genes, Autoimmunity and Prevention, University of Cambridge, Cambridge, UK
| | - C Guy
- University Department of Paediatrics, Addenbrooke's Hospital, Cambridge, UK
- JDRF Centre for Diabetes Genes, Autoimmunity and Prevention, University of Cambridge, Cambridge, UK
| | - D B Dunger
- University Department of Paediatrics, Addenbrooke's Hospital, Cambridge, UK
- JDRF Centre for Diabetes Genes, Autoimmunity and Prevention, University of Cambridge, Cambridge, UK
| | - C M Dayan
- Institute of Molecular and Experimental Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - J Powrie
- Department of Diabetes and Endocrinology, Guy's & St Thomas' National Health Service (NHS) Foundation Trust, London, UK
| | - A Lorenc
- National Institute for Health Research, Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, UK
| | - M Peakman
- Department of Immunobiology, King's College London, London
- JDRF Centre for Diabetes Genes, Autoimmunity and Prevention, University of Cambridge, Cambridge, UK
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Butt A, Ahmad MS, Powrie J, Swaminathan R. Assessment of diabetic retinopathy by measuring retina-specific mRNA in blood. Expert Opin Biol Ther 2012; 12 Suppl 1:S79-84. [DOI: 10.1517/14712598.2012.688947] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Tysome JR, Chandra A, Chang F, Puwanarajah P, Elliott M, Caroll P, Powrie J, Hubbard JG, Clarke SEM, Jeannon JP, Simo R. Improving prediction of malignancy of cytologically indeterminate thyroid nodules. Br J Surg 2009; 96:1400-5. [DOI: 10.1002/bjs.6734] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Abstract
Background
Fine-needle aspiration (FNA) is essential in the investigation of thyroid nodules. The British Thyroid Association guidelines recommend clarification of whether follicular nodules are probable follicular neoplasms that require surgical excision. This study assessed the value of the subclassification of cytologically indeterminate thyroid nodules into either follicular neoplasms or other pathology.
Methods
The cytology reports of all thyroid FNAs performed between November 2005 and December 2007 at a single institution reported as Thy 3 (follicular lesions) were reviewed. They were reclassified as Thy 3A (probable follicular neoplasm) or Thy 3B (probable non-neoplastic lesion), and subsequently correlated with final clinical outcome to determine the predictive value of this subclassification.
Results
Forty-nine specimens were categorized as Thy 3A and 55 as Thy 3B. Of excised lesions, 14 (29 per cent) of 48 Thy 3A and 4 (10 per cent) of 42 Thy 3B nodules were malignant. If Thy 3A were to predict malignancy and Thy 3B benign disease, the sensitivity of the classification was 88 per cent, with a specificity of 55 per cent and negative predictive value of 91 per cent.
Conclusion
Subclassification of Thy 3 nodules into Thy 3A and Thy 3B improves the assessment of risk for thyroid malignancy.
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Affiliation(s)
- J R Tysome
- Department of Otolaryngology—Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Chandra
- Department of Histopathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - F Chang
- Department of Histopathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - P Puwanarajah
- Department of Otolaryngology—Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Elliott
- Department of Otolaryngology—Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - P Caroll
- Department of Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J Powrie
- Department of Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J G Hubbard
- Department of Endocrine Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S E M Clarke
- Department of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J P Jeannon
- Department of Otolaryngology—Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - R Simo
- Department of Otolaryngology—Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Shalchi Z, Sandhu H, Butt A, Smith S, Powrie J, Swaminathan R. Retina-Specific mRNA in the Assessment of Diabetic Retinopathy. Ann N Y Acad Sci 2008; 1137:253-7. [DOI: 10.1196/annals.1448.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Sandhu HS, Butt AN, Powrie J, Swaminathan R. Measurement of Circulating Neuron-Specific Enolase mRNA in Diabetes Mellitus. Ann N Y Acad Sci 2008; 1137:258-63. [DOI: 10.1196/annals.1448.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Thakkar H, Butt A, Powrie J, Holt R, Swaminathan R. Circulating Nucleic Acids in the Assessment of Endogenous Growth Hormone Production. Ann N Y Acad Sci 2008; 1137:58-65. [DOI: 10.1196/annals.1448.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Giannoulis MG, Boroujerdi MA, Powrie J, Dall R, Napoli R, Ehrnborg C, Pentecost C, Cittadini A, Jørgensen JOL, Sonksen PH. Gender differences in growth hormone response to exercise before and after rhGH administration and the effect of rhGH on the hormone profile of fit normal adults. Clin Endocrinol (Oxf) 2005; 62:315-22. [PMID: 15730413 DOI: 10.1111/j.1365-2265.2005.02216.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Exercise is a potent physiological stimulus of GH secretion. We hypothesized that exogenous recombinant human growth hormone (rhGH) administration through an increase in GH and IGF-I levels would blunt the GH response to exercise. The aim of the study was to examine and compare the impact of rhGH on the exercise-induced GH response in healthy normal men and women. DESIGN AND MEASUREMENTS Sixty-nine subjects (36 men, 33 women) were randomized to receive low-dose rhGH (0.1 U/kg/day), high dose rhGH (0.2 U/kg/day), or placebo. Subjects were matched for age (24 +/- 3.1), and body mass index (BMI). rhGH was given as a single subcutaneous (s.c.) injection for the first 28 days. All subjects exercised to exhaustion (maximal oxygen consumption--VO2max) before rhGH treatment (Test 1), and on day 28 (Test 2). GH was measured before exercise (time 0), immediately after exercise (time 0') and at 15, 30, 60, 90 and 120 min postexercise. Baseline IGF-I levels were measured before exercise on days 0 and 28. RESULTS Baseline IGF-I levels showed no gender differences (42.3 women vs. 38.8 nmol/l men) but basal GH values were higher in women (9.9 vs. 1.8 mU/l, P < 0.001). The areas under the GH response curve, for Test 1 were similar in men and women. Peak GH values were higher in women than men (37.9 vs. 23.5 mU/l, but this did not quite reach statistical significance (P = 0.055). In men, administration of rhGH resulted in a significant increase in IGF-I levels over the basal state in both the LD and HD groups (P < 0.0001). In women, the increase in lGF-I levels reached significance only in the HD group (P < 0.0001). On day 28, GH secretion in response to exercise was calculated from the areas under the GH response curve correcting for an exogenous rhGH component (delta AUC). In men, the delta AUC, for Test 2 were similar in all three groups. In women, the delta AUC was higher in the placebo group, than in the HD group (P < 0.02). Free T4 levels decreased significantly in men, and free T3 increased in both men and women, in HD group after the rhGH administration. TSH levels were suppressed only in women. No changes in sex hormones were found in men or women in any of the treatment groups. Conclusions In terms of IGF-I, men are more responsive to rhGH treatment than women. In addition, as men, but not women, were able to overcome the negative feedback control of the elevated IGF-I levels, it seems that exercise may be a more robust stimulus to GH release in men compared to women.
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Affiliation(s)
- M G Giannoulis
- Department of Diabetes and Endocrinology, Division of Medicine, King's College London, St Thomas's Hospital, London, UK
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Longobardi S, Keay N, Ehrnborg C, Cittadini A, Rosén T, Dall R, Boroujerdi MA, Bassett EE, Healy ML, Pentecost C, Wallace JD, Powrie J, Jørgensen JO, Saccà L. Growth hormone (GH) effects on bone and collagen turnover in healthy adults and its potential as a marker of GH abuse in sports: a double blind, placebo-controlled study. The GH-2000 Study Group. J Clin Endocrinol Metab 2000; 85:1505-12. [PMID: 10770189 DOI: 10.1210/jcem.85.4.6551] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The effects of GH on bone remodeling in healthy adults have not been systematically investigated. An analysis of these effects might provide insights into GH physiology and might yield data useful for the detection of GH doping in sports. The aim of this study was to evaluate the effects of GH administration on biochemical markers of bone and collagen turnover in healthy volunteers. Ninety-nine healthy volunteers of both sexes were enrolled in a multicenter, randomized, double blind, placebo-controlled study and assigned to receive either placebo (40 subjects) or recombinant human GH (0.1 IU/kg day in 29 subjects and 0.2 IU/kg x day in 30 subjects). The treatment duration was 28 days, followed by a 56-day wash-out period. The biochemical markers evaluated were the bone formation markers osteocalcin and C-terminal propeptide of type I procollagen, the resorption marker type I collagen telopeptide, and the soft tissue marker procollagen type III. All variables increased on days 21 and 28 in the two active treatment groups vs. levels in both the baseline (P < 0.01) and placebo (P < 0.01) groups. The increment was more pronounced in the 0.2 IU/kg-day group and remained significant on day 84 for procollagen type III (from 0.53 +/- 0.13 to 0.61 +/- 0.14 kU/L; P < 0.02) and osteocalcin (from 12.2 + 2.9 to 14.6 +/- 3.6 UG/L; P < 0.02), whereas levels of C-terminal propeptide of type I procollagen and type I collagen telopeptide declined after day 42 and were no longer significantly above baseline on day 84 (from 3.9 +/- 1.2 to 5.1 +/-1.5 microg/L and from 174 +/- 60 to 173 +/- 53 microg/L, respectively). Gender-related differences were observed in the study; females were less responsive than males to GH administration with respect to procollagen type III and type I collagen telopeptide (P < 0.001). In conclusion, exogenous GH administration affects the biochemical parameters of bone and collagen turnover in a dose- and gender-dependent manner. As GH-induced modifications of most markers, in particular procollagen type III and osteocalcin, persist after GH withdrawal, they may be suitable markers for detecting GH abuse.
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Affiliation(s)
- S Longobardi
- Department of Clinical Medicine and Cardiovascular Sciences, University Federico II, Naples, Italy
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Kicman AT, Miell JP, Teale JD, Powrie J, Wood PJ, Laidler P, Milligan PJ, Cowan DA. Serum IGF-I and IGF binding proteins 2 and 3 as potential markers of doping with human GH. Clin Endocrinol (Oxf) 1997; 47:43-50. [PMID: 9302371 DOI: 10.1046/j.1365-2265.1997.2111036.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE IGF-I and IGF binding protein (IGFBP)-3 levels in man are positively regulated by GH status; in contrast, evidence suggests an inverse relationship between GH status and IGFBP-2. We investigated the effects of somatropin administration on the serum concentrations of these analytes, together with serum and urinary concentrations of GH, to evaluate their potential as markers in the development of a test for detecting doping with GH in sports competitors. DESIGN Somatropin was administered subcutaneously at a dose of 0.15 U/kg bodyweight/day at 1000 h for 3 days to eight healthy men (20-32 years old). MEASUREMENTS Serum concentrations of GH, IGF-I, IGFBP-2 and -3 were determined in blood samples collected at 1600 h on the days prior to (day -1), during (days 0, 1 and 2), and following administration (days 3 and 7). Urine was collected continuously from days -2 to 3 and then on day 7. RESULTS Serum and urinary concentrations of GH were only raised on the days of administration whereas, following cessation of somatropin, the increases in the serum concentrations of IGF-I and IGFBP-3 were sustained for at least 1 day (30 h). Serum IGFBP-2 decreased during the period of administration and was still suppressed on day 3. The concentration ratios of IGFBP-3 to IGFBP-2 and IGF-I to IGFBP-2 increased markedly with administration and both ratios were still significantly augmented compared with basal values 30 h after the last administration. CONCLUSION With acute administration of somatropin to healthy men the serum concentration of IGFBP-2 decreases and the ratios of serum IGF-I/ IGFBP-2 and IGFBP-3/IGFBP-2 increase. These ratios should be considered in the development of a test for detecting somatropin administration in sport.
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Affiliation(s)
- A T Kicman
- Drug Control Centre, King's College London, UK
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Abstract
Recent research has confirmed previous clinical suspicion that adults with pituitary disease and growth hormone (GH) deficiency have impaired physical and psychological performance even in the presence of adequate adrenal, thyroid and gonadal hormone replacement therapy. This GH deficiency syndrome is characterised particularly by impaired psychological well-being, abnormal body composition with increased abdominal adiposity, reduced strength and exercise capacity, reduced basal metabolic rate, reduced bone density and an elevation in total and low density lipoprotein cholesterol. This latter finding may be important in the context of the observed increase in cardiovascular mortality rates of GH-deficient adults. GH replacement therapy administered as a once-daily subcutaneous injection can restore a near normal quality of life to many of these patients, although there is as yet no evidence that this treatment reduces mortality. Adverse effects of GH therapy are few and have probably been overstated due to excessive doses used in the initial studies. These can be minimised by starting at a low initial dose and increasing gradually while monitoring clinical response and serum insulin-like growth factor-1 values. All adults with GH deficiency should now be considered for GH replacement therapy.
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Affiliation(s)
- J Powrie
- Division of Medicine, United Medical School of Guy's Hospital, London, England
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Powrie J. On the earliest known vestiges of vertebrate life; being a description of the fish remains of the Old Red Sandstone rocks of Forfarshire. ACTA ACUST UNITED AC 1870. [DOI: 10.1144/transed.1.3.284] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.2] [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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