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Friedman N, Weinstein-Fudim L, Mostinski Y, Elia J, Cohen S, Steinberg E, Frankenburg S, Peretz T, Eisenberg G, Lotem M, Benny O, Merims S. Preventing skin toxicities induced by EGFR inhibitors by topically blocking drug-receptor interactions. Sci Transl Med 2023; 15:eabo0684. [PMID: 37285403 DOI: 10.1126/scitranslmed.abo0684] [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] [Received: 01/11/2022] [Accepted: 05/18/2023] [Indexed: 06/09/2023]
Abstract
Epidermal growth factor receptor (EGFR) inhibitors are used to treat many advanced-stage epithelial cancers but induce severe skin toxicities in most treated patients. These side effects lead to a deterioration in the quality of life of the patients and compromise the anticancer treatment. Current treatment strategies for these skin toxicities focus on symptom reduction rather than preventing the initial trigger that causes the toxicity. In this study, we developed a compound and method for treating "on-target" skin toxicity by blocking the drug at the site of toxicity without reducing the systemic dose reaching the tumor. We first screened for small molecules that effectively blocked the binding of anti-EGFR monoclonal antibodies to EGFR and identified a potential candidate, SDT-011. In silico docking predicted that SDT-011 interacted with the same residues on EGFR found to be important for the binding of EGFR inhibitors cetuximab and panitumumab. Binding of SDT-011 to EGFR reduced the binding affinity of cetuximab to EGFR and could reactivate EGFR signaling in keratinocyte cell lines, ex vivo cetuximab-treated whole human skin, and A431-injected mice. Specific small molecules were topically applied and were delivered via a slow-release system derived from biodegradable nanoparticles that penetrate the hair follicles and sebaceous glands, within which EGFR is highly expressed. Our approach has the potential to reduce skin toxicity caused by EGFR inhibitors.
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Affiliation(s)
- Nethanel Friedman
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Liza Weinstein-Fudim
- Sharett Institute of Oncology, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem 91120, Israel
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem 91120, Israel
| | - Yelena Mostinski
- Sharett Institute of Oncology, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem 91120, Israel
| | - Jhonatan Elia
- Department of Plastic and Reconstructive Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem 91120, Israel
| | - Sherri Cohen
- Sharett Institute of Oncology, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem 91120, Israel
| | - Eliana Steinberg
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Shoshana Frankenburg
- Sharett Institute of Oncology, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem 91120, Israel
- Wohl Institute for Translational Medicine, Hadassah Medical Organization, Jerusalem 91120, Israel
- Hadassah Cancer Research Institute (HCRI), Jerusalem 91120, Israel
| | - Tamar Peretz
- Sharett Institute of Oncology, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem 91120, Israel
| | - Galit Eisenberg
- Sharett Institute of Oncology, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem 91120, Israel
- Wohl Institute for Translational Medicine, Hadassah Medical Organization, Jerusalem 91120, Israel
- Hadassah Cancer Research Institute (HCRI), Jerusalem 91120, Israel
| | - Michal Lotem
- Sharett Institute of Oncology, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem 91120, Israel
- Wohl Institute for Translational Medicine, Hadassah Medical Organization, Jerusalem 91120, Israel
- Hadassah Cancer Research Institute (HCRI), Jerusalem 91120, Israel
| | - Ofra Benny
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Sharon Merims
- Sharett Institute of Oncology, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem 91120, Israel
- Wohl Institute for Translational Medicine, Hadassah Medical Organization, Jerusalem 91120, Israel
- Hadassah Cancer Research Institute (HCRI), Jerusalem 91120, Israel
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Friedman N, Merims S, Elia J, Benny O. Ex-vivo Skin Permeability Tests of Nanoparticles for Microscopy Imaging. Bio Protoc 2022; 12:e4375. [PMID: 35530520 PMCID: PMC9018434 DOI: 10.21769/bioprotoc.4375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 12/23/2021] [Accepted: 02/23/2022] [Indexed: 12/29/2022] Open
Abstract
Delivery of drugs through the skin is a major challenge in the field of drug delivery systems. Quantification of materials, and specifically nanoparticles, within the skin layers is essential for the development of advanced topical and transdermal delivery systems. We have developed a technique for ex-vivo segmentation and evaluation of human skin samples treated with fluorescent nanoparticles. The method is based on horizontal cryosections of skin samples, followed by confocal microscopy and image analysis. This protocol is relatively simple to perform with basic histological tools, thus it can serve for various dermatology assays.
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Affiliation(s)
- Nethanel Friedman
- The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Sharon Merims
- Sharet institute of oncology, Hadassah Ein-Karem hospital, Jerusalem, Israel
| | - Jhonatan Elia
- Department of plastic and aesthetic surgery, Hadassah Ein-Karem hospital, Jerusalem, Israel
| | - Ofra Benny
- The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University, Jerusalem, Israel,*For correspondence:
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Kerestes CA, Delafield R, Elia J, Chong E, Kaneshiro B, Soon R. ORAL ABSTRACTS. Contraception 2021. [DOI: 10.1016/j.contraception.2021.07.016] [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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Elia J, Do NTK, Chang TNJ, Lai CH, Chou HH, Chang FCS, Huang JJ. Redefining the Reconstructive Ladder in Vulvoperineal Reconstruction: The Role of Pedicled Perforator Flaps. J Reconstr Microsurg 2021; 38:10-26. [PMID: 33853124 DOI: 10.1055/s-0041-1727199] [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: 10/21/2022]
Abstract
BACKGROUND Gynecological reconstruction is difficult, particularly in cases with recurrence and received previous surgeries and/or radiotherapy and necessitate secondary reconstruction. Perforator flaps can preserve other donor sites for potential later reconstruction, and they also can be better tailored to the defect. We hypothesized that the use of perforator-based flaps can better restore the defect with less complications. METHODS A retrospective review was conducted of all patients who underwent vulvar-perineum reconstruction between 2011 and 2018 by the senior author, and oncologic and reconstructive outcomes and complications were analyzed. RESULTS Thirty-three patients underwent 55 soft tissue reconstructions for vulvar-perineum defects during the study period. The mean follow-up time was 27.6 ± 28.9 months. Squamous cell carcinoma was the most common cancer (45.5%). For 11 patients (33.3%), the procedures were performed for the treatment of recurrent cancer. The average defect size was 39.8 ± 34.3 cm2. The overall survival rate was 90.3%. Profunda artery perforator flaps were the most commonly applied flap for reconstruction in both the primary and recurrent groups. Poor wound healing was the most common complication which occurred in 10 of the 55 flaps (18.2%). Perforator flaps presented fewer complications than myocutaneous flaps or traditional random flaps. Similarly, Island pedicle flap design also presented fewer complications than traditional rotation flaps. With proper reconstruction, previous surgery or radiotherapy did not contribute to an increase in complications. CONCLUSION In our experience, perforator flaps can provide satisfactory reconstruction for perineum reconstruction with low postoperative complications while preserving other donor sites in the event of disease recurrence for repeat resection and reconstruction. Previous surgery or radiotherapy did not increase the complications or preclude its usage. A redefined reconstructive ladder was created to help selecting the best state-of-the-art technique for reconstruction to achieve better results.
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Affiliation(s)
- Jhonatan Elia
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Nicholas T K Do
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tommy N-J Chang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chyong-Huey Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Hung-Hsueh Chou
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Frank C-S Chang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Craniofacial Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Jung-Ju Huang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
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Markovskyi A, Gorbenko V, Zorenko T, Yokosawa T, Will J, Spiecker E, Batentschuk M, Elia J, Fedorov A, Zorenko Y. LPE growth of Tb 3Al 5O 12:Ce single crystalline film converters for WLED application. CrystEngComm 2021. [DOI: 10.1039/d1ce00268f] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Efficient phosphor converters for white LEDs based on TbAG:Ce single crystalline films, LPE grown onto YAG substrates, is developed. The film-substrate interface of TbAG:Ce SCF/YAG epitaxial structures was studied using high-resolution STEM images.
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Affiliation(s)
- A. Markovskyi
- Institute of Physics
- Kazimierz Wielki University
- Bydgoszcz
- Poland
| | - V. Gorbenko
- Institute of Physics
- Kazimierz Wielki University
- Bydgoszcz
- Poland
| | - T. Zorenko
- Institute of Physics
- Kazimierz Wielki University
- Bydgoszcz
- Poland
| | - T. Yokosawa
- Institute of Micro- and Nanostructure Research
- and Center for Nanoanalysis and Electron Microscopy (CENEM)
- Friedrich Alexander University of Erlangen-Nuremberg
- Erlangen
- Germany
| | - J. Will
- Institute of Micro- and Nanostructure Research
- and Center for Nanoanalysis and Electron Microscopy (CENEM)
- Friedrich Alexander University of Erlangen-Nuremberg
- Erlangen
- Germany
| | - E. Spiecker
- Institute of Micro- and Nanostructure Research
- and Center for Nanoanalysis and Electron Microscopy (CENEM)
- Friedrich Alexander University of Erlangen-Nuremberg
- Erlangen
- Germany
| | - M. Batentschuk
- Institute of Materials for Electronics and Energy Technology
- University of Erlangen-Nuremberg
- 91058 Erlangen
- Germany
| | - J. Elia
- Institute of Materials for Electronics and Energy Technology
- University of Erlangen-Nuremberg
- 91058 Erlangen
- Germany
| | - A. Fedorov
- SSI Institute for Single Crystals
- National Academy of Sciences of Ukraine
- 61178 Kharkiv
- Ukraine
| | - Yu. Zorenko
- Institute of Physics
- Kazimierz Wielki University
- Bydgoszcz
- Poland
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Elia J, Hassidim A, Billig A, Chapchay K, Wu CT, Hung SY, Cheong DCF, Tsao CK. Objective and quantifiable measuring mechanism for assessing flap pliability: Our experience with 92 patients. Head Neck 2019; 41:3348-3355. [PMID: 31283090 DOI: 10.1002/hed.25851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 04/19/2019] [Accepted: 06/14/2019] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Pliability describes a flaps' ability to bend under spatial limitations, yet a quantifiable measurement for this flexibility does not exist. METHODS Between January 2015 and January 2017, we applied a novel measuring mechanism to two free flaps for head and neck reconstruction. We allocated a flap pliability score (FPS) to these flaps and observed correlations to common variables. RESULTS Forty profunda artery perforator (PAP) and 52 anterolateral thigh (ALT) flaps were allotted a score depending on how pliable they performed on our test. Proximal PAP and distal ALT were more pliable than their respective opposite ends. Other interesting conclusions regarding these flaps were also made. CONCLUSIONS With our technique, pliability of the proximal and distal ends of PAP and ALT flaps was ascertained. Herein, we describe an innovative measuring mechanism via which we can allocate a FPS to any flap and thus obtain information regarding how suitable they are for a given recipient site.
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Affiliation(s)
- Jhonatan Elia
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan
| | - Ayal Hassidim
- Department of Plastic and Reconstructive Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Allan Billig
- Department of Plastic and Reconstructive Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Katya Chapchay
- Department of Plastic and Reconstructive Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Chieh-Tsai Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Yu Hung
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan
| | - David Chon-Fok Cheong
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan
| | - Chung-Kan Tsao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Tschann MS, Elia J, Salcedo J, Soon R, Kaneshiro B. Assessing the effectiveness of patient-centered nonpharmacologic pain management techniques on pain during first-trimester aspiration abortion: a randomized controlled trial. Contraception 2017. [DOI: 10.1016/j.contraception.2017.07.034] [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: 10/18/2022]
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Margulis A, Billig A, Elia J, Shachar Y, Adler N. Complications of Post-Burn Tissue Expansion Reconstruction: 9 Years Experience with 42 Pediatric and 26 Adult Patients. Isr Med Assoc J 2017; 19:100-104. [PMID: 28457060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Burn scar reconstruction is extremely challenging, even for the most proficient reconstructive surgeon. Within the arsenal of tools at the plastic surgeon's disposal, tissue expansion provides an efficient modality for reconstruction despite the reported complication rates. OBJECTIVES To critically review our experience with tissue expansion for burn scar reconstruction, comparing particularly the adult and pediatric populations. METHODS We conducted a retrospective study of the outcomes of patients who underwent burn scar reconstruction with tissue expansion at Hadassah Medical Center between January 2003 and July 2012. The data included patient age, anatomical site of expansion, number of procedures, and associated complications. The outcomes of the above-mentioned populations were also compared with those in a control group of patients undergoing reconstruction with tissue expansion for indications other than burn scars. RESULTS Sixty-seven tissue expansion procedures were carried out in 50 patients, 42 in the pediatric population (< 16 years of age) and 25 in the adult population. Complications were observed in 10 of the 42 pediatric procedures (23.8%) and in 3 of the 25 adult procedures (12%). This difference was found to be statistically significant. When the complication rate for each population was compared to its control group (tissue expansion for indications other than burn scar reconstruction, such as reconstruction for motor vehicle accident scarring, congenital nevi, or vascular malformations), no statistically significant difference was found between them (complication rates 19.8% and 12.5%, respectively). Furthermore, there was no statistically significant difference in complication rates between the different anatomical areas of expansion within both populations undergoing burn scar reconstruction. Most of the complicated cases completed successful reconstruction. CONCLUSIONS Tissue expansion is a useful surgical tool in post-burn scar reconstruction, both in the adult and pediatric populations and in all anatomic sites, despite consistently high complication rates, especially in the pediatric population. This complication rate is not higher than in patients undergoing tissue expansion for indications other than burn scar reconstruction.
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Affiliation(s)
- Alexander Margulis
- Department of Plastic and Reconstructive Surgery
- Center for Pediatric and Craniofacial Surgery, Hadassah Medical Center
- Hadassah-Hebrew University Medical School Jerusalem, Israel
| | - Allan Billig
- 1Department of Plastic and Reconstructive Surgery Hadassah Medical Center, Jerusalem, Israel
| | - Jhonatan Elia
- 1Department of Plastic and Reconstructive Surgery Hadassah Medical Center, Jerusalem, Israel
| | - Yair Shachar
- 1Department of Plastic and Reconstructive Surgery Hadassah Medical Center, Jerusalem, Israel
| | - Neta Adler
- Department of Plastic and Reconstructive Surgery
- Hadassah-Hebrew University Medical School Jerusalem, Israel
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Mazzilli R, Elia J, Delfino M, Benedetti F, Scordovillo G, Mazzilli F. Prevalence of Diabetes Mellitus (DM) in a population of men affected by Erectile Dysfunction (ED). Clin Ter 2016; 166:e317-20. [PMID: 26550816 DOI: 10.7417/t.2015.1885] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS A) to evaluate the prevalence of patients affected by Diabetes Mellitus (DM) in a population of men with Erectile Dysfunction (ED); B) to define the epidemiological, biochemical and therapeutic aspects. MATERIALS AND METHODS N.934 subjects referred at our Andrology Unit for ED were studied. The diagnosis of ED was evaluated using the IIEF-5 questionnaire (Total score ≤21). RESULTS The prevalence of subjects affected by DM in a population of men with ED was 19.5% (182/934). The age ranges were: ≥55 years (108/182; 59.3%); ≥40<55 years (70/182; 38.5%); <40 years (4/182; 2.2%). HbA1c mean value was 7.9% ± 0.8%. No significant differences were found in DM onset timing or in anti-diabetic treatment. In n.125/182 cases (68.7%) the ED onset followed the diagnosis of DM; in n.34/182 cases (18.7%) it appeared at the same time; and in n.23/182 cases (12.6%) appeared before DM diagnosis. ED TREATMENT in n.18/182 subjects (9.9%) there was a concomitant hypotestosteronemia; these patients were treated only with testosterone replacement; this treatment was efficacious (IIEF-5 total score ≥22) in 8/18 subjects (44.4%). In n.146/182 subjects (80.2%) a treatment with PDE5-i was given. Of these 146 subjects, the therapy was given "on demand" to 108 subjects (efficacy in 50.9%; 55/108) and "once a day" to the remaining 38 subjects (efficacy 63.1%, 24/38) (p=0.428, n.s.). N.15/182 subjects (8.2%) were treated with intracavernous injections of Alprostadil (efficacy in 8/15, 53.3%). In n.3/182 subjects (1.6%) a penile prosthesis was implanted. CONCLUSIONS DM is one of the most frequent organic causes of ED; there were many strategies to treat this symptom without interfering with the antidiabetic treatment. Finally, ED can be predictive of DM.
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Affiliation(s)
- R Mazzilli
- Department of Clinical and Molecular Medicine. Sant'Andrea Hospital, Unit of Andrology, University of Rome "Sapienza", Rome, Italy
| | - J Elia
- Department of Clinical and Molecular Medicine. Sant'Andrea Hospital, Unit of Andrology, University of Rome "Sapienza", Rome, Italy
| | - M Delfino
- Department of Clinical and Molecular Medicine. Sant'Andrea Hospital, Unit of Andrology, University of Rome "Sapienza", Rome, Italy
| | - F Benedetti
- Department of Clinical and Molecular Medicine. Sant'Andrea Hospital, Unit of Andrology, University of Rome "Sapienza", Rome, Italy
| | - G Scordovillo
- Department of Clinical and Molecular Medicine. Sant'Andrea Hospital, Unit of Andrology, University of Rome "Sapienza", Rome, Italy
| | - F Mazzilli
- Department of Clinical and Molecular Medicine. Sant'Andrea Hospital, Unit of Andrology, University of Rome "Sapienza", Rome, Italy
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Connolly JJ, Glessner JT, Elia J, Hakonarson H. ADHD & Pharmacotherapy: Past, Present and Future: A Review of the Changing Landscape of Drug Therapy for Attention Deficit Hyperactivity Disorder. Ther Innov Regul Sci 2015; 49:632-642. [PMID: 26366330 DOI: 10.1177/2168479015599811] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Attention deficit hyperactivity disorder (ADHD) is the most common neurobiological disorder in children, with a prevalence of ~6-7%1,2 that has remained stable for decades2. The social and economic burden associated with patients3, families, and broader systems (healthcare/educational) is substantial, with the annual economic impact of ADHD exceed $30 billion in the US alone4. Efficacy of pharmacotherapy in treating ADHD symptoms has generally been considerable with at least ¾ of individuals benefitting from pharmacotherapy, typically in the form of stimulants5. In this review, we begin by briefly reviewing the history of pharmacotherapy in relation to ADHD, before focusing (primarily) on the state-of-the-field on themes such as biophysiology, pharmacokinetics, and pharmacogenomics. We conclude with a summary of emerging clinical and research studies, particularly the potential role for precision therapy in matching ADHD patients and drug types.
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Affiliation(s)
- J J Connolly
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - J T Glessner
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - J Elia
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA ; AI Dupont Hospital for Children, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - H Hakonarson
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA ; Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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Soon R, Elia J, Beckwith N, Kaneshiro B, De Ver Dye T. Contraceptive decision making among native Hawaiian women. Contraception 2015. [DOI: 10.1016/j.contraception.2015.06.161] [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: 11/29/2022]
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Elia J, Soon R, Beckwith N, Uemoto M, Kaneshiro B, De ver Dye T. Understanding pregnancy intention and contraceptive decision making among Native Hawaiians: focus groups with women and men. Contraception 2015. [DOI: 10.1016/j.contraception.2015.06.151] [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: 11/28/2022]
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Bullock H, Steele S, Kurata N, Tschann M, Elia J, Kaneshiro B, Salcedo J. “I Need to Look That Up. I’ve Never Filled It before”: information from pharmacy staff regarding ulipristal acetate. Contraception 2015. [DOI: 10.1016/j.contraception.2015.06.140] [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: 10/23/2022]
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Elia J, Soon R, Hayes D, Kaneshiro B. Age as a determinant of contraceptive nonuse: an examination of Hawai‘i Title X data. Contraception 2014. [DOI: 10.1016/j.contraception.2014.05.094] [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: 10/24/2022]
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Soon R, Elia J, Beckwith N, Kaneshiro B, Dye T. Cultural factors affecting attitudes toward pregnancy and pregnancy planning among native Hawaiians. Contraception 2014. [DOI: 10.1016/j.contraception.2014.05.170] [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: 11/16/2022]
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Soon R, Elia J, Hayes D, Harvey S, Salcedo J, Kaneshiro B. Highly effective contraceptive use more likely among native Hawaiian women than non-Hawaiian women at Title X clinics in Hawai‘i. Contraception 2014. [DOI: 10.1016/j.contraception.2014.05.089] [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: 10/24/2022]
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Elia J, Albright C, Steffen A, Saiki K. Is moderate-to-vigorous physical activity recorded on 7-day log correlated with accelerometer data in a sample of ethnic minority postpartum women? J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.832] [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: 11/29/2022]
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Jain M, Vélez JI, Acosta MT, Palacio LG, Balog J, Roessler E, Pineda D, Londoño AC, Palacio JD, Arbelaez A, Lopera F, Elia J, Hakonarson H, Seitz C, Freitag CM, Palmason H, Meyer J, Romanos M, Walitza S, Hemminger U, Warnke A, Romanos J, Renner T, Jacob C, Lesch KP, Swanson J, Castellanos FX, Bailey-Wilson JE, Arcos-Burgos M, Muenke M. A cooperative interaction between LPHN3 and 11q doubles the risk for ADHD. Mol Psychiatry 2012; 17:741-7. [PMID: 21606926 PMCID: PMC3382263 DOI: 10.1038/mp.2011.59] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In previous studies of a genetic isolate, we identified significant linkage of attention deficit hyperactivity disorder (ADHD) to 4q, 5q, 8q, 11q and 17p. The existence of unique large size families linked to multiple regions, and the fact that these families came from an isolated population, we hypothesized that two-locus interaction contributions to ADHD were plausible. Several analytical models converged to show significant interaction between 4q and 11q (P<1 × 10(-8)) and 11q and 17p (P<1 × 10(-6)). As we have identified that common variants of the LPHN3 gene were responsible for the 4q linkage signal, we focused on 4q-11q interaction to determine that single-nucleotide polymorphisms (SNPs) harbored in the LPHN3 gene interact with SNPs spanning the 11q region that contains DRD2 and NCAM1 genes, to double the risk of developing ADHD. This interaction not only explains genetic effects much better than taking each of these loci effects by separated but also differences in brain metabolism as depicted by proton magnetic resonance spectroscopy data and pharmacogenetic response to stimulant medication. These findings not only add information about how high order genetic interactions might be implicated in conferring susceptibility to develop ADHD but also show that future studies of the effects of genetic interactions on ADHD clinical information will help to shape predictive models of individual outcome.
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Affiliation(s)
- M Jain
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - J I Vélez
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - M T Acosta
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - L G Palacio
- Neurosciences Group, University of Antioquia, Medellín, Colombia
| | - J Balog
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - E Roessler
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - D Pineda
- Neurosciences Group, University of Antioquia, Medellín, Colombia
| | - A C Londoño
- Neurosciences Group, University of Antioquia, Medellín, Colombia
| | - J D Palacio
- Neurosciences Group, University of Antioquia, Medellín, Colombia
| | - A Arbelaez
- Neurosciences Group, University of Antioquia, Medellín, Colombia
| | - F Lopera
- Neurosciences Group, University of Antioquia, Medellín, Colombia
| | - J Elia
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - H Hakonarson
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - C Seitz
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Saar, Germany
| | - C M Freitag
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Saar, Germany
| | - H Palmason
- Graduate School for Psychobiology, Division of Neuro-Behavioral Genetics, University of Trier, Trier, Germany
| | - J Meyer
- Graduate School for Psychobiology, Division of Neuro-Behavioral Genetics, University of Trier, Trier, Germany
| | - M Romanos
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - S Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - U Hemminger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - A Warnke
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - J Romanos
- Department of Psychiatry and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - T Renner
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Würzburg, Würzburg, Germany,Department of Psychiatry and Psychotherapy, University of Würzburg, Würzburg, Germany,Molecular and Psychobiology, University of Würzburg, Würzburg, Germany
| | - C Jacob
- Department of Psychiatry and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - K-P Lesch
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Würzburg, Würzburg, Germany,Department of Psychiatry and Psychotherapy, University of Würzburg, Würzburg, Germany,Molecular and Psychobiology, University of Würzburg, Würzburg, Germany
| | - J Swanson
- UCI Child Development Center, University of California, Irvine, CA, USA
| | | | - J E Bailey-Wilson
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - M Arcos-Burgos
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA,Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Building 35, Room 1B-209, Bethesda, MD 20892-3717, USA. E-mails: and
| | - M Muenke
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA,Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Building 35, Room 1B-209, Bethesda, MD 20892-3717, USA. E-mails: and
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21
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Gai X, Xie HM, Perin JC, Takahashi N, Murphy K, Wenocur AS, D'arcy M, O'Hara RJ, Goldmuntz E, Grice DE, Shaikh TH, Hakonarson H, Buxbaum JD, Elia J, White PS. Rare structural variation of synapse and neurotransmission genes in autism. Mol Psychiatry 2012; 17:402-11. [PMID: 21358714 PMCID: PMC3314176 DOI: 10.1038/mp.2011.10] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Autism spectrum disorders (ASDs) comprise a constellation of highly heritable neuropsychiatric disorders. Genome-wide studies of autistic individuals have implicated numerous minor risk alleles but few common variants, suggesting a complex genetic model with many contributing loci. To assess commonality of biological function among rare risk alleles, we compared functional knowledge of genes overlapping inherited structural variants in idiopathic ASD subjects relative to healthy controls. In this study we show that biological processes associated with synapse function and neurotransmission are significantly enriched, with replication, in ASD subjects versus controls. Analysis of phenotypes observed for mouse models of copy-variant genes established significant and replicated enrichment of observable phenotypes consistent with ASD behaviors. Most functional terms retained significance after excluding previously reported ASD loci. These results implicate several new variants that involve synaptic function and glutamatergic signaling processes as important contributors of ASD pathophysiology and suggest a sizable pool of additional potential ASD risk loci.
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Affiliation(s)
- X Gai
- Center for Biomedical Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - H M Xie
- Center for Biomedical Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - J C Perin
- Center for Biomedical Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - N Takahashi
- Seaver Autism Center and Department of Psychiatry, Mt Sinai School of Medicine, New York, NY, USA
| | - K Murphy
- Center for Biomedical Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - A S Wenocur
- Center for Biomedical Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M D'arcy
- Center for Biomedical Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - R J O'Hara
- Center for Biomedical Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - E Goldmuntz
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA,Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - D E Grice
- Department of Child and Adolescent Psychiatry, Columbia University, New York, NY, USA
| | - T H Shaikh
- Department of Pediatrics, University of Colorado School of Medicine, Denver, CO, USA
| | - H Hakonarson
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA,Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, USA,Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - J D Buxbaum
- Seaver Autism Center and Department of Psychiatry, Mt Sinai School of Medicine, New York, NY, USA
| | - J Elia
- Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia, Philadelphia, PA, USA,Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - P S White
- Center for Biomedical Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA,Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA,Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA,Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Room 1407 CHOP North, Philadelphia, PA 19104-4318, USA. E-mail:
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22
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Hattle S, Hayton C, Elia J, Wilson AM. P145 Evaluation of a quadriceps muscle endurance leg lift test in patients with chronic obstructive pulmonary disease. Thorax 2010. [DOI: 10.1136/thx.2010.150987.46] [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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23
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Elia J, Gai X, Xie HM, Perin JC, Geiger E, Glessner JT, D'arcy M, deBerardinis R, Frackelton E, Kim C, Lantieri F, Muganga BM, Wang L, Takeda T, Rappaport EF, Grant SFA, Berrettini W, Devoto M, Shaikh TH, Hakonarson H, White PS. Rare structural variants found in attention-deficit hyperactivity disorder are preferentially associated with neurodevelopmental genes. Mol Psychiatry 2010; 15:637-46. [PMID: 19546859 PMCID: PMC2877197 DOI: 10.1038/mp.2009.57] [Citation(s) in RCA: 414] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common and highly heritable disorder, but specific genetic factors underlying risk remain elusive. To assess the role of structural variation in ADHD, we identified 222 inherited copy number variations (CNVs) within 335 ADHD patients and their parents that were not detected in 2026 unrelated healthy individuals. Although no excess CNVs, either deletions or duplications, were found in the ADHD cohort relative to controls, the inherited rare CNV-associated gene set was significantly enriched for genes reported as candidates in studies of autism, schizophrenia and Tourette syndrome, including A2BP1, AUTS2, CNTNAP2 and IMMP2L. The ADHD CNV gene set was also significantly enriched for genes known to be important for psychological and neurological functions, including learning, behavior, synaptic transmission and central nervous system development. Four independent deletions were located within the protein tyrosine phosphatase gene, PTPRD, recently implicated as a candidate gene for restless legs syndrome, which frequently presents with ADHD. A deletion within the glutamate receptor gene, GRM5, was found in an affected parent and all three affected offspring whose ADHD phenotypes closely resembled those of the GRM5 null mouse. Together, these results suggest that rare inherited structural variations play an important role in ADHD development and indicate a set of putative candidate genes for further study in the etiology of ADHD.
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Affiliation(s)
- J Elia
- Department of Child and Adolescent Psychiatry, The Children's Hospital of Philadelphia Philadelphia, PA, USA,Department of Psychiatry, University of Pennsylvania School of Medicine Philadelphia, PA, USA
| | - X Gai
- Center for Biomedical Informatics, The Children's Hospital of Philadelphia Philadelphia, PA, USA
| | - H M Xie
- Center for Biomedical Informatics, The Children's Hospital of Philadelphia Philadelphia, PA, USA
| | - J C Perin
- Center for Biomedical Informatics, The Children's Hospital of Philadelphia Philadelphia, PA, USA
| | - E Geiger
- Division of Genetics, The Children's Hospital of Philadelphia Philadelphia, PA, USA
| | - J T Glessner
- Center for Applied Genomics, The Children's Hospital of Philadelphia Philadelphia, PA, USA
| | - M D'arcy
- Center for Biomedical Informatics, The Children's Hospital of Philadelphia Philadelphia, PA, USA
| | - R deBerardinis
- Department of Child and Adolescent Psychiatry, The Children's Hospital of Philadelphia Philadelphia, PA, USA
| | - E Frackelton
- Center for Applied Genomics, The Children's Hospital of Philadelphia Philadelphia, PA, USA
| | - C Kim
- Center for Applied Genomics, The Children's Hospital of Philadelphia Philadelphia, PA, USA
| | - F Lantieri
- Division of Genetics, The Children's Hospital of Philadelphia Philadelphia, PA, USA
| | - B M Muganga
- Center for Biomedical Informatics, The Children's Hospital of Philadelphia Philadelphia, PA, USA
| | - L Wang
- Center for Biomedical Informatics, The Children's Hospital of Philadelphia Philadelphia, PA, USA
| | - T Takeda
- Department of Child and Adolescent Psychiatry, The Children's Hospital of Philadelphia Philadelphia, PA, USA
| | - E F Rappaport
- Joseph Stokes Jr Research Institute, The Children's Hospital of Philadelphia Philadelphia, PA, USA
| | - S F A Grant
- Division of Genetics, The Children's Hospital of Philadelphia Philadelphia, PA, USA,Center for Applied Genomics, The Children's Hospital of Philadelphia Philadelphia, PA, USA,Department of Pediatrics, University of Pennsylvania School of Medicine Philadelphia, PA, USA
| | - W Berrettini
- Department of Psychiatry, University of Pennsylvania School of Medicine Philadelphia, PA, USA
| | - M Devoto
- Division of Genetics, The Children's Hospital of Philadelphia Philadelphia, PA, USA,Department of Pediatrics, University of Pennsylvania School of Medicine Philadelphia, PA, USA,Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine Philadelphia, PA, USA,Dipartimento di Medicina Sperimentale, University La Sapienza Rome, Italy
| | - T H Shaikh
- Division of Genetics, The Children's Hospital of Philadelphia Philadelphia, PA, USA,Department of Pediatrics, University of Pennsylvania School of Medicine Philadelphia, PA, USA
| | - H Hakonarson
- Center for Applied Genomics, The Children's Hospital of Philadelphia Philadelphia, PA, USA,Department of Pediatrics, University of Pennsylvania School of Medicine Philadelphia, PA, USA,Division of Pulmonary Medicine, The Children's Hospital of Philadelphia Philadelphia, PA, USA,Author for correspondence:
| | - P S White
- Center for Biomedical Informatics, The Children's Hospital of Philadelphia Philadelphia, PA, USA,Department of Pediatrics, University of Pennsylvania School of Medicine Philadelphia, PA, USA,Division of Oncology, The Children's Hospital of Philadelphia Philadelphia, PA, USA,Author for correspondence:
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Abstract
AIM The aim was to study: a) the prevalence of sexual dysfunction in male partners of subfertile couples; b) the possible correlation between sexual dysfunction and seminal profile. SUBJECTS AND METHODS Male partners (no.=171) of subfertile couples were studied, aged between 25 and 40 yr, attending the Andrology Unit of Sant'Andrea Hospital. All the subjects responded to a modified International Index of Erectile Function (IIEF) questionnaire, made up of 5 questions: 2 regarding erectile function, 1 concerning orgasmic function, 1 question on sexual desire, and 1 on satisfaction with intercourse. The questionnaire investigated both spontaneous sex for pleasure and sex intended to lead to pregnancy. The subjects underwent standard semen analysis, according to World Health Organization guidelines. RESULTS The data showed a disorder in sexual intercourse for reproductive purposes in 37 subjects (23.7%). Of these, only 14 (8.9%) also had problems with sex for pleasure. On the other hand, there was no significant variation in the prevalence of sexual dysfunction related to seminal profile. CONCLUSIONS A diagnosis of subfertility represents a stressful situation which can reduce the pleasure of sex, especially in intercourse intended for reproductive purposes; this disorder in sexual activity does not seem to be directly correlated with awareness of the severity of the semen alterations.
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Affiliation(s)
- J Elia
- Department of Medical Physiopathology, University of Rome Sapienza, Via di Grottarossa 1035, Rome, Italy
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25
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Rossi T, Delfino M, Imbrogno N, Elia J, Centini S, Mazzilli F. New software for the automatic and semiautomatic assessment of sperm morphology. MINERVA UROL NEFROL 2007; 59:413-416. [PMID: 17947958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
AIM An attempt was made to improve the standardization of sperm morphology assessment. METHODS A software for computerized automatic/semiautomatic sperm morphology assessment was developed and a comparative study between this computerized system and the subjective micrometric method was carried out. RESULTS The software has shown to be very reliable and reproducible. The subjective micrometric method significantly underestimated the percentage of atypical forms compared with the objective method. CONCLUSION Until the development of new fully-automatic techniques, this system is certainly an effective first step in the objective, reproducible standardization of sperm morphology assessment.
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Affiliation(s)
- T Rossi
- Unit of Andrology, Department of Medical Pathophysiology, 2nd Faculty of Medicine, Sant'Andrea Hospital, La Sapienza University, Rome, Italy
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26
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Delfino M, Imbrogno N, Elia J, Capogreco F, Mazzilli F. Prevalence of diabetes mellitus in male partners of infertile couples. MINERVA UROL NEFROL 2007; 59:131-5. [PMID: 17571048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
AIM The aim of this study was to investigate the prevalence of diabetes mellitus (DM) in a population of male partners of infertile couples, to evaluate their seminal and biochemical parameters and to plan therapeutic strategies to achieve pregnancy. METHODS Standard semen analysis was carried out in 510 male partners of infertile couples, aged 25 to 51 years. RESULTS The prevalence of DM in the subjects studied was 1.18%, 4 cases with non insulin dependent diabetes mellitus (NIDDM) and 2 cases with insulin dependent diabetes mellitus (IDDM). Three subjects with NIDDM and 1 with IDDM had normal ejaculation. Semen analysis of these subjects showed qualitative alteration; the most important effects concerned the kinetic properties, especially progressive motility. Sperm morphology was also significantly compromised. On the other hand, sperm concentration did not show significant alterations. The therapeutic iter in these subjects is similar to that for other dyspermic male partners of infertile couples. The 2 remaining subjects (one with NIDDM and one with IDDM) had retrograde ejaculation (sperm recovery from post-orgasmic urine) and were included in intrauterine insemination or in vitro fertilization programs. In addition, in the subjects with DM, the biochemical seminal profile showed significantly higher levels of fructose compared with the nondiabetic subjects. CONCLUSION DM has a negative impact both in terms of sperm quality and of the ejaculation mechanism. The low prevalence of DM among this study population of 510 male partners of infertile couples is due to the low prevalence of DM in this age range.
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Affiliation(s)
- M Delfino
- Unit of Andrology, Department of Medical Pathophysiology, Second Faculty of Medicine, Sant'Andrea Hospital, La Sapienza University, Rome, Italy
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27
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Mazzilli F, Delfino M, Imbrogno N, Elia J, Dondero F. Survival of micro-organisms in cryostorage of human sperm. Cell Tissue Bank 2006; 7:75-9. [PMID: 16732409 DOI: 10.1007/s10561-005-1966-x] [Citation(s) in RCA: 25] [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: 08/08/2005] [Accepted: 08/09/2005] [Indexed: 11/29/2022]
Abstract
The authors describe the clinical application of semen cryostorage, survival of micro-organism during cryostorage procedures and the risk of cross-contamination.
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Affiliation(s)
- F Mazzilli
- Department of Medical Pathophysiology, 2nd Faculty of Medicine, Unit of Andrology, University La Sapienza, Rome, Italy
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28
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Mazzilli F, Delfino M, Imbrogno N, Elia J, Balducelli F, Rossi T. An attempt to improve standardization of sperm motility class assessment using the superimposed image analysis system (SIAS) software. MINERVA UROL NEFROL 2006; 58:201-5. [PMID: 16767074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
AIM An attempt was made to improve the standardization of sperm motility assessment. METHODS A computerized system based on image superimposition producing final image with a motion effect was employed. Numerical definition of straight-line velocity (VSL), curvilinear velocity (VCL) and linearity (LIN) related to these motility classes were made, at different frame/rates (20 frames/s, 30 frames/s and 60 frames/s). RESULTS At least 4 motility class categories were found to be necessary (instead of 3, WHO) for a valid assessment. According to the cut-offs suggested by the ROC curves, motility classes were defined as follows: Class 1 (straight progressive motility): VSL = or > 23 microm/s; LIN = or > 0.58 at 20 frames/s; LIN = or > 0.50 at 30 frames/s; LIN = or > 0.44 at 60 frames/s. Class 2 (straight slow motility): VSL > 10 microm/s and < 23 microm/s; LIN = or > 0.58 at 20 frames/s; LIN = or > 0.51 at 30 frames/s; LIN = or > 0.43 at 60 frames/s. Class 3 (progressive non straight motility): VSL > 10 microm/s; LIN < 0.58 at 20 frames/s; LIN < 0.51 at 30 frames/s; LIN<0.43 at 60 frames/s. Class 4 (non progressive motility): VSL <10 microm/s. A frame rate of 20 frames/s was found to be sufficient to distinguish sperm motility classes in standard semen analysis. CONCLUSIONS The numerical definition of sperm motility classes may contribute towards standardization in the objective evaluation of sperm kinematics.
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Affiliation(s)
- F Mazzilli
- Unit of Andrology, Department of Medical Pathophysiology, 2nd Faculty of Medicine, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy.
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29
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Ambrosini PJ, Elia J, Rynn MA. 49th Annual Meeting of the American Academy of Child & Adolescent Psychiatry. 22-27 October 2002, San Francisco, CA, USA. Expert Opin Pharmacother 2003; 4:591-4. [PMID: 12667122 DOI: 10.1517/14656566.4.4.591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The diverse programme covered recent advances in developmental neurobiology, genetics, psychotherapy and pharmacotherapy. Presentations included clinical consultation breakfasts, with experts in their specialities, clinical case conferences, media theatre events, symposia, special interest groups, workshops and poster presentations. Several awards were presented to members to acknowledge their research achievements and service to the academy, and to children in need. All the presentations were focused on keeping the clinician and the researcher up-to-date on the advancements within the field of child and adolescent psychiatry. This report will focus on the new research poster presentations, which highlight the current status of paediatric pharmacotherapy. The data will be presented within the major diagnostic groups of the affective, behavioural, anxiety and developmental, autistic and psychotic syndromes. In paediatric pharmacotherapy particularly, several agents are administered as broad spectrum pharmacotherapeutics, and therefore, are used across several disorders.
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Affiliation(s)
- P J Ambrosini
- Drexel University College of Medicine, 3200 Henry Avenue, Philadelphia, PA 19129, USA.
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30
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Abstract
PURPOSE To describe two cases of orbital abscess in neonates and to review the literature of orbital cellulitis in neonates. DESIGN Two interventional case reports. METHODS Photographs, orbital computed tomography scans, and full pediatric examination were obtained in two cases of orbital abscess in neonates. RESULTS Acute ethmoiditis with orbital abscess formation was found in both infants. In one of them, Staphylococcus aureus was identified as the source of infection. CONCLUSIONS The clinical findings of our cases concur with the literature (eight cases) indicating that orbital abscess caused by Staphylococcal ethmoiditis is the most common form of orbital cellulitis in neonates.
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Affiliation(s)
- A A Cruz
- Department of Ophthalmology, School of Medicine of Ribeirão Preto, Hospital das Clínicas-Campus, Av. Bandeirantes 3900, 14049-900 Ribeirão Preto, São Paulo, Brazil
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31
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Elia J, Aoki A, Maldonado CA. Response of bronchiolar Clara cells induced by a domestic insecticide. Analysis of CC10 kDa protein content. Histochem Cell Biol 2000; 113:125-33. [PMID: 10766265 DOI: 10.1007/s004180050015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Clara cells are the most reactive to xenobiotics among the mammalian respiratory tract cells. In this report, the response of Clara cells to acute or repetitive exposure to a commercial insecticide was studied, correlating the changes in the cell ultrastructure with the intracellular content of CC10 kDa protein as quantified by immunocytochemical morphometry. After a single exposure to insecticide, Clara cells reveal great expansion of their volume which is accompanied by a remarkable proliferation of smooth endoplasmic reticulum, swelling of the mitochondria, and changes in the nucleus. Morphometric analysis of CC10 bronchiolar content showed significant increases in both the number of Clara cells and the immunostained areas in individual cells. By western blot, CC10 immunoreactive bands strongly increased in lungs after insecticide treatment, but they were only slightly higher than the control when the vehicle of the insecticide was tested. By repetitive exposure to the insecticide, the rat bronchiolar epithelium undergoes extensive alterations, particularly on Clara cells, the number of which is considerably reduced. The remaining Clara cells shrink in size and the typical dome-like cytoplasm is lost. Secretory granule release is no longer seen and the changes of their shape and secretory content reflect a marked degradation and condensation process. Repetitive exposures to the insecticide produced a severe blockage of the proteinopoietic activity, particularly on the synthesis of CC10. Results reported here reveal that the acute inhalation of a commercial insecticide produces hypertrophy of Clara cells, a significant augmentation of CC10 synthesis, and probably differentiation de novo of Clara cells, and morphological changes compatible with a detoxification process. By contrast, exposure for 5 days provoked a general inhibitory effect on Clara cell activity with the loss of cell capability to synthesize and secrete CC10 kDa protein.
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Affiliation(s)
- J Elia
- Centro de Microscopía Electrónica Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Argentina
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32
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Weller EB, Rowan A, Elia J, Weller RA. Aggressive behavior in patients with attention-deficit/hyperactivity disorder, conduct disorder, and pervasive developmental disorders. J Clin Psychiatry 1999; 60 Suppl 15:5-11. [PMID: 10418807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Aggressive behaviors are frequently observed in patients with attention-deficit/hyperactivity disorder, conduct disorder, and pervasive developmental disorders. Several theories have been postulated to explain the etiology of aggression in these disorders, but no one theory can account for all the different types of aggressive behaviors observed. Numerous uncontrolled studies with small sample sizes have produced mixed results of pharmacologic agents now being used to treat aggression. This article discusses the phenomenology, etiology, assessment, and pharmacologic treatment of aggressive behavior in patients who have attention-deficit/hyperactivity disorder, conduct disorder, and pervasive developmental disorders.
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Affiliation(s)
- E B Weller
- Department of Child and Adolescent Psychiatry, University of Pennsylvania, and the Childrens Hospital of Philadelphia, 19104, USA
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Ambrosini PJ, Wagner KD, Biederman J, Glick I, Tan C, Elia J, Hebeler JR, Rabinovich H, Lock J, Geller D. Multicenter open-label sertraline study in adolescent outpatients with major depression. J Am Acad Child Adolesc Psychiatry 1999; 38:566-72. [PMID: 10230188 DOI: 10.1097/00004583-199905000-00018] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.6] [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: 11/26/2022]
Abstract
OBJECTIVE The aim of this multicenter outpatient study was to assess the therapeutic benefits, response patterns, and safety of sertraline in adolescent major depressive disorder (MDD). METHOD Fifty-three adolescent outpatients with MDD were treated in an open-label, 10-week, acute-phase trial with sertraline and, if responders, for an additional 12-week continuation phase. Diagnostic and response assessments included the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS), 17-item K-SADS-derived depression severity score, Hamilton Depression Rating Scale, Beck Depression Inventory, and Clinical Global Impression Scale. RESULTS By 2 weeks, when analyzed as continuous variables, all severity scores showed significant differences from baseline. This pattern persisted through 10 weeks, with a significantly greater response occurring when treatment was extended from 6 to 10 weeks. Both clinician- and patient-rated improvement was maintained during continuation treatment. Response rates varied considerably when depression rating scales were analyzed categorically. Sertraline was generally well tolerated and did not induce manic symptoms. CONCLUSIONS In open treatment of adolescent MDD with sertraline, significant improvement occurred early on and was maintained for 22 weeks. Absolute response rates varied depending on the rating scales used, definition of response, and length of treatment. Maximal response rates were obtained by clinician-defined ratings after 10 weeks of treatment.
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Affiliation(s)
- P J Ambrosini
- MCP-Hahnemann University, Eastern Pennsylvania Psychiatric Institute, Philadelphia 19129, USA
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Affiliation(s)
- J Elia
- Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 19104-4399, USA
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Nishawala MA, Callaghan M, Malatack JJ, Moughan B, Ambrosini PJ, Price B, Elia J. Pancreatitis associated with serotonin-dopamine antagonists. J Child Adolesc Psychopharmacol 1998; 7:211-3. [PMID: 9466237 DOI: 10.1089/cap.1997.7.211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Castellanos FX, Giedd JN, Elia J, Marsh WL, Ritchie GF, Hamburger SD, Rapoport JL. Controlled stimulant treatment of ADHD and comorbid Tourette's syndrome: effects of stimulant and dose. J Am Acad Child Adolesc Psychiatry 1997; 36:589-96. [PMID: 9136492 DOI: 10.1097/00004583-199705000-00008] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.3] [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: 02/04/2023]
Abstract
OBJECTIVE To determine the effects of methylphenidate (MPH) and dextroamphetamine (DEX) on tic severity in boys with attention-deficit/hyperactivity disorder (ADHD) comorbid with Tourette's syndrome. METHOD A 9-week, placebo-controlled, double-blind crossover using a wide range of doses was completed by 20 subjects in three cohorts. RESULTS Relatively high doses of MPH and DEX in the first cohort produced significant increases in tic severity which were sustained on higher doses of DEX but which attenuated on MPH. Overall, 14 of 20 subjects continued stimulant treatment for 1 to 3 years, generally in combination with other psychotropics. Stimulant-associated adverse effects, including tic exacerbations, were reversible in all cases. CONCLUSION A substantial minority of comorbid subjects had consistent worsening of tics on stimulants, although the majority experienced improvement in ADHD symptoms with acceptable effects on tics. MPH was better tolerated than DEX.
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Aoki A, Pasolli HA, Raida M, Meyer M, Schulz-Knappe P, Mostafavi H, Schepky AG, Znottka R, Elia J, Hock D, Beier HM, Forssmann WG. Isolation of human uteroglobin from blood filtrate. Mol Hum Reprod 1996; 2:489-97. [PMID: 9239658 DOI: 10.1093/molehr/2.7.489] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The purpose of this study was to assess the possibility of isolating biologically active peptides from human blood using large volumes of blood filtrate, which are available from patients undergoing extracorporeal ultrafiltration because of renal insufficiency. This filtrate was submitted to six chromatographic separation steps, yielding one purified peptide which was completely analysed in its primary structure. It was found to be strikingly similar to proteins, described initially as rabbit uteroglobin (or blastokinin) and, more recently, from human bronchial lavage as the '10 kDa Clare cell protein', as well as from human urine as 'protein-1'. The natural molecule contains two chains of identical amino acid sequences of 70 residues which are arranged as an antiparallel dimer due to the disulphide bonds between two cysteines at positions 3 and 69. Mass analysis of the molecular forms yielded molecular weights from 15827 Da (non-oxidized form) to 15859 Da (bi-oxidized form). We conclude that this peptide isolated from the filtrate represents the human uteroglobin, and we demonstrate for the first time that this peptide may be involved as a humoral factor in reproductive or other physiological functions.
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Affiliation(s)
- A Aoki
- Lower Saxony Institute of Peptide Research, Hannover, Germany
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38
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Castellanos FX, Elia J, Kruesi MJ, Marsh WL, Gulotta CS, Potter WZ, Ritchie GF, Hamburger SD, Rapoport JL. Cerebrospinal fluid homovanillic acid predicts behavioral response to stimulants in 45 boys with attention deficit/hyperactivity disorder. Neuropsychopharmacology 1996; 14:125-37. [PMID: 8822535 DOI: 10.1016/0893-133x(95)00077-q] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.5] [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: 02/02/2023]
Abstract
Central dopaminergic activity has been assumed to play a role in the efficacy of stimulant drugs in attention deficit/hyperactivity disorder (ADHD), although supporting evidence has been scant. This study examined baseline cerebrospinal fluid (CSF) of boys with ADHD in relation to response to three different stimulant drugs. Forty five boys with DSM-III-R-diagnosed ADHD had a lumbar puncture before double-blind trials of methylphenidate, dextroamphetamine, and placebo. Sixteen also received pemoline as part of a subsequent open trial. Stepwise linear regressions determined significant predictors of drug response. Our prior report of a positive significant correlation between CSF homovanillic acid (HVA) and ratings of hyperactivity on placebo was replicated in a new sample of 20 boys. After baseline symptom severity, CSF HVA was the best predictor of stimulant drug response, with significant independent contribution to four of the ten measures of hyperactivity that changed significantly with medication. Higher HVA predicted better drug response, and lower HVA was associated with worsening on some measures. This supports the mediating role of central dopaminergic activity in stimulant drug efficacy in childhood hyperactivity.
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Affiliation(s)
- F X Castellanos
- Child Psychiatry Branch, Institute of Mental Health, National Institute of Mental Health, Bethesda, MD 20892-1600, USA
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Schmidt ME, Kruesi MJ, Elia J, Borcherding BG, Elin RJ, Hosseini JM, McFarlin KE, Hamburger S. Effect of dextroamphetamine and methylphenidate on calcium and magnesium concentration in hyperactive boys. Psychiatry Res 1994; 54:199-210. [PMID: 7761553 DOI: 10.1016/0165-1781(94)90007-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Levels of calcium in plasma, red blood cells, and mononuclear blood cells, levels of calcium in plasma, and the plasma calcium-to-magnesium ratio were measured at baseline and after 3 weeks of each drug phase of a double-blind, placebo-controlled study of methylphenidate and dextroamphetamine in hyperactive boys. Levels of magnesium in plasma were significantly higher after 3 weeks of dextroamphetamine treatment, and the calcium-to-magnesium ratio was significantly lower after 3 weeks of either drug compared with the baseline or placebo condition. There was no change in magnesium levels in red blood cells or mononuclear blood cells. These measures were obtained 30 minutes before the morning dose and at 9 a.m., 9:30 a.m., 10:30 a.m., 11:00 a.m., and noon on the last day of each 3-week phase. Analysis of variance revealed a drug effect on plasma magnesium and on the calcium-to-magnesium ratio but no drug x time interaction. Although these changes were not correlated with the time course of acute symptomatic response to stimulant therapy, the decrease in the ratio may be relevant to side effects and treatment resistance associated with stimulant use.
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Affiliation(s)
- M E Schmidt
- Section on Clinical Pharmacology, National Institute of Mental Health, Bethesda, MD 20892, USA
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40
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Castellanos FX, Elia J, Kruesi MJ, Gulotta CS, Mefford IN, Potter WZ, Ritchie GF, Rapoport JL. Cerebrospinal fluid monoamine metabolites in boys with attention-deficit hyperactivity disorder. Psychiatry Res 1994; 52:305-16. [PMID: 7527565 DOI: 10.1016/0165-1781(94)90076-0] [Citation(s) in RCA: 136] [Impact Index Per Article: 4.5] [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: 01/25/2023]
Abstract
Cerebrospinal fluid (CSF), plasma, and urinary monoamine metabolites were determined for 29 boys, aged 6-12, with attention-deficit hyperactivity disorder (ADHD). Levels of CSF 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol (MHPG), the metabolites of serotonin, dopamine, and norepinephrine, respectively, correlated significantly with behavioral measures of aggression and impulsivity/hyperactivity. However, these correlations were in the unexpected direction; for example, CSF 5-HIAA correlated positively with the Brown-Goodwin Lifetime History of Aggression Scale. HVA in CSF was positively correlated with several measures of hyperactivity. The replicability of these findings, as well as possible socioenvironmental effects, and the predictive value of CSF monoamines in prepubertal hyperactivity are the subjects of ongoing study.
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Affiliation(s)
- F X Castellanos
- Child Psychiatry Branch, National Institute of Mental Health (NIMH), Bethesda, MD 20892
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Abstract
OBJECTIVE To examine thyroid indices in a community referred sample of boys with attention-deficit hyperactivity disorder (ADHD) for evidence of generalized resistance to thyroid hormone (GRTH). METHOD TSH, T3, and T4 values were gathered prospectively in 53 physician, school, and/or parent referred ADHD subjects, and in 41 age and gender-matched normal controls. RESULTS None were in the range suggestive of global or pituitary thyroid hormone resistance. CONCLUSIONS GRTH is rare, and thyroid function should not be measured routinely in nonfamilial ADHD.
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Affiliation(s)
- J Elia
- Department of Psychiatry, Medical College of Pennsylvania, Philadelphia
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Abstract
Attention deficit hyperactivity disorder (ADHD) is a common childhood behavioural disorder and medication is one of the principal treatments. Methylphenidate and dexamphetamine (dextroamphetamine) have a long record of use in children and well proven efficacy, and are the preferred drugs. Current clinical guidelines recommend a trial of methylphenidate and of dexamphetamine for each child meeting criteria for the disorder in order to maximise response rate and minimise adverse effects.
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Affiliation(s)
- J Elia
- Medical College of Pennsylvania, Philadelphia
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Abstract
Daily academic classroom performance was recorded in a day hospital school using a commonly employed reading and math series as part of an 11-week double-blind, placebo controlled, crossover comparison of dextroamphetamine (d-AMPH) and methylphenidate (MPH) in 33 hyperactive boys. Students attempted more math and reading tasks while on either active drug. The percent correct and the number of attempted problems of the reading series improved with both drugs while the percent correct for the math series occurred with d-AMPH only. No dose-response relationship was found for either stimulant. Moderate, transient adverse effects were common for both drugs.
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Affiliation(s)
- J Elia
- Child Psychiatry Branch, National Institute of Mental Health, Bethesda, MD 20892
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Ambrosini PJ, Bianchi MD, Rabinovich H, Elia J. Antidepressant treatments in children and adolescents: II. Anxiety, physical, and behavioral disorders. J Am Acad Child Adolesc Psychiatry 1993; 32:483-93. [PMID: 8496110 DOI: 10.1097/00004583-199305000-00001] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Part II of this review critically evaluates antidepressants' (AD) efficacy in children and adolescents with anxiety, physical, and behavioral disorders as well as AD's side-effect spectrum. AD are administered increasingly to youths with specific anxiety syndromes phenomenologically paralleling those in adults which are responsive to AD (e.g., panic, obsessive-compulsive disorders). While several trials have not substantiated earlier theoretical considerations suggesting their usefulness in separation anxiety, their recent success in ameliorating obsessive-compulsive symptoms is encouraging. Systematic drug treatment studies however are limited because of the common overlap of anxiety syndromes with each other and other prominent psychiatric disturbances. More consistent benefits with AD are seen in the physical (e.g., enuresis, bulimia nervosa) and behavioral disorders (e.g., attention deficit-hyperactivity disorder). The wide-ranging benefits of AD in nonaffective disorders suggest AD are more appropriately viewed as broad spectrum pharmacotherapeutics.
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Affiliation(s)
- P J Ambrosini
- Division of Child & Adolescent Psychiatry, Medical College of Pennsylvania/Eastern Pennsylvania Psychiatric Institute, Philadelphia 19129
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Abstract
Part I of this review critically evaluates antidepressants' benefits for children and adolescents with affective disorders. The effectiveness of antidepressants is characterized with specific references regarding diagnostic methodology, measurement characteristics, response definitions, recovery rates, length of treatment, and plasma level monitoring. Antidepressants' efficacy for depressed youths is quite circumscribed, and their superiority to placebo remains unproved. Their intriguing lack of efficacy in affective disorders is discussed based on methodological issues and from a theoretical perspective. Clinical and research implications are presented.
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Affiliation(s)
- P J Ambrosini
- Division of Child and Adolescent Psychiatry, Medical College of Pennsylvania/Eastern Pennsylvania Psychiatric Institute, Philadelphia 19129
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Heyes MP, Saito K, Crowley JS, Davis LE, Demitrack MA, Der M, Dilling LA, Elia J, Kruesi MJ, Lackner A. Quinolinic acid and kynurenine pathway metabolism in inflammatory and non-inflammatory neurological disease. Brain 1992; 115 ( Pt 5):1249-73. [PMID: 1422788 DOI: 10.1093/brain/115.5.1249] [Citation(s) in RCA: 474] [Impact Index Per Article: 14.8] [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] [Indexed: 12/27/2022] Open
Abstract
Neurological dysfunction, seizures and brain atrophy occur in a broad spectrum of acute and chronic neurological diseases. In certain instances, over-stimulation of N-methyl-D-aspartate receptors has been implicated. Quinolinic acid (QUIN) is an endogenous N-methyl-D-aspartate receptor agonist synthesized from L-tryptophan via the kynurenine pathway and thereby has the potential of mediating N-methyl-D-aspartate neuronal damage and dysfunction. Conversely, the related metabolite, kynurenic acid, is an antagonist of N-methyl-D-aspartate receptors and could modulate the neurotoxic effects of QUIN as well as disrupt excitatory amino acid neurotransmission. In the present study, markedly increased concentrations of QUIN were found in both lumbar cerebrospinal fluid (CSF) and post-mortem brain tissue of patients with inflammatory diseases (bacterial, viral, fungal and parasitic infections, meningitis, autoimmune diseases and septicaemia) independent of breakdown of the blood-brain barrier. The concentrations of kynurenic acid were also increased, but generally to a lesser degree than the increases in QUIN. In contrast, no increases in CSF QUIN were found in chronic neurodegenerative disorders, depression or myoclonic seizure disorders, while CSF kynurenic acid concentrations were significantly lower in Huntington's disease and Alzheimer's disease. In inflammatory disease patients, proportional increases in CSF L-kynurenine and reduced L-tryptophan accompanied the increases in CSF QUIN and kynurenic acid. These responses are consistent with induction of indoleamine-2,3-dioxygenase, the first enzyme of the kynurenine pathway which converts L-tryptophan to kynurenic acid and QUIN. Indeed, increases in both indoleamine-2,3-dioxygenase activity and QUIN concentrations were observed in the cerebral cortex of macaques infected with retrovirus, particularly those with local inflammatory lesions. Correlations between CSF QUIN, kynurenic acid and L-kynurenine with markers of immune stimulation (neopterin, white blood cell counts and IgG levels) indicate a relationship between accelerated kynurenine pathway metabolism and the degree of intracerebral immune stimulation. We conclude that inflammatory diseases are associated with accumulation of QUIN, kynurenic acid and L-kynurenine within the central nervous system, but that the available data do not support a role for QUIN in the aetiology of Huntington's disease or Alzheimer's disease. In conjunction with our previous reports that CSF QUIN concentrations are correlated to objective measures of neuropsychological deficits in HIV-1-infected patients, we hypothesize that QUIN and kynurenic acid are mediators of neuronal dysfunction and nerve cell death in inflammatory diseases. Therefore, strategies to attenuate the neurological effects of kynurenine pathway metabolites or attenuate the rate of their synthesis offer new approaches to therapy.
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Affiliation(s)
- M P Heyes
- Section on Analytical Biochemistry, NIMH, NIH, Bethesda, MD 20892
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Affiliation(s)
- M G Kruger
- Department of Microbiology and Immunology, University of Miami, Florida 33101
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Elia J, Stoff DM, Coccaro EF. Biological correlates of impulsive disruptive behavior disorders: Attention deficit hyperactivity disorder, conduct disorder, and borderline personality disorder. New Directions for Mental Health Services 1992:51-7. [PMID: 1352623 DOI: 10.1002/yd.23319925411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- J Elia
- St. Christopher's Hospital, Department of Psychiatry, Medical College of Pennsylvania
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Vitiello B, Hill JL, Elia J, Cunningham E, McLeer SV, Behar D. P.r.n. medications in child psychiatric patients: a pilot placebo-controlled study. J Clin Psychiatry 1991; 52:499-501. [PMID: 1752851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The administration p.r.n. (as needed) of sedative medications is a widespread practice in the management of acute dyscontrol of child psychiatric inpatients. Its efficacy, however, has never been tested in a controlled clinical trial. METHOD Twenty-one male inpatients, aged 5-13 years, participated in a double-blind, placebo-controlled study of the p.r.n. use of diphenhydramine, a sedative antihistaminic often used in child psychiatry wards. The patients' DSM-III-R diagnoses were conduct disorder, attention-deficit hyperactivity, and major depression. Each patient in acute dyscontrol blindly received either oral or intramuscular doses of diphenhydramine 25-50 mg (N = 9) or placebo (N = 12). The Conners Abbreviated 10-Item Teacher Rating Scale and the Clinical Global Impressions scale were completed before and 0.5, 1, and 2 hours after the dose. RESULTS Repeated measures ANOVA showed significant time effects, but no difference due to drug. The intramuscular route tended to be more effective than the oral, regardless of whether active drug or placebo was given. CONCLUSION The data indicate that if p.r.n. administrations are effective, this is a placebo effect. Likewise, intramuscular administrations are more effective because of a route effect ("the needle") and not because of a specific pharmacologic activity.
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Affiliation(s)
- B Vitiello
- Department of Psychiatry, Medical College of Pennsylvania, Philadelphia
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Riley RL, Kruger MG, Elia J. B cell precursors are decreased in senescent BALB/c mice, but retain normal mitotic activity in vivo and in vitro. Clin Immunol Immunopathol 1991; 59:301-13. [PMID: 2009646 DOI: 10.1016/0090-1229(91)90026-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The numbers of phenotypic (sIg- Ly5[220]+) and functional B cell precursors were significantly reduced in the bone marrow of senescent (22-24 months old) BALB/c mice when compared to their young (2-4 months old) cohorts. Little alteration in the numbers of B cell precursors occurred during the first 12 months of life in this strain. In contrast, an accelerated loss of B cell precursors between 15 and 18 months of age was observed. In particular, the levels of small Ly5(220)+ B cell precursors were decreased with advanced age, although a decline in numbers of large sIg- Ly5(220)+ B cell precursors was also evident. The percentages of large sIg- Ly5(220)+ B cell precursors in (S + G2/M) stages of cell cycle were similar (e.g., 60-80%) in aged and young BALB/c mice. Importantly, Ly5(220)+ pre-B cells from both young and aged BALB/c mice, either present in vivo or derived from Ly5(220)- cells in vitro, were capable of proliferation in response to rIL-7. These observations suggest that the aging process results in a progressive decline in the numbers of pre-B cells; however, this apparently is not due to failure of B lineage precursor cells to respond to growth mediators either in vivo or in vitro.
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Affiliation(s)
- R L Riley
- Department of Microbiology and Immunology, University of Miami School of Medicine, Florida 33101
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