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Detterbeck FC, Ostrowski M, Hoffmann H, Rami-Porta R, Osarogiagbon RU, Donnington J, Infante M, Marino M, Marom EM, Nakajima J, Nicholson AG, van Schil P, Travis WD, Tsao MS, Edwards JG, Asamura H. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for Revision of the Classification of Residual Tumor After Resection for the Forthcoming (Ninth) Edition of the TNM Classification of Lung Cancer. J Thorac Oncol 2024:S1556-0864(24)00129-1. [PMID: 38569931 DOI: 10.1016/j.jtho.2024.03.021] [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: 02/10/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION The goal of surgical resection is to completely remove a cancer; it is useful to have a system to describe how well this was accomplished. This is captured by the residual tumor (R) classification, which is separate from the TNM classification that describes the anatomic extent of a cancer independent of treatment. The traditional R-classification designates as R0 a complete resection, as R1 a macroscopically complete resection but with microscopic tumor at the surgical margin, and as R2 a resection that leaves gross tumor behind. For lung cancer, an additional category encompasses situations in which the presence of residual tumor is uncertain. METHODS This paper represents a comprehensive review of evidence regarding these R categories and the descriptors thereof, focusing on studies published after the year 2000 and with adjustment for potential confounders. RESULTS Consistent discrimination between complete, uncertain, and incomplete resection is revealed with respect to overall survival. Evidence regarding specific descriptors is generally somewhat limited and only partially consistent; nevertheless, the data suggest retaining all descriptors but with clarifications to address ambiguities. CONCLUSION On the basis of this review, the R-classification for the ninth edition of stage classification of lung cancer is proposed to retain the same overall framework and descriptors, with more precise definitions of descriptors. These refinements should facilitate application and further research.
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Affiliation(s)
- Frank C Detterbeck
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
| | - Marcin Ostrowski
- Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Hans Hoffmann
- Division of Thoracic Surgery, Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain
| | - Ray U Osarogiagbon
- Oncology Research Group, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
| | | | - Maurizio Infante
- Department of Thoracic Surgery, Ospedale Borgo Trento, Verona, Italy
| | - Mirella Marino
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Edith M Marom
- Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Jun Nakajima
- Department of Thoracic Surgery, The University of Tokyo, Tokyo, Japan
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield NHS Hospitals, Guy's and St. Thomas' NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Paul van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem (Antwerp), Belgium
| | - William D Travis
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ming S Tsao
- Department of Pathology, The Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - John G Edwards
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals National Health Service Foundation Trust, Northern General Hospital, Sheffield, United Kingdom
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio School of Medicine, Tokyo, Japan
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Rami-Porta R, Nishimura KK, Giroux DJ, Detterbeck F, Cardillo G, Edwards JG, Fong KM, Giuliani M, Huang J, Kernstine KH, Marom EM, Nicholson AG, Van Schil PE, Travis WD, Tsao MS, Watanabe SI, Rusch VW, Asamura H. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groups in the Forthcoming (Ninth) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2024:S1556-0864(24)00079-0. [PMID: 38447919 DOI: 10.1016/j.jtho.2024.02.011] [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: 01/04/2024] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION The TNM classification of lung cancer is periodically revised. The International Association for the Study of Lung Cancer collected and analyzed a new database to inform the forthcoming ninth edition of the TNM classification. The results are herewith presented. METHODS After exclusions, 76,518 patients from a total of 124,581 registered patients were available for analyses: 58,193 with clinical stage, 39,192 with pathologic stage, and 62,611 with best stage NSCLC. The proposed new N2 subcategories (N2a, involvement of single ipsilateral mediastinal or subcarinal nodal station, and N2b, involvement of multiple ipsilateral mediastinal nodal stations with or without involvement of the subcarinal nodal station) and the new M1c subcategories (M1c1, multiple extrathoracic metastases in one organ system, and M1c2, multiple extrathoracic metastases in multiple organ systems) were considered in the survival analyses. Several potential stage groupings were evaluated, using multiple analyses, including recursive partitioning, assessment of homogeneity within and discrimination between potential groups, clinical and statistical significance of survival differences, multivariable regression, and broad assessment of generalizability. RESULTS T1N1, T1N2a, and T3N2a subgroups are assigned to IIA, IIB, and IIIA stage groups, respectively. T2aN2b and T2bN2b subgroups are assigned to IIIB. M1c1 and M1c2 remain in stage group IVB. Analyses reveal consistent ordering, discrimination of prognosis, and broad generalizability of the proposed ninth edition stage classification of lung cancer. CONCLUSIONS The proposed stages for the ninth edition TNM improve the granularity of nomenclature about anatomic extent that has benefits as treatment approaches become increasingly differentiated and complex.
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Affiliation(s)
- Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain; Network of Centers for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain.
| | | | | | | | - Giuseppe Cardillo
- Department of Thoracic Surgery, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy; UniCamillus-Saint Camillus International University of Health Science, Rome, Italy
| | - John G Edwards
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, United Kingdom
| | - Kwun M Fong
- Department of Thoracic Medicine, University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Chermside, Brisbane, Queensland, Australia
| | - Meredith Giuliani
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kemp H Kernstine
- Cardiovascular and Thoracic Surgery, University of Texas Southwestern, Dallas, Texas
| | - Edith M Marom
- The Chaim Sheba Medical Center, University of Tel Aviv, Tel Aviv, Israel
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield NHS Hospitals, Guy's and St. Thomas' NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Edegem (Antwerp), Belgium
| | - William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ming S Tsao
- Department of Pathology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Shun-Ichi Watanabe
- Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Valerie W Rusch
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
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Edwards S, Adams J, Tchernikov A, Edwards JG. Low-dose X-ray radiation induces an adaptive response: A potential countermeasure to galactic cosmic radiation exposure. Exp Physiol 2024. [PMID: 38180298 DOI: 10.1113/ep091350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024]
Abstract
Space exploration involves many dangers including galactic cosmic radiation (GCR). This class of radiation includes high-energy protons and heavy ionizing ions. NASA has defined GCR as a carcinogenic risk for long-duration space missions. To date, no clear strategy has been developed to counter chronic GCR exposure. We hypothesize that preconditioning cells with low levels of radiation will be protective from subsequent higher radiation exposures. H9C2 cells were pretreated with 0.1 to 1.0 Gy X-rays. The challenge radiation exposure consisted of either 8 Gy X-rays or 75 cGy of GCR, using a five-ion GCRsim protocol. A cell doubling time assay was used to determine cell viability. An 8 Gy X-ray challenge alone significantly (P < 0.05) increased cell doubling time compared to the no-radiation control group. Low-dose radiation pre-treatment ameliorated the 8 Gy X-ray-induced increases in cell doubling time. A 75 cGy GCR challenge alone significantly increased cell doubling time compared to the no-radiation group. Following the 75 cGy challenge, only the 0.5 and 1.0 Gy pre-treatment ameliorated the 75 cGy-induced increases in cell doubling time. DNA damage or pathological oxidant stress will delay replicative functions and increase cell doubling time. Our results suggested that pretreatment with low-dose X-rays induced an adaptive response which offered a small but significant protection against a following higher radiation challenge. Although perhaps not a practical countermeasure, these findings may serve to offer insight into cell signalling pathways activated in response to low-dose irradiation and targeted for countermeasure development.
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Bedawi EO, Stavroulias D, Hedley E, Blyth KG, Kirk A, De Fonseka D, Edwards JG, Internullo E, Corcoran JP, Marchbank A, Panchal R, Caruana E, Kadwani O, Okiror L, Saba T, Purohit M, Mercer RM, Taberham R, Kanellakis N, Condliffe AM, Lewis LG, Addala DN, Asciak R, Banka R, George V, Hassan M, McCracken D, Sundaralingam A, Wrightson JM, Dobson M, West A, Barnes G, Harvey J, Slade M, Chester-Jones M, Dutton S, Miller RF, Maskell NA, Belcher E, Rahman NM. Early Video-assisted Thoracoscopic Surgery or Intrapleural Enzyme Therapy in Pleural Infection: A Feasibility Randomized Controlled Trial. The Third Multicenter Intrapleural Sepsis Trial-MIST-3. Am J Respir Crit Care Med 2023; 208:1305-1315. [PMID: 37820359 PMCID: PMC10765402 DOI: 10.1164/rccm.202305-0854oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/11/2023] [Indexed: 10/13/2023] Open
Abstract
Rationale: Assessing the early use of video-assisted thoracoscopic surgery (VATS) or intrapleural enzyme therapy (IET) in pleural infection requires a phase III randomized controlled trial (RCT). Objectives: To establish the feasibility of randomization in a surgery-versus-nonsurgery trial as well as the key outcome measures that are important to identify relevant patient-centered outcomes in a subsequent RCT. Methods: The MIST-3 (third Multicenter Intrapleural Sepsis Trial) was a prospective multicenter RCT involving eight U.K. centers combining on-site and off-site surgical services. The study enrolled all patients with a confirmed diagnosis of pleural infection and randomized those with ongoing pleural sepsis after an initial period (as long as 24 h) of standard care to one of three treatment arms: continued standard care, early IET, or a surgical opinion with regard to early VATS. The primary outcome was feasibility based on >50% of eligible patients being successfully randomized, >95% of randomized participants retained to discharge, and >80% of randomized participants retained to 2 weeks of follow-up. The analysis was performed per intention to treat. Measurements and Main Results: Of 97 eligible patients, 60 (62%) were randomized, with 100% retained to discharge and 84% retained to 2 weeks. Baseline demographic, clinical, and microbiological characteristics of the patients were similar across groups. Median times to intervention were 1.0 and 3.5 days in the IET and surgery groups, respectively (P = 0.02). Despite the difference in time to intervention, length of stay (from randomization to discharge) was similar in both intervention arms (7 d) compared with standard care (10 d) (P = 0.70). There were no significant intergroup differences in 2-month readmission and further intervention, although the study was not adequately powered for this outcome. Compared with VATS, IET demonstrated a larger improvement in mean EuroQol five-dimension health utility index (five-level edition) from baseline (0.35) to 2 months (0.83) (P = 0.023). One serious adverse event was reported in the VATS arm. Conclusions: This is the first multicenter RCT of early IET versus early surgery in pleural infection. Despite the logistical challenges posed by the coronavirus disease (COVID-19) pandemic, the study met its predefined feasibility criteria, demonstrated potential shortening of length of stay with early surgery, and signals toward earlier resolution of pain and a shortened recovery with IET. The study findings suggest that a definitive phase III study is feasible but highlights important considerations and significant modifications to the design that would be required to adequately assess optimal initial management in pleural infection.The trial was registered on ISRCTN (number 18,192,121).
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Affiliation(s)
- Eihab O. Bedawi
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- National Institute for Health and Care Research Oxford Biomedical Research Centre
- Oxford Centre for Respiratory Medicine and
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Academic Directorate of Respiratory Medicine
| | - Dionisios Stavroulias
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom
| | - Emma Hedley
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
| | - Kevin G. Blyth
- School of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Alan Kirk
- Department of Thoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | | | - John G. Edwards
- Department of Thoracic Surgery, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Eveline Internullo
- Department of Thoracic Surgery, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | | | - Adrian Marchbank
- Department of Cardiothoracic Surgery, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Rakesh Panchal
- Department of Respiratory Medicine, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Edward Caruana
- Department of Thoracic Surgery, Glenfield Hospitals, University Hospitals of Leicester, Leicester, United Kingdom
| | | | - Lawrence Okiror
- Department of Thoracic Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | | | - Manoj Purohit
- Department of Cardiothoracic Surgery, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
| | - Rachel M. Mercer
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Rhona Taberham
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom
| | - Nikolaos Kanellakis
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- National Institute for Health and Care Research Oxford Biomedical Research Centre
- Laboratory of Pleural and Lung Cancer Translational Research
- Chinese Academy of Medical Sciences Oxford Institute, Nuffield Department of Medicine, and
| | - Alison M. Condliffe
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Academic Directorate of Respiratory Medicine
| | | | - Dinesh N. Addala
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- National Institute for Health and Care Research Oxford Biomedical Research Centre
- Oxford Centre for Respiratory Medicine and
| | - Rachelle Asciak
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Radhika Banka
- Department of Respiratory Medicine, PD Hinduja National Hospital, Mumbai, India
| | - Vineeth George
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Maged Hassan
- Chest Diseases Department, Alexandria University, Alexandria, Egypt
| | - David McCracken
- Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Anand Sundaralingam
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- Oxford Centre for Respiratory Medicine and
| | - John M. Wrightson
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- Oxford Centre for Respiratory Medicine and
| | - Melissa Dobson
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- National Institute for Health and Care Research Oxford Biomedical Research Centre
| | - Alex West
- Department of Respiratory Medicine and
| | | | - John Harvey
- Department of Respiratory Medicine, North Bristol NHS Trust, Bristol, United Kingdom
- Academic Respiratory Unit, University of Bristol, Bristol, United Kingdom
| | - Mark Slade
- Department of Respiratory Medicine, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom; and
| | - Mae Chester-Jones
- Oxford Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Susan Dutton
- Oxford Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Robert F. Miller
- Institute for Global Health, University College London, London, United Kingdom
| | - Nick A. Maskell
- Department of Respiratory Medicine, North Bristol NHS Trust, Bristol, United Kingdom
- Academic Respiratory Unit, University of Bristol, Bristol, United Kingdom
| | - Elizabeth Belcher
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom
| | - Najib M. Rahman
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- National Institute for Health and Care Research Oxford Biomedical Research Centre
- Laboratory of Pleural and Lung Cancer Translational Research
- Chinese Academy of Medical Sciences Oxford Institute, Nuffield Department of Medicine, and
- Oxford Centre for Respiratory Medicine and
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Byers JL, Rao JN, Socci L, Hopkinson DN, Tenconi S, Edwards JG. Costal margin injuries and trans-diaphragmatic intercostal hernia: Presentation, management and outcomes according to the Sheffield classification. J Trauma Acute Care Surg 2023; 95:839-845. [PMID: 37533145 DOI: 10.1097/ta.0000000000004068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
BACKGROUND Costal margin rupture (CMR) injuries are under-diagnosed and inconsistently managed, while carrying significant symptomatic burden. We hypothesized that the Sheffield Classification system of CMR injuries would relate to injury patterns and management options. METHODS Data were collected prospectively between 2006 and 2023 at a major trauma center in the United Kingdom. Computed tomography scans were interrogated and injuries were categorized according to the Sheffield Classification. Clinical, radiologic, management and outcome variables were assessed. RESULTS Fifty-four patients were included in the study. Intercostal hernia (IH) was present in 30 patients and associated with delayed presentation ( p = 0.004), expulsive mechanism of injury (i.e. such as occurs with coughing, sneezing, or retching), higher body mass index ( p < 0.001), and surgical management ( p = 0.02). There was a bimodal distribution of the level of the costal margin rupture, with IH Present and expulsive mechanism injuries occurring predominantly at the ninth costal cartilage, and IH Absent cases and other mechanisms at the seventh costal cartilage ( p < 0.001). There were correlations between the costal cartilage being thin at the site of the CMR and the presence of IH and expulsive etiology ( p < 0.001). Management was conservative in 23 and surgical in 31 cases. Extrathoracic mesh IH repairs were performed in 3, Double Layer Mesh Repairs in 8, Suture IH repairs in 5, CMR plating in 8, CMR sutures in 2, and associated Surgical Stabilization of Rib Fractures in 11 patients. There was one postoperative death. There were seven repeat surgical procedures in five patients. CONCLUSION The Sheffield Classification is associated statistically with presentation, related chest wall injury patterns, and type of definitive management. Further collaborative data collection is required to determine the optimal management strategies. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Jonathan L Byers
- From the Department of Thoracic Surgery, Sheffield Teaching Hospitals NHS Trust, Sheffield, England
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Forrester JD, Bauman ZM, Cole PA, Edwards JG, Knight AW, LaRoque M, Raffa T, White TW, Kartiko S. Chest Wall Injury Society recommendation for surgical stabilization of nonunited rib fractures to decrease pain, reduce opiate use, and improve patient reported outcomes in patients with rib fracture nonunion after trauma. J Trauma Acute Care Surg 2023; 95:943-950. [PMID: 37728432 DOI: 10.1097/ta.0000000000004083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Rib fractures are common injuries which can be associated with acute pain and chronic disability. While most rib fractures ultimately go on to achieve bony union, a subset of patients may go on to develop non-union. Management of these nonunited rib fractures can be challenging and variability in management exists. METHODS The Chest Wall Injury Society's Publication Committee convened to develop recommendations for use of surgical stabilization of nonunited rib fractures (SSNURF) to treat traumatic rib fracture nonunions. PubMed, Embase, and the Cochrane database were searched for pertinent studies. Using a process of iterative consensus, all committee members voted to accept or reject the recommendation. RESULTS No identified studies compared SSNURF to alternative therapy and the overall quality of the body of evidence was rated as low. Risk of bias was identified in all studies. Despite these limitations, there is lower-quality evidence suggesting that SSNURF may be beneficial for decreasing pain, reducing opiate use, and improving patient reported outcomes among patients with symptomatic rib nonunion. However, these benefits should be balanced against risk of symptomatic hardware failure and infection. CONCLUSION This guideline document summarizes the current CWIS recommendations regarding use of SSNURF for management of rib nonunion. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.
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Affiliation(s)
- Joseph D Forrester
- From the Division of General Surgery, Department of Surgery (J.D.F., A.K.), Stanford University, Stanford, California; Division of Acute Care Surgery (Z.M.B.), University of Nebraska Medical Center, Omaha, Nebraska; HealthPartners Orthopaedics and Sports Medicine (P.A.C.), Bloomington, Minnesota; Department of Orthopaedic Surgery (P.A.C., M.L.), University of Minnesota, Minneapolis, Minnesota; Department of Orthopaedic Surgery (P.A.C.), Regions Hospital, Saint Paul, Minnesota; Sheffield Teaching Hospitals NHS Trust (J.G.E.), Sheffield, United Kingdom; and Center for Trauma and Critical Care (T.R., T.W.W.), Department of Surgery (T.R., S.K.), George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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Eriksson EA, Waite A, Whitbeck SS, Bach JA, Bauman ZM, Cavlovic L, Dale K, DeVoe WB, Doben AR, Edwards JG, Forrester JD, Kaye AJ, Green J, Hsu J, Hufford A, Janowak C, Kartiko S, Moore EE, Patel B, Pieracci F, Sarani B, Schubl SD, Semon G, Thomas BW, Tung J, Van Lieshout EMM, White TW, Wijffels MME, Wullschleger ME. An initiative to assess and improve the resources and patient care processes used among Chest Wall Injury Society collaborative centers (CWIS-CC2). J Trauma Acute Care Surg 2023:01586154-990000000-00535. [PMID: 37889926 DOI: 10.1097/ta.0000000000004158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
BACKGROUND Over the last two decades, the acute management of rib fractures has changed significantly. In 2021, the Chest Wall injury Society (CWIS) began recognizing centers who epitomize their mission as CWIS Collaborative Centers (CWIS-CC). The primary aim of this study was to determine the resources, surgical expertise, access to care, and institutional support that are present among centers. METHODS A survey was performed including all CWIS-CC evaluating the resources available at their hospital for the treatment of patients with chest wall injury. Data about each Chest Wall Injury Center (CWIC) care process, availability of resources, institutional support, research support, and educational offerings were recorded. RESULTS Data was collected from 20 trauma centers resulting in an 80% response rate. These trauma centers were made up of 5 international and 15 US based trauma centers. Eighty percent (16/20) have dedicated care team members for the evaluation and management of rib fractures. Twenty-five percent (5/20) have a dedicated rib fracture service with a separate call schedule. Staffing for chest wall injury clinics consists of a multidisciplinary team: with attending surgeons in all clinics, 80%(8/10) with APPs and 70%(7/10) with care coordinators. Forty percent(8/20) of centers have dedicated rib fracture research support and 35%(7/20) have SSRF-related grants. Forty percent (8/20) of centers have marketing support and 30%(8/20) have a web page support to bring awareness to their center. At these trauma centers, a median of 4(1-9) surgeons perform surgical stabilization of rib fractures (SSRF). In the majority of trauma centers the trauma surgeons perform SSRF. CONCLUSIONS Considerable similarities and differences exist within these CWIS collaborative centers. These differences in resources are hypothesis generating in determining the optimal CWIC. These findings may generate several patient care and team process questions to optimize patient care, patient experience, provider satisfaction, research productivity, education, and outreach. LEVEL OF EVIDENCE IV Economic & Value-Based Evaluations.
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Affiliation(s)
| | - Amanda Waite
- Medical University of South Carolina, Department of Surgery
| | | | - John A Bach
- Riverside Methodist Hospital, Department of Surgery
| | | | | | - Kate Dale
- Gold Coast Health, Department of Surgery
| | | | - Andrew R Doben
- St Francis Hospital and Medical Center, Department of Surgery
| | - John G Edwards
- Sheffield Teaching Hospitals NHS Foundation, Department of Cardiothoracic Surgery
| | | | - Adam J Kaye
- Overland Park Regional Medical Center, Department of Surgery
| | | | - Jeremy Hsu
- Westmead Hospital University of Sydney, Department of Surgery
| | - Andrea Hufford
- Overland Park Regional Medical Center, Department of Surgery
| | | | - Susan Kartiko
- The George Washington University, Department of Surgery
| | | | | | | | - Babak Sarani
- The George Washington University, Department of Surgery
| | | | | | | | - Jamie Tung
- Stanford University, Department of Surgery
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Rami-Porta R, Edwards JG, Osarogiagbon RU. Is it time to revise the International Association for the Study of Lung Cancer definitions of completeness of lung cancer resection? Transl Cancer Res 2022; 11:4474-4478. [PMID: 36644172 PMCID: PMC9834576 DOI: 10.21037/tcr-22-2426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain;,Network of Centres for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain
| | - John G. Edwards
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| | - Raymond U. Osarogiagbon
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee, USA;,Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee, USA
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9
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Weiss M, Nikisher B, Haran H, Tefft K, Adams J, Edwards JG. High throughput screen of small molecules as potential countermeasures to galactic cosmic radiation induced cellular dysfunction. Life Sci Space Res (Amst) 2022; 35:76-87. [PMID: 36336373 DOI: 10.1016/j.lssr.2022.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/23/2022] [Accepted: 06/16/2022] [Indexed: 06/16/2023]
Abstract
Space travel increases galactic cosmic ray exposure to flight crews and this is significantly elevated once travel moves beyond low Earth orbit. This includes combinations of high energy protons and heavy ions such as 56Fe or 16O. There are distinct differences in the biological response to low-energy transfer (x-rays) or high-energy transfer (High-LET). However, given the relatively low fluence rate of exposure during flight operations, it might be possible to manage these deleterious effects using small molecules currently available. Virtually all reports to date examining small molecule management of radiation exposure are based on low-LET challenges. To that end an FDA approved drug library (725 drugs) was used to perform a high throughput screen of cultured cells following exposure to galactic cosmic radiation. The H9c2 myoblasts, ES-D3 pluripotent cells, and Hy926 endothelial cell lines were exposed to a single exposure (75 cGy) using the 5-ion GCRsim protocol developed at the NASA Space Radiation Laboratory (NSRL). Following GCR exposure cells were maintained for up to two weeks. For each drug (@10µM), a hierarchical cumulative score was developed incorporating measures of mitochondrial and cellular function, oxidant stress and cell senescence. The top 160 scores were retested following a similar protocol using 1µM of each drug. Within the 160 drugs, 33 are considered to have an anti-inflammatory capacity, while others also indirectly suppressed pro-inflammatory pathways or had noted antioxidant capacity. Lead candidates came from different drug classes that included angiotensin converting enzyme inhibitors or AT1 antagonists, COX2 inhibitors, as well as drugs mediated by histamine receptors. Surprisingly, different classes of anti-diabetic medications were observed to be useful including sulfonylureas and metformin. Using a hierarchical decision structure, we have identified several lead candidates. That no one drug or even drug class was completely successful across all parameters tested suggests the complexity of managing the consequences of galactic cosmic radiation exposure.
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Affiliation(s)
- M Weiss
- Department of Physiology, New York Medical College, Valhalla, New York
| | - B Nikisher
- Department of Physiology, New York Medical College, Valhalla, New York
| | - H Haran
- Department of Physiology, New York Medical College, Valhalla, New York
| | - K Tefft
- Department of Physiology, New York Medical College, Valhalla, New York
| | - J Adams
- Department of Physiology, New York Medical College, Valhalla, New York
| | - J G Edwards
- Department of Physiology, New York Medical College, Valhalla, New York.
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10
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Thomas PA, Edwards JG, Rami-Porta R, Van Schil P, Mercier O, Le Rochais JP, Falcoz PE, Meunier JP, Gkika E, Kheira H, Riesterer O, Ghigna MR, Bardet A, Le Pechoux C. The Lung ART adjuvant radiotherapy phase 3 randomized trial: Impact of quality of resection in stage IIIAN2 patients. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.8522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8522 Background: Lung ART is an international phase 3 trial whose main objective was to evaluate the impact of post-operative conformal radiotherapy (PORT) on disease-free survival (DFS) in patients with completely resected pathologically proven N2 non-small cell lung cancer (NSCLC), with or without neo- or adjuvant chemotherapy. Previously communicated results showed no impact of PORT on DFS. However, as quality of surgical resection and extent of lymph node dissection were expected to be critically important in the interpretation of results, surgical and pathological reports were centrally reviewed by a surgical committee. Methods: A surgical advisory committee composed of 4 expert thoracic surgeons reviewed anonymized surgical and pathological reports of all included patients. Pre-defined classification rules were defined using published guidelines from the International Association for the Study of Lung Cancer and the European Society of Thoracic Surgeons. Tumor resection was defined as complete (no residual tumor and adequate lymph node assessment), uncertain (highest mediastinal nodal station involved, incomplete nodal exploration, involved N2 removed in fragments) or incomplete (presence of residual tumor). Nodal exploration was classified as sampling, selective dissection or extensive dissection. Results: 501 patients were included in the Lung ART trial. Before surgical committee review intervention, all patients except 2 had complete resection. 496 patients’ reports were analyzed by the surgical advisory committee. The basic characteristics are specified in the following table: Conclusions: Monitoring of the quality of nodal exploration and of resection should be implemented in randomized studies evaluating peri-operative strategies in NSCLC in order to provide reliable and generalizable results. Clinical trial information: NCT00410683. [Table: see text]
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Affiliation(s)
| | | | - Ramón Rami-Porta
- Hospital Mutua de Terrassa, Thoracic Surgery Service, Terrassa, Spain
| | | | - Olaf Mercier
- Department of Thoracic Surgery, Institut d'Oncologie Thoracique, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | | | | | | | - Eleni Gkika
- Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany
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11
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Navani N, Baldwin DR, Edwards JG, Evison M, McDonald F, Nicholson AG, Fenemore J, Sage EK, Popat S. Lung Cancer in the United Kingdom. J Thorac Oncol 2022; 17:186-193. [PMID: 35074225 DOI: 10.1016/j.jtho.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 10/31/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom; Department of Thoracic Medicine, University College London Hospital, London, United Kingdom.
| | - David R Baldwin
- Department of Thoracic Medicine, University College London Hospital, London, United Kingdom; Respiratory Medicine Unit, Nottingham University Hospitals, Nottingham, United Kingdom
| | - John G Edwards
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield Teaching Hospitals National Health Service (NHS) Foundation Trust, Sheffield, United Kingdom
| | - Matthew Evison
- Lung Cancer & Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Fiona McDonald
- Lung Unit, Royal Marsden Hospital, London, United Kingdom; Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom; Genomics and Environmental Medicine Section, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Jackie Fenemore
- The Lung Cancer Team, The Christie Hospital, Manchester, United Kingdom; Lung Cancer Nurses UK, Solihull, United Kingdom
| | - Elizabeth K Sage
- Department of Respiratory Medicine, Raigmore Hospital, National Health Service (NHS) Highland and Centre for Rural Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Sanjay Popat
- Lung Unit, Royal Marsden Hospital, London, United Kingdom; Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
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12
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Faivre-Finn C, Edwards JG, Hatton M. Postoperative Radiation Therapy Should Not Be Used for the Therapy of Stage III-N2 NSCLC. J Thorac Oncol 2022; 17:197-199. [PMID: 35074227 DOI: 10.1016/j.jtho.2021.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Corinne Faivre-Finn
- The Christie NHS Foundation Trust, Manchester, United Kingdom; Department of Radiotherapy Related Research, University of Manchester, Manchester, United Kingdom.
| | - John G Edwards
- Sheffield Teaching Hospital NHS Foundation Trust, Northern General Hospital, Sheffield, United Kingdom
| | - Matthew Hatton
- Department of Clinical Oncology, Weston Park Hospital, Sheffield, United Kingdom
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13
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Le Pechoux C, Pourel N, Barlesi F, Lerouge D, Antoni D, Lamezec B, Nestle U, Boisselier P, Dansin E, Paumier A, Peignaux K, Thillays F, Zalcman G, Madelaine J, Pichon E, Larrouy A, Lavole A, Argo-Leignel D, Derollez M, Faivre-Finn C, Hatton MQ, Riesterer O, Bouvier-Morel E, Dunant A, Edwards JG, Thomas PA, Mercier O, Bardet A. Postoperative radiotherapy versus no postoperative radiotherapy in patients with completely resected non-small-cell lung cancer and proven mediastinal N2 involvement (Lung ART): an open-label, randomised, phase 3 trial. Lancet Oncol 2022; 23:104-114. [PMID: 34919827 DOI: 10.1016/s1470-2045(21)00606-9] [Citation(s) in RCA: 94] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND In patients with non-small-cell lung cancer (NSCLC), the use of postoperative radiotherapy (PORT) has been controversial since 1998, because of one meta-analysis showing a deleterious effect on survival in patients with pN0 and pN1, but with an unclear effect in patients with pN2 NSCLC. Because many changes have occurred in the management of patients with NSCLC, the role of three-dimensional (3D) conformal PORT warrants further investigation in patients with stage IIIAN2 NSCLC. The aim of this study was to establish whether PORT should be part of their standard treatment. METHODS Lung ART is an open-label, randomised, phase 3, superiority trial comparing mediastinal PORT to no PORT in patients with NSCLC with complete resection, nodal exploration, and cytologically or histologically proven N2 involvement. Previous neoadjuvant or adjuvant chemotherapy was allowed. Patients aged 18 years or older, with an WHO performance status of 0-2, were recruited from 64 hospitals and cancer centres in five countries (France, UK, Germany, Switzerland, and Belgium). Patients were randomly assigned (1:1) to either the PORT or no PORT (control) groups via a web randomisation system, and minimisation factors were the institution, administration of chemotherapy, number of mediastinal lymph node stations involved, histology, and use of pre-treatment PET scan. Patients received PORT at a dose of 54 Gy in 27 or 30 daily fractions, on five consecutive days a week. Three dimensional conformal radiotherapy was mandatory, and intensity-modulated radiotherapy was permitted in centres with expertise. The primary endpoint was disease-free survival, analysed by intention to treat at 3 years; patients from the PORT group who did not receive radiotherapy and patients from the control group with no follow-up were excluded from the safety analyses. This trial is now closed. This trial is registered with ClinicalTrials.gov number, NCT00410683. FINDINGS Between Aug 7, 2007, and July 17, 2018, 501 patients, predominantly staged with 18F-fluorodeoxyglucose (18F-FDG) PET (456 [91%]; 232 (92%) in the PORT group and 224 (90%) in the control group), were enrolled and randomly assigned to receive PORT (252 patients) or no PORT (249 patients). At the cutoff date of May 31, 2019, median follow-up was 4·8 years (IQR 2·9-7·0). 3-year disease-free survival was 47% (95% CI 40-54) with PORT versus 44% (37-51) without PORT, and the median disease-free survival was 30·5 months (95% CI 24-49) in the PORT group and 22·8 months (17-37) in the control group (hazard ratio 0·86; 95% CI 0·68-1·08; p=0·18). The most common grade 3-4 adverse events were pneumonitis (13 [5%] of 241 patients in the PORT group vs one [<1%] of 246 in the control group), lymphopenia (nine [4%] vs 0), and fatigue (six [3%] vs one [<1%]). Late-grade 3-4 cardiopulmonary toxicity was reported in 26 patients (11%) in the PORT group versus 12 (5%) in the control group. Two patients died from pneumonitis, partly related to radiotherapy and infection, and one patient died due to chemotherapy toxicity (sepsis) that was deemed to be treatment-related, all of whom were in the PORT group. INTERPRETATION Lung ART evaluated 3D conformal PORT after complete resection in patients who predominantly had been staged using (18F-FDG PET-CT and received neoadjuvant or adjuvant chemotherapy. 3-year disease-free survival was higher than expected in both groups, but PORT was not associated with an increased disease-free survival compared with no PORT. Conformal PORT cannot be recommended as the standard of care in patients with stage IIIAN2 NSCLC. FUNDING French National Cancer Institute, Programme Hospitalier de Recherche Clinique from the French Health Ministry, Gustave Roussy, Cancer Research UK, Swiss State Secretary for Education, Research, and Innovation, Swiss Cancer Research Foundation, Swiss Cancer League.
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Affiliation(s)
- Cecile Le Pechoux
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France.
| | - Nicolas Pourel
- Radiation Oncology, Institut Sainte Catherine, Avignon, France
| | - Fabrice Barlesi
- Department of Medical Oncology, Gustave Roussy, Villejuif, France; Aix-Marseille University, Centre National de la Recherche Scientifique, Institut National des Sciences et de la Recherche Médicale, Centre de Recherche en Cancérologie de Marseille, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | | | - Delphine Antoni
- Department of Radiation Oncology, Centre Paul Strauss, Strasbourg, France
| | - Bruno Lamezec
- Radiation Oncology, Centre Armoricain de Radiothérapie, d'Imagerie médicale et d'Oncologie, St Brieuc, France
| | - Ursula Nestle
- Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany; Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany
| | - Pierre Boisselier
- Department of Radiation Oncology, Centre Val d'Aurelle, Montpellier, France
| | - Eric Dansin
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | - Amaury Paumier
- Department of Radiation Oncology, Institut de cancérologie de l'Ouest Centre Paul Papin, Angers, France
| | - Karine Peignaux
- Department of Radiation Oncology, Centre Georges-Francois Leclerc, Dijon, France
| | - François Thillays
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest Centre René Gauducheau, Nantes, France
| | - Gerard Zalcman
- Department of Pneumology, Centre Hospitalier Universitaire de Caen, Caen, France; Department of Thoracic Oncology, Université de Paris, Centre d'Investigation Clinique-1425-Bichat-Claude Bernard Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Jeannick Madelaine
- Department of Pneumology, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Eric Pichon
- Department of Pneumology, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Anne Larrouy
- Radiation Oncology, Centre Specialisé Cancerologie Paris Nord, Sarcelles, France
| | - Armelle Lavole
- Department of Thoracic Oncology, Tenon University Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | | | - Marc Derollez
- Pneumology, Polyclinique du Val de Sambre, Maubeuge, France
| | - Corinne Faivre-Finn
- University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Matthew Q Hatton
- Department of Clinical Oncology, Weston Park Hospital, Sheffield, UK
| | - Oliver Riesterer
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich and Centre for Radiation Oncology, Cantonal Hospitals Aarau and Baden, Aarau, Switzerland
| | - Emilie Bouvier-Morel
- International Center for Thoracic Cancers, and Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France
| | - Ariane Dunant
- International Center for Thoracic Cancers, and Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France
| | - John G Edwards
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK
| | - Pascal Alexandre Thomas
- Department of Thoracic Surgery, Hôpital Nord, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Olaf Mercier
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Institut d'Oncologie Thoracique, Marie-Lannelongue Hospital, Paris-Saclay University, Le Plessis Robinson, France
| | - Aurelie Bardet
- International Center for Thoracic Cancers, and Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France; Oncostat Unité Mixte de Recherche 1018, Inserm, University Paris-Saclay, labeled Ligue Contre le Cancer, Villejuif, France
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14
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Round T, L'Esperance V, Bayly J, Brain K, Dallas L, Edwards JG, Haswell T, Hiley C, Lovell N, McAdam J, McCutchan G, Nair A, Newsom-Davis T, Sage EK, Navani N. COVID-19 and the multidisciplinary care of patients with lung cancer: an evidence-based review and commentary. Br J Cancer 2021; 125:629-640. [PMID: 33972746 PMCID: PMC8108433 DOI: 10.1038/s41416-021-01361-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/04/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
Delivering lung cancer care during the COVID-19 pandemic has posed significant and ongoing challenges. There is a lack of published COVID-19 and lung cancer evidence-based reviews, including for the whole patient pathway. We searched for COVID-19 and lung cancer publications and brought together a multidisciplinary group of stakeholders to review and comment on the evidence and challenges. A rapid review of the literature was undertaken up to 28 October 2020, producing 144 papers, with 113 full texts screened. We focused on new primary data collection (qualitative or quantitative evidence) and excluded case reports, editorials and commentaries. Following exclusions, 15 published papers were included in the review and are summarised. They included one qualitative paper and 14 quantitative studies (surveys or cohort studies), with a total of 2295 lung cancer patients data included (mean study size 153 patients; range 7-803). Review of current evidence and commentary included awareness and help-seeking; lung cancer screening; primary care assessment and referral; diagnosis and treatment in secondary care, including oncology and surgery; patient experience and palliative care. Cross-cutting themes and challenges were identified using qualitative methods for patients, healthcare professionals and service delivery, with a clear need for continued studies to guide evidence-based decision-making.
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Affiliation(s)
- Thomas Round
- School of Population Health Sciences, King's College London, London, UK
| | | | - Joanne Bayly
- Cicely Saunders Institute, King's College London, London, UK
| | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | | | | | - Crispin Hiley
- Research Department of Oncology, Cancer Institute, University College London, London, UK
| | - Natasha Lovell
- Cicely Saunders Institute, King's College London, London, UK
| | - Julia McAdam
- Shrewsbury and Telford Hospitals NHS Trust, Lung Cancer Nurses UK, Shrewsbury, UK
| | - Grace McCutchan
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Arjun Nair
- NHS England Targeted Lung Health Checks Programme, Department of Radiology, University College London Hospitals NHS Foundation Trust and Joint Clinical Lead, London, UK
| | | | | | - Neal Navani
- Lungs For Living Research Centre, University College London and Department of Thoracic Medicine, University College London Hospital, London, UK.
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15
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Dhagia V, Kitagawa A, Jacob C, Zheng C, D'Alessandro A, Edwards JG, Rocic P, Gupte R, Gupte SA. G6PD activity contributes to the regulation of histone acetylation and gene expression in smooth muscle cells and to the pathogenesis of vascular diseases. Am J Physiol Heart Circ Physiol 2021; 320:H999-H1016. [PMID: 33416454 PMCID: PMC7988761 DOI: 10.1152/ajpheart.00488.2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/18/2020] [Accepted: 01/04/2021] [Indexed: 02/05/2023]
Abstract
We aimed to determine 1) the mechanism(s) that enables glucose-6-phosphate dehydrogenase (G6PD) to regulate serum response factor (SRF)- and myocardin (MYOCD)-driven smooth muscle cell (SMC)-restricted gene expression, a process that aids in the differentiation of SMCs, and 2) whether G6PD-mediated metabolic reprogramming contributes to the pathogenesis of vascular diseases in metabolic syndrome (MetS). Inhibition of G6PD activity increased (>30%) expression of SMC-restricted genes and concurrently decreased (40%) the growth of human and rat SMCs ex vivo. Expression of SMC-restricted genes decreased (>100-fold) across successive passages in primary cultures of SMCs isolated from mouse aorta. G6PD inhibition increased Myh11 (47%) while decreasing (>50%) Sca-1, a stem cell marker, in cells passaged seven times. Similarly, CRISPR-Cas9-mediated expression of the loss-of-function Mediterranean variant of G6PD (S188F; G6PDS188F) in rats promoted transcription of SMC-restricted genes. G6PD knockdown or inhibition decreased (48.5%) histone deacetylase (HDAC) activity, enriched (by 3-fold) H3K27ac on the Myocd promoter, and increased Myocd and Myh11 expression. Interestingly, G6PD activity was significantly higher in aortas from JCR rats with MetS than control Sprague-Dawley (SD) rats. Treating JCR rats with epiandrosterone (30 mg/kg/day), a G6PD inhibitor, increased expression of SMC-restricted genes, suppressed Serpine1 and Epha4, and reduced blood pressure. Moreover, feeding SD control (littermates) and G6PDS188F rats a high-fat diet for 4 mo increased Serpine1 and Epha4 expression and mean arterial pressure in SD but not G6PDS188F rats. Our findings demonstrate that G6PD downregulates transcription of SMC-restricted genes through HDAC-dependent deacetylation and potentially augments the severity of vascular diseases associated with MetS.NEW & NOTEWORTHY This study gives detailed mechanistic insight about the regulation of smooth muscle cell (SMC) phenotype by metabolic reprogramming and glucose-6-phosphate dehydrogenase (G6PD) in diabetes and metabolic syndrome. We demonstrate that G6PD controls the chromatin modifications by regulating histone deacetylase (HDAC) activity, which deacetylates histone 3-lysine 9 and 27. Notably, inhibition of G6PD decreases HDAC activity and enriches H3K27ac on myocardin gene promoter to enhance the expression of SMC-restricted genes. Also, we demonstrate for the first time that G6PD inhibitor treatment accentuates metabolic and transcriptomic reprogramming to reduce neointimal formation in coronary artery and large artery elastance in metabolic syndrome rats.
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MESH Headings
- Acetylation
- Animals
- Cell Line
- Disease Models, Animal
- Female
- Gene Expression Regulation
- Glucosephosphate Dehydrogenase/genetics
- Glucosephosphate Dehydrogenase/metabolism
- Hemodynamics
- Histones/metabolism
- Humans
- Male
- Metabolic Syndrome/enzymology
- Metabolic Syndrome/genetics
- Metabolic Syndrome/pathology
- Metabolic Syndrome/physiopathology
- Mice, Transgenic
- Muscle, Smooth, Vascular/enzymology
- Muscle, Smooth, Vascular/pathology
- Muscle, Smooth, Vascular/physiopathology
- Mutation
- Myocytes, Smooth Muscle/enzymology
- Myocytes, Smooth Muscle/pathology
- Myosin Heavy Chains/genetics
- Myosin Heavy Chains/metabolism
- Nuclear Proteins/genetics
- Nuclear Proteins/metabolism
- Protein Processing, Post-Translational
- Rats, Sprague-Dawley
- Serum Response Factor/genetics
- Serum Response Factor/metabolism
- Trans-Activators/genetics
- Trans-Activators/metabolism
- Transcription Factors/genetics
- Transcription Factors/metabolism
- Vascular Remodeling
- Rats
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Affiliation(s)
- Vidhi Dhagia
- Department of Pharmacology, New York Medical College, Valhalla, New York
- Department of Physiology, New York Medical College, Valhalla, New York
| | - Atsushi Kitagawa
- Department of Pharmacology, New York Medical College, Valhalla, New York
- Department of Physiology, New York Medical College, Valhalla, New York
| | - Christina Jacob
- Department of Pharmacology, New York Medical College, Valhalla, New York
- Department of Physiology, New York Medical College, Valhalla, New York
| | - Connie Zheng
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - John G Edwards
- Department of Physiology, New York Medical College, Valhalla, New York
| | - Petra Rocic
- Department of Pharmacology, New York Medical College, Valhalla, New York
- Department of Physiology, New York Medical College, Valhalla, New York
| | - Rakhee Gupte
- Raadysan Biotech., Incorporated, Fishkill, New York
| | - Sachin A Gupte
- Department of Pharmacology, New York Medical College, Valhalla, New York
- Department of Physiology, New York Medical College, Valhalla, New York
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16
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Danson SJ, Conner J, Edwards JG, Blyth KG, Fisher PM, Muthana M, Salawu A, Taylor F, Hodgkinson E, Joyce P, Roman J, Simpson K, Graham A, Learmonth K, Woll PJ. Oncolytic herpesvirus therapy for mesothelioma - A phase I/IIa trial of intrapleural administration of HSV1716. Lung Cancer 2020; 150:145-151. [PMID: 33160198 DOI: 10.1016/j.lungcan.2020.10.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 04/28/2020] [Revised: 08/14/2020] [Accepted: 10/10/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Malignant Pleural Mesothelioma (MPM) remains a major oncological challenge with limited therapeutic options. HSV1716 is a replication restricted oncolytic herpes simplex virus with anti-tumor effects in multiple cell lines including MPM. Intrapleural treatment appeals because MPM is typically multifocal but confined to the pleura, and distant metastases are uncommon. We assessed the safety and possible efficacy of intrapleural HSV1716 for inoperable MPM. MATERIALS AND METHODS Patients with MPM received 1 × 107iu HSV1716 injected via an indwelling intrapleural catheter (IPC) on one, two or four occasions a week apart. The primary endpoint was the safety and tolerability of HSV1716. Secondary endpoints were assessment of HSV1716 replication, detection of immune response and evaluation of tumor response. RESULTS Of thirteen patients enrolled, five had received previous pemetrexed-cisplatin chemotherapy, and eight were chemotherapy naïve. Three patients were enrolled to receive one dose, three patients to two doses and seven patients to four doses. The treatment was well-tolerated with few virus-related adverse events and no dose limiting toxicities. Twelve patients were evaluable for response, as one patient withdrew early after a catheter fracture. There was evidence of viral replication/persistence in pleural fluid in seven of the twelve patients. Induction of Th1 cytokine responses to HSV1716 treatment occurred in eight patients and four patients developed novel anti-tumor IgG. No objective responses were observed but disease stabilization was reported in 50 % of patients at 8 weeks. CONCLUSIONS Intrapleural HSV1716 was well-tolerated and demonstrated an anti-tumor immune response in MPM patients. These results provide a rationale for further studies with this agent in MPM and in combination with other therapies.
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Affiliation(s)
- Sarah J Danson
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK.
| | - Joe Conner
- Virttu Biologics/Sorrento Therapeutics, Biocity Scotland, Newhouse, UK
| | - John G Edwards
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - Kevin G Blyth
- Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK; Institute of Infection, Immunity and Inflammation, University of Glasgow, UK
| | - Patricia M Fisher
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - Munitta Muthana
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - Abdulazeez Salawu
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - Fiona Taylor
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - Elizabeth Hodgkinson
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - Patrick Joyce
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - Jennifer Roman
- Virttu Biologics/Sorrento Therapeutics, Biocity Scotland, Newhouse, UK
| | - Kathleen Simpson
- Virttu Biologics/Sorrento Therapeutics, Biocity Scotland, Newhouse, UK
| | - Alexander Graham
- Virttu Biologics/Sorrento Therapeutics, Biocity Scotland, Newhouse, UK
| | - Kirsty Learmonth
- Virttu Biologics/Sorrento Therapeutics, Biocity Scotland, Newhouse, UK
| | - Penella J Woll
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK
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17
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Gooseman MR, Rawashdeh M, Mattam K, Rao JN, Vaughan PR, Edwards JG. Unifying classification for transdiaphragmatic intercostal hernia and other costal margin injuries. Eur J Cardiothorac Surg 2020; 56:150-158. [PMID: 30770701 DOI: 10.1093/ejcts/ezz020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Received: 10/17/2018] [Revised: 12/10/2018] [Accepted: 12/22/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Taxonomy of injuries involving the costal margin is poorly described and surgical management varies. These injuries, though commonly caused by trauma, may also occur spontaneously, in association with coughing or sneezing, and can be severe. Our goal was to describe our experience using sequential segmental analysis of computed tomographic (CT) scans to perform accurate assessment of injuries around the costal margin. We propose a unifying classification for transdiaphragmatic intercostal hernia and other injuries involving the costal margin. We identify the essential components and favoured techniques of surgical repair. METHODS Patients presenting with injuries to the diaphragm or to the costal margin or with chest wall herniation were included in the study. We performed sequential segmental analysis of CT scans, assessing individual injury patterns to the costal margin, diaphragm and intercostal muscles, to create 7 distinct logical categories of injuries. Management was tailored to each category, adapted to the individual case when required. Patients with simple traumatic diaphragmatic rupture were considered separately, to allow an estimation of the relative incidence of injuries to the costal margin compared to those of the diaphragm alone. RESULTS We identified 38 patients. Of these, 19 had injuries involving the costal margin and/or intercostal muscles (group 1). Sixteen patients in group 1 underwent surgery, 2 of whom had undergone prior surgery, with 4 requiring a novel double-layer mesh technique. Nineteen patients (group 2) with diaphragmatic rupture alone had a standard repair. CONCLUSIONS Sequential analysis of CT scans of the costal margin, diaphragm and intercostal muscles defines accurately the categories of injury. We propose a 'Sheffield classification' in order to guide the clinical team to the most appropriate surgical repair. A variety of surgical techniques may be required, including a single- or double-layer mesh reinforcement and plate and screw fixation.
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Affiliation(s)
- Michael R Gooseman
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
| | - Majd Rawashdeh
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
| | - Kavitha Mattam
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
| | - Jagan N Rao
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
| | - Paul R Vaughan
- Department of Cardiothoracic Surgery, St Georges Hospital, London, UK
| | - John G Edwards
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
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18
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Dorman JR, Clarke PTM, Simpson RB, Edwards JG. Testing the clinical validity of the Bemelman Rib Fracture Management Guideline. Interact Cardiovasc Thorac Surg 2020; 30:597-599. [PMID: 31971227 DOI: 10.1093/icvts/ivz317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/06/2019] [Accepted: 12/19/2019] [Indexed: 11/13/2022] Open
Abstract
Whilst surgical stabilization of rib fractures (SSRF) results in better outcomes, selection algorithms are lacking. We aimed to validate the Rib Fracture Management Guideline proposed by Bemelman. From a cohort of 792 patients with multiple rib fractures, 2 sequential cohorts were selected: 48 patients who underwent SSRF and 48 patients who managed conservatively. Admission computed tomography scans and records were reviewed by an investigator blinded to the SSRF outcome. Adherence to the Bemelman guideline, revised to take account of consensus rib fracture definitions, was tested. Fifty-seven patients had multiple rib fractures only, and 39 patients also had a flail segment. Thirty-nine patients with flail segment underwent SSRF, and 18 patients were managed conservatively. Of the patients that the guideline predicted should have received surgery, 87% did. Of those that it predicted should not receive SSRF, 98% did not. The guideline displayed a sensitivity (95% confidence interval) and specificity for predicting the fixation of 0.98 (0.89-0.9995) and 0.83 (0.70-0.93), respectively. The positive and negative predictive values for surgical fixation were 0.87 (0.76-0.92) and 0.98 (0.85-0.99), respectively. The Bemelman guideline was thus a good predictor of SSRF in retrospective cohort but should be used in conjunction with clinical judgement. Further validation is indicated in a prospective study.
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Affiliation(s)
- Jessica R Dorman
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,The Medical School, University of Sheffield, Sheffield, UK
| | - Peter T M Clarke
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,The Medical School, University of Sheffield, Sheffield, UK
| | - Rosalind B Simpson
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,The Medical School, University of Sheffield, Sheffield, UK
| | - John G Edwards
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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19
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Sinha S, Swift AJ, Kamil MA, Matthews S, Bull MJ, Fisher P, De Fonseka D, Saha S, Edwards JG, Johns CS. The role of imaging in malignant pleural mesothelioma: an update after the 2018 BTS guidelines. Clin Radiol 2020; 75:423-432. [PMID: 32081346 DOI: 10.1016/j.crad.2019.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/04/2019] [Indexed: 02/07/2023]
Abstract
Malignant pleural mesothelioma (MPM) is a primary malignancy of the pleura and is associated with a poor outcome. The symptoms and signs of malignant mesothelioma present late in the natural history of the disease and are non-specific, making the diagnosis challenging and imaging key. In 2018, the British Thoracic Society (BTS) updated the guideline on diagnosis, staging, and follow-up of patients with MPM. These recommendations are discussed in this review of the current literature on imaging of MPM. It is estimated MPM will continue to cause serious morbidity and mortality in the UK late into the 21st century, and internationally, people continue to be exposed to asbestos. We aim to update the reader on current and future imaging strategies, which could aid early diagnosis of pleural malignancy and provide an update on staging and assessment of tumour response.
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Affiliation(s)
- S Sinha
- Department of Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - A J Swift
- Department of Radiology, Sheffield Teaching Hospitals, Sheffield, UK; Academic Unit of Radiology, The University of Sheffield, Sheffield, UK
| | - M A Kamil
- Department of Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - S Matthews
- Department of Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - M J Bull
- Department of Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - P Fisher
- Department of Oncology, Sheffield Teaching Hospitals, Sheffield, UK
| | - D De Fonseka
- Department of Respiratory Medicine, Sheffield Teaching Hospitals, Sheffield, UK
| | - S Saha
- Department of Respiratory Medicine, Sheffield Teaching Hospitals, Sheffield, UK
| | - J G Edwards
- Department of Thoracic Surgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - C S Johns
- Department of Radiology, Sheffield Teaching Hospitals, Sheffield, UK.
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20
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Mitry MA, Laurent D, Keith BL, Sira E, Eisenberg CA, Eisenberg LM, Joshi S, Gupte S, Edwards JG. Accelerated cardiomyocyte senescence contributes to late-onset doxorubicin-induced cardiotoxicity. Am J Physiol Cell Physiol 2020; 318:C380-C391. [PMID: 31913702 DOI: 10.1152/ajpcell.00073.2019] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Children surviving cancer and chemotherapy are at risk for adverse health events including heart failure that may be delayed by years. Although the early effects of doxorubicin-induced cardiotoxicity may be attributed to a direct effect on the cardiomyocytes, the mechanisms underlying the delayed or late effects (8-20 yr) are unknown. The goal of this project was to develop a model of late-onset doxorubicin-induced cardiotoxicity to better delineate the underlying pathophysiology responsible. The underlying hypothesis was that doxorubicin-induced "late-onset cardiotoxicity" was the result of mitochondrial dysfunction leading to cell failure and death. Wistar rats, 3-4 wk of age, were randomly assigned to vehicle or doxorubicin injection groups (1-45 mg/kg). Cardiovascular function was unaltered at the lower dosages (1-15 kg/mg), but beginning at 6 mo after injection significant cardiac degradation was observed in the 45 mg/kg group. Doxorubicin significantly increased myocardial mitochondrial DNA (mtDNA) damage. In contrast, in isolated c-kit left ventricular (LV) cells, doxorubicin treatment did not increase mtDNA damage. Biomarkers of senescence within the LV were significantly increased, suggesting accelerated aging of the LV. Doxorubicin also significantly increased LV histamine content suggestive of mast cell activation. With the use of flow cytometry, a significant expansion of the c-kit and stage-specific embryonic antigen 1 cell populations within the LV were concomitant with significant decreases in the circulating peripheral blood population of these cells. These results are consistent with the concept that doxorubicin induced significant damage to the cardiomyocyte population and that although the heart attempted to compensate it eventually succumbed to an inability for self-repair.
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Affiliation(s)
- Maria A Mitry
- Department of Physiology, New York Medical College, Valhalla, New York
| | - Dimitri Laurent
- Department of Physiology, New York Medical College, Valhalla, New York
| | - Britny L Keith
- Department of Physiology, New York Medical College, Valhalla, New York
| | - Elizabeth Sira
- Department of Physiology, New York Medical College, Valhalla, New York
| | - Carol A Eisenberg
- Department of Physiology, New York Medical College, Valhalla, New York
| | | | - Sachindra Joshi
- Department of Pharmacology, New York Medical College, Valhalla, New York
| | - Sachin Gupte
- Department of Pharmacology, New York Medical College, Valhalla, New York
| | - John G Edwards
- Department of Physiology, New York Medical College, Valhalla, New York
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21
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Abstract
Background The accepted classification for multiple rib fractures is binary: flail chest or not. There is a wide spectrum of morphology with subsequent variation in the impact on chest wall mechanics and clinical outcomes. As the practice of surgical stabilisation of rib fractures evolves, there is a need for a better taxonomy. The aim of this study was to create a data-driven radiological classification system for multiple rib fractures, prognostic of both complications and surgical stabilisation of rib fracture. Methods The radiological pattern of injury was assessed for cases undergoing surgical stabilisation of rib fracture (n = 48) over a five-year period and a consecutive sample of non-operative controls (n = 48). Every rib fracture (n = 1032) was assessed on CT scans for location, displacement and comminution. An iterative classification system was developed and tested for inter-observer agreement and outcome prediction. Results The fractures occurred in a ‘series’ (≥3 consecutive ribs at a similar location) in 72% of cases: these were more likely to be displaced (p < 0.001). Variables included in the classification were the anatomical pattern (presence, length and overlap of series) and degree of displacement. The classification was prognostic for complications (p < 0.001), discriminated for fixation (C = 0.907) and had acceptable inter-observer agreement (k = 0.50). Conclusions The Sheffield Multiple Rib Fracture Classification derived categories of short/long series, and short/long flail chest, with sub-division according to the presence of displacement. It was prognostic for clinical outcomes and of surgical fixation. It may facilitate communication, comparison of outcomes and selection for management protocols.
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Affiliation(s)
- Rosalind B Simpson
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK
| | - Jessica R Dorman
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK
| | - William J Hunt
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK
| | - John G Edwards
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK
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22
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Gooseman MR, Cooper GJ, Edwards JG. Elastic-Stable Chest Repair: Costal Plate Fixation for Sternotomy Nonunion. Ann Thorac Surg 2019; 105:e175-e176. [PMID: 29571350 DOI: 10.1016/j.athoracsur.2017.10.030] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 10/19/2017] [Indexed: 10/17/2022]
Abstract
Sterile sternotomy nonunion is a recognized complication after median sternotomy. It is defined as sternotomy that persists after 3 months without evidence of bony healing but with healing of the overlying soft tissues. It is a morbid condition associated with pain and sternal instability. We present two challenging cases of sterile sternotomy nonunion after cardiac operations that were treated successfully with novel methods adopted from the Elastic Stable Chest Repair for complex pectus deformity repair, using transverse costal to costal external cortical plates and bicortical screws, after debridement, autologous bone grafting and double loop wire sternal approximation.
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Affiliation(s)
- Michael R Gooseman
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, United Kingdom
| | - Graham J Cooper
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, United Kingdom
| | - John G Edwards
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, United Kingdom.
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23
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Bayman N, Appel W, Ashcroft L, Baldwin DR, Bates A, Darlison L, Edwards JG, Ezhil V, Gilligan D, Hatton M, Jegannathen A, Mansy T, Peake MD, Pemberton L, Rintoul RC, Snee M, Ryder WD, Taylor P, Faivre-Finn C. Prophylactic Irradiation of Tracts in Patients With Malignant Pleural Mesothelioma: An Open-Label, Multicenter, Phase III Randomized Trial. J Clin Oncol 2019; 37:1200-1208. [PMID: 30920878 DOI: 10.1200/jco.18.01678] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Prophylactic irradiation to the chest wall after diagnostic or therapeutic procedures in patients with malignant pleural mesothelioma (MPM) has been a widespread practice across Europe, although the efficacy of this treatment is uncertain. In this study, we aimed to determine the efficacy of prophylactic radiotherapy in reducing the incidence of chest wall metastases (CWM) after a procedure in MPM. METHODS After undergoing a chest wall procedure, patients with MPM were randomly assigned to receive prophylactic radiotherapy (within 42 days of the procedure) or no radiotherapy. Open thoracotomies, needle biopsies, and indwelling pleural catheters were excluded. Prophylactic radiotherapy was delivered at a dose of 21 Gy in three fractions over three consecutive working days, using a single electron field adapted to maximize coverage of the tract from skin surface to pleura. The primary outcome was the incidence of CWM within 6 months from random assignment, assessed in the intention-to-treat population. Stratification factors included epithelioid histology and intention to give chemotherapy. RESULTS Between July 30, 2012, and December 12, 2015, 375 patients were recruited from 54 centers and randomly assigned to receive prophylactic radiotherapy (n = 186) or no prophylactic radiotherapy (n = 189). Participants were well matched at baseline. No significant difference was seen in the incidence of CWM at 6 months between the prophylactic radiotherapy and no radiotherapy groups (no. [%]: 6 [3.2] v 10 [5.3], respectively; odds ratio, 0.60; 95% CI, 0.17 to 1.86; P = .44). Skin toxicity was the most common radiotherapy-related adverse event in the prophylactic radiotherapy group, with 96 patients (51.6%) receiving grade 1; 19 (10.2%), grade 2; and 1 (0.5%) grade 3 radiation dermatitis (Common Terminology Criteria for Adverse Events, version 4.0). CONCLUSION There is no role for the routine use of prophylactic irradiation to chest wall procedure sites in patients with MPM.
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Affiliation(s)
- Neil Bayman
- 1 The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Wiebke Appel
- 2 Lancashire Teaching Hospitals National Health Service Foundation Trust, Preston, United Kingdom
| | - Linda Ashcroft
- 1 The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - David R Baldwin
- 3 Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom
| | - Andrew Bates
- 4 University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Liz Darlison
- 5 University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom
| | - John G Edwards
- 6 Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Veni Ezhil
- 7 Royal Surrey County Hospital, National Health Service Foundation Trust, Guildford, United Kingdom
| | - David Gilligan
- 8 Cambridge University Hospital National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Matthew Hatton
- 6 Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Apurna Jegannathen
- 9 University Hospitals of North Midlands National Health Service Trust, Stoke-on-Trent, United Kingdom
| | - Talal Mansy
- 10 South Tees Hospitals National Health Service Foundation Trust, Middlesbrough, United Kingdom
| | - Michael D Peake
- 5 University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom
| | - Laura Pemberton
- 1 The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Robert C Rintoul
- 11 Cancer Research UK Cambridge Centre, Cambridge, United Kingdom
| | - Michael Snee
- 12 Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
| | - W David Ryder
- 1 The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Paul Taylor
- 13 Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- 1 The Christie National Health Service Foundation Trust, Manchester, United Kingdom.,14 University of Manchester, Manchester, United Kingdom
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24
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Matthews C, Freeman C, Sharples LD, Fox-Rushby J, Tod A, Maskell NA, Edwards JG, Coonar AS, Sivasothy P, Hughes V, Rahman NM, Waller DA, Rintoul RC. MesoTRAP: a feasibility study that includes a pilot clinical trial comparing video-assisted thoracoscopic partial pleurectomy decortication with indwelling pleural catheter in patients with trapped lung due to malignant pleural mesothelioma designed to address recruitment and randomisation uncertainties and sample size requirements for a phase III trial. BMJ Open Respir Res 2019; 6:e000368. [PMID: 30687504 PMCID: PMC6326291 DOI: 10.1136/bmjresp-2018-000368] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 10/15/2018] [Indexed: 12/29/2022] Open
Abstract
Introduction One of the most debilitating symptoms of malignant pleural mesothelioma (MPM) is dyspnoea caused by pleural effusion. MPM can be complicated by the presence of tumour on the visceral pleura preventing the lung from re-expanding, known as trapped lung (TL). There is currently no consensus on the best way to manage TL. One approach is insertion of an indwelling pleural catheter (IPC) under local anaesthesia. Another is video-assisted thoracoscopic partial pleurectomy/decortication (VAT-PD). Performed under general anaesthesia, VAT-PD permits surgical removal of the rind of tumour from the visceral pleura thereby allowing the lung to fully re-expand. Methods and analysis MesoTRAP is a feasibility study that includes a pilot multicentre, randomised controlled clinical trial comparing VAT-PD with IPC in patients with TL and pleural effusion due to MPM. The primary objective is to measure the SD of visual analogue scale scores for dyspnoea following randomisation and examine the patterns of change over time in each treatment group. Secondary objectives include documenting survival and adverse events, estimating the incidence and prevalence of TL in patients with MPM, examining completion of alternative forms of data capture for economic evaluation and determining the ability to randomise 38 patients in 18 months. Ethics and dissemination This study was approved by the East of England-Cambridge Central Research Ethics Committee and the Health Research Authority (reference number 16/EE/0370). We aim to publish the outputs of this work in international peer-reviewed journals compliant with an Open Access policy. Trial registration NCT03412357.
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Affiliation(s)
- Claire Matthews
- Papworth Trials Unit Collaboration, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Carol Freeman
- Papworth Trials Unit Collaboration, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Linda D Sharples
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Julia Fox-Rushby
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Angela Tod
- School of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | | | - John G Edwards
- Department of Thoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Aman S Coonar
- Department of Thoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Victoria Hughes
- Papworth Trials Unit Collaboration, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Najib M Rahman
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - David A Waller
- Department of Thoracic Surgery, St Bartholomew's Hospital, London, UK
| | - Robert Campbell Rintoul
- Papworth Trials Unit Collaboration, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.,Department of Oncology, University of Cambridge, Cambridge, UK
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25
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Xie D, Choudhary V, Seremwe M, Edwards JG, Wang A, Emmons AC, Bollag KA, Johnson MH, Bollag WB. Soy Phosphatidylglycerol Reduces Inflammation in a Contact Irritant Ear Edema Mouse Model In Vivo. J Pharmacol Exp Ther 2018; 366:1-8. [PMID: 29695409 PMCID: PMC5988020 DOI: 10.1124/jpet.117.244756] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 04/17/2018] [Indexed: 01/05/2023] Open
Abstract
We have previously shown that phosphatidylglycerol (PG) regulates the function of keratinocytes, the predominant cells that compose the epidermis, inhibiting the proliferation of rapidly dividing keratinocytes. In particular, soy PG, a PG mixture with a high proportion of polyunsaturated fatty acids, is efficacious at inhibiting these proliferating keratinocytes. Psoriasis is a skin disorder characterized by hyperproliferation of keratinocytes and inflammation. Data in the lung suggest that PG in pulmonary surfactant inhibits inflammation. To investigate the possibility of using PG containing polyunsaturated fatty acids for the treatment of psoriasis, we examined the effect of soy PG on inflammation induced by the application of 12-O-tetradecanoylphorbol 13-acetate (TPA), a contact irritant, to mouse ears in vivo. We monitored ear thickness and weight as a measure of ear edema, as well as CD45-positive immune cell infiltration. Our results indicate that soy PG when applied together with 1,25-dihydroxyvitamin D3 (vitamin D), an agent known to acutely disrupt the skin barrier, suppressed ear edema and inhibited the infiltration of CD45-positive immune cells. On the other hand, neither PG nor vitamin D alone was effective. The combination also decreased tumor necrosis factor-α (TNFα) levels. This result suggested the possibility that PG was not permeating the skin barrier efficiently. Therefore, in a further study we applied PG in a penetration-enhancing vehicle and found that it inhibited inflammation induced by the phorbol ester and decreased CD45-positive immune cell infiltration. Our results suggest the possibility of using soy PG as a topical treatment option for psoriasis.
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Affiliation(s)
- Ding Xie
- Charlie Norwood VA Medical Center, Augusta, Georgia (V.C., W.B.B.); Institute of Molecular Medicine and Genetics, Department of Medicine (D.X., M.S., W.B.B.), Department of Physiology (D.X., V.C., M.S., A.W., A.C.E., K.A.B., W.B.B.), Department of Family Medicine (D.X.), Department of Neuroscience and Regenerative Medicine (M.H.J.), and Division of Dermatology, Department of Medicine (W.B.B.), Medical College of Georgia, Augusta University, Augusta, Georgia; and Apeliotus Technologies, Inc., Philadelphia, Pennsylvania (J.G.E., W.B.B.)
| | - Vivek Choudhary
- Charlie Norwood VA Medical Center, Augusta, Georgia (V.C., W.B.B.); Institute of Molecular Medicine and Genetics, Department of Medicine (D.X., M.S., W.B.B.), Department of Physiology (D.X., V.C., M.S., A.W., A.C.E., K.A.B., W.B.B.), Department of Family Medicine (D.X.), Department of Neuroscience and Regenerative Medicine (M.H.J.), and Division of Dermatology, Department of Medicine (W.B.B.), Medical College of Georgia, Augusta University, Augusta, Georgia; and Apeliotus Technologies, Inc., Philadelphia, Pennsylvania (J.G.E., W.B.B.)
| | - Mutsa Seremwe
- Charlie Norwood VA Medical Center, Augusta, Georgia (V.C., W.B.B.); Institute of Molecular Medicine and Genetics, Department of Medicine (D.X., M.S., W.B.B.), Department of Physiology (D.X., V.C., M.S., A.W., A.C.E., K.A.B., W.B.B.), Department of Family Medicine (D.X.), Department of Neuroscience and Regenerative Medicine (M.H.J.), and Division of Dermatology, Department of Medicine (W.B.B.), Medical College of Georgia, Augusta University, Augusta, Georgia; and Apeliotus Technologies, Inc., Philadelphia, Pennsylvania (J.G.E., W.B.B.)
| | - John G Edwards
- Charlie Norwood VA Medical Center, Augusta, Georgia (V.C., W.B.B.); Institute of Molecular Medicine and Genetics, Department of Medicine (D.X., M.S., W.B.B.), Department of Physiology (D.X., V.C., M.S., A.W., A.C.E., K.A.B., W.B.B.), Department of Family Medicine (D.X.), Department of Neuroscience and Regenerative Medicine (M.H.J.), and Division of Dermatology, Department of Medicine (W.B.B.), Medical College of Georgia, Augusta University, Augusta, Georgia; and Apeliotus Technologies, Inc., Philadelphia, Pennsylvania (J.G.E., W.B.B.)
| | - Angela Wang
- Charlie Norwood VA Medical Center, Augusta, Georgia (V.C., W.B.B.); Institute of Molecular Medicine and Genetics, Department of Medicine (D.X., M.S., W.B.B.), Department of Physiology (D.X., V.C., M.S., A.W., A.C.E., K.A.B., W.B.B.), Department of Family Medicine (D.X.), Department of Neuroscience and Regenerative Medicine (M.H.J.), and Division of Dermatology, Department of Medicine (W.B.B.), Medical College of Georgia, Augusta University, Augusta, Georgia; and Apeliotus Technologies, Inc., Philadelphia, Pennsylvania (J.G.E., W.B.B.)
| | - Aaron C Emmons
- Charlie Norwood VA Medical Center, Augusta, Georgia (V.C., W.B.B.); Institute of Molecular Medicine and Genetics, Department of Medicine (D.X., M.S., W.B.B.), Department of Physiology (D.X., V.C., M.S., A.W., A.C.E., K.A.B., W.B.B.), Department of Family Medicine (D.X.), Department of Neuroscience and Regenerative Medicine (M.H.J.), and Division of Dermatology, Department of Medicine (W.B.B.), Medical College of Georgia, Augusta University, Augusta, Georgia; and Apeliotus Technologies, Inc., Philadelphia, Pennsylvania (J.G.E., W.B.B.)
| | - Katherine A Bollag
- Charlie Norwood VA Medical Center, Augusta, Georgia (V.C., W.B.B.); Institute of Molecular Medicine and Genetics, Department of Medicine (D.X., M.S., W.B.B.), Department of Physiology (D.X., V.C., M.S., A.W., A.C.E., K.A.B., W.B.B.), Department of Family Medicine (D.X.), Department of Neuroscience and Regenerative Medicine (M.H.J.), and Division of Dermatology, Department of Medicine (W.B.B.), Medical College of Georgia, Augusta University, Augusta, Georgia; and Apeliotus Technologies, Inc., Philadelphia, Pennsylvania (J.G.E., W.B.B.)
| | - Maribeth H Johnson
- Charlie Norwood VA Medical Center, Augusta, Georgia (V.C., W.B.B.); Institute of Molecular Medicine and Genetics, Department of Medicine (D.X., M.S., W.B.B.), Department of Physiology (D.X., V.C., M.S., A.W., A.C.E., K.A.B., W.B.B.), Department of Family Medicine (D.X.), Department of Neuroscience and Regenerative Medicine (M.H.J.), and Division of Dermatology, Department of Medicine (W.B.B.), Medical College of Georgia, Augusta University, Augusta, Georgia; and Apeliotus Technologies, Inc., Philadelphia, Pennsylvania (J.G.E., W.B.B.)
| | - Wendy B Bollag
- Charlie Norwood VA Medical Center, Augusta, Georgia (V.C., W.B.B.); Institute of Molecular Medicine and Genetics, Department of Medicine (D.X., M.S., W.B.B.), Department of Physiology (D.X., V.C., M.S., A.W., A.C.E., K.A.B., W.B.B.), Department of Family Medicine (D.X.), Department of Neuroscience and Regenerative Medicine (M.H.J.), and Division of Dermatology, Department of Medicine (W.B.B.), Medical College of Georgia, Augusta University, Augusta, Georgia; and Apeliotus Technologies, Inc., Philadelphia, Pennsylvania (J.G.E., W.B.B.)
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Dhagia V, Joshi S, Soldatos V, Edwards JG, Gupte SA. Abstract 502: Glucose-6-Phosphate Dehydrogenase Regulates MYH11 and MYOCD Expression in HDAC and miR-1 Dependent Manner. Arterioscler Thromb Vasc Biol 2018. [DOI: 10.1161/atvb.38.suppl_1.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Vascular smooth muscle cell (VSMC) phenotype and function is altered in diabetic and obese patients and animals. Increased activity of glucose-6-phosphate dehydrogenase (G6PD), the rate-limiting enzyme in Pentose Phosphate Pathway, in diabetic and obese animals is associated with decreased expression of MYOCD and MYOCD-dependent genes in the arteries of these animals. Therefore, we hypothesize that reprogrammed metabolism and increased G6PD activity is critical in switching the VSMC from a differentiated to a dedifferentiated phenotype. Our results demonstrated metabolic reprogramming and decrease in MYOCD and MYOCD-driven MYH11 in the aorta of normal chow- and high fat diet (HFD)-fed diabetic Goto-Kakizaki (GK) as compared to control rats. Up regulated G6PD activity in the aorta of these animals positively correlated with increased arterial elastance (R
2
= 0.8322) and total peripheral resistance (R
2
= 0.8364).
In vitro
, VSMCs (A7r5) treated with Ad-shRNA for G6PD, epiandrosterone (Epi), G6PD inhibitor, and PD2958, a selective inhibitor of G6PD activity, increased (P<0.05)
Myocd
and
Myh11
levels and MYOCD-regulated MYH11 and CNN1 expressions as compared to untreated cells. Furthermore, we found that G6PD-mediated expression of MYOCD and MYH11 expressions was regulated at transcriptional and post transcriptional level. Inhibition of G6PD by PD2958 or Epi decreased histone deacetylase (HDAC) activity by 70-80% (P<0.05), and concomitantly, PD2958 and Ad-shRNA-G6PD up regulated H3K9Ac expression in A7r5 cells as compared to their respective controls. Next, we compared the expression of VSMC-restricted MYH11 in A7r5 cells treated with HDAC inhibitor, Trichostatin (TSA), and PD2958+TSA. Our results demonstrated that MYH11 expression increased by TSA and PD2958 was not further potentiated by PD2958+TSA, suggesting that G6PD inhibition up regulated MYH11 via HDAC inhibition. We also found that G6PD inhibition increased miR-1 levels, which post-transcriptionally regulates MYOCD and MYOCD-dependent gene expression. Therefore, our results collectively suggest that increased G6PD activity is associated with switching of VSMCs from a differentiated to a dedifferentiated phenotype in HDAC and miR-1 dependent manner.
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Camp R, Stier CT, Serova LI, McCloskey J, Edwards JG, Reyes-Zaragoza M, Sabban EL. Cardiovascular responses to intranasal neuropeptide Y in single prolonged stress rodent model of post-traumatic stress disorder. Neuropeptides 2018; 67:87-94. [PMID: 29169656 DOI: 10.1016/j.npep.2017.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/26/2017] [Accepted: 11/08/2017] [Indexed: 01/25/2023]
Abstract
Delivery of neuropeptide Y (NPY) to the brain by intranasal administration shows promise as non-invasive means for preventing or treating PTSD symptoms. Here, radiotelemetry and echocardiography were used to determine effects of intranasal NPY on cardiovascular functions in absence and presence of stress. Male adult Sprague Dawley rats were implanted with radiotelemetric probes, and subjected to single prolonged stress (SPS), followed by intranasal vehicle (V) or NPY (150μg) under conditions shown to prevent development of many of the behavioral neuroendocrine and biochemical impairments. In both groups, mean arterial pressure (MAP) rose rapidly peaking at about 125mmHg, remaining near maximal levels for 1h. SPS also elicited robust rise in heart rate (HR) which was mitigated by intranasal NPY, and significantly lower than V-treated rats 12-50min after exposure to SPS stressors. In the first hr. after SPS, locomotor activity was elevated but only in the V-treated group. By 3h, MAP returned to pre-stress levels in both groups with no further change when monitored for 6days. HR remained elevated during the 6h remaining light phase after SPS. Subsequently HR was at pre-SPS levels during the remaining days. However dark phase HR was low following SPS, gradually recovered over 6days and was associated with reduced activity. When administered in the absence of further stress, intranasal NPY or V elicited similar much smaller, short-lived rises in MAP and HR. Echocardiography revealed no change in HR, stroke volume (SV) or cardiac output (Q) with intranasal NPY in the absence of stress. SPS led to reduced SV and Q but was not affected by NPY. Overall the results demonstrate no major cardiovascular effects of intranasal NPY and indicate possible benefit from transient amelioration of HR response in line with its translational potential to combat PTSD and comorbid impairments.
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Affiliation(s)
- Robert Camp
- Department of Biochemistry and Molecular Biology, New York Medical College, Valhalla, New York 10595, USA
| | - Charles T Stier
- Department of Pharmacology, New York Medical College, Valhalla, New York 10595, USA
| | - Lidia I Serova
- Department of Biochemistry and Molecular Biology, New York Medical College, Valhalla, New York 10595, USA
| | - Jaclyn McCloskey
- Department of Biochemistry and Molecular Biology, New York Medical College, Valhalla, New York 10595, USA
| | - John G Edwards
- Department of Physiology, New York Medical College, Valhalla, New York 10595, USA
| | - Miguel Reyes-Zaragoza
- Department of Biochemistry and Molecular Biology, New York Medical College, Valhalla, New York 10595, USA
| | - Esther L Sabban
- Department of Biochemistry and Molecular Biology, New York Medical College, Valhalla, New York 10595, USA.
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28
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Surendrakumar V, Martin-Ucar AE, Edwards JG, Rao J, Socci L. Evaluation of surgical approaches to anatomical segmentectomies: the transition to minimal invasive surgery improves hospital outcomes. J Thorac Dis 2017; 9:3896-3902. [PMID: 29268399 DOI: 10.21037/jtd.2017.09.91] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background We aim to evaluate the transition process from open to video-assisted thoracoscopic surgery (VATS) anatomical segmentectomies in a regional thoracic surgical unit. Methods In a retrospective study from January 2013 to December 2015, we identified all anatomical segmentectomies performed in our unit. Pre, peri and postoperative data were compared between the three years (2013, 2014 and 2015) and according to operative approach. Thoracotomy after VATS intraoperative biopsy was considered a conversion for the purposes of the study. Results A total of 86 consecutive cases [56 females and 30 males, median age 70 years (range, 43 to 83 years); median FEV1 of 78% predicted (range, 41% to 126%)] were included. There was a significant change in the surgical approach with time. Fifty-two cases underwent VATS (73% via single-port) and 34 open surgeries, including nine conversions. There were no postoperative deaths in the VATS group and one in the open group. Operative outcomes were similar over time with no haemorrhagic events, equivalent R1 resection and nodal stations explored in all lymph node positive patients. In node negative cases however, open surgery was associated with more extensive mediastinal exploration. Patients in 2015 had a shorter hospital stay in comparison to those in previous years [median 4 days (range, 1-15 days) vs. median 6 days (range, 3-27 days), P=0.01]. There were no differences in the incidence of complications or readmissions to hospital over time. Conclusions The transition over a short period of time from open to single-port VATS segmentectomy has allowed us to significantly reduce postoperative hospital stay without compromising operative or postoperative outcomes.
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Affiliation(s)
- Veena Surendrakumar
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Sheffield, UK
| | - Antonio E Martin-Ucar
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Sheffield, UK
| | - John G Edwards
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Sheffield, UK
| | - Jagan Rao
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Sheffield, UK
| | - Laura Socci
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Sheffield, UK
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Borghetti G, Eisenberg CA, Signore S, Sorrentino A, Kaur K, Andrade-Vicenty A, Edwards JG, Nerkar M, Qanud K, Sun D, Goichberg P, Leri A, Anversa P, Eisenberg LM, Jacobson JT, Hintze TH, Rota M. Notch signaling modulates the electrical behavior of cardiomyocytes. Am J Physiol Heart Circ Physiol 2017; 314:H68-H81. [PMID: 28939651 DOI: 10.1152/ajpheart.00587.2016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 01/16/2023]
Abstract
Notch receptor signaling is active during cardiac development and silenced in myocytes after birth. Conversely, outward K+ Kv currents progressively appear in postnatal myocytes leading to shortening of the action potential (AP) and acquisition of the mature electrical phenotype. In the present study, we tested the possibility that Notch signaling modulates the electrical behavior of cardiomyocytes by interfering with Kv currents. For this purpose, the effects of Notch receptor activity on electrophysiological properties of myocytes were evaluated using transgenic mice with inducible expression of the Notch1 intracellular domain (NICD), the functional fragment of the activated Notch receptor, and in neonatal myocytes after inhibition of the Notch transduction pathway. By patch clamp, NICD-overexpressing cells presented prolonged AP duration and reduced upstroke amplitude, properties that were coupled with reduced rapidly activating Kv and fast Na+ currents, compared with cells obtained from wild-type mice. In cultured neonatal myocytes, inhibition of the proteolitic release of NICD with a γ-secretase antagonist increased transcript levels of the Kv channel-interacting proteins 2 (KChIP2) and enhanced the density of Kv currents. Collectively, these results indicate that Notch signaling represents an important regulator of the electrophysiological behavior of developing and adult myocytes by repressing, at least in part, repolarizing Kv currents. NEW & NOTEWORTHY We investigated the effects of Notch receptor signaling on the electrical properties of cardiomyocytes. Our results indicate that the Notch transduction pathway interferes with outward K+ Kv currents, critical determinants of the electrical repolarization of myocytes.
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Affiliation(s)
- Giulia Borghetti
- Departments of Anesthesia and Medicine, and Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts
| | - Carol A Eisenberg
- Department of Physiology, New York Medical College, Valhalla, New York
| | - Sergio Signore
- Departments of Anesthesia and Medicine, and Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts
| | - Andrea Sorrentino
- Departments of Anesthesia and Medicine, and Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts
| | - Keerat Kaur
- Department of Physiology, New York Medical College, Valhalla, New York
| | | | - John G Edwards
- Department of Physiology, New York Medical College, Valhalla, New York
| | - Mriganka Nerkar
- Department of Physiology, New York Medical College, Valhalla, New York
| | - Khaled Qanud
- Department of Physiology, New York Medical College, Valhalla, New York
| | - Dong Sun
- Department of Physiology, New York Medical College, Valhalla, New York
| | - Polina Goichberg
- Departments of Anesthesia and Medicine, and Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts
| | - Annarosa Leri
- Departments of Anesthesia and Medicine, and Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts
| | - Piero Anversa
- Departments of Anesthesia and Medicine, and Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts
| | | | - Jason T Jacobson
- Department of Physiology, New York Medical College, Valhalla, New York.,Department of Cardiology, Westchester Medical Center, Valhalla, New York
| | - Thomas H Hintze
- Department of Physiology, New York Medical College, Valhalla, New York
| | - Marcello Rota
- Department of Physiology, New York Medical College, Valhalla, New York
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30
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Affiliation(s)
- John G Edwards
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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31
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Joshi SR, Dhagia V, Gairhe S, Edwards JG, McMurtry IF, Gupte SA. MicroRNA-140 is elevated and mitofusin-1 is downregulated in the right ventricle of the Sugen5416/hypoxia/normoxia model of pulmonary arterial hypertension. Am J Physiol Heart Circ Physiol 2016; 311:H689-98. [PMID: 27422986 DOI: 10.1152/ajpheart.00264.2016] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [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] [Received: 03/28/2016] [Accepted: 07/13/2016] [Indexed: 01/18/2023]
Abstract
Heart failure, a major cause of morbidity and mortality in patients with pulmonary arterial hypertension (PAH), is an outcome of complex biochemical processes. In this study, we determined changes in microRNAs (miRs) in the right and left ventricles of normal and PAH rats. Using an unbiased quantitative miR microarray analysis, we found 1) miR-21-5p, miR-31-5 and 3p, miR-140-5 and 3p, miR-208b-3p, miR-221-3p, miR-222-3p, miR-702-3p, and miR-1298 were upregulated (>2-fold; P < 0.05) in the right ventricle (RV) of PAH compared with normal rats; 2) miR-31-5 and 3p, and miR-208b-3p were upregulated (>2-fold; P < 0.05) in the left ventricle plus septum (LV+S) of PAH compared with normal rats; 3) miR-187-5p, miR-208a-3p, and miR-877 were downregulated (>2-fold; P < 0.05) in the RV of PAH compared with normal rats; and 4) no miRs were up- or downregulated with >2-fold in LV+S compared with RV of PAH and normal. Upregulation of miR-140 and miR-31 in the hypertrophic RV was further confirmed by quantitative PCR. Interestingly, compared with control rats, expression of mitofusin-1 (MFN1), a mitochondrial fusion protein that regulates apoptosis, and which is a direct target of miR-140, was reduced in the RV relative to LV+S of PAH rats. We found a correlation between increased miR-140 and decreased MFN1 expression in the hypertrophic RV. Our results also demonstrated that upregulation of miR-140 and downregulation of MFN1 correlated with increased RV systolic pressure and hypertrophy. These results suggest that miR-140 and MFN1 play a role in the pathogenesis of PAH-associated RV dysfunction.
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Affiliation(s)
| | - Vidhi Dhagia
- Department of Pharmacology, New York Medical College, Valhalla, New York
| | - Salina Gairhe
- Department of Pharmacology and Center for Lung Biology, University of South Alabama, College of Medicine, Mobile, Alabama; and
| | - John G Edwards
- Department of Physiology, New York Medical College, Valhalla, New York
| | - Ivan F McMurtry
- Department of Pharmacology and Center for Lung Biology, University of South Alabama, College of Medicine, Mobile, Alabama; and
| | - Sachin A Gupte
- Department of Pharmacology, New York Medical College, Valhalla, New York;
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32
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Kaur K, Yang J, Edwards JG, Eisenberg CA, Eisenberg LM. G9a histone methyltransferase inhibitor BIX01294 promotes expansion of adult cardiac progenitor cells without changing their phenotype or differentiation potential. Cell Prolif 2016; 49:373-85. [PMID: 27109896 DOI: 10.1111/cpr.12255] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/02/2016] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES As a follow-up to our previous reports showing that the G9a histone methyltransferase-specific inhibitor BIX01294 enhances bone marrow cell cardiac potential, this drug was examined for its effects on cardiomyocytes and mouse cardiac progenitor cells (CPCs). MATERIALS AND METHODS Cardiomyocytes and cardiac explants were cultured ± BIX01294, and examined for changes in cardiac function, protein and gene expression. Additionally, enriched populations of CPCs, contained in the 'phase bright cell' component of explants, were harvested from non-treated and BIX01294-treated cardiac tissue, and assayed for differences in cell phenotype and differentiation potential. Mouse CPCs were cultured with rat cardiomyocytes to allow differentiation of the progenitors to be assayed using species-specific PCR primers. RESULTS While BIX01294 had no discernible effect on myocyte function and sarcomeric organization, treatment with this drug significantly increased CPC proliferation, as indicated by enhanced MTT metabolization and BrdUrd incorporation (4.1- and 2.0-fold, respectively, P < 0.001) after 48 h labelling, and increased Ki67 expression (4.8-fold, P < 0.001) after 7 days culture. Heart explants exposed to BIX01294 generated 3.6-fold (P < 0.005) greater yields of CPCs by 2 weeks culture. Importantly, CPCs obtained from non-treated and BIX01294-treated cultures did not differ in phenotype or differentiation potential. CONCLUSIONS These data indicate that BIX01294 can expand CPCs without undermining their capacity as cardiac progenitors, and suggest that this drug may have utility for generating large numbers of CPCs for cardiac repair.
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Affiliation(s)
- K Kaur
- New York Medical College/Westchester Medical Center Stem Cell Laboratory, Departments of Physiology and Medicine, New York Medical College, Valhalla, New York, 10595, USA
| | - J Yang
- New York Medical College/Westchester Medical Center Stem Cell Laboratory, Departments of Physiology and Medicine, New York Medical College, Valhalla, New York, 10595, USA
- Department of Biology and Genomics, New York University, New York, New York, 10003, USA
| | - J G Edwards
- Department of Physiology and Medicine, New York Medical College, Valhalla, New York, 10595, USA
| | - C A Eisenberg
- New York Medical College/Westchester Medical Center Stem Cell Laboratory, Departments of Physiology and Medicine, New York Medical College, Valhalla, New York, 10595, USA
| | - L M Eisenberg
- New York Medical College/Westchester Medical Center Stem Cell Laboratory, Departments of Physiology and Medicine, New York Medical College, Valhalla, New York, 10595, USA
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33
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Abstract
Long term survival of childhood cancers is now more than 70%. Anthracyclines, including doxorubicin, are some of the most efficacious anticancer drugs available. However, its use as a chemotherapeutic agent is severely hindered by its dose-limiting toxicities. Most notably observed is cardiotoxicity, but other organ systems are also degraded by doxorubicin use. Despite the years of its use and the amount of information written about this drug, an understanding of its cellular mechanisms is not fully appreciated. The mechanisms by which doxorubicin induces cytotoxicity in target cancer cells have given insight about how the drug damages cardiomyocytes. The major mechanisms of doxorubicin actions are thought to be as an oxidant generator and as an inhibitor of topoisomerase 2. However, other signaling pathways are also invoked with significant consequences for the cardiomyocyte. Further the interaction between oxidant generation and topoisomerase function has only recently been appreciated and the consequences of this interaction are still not fully understood. The unfortunate consequences of doxorubicin within cardiomyocytes have promoted the search for new drugs and methods that can prevent or reverse the damage caused to the heart after treatment in cancer patients. Alternative protocols have lessened the impact on newly diagnosed cancer patients. However the years of doxorubicin use have generated a need for monitoring the onset of cardiotoxicity as well as understanding its potential long-term consequences. Although a fairly clear understanding of the short-term pathologic mechanisms of doxorubicin actions has been achieved, the long-term mechanisms of doxorubicin induced heart failure remain to be carefully delineated.
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Affiliation(s)
| | - John G. Edwards
- Corresponding author at: Department of Physiology, New York Medical College, 15 Dana Road, Valhalla, NY, United States.Department of PhysiologyNew York Medical College15 Dana RoadValhallaNYUnited States
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34
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Bayman N, Ardron D, Ashcroft L, Baldwin DR, Booton R, Darlison L, Edwards JG, Lang-Lazdunski L, Lester JF, Peake M, Rintoul RC, Snee M, Taylor P, Lunt C, Faivre-Finn C. Protocol for PIT: a phase III trial of prophylactic irradiation of tracts in patients with malignant pleural mesothelioma following invasive chest wall intervention. BMJ Open 2016; 6:e010589. [PMID: 26817643 PMCID: PMC4735163 DOI: 10.1136/bmjopen-2015-010589] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/02/2015] [Accepted: 12/07/2015] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Histological diagnosis of malignant mesothelioma requires an invasive procedure such as CT-guided needle biopsy, thoracoscopy, video-assisted thorascopic surgery (VATs) or thoracotomy. These invasive procedures encourage tumour cell seeding at the intervention site and patients can develop tumour nodules within the chest wall. In an effort to prevent nodules developing, it has been widespread practice across Europe to irradiate intervention sites postprocedure--a practice known as prophylactic irradiation of tracts (PIT). To date there has not been a suitably powered randomised trial to determine whether PIT is effective at reducing the risk of chest wall nodule development. METHODS AND ANALYSIS In this multicentre phase III randomised controlled superiority trial, 374 patients who can receive radiotherapy within 42 days of a chest wall intervention will be randomised to receive PIT or no PIT. Patients will be randomised on a 1:1 basis. Radiotherapy in the PIT arm will be 21 Gy in three fractions. Subsequent chemotherapy is given at the clinicians' discretion. A reduction in the incidence of chest wall nodules from 15% to 5% in favour of radiotherapy 6 months after randomisation would be clinically significant. All patients will be followed up for up to 2 years with monthly telephone contact and at least four outpatient visits in the first year. ETHICS AND DISSEMINATION PIT was approved by NRES Committee North West-Greater Manchester West (REC reference 12/NW/0249) and recruitment is currently on-going, the last patient is expected to be randomised by the end of 2015. The analysis of the primary end point, incidence of chest wall nodules 6 months after randomisation, is expected to be published in 2016 in a peer reviewed journal and results will also be presented at scientific meetings and summary results published online. A follow-up analysis is expected to be published in 2018. TRIAL REGISTRATION NUMBER ISRCTN04240319; NCT01604005; Pre-results.
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Affiliation(s)
- N Bayman
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - D Ardron
- The National Cancer Research Institute (NCRI) Consumer Liaison Group, London, UK
| | - L Ashcroft
- Manchester Academic Health Science Centre Trials Co-ordination Unit (MAHSC-CTU), The Christie NHS Foundation Trust, Manchester, UK
| | - D R Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals NHS Trust, Nottingham City Hospital Campus, Nottingham, UK
| | - R Booton
- Respiratory and Allergy Research Group, Institute of Inflammation & Repair, The University of Manchester North West Lung Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - L Darlison
- Mesothelioma UK Charitable Trust, c/o Glenfield Hospital, Leicester, UK
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - J G Edwards
- Department of Cardiothoracic Surgery, Chesterman Unit, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust UK, Sheffield, UK
| | | | - J F Lester
- Department of Clinical Oncology, Velindre NHS Trust UK, Cardiff, UK
| | - M Peake
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
- National Cancer Intelligence Network, (NCIN), Public Health England, London, UK
| | - R C Rintoul
- Department of Thoracic Oncology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - M Snee
- Department of Clinical Oncology, Leeds Teaching Hospital NHS Trust, St James Hospital, Leeds, UK
| | - P Taylor
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Department Pulmonary Oncology, Wythenshawe Hospital Manchester, Manchester, UK
| | - C Lunt
- Manchester Academic Health Science Centre Trials Co-ordination Unit (MAHSC-CTU), The Christie NHS Foundation Trust, Manchester, UK
| | - C Faivre-Finn
- The University of Manchester, Manchester Academic Health Science Centre, Institute of Cancer Sciences, Manchester Cancer Research Centre (MCRC), Manchester, UK
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK
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35
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Surendrakumar V, Vaughan PR, Rao J, Edwards JG, Socci L. Comparing the quality of uniportal and multiportal video-assisted anatomical resection for primary lung cancer: the preliminary results of a single centre audit. J Cardiothorac Surg 2015. [PMCID: PMC4695700 DOI: 10.1186/1749-8090-10-s1-a235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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36
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Yang YM, Yuan H, Edwards JG, Skayian Y, Ochani K, Miller EJ, Sehgal PB. Deletion of STAT5a/b in vascular smooth muscle abrogates the male bias in hypoxic pulmonary hypertension in mice: implications in the human disease. Mol Med 2015; 20:625-38. [PMID: 25470773 DOI: 10.2119/molmed.2014.00180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 11/20/2014] [Indexed: 12/27/2022] Open
Abstract
Chronic hypoxia typically elicits pulmonary hypertension (PH) in mice with a male-dominant phenotype. There is an opposite-sex bias in human PH, with a higher prevalence in women, but greater survival (the "estrogen paradox"). We investigated the involvement of the STAT5a/b species, previously established to mediate sexual dimorphism in other contexts, in the sex bias in PH. Mice with heterozygous or homozygous deletions of the STAT5a/b locus in vascular smooth muscle cells (SMCs) were generated in crosses between STAT5a/b(fl/fl) and transgelin (SM22α)-Cre(+/+) parents. Wild-type (wt) males subjected to chronic hypoxia showed significant PH and pulmonary arterial remodeling, with wt females showing minimal changes (a male-dominant phenotype). However, in conditional STAT5(+/-) or STAT5(-/-) mice, hypoxic females showed the severest manifestations of PH (a female-dominant phenotype). Immunofluorescence studies on human lung sections showed that obliterative pulmonary arterial lesions in patients with idiopathic pulmonary arterial hypertension (IPAH) or hereditary pulmonary arterial hypertension (HPAH), both male and female, overall had reduced STAT5a/b, reduced PY-STAT5 and reduced endoplasmic reticulum (ER) GTPase atlastin-3 (ATL3). Studies of SMCs and endothelial cell (EC) lines derived from vessels isolated from lungs of male and female IPAH patients and controls revealed instances of coordinate reductions in STAT5a, STAT5b and ATL3 in IPAH-derived cells, including SMCs and ECs from the same patient. Taken together, these data provide the first definitive evidence for a contribution of STAT5a/b to the sex bias in PH in the hypoxic mouse and implicate reduced STAT5 in the pathogenesis of the human disease.
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Affiliation(s)
- Yang-Ming Yang
- Department of Cell Biology & Anatomy, New York Medical College, Valhalla, New York, United States of America
| | - Huijuan Yuan
- Department of Cell Biology & Anatomy, New York Medical College, Valhalla, New York, United States of America
| | - John G Edwards
- Department of Physiology, New York Medical College, Valhalla, New York, United States of America
| | - Yester Skayian
- Department of Physiology, New York Medical College, Valhalla, New York, United States of America
| | - Kanta Ochani
- Center for Heart and Lung Research, The Feinstein Institute for Medical Research, Manhasset, New York, United States of America
| | - Edmund J Miller
- Center for Heart and Lung Research, The Feinstein Institute for Medical Research, Manhasset, New York, United States of America
| | - Pravin B Sehgal
- Department of Cell Biology & Anatomy, New York Medical College, Valhalla, New York, United States of America.,Department of Medicine, New York Medical College, Valhalla, New York, United States of America
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Rintoul RC, Ritchie AJ, Edwards JG, Waller DA, Coonar AS, Bennett M, Lovato E, Hughes V, Fox-Rushby JA, Sharples LD. Efficacy and cost of video-assisted thoracoscopic partial pleurectomy versus talc pleurodesis in patients with malignant pleural mesothelioma (MesoVATS): an open-label, randomised, controlled trial. Lancet 2014; 384:1118-27. [PMID: 24942631 DOI: 10.1016/s0140-6736(14)60418-9] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Malignant pleural mesothelioma incidence continues to rise, with few available evidence-based therapeutic options. Results of previous non-randomised studies suggested that video-assisted thoracoscopic partial pleurectomy (VAT-PP) might improve symptom control and survival. We aimed to compare efficacy in terms of overall survival, and cost, of VAT-PP and talc pleurodesis in patients with malignant pleural mesothelioma. METHODS We undertook an open-label, parallel-group, randomised, controlled trial in patients aged 18 years or older with any subtype of confirmed or suspected mesothelioma with pleural effusion, recruited from 12 hospitals in the UK. Eligible patients were randomly assigned (1:1) to either VAT-PP or talc pleurodesis by computer-generated random numbers, stratified by European Organisation for Research and Treatment of Cancer risk category (high vs low). The primary outcome was overall survival at 1 year, analysed by intention to treat (all patients randomly assigned to a treatment group with a final diagnosis of mesothelioma). This trial is registered with ClinicalTrials.gov, number NCT00821860. FINDINGS Between Oct 24, 2003, and Jan 24, 2012, we randomly assigned 196 patients, of whom 175 (88 assigned to talc pleurodesis, 87 assigned to VAT-PP) had confirmed mesothelioma. Overall survival at 1 year was 52% (95% CI 41-62) in the VAT-PP group and 57% (46-66) in the talc pleurodesis group (hazard ratio 1·04 [95% CI 0·76-1·42]; p=0·81). Surgical complications were significantly more common after VAT-PP than after talc pleurodesis, occurring in 24 (31%) of 78 patients who completed VAT-PP versus ten (14%) of 73 patients who completed talc pleurodesis (p=0·019), as were respiratory complications (19 [24%] vs 11 [15%]; p=0·22) and air-leak beyond 10 days (five [6%] vs one [1%]; p=0·21), although not significantly so. Median hospital stay was longer at 7 days (IQR 5-11) in patients who received VAT-PP compared with 3 days (2-5) for those who received talc pleurodesis (p<0·0001). INTERPRETATION VAT-PP is not recommended to improve overall survival in patients with pleural effusion due to malignant pleural mesothelioma, and talc pleurodesis might be preferable considering the fewer complications and shorter hospital stay associated with this treatment. FUNDING BUPA Foundation.
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Affiliation(s)
- Robert C Rintoul
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK
| | | | - John G Edwards
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK
| | - David A Waller
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - Aman S Coonar
- Department of Thoracic Surgery, Papworth Hospital, Cambridge, UK
| | | | - Eleonora Lovato
- Health Economics Research Group, Brunel University, Uxbridge, UK
| | - Victoria Hughes
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK
| | | | - Linda D Sharples
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK; MRC Biostatistics Unit, Cambridge, UK; Clinical Trials Research Unit, University of Leeds, Leeds, UK.
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38
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Xie D, Seremwe M, Edwards JG, Podolsky R, Bollag WB. Distinct effects of different phosphatidylglycerol species on mouse keratinocyte proliferation. PLoS One 2014; 9:e107119. [PMID: 25233484 PMCID: PMC4169417 DOI: 10.1371/journal.pone.0107119] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 08/12/2014] [Indexed: 01/17/2023] Open
Abstract
We have previously shown that liposomes composed of egg-derived phosphatidylglycerol (PG), with a mixed fatty acid composition (comprising mainly palmitate and oleate), inhibit the proliferation and promote the differentiation of rapidly dividing keratinocytes, and stimulate the growth of slowly proliferating epidermal cells. To determine the species of PG most effective at modulating keratinocyte proliferation, primary mouse keratinocytes were treated with different PG species, and proliferation was measured. PG species containing polyunsaturated fatty acids were effective at inhibiting rapidly proliferating keratinocytes, whereas PG species with monounsaturated fatty acids were effective at promoting proliferation in slowly dividing cells. Thus, palmitoyl-arachidonyl-PG (16∶0/20∶4), palmitoyl-linoleoyl-PG (16∶0/18∶2), dilinoleoyl-PG (18∶2/18∶2) and soy PG (a PG mixture with a large percentage of polyunsaturated fatty acids) were particularly effective at inhibiting proliferation in rapidly dividing keratinocytes. Conversely, palmitoyl-oleoyl-PG (16∶0/18∶1) and dioleoyl-PG (18∶1/18∶1) were especially effective proproliferative PG species. This result represents the first demonstration of opposite effects of different species of a single class of phospholipid and suggests that these different PG species may signal to diverse effector enzymes to differentially affect keratinocyte proliferation and normalize keratinocyte proliferation. Thus, different PG species may be useful for treating skin diseases characterized by excessive or insufficient proliferation.
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Affiliation(s)
- Ding Xie
- Department of Physiology, Medical College of Georgia at Georgia Regents University, Augusta, Georgia, United States of America
| | - Mutsa Seremwe
- Department of Physiology, Medical College of Georgia at Georgia Regents University, Augusta, Georgia, United States of America
| | - John G. Edwards
- Apeliotus Technologies, Inc., Atlanta, Georgia, United States of America
| | - Robert Podolsky
- Center for Biotechnology and Genomic Medicine, Department of Medicine, Medical College of Georgia at Georgia Regents University, Augusta, Georgia, United States of America
| | - Wendy B. Bollag
- Charlie Norwood VA Medical Center, Augusta, Georgia, United States of America
- Department of Physiology, Medical College of Georgia at Georgia Regents University, Augusta, Georgia, United States of America
- * E-mail:
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Laurent D, Mathew JE, Mitry M, Taft M, Force A, Edwards JG. Chronic ethanol consumption increases myocardial mitochondrial DNA mutations: a potential contribution by mitochondrial topoisomerases. Alcohol Alcohol 2014; 49:381-9. [PMID: 24852753 PMCID: PMC4060737 DOI: 10.1093/alcalc/agu029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 03/26/2014] [Accepted: 03/27/2014] [Indexed: 11/14/2022] Open
Abstract
AIMS Alcoholic cardiomyopathy (ACM) presents as decreased myocardial contractility, arrhythmias and secondary non-ischemic dilated cardiomyopathy leading to heart failure. Mitochondrial dysfunction is known to have a significant role in the development and complications of ACM. This study investigated if chronic ethanol feeding promoted myocardial mitochondrial topoisomerase dysfunction as one underlying cause of mitochondrial DNA (mtDNA) damage and mitochondrial dysfunction in ACM. METHODS The impact of chronic ethanol exposure on the myocardial mitochondria was examined in both neonatal cardiomyocytes using 50 mM ethanol for 6 days and in rats assigned to control or ethanol feeding groups for 4 months. RESULTS Chronic ethanol feeding led to significant (P < 0.05) decreases in M-mode Fractional Shortening, ejection fraction, and the cardiac output index as well as increases in Tau. Ethanol feeding promoted mitochondrial dysfunction as evidenced by significantly decreased left ventricle cytochrome oxidase activity and decreases in mitochondrial protein content. Both in rats and in cultured cardiomyocytes, chronic ethanol presentation significantly increased mtDNA damage. Using isolated myocardial mitochondria, both mitochondrial topoisomerase-dependent DNA cleavage and DNA relaxation were significantly altered by ethanol feeding. CONCLUSION Chronic ethanol feeding compromised cardiovascular and mitochondrial function as a result of a decline in mtDNA integrity that was in part the consequence of mitochondrial topoisomerase dysfunction. Understanding the regulation of the mitochondrial topoisomerases is critical for protection of mtDNA, not only for the management of alcoholic cardiomyopathy, but also for the many other clinical treatments that targets the topoisomerases in the alcoholic patient.
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Affiliation(s)
- D Laurent
- Department of Physiology, New York Medical College, Valhalla, NY, USA
| | - J E Mathew
- Department of Physiology, New York Medical College, Valhalla, NY, USA
| | - M Mitry
- Department of Physiology, New York Medical College, Valhalla, NY, USA
| | - M Taft
- Department of Physiology, New York Medical College, Valhalla, NY, USA
| | - A Force
- Department of Physiology, New York Medical College, Valhalla, NY, USA
| | - J G Edwards
- Department of Physiology, New York Medical College, Valhalla, NY, USA
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40
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Rintoul RC, Ritchie AJ, Edwards JG, Waller DA, Coonar AS, Bennett M, Lovato E, Hughes V, Fox-Rushby JA, Sharples LD. Efficacy and cost of video-assisted thoracoscopic partial pleurectomy versus talc pleurodesis in patients with malignant pleural mesothelioma (MesoVATS): an open-label, randomised, controlled trial. Lancet 2014. [PMID: 24942631 DOI: 10.1016/sd140-6736(14)60418-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Malignant pleural mesothelioma incidence continues to rise, with few available evidence-based therapeutic options. Results of previous non-randomised studies suggested that video-assisted thoracoscopic partial pleurectomy (VAT-PP) might improve symptom control and survival. We aimed to compare efficacy in terms of overall survival, and cost, of VAT-PP and talc pleurodesis in patients with malignant pleural mesothelioma. METHODS We undertook an open-label, parallel-group, randomised, controlled trial in patients aged 18 years or older with any subtype of confirmed or suspected mesothelioma with pleural effusion, recruited from 12 hospitals in the UK. Eligible patients were randomly assigned (1:1) to either VAT-PP or talc pleurodesis by computer-generated random numbers, stratified by European Organisation for Research and Treatment of Cancer risk category (high vs low). The primary outcome was overall survival at 1 year, analysed by intention to treat (all patients randomly assigned to a treatment group with a final diagnosis of mesothelioma). This trial is registered with ClinicalTrials.gov, number NCT00821860. FINDINGS Between Oct 24, 2003, and Jan 24, 2012, we randomly assigned 196 patients, of whom 175 (88 assigned to talc pleurodesis, 87 assigned to VAT-PP) had confirmed mesothelioma. Overall survival at 1 year was 52% (95% CI 41-62) in the VAT-PP group and 57% (46-66) in the talc pleurodesis group (hazard ratio 1·04 [95% CI 0·76-1·42]; p=0·81). Surgical complications were significantly more common after VAT-PP than after talc pleurodesis, occurring in 24 (31%) of 78 patients who completed VAT-PP versus ten (14%) of 73 patients who completed talc pleurodesis (p=0·019), as were respiratory complications (19 [24%] vs 11 [15%]; p=0·22) and air-leak beyond 10 days (five [6%] vs one [1%]; p=0·21), although not significantly so. Median hospital stay was longer at 7 days (IQR 5-11) in patients who received VAT-PP compared with 3 days (2-5) for those who received talc pleurodesis (p<0·0001). INTERPRETATION VAT-PP is not recommended to improve overall survival in patients with pleural effusion due to malignant pleural mesothelioma, and talc pleurodesis might be preferable considering the fewer complications and shorter hospital stay associated with this treatment. FUNDING BUPA Foundation.
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Affiliation(s)
- Robert C Rintoul
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK
| | | | - John G Edwards
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK
| | - David A Waller
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - Aman S Coonar
- Department of Thoracic Surgery, Papworth Hospital, Cambridge, UK
| | | | - Eleonora Lovato
- Health Economics Research Group, Brunel University, Uxbridge, UK
| | - Victoria Hughes
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK
| | | | - Linda D Sharples
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK; MRC Biostatistics Unit, Cambridge, UK; Clinical Trials Research Unit, University of Leeds, Leeds, UK.
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Jackson GR, Scott IU, Kim IK, Quillen DA, Iannaccone A, Edwards JG. Author Response: Additional Considerations in the Utility of Dark Adaptometry for the Diagnosis of Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2014; 55:3149. [DOI: 10.1167/iovs.14-14569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Gregory R. Jackson
- Penn State Hershey Eye Center, Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Ingrid U. Scott
- Penn State Hershey Eye Center, Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Ivana K. Kim
- Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, United States
| | - David A. Quillen
- Penn State Hershey Eye Center, Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Alessandro Iannaccone
- University of Tennessee Health Science Center, Memphis, Tennessee, United States; and
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42
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Jackson GR, Scott IU, Kim IK, Quillen DA, Iannaccone A, Edwards JG. Diagnostic sensitivity and specificity of dark adaptometry for detection of age-related macular degeneration. Invest Ophthalmol Vis Sci 2014; 55:1427-31. [PMID: 24550363 DOI: 10.1167/iovs.13-13745] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Difficulty with night vision is a common complaint of patients with age-related macular degeneration (AMD). Consistent with this complaint, dark adaptation (DA) is substantially impaired in these patients. Because of the severity of the deficit, measurement of DA has been suggested as a means for the diagnosis of AMD. Previous methods for measurement of DA were time intensive (>30 minutes), which made them unsuitable for clinical use. This study evaluated a rapid DA test (≤ 6.5 minutes) for the detection of AMD. METHODS Dark adaptation was measured by using the AdaptDx dark adaptometer in two groups: subjects with normal retinal health and subjects with AMD. Subjects were assigned to their group by clinical examination and grading of fundus photographs. Subjects were classified as having DA consistent with normal retinal health (rod intercept ≤ 6.5 minutes) or having dark adaptation consistent with AMD (rod intercept > 6.5 minutes). RESULTS The eligible sample for analysis included 21 normal adults and 127 AMD patients. The rapid test was found to have a diagnostic sensitivity of 90.6% (P < 0.001) and specificity of 90.5% (P < 0.027). Thus, abnormal DA was detected in 115 of 127 AMD patients, and normal DA was found in 19 of 21 normal adults. CONCLUSIONS The high diagnostic sensitivity and specificity compared favorably to long-duration research methods for the measurement of DA, and slit lamp biomicroscopy performed by a retina specialist. These results suggest that a rapid DA test is useful for the detection of AMD.
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Affiliation(s)
- Gregory R Jackson
- Penn State Hershey Eye Center, Penn State College of Medicine, Hershey, Pennsylvania
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43
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Chettimada S, Ata H, Rawat DK, Gulati S, Kahn AG, Edwards JG, Gupte SA. Contractile protein expression is upregulated by reactive oxygen species in aorta of Goto-Kakizaki rat. Am J Physiol Heart Circ Physiol 2014; 306:H214-24. [PMID: 24213617 PMCID: PMC3920128 DOI: 10.1152/ajpheart.00310.2013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 10/28/2013] [Indexed: 01/28/2023]
Abstract
Although it is known that blood vessels undergo remodeling in type 2 diabetes (T2D), the signaling pathways that underlie the structural and functional changes seen in diabetic arteries remain unclear. Our objective was to determine whether the remodeling in type 2 diabetic Goto-Kakizaki (GK) rats is evoked by elevated reactive oxygen species (ROS). Our results show that aortas from GK rats produced greater force (P < 0.05) in response to stimulation with KCl and U46619 than aortas from Wistar rats. Associated with these changes, aortic expression of contractile proteins (measured as an index of remodeling) and the microRNA (miR-145), which act to upregulate transcription of contractile protein genes, was twofold higher (P < 0.05) in GK than Wistar (age-matched control) rats, and there was a corresponding increase in ROS and decrease in nitric oxide signaling. Oral administration of the antioxidant Tempol (1 mmol/l) to Wistar and GK rats reduced (P < 0.05) myocardin and calponin expression. Tempol (1 mmol/l) decreased expression of miR-145 in Wistar and GK rat aorta. To elucidate the mechanism through which ROS increases miR-145, we measured their levels in freshly isolated aorta and cultured aortic smooth muscle cells incubated for 12 h in the presence of H2O2 (300 μmol/l). H2O2 increased expression of miR-145, and there were corresponding nuclear increases in myocardin, a miR-145 target protein. Intriguingly, H2O2-induced expression of miR-145 was decreased by U0126 (10 μmol/l), a MEK1/2 inhibitor, and myocardin was decreased by anti-miR-145 (50 nmol/l) and U0126 (10 μmol/l). Our novel findings demonstrate that ROS evokes vascular wall remodeling and dysfunction by enhancing expression of contractile proteins in T2D.
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MESH Headings
- 15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic Acid/pharmacology
- Animals
- Aorta/metabolism
- Aorta/pathology
- Butadienes/pharmacology
- Calcium-Binding Proteins/genetics
- Calcium-Binding Proteins/metabolism
- Cells, Cultured
- Cyclic N-Oxides/pharmacology
- Diabetes Mellitus, Type 2/metabolism
- Diabetes Mellitus, Type 2/pathology
- MicroRNAs/genetics
- MicroRNAs/metabolism
- Microfilament Proteins/genetics
- Microfilament Proteins/metabolism
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/metabolism
- Myosins/genetics
- Myosins/metabolism
- Nitric Oxide/metabolism
- Nitriles/pharmacology
- Nuclear Proteins/genetics
- Nuclear Proteins/metabolism
- Potassium Chloride/pharmacology
- Protein Kinase Inhibitors/pharmacology
- Rats
- Rats, Wistar
- Reactive Oxygen Species/metabolism
- Spin Labels
- Trans-Activators/genetics
- Trans-Activators/metabolism
- Transcription, Genetic
- Up-Regulation
- Vasoconstrictor Agents/pharmacology
- Calponins
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Affiliation(s)
- Sukrutha Chettimada
- Department of Biochemistry and Molecular Biology, College of Medicine, University of South Alabama, Mobile, Alabama
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44
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Laurent D, Edwards JG. Alcoholic Cardiomyopathy: Multigenic Changes Underlie Cardiovascular Dysfunction. J Cardiol Clin Res 2014; 2:1022. [PMID: 26478905 PMCID: PMC4607291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Alcoholism is the third leading cause of preventable death in the United States. Aside from promoting cardiomyopathies, chronic alcohol consumption is associated with an increased risk of dementia, the development of liver or pancreas failure, and cancers of the oral cavity and pharynx. Although a J-shaped curve for all cause mortality has been identified for average alcohol consumption, irregular heavy drinking also carries significantly greater risks for cardiovascular disease. Alcohol induced cardiovascular disease has a complex multigenic etiology. There is significant variation in the initial presentation of alcoholic cardiomyopathy with diastolic dysfunction possibly being the first indication. Ethanol exposure generates toxic metabolites, primarily acetaldehyde and ROS, which activate several cell signaling systems to alter cell function across many levels. Sudden cardiac death is a known occurrence of alcoholism that may be linked to an arrhythmogenic effect of alcohol. Microscopic and molecular examination of diseased hearts has demonstrated abnormal alterations to various cellular components, including the mitochondria and myofibrils. These studies have shown not only the direct impact on myocardial contractility but also disrupted metabolism that determines the long-term survival of the myocardium. Significant variations in the response to chronic alcohol consumption may be related to unique genotypes that modify the metabolic response to ethanol. Future studies to further characterize the role of different genotypes will help indentify those genotypes are more susceptible to chronic alcohol consumption.
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Affiliation(s)
| | - John G. Edwards
- Corresponding author, J.G. Edwards, Department of Physiology, New York, Medical College, 15 Dana Road, Valhalla, New York, USA,
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45
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Hicks S, Labinskyy N, Piteo B, Laurent D, Mathew JE, Gupte SA, Edwards JG. Type II diabetes increases mitochondrial DNA mutations in the left ventricle of the Goto-Kakizaki diabetic rat. Am J Physiol Heart Circ Physiol 2013; 304:H903-15. [PMID: 23376826 DOI: 10.1152/ajpheart.00567.2012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Mitochondrial dysfunction has a significant role in the development of diabetic cardiomyopathy. Mitochondrial oxidant stress has been accepted as the singular cause of mitochondrial DNA (mtDNA) damage as an underlying cause of mitochondrial dysfunction. However, separate from a direct effect on mtDNA integrity, diabetic-induced increases in oxidant stress alter mitochondrial topoisomerase function to propagate mtDNA mutations as a contributor to mitochondrial dysfunction. Both glucose-challenged neonatal cardiomyocytes and the diabetic Goto-Kakizaki (GK) rat were studied. In both the GK left ventricle (LV) and in cardiomyocytes, chronically elevated glucose presentation induced a significant increase in mtDNA damage that was accompanied by decreased mitochondrial function. TTGE analysis revealed a number of base pair substitutions in the 3' end of COX3 from GK LV mtDNA that significantly altered the protein sequence. Mitochondrial topoisomerase DNA cleavage activity in isolated mitochondria was significantly increased in the GK LV compared with Wistar controls. Both hydroxycamptothecin, a topoisomerase type 1 inhibitor, and doxorubicin, a topoisomerase type 2 inhibitor, significantly exacerbated the DNA cleavage activity of isolated mitochondrial extracts indicating the presence of multiple functional topoisomerases in the mitochondria. Mitochondrial topoisomerase function was significantly altered in the presence of H2O2 suggesting that separate from a direct effect on mtDNA, oxidant stress mediated type II diabetes-induced alterations of mitochondrial topoisomerase function. These findings are significant in that the activation/inhibition state of the mitochondrial topoisomerases will have important consequences for mtDNA integrity and the well being of the diabetic myocardium.
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Affiliation(s)
- S Hicks
- Department of Physiology, New York Medical College, Valhalla, NY, USA
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46
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Rawat DK, Hecker P, Watanabe M, Chettimada S, Levy RJ, Okada T, Edwards JG, Gupte SA. Glucose-6-phosphate dehydrogenase and NADPH redox regulates cardiac myocyte L-type calcium channel activity and myocardial contractile function. PLoS One 2012; 7:e45365. [PMID: 23071515 PMCID: PMC3465299 DOI: 10.1371/journal.pone.0045365] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 08/21/2012] [Indexed: 11/27/2022] Open
Abstract
We recently demonstrated that a 17-ketosteroid, epiandrosterone, attenuates L-type Ca2+ currents (ICa-L) in cardiac myocytes and inhibits myocardial contractility. Because 17-ketosteroids are known to inhibit glucose-6-phosphate dehydrogenase (G6PD), the rate-limiting enzyme in the pentose phosphate pathway, and to reduce intracellular NADPH levels, we hypothesized that inhibition of G6PD could be a novel signaling mechanism which inhibit ICa-L and, therefore, cardiac contractile function. We tested this idea by examining myocardial function in isolated hearts and Ca2+ channel activity in isolated cardiac myocytes. Myocardial function was tested in Langendorff perfused hearts and ICa-L were recorded in the whole-cell patch configuration by applying double pulses from a holding potential of −80 mV and then normalized to the peak amplitudes of control currents. 6-Aminonicotinamide, a competitive inhibitor of G6PD, increased pCO2 and decreased pH. Additionally, 6-aminonicotinamide inhibited G6PD activity, reduced NADPH levels, attenuated peak ICa-L amplitudes, and decreased left ventricular developed pressure and ±dp/dt. Finally, dialyzing NADPH into cells from the patch pipette solution attenuated the suppression of ICa-L by 6-aminonicotinamide. Likewise, in G6PD-deficient mice, G6PD insufficiency in the heart decreased GSH-to-GSSG ratio, superoxide, cholesterol and acetyl CoA. In these mice, M-mode echocardiographic findings showed increased diastolic volume and end-diastolic diameter without changes in the fraction shortening. Taken together, these findings suggest that inhibiting G6PD activity and reducing NADPH levels alters metabolism and leads to inhibition of L-type Ca2+ channel activity. Notably, this pathway may be involved in modulating myocardial contractility under physiological and pathophysiological conditions during which the pentose phosphate pathway-derived NADPH redox is modulated (e.g., ischemia-reperfusion and heart failure).
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Affiliation(s)
- Dhwajbahadur K Rawat
- Department of Biochemistry and Molecular Biology, University of South Alabama, Mobile, Alabama, United States of America
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47
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Edwards JG, Laurent D, Mathew J, Force A, Taft M, Labinskyy N. Ethanol feeding compromises cardiovascular function; a potential role for mitochondrial topoisomerases. FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.565.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | - Mathew Taft
- PhysiologyNew York Medical CollegeValhallaNY
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48
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Edwards JG, Hicks S, Piteo B, Laurent D, Mathew J, Labinskyy N. Dysfunctional mitochondrial topoisomerases mediates diabetic induced myocardial mitochondrial DNA damage. FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.1057.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Brian Piteo
- PhysiologyNew York Medical CollegeValhallaNY
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49
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Xiong H, Lee RJ, Haura EB, Edwards JG, Dynan WS, Li S. Intranuclear delivery of a novel antibody-derived radiosensitizer targeting the DNA-dependent protein kinase catalytic subunit. Int J Radiat Oncol Biol Phys 2011; 83:1023-30. [PMID: 22138455 DOI: 10.1016/j.ijrobp.2011.08.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 08/11/2011] [Accepted: 08/26/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE To inhibit DNA double-strand break repair in tumor cells by delivery of a single-chain antibody variable region fragment (ScFv 18-2) to the cell nucleus. ScFv 18-2 binds to a regulatory region of the DNA-dependent protein kinase (DNA-PK), an essential enzyme in the nonhomologous end-joining pathway, and inhibits DNA end-joining in a cell-free system and when microinjected into single cells. Development as a radiosensitizer has been limited by the lack of a method for intranuclear delivery to target cells. We investigated a delivery method based on folate receptor-mediated endocytosis. METHODS AND MATERIALS A recombinant ScFv 18-2 derivative was conjugated to folate via a scissile disulfide linker. Folate-ScFv 18-2 was characterized for its ability to be internalized by tumor cells and to influence the behavior of ionizing radiation-induced repair foci. Radiosensitization was measured in a clonogenic survival assay. Survival curves were fitted to a linear-quadratic model, and between-group differences were evaluated by an F test. Sensitization ratios were determined based on mean inhibitory dose. RESULTS Human KB and NCI-H292 lung cancer cells treated with folate-conjugated ScFv 18-2 showed significant radiosensitization (p < 0.001). Sensitization enhancement ratios were 1.92 ± 0.42 for KB cells and 1.63 ± 0.13 for NCI-H292 cells. Studies suggest that treatment inhibits repair of radiation-induced DSBs, as evidenced by the persistence of γ-H2AX-stained foci and by inhibition of staining with anti-DNA-PKcs phosphoserine 2056. CONCLUSIONS Folate-mediated endocytosis is an effective method for intranuclear delivery of an antibody-derived DNA repair inhibitor.
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Affiliation(s)
- Hairong Xiong
- Institute of Molecular Medicine and Genetics, Georgia Health Sciences University, Augusta, GA 30912, USA
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Medikayala S, Piteo B, Zhao X, Edwards JG. Chronically elevated glucose compromises myocardial mitochondrial DNA integrity by alteration of mitochondrial topoisomerase function. Am J Physiol Cell Physiol 2010; 300:C338-48. [PMID: 21123731 DOI: 10.1152/ajpcell.00248.2010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Mitochondrial dysfunction has a significant role in the development and complications of diabetic cardiomyopathy. Mitochondrial dysfunction and mitochondrial DNA (mtDNA) mutations are also associated with different types of cancer and neurodegenerative diseases. The goal of this study was to determine if chronically elevated glucose increase in mtDNA damage contributed to mitochondrial dysfunction and identify the underlying basis for mtDNA damage. H9c2 myotubes (a cardiac-derived cell line) were studied in the presence of 5.5, 16.5, or 33.0 mM glucose for up to 13 days. Tests of mitochondria function (Complex I and IV activity and ATP generation) were all significantly depressed by elevated media glucose. Intramitochondrial superoxide and intracellular superoxide levels were transiently increased during the experimental period. AnnexinV binding (a marker of apoptosis) was significantly increased after 7 and 13 days of high glucose. Thirteen days of elevated glucose significantly increased mtDNA damage globally and across the region encoding for the three subunits of cytochrome oxidase. Using mitochondria isolated from cells chronically exposed to elevated glucose, we observed significant increases in topoisomerase-linked DNA cleavage. Mitochondria-dependent DNA cleavage was significantly exacerbated by H(2)O(2) and that immunoprecipitation of mitochondrial extracts with a mtTOP1 antibody significantly decreased DNA cleavage, indicating that at least part of this activity could be attributed to mtTOP1. We conclude that even mild increases in glucose presentation compromised mitochondrial function as a result of a decline in mtDNA integrity. Separate from a direct impact of oxidative stress on mtDNA, ROS-induced alteration of mitochondrial topoisomerase activity exacerbated and propagated increases in mtDNA damage. These findings are significant in that the activation/inhibition state of the mitochondrial topoisomerases will have important consequences for mitochondrial DNA integrity and the well being of the myocardium.
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Affiliation(s)
- S Medikayala
- Dept. of Physiology, New York Medical College, Valhalla, NY 10595, USA
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