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Daher D, Seif El Dahan K, Rich NE, Tayob N, Merrill V, Huang DQ, Yang JD, Kulkarni AV, Kanwal F, Marrero J, Parikh N, Singal AG. Hepatocellular Carcinoma Screening in a Contemporary Cohort of At-Risk Patients. JAMA Netw Open 2024; 7:e248755. [PMID: 38683607 PMCID: PMC11059036 DOI: 10.1001/jamanetworkopen.2024.8755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/26/2024] [Indexed: 05/01/2024] Open
Abstract
Importance Cohort studies demonstrating an association of hepatocellular carcinoma (HCC) screening with reduced mortality are prone to lead-time and length-time biases. Objective To characterize the clinical benefits of HCC screening, adjusting for lead-time and length-time biases, in a diverse, contemporary cohort of at-risk patients. Design, Setting, and Participants This retrospective cohort study of patients with HCC was conducted between January 2008 and December 2022 at 2 large US health systems. Data analysis was performed from September to November 2023. Main Outcomes and Measures The primary outcome was screen-detected HCC, defined by abnormal screening-intent abdominal imaging or α-fetoprotein level within 6 months before diagnosis. Cox regression analysis was used to characterize differences in overall survival between patients with screen-detected and non-screen-detected HCC; lead-time and length-time adjustments were calculated using the Duffy parametric formula. Results Among 1313 patients with HCC (mean [SD] age, 61.7 [9.6] years; 993 male [75.6%]; 739 [56.3%] with Barcelona Clinic Liver Cancer stage 0/A disease), HCC was screen-detected in 556 (42.3%) and non-screen detected in 757 (57.7%). Patients with screen-detected HCC had higher proportions of early-stage HCC (393 patients [70.7%] vs 346 patients [45.7%]; risk ratio [RR], 1.54; 95% CI, 1.41-1.70) and curative treatment receipt (283 patients [51.1%] vs 252 patients [33.5%]; RR, 1.52; 95% CI, 1.34-1.74) compared with patients with non-screen-detected HCC. The screen-detected group had significantly lower mortality, which persisted after correcting for lead-time bias (hazard ratio, 0.75; 95% CI, 0.65-0.87) in fully adjusted models. Both groups had similar tumor doubling times (median [IQR], 3.8 [2.2-10.7] vs 5.6 [1.7-11.4] months) and proportions of indolent tumors (28 patients [35.4%] vs 24 patients [38.1%]; RR, 0.93; 95% CI, 0.60-1.43). Adjustment for length-time bias decreased survival estimates, although 3-year and 5-year survival for patients with screen-detected HCC remained longer than that for patients with non-screen-detected HCC. Conclusions and Relevance The findings of this cohort study suggest that HCC screening is associated with reduced mortality even after accounting for lead-time and length-time biases. However, these biases should be considered in future studies.
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Affiliation(s)
- Darine Daher
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Karim Seif El Dahan
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Nicole E. Rich
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Nabihah Tayob
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Vincent Merrill
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Daniel Q. Huang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ju Dong Yang
- Department of Internal Medicine, Cedars Sinai Medical Center, Los Angeles, California
| | - Anand V. Kulkarni
- Department of Hepatology and Liver Transplantation, AIG Hospitals, Hyderabad India
| | - Fasiha Kanwal
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Jorge Marrero
- Department of Internal Medicine, University of Pennsylvania, Philadelphia
| | - Neehar Parikh
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Amit G. Singal
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
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Lieber SR, Jiang Y, Jones AR, Gowda P, Ufere NN, Patel MS, Gurley T, Noriega Ramirez A, Ngo VM, Olumesi MC, Trudeau RE, Marrero J, Craddock Lee SJ, Mufti A, Singal AG, VanWagner LB. The financial burden after liver transplantation is significant among commercially insured adults: A large US National Cohort. Liver Transpl 2023:01445473-990000000-00303. [PMID: 38108824 DOI: 10.1097/lvt.0000000000000320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Abstract
Liver transplantation (LT) is lifesaving for patients with cirrhosis; however, the resultant financial burden to patients has not been well characterized. We aimed to provide a nationally representative portrayal of patient financial burden after LT. Adult recipients of LT from 2006 to 2021 were identified using IQVIA PharMetrics® Plus for Academics-a large nationally representative claims database of commercially insured Americans. Patient financial liability (ie, what patients owe) was estimated using the difference between allowed and paid costs for adjudicated medical/pharmacy claims. Descriptive statistics were provided stratified by the financial liability group within 1 year after LT. Multivariable logistic regression modeling identified factors associated with high/extreme liability adjusting for covariates. Potential indirect costs of post-LT care were estimated based on hourly wages lost for care. Among 1412 recipients of LT, financial liability was heterogeneous-~3% had no liability and 21% had extreme liability > $10K for 1-year post-LT care; most (69%) paid between $1 and 10K, with 48% having liability >$5K. Factors associated with >$5K liability included older age, insurance/enrollment type, US region, history of HCC, and simultaneous liver-kidney transplant (for liability >$10K). Medication costs comprised ~30% of outpatient financial liability. Potential indirect costs from wages lost were $2,201-$6,073 per person, depending on an hourly wage. In a large national cohort of commercially insured recipients of LT, financial liability was highly variable across sociodemographic and clinical characteristics; nearly 1 out of 2 recipients of LT owed >$5K for 1 year of post-LT care. Transplant programs should help patients anticipate potential costs and identify vulnerable populations who would benefit from enhanced financial counseling.
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Affiliation(s)
- Sarah R Lieber
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Yue Jiang
- Department of Statistical Science, Duke University, Durham, North Carolina, USA
| | - Alex R Jones
- Department of Medicine, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Prajwal Gowda
- Department of Medicine, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Nneka N Ufere
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Madhukar S Patel
- Department of Surgery, Division of Surgical Transplantation, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Tami Gurley
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Alvaro Noriega Ramirez
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Van M Ngo
- Department of Pharmacy, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Mary C Olumesi
- Department of Pharmacy, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Raelene E Trudeau
- Department of Pharmacy, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Jorge Marrero
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Simon J Craddock Lee
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Arjmand Mufti
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Amit G Singal
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Lisa B VanWagner
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
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San Martín-López JV, Mesa N, Bernal-Bello D, Morales-Ortega A, Rivilla M, Guerrero M, Calderón R, Farfán AI, Rivas L, Soria G, Izquierdo A, Madroñal E, Duarte M, Piedrabuena S, Toledano-Macías M, Marrero J, de Ancos C, Frutos B, Cristóbal R, Velázquez L, Mora B, Cuenca P, Satué JÁ, Ayala-Larrañaga I, Carpintero L, Lara C, Llerena ÁR, García V, García de Viedma V, Prieto S, González-Pereira N, Bravo C, Mariño C, Lechuga LA, Tarancón J, Gonzalo S, Moreno S, Ruiz-Giardin JM. Seven Epidemic Waves of COVID-19 in a Hospital in Madrid: Analysis of Severity and Associated Factors. Viruses 2023; 15:1839. [PMID: 37766248 PMCID: PMC10538062 DOI: 10.3390/v15091839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: COVID-19 has evolved during seven epidemic waves in Spain. Our objective was to describe changes in mortality and severity in our hospitalized patients. (2) Method: This study employed a descriptive, retrospective approach for COVID-19 patients admitted to the Hospital de Fuenlabrada (Madrid, Spain) until 31 December 2022. (3) Results: A total of 5510 admissions for COVID-19 were recorded. The first wave accounted for 1823 (33%) admissions and exhibited the highest proportion of severe patients: 65% with bilateral pneumonia and 83% with oxygen saturation under 94% during admission and elevated levels of CRP, IL-6, and D-dimer. In contrast, the seventh wave had the highest median age (79 years) and comorbidity (Charlson: 2.7), while only 3% of patients had bilateral pneumonia and 3% required intubation. The overall mortality rate was 10.3%. The first wave represented 39% of the total. The variables related to mortality were age (OR: 1.08, 1.07-1.09), cancer (OR: 1.99, 1.53-2.60), dementia (OR: 1.82, 1.20-2.75), the Charlson index (1.38, 1.31-1.47), the need for high-flow oxygen (OR: 6.10, 4.94-7.52), mechanical ventilation (OR: 11.554, 6.996-19.080), and CRP (OR: 1.04, 1.03-1.06). (4) Conclusions: The variables associated with mortality included age, comorbidity, respiratory failure, and inflammation. Differences in the baseline characteristics of admitted patients explained the differences in mortality in each wave. Differences observed between patients admitted in the latest wave and the earlier ones suggest that COVID-19 has evolved into a distinct disease, requiring a distinct approach.
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Affiliation(s)
- Juan Víctor San Martín-López
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, 28029 Madrid, Spain;
| | - Nieves Mesa
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - David Bernal-Bello
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Alejandro Morales-Ortega
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
- Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, 28871 Madrid, Spain
| | - Marta Rivilla
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Marta Guerrero
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Ruth Calderón
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Ana I. Farfán
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Luis Rivas
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Guillermo Soria
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Aída Izquierdo
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Elena Madroñal
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Miguel Duarte
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Sara Piedrabuena
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - María Toledano-Macías
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Jorge Marrero
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Cristina de Ancos
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Begoña Frutos
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Rafael Cristóbal
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Laura Velázquez
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Belén Mora
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Paula Cuenca
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - José Á. Satué
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Ibone Ayala-Larrañaga
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Lorena Carpintero
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Celia Lara
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Álvaro R. Llerena
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Virginia García
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Vanessa García de Viedma
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Santiago Prieto
- Servicio de Laboratorio Clínico, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (S.P.); (N.G.-P.)
| | - Natalia González-Pereira
- Servicio de Laboratorio Clínico, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (S.P.); (N.G.-P.)
| | - Cristina Bravo
- Servicio de Farmacia, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (C.B.); (C.M.)
| | - Carolina Mariño
- Servicio de Farmacia, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (C.B.); (C.M.)
| | - Luis Antonio Lechuga
- Sistemas, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (L.A.L.); (J.T.)
| | - Jorge Tarancón
- Sistemas, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (L.A.L.); (J.T.)
| | - Sonia Gonzalo
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
| | - Santiago Moreno
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, 28029 Madrid, Spain;
- Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, 28871 Madrid, Spain
- Servicio de Enfermedades Infecciosas, Hospital U. Ramón y Cajal, IRYCIS, 28034 Madrid, Spain
| | - José M. Ruiz-Giardin
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (N.M.); (D.B.-B.); (A.M.-O.); (M.R.); (M.G.); (R.C.); (A.I.F.); (L.R.); (G.S.); (A.I.); (E.M.); (M.D.); (S.P.); (M.T.-M.); (J.M.); (C.d.A.); (B.F.); (R.C.); (L.V.); (B.M.); (P.C.); (J.Á.S.); (I.A.-L.); (L.C.); (C.L.); (Á.R.L.); (V.G.); (V.G.d.V.); (S.G.); (J.M.R.-G.)
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, 28029 Madrid, Spain;
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Singal AG, Marrero J, Parikh ND. Reply to: "Correction for length bias reduces the mortality benefit from hepatocellular carcinoma surveillance". J Hepatol 2023; 79:e90-e92. [PMID: 37201671 DOI: 10.1016/j.jhep.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 05/02/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Amit G Singal
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.
| | - Jorge Marrero
- Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Neehar D Parikh
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Singal AG, Sanduzzi-Zamparelli M, Nahon P, Ronot M, Hoshida Y, Rich N, Reig M, Vilgrain V, Marrero J, Llovet JM, Parikh ND, Villanueva A. International Liver Cancer Association (ILCA) white paper on hepatocellular carcinoma risk stratification and surveillance. J Hepatol 2023; 79:226-239. [PMID: 36854345 DOI: 10.1016/j.jhep.2023.02.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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] [Received: 11/14/2022] [Revised: 01/16/2023] [Accepted: 02/04/2023] [Indexed: 03/02/2023]
Abstract
Major research efforts in liver cancer have been devoted to increasing the efficacy and effectiveness of surveillance for hepatocellular carcinoma (HCC). As with other cancers, surveillance programmes aim to detect tumours at an early stage, facilitate curative-intent treatment, and reduce cancer-related mortality. HCC surveillance is supported by a large randomised-controlled trial in patients with chronic HBV infection and several cohort studies in cirrhosis; however, effectiveness in clinical practice is limited by several barriers, including inadequate risk stratification, underuse of surveillance, and suboptimal accuracy of screening tests. There are several proposed strategies to address these limitations, including risk stratification algorithms and biomarkers to better identity at-risk individuals, interventions to increase surveillance, and emerging imaging- and blood-based surveillance tests with improved sensitivity and specificity for early HCC detection. Beyond clinical validation, data are needed to establish clinical utility, i.e. increased early tumour detection and reduced HCC-related mortality. If successful, these data could facilitate a precision screening paradigm in which surveillance strategies are tailored to individual HCC risk to maximise overall surveillance value. However, practical and logistical considerations must be considered when designing and implementing these validation efforts. To address these issues, ILCA (the International Liver Cancer Association) adjourned a single topic workshop on HCC risk stratification and surveillance in June 2022. Herein, we present a white paper on these topics, including the status of the field, ongoing research efforts, and barriers to the translation of emerging strategies.
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Affiliation(s)
- Amit G Singal
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Marco Sanduzzi-Zamparelli
- BCLC Group, Liver Oncology Unit, Liver Unit, Hospital Clinic of Barcelona, Institut d'Investigacions, Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERehd, University of Barcelona, Barcelona, Spain
| | - Pierre Nahon
- APHP, Liver Unit, Bobigny, Université Sorbonne Paris Nord, F-93000 Bobigny, France; Inserm, UMR-1138 "Functional Genomics of Solid Tumors", Centre de recherche des Cordeliers, Université de Paris, Paris, France
| | - Maxime Ronot
- Université Paris Cité, CRI INSERM UMR 1149, Paris & Department of radiology, Hôpital Beaujon, APHP. Nord, Clichy, France
| | - Yujin Hoshida
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nicole Rich
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Maria Reig
- BCLC Group, Liver Oncology Unit, Liver Unit, Hospital Clinic of Barcelona, Institut d'Investigacions, Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERehd, University of Barcelona, Barcelona, Spain
| | - Valerie Vilgrain
- Université Paris Cité, CRI INSERM UMR 1149, Paris & Department of radiology, Hôpital Beaujon, APHP. Nord, Clichy, France
| | - Jorge Marrero
- Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Josep M Llovet
- Mount Sinai Liver Cancer Program, Division of Liver Diseases, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Translational Research in Hepatic Oncology, Liver Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Catalonia, Spain
| | - Neehar D Parikh
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Augusto Villanueva
- Mount Sinai Liver Cancer Program, Division of Liver Diseases, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Wang M, Singal AG, Parikh N, Kono Y, Marrero J, Mehta A. A Biomarker Panel Based upon AFP, Fucosylated Kininogen and PEG-Precipitated IgG Is Highly Accurate for the Early Detection Hepatocellular Carcinoma in Patients with Cirrhosis in Phase II and Phase III Biomarker Evaluation. Cancers (Basel) 2022; 14:5970. [PMID: 36497452 PMCID: PMC9740205 DOI: 10.3390/cancers14235970] [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] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/07/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
We have previously identified alterations in glycosylation on serum proteins from patients with HCC and developed plate-based assays using lectins to detect the change in glycosylation. However, heterophilic antibodies, which increase with non-malignant liver disease, compromised these assays. To address this, we developed a method of polyethylene glycol (PEG) precipitation that removed the contaminating IgG and IgM but allowed for the lectin detection of the relevant glycoprotein. We found that this PEG-precipitated material itself could differentiate between cirrhosis and HCC. In the analysis of three training cohorts and one validation cohort, consisting of 571 patients, PEG-IgG had AUC values that ranged from 0.713 to 0.810. In the validation cohort, which contained samples from patients at a time of 1-6 months prior to HCC detection or 7+ months prior to detection, the AUC of this marker remained consistent (0.813 and 0.846, respectively). When this marker was incorporated into a biomarker algorithm that also consisted of AFP and fucosylated kininogen, the AUROC increased to 0.816-0.883 in the training cohort and was 0.909 in the external validation cohort. Biomarker performance was also examined though the analysis of partial ROC curves, at false positive values less than 10% (90-ROC), ≤20% (80-ROC) or ≤30% (70-ROC), which highlighted the algorithm's improvement over the individual markers at clinically relevant specificity values.
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Affiliation(s)
- Mengjun Wang
- Basic Science Building Room 310, Department of Cell and Molecular Pharmacology, Medical University of South Carolina, 173 Ashley Avenue, Charleston, SC 29425, USA
| | - Amit G. Singal
- Division of Digestive and Liver Diseases, University of Texas Southwestern, 5959 Harry Hines Blvd POB I Suite 420B, Dallas, TX 75201, USA
| | - Neehar Parikh
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Yuko Kono
- Division of Gastroenterology, University of California at San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Jorge Marrero
- Division of Gastroenterology, University of Pennsylvania, 3400 Civic Center Boulevard South Pavilion, 4th Floor, Philadelphia, PA 19104, USA
| | - Anand Mehta
- Basic Science Building Room 310, Department of Cell and Molecular Pharmacology, Medical University of South Carolina, 173 Ashley Avenue, Charleston, SC 29425, USA
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Murvelashvili N, Polanco P, Khorsand S, Marrero J, Jia L, Mirfakhraee S, Else T, Habra M, Cole S, Hamidi O. PSAT010 Severe Cholestatic Jaundice (Stauffer Syndrome) as a Rare Paraneoplastic Manifestation in Adrenocortical Carcinoma. J Endocr Soc 2022. [PMCID: PMC9629174 DOI: 10.1210/jendso/bvac150.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction Adrenocortical Carcinoma (ACC) is a rare and often aggressive malignancy arising from the adrenal cortex. Rarely, ACC can be associated with a paraneoplastic syndrome, such as tumor-associated hypoglycemia due to insulin-like growth factor-2 secretion, hyperreninemic hyperaldosteronism, erythropoietin-associated polycythemia, and leukocytosis due to chemokine release from the tumor. Stauffer syndrome is a paraneoplastic syndrome characterized by reversible cholestasis in the absence of liver metastases, most frequently described in the context of renal cell carcinoma. Our case is the first reported association between Stauffer syndrome and ACC. Clinical Case A 38-year-old man presented with nausea, vomiting, painless jaundice, pruritus, and weight loss. Laboratory evaluation revealed an elevated total bilirubin of 8.7 mg/dL (N<1.3), the INR was elevated secondary to the cholestasis from vitamin K insufficiency. Computed tomography (CT) scan revealed a 20.4 cm, heterogeneous left adrenal mass with central necrosis concerning for ACC. There was no evidence of liver metastases. Additional laboratory workup showed elevated DHEA-sulfate of 1764.2 ug/dL (N<568.9), ACTH of 18 pg/mL (N<7-63), cortisol of 18.30 mcg/dL (N<19.50), androstenedione of 247 ng/dL (N<150), estradiol of 123 pg/mL (N<41), testosterone of 237 ng/dL (N<871), aldosterone of 11 ng/dL (N<=21), and plasma renin activity of 14 ng/mL/hr (N<4.3). Plasma metanephrines and catecholamines were normal. The patient's condition deteriorated rapidly with progressive renal failure and uremia requiring intensive care unit admission for continuous renal replacement therapy and critical care optimization preoperatively. The patient's total bilirubin increased to 34.5 mg/dL, which prompted liver biopsy. This revealed no evidence of cirrhosis or hepatic metastasis. Therefore, severe cholestasis was attributed to Stauffer syndrome, a paraneoplastic cholestatic jaundice from the underlying adrenal mass. The patient underwent exploratory laparotomy with left adrenalectomy, left nephrectomy, left ureterolysis, and wedge liver biopsy. Histopathology showed a necrotic ACC with tumor invasion into the adrenal capsule, no lymphovascular invasion, margins uninvolved, and Ki-67 index of 40%. Kidney parenchyma exhibited diffuse pigment casts. The liver specimen contained diffuse bile deposits and minimal chronic inflammation in the portal tracts, consistent with Stauffer syndrome. Postoperatively, the patient had rapid improvement in his renal function, and bilirubin level normalized after several weeks. Mitotane therapy was deferred until the complete recovery of the liver function. Conclusion Our case highlights a unique presentation of paraneoplastic hepatic dysfunction with jaundice associated with newly diagnosed ACC. Although Stauffer syndrome is one of the most characteristic paraneoplastic syndromes associated with renal cell carcinoma and other malignancies, paraneoplastic hepatic dysfunction associated with ACC has not been previously reported. The patient had rapid improvement of hyperbilirubinemia after surgical resection of the tumor. Stauffer syndrome should be considered in patients with ACC with liver dysfunction and jaundice without evidence of liver metastases. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
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Ruiz-Giardin JM, Rivilla M, Mesa N, Morales A, Rivas L, Izquierdo A, Escribá A, San Martín JV, Bernal-Bello D, Madroñal E, Farfán AI, Guerrero M, Calderón R, Duarte MA, Piedrabuena SI, Toledano-Macías M, Satué JÁ, Marrero J, de Ancos CL, Frutos B, Cristóbal R, Soria G, Ayala-Larrañaga I, Carpintero L, de Hita M, Lara C, Llerena ÁR, García V, Jiménez R, García V, Saiz-Lou EM, Prieto S, González-Pereira N, Lechuga LA, Tarancón J, Gonzalo S. Comparative Study of Vaccinated and Unvaccinated Hospitalised Patients: A Retrospective Population Study of 500 Hospitalised Patients with SARS-CoV-2 Infection in a Spanish Population of 220,000 Inhabitants. Viruses 2022; 14:v14102284. [PMID: 36298839 PMCID: PMC9611498 DOI: 10.3390/v14102284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives. This study aimed to compare the characteristics of fully and partially vaccinated or unvaccinated coronavirus disease 2019 (COVID-19) patients who were hospitalised in a population of 220,000 habitants. Methods: Retrospective, observational, and population studies were conducted on patients who were hospitalised due to COVID-19 from March to October 2021. We assessed the impact of vaccination and other risk factors through Cox multivariate analysis. Results: A total of 500 patients were hospitalised, among whom 77 (15.4%) were fully vaccinated, 86 (17.2%) were partially vaccinated, and 337 (67.4%) were unvaccinated. Fully vaccinated (FV) patients were older and had a higher Charlson index than those of partially vaccinated and unvaccinated patients (NFV). Bilateral pneumonia was more frequent among NFV (259/376 (68.9%)) than among FV patients (32/75 (42.7%)). The former had more intensive care unit admissions (63/423) than the latter (4/77); OR: 2.80; CI (1.07–9.47). Increasing age HZ: 1.1 (1.06–1.14)) and haematological disease at admission HZ: 2.99 (1.26–7.11)) were independent risk factors for higher mortality during the first 30 days of hospitalisation. The probability of an earlier discharge in the subgroup of 440 patients who did not die during the first 30 days of hospitalisation was related to age (older to younger: HZ: 0.98 (0.97–0.99)) and vaccination status. Conclusions: Among the patients hospitalised because of COVID-19, complete vaccination was associated with less severe forms of COVID-19, with an earlier discharge date. Age and haematological disease were related to a higher mortality rate during the first 30 days of hospitalisation.
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Affiliation(s)
- José M. Ruiz-Giardin
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
- CIBERINFEC, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-916006179
| | - Marta Rivilla
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Nieves Mesa
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Alejandro Morales
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Luis Rivas
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Aída Izquierdo
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Almudena Escribá
- Oficina Regional de Coordinación de Transplante de la Comunidad de Madrid, 28046 Madrid, Spain
| | - Juan V. San Martín
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
- CIBERINFEC, 28029 Madrid, Spain
| | - David Bernal-Bello
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Elena Madroñal
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Ana I. Farfán
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Marta Guerrero
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Ruth Calderón
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Miguel A. Duarte
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Sara I. Piedrabuena
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | | | - José Á. Satué
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Jorge Marrero
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | | | - Begoña Frutos
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Rafael Cristóbal
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Guillermo Soria
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | | | - Lorena Carpintero
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Miguel de Hita
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Celia Lara
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Álvaro R. Llerena
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Virginia García
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Raquel Jiménez
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Vanesa García
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Elena M. Saiz-Lou
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Santiago Prieto
- Laboratorio Clínico, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | | | | | - Jorge Tarancón
- Sistemas, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Sonia Gonzalo
- Medicina Interna, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
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Asrani SK, Ghabril MS, Kuo A, Merriman RB, Morgan T, Parikh ND, Ovchinsky N, Kanwal F, Volk ML, Ho C, Serper M, Mehta S, Agopian V, Cabrera R, Chernyak V, El-Serag HB, Heimbach J, Ioannou GN, Kaplan D, Marrero J, Mehta N, Singal A, Salem R, Taddei T, Walling AM, Tapper EB. Quality measures in HCC care by the Practice Metrics Committee of the American Association for the Study of Liver Diseases. Hepatology 2022; 75:1289-1299. [PMID: 34778999 DOI: 10.1002/hep.32240] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 12/14/2022]
Abstract
The burden of HCC is substantial. To address gaps in HCC care, the American Association for the Study of Liver Diseases (AASLD) Practice Metrics Committee (PMC) aimed to develop a standard set of process-based measures and patient-reported outcomes (PROs) along the HCC care continuum. We identified candidate process and outcomes measures for HCC care based on structured literature review. A 13-member panel with content expertise across the HCC care continuum evaluated candidate measures on importance and performance gap using a modified Delphi approach (two rounds of rating) to define the final set of measures. Candidate PROs based on a structured scoping review were ranked by 74 patients with HCC across 7 diverse institutions. Out of 135 measures, 29 measures made the final set. These covered surveillance (6 measures), diagnosis (6 measures), staging (2 measures), treatment (10 measures), and outcomes (5 measures). Examples included the use of ultrasound (± alpha-fetoprotein [AFP]) every 6 months, need for surveillance in high-risk populations, diagnostic testing for patients with a new AFP elevation, multidisciplinary liver tumor board (MLTB) review of Liver Imaging-Reporting and Data System 4 lesions, standard evaluation at diagnosis, treatment recommendations based on Barcelona Clinic Liver Cancer staging, MLTB discussion of treatment options, appropriate referral for evaluation of liver transplantation candidacy, and role of palliative therapy. PROs include those related to pain, anxiety, fear of treatment, and uncertainty about the best individual treatment and the future. The AASLD PMC has developed a set of explicit quality measures in HCC care to help bridge the gap between guideline recommendations and measurable processes and outcomes. Measurement and subsequent implementation of these metrics could be a central step in the improvement of patient care and outcomes in this high-risk population.
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Affiliation(s)
| | - Marwan S Ghabril
- 12250Division of GastroenterologyDepartment of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Alexander Kuo
- Division of GastroenterologyCedars-Sinai Medical CenterUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Raphael B Merriman
- Division of General and Transplant HepatologyCalifornia Pacific Medical Center and Research InstituteSan FranciscoCaliforniaUSA
| | - Timothy Morgan
- Medicine and Research ServicesVA Long Beach Healthcare SystemLong BeachCaliforniaUSA
| | - Neehar D Parikh
- Division of Gastroenterology and HepatologyUniversity of MichiganAnn ArborMichiganUSA
| | - Nadia Ovchinsky
- Division of Pediatric GastroenterologyChildren's Hospital at MontefioreBronxNew YorkUSA
| | - Fasiha Kanwal
- Section of Gastroenterology and HepatologyDepartment of MedicineBaylor College of MedicineHoustonTexasUSA.,Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey Veterans Affairs Medical CenterHoustonTexasUSA.,Section of Health Services ResearchDepartment of MedicineBaylor College of MedicineHoustonTexasUSA
| | - Michael L Volk
- 4608Division of Gastroenterology and Transplantation InstituteLoma Linda UniversityLoma LindaCaliforniaUSA
| | - Chanda Ho
- Department of TransplantationCalifornia Pacific Medical CenterSan FranciscoCaliforniaUSA
| | - Marina Serper
- Division of Gastroenterology and HepatologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA.,Leonard Davis Institute of Health EconomicsPhiladelphiaPennsylvaniaUSA
| | | | - Vatche Agopian
- Division of Liver and Pancreas TransplantationDepartment of SurgeryDavid Geffen School of Medicine at University of CaliforniaLos AngelesCaliforniaUSA
| | - Roniel Cabrera
- Department of MedicineDivision of Gastroenterology, Hepatology and NutritionUniversity of FloridaGainesvilleFloridaUSA
| | | | | | - Julie Heimbach
- Division of Transplant SurgeryWilliam J. von Liebig Transplant CenterMayo ClinicRochesterMinnesotaUSA
| | - George N Ioannou
- Division of GastroenterologyDepartment of MedicineVeterans Affairs Puget Sound Health Care System and University of WashingtonSeattleWashingtonUSA
| | - David Kaplan
- Division of Gastroenterology and HepatologyPerelman University of Pennsylvania School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Jorge Marrero
- Digestive and Liver Diseases DivisionDepartment of Internal MedicineUT Southwestern Medical CenterDallasTexasUSA
| | - Neil Mehta
- Division of GastroenterologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Amit Singal
- Division of Digestive and Liver DiseasesUT Southwestern Medical CenterDallasTexasUSA
| | - Riad Salem
- Division of Interventional RadiologyDepartment of RadiologyNorthwestern UniversityChicagoIllinoisUSA
| | - Tamar Taddei
- Section of Digestive DiseasesYale School of MedicineNew HavenConnecticutUSA.,VA Connecticut Healthcare SystemWest HavenConnecticutUSA
| | - Anne M Walling
- VA Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA.,Division of General Internal Medicine and Health Services ResearchUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Elliot B Tapper
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
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10
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Díaz A, Marrero J, Cabrera G, Coto O, Gómez JM. Optimization of nickel and cobalt biosorption by native Serratia marcescens strains isolated from serpentine deposits using response surface methodology. Environ Monit Assess 2022; 194:167. [PMID: 35142917 PMCID: PMC8831376 DOI: 10.1007/s10661-022-09816-w] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/22/2022] [Indexed: 05/28/2023]
Abstract
The treatment of metal-polluted wastes is a challenging issue of environmental concern. Metals can be removed using microbial biomass, and this is an interesting approach towards the design of eco-friendly technologies for liquid waste treatment. The study reported here aimed to optimize nickel and cobalt biosorption from aqueous solutions using three native metal-resistant Serratia marcescens strains. Ni(II) and Co(II) biosorption by S. marcescens strains was found to fit better to Langmuir's model, with maximum uptake capacities of 13.5 mg g-1 for Ni(II) ions and 19.9 mg g-1 for Co(II) ions. Different experimental conditions of initial metal concentration, pH, initial biomass, and temperature were optimized using the Plackett-Burman method, and, finally, biomass and metal concentration were studied using the response surface methodology (RSM) to improve biosorption. The optimum uptake capacities for Co(II) ions by the three biosorbents used were obtained for initial metal concentrations of 35-40 mg L-1 and an initial biomass of 6 mg. For Ni(II) ions, the optimum uptake capacity was achieved with 1 mg of initial biomass for S. marcescens C-1 and C-19, and with 7 mg for S. marcescens C-16, with initial concentrations of 20-50 mg L-1. The results obtained demonstrate the viability of native S. marcescens strains as biosorbents for Ni(II) and Co(II) removal. This study also contributes to our understanding of the potential uses of serpentine microbial populations for the design of environmental cleanup technologies.
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Affiliation(s)
- A Díaz
- Metal Biotechnology Laboratory, Faculty of Biology, University of Havana (Cuba), Calle 25 #455 Vedado, 10400, La Habana, Cuba
| | - J Marrero
- Metal Biotechnology Laboratory, Faculty of Biology, University of Havana (Cuba), Calle 25 #455 Vedado, 10400, La Habana, Cuba
| | - G Cabrera
- Biological and Enzymatic Reactors Group, Department of Chemical Engineering and Food Technology, Faculty of Sciences, 11510, Puerto Real, Cadiz, Spain
| | - O Coto
- Metal Biotechnology Laboratory, Faculty of Biology, University of Havana (Cuba), Calle 25 #455 Vedado, 10400, La Habana, Cuba
| | - J M Gómez
- Biological and Enzymatic Reactors Group, Department of Chemical Engineering and Food Technology, Faculty of Sciences, 11510, Puerto Real, Cadiz, Spain.
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11
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Díaz A, Marrero J, Cabrera G, Coto O, Gómez JM. Biosorption of nickel, cobalt, zinc and copper ions by Serratia marcescens strain 16 in mono and multimetallic systems. Biodegradation 2022; 33:33-43. [PMID: 34657229 PMCID: PMC8803796 DOI: 10.1007/s10532-021-09964-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 10/05/2021] [Indexed: 12/18/2022]
Abstract
The metallurgical industry is one of the main sources of heavy metal pollution, which represents a severe threat to life. Metals can be removed from aqueous solutions by using microbial biomasses. This paper analyses the heavy metal biosorption capacity of Serratia marcescens strain 16 in single and multimetallic systems. The results obtained show that Co(II), Ni(II) and Zn(II) biosorption in monometallic systems is two to three times higher than in the presence of bi-metallic and multimetallic solutions. Fourier transform infrared spectroscopy confirmed that carbonyl, carboxyl and hydroxyl were the main functional groups, as well as the amide bands I and II involved in metal uptake, which are present in external structures of the bacterial cell. The results obtained demonstrated the viability of S. marcescens strain 16 as a biosorbent for the design of eco-friendly technologies for the treatment of waste liquor.
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Affiliation(s)
- A Díaz
- Metal Biotechnology Laboratory, Faculty of Biology, University of Havana (Cuba), 25th Street #455 Vedado, 10400, La Habana, Cuba
| | - J Marrero
- Metal Biotechnology Laboratory, Faculty of Biology, University of Havana (Cuba), 25th Street #455 Vedado, 10400, La Habana, Cuba
| | - G Cabrera
- Biological and Enzymatic Reactors Group, Department of Chemical Engineering and Food Technology, Faculty of Sciences, Puerto Real, 11510, Cádiz, Spain
| | - O Coto
- Metal Biotechnology Laboratory, Faculty of Biology, University of Havana (Cuba), 25th Street #455 Vedado, 10400, La Habana, Cuba
| | - J M Gómez
- Biological and Enzymatic Reactors Group, Department of Chemical Engineering and Food Technology, Faculty of Sciences, Puerto Real, 11510, Cádiz, Spain.
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12
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Singal AG, Hoshida Y, Pinato DJ, Marrero J, Nault JC, Paradis V, Tayob N, Sherman M, Lim YS, Feng Z, Lok AS, Rinaudo JA, Srivastava S, Llovet JM, Villanueva A. International Liver Cancer Association (ILCA) White Paper on Biomarker Development for Hepatocellular Carcinoma. Gastroenterology 2021; 160:2572-2584. [PMID: 33705745 PMCID: PMC8169638 DOI: 10.1053/j.gastro.2021.01.233] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Amit G Singal
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, Texas.
| | - Yujin Hoshida
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, Texas
| | - David J Pinato
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Jorge Marrero
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, Texas
| | - Jean-Charles Nault
- Service d'hépatologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France; Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Paris, France; Centre de Recherche des Cordeliers, Inserm, Sorbonne Université, Université Paris, INSERM UMR 118 Functional Genomics of Solid Tumors Laboratory, F-75006, Paris, France
| | - Valerie Paradis
- Pathology Department, Beaujon hospital, Clichy, University Paris, France
| | - Nabihah Tayob
- Department of Data Science, Dana Farber Cancer Institute, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | | | - Young Suk Lim
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ziding Feng
- Biostatistics Program, Public Health Science Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Anna S Lok
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan
| | - Jo Ann Rinaudo
- Cancer Biomarker Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Sudhir Srivastava
- Cancer Biomarker Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Josep M Llovet
- Division of Liver Diseases and Hematology/Medical Oncology, Liver Cancer Program, Tisch Cancer Institute, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Translational Research in Hepatic Oncology, Liver Unit, IDIBAPS, Hospital Clinic, University of Barcelona, Catalonia, Spain; Institució Catalana d'Estudis Avançats (ICREA), Barcelona, Catalonia, Spain
| | - Augusto Villanueva
- Division of Liver Diseases and Hematology/Medical Oncology, Liver Cancer Program, Tisch Cancer Institute, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
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13
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Montero E, López M, Vidal H, Martínez M, Virto L, Marrero J, Herrera D, Zapatero A, Sanz M. Impact of periodontal therapy on systemic markers of inflammation in patients with metabolic syndrome: A randomized clinical trial. Diabetes Obes Metab 2020; 22:2120-2132. [PMID: 32613714 DOI: 10.1111/dom.14131] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 05/10/2020] [Revised: 06/21/2020] [Accepted: 06/27/2020] [Indexed: 12/27/2022]
Abstract
AIM To determine the impact of periodontal treatment on systemic markers of inflammation in patients with metabolic syndrome (MetS) and periodontitis. MATERIALS AND METHODS In this parallel-arm, double-blind, randomized controlled clinical trial, 63 patients with MetS and severe periodontitis were randomly assigned to receive either intensive periodontal treatment (IPT; scaling and root planing plus azithromycin 500 mg every day for 3 days) or minimal periodontal treatment (MPT; supragingival professional mechanical plaque removal plus a placebo). The primary outcome was the impact of the tested interventions on high-sensitivity C-reactive protein (hs-CRP) serum levels at 6 months. As secondary outcomes, differences in the levels of cytokines, markers of prothrombotic states, carbohydrate and lipid metabolism, as well as blood pressure, were measured at 3 and 6 months after therapy. RESULTS The intention-to-treat population consisted of 63 subjects randomly assigned to either the MPT (n = 31) or the IPT (n = 32) group. At baseline, mean hs-CRP was 3.9 mg/L (standard deviation [SD] = 2.9) and 3.9 mg/L (SD = 3.4), respectively, and no significant differences in cardiometabolic risk profiles were detected between the groups. Adjusting for baseline hs-CRP, sex, age, smoking status and body mass index, hs-CRP at 6 months was 1.2 mg/L (95% CI 0.4; 2.0; P = .004) lower in the IPT group than in the MPT group. In the secondary outcomes, significant reductions in IL-1β, TNF-α, HbA1c and blood pressure were observed in the IPT group at 3 months compared with the MPT group. CONCLUSION Effective periodontal treatment significantly reduced hs-CRP after 6 months in patients with MetS and severe periodontitis. Periodontal therapy might be useful to reduce cardiovascular risk in these patients.
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Affiliation(s)
- Eduardo Montero
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
| | - Mercedes López
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
| | - Honorato Vidal
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
| | - María Martínez
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
| | - Leire Virto
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Jorge Marrero
- Internal Medicine Department, Fuenlabrada Hospital, Madrid, Spain
| | - David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
| | - Antonio Zapatero
- Internal Medicine Department, Fuenlabrada Hospital, Madrid, Spain
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
- Section of Graduate Periodontology, University Complutense, Madrid, Spain
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14
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Contreras Muruaga M, Reig G, Vivancos J, González A, Cardona P, Ramírez-Moreno J, Martí-Fábregas J, Suárez Fernández C, Pose A, Díaz JA, Rodríguez M, Pena M, Arias S, Larrosa D, González Á, Rodríguez E, González M, Fernández D, Barbagelata C, Raña N, Freire S, Cerqueiro JM, Guerrero H, Ramos L, Álvarez L, de Lis JM, Caro C, Seijo M, Mederer S, de Zarraga MA, Ferreiro J, Terrero JM, Arias M, Pérez R, Sánchez J, Maciñeiras J, Fernández J, Jaén F, Esteva D, Zamora M, Navarrete N, García J, Mérida L, Corrales MÁ, Quirós R, Cantero J, Barrero FJ, Villegas I, Castro J, Foronda J, Carrillo D, Vega J, Trujillo JA, Montero M, Jurado A, Sánchez C, Agüera-Morales E, Sánchez M, Durán P, Fernández de la Puerta R, Pérez de la Blanca M, Martínez MP, Fernández Ó, Tamayo JA, Bustamante R, Serrano PJ, Arjona A, Fernández J, Payan M, Gómez R, Peña D, Cabrerizo E, Salgado F, Ivanova Georgieva R, Gil-Núñez A, Bello E, Díaz F, Medina A, Castellano A, Miranda Y, Fabre Ó, García Polo I, Ibáñez P, Sainz C, Sierra F, Aragón E, Díaz J, Aguilar F, Ortega MÁ, Egido JA, Pontes JC, García MÁ, Cabrera F, Batalla B, Culla A, Molina C, Flores A, Seró L, Muchada M, Meler P, Boned-Riera S, Cánovas D, Estela J, Font J, Purroy F, Benabdelhak I, Sanahuja J, Roquer J, Rodríguez A, Ois Á, Cuadrado E, Jiménez J, Nogués X, Kuprinski J, German A, Irigoyen D, Cara JJ, Font MÀ, Huertas S, Martínez-Domeño A, Arroyo JA, Delgado-Mederos R, Gómez-Choco MJ, Mengual JJ, García SM, Castellanos MDM, van Eedenburg C, Cañas I, Espinosa J, Montull S, Quesada H, Ustrell X, Homedes C, Navalpotro I, Casanova J, Lago AP, Morata C, Gorriz D, Moreno I, Tembl J, Ponz A, Fonseca MJ, Chamarro R, Gil R, Oliver V, Pampliega A, Artero A, Puchades F, Landete L, Vilar C, Jiménez C, Vives B, Moragues MD, Díaz R, Tur S, Escribano JB, Lucas C, Martínez F, Pons JM, Romero A, García D, Pérez J, Villaverde R, Martínez S, Rodríguez A, Tejero C, Pérez C, Mostacero E, Fernández C, Luna A, Pérez T, González F, de Arce A, Martínez M, Díez N, Gállego J, Zandio B, Herrera M, Aymerich N, Muñoz R, Marta J, Artal J, Errea JM, Timiraos JJ, Moreno MP, Freijo M, García JM, Gil MC, Revilla MÁ, Palacio E, Vázquez JL, Bestué M, Latorre A, Calvo E, Ballester L, Serrano M, Juega JM, López MÁ, Irimia P, Imaz L, Fuentes B, Sanz BE, Beltrán L, Ruiz G, Martínez P, Sánchez D, Barroso E, Molina I, Budiño MA, Masjuan J, de Felipe A, Matute C, Tejada J, Morán A, Fernández E, Riveira MDC, Carnedo J, Manquillo A, González R, Fernández JC, Guillan M, Yebra M, Trejo JM, Saiz J, Martínez-Acitores JC, Bravo Y, Arenillas JF, Calleja A, Cortijo E, Reyes J, López L, Muñoz PL, Fidalgo MÁ, Hernández J, Gómez JC, Morán JC, Gonzalo S, Marrero J, Satué JÁ, Belinchón JC, Moniche F, Calderón E, Escudero I, de la Torre J, Casado I, Antón J, Portilla JC, Luengo J, Rosal J, Calzado E, Anglada JC, Girón J, Ramírez JM, Pijierro A, Roa A, Romero J, Aguayo M, Borrachero C, Sanz G, Gómez MJ, Rico MÁ, Cayon A, Carmona E, Cerro R, López R, Aguirre A, Lozano F, Rivera JM. Factors associated with poor anticoagulation control with vitamin K antagonists among outpatients attended in Internal Medicine and Neurology. The ALADIN study. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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15
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Wang M, Sanda M, Comunale MA, Herrera H, Swindell C, Kono Y, Singal AG, Marrero J, Block T, Goldman R, Mehta A. Changes in the Glycosylation of Kininogen and the Development of a Kininogen-Based Algorithm for the Early Detection of HCC. Cancer Epidemiol Biomarkers Prev 2017; 26:795-803. [PMID: 28223431 DOI: 10.1158/1055-9965.epi-16-0974] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/13/2017] [Accepted: 01/30/2017] [Indexed: 02/07/2023] Open
Abstract
Background: Hepatocellular carcinoma (HCC) has the greatest increase in mortality among all solids tumors in the United States related to low rates of early tumor detection. Development of noninvasive biomarkers for the early detection of HCC may reduce HCC-related mortality.Methods: We have developed an algorithm that combines routinely observed clinical values into a single equation that in a study of >3,000 patients from 5 independent sites improved detection of HCC as compared with the currently used biomarker, alpha-fetoprotein (AFP), by 4% to 20%. However, this algorithm had limited benefit in those with AFP <20 ng/mL. To that end, we have developed a secondary algorithm that incorporates a marker, fucosylated kininogen, to improve the detection of HCC, especially in those with AFP <20 ng/mL and early-stage disease.Results: The ability to detect early-stage AFP-negative (AFP <20 ng/mL) HCC increased from 0% (AFP alone) to 89% (for the new algorithm). Glycan analysis revealed that kininogen has several glycan modifications that have been associated with HCC, but often not with specific proteins, including increased levels of core and outer-arm fucosylation and increased branching.Conclusions: An algorithm combining fucosylated kininogen, AFP, and clinical characteristics is highly accurate for early HCC detection.Impact: Our biomarker algorithm could significantly improve early HCC detection and curative treatment eligibility in patients with cirrhosis. Cancer Epidemiol Biomarkers Prev; 26(5); 795-803. ©2017 AACR.
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Affiliation(s)
- Mengjun Wang
- Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Medical University of South Carolina, Charleston, South Carolina
| | - Miloslav Sanda
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Mary Ann Comunale
- Department of Microbiology and Immunology, Drexel University, Philadelphia, Pennsylvania
| | - Harmin Herrera
- Department of Microbiology and Immunology, Drexel University, Philadelphia, Pennsylvania
| | | | - Yuko Kono
- Division of Gastroenterology and Hepatology, University of California, San Diego, California
| | - Amit G Singal
- Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, Texas
| | - Jorge Marrero
- Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, Texas
| | - Timothy Block
- The Baruch S. Blumberg Institute, Doylestown, Pennsylvania
| | - Radoslav Goldman
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Anand Mehta
- Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Medical University of South Carolina, Charleston, South Carolina.
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16
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Zhang Y, Zhu J, Yin H, Marrero J, Zhang XX, Lubman DM. ESI-LC-MS Method for Haptoglobin Fucosylation Analysis in Hepatocellular Carcinoma and Liver Cirrhosis. J Proteome Res 2015; 14:5388-95. [PMID: 26503433 DOI: 10.1021/acs.jproteome.5b00792] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
A method for the detection of fucosylated glycans from haptoglobin in patient serum has been developed that provides enhanced sensitivity. The workflow involves isolation of the haptoglobin using an HPLC-based affinity column followed by glycan removal, extraction, and desialylation. The fucosylated glycans are then derivatized by Meladrazine, which significantly enhances the detection of the glycans in electrospray ionization. The separation of the derivatized glycans in a HILIC column shows that eight glycans from haptoglobin can be detected using less than 1 μL of a serum sample, with excellent reproducibility and quantitation, where without derivatization the glycans could not be detected. The ratio of the fucosylated peaks to their corresponding nonfucosylated forms shows that the fucosylated glycans are upregulated in the case of hepatocellular carcinoma (HCC) samples versus cirrhosis samples, where the relatively low abundance bifucosylated tetra-antennary form can be detected and may be a particularly good marker for HCC.
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Affiliation(s)
- Yiwei Zhang
- Department of Surgery, University of Michigan Medical Center , Ann Arbor, Michigan 48109, United States.,Beijing National Laboratory for Molecular Sciences (BNLMS), Key Laboratory of Bioorganic Chemistry and Molecular Engineering of Ministry of Education, College of Chemistry and Molecular Engineering, Peking University , Beijing 100871, China
| | - Jianhui Zhu
- Department of Surgery, University of Michigan Medical Center , Ann Arbor, Michigan 48109, United States
| | - Haidi Yin
- Department of Surgery, University of Michigan Medical Center , Ann Arbor, Michigan 48109, United States
| | - Jorge Marrero
- Liver Transplantation Program, University of Texas Southwestern Medical Center , Dallas, Texas 75390, United States
| | - Xin-Xiang Zhang
- Beijing National Laboratory for Molecular Sciences (BNLMS), Key Laboratory of Bioorganic Chemistry and Molecular Engineering of Ministry of Education, College of Chemistry and Molecular Engineering, Peking University , Beijing 100871, China
| | - David M Lubman
- Department of Surgery, University of Michigan Medical Center , Ann Arbor, Michigan 48109, United States
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Zhu J, Wu J, Yin H, Marrero J, Lubman DM. Mass Spectrometric N-Glycan Analysis of Haptoglobin from Patient Serum Samples Using a 96-Well Plate Format. J Proteome Res 2015; 14:4932-9. [PMID: 26448449 DOI: 10.1021/acs.jproteome.5b00662] [Citation(s) in RCA: 25] [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] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Alterations in glycosylation of serum glycoproteins can provide unique and highly specific fingerprints of malignancy. Our previous mass spectrometric study revealed that the bifucosylation level of serum haptoglobin was distinctly increased in hepatocellular carcinoma (HCC) patients versus liver cirrhosis of all three major etiologies. We have thus developed a method for the analysis of large numbers of serum samples based on a 96-well plate platform for the evaluation of fucosylation changes of serum haptoglobin between HCC versus cirrhosis. Haptoglobin was isolated from the serum of individual patient samples based on an HPLC column immobilized with antihaptoglobin antibody via hydrazide immobilization chemistry. Only 10 μL of serum was required for glycan extraction and processing for MALDI-QIT mass spectrometry analysis using the 96-well plate format. The bifucosylation degrees of haptoglobin in individuals were calculated using a quantitative glycomics method. The MS data confirmed that the bifucosylated tetra-anntenary glycan was upregulated in HCC samples of all etiologies. This study provides a parallel method for processing glycan content for haptoglobin and evaluating detailed changes in glycan structures for a potentially large cohort of clinical serum samples.
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Affiliation(s)
- Jianhui Zhu
- Department of Surgery, University of Michigan Medical Center , 1150 West Medical Center Drive, Ann Arbor, Michigan 48109, United States
| | - Jing Wu
- Department of Surgery, University of Michigan Medical Center , 1150 West Medical Center Drive, Ann Arbor, Michigan 48109, United States
| | - Haidi Yin
- Department of Surgery, University of Michigan Medical Center , 1150 West Medical Center Drive, Ann Arbor, Michigan 48109, United States
| | - Jorge Marrero
- Department of Internal Medicine, UT Southwestern Medical Center , 5323 Harry Hines Boulevard, Dallas, Texas 75390, United States
| | - David M Lubman
- Department of Surgery, University of Michigan Medical Center , 1150 West Medical Center Drive, Ann Arbor, Michigan 48109, United States
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Yin H, Tan Z, Wu J, Zhu J, Shedden KA, Marrero J, Lubman DM. Mass-Selected Site-Specific Core-Fucosylation of Serum Proteins in Hepatocellular Carcinoma. J Proteome Res 2015; 14:4876-84. [PMID: 26403951 DOI: 10.1021/acs.jproteome.5b00718] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 02/08/2023]
Abstract
A mass spectrometry-based methodology has been developed to screen for changes in site-specific core-fucosylation (CF) of serum proteins in early stage HCC with different etiologies. The methods involve depletion of high-abundance proteins, trypsin digestion of medium-to-low-abundance proteins into peptides, iTRAQ labeling, and Lens culinaris Agglutinin (LCA) enrichment of CF peptides, followed by endoglycosidase F3 digestion before mass spectrometry analysis. 1300 CF peptides from 613 CF proteins were identified from patients sera, where 20 CF peptides were differentially expressed in alcohol (ALC)-related HCC samples compared with ALC-related cirrhosis samples and 26 CF peptides changed in hepatitis C virus (HCV)-related HCC samples compared with HCV-related cirrhosis samples. Among these, we found three CF peptides from fibronectin upregulated in ALC-related HCC samples compared with ALC-related cirrhosis samples with an AUC (area under the curve) value of 0.89 at site 1007 with a specificity of 85.7% at a sensitivity of 92.9% (generated with 10-fold cross-validation). When combined with the AFP index, the AUC value reached to 0.92 with a specificity of 92.9% at a sensitivity of 100%, significantly improved compared to that with AFP alone (LR test p < 0.001). In HCV-related samples, the CF level of cadherin-5 at site 61 showed the best AUC value of 0.75 but was not as promising as that of fibronectin site 1007 for ALC-related samples. The CF peptides of fibronectin may serve as potential biomarkers for early stage HCC screening in ALC-related cirrhosis patients.
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Affiliation(s)
- Haidi Yin
- Department of Surgery, University of Michigan Medical Center , Ann Arbor, Michigan 48109, United States
| | - Zhijing Tan
- Department of Surgery, University of Michigan Medical Center , Ann Arbor, Michigan 48109, United States
| | - Jing Wu
- Department of Surgery, University of Michigan Medical Center , Ann Arbor, Michigan 48109, United States
| | - Jianhui Zhu
- Department of Surgery, University of Michigan Medical Center , Ann Arbor, Michigan 48109, United States
| | - Kerby A Shedden
- Department of Statistics, University of Michigan , Ann Arbor, Michigan 48109, United States
| | - Jorge Marrero
- Liver Transplantation Program, University of Texas Southwestern Medical Center , Dallas, Texas 75390, United States
| | - David M Lubman
- Department of Surgery, University of Michigan Medical Center , Ann Arbor, Michigan 48109, United States
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19
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Marrero J, Coto O, Goldmann S, Graupner T, Schippers A. Recovery of Nickel and Cobalt from Laterite Tailings by Reductive Dissolution under Aerobic Conditions Using Acidithiobacillus Species. Environ Sci Technol 2015; 49:6674-6682. [PMID: 25923144 DOI: 10.1021/acs.est.5b00944] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Biomining of sulfidic ores has been applied for almost five decades. However, the bioprocessing of oxide ores such as laterites lags commercially behind. Recently, the Ferredox process was proposed to treat limonitic laterite ores by means of anaerobic reductive dissolution (AnRD), which was found to be more effective than aerobic bioleaching by fungi and other bacteria. We show here that the ferric iron reduction mediated by Acidithiobacillus thiooxidans can be applied to an aerobic reductive dissolution (AeRD) of nickel laterite tailings. AeRD using a consortium of Acidithiobacillus thiooxidans and Acidithiobacillus ferrooxidans extracted similar amounts of nickel (53-57%) and cobalt (55-60%) in only 7 days as AnRD using Acidithiobacillus ferrooxidans. The economic and environmental advantages of AeRD for processing of laterite tailings comprise no requirement for an anoxic atmosphere, 1.8-fold less acid consumption than for AnRD, as well as nickel and cobalt recovered in a ferrous-based pregnant leach solution (PLS), facilitating the subsequent metal recovery. In addition, an aerobic acid regeneration stage is proposed. Therefore, AeRD process development can be considered as environmentally friendly for treating laterites with low operational costs and as an attractive alternative to AnRD.
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Affiliation(s)
- J Marrero
- †Federal Institute for Geosciences and Natural Resources (BGR), Stilleweg 2, 30655 Hannover, Germany
| | - O Coto
- ‡Laboratory of Metals, Department of Microbiology, University of Havana, Calle 25 e/J e I, Havana, Cuba
| | - S Goldmann
- †Federal Institute for Geosciences and Natural Resources (BGR), Stilleweg 2, 30655 Hannover, Germany
| | - T Graupner
- †Federal Institute for Geosciences and Natural Resources (BGR), Stilleweg 2, 30655 Hannover, Germany
| | - A Schippers
- †Federal Institute for Geosciences and Natural Resources (BGR), Stilleweg 2, 30655 Hannover, Germany
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Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death, with a rising global incidence. The vast majority of HCC cases occur in the setting of liver cirrhosis, mainly due to chronic hepatitis C (HCV) or hepatitis B (HBV) viral infections, alcohol consumption, and nonalcoholic fatty liver disease. The new approval of curative therapy with two NS5A inhibitors, ledipasvir and sofosbuvir, for the treatment of HCV will no doubt affect HCC incidence and outcome. No studies have evaluated the use of the new antivirals in patients with HCC. Staging and scoring remain an integral part of the management of patients with advanced HCC. Curative therapies for the treatment of HCC are evolving. Improvements in surgical techniques and risk stratification for orthotopic liver transplantation (OLT) have expanded access and improved the outlook for patients suffering from HCC. Interventional locoregional treatments continue to play a key role in the management of HCC. Transarterial chemoembolization is considered the standard of care for patients with noninvasive multinodular tumors at the intermediate stage. Bland embolization appears to have similar virtues in some studies. Y90 radioembolization represents a promising treatment option for patients unfit or refractory to transarterial chemoembolization. The advent of sorafenib as a standard of care with an improvement in survival sadly remain the only major breakthrough in the treatment of advanced HCC, with mounting negative data from multiple clinical trials. Advances in immunotherapy and customized therapy may hopefully help reverse this tide.
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Affiliation(s)
- Ghassan K Abou-Alfa
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY; The University of Texas Southwestern, Dallas, TX; The University of Chicago, Chicago, IL; and Pisa University Hospital and School of Medicine, Pisa, Italy
| | - Jorge Marrero
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY; The University of Texas Southwestern, Dallas, TX; The University of Chicago, Chicago, IL; and Pisa University Hospital and School of Medicine, Pisa, Italy
| | - John Renz
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY; The University of Texas Southwestern, Dallas, TX; The University of Chicago, Chicago, IL; and Pisa University Hospital and School of Medicine, Pisa, Italy
| | - Riccardo Lencioni
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY; The University of Texas Southwestern, Dallas, TX; The University of Chicago, Chicago, IL; and Pisa University Hospital and School of Medicine, Pisa, Italy
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21
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Yin H, Lin Z, Nie S, Wu J, Tan Z, Zhu J, Dai J, Feng Z, Marrero J, Lubman DM. Mass-selected site-specific core-fucosylation of ceruloplasmin in alcohol-related hepatocellular carcinoma. J Proteome Res 2014; 13:2887-96. [PMID: 24799124 PMCID: PMC4059274 DOI: 10.1021/pr500043k] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 01/13/2014] [Indexed: 12/17/2022]
Abstract
A mass spectrometry-based methodology has been developed to study changes in core-fucosylation of serum ceruloplasmin that are site-specific between cirrhosis and hepatocellular carcinoma (HCC). The serum samples studied for these changes were from patients affected by cirrhosis or HCC with different etiologies, including alcohol, hepatitis B virus, or hepatitis C virus. The methods involved trypsin digestion of ceruloplasmin into peptides followed by Endo F3 digestion, which removed most of the glycan structure while retaining the innermost N-acetylglucosamine (GlcNAc) and/or core-fucose bound to the peptide. This procedure simplified the structures for further analysis by mass spectrometry, where four core-fucosylated sites (sites 138, 358, 397, and 762) were detected in ceruloplasmin. The core-fucosylation ratio of three of these sites increased significantly in alcohol-related HCC samples (sample size = 24) compared to that in alcohol-related cirrhosis samples (sample size = 18), with the highest AUC value of 0.838 at site 138. When combining the core-fucosylation ratio of site 138 in ceruloplasmin and the alpha-fetoprotein (AFP) value, the AUC value increased to 0.954 (ORsite138 = 12.26, p = 0.017; ORAFP = 3.64, p = 0.022), which was markedly improved compared to that of AFP (AUC = 0.867) (LR test p = 0.0002) alone. However, in HBV- or HCV-related liver diseases, no significant site-specific change in core-fucosylation of ceruloplasmin was observed between HCC and cirrhosis.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Alcohol Drinking/adverse effects
- Amino Acid Sequence
- Biomarkers, Tumor/blood
- Biomarkers, Tumor/chemistry
- Carcinoma, Hepatocellular/blood
- Carcinoma, Hepatocellular/diagnosis
- Carcinoma, Hepatocellular/etiology
- Case-Control Studies
- Ceruloplasmin/chemistry
- Ceruloplasmin/metabolism
- Female
- Glycosylation
- Hepatitis B/blood
- Hepatitis B/complications
- Hepatitis C/blood
- Hepatitis C/complications
- Humans
- Liver Diseases, Alcoholic/blood
- Liver Diseases, Alcoholic/diagnosis
- Liver Diseases, Alcoholic/etiology
- Liver Neoplasms/blood
- Liver Neoplasms/diagnosis
- Liver Neoplasms/etiology
- Male
- Middle Aged
- Molecular Sequence Data
- Molecular Weight
- Protein Processing, Post-Translational
- ROC Curve
- Tandem Mass Spectrometry
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Affiliation(s)
- Haidi Yin
- Department
of Surgery, University of Michigan Medical
Center, Ann Arbor, Michigan 48109, United
States
| | - Zhenxin Lin
- Department
of Surgery, University of Michigan Medical
Center, Ann Arbor, Michigan 48109, United
States
| | - Song Nie
- Department
of Surgery, University of Michigan Medical
Center, Ann Arbor, Michigan 48109, United
States
| | - Jing Wu
- Department
of Surgery, University of Michigan Medical
Center, Ann Arbor, Michigan 48109, United
States
| | - Zhijing Tan
- Department
of Surgery, University of Michigan Medical
Center, Ann Arbor, Michigan 48109, United
States
| | - Jianhui Zhu
- Department
of Surgery, University of Michigan Medical
Center, Ann Arbor, Michigan 48109, United
States
| | - Jianliang Dai
- Department
of Biostatistics, University of Texas MD
Anderson Cancer Center, Houston, Texas 77030, United States
| | - Ziding Feng
- Department
of Biostatistics, University of Texas MD
Anderson Cancer Center, Houston, Texas 77030, United States
| | - Jorge Marrero
- Liver
Transplantation Program, University of Texas
Southwestern Medical Center, Dallas, Texas 75390, United States
| | - David M. Lubman
- Department
of Surgery, University of Michigan Medical
Center, Ann Arbor, Michigan 48109, United
States
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22
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Zhu J, Lin Z, Wu J, Yin H, Dai J, Feng Z, Marrero J, Lubman DM. Analysis of serum haptoglobin fucosylation in hepatocellular carcinoma and liver cirrhosis of different etiologies. J Proteome Res 2014; 13:2986-97. [PMID: 24807840 PMCID: PMC4059532 DOI: 10.1021/pr500128t] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We have developed herein a quantitative mass spectrometry-based approach to analyze the etiology-related alterations in fucosylation degree of serum haptoglobin in patients with liver cirrhosis and hepatocellular carcinoma (HCC). The three most common etiologies, including infection with hepatitis B virus (HBV), infection with hepatitis C virus (HCV), and heavy alcohol consumption (ALC), were investigated. Only 10 μL of serum was used in this assay in which haptoglobin was immunoprecipitated using a monoclonal antibody. The N-glycans of haptoglobin were released with PNGase F, desialylated, and permethylated prior to MALDI-QIT-TOF MS analysis. In total, N-glycan profiles derived from 104 individual patient samples were quantified (14 healthy controls, 40 cirrhosis, and 50 HCCs). A unique pattern of bifucosylated tetra-antennary glycan, with both core and antennary fucosylation, was identified in HCC patients. Quantitative analysis indicated that the increased fucosylation degree was highly associated with HBV- and ALC-related HCC patients compared to that of the corresponding cirrhosis patients. Notably, the bifucosylation degree was distinctly increased in HCC patients versus that in cirrhosis of all etiologies. The elevated bifucosylation degree of haptoglobin can discriminate early stage HCC patients from cirrhosis in each etiologic category, which may be used to provide a potential marker for early detection and to predict HCC in patients with cirrhosis.
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Affiliation(s)
- Jianhui Zhu
- Department of Surgery, University of Michigan Medical Center , Ann Arbor, Michigan 48109, United States
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23
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Marrero J, Maluccio MA, McCurdy H, Abou-Alfa GK. Expert perspectives on evidence-based treatment planning for patients with hepatocellular carcinoma. Cancer Control 2014; 21:5-16. [PMID: 24681845 DOI: 10.1177/1073274814021002s02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Jorge Marrero
- University of Texas Southwestern Medical Center, Dallas, TX 75390.
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24
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Wang M, Mehta A, Block TM, Marrero J, Di Bisceglie AM, Devarajan K. ErratumTo: A comparison of statistical methods for the detection of hepatocellular carcinoma based on serum biomarkers and clinical variables. BMC Med Genomics 2013. [PMCID: PMC3878211 DOI: 10.1186/1755-8794-6-s3-s11] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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25
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Wang M, Mehta A, Block TM, Marrero J, Di Bisceglie AM, Devarajan K. A comparison of statistical methods for the detection of hepatocellular carcinoma based on serum biomarkers and clinical variables. BMC Med Genomics 2013; 6 Suppl 3:S9. [PMID: 24564861 PMCID: PMC3980825 DOI: 10.1186/1755-8794-6-s3-s9] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Currently, a surgical approach is the best curative treatment for those with hepatocellular carcinoma (HCC). However, this requires HCC detection and removal of the lesion at an early stage. Unfortunately, most cases of HCC are detected at an advanced stage because of the lack of accurate biomarkers that can be used in the surveillance of those at risk. It is believed that biomarkers that could detect HCC early will play an important role in the successful treatment of HCC. METHODS In this study, we analyzed serum levels of alpha fetoprotein, Golgi protein, fucosylated alpha-1-anti-trypsin, and fucosylated kininogen from 113 patients with cirrhosis and 164 serum samples from patients with cirrhosis plus HCC. We utilized two different methods, namely, stepwise penalized logistic regression (stepPLR) and model-based classification and regression trees (mob), along with the inclusion of clinical and demographic factors such as age and gender, to determine if these improved algorithms could be used to increase the detection of cancer. RESULTS AND DISCUSSION The performance of multiple biomarkers was found to be better than that of individual biomarkers. Using several statistical methods, we were able to detect HCC in the background of cirrhosis with an area under the receiver operating characteristic curve of at least 0.95. stepPLR and mob demonstrated better predictive performance relative to logistic regression (LR), penalized LR and classification and regression trees (CART) used in our prior study based on three-fold cross-validation and leave one out cross-validation. In addition, mob provided unparalleled intuitive interpretation of results and potential cut-points for biomarker levels. The inclusion of age and gender improved the overall performance of both methods among all models considered, while the stratified male-only subset provided the best overall performance among all methods and models considered. CONCLUSIONS In addition to multiple biomarkers, the incorporation of age and gender into statistical models significantly improved their predictive performance in the detection of HCC.
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Affiliation(s)
| | - Anand Mehta
- 3508 Old Easton Rd, Doylestown, PA, 18902, USA
| | | | - Jorge Marrero
- Division of Gastroenterology, University of Michigan, 3912 Taubman Center, Ann Arbor, MI 48109, USA
| | - Adrian M Di Bisceglie
- Saint Louis University School of Medicine, 1402 S. Grand FDT 12th Floor, St. Louis, MO 63104, USA
| | - Karthik Devarajan
- Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 18901, USA
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Comunale MA, Wang M, Anbarasan N, Betesh L, Karabudak A, Moritz E, Devarajan K, Marrero J, Block TM, Mehta A. Total serum glycan analysis is superior to lectin-FLISA for the early detection of hepatocellular carcinoma. Proteomics Clin Appl 2013; 7:690-700. [PMID: 23857719 DOI: 10.1002/prca.201200125] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [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: 12/03/2012] [Revised: 02/22/2013] [Accepted: 03/30/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE Hepatocellular carcinoma (HCC) is a primary cancer of the liver that is predominantly the result of infection with a hepatotropic virus such as hepatitis B virus or hepatitis C virus. As liver cancer is often asymptomatic, the development of sensitive noninvasive biomarkers is needed for early detection and improved survival. EXPERIMENTAL DESIGN We have previously identified alterations in the N-linked glycosylation of serum proteins with the development of HCC and identified many of the proteins that contained the altered glycosylation. In the current study, we compared the ability of the identified proteins to diagnose HCC with the total serum glycan analysis. RESULTS Surprisingly, glycan analysis of total serum had the greatest ability to distinguish HCC from cirrhosis with an AUROC of 0.851, a sensitivity of 73% at a specificity of 88%. When total glycan sequencing was combined with alpha-fetoprotein (AFP), the sensitivity increased to 95% at a specificity of 90%. CONCLUSION AND CLINICAL RELEVANCE Changes in glycosylation as detected in whole serum could be used to diagnose HCC with greater sensitivity and specificity than that observed through the analysis of specific protein glycoforms or protein levels. Such an assay could have value in the management of those at risk for the development of HCC.
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Affiliation(s)
- Mary Ann Comunale
- Department of Microbiology and Immunology, Drexel Institute for Biotechnology and Virology, Drexel University College of Medicine, Doylestown, PA 18901, USA
| | - Mengjun Wang
- Department of Microbiology and Immunology, Drexel Institute for Biotechnology and Virology, Drexel University College of Medicine, Doylestown, PA, USA
| | | | - Lucy Betesh
- Department of Microbiology and Immunology, Drexel Institute for Biotechnology and Virology, Drexel University College of Medicine, Doylestown, PA, USA
| | - Aykan Karabudak
- Institute for Hepatitis and Virus Research, Doylestown, PA, USA
| | - Ethan Moritz
- Institute for Hepatitis and Virus Research, Doylestown, PA, USA
| | | | - Jorge Marrero
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | - Timothy M Block
- Department of Microbiology and Immunology, Drexel Institute for Biotechnology and Virology, Drexel University College of Medicine, Doylestown, PA, USA
| | - Anand Mehta
- Department of Microbiology and Immunology, Drexel Institute for Biotechnology and Virology, Drexel University College of Medicine, Doylestown, PA, USA
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27
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Waljee AK, Mukherjee A, Singal AG, Zhang Y, Warren J, Balis U, Marrero J, Zhu J, Higgins PDR. Comparison of imputation methods for missing laboratory data in medicine. BMJ Open 2013; 3:bmjopen-2013-002847. [PMID: 23906948 PMCID: PMC3733317 DOI: 10.1136/bmjopen-2013-002847] [Citation(s) in RCA: 213] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Missing laboratory data is a common issue, but the optimal method of imputation of missing values has not been determined. The aims of our study were to compare the accuracy of four imputation methods for missing completely at random laboratory data and to compare the effect of the imputed values on the accuracy of two clinical predictive models. DESIGN Retrospective cohort analysis of two large data sets. SETTING A tertiary level care institution in Ann Arbor, Michigan. PARTICIPANTS The Cirrhosis cohort had 446 patients and the Inflammatory Bowel Disease cohort had 395 patients. METHODS Non-missing laboratory data were randomly removed with varying frequencies from two large data sets, and we then compared the ability of four methods-missForest, mean imputation, nearest neighbour imputation and multivariate imputation by chained equations (MICE)-to impute the simulated missing data. We characterised the accuracy of the imputation and the effect of the imputation on predictive ability in two large data sets. RESULTS MissForest had the least imputation error for both continuous and categorical variables at each frequency of missingness, and it had the smallest prediction difference when models used imputed laboratory values. In both data sets, MICE had the second least imputation error and prediction difference, followed by the nearest neighbour and mean imputation. CONCLUSIONS MissForest is a highly accurate method of imputation for missing laboratory data and outperforms other common imputation techniques in terms of imputation error and maintenance of predictive ability with imputed values in two clinical predicative models.
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Affiliation(s)
- Akbar K Waljee
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | - Ashin Mukherjee
- Department of Statistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Amit G Singal
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
- Department of Clinical Sciences, UT Southwestern, Dallas, Texas, USA
| | - Yiwei Zhang
- Department of Statistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeffrey Warren
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ulysses Balis
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jorge Marrero
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ji Zhu
- Department of Statistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Peter DR Higgins
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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28
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Lamontagne A, Long RE, Comunale MA, Hafner J, Rodemich-Betesh L, Wang M, Marrero J, Di Bisceglie AM, Block T, Mehta A. Altered functionality of anti-bacterial antibodies in patients with chronic hepatitis C virus infection. PLoS One 2013; 8:e64992. [PMID: 23750224 PMCID: PMC3672197 DOI: 10.1371/journal.pone.0064992] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [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: 10/12/2012] [Accepted: 04/19/2013] [Indexed: 02/07/2023] Open
Abstract
Background Using comparative glycoproteomics, we have previously identified a glycoprotein that is altered in both amount and glycosylation as a function of liver cirrhosis. The altered glycoprotein is an agalactosylated (G0) immunoglobulin G molecule (IgG) that recognizes the heterophilic alpha-gal epitope. Since the alpha gal epitope is found on gut enterobacteria, it has been hypothesized that anti-gal antibodies are generated as a result of increased bacterial exposure in patients with liver disease. Methods The N-linked glycosylation of anti-gal IgG molecules from patients with fibrosis and cirrhosis was determined and the effector function of anti-bacterial antibodies from over 100 patients examined. In addition, markers of microbial exposure were determined. Results Surprisingly, the subset of agalactosylated anti-gal antibodies described here, was impaired in their ability to mediate complement mediated lysis and inhibited the complement-mediated destruction of common gut bacteria. In an analysis of serum from more than 100 patients with liver disease, we have shown that those with increased levels of this modified anti-gal antibody had increased levels of markers of bacterial exposure. Conclusions Anti-gal antibodies in patients with liver cirrhosis were reduced in their ability to mediate complement mediated lysis of target cells. As bacterial infection is a major complication in patients with cirrhosis and bacterial products such as LPS are thought to play a major role in the development and progression of liver fibrosis, this finding has many clinical implications in the etiology, prognosis and treatment of liver disease.
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Affiliation(s)
- Anne Lamontagne
- Drexel University College of Medicine, and Department of Microbiology and Immunology and Drexel Institute for Biotechnology and Virology, Doylestown, Pennsylvania, United States of America
- * E-mail: (AL); (AM)
| | - Ronald E. Long
- Drexel University College of Medicine, and Department of Microbiology and Immunology and Drexel Institute for Biotechnology and Virology, Doylestown, Pennsylvania, United States of America
| | - Mary Ann Comunale
- Drexel University College of Medicine, and Department of Microbiology and Immunology and Drexel Institute for Biotechnology and Virology, Doylestown, Pennsylvania, United States of America
| | - Julie Hafner
- Immunotope Inc., Doylestown, Pennsylvania, United States of America
| | - Lucy Rodemich-Betesh
- Drexel University College of Medicine, and Department of Microbiology and Immunology and Drexel Institute for Biotechnology and Virology, Doylestown, Pennsylvania, United States of America
| | - Mengjun Wang
- Drexel University College of Medicine, and Department of Microbiology and Immunology and Drexel Institute for Biotechnology and Virology, Doylestown, Pennsylvania, United States of America
| | - Jorge Marrero
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Adrian M. Di Bisceglie
- Department of Internal Medicine and Saint Louis University Liver Center, Saint Louis University School of Medicine, St Louis, Missouri, United States of America
| | - Timothy Block
- Drexel University College of Medicine, and Department of Microbiology and Immunology and Drexel Institute for Biotechnology and Virology, Doylestown, Pennsylvania, United States of America
| | - Anand Mehta
- Drexel University College of Medicine, and Department of Microbiology and Immunology and Drexel Institute for Biotechnology and Virology, Doylestown, Pennsylvania, United States of America
- * E-mail: (AL); (AM)
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Liang H, Block TM, Wang M, Nefsky B, Long R, Hafner J, Mehta AS, Marrero J, Gish R, Norton PA. Interleukin-6 and oncostatin M are elevated in liver disease in conjunction with candidate hepatocellular carcinoma biomarker GP73. Cancer Biomark 2013; 11:161-71. [PMID: 23144154 DOI: 10.3233/cbm-2012-00276] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Golgi phosphoprotein GP73 is elevated in the circulation of individuals with a diagnosis of hepatocellular carcinoma. Its usefulness as a biomarker of HCC is questioned, since it has also been reported to be elevated in the circulation of people with liver cirrhosis. Regulation of GP73 by inflammatory cytokines is therefore of interest. The interleukin-6 (IL-6) family cytokines were tested for effects on GP73 mRNA and/or protein levels in human hepatoblastoma HepG2 cells. Levels of GP73 mRNA and protein were up-regulated in HepG2 cells following treatment with either proinflammatory cytokine IL-6 or the related cytokine oncostatin M (OSM). Induction required the shared receptor subunit gp130, and correlated with increased tyrosine phosphorylation of STAT3. Maximal cytokine-mediated induction was not observed in the presence of protein synthesis inhibitor cycloheximide, suggesting additional regulatory factors play an important role. ELISA measurement of GP73 and IL-6 levels in the sera of patients with pre-malignant liver disease revealed a significant correlation between circulating levels of the two proteins. Similarly, a sensitive ELISA assay was developed to measure circulating OSM. OSM levels were elevated 6-7 fold in sera from patients with either cirrhosis or HCC relative to controls without liver disease. Although there was an association between levels of GP73 and OSM in serum from people with liver cirrhosis, there was not a statistically significant correlation in HCC, suggesting that the role of the cytokines in determining circulating levels may be complex. To our knowledge, this is the first report of OSM elevation being associated with liver disease.
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Affiliation(s)
- Hongyan Liang
- Department of Microbiology and Immunology, Drexel Institute for Biotechnology and Virology Research, Drexel University College of Medicine, Doylestown, PA 18902, USA
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Wang M, Block TM, Marrero J, Di Bisceglie AM, Devarajan K, Mehta A. Improved biomarker performance for the detection of hepatocellular carcinoma by inclusion of clinical parameters. Proceedings (IEEE Int Conf Bioinformatics Biomed) 2012; 2012. [PMID: 24307972 DOI: 10.1109/bibm.2012.6392612] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We have previously identified several biomarkers of hepatocellular carcinoma (HCC). The levels of three of these biomarkers were analyzed individually and in combination with the currently used marker, alpha fetoprotein (AFP), for the ability to distinguish between a diagnosis of cirrhosis (n=113) and HCC (n=164). We have utilized several novel biostatistical tools, along with the inclusion of clinical factors such as age and gender, to determine if improved algorithms could be used to increase the probability of cancer detection. Using several of these methods, we are able to detect HCC in the background of cirrhosis with an AUC of at least 0.95. The use of clinical factors in combination with biomarker values to detect HCC is discussed.
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Affiliation(s)
- Mengjun Wang
- Drexel University College of Medicine, Doylestown, PA, 18901
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Bronowicki J, Ye S, Kudo M, Marrero J, Venook A, Nakajima K, Lencioni R. Gideon (Global Investigation of Therapeutic Decisions in Hepatocellular Carcinoma [HCC] and of Its Treatment with Sorafenib [SOR]) 2nd Interim Analysis (IA): Subgroup Analysis by Disease Etiology. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33283-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Kanwal F, Befeler A, Chari RS, Marrero J, Kahn J, Afdhal N, Morgan T, Roberts L, Mohanty SR, Schwartz J, VanThiel D, Li J, Zeringue A, Di'Bisceglie A. Potentially curative treatment in patients with hepatocellular cancer--results from the liver cancer research network. Aliment Pharmacol Ther 2012; 36:257-65. [PMID: 22670798 DOI: 10.1111/j.1365-2036.2012.05174.x] [Citation(s) in RCA: 33] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 10/18/2011] [Accepted: 05/15/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND The extent to which potentially curative therapies are used in patients with hepatocellular cancer (HCC) and their related outcomes are unknown in the US. AIM To determine the rate and outcomes of potentially curative treatment in patients with HCC. METHODS Eleven US centers followed patients with HCC between 2001 and 2007. We determined rates of liver transplantation, surgical resection, or tumour ablation during follow-up, examined differences in adjusted survival of patients receiving these treatments, and determined the factors associated with receipt of potentially curative treatment. RESULTS Of the 267 patients, 76 (28%) patients had early HCC, defined as Child A or B cirrhosis, with a solitary HCC or ≤ 3 nodules, each ≤ 3 cm. Of these, 53 (69.7%) received curative treatment. Thirty six percent of patients with non-early HCC received curative treatment. Compared to patients with non-early HCC who did not receive curative treatment, patients with early HCC and curative treatment had the best survival [hazard ratio, HR = 0.19 (95% CI, 0.08-0.42)] followed by patients with advanced HCC who received curative treatment [HR = 0.37 (95% CI, 0.22-0.64)]. Baseline performance status was significantly associated with receipt of curative treatment as well as survival after adjusting for demographics, clinical characteristics, and HCC stage. CONCLUSIONS In this multicenter database, most of the patients with early HCC received potentially curative treatment. However, only 28% of patients had early HCC. One-third of patients with non-early HCC also underwent curative therapy. Potentially curative treatment improved survival and this effect was seen in patients with early as well as non-early HCC.
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Affiliation(s)
- F Kanwal
- John Cochran VA Medical Center, Saint Louis, MO, USA.
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Geschwind J, Lencioni R, Marrero J, Venook A, Ye S, Nakajima K, Kudo M. Abstract No. 196: Worldwide trends in locoregional therapy (LRT) for hepatocellular carcinoma (HCC): 2nd interim analysis (IA; 1500 patients [pts]) of the GIDEON (global investigation of therapeutic decisions in HCC and of its treatment with sorafenib) study. J Vasc Interv Radiol 2012. [DOI: 10.1016/j.jvir.2011.12.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sharma P, Welch K, Hussain H, Pelletier SJ, Fontana RJ, Marrero J, Merion RM. Incidence and risk factors of hepatocellular carcinoma recurrence after liver transplantation in the MELD era. Dig Dis Sci 2012; 57:806-12. [PMID: 21953139 PMCID: PMC3288660 DOI: 10.1007/s10620-011-1910-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [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: 07/07/2011] [Accepted: 09/02/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Deceased donor liver transplantation (DDLT) rates for candidates with hepatocellular carcinoma (HCC) have significantly increased in the MELD era because of the extra priority given to these candidates. We examined the incidence and pre-DDLT radiological and donor factors associated with post-DDLT HCC recurrence in the MELD era. METHODS Outcomes of HCC candidates aged ≥18 years that underwent DDLT between 2/28/02 and 6/30/08 (n = 94) were reviewed. The primary outcome was biopsy-proven post-LT HCC recurrence at any site. Kaplan-Meier analysis was used to calculate the cumulative incidence and Cox regression was used to identify the predictors of post-LT HCC recurrence. RESULTS The median age of the 94 candidates who met the study criteria was 54 years, 64% had hepatitis C, median lab MELD was 13, and median pre-LT AFP was 47 ng/dl. Based upon pre-DDLT imaging, 94% candidates met the Milan criteria. The median waiting time to transplant was 47 days and 27% received pre-DDLT loco-regional therapy. Seventeen (18%) developed HCC recurrence after 2.1 median years with a cumulative incidence of 6.8, 12, and 19% at 1, 2, and 3 years post-DDLT. The pre-DDLT number of lesions (p = 0.015), largest lesion diameter (p = 0.008), and higher donor age (p = 0.002) were the significant predictors of HCC recurrence after adjusting for pre-LT loco-regional therapy and waiting time. Post-LT HCC recurrence (p < 0.0001) and higher donor age (p = 0.029) were associated with lower post-LT survival. CONCLUSIONS Post-LT HCC recurrence is higher in our MELD era cohort than the reported rate of 8% at 4 years in Mazzaferro et al.'s study. The risk of HCC recurrence was significantly associated with the number of lesions and size of the largest lesion at the time of DDLT as well as with older donor age. Risk stratification using a predictive model for post-LT HCC recurrence based on pre-LT imaging and donor factors may help guide candidate selection and tailoring of HCC surveillance strategies after LT.
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Affiliation(s)
- Pratima Sharma
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Kathy Welch
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | | | | | - Robert J Fontana
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Jorge Marrero
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Robert M Merion
- Department of Surgery, University of Michigan, Ann Arbor, MI
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Comunale MA, Wang M, Rodemich-Betesh L, Hafner J, Lamontagne A, Klein A, Marrero J, Di Bisceglie AM, Gish R, Block T, Mehta A. Novel changes in glycosylation of serum Apo-J in patients with hepatocellular carcinoma. Cancer Epidemiol Biomarkers Prev 2011; 20:1222-9. [PMID: 21467232 DOI: 10.1158/1055-9965.epi-10-1047] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide and the occurrence of HCC has more than doubled in the United States in the past decade. Early detection is considered key to reducing the mortality of HCC. METHODS Using two-dimensional gel electrophoresis and high-performance liquid chromatography we have analyzed the glycosylation of Apo-J from healthy controls, patients with liver cirrhosis, or those with HCC. RESULTS Apo-J in the serum from patients with HCC had decreased levels of (β-1,4) triantennary N-linked glycan compared with the healthy controls or patients with liver cirrhosis. We analyzed this change in an independent cohort of 76 patients with HCC, 32 with cirrhosis, and 43 infected with hepatitis C virus using the Datura stramonium lectin (DSL), which binds to (β-1,4) triantennary N-linked glycan. The level of DSL-reactive Apo-J allowed us to differentiate HCC from cirrhosis with an area under the receiver operating characteristic curve (AUROC) of 0.852. When Apo-J was combined with other serum biomarkers such as α-fetoprotein (AFP) and fucosylated kininogen by using a multivariate logistic regression model, the AUROC increased to 0.944, a value much greater than that observed with AFP alone (AUROC of 0.765). CONCLUSIONS The glycosylation of Apo-J is a useful marker when used alone or in combination with outer makers for the early detection of HCC. IMPACT The potential use of a combination of AFP, DSL-reactive Apo-J, and fucosylated kininogen as a biomarker of HCC would have great value in the management of patients with liver disease.
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Affiliation(s)
- Mary Ann Comunale
- Department of Microbiology and Immunology, Drexel Institute for Biotechnology and Virus Research, Drexel University College of Medicine, Doylestown, Pennsylvania 18902, USA
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Lencioni R, Marrero J, Venook A, Ye SL, Kudo M. Design and rationale for the non-interventional Global Investigation of Therapeutic DEcisions in Hepatocellular Carcinoma and Of its Treatment with Sorafenib (GIDEON) study. Int J Clin Pract 2010; 64:1034-41. [PMID: 20642705 PMCID: PMC2905618 DOI: 10.1111/j.1742-1241.2010.02414.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a complicated condition influenced by multiple confounding factors, making optimum patient management extremely challenging. Ethnicity, stage at diagnosis, comorbidities and tumour morphology affect outcomes and vary from region to region, and there is no common language to assess patient prognosis and make treatment recommendations. Despite recent efforts to reduce the incidence of HCC, most patients present with unresectable disease. Non-surgical treatments include ablation, transarterial chemoembolisation and the multikinase inhibitor, sorafenib, but their effects in all patient subgroups are not known and further information is needed to optimise the use of these treatments. AIMS The Global Investigation of Therapeutic DEcisions in Hepatocellular Carcinoma and Of its Treatment with SorafeNib (GIDEON) study (ClinicalTrials.gov identifier NCT00812175; http://clinicaltrials.gov/) is an ongoing global, prospective, non-interventional study of patients with unresectable HCC who are eligible for systemic therapy and for whom the decision has been taken to treat with sorafenib under real-life practice conditions. The aim of this study is to evaluate the safety and efficacy of sorafenib in different subgroups, especially Child-Pugh B where data are limited. DISCUSSION This study will recruit 3000 patients from > 40 countries and follow them for approximately 5 years to compile a large and robust database of information that will be used to analyse local, regional and global differences in baseline characteristics, disease aetiology, treatment practice patterns and treatment outcomes, with a view to improve the knowledge base used to guide physician treatment decisions and to improve patient outcomes.
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Affiliation(s)
- R Lencioni
- Division of Diagnostic Imaging and Intervention, Department of Liver Transplantation, Hepatology and Infectious Diseases, Pisa University School of Medicine, Cisanello Hospital, Pisa, Italy.
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Liu Y, He J, Li C, Benitez R, Fu S, Marrero J, Lubman DM. Identification and confirmation of biomarkers using an integrated platform for quantitative analysis of glycoproteins and their glycosylations. J Proteome Res 2010; 9:798-805. [PMID: 19961239 DOI: 10.1021/pr900715p] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver. However, accurate diagnosis can be difficult as most of the patients who develop this tumor have symptoms similar to those caused by longstanding liver disease. Herein we developed an integrated platform to discover the glycoprotein biomarkers in early HCC. At first, lectin arrays were applied to investigate the differences in glycan structures on serum glycoproteins from HCC and cirrhosis patients. The intensity for AAL and LCA was significantly higher in HCC, indicating an elevation of fucosylation level. Then serum from 10 HCC samples and 10 cirrhosis samples were used to screen the altered fucosylated proteins by a combination of Exactag labeling, lectin extraction and LC-MS/MS. Finally, 27 HCC and 27 cirrhosis serum samples were used for lectin-antibody arrays to confirm the change of these fucosylated proteins. C3, CE, HRG, CD14 and HGF were found to be biomarker candidates for distinguishing early HCC from cirrhosis, with a sensitivity of 72% and specificity of 79%. Our work gives insight to the detection of early HCC, and the application of this comprehensive strategy has the potential to facilitate biomarker discovery on a large scale.
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Affiliation(s)
- Yashu Liu
- Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan 48109-0656, USA
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Askari F, Innis D, Dick RB, Hou G, Marrero J, Greenson J, Brewer GJ. Treatment of primary biliary cirrhosis with tetrathiomolybdate: results of a double-blind trial. Transl Res 2010; 155:123-30. [PMID: 20171597 DOI: 10.1016/j.trsl.2009.09.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [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] [Received: 08/10/2009] [Revised: 09/22/2009] [Accepted: 09/23/2009] [Indexed: 11/19/2022]
Abstract
The results of a double-blind trial of tetrathiomolybdate therapy and standard of care, versus placebo and standard of care treatment, in primary biliary cirrhosis patients are presented. Baseline studies of liver function, various safety variables, ceruloplasmin, a liver biopsy for histologic analysis, and for various cytokine analyses were carried out. Patients were observed every 4 months for up to 2 years of treatment by a hepatologist for clinical evaluation and repeat of all the baseline studies except liver biopsy, which was repeated at 2 years. The primary end points were improvement in 2 liver function tests and in 1 inflammatory cytokine. Fifteen placebo patients were followed for an average of 13 months, and 13 tetrathiomolybdate patients were followed for an average of 14 months. The predefined primary end points for efficacy were met. Tetrathiomolybdate was well tolerated. Because tetrathiomolybdate has been shown in numerous animal studies to inhibit autoimmune and inflammatory processes, and because primary biliary cirrhosis is an autoimmune attack on bile ducts, these positive findings on efficacy of tetrathiomolybdate therapy in primary biliary cirrhosis fit with the animal studies and suggest the need for a longer clinical trial to examine transplant-free survival.
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Affiliation(s)
- Fred Askari
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109-5720, USA
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Benson AB, Abrams TA, Ben-Josef E, Bloomston PM, Botha JF, Clary BM, Covey A, Curley SA, D'Angelica MI, Davila R, Ensminger WD, Gibbs JF, Laheru D, Malafa MP, Marrero J, Meranze SG, Mulvihill SJ, Park JO, Posey JA, Sachdev J, Salem R, Sigurdson ER, Sofocleous C, Vauthey JN, Venook AP, Goff LW, Yen Y, Zhu AX. NCCN clinical practice guidelines in oncology: hepatobiliary cancers. J Natl Compr Canc Netw 2009; 7:350-91. [PMID: 19406039 DOI: 10.6004/jnccn.2009.0027] [Citation(s) in RCA: 404] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Al B Benson
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, USA
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Wang M, Long RE, Comunale MA, Junaidi O, Marrero J, Di Bisceglie AM, Block TM, Mehta AS. Novel fucosylated biomarkers for the early detection of hepatocellular carcinoma. Cancer Epidemiol Biomarkers Prev 2009; 18:1914-21. [PMID: 19454616 DOI: 10.1158/1055-9965.epi-08-0980] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Changes in glycosylation, most notably fucosylation, have been associated with the development of hepatocellular carcinoma (HCC). In this report, the levels of fucosylated kininogen (Fc-Kin) and fucosylated alpha-1-antitrypsin were analyzed individually and in combination with the currently used marker, alpha-fetoprotein, and a previously identified biomarker, Golgi protein 73 (GP73), for the ability to distinguish between a diagnosis of cirrhosis and HCC. This analysis was done on serum from 113 patients with cirrhosis and 164 serum samples from patients with cirrhosis plus HCC. The levels of Fc-Kin and fucosylated alpha-1-antitrypsin were significantly higher in patients with HCC compared with those with cirrhosis (P < 0.0001). Greatest performance was achieved through the combination of Fc-Kin, alpha-fetoprotein, and GP73, giving an optimal sensitivity of 95%, a specificity of 70%, and an area under the receiver operating characteristic of 0.94. In conclusion, the altered glycosylation of serum glycoproteins can act as potential biomarkers of primary HCC when used independently or in combination with other markers of HCC.
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Affiliation(s)
- Mengjun Wang
- Department of Microbiology and Immunology, Drexel Institute for Biotechnology and Virology, Drexel University College of Medicine, Doylestown, Pennsylvania, USA
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Block TM, Marrero J, Gish RG, Sherman M, London WT, Srivastava S, Wagner PD. The degree of readiness of selected biomarkers for the early detection of hepatocellular carcinoma: notes from a recent workshop. Cancer Biomark 2008; 4:19-33. [PMID: 18334731 DOI: 10.3233/cbm-2008-4103] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This opinion piece evaluates the degree of readiness of 13 candidate biomarkers or panels of biomarkers for the early detection of hepatocellular carcinoma (HCC), or for the staging of liver fibrosis. As candidate biomarkers for the early detection of disease are identified, it is important to understand where they are in the developmental pipeline and how they might be employed. HCC is a growing public health problem, and its early detection is believed to be important in its management. Current detection methods are limited in usefulness or practicality, and there is a need for better methods to diagnose liver disease. Therefore, a number of candidate biomarkers, considered to be attractive because of their advanced stage of development or inherent scientific value, were evaluated for specificity and sensitivity for detection of liver disease. Study design, confirmatory evidence and assay practicality associated with each of the biomarkers are considered. The comments in this review reflect the authors' opinions and are based on a recent workshop convened by the Hepatitis B Foundation of America and the US National Cancer Institute's Early Detection Research Network. It is emphasized that only a selected set of biomarkers was considered; thus, this review is not comprehensive and not intended to review all candidate HCC biomarkers.
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Affiliation(s)
- Timothy M Block
- Drexel Institute for Biotechnology and Virology Research, Drexel University College of Medicine, Doylestown, PA 18902, USA.
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Chignard N, Shang S, Wang H, Marrero J, Bréchot C, Hanash S, Beretta L. Cleavage of endoplasmic reticulum proteins in hepatocellular carcinoma: Detection of generated fragments in patient sera. Gastroenterology 2006; 130:2010-22. [PMID: 16762624 DOI: 10.1053/j.gastro.2006.02.058] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [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] [Received: 04/25/2005] [Accepted: 02/15/2006] [Indexed: 02/02/2023]
Abstract
BACKGROUND & AIMS In the past decade, there has been a rising incidence of hepatocellular carcinoma (HCC) and a progressive increase in HCC-related mortality in the United States and Western Europe. The poor survival of patients with HCC is largely related to the lack of reliable tools for early diagnosis. METHODS We have applied proteomics tools to the comparative analysis of protein profiles between HCC and adjacent nontumor tissues as a means for discovering novel molecular markers. RESULTS Forty-seven protein spots that showed reproducible variation were identified by mass spectrometry, corresponding to 23 distinct genes. A positive correlation between transcript and protein level variations was observed for only 7 out of the 23 genes. Proteolytic cleavage accounted for the discrepancies between messenger RNA and protein level changes for 7 genes including calreticulin, PDIA3, PDI, and GRP78. We detected a fragment of each of these 4 endoplasmic reticulum proteins in the culture supernatant of the PLC-PRF5 hepatoma cell line, suggesting that their cleavage leads to release of selected cleaved products in the extracellular compartment. We also detected calreticulin and PDIA3 cleavage products in sera of patients with HCC. A statistically highly significant difference in calreticulin and PDIA3 fragment serum levels between patients with HCC and healthy individuals was observed. Amounts of calreticulin and PDIA3 fragments were also significantly different between patients with HCC and at-risk patients (patients with chronic hepatitis or cirrhosis). CONCLUSIONS Specific isoforms in general and cleavage products in particular should therefore be further evaluated as new markers for HCC.
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Affiliation(s)
- Nicolas Chignard
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Fung SK, Chae HB, Fontana RJ, Conjeevaram H, Marrero J, Oberhelman K, Hussain M, Lok ASF. Virologic response and resistance to adefovir in patients with chronic hepatitis B. J Hepatol 2006; 44:283-90. [PMID: 16338024 DOI: 10.1016/j.jhep.2005.10.018] [Citation(s) in RCA: 281] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2005] [Revised: 09/23/2005] [Accepted: 10/14/2005] [Indexed: 02/08/2023]
Abstract
BACKGROUND The incidence and risk factors for adefovir-resistant HBV have not been clearly defined. AIMS To characterize the virologic response to adefovir, to determine the rate of adefovir resistance and to explore factors associated with initial virologic response (IVR) and adefovir resistance. METHODS All hepatitis B patients who received adefovir for > or =6 months at our center were prospectively monitored for virologic response and adefovir resistance. RESULTS Forty three patients were included; mean treatment duration was 18 months (range 6-45). Thirty four (79%) patients had prior lamivudine. IVR was observed in 44% patients and associated with higher pretreatment ALT (P = 0.05) and the absence of HBeAg (P = 0.02). Six (14%) patients were found to have adefovir-resistant mutations. The cumulative probability of genotypic resistance to adefovir at month 24 was 22%. Patients with adefovir resistance were more likely to have been switched from lamivudine to adefovir monotherapy (P = 0.01), to be older (P = 0.04), and to be infected with HBV genotype D (P = 0.02). CONCLUSIONS Roughly 50% of patients failed to achieve IVR on adefovir. The cumulative probability of adefovir resistance at 2 years was 22%. Our data suggest that combination of lamivudine and adefovir may prevent emergence of adefovir resistance in patients with lamivudine-resistant HBV.
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Affiliation(s)
- Scott K Fung
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI 48109-0362, USA
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Affiliation(s)
- Jorge Marrero
- Division of Gastroenterology, University of Michigan Health System, Ann Arbor, MI 48109, USA
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Fernández Guerrero ML, Ramos JM, Marrero J, Cuenca M, Fernández Roblas R, de Górgolas M. Bacteremic pneumococcal infections in immunocompromised patients without AIDS: the impact of beta-lactam resistance on mortality. Int J Infect Dis 2003; 7:46-52. [PMID: 12718810 DOI: 10.1016/s1201-9712(03)90042-7] [Citation(s) in RCA: 21] [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: 11/26/2022] Open
Abstract
BACKGROUND Streptococcus pneumoniae is the leading cause of community-acquired pneumonia in the elderly, and in recent years it has arisen as an important pathogen in HIV-infected patients. However, there is a scarcity of information on clinical and therapeutic problems associated with pneumococcal infections in other immuno-compromised patients. The objective of this study was to assess the most relevant epidemiologic aspects, clinical features and prognostic factors of pneumococcal bacteremia in immunocompromised hosts without AIDS. METHODS This was a retrospective analysis of patients with pneumococcemia, carried out in a 600-bed, university-affiliated hospital in Madrid, Spain. Two-hundred and sixty patients were evaluated retrospectively; 69 (26.5%) immunocompromised patients based on strict case definitions were compared with a group composed of 191 non-immunocompromised hosts with a variety of chronic conditions. Conventional management of pneumococcal bacteremia according to clinical standards was assessed. The MICs of penicillin and other beta-lactam antibiotics, and related mortality and hospital mortality at 30 days, were measured. RESULTS A comparison of clinical manifestations of pneumococcemia between immunocompromised patients and non-immunocompromised patients did not show differences in the presence of fever, obtundation, type of lung involvement, frequency of primary bacteremia, or meningitis. Hospital-acquired pneumococcemia was significantly more frequent in immunocompromised patients (34.7% versus 6.8%, P<0.0001), and resistance to penicillin was also more common in pneumococcal strains isolated from these patients (37.5% versus 20%, P=0.0009). Septic shock occurred more frequently in immunocompromised patients, although the overall and related mortality were not significantly different from those found in non-immunocompromised patients (33.3% versus 22.5%, P=0.07, and 28.9% versus 20.9%, P=0.7 respectively). In the multivariate analysis, multilobar pneumonia (odds ratio (OR) 15.7; 95% CI 6.00-41.30; P<0.001), inadequate treatment (OR 12.20; 95% CI 4.10-37.20; P<0.001), obtundation (OR 5.80; 95% CI 2.20-15.00; P<0.001) and hospital-acquired bacteremia (OR 4.80; 95% CI 1.00-14.60; P<0.006) were associated with an increased risk of mortality in patients with pneumococcemia. Only multilobar pneumonia (OR 7.90; 95% CI 4.10-15.35; P<0.001) was significantly associated with an increased risk of mortality in immunocompromised patients. Patients with acute leukemia and lymphoma had a greater mortality rate than non-immunocompromised patients (53.8% related mortality, P=0.05). Analysis of these patients showed frequent inadequate empirical therapy with ceftazidime plus amikacin in the presence of beta-lactam resistance. CONCLUSIONS Much of the burden of pneumococcal bacteremia was attributable to immunosuppressive diseases. In immunocompromised patients, pneumococcemia was frequently acquired within the hospital during the treatment of the underlying condition, and resistance to penicillin was common. Patients with acute leukemia and lymphoma who develop fever and pneumonia should be treated with drugs active against beta-lactam-resistant pneumococci, irrespective of the setting in which the infection develops.
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Affiliation(s)
- Manuel L Fernández Guerrero
- Division of Infectious Diseases, Department of Clinical Microbiology, Fundación Jiménez Díaz, Universidad Autónoma, Avda. Reyes Católicos 2, 28040 Madrid, Spain.
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Fontana RJ, Hamidullah H, Nghiem H, Greenson JK, Hussain H, Marrero J, Rudich S, McClure LA, Arenas J. Percutaneous radiofrequency thermal ablation of hepatocellular carcinoma: a safe and effective bridge to liver transplantation. Liver Transpl 2002; 8:1165-74. [PMID: 12474157 DOI: 10.1053/jlts.2002.36394] [Citation(s) in RCA: 139] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The incidence of hepatocellular carcinoma (HCC) is increasing in the United States. Although liver transplantation is an effective means of treating selected patients, pretransplantation tumor progression may preclude some patients from undergoing transplantation. The aim of this study is to determine the safety and efficacy of percutaneous radiofrequency thermal ablation (RFA) in 33 consecutive patients with nonresectable HCC and advanced cirrhosis. Mean subject age was 57.2 +/- 10.6 years, mean Child-Turcotte-Pugh score was 7.0 +/- 1.4, and mean maximal tumor diameter was 3.6 +/- 1.1 cm. Using contrast-enhanced computed tomography and magnetic resonance imaging, 22 patients (66%) had a complete radiological response at 3 months post-RFA, whereas 11 patients (33%) had an incomplete radiological response. During follow-up, 18 patients (54%) experienced tumor progression and 9 subjects underwent repeated ablation for either residual disease or tumor progression. The overall actuarial patient survival rate of the 33 patients was 58% at 2 years, whereas the transplantation-free patient survival rate was 34% at 2 years. Fifteen of 23 transplant candidates were successfully bridged to liver transplantation after a mean post-RFA follow-up of 7.9 +/- 6.7 months. The extent of tumor necrosis in the explant varied, but no subjects had evidence of tumor seeding on post-RFA imaging, at liver transplantation, or in the explant. The 3-year actuarial posttransplantation patient survival rate was 85%. Two patients have developed posttransplantation recurrence, and both had microscopic vascular invasion in their explants. In summary, our data show that RFA is a safe and effective treatment modality for patients with advanced cirrhosis and nonresectable HCC. Although the ability of RFA to prevent or delay tumor progression requires further prospective study, its favorable safety profile and promising efficacy make it an attractive treatment option for liver transplant candidates with nonresectable HCC.
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Affiliation(s)
- Robert J Fontana
- Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA.
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Affiliation(s)
- Jorge Marrero
- CAPEC, Department of Chemical Engineering, Technical University of Denmark, Building 227, DK-2800 Lyngby, Denmark
| | - Rafiqul Gani
- CAPEC, Department of Chemical Engineering, Technical University of Denmark, Building 227, DK-2800 Lyngby, Denmark
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Abstract
We prepared synthetic hydroxyapatite [HAP; Ca5(PO4)(3-x)(CO3)x(OH)(1+x) (x = 0.3)] and then investigated this material's ability to remove trivalent antimony [Sb(III)] from water. The HAP was characterized by X-ray diffraction analysis, scanning electron microscopy, X-ray energy dispersive spectroscopy, X-ray photoelectron spectroscopy, and infrared spectroscopy. The sorption of Sb(III) to HAP was measured over an Sb(III) concentration range of 0.05-50 mg L(-1), at constant ionic strength (I = 0.01 mol dm(-3)) in equilibrated aqueous suspensions (34 g dm(-3)) for 5 < pH < 8 in vessels that were closed to the atmosphere. Under these conditions, we found that HAP particles were enriched in Ca after incongruent dissolution of the solid. More than 95% of the Sb(III) in solution adsorbed to the solid-phase HAP in <30 min. The equilibrium distribution of Sb(III) (solid vs liquid phase) was characterized by a Langmuir model with gamma(max) = 6.7 +/- 0.1 x 10(-8) mol m(-2) (1.4 +/- 0.2 x 10(-4) mol dm(-3) g(-1)) and K(ads) = 1.5 +/- 0.2 x 10(3) dm3 mol(-1). As Sb adsorption occurred, the pH of the isoelectric point (pH(iep)) of the HAP suspensions declined from 7.7 to 6.9. This finding supports the idea that the negative surface potential of the HAP increased due to the adsorption of Sb as a charged species. The decline in pH(iep) during Sb adsorption plus the thermodynamic description of the Sb(III)-HAP-H2O system suggest likely surface reactions for the interaction of Sb with HAP. We discuss the efficiency of Sb removal from water by HAP in the context of phosphate enrichment.
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Affiliation(s)
- A G Leyva
- Comisión Nacional de Energía Atómica, Unidad de Actividad Fisica, Centro Atómico Constituyentes, San Martin, Argentina
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Magallanes JF, Smichowski P, Marrero J. Optimization and empirical modeling of HG-ICP-AES analytical technique through artificial neural networks. J Chem Inf Comput Sci 2001; 41:824-9. [PMID: 11410064 DOI: 10.1021/ci000337k] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An artificial neural network technique has been applied to the optimization of a hydride generation-inductively coupled plasma-atomic emission spectrometry (HG-ICP-AES) coupling for the determination of Ge at trace levels. The back propagation of errors net architecture was used. Experimental parameters and their relationship have been studied, obtaining a surface response of the system. The results and optimization aspects achieved with the neural network approach have been compared to the "one variable at time" and SIMPLEX methods.
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Affiliation(s)
- J F Magallanes
- Unidad de Actividad Química, Centro Atómico Constituyentes, Comisión Nacional de Energía Atómica, Av. del Libertador 8250, 1429 Buenos Aires, Argentina.
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Matkowskyj KA, Danilkovich A, Marrero J, Savkovic SD, Hecht G, Benya RV. Galanin-1 receptor up-regulation mediates the excess colonic fluid production caused by infection with enteric pathogens. Nat Med 2000; 6:1048-51. [PMID: 10973327 DOI: 10.1038/79563] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Galanin is widely distributed in enteric nerve terminals lining the gastrointestinal tract. We previously showed that pathogenic Escherichia coli, but not normal commensal organisms, increase galanin-1 receptor expression by epithelial cells lining the colon (i.e., colonocytes). When present, galanin-1 receptor activation by ligand causes colonocyte Cl- secretion. We herein demonstrate that disparate pathogens including Salmonella typhimurium and Shigella flexerii also increase colonocyte galanin-1 receptor expression, whose activation is responsible for a principal component of the increased colonic fluid secretion observed. Although eliminating the GAL1R gene by homologous recombination does not alter basal colonic fluid secretion, removal of one or both alleles completely attenuates the increase in fluid secretion due to infection with enteric pathogens. Galanin-1 receptor up-regulation therefore represents a novel mechanism accounting for the increased colonic fluid secretion observed in infectious diarrhea due to several different pathogens.
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Affiliation(s)
- K A Matkowskyj
- Department of Medicine, University of Illinois at Chicago and Chicago Veterans Administration Medical Center (West Side Division), Chicago, Illinois 60612, USA
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