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Brown CE, Hibbard JC, Alizadeh D, Blanchard MS, Natri HM, Wang D, Ostberg JR, Aguilar B, Wagner JR, Paul JA, Starr R, Wong RA, Chen W, Shulkin N, Aftabizadeh M, Filippov A, Chaudhry A, Ressler JA, Kilpatrick J, Myers-McNamara P, Chen M, Wang LD, Rockne RC, Georges J, Portnow J, Barish ME, D'Apuzzo M, Banovich NE, Forman SJ, Badie B. Locoregional delivery of IL-13Rα2-targeting CAR-T cells in recurrent high-grade glioma: a phase 1 trial. Nat Med 2024; 30:1001-1012. [PMID: 38454126 PMCID: PMC11031404 DOI: 10.1038/s41591-024-02875-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 02/15/2024] [Indexed: 03/09/2024]
Abstract
Chimeric antigen receptor T cell (CAR-T) therapy is an emerging strategy to improve treatment outcomes for recurrent high-grade glioma, a cancer that responds poorly to current therapies. Here we report a completed phase I trial evaluating IL-13Rα2-targeted CAR-T cells in 65 patients with recurrent high-grade glioma, the majority being recurrent glioblastoma (rGBM). Primary objectives were safety and feasibility, maximum tolerated dose/maximum feasible dose and a recommended phase 2 dose plan. Secondary objectives included overall survival, disease response, cytokine dynamics and tumor immune contexture biomarkers. This trial evolved to evaluate three routes of locoregional T cell administration (intratumoral (ICT), intraventricular (ICV) and dual ICT/ICV) and two manufacturing platforms, culminating in arm 5, which utilized dual ICT/ICV delivery and an optimized manufacturing process. Locoregional CAR-T cell administration was feasible and well tolerated, and as there were no dose-limiting toxicities across all arms, a maximum tolerated dose was not determined. Probable treatment-related grade 3+ toxicities were one grade 3 encephalopathy and one grade 3 ataxia. A clinical maximum feasible dose of 200 × 106 CAR-T cells per infusion cycle was achieved for arm 5; however, other arms either did not test or achieve this dose due to manufacturing feasibility. A recommended phase 2 dose will be refined in future studies based on data from this trial. Stable disease or better was achieved in 50% (29/58) of patients, with two partial responses, one complete response and a second complete response after additional CAR-T cycles off protocol. For rGBM, median overall survival for all patients was 7.7 months and for arm 5 was 10.2 months. Central nervous system increases in inflammatory cytokines, including IFNγ, CXCL9 and CXCL10, were associated with CAR-T cell administration and bioactivity. Pretreatment intratumoral CD3 T cell levels were positively associated with survival. These findings demonstrate that locoregional IL-13Rα2-targeted CAR-T therapy is safe with promising clinical activity in a subset of patients. ClinicalTrials.gov Identifier: NCT02208362 .
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Affiliation(s)
- Christine E Brown
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA.
| | - Jonathan C Hibbard
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Darya Alizadeh
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - M Suzette Blanchard
- Department of Computational and Quantitative Medicine, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Heini M Natri
- The Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Dongrui Wang
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
- Bone Marrow Transplantation Center, the First Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
| | - Julie R Ostberg
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Brenda Aguilar
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Jamie R Wagner
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Jinny A Paul
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Renate Starr
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Robyn A Wong
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Wuyang Chen
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Noah Shulkin
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Maryam Aftabizadeh
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Aleksandr Filippov
- Department of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Ammar Chaudhry
- Department of Diagnostic Radiology, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Julie A Ressler
- Department of Diagnostic Radiology, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Julie Kilpatrick
- Department of Clinical Research, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Paige Myers-McNamara
- Department of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Mike Chen
- Department of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Leo D Wang
- Departments of Immuno-Oncology and Pediatrics, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Russell C Rockne
- Department of Computational and Quantitative Medicine, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Joseph Georges
- Department of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Jana Portnow
- Department of Medical Oncology, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Michael E Barish
- Department of Stem Cell Biology & Regenerative Medicine, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Massimo D'Apuzzo
- Department of Pathology, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | | | - Stephen J Forman
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Behnam Badie
- Department of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
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Brown CE, Hibbard JC, Alizadeh D, Blanchard MS, Natri HM, Wang D, Ostberg JR, Aguilar B, Wagner JR, Paul JA, Starr R, Wong RA, Chen W, Shulkin N, Aftabizadeh M, Filippov A, Chaudhry A, Ressler JA, Kilpatrick J, Myers-McNamara P, Chen M, Wang LD, Rockne RC, Georges J, Portnow J, Barish ME, D'Apuzzo M, Banovich NE, Forman SJ, Badie B. Author Correction: Locoregional delivery of IL-13Rα2-targeting CAR-T cells in recurrent high-grade glioma: a phase 1 trial. Nat Med 2024:10.1038/s41591-024-02928-5. [PMID: 38514871 DOI: 10.1038/s41591-024-02928-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Affiliation(s)
- Christine E Brown
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA.
| | - Jonathan C Hibbard
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Darya Alizadeh
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - M Suzette Blanchard
- Department of Computational and Quantitative Medicine, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Heini M Natri
- The Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Dongrui Wang
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
- Bone Marrow Transplantation Center, the First Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
| | - Julie R Ostberg
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Brenda Aguilar
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Jamie R Wagner
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Jinny A Paul
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Renate Starr
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Robyn A Wong
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Wuyang Chen
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Noah Shulkin
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Maryam Aftabizadeh
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Aleksandr Filippov
- Department of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Ammar Chaudhry
- Department of Diagnostic Radiology, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Julie A Ressler
- Department of Diagnostic Radiology, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Julie Kilpatrick
- Department of Clinical Research, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Paige Myers-McNamara
- Department of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Mike Chen
- Department of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Leo D Wang
- Departments of Immuno-Oncology and Pediatrics, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Russell C Rockne
- Department of Computational and Quantitative Medicine, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Joseph Georges
- Department of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Jana Portnow
- Department of Medical Oncology, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Michael E Barish
- Department of Stem Cell Biology & Regenerative Medicine, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Massimo D'Apuzzo
- Department of Pathology, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | | | - Stephen J Forman
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Behnam Badie
- Department of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
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Bradshaw AC, Georges J. Anti-Amyloid Therapies for Alzheimer's Disease: An Alzheimer Europe Position Paper and Call to Action. J Prev Alzheimers Dis 2024; 11:265-273. [PMID: 38374732 DOI: 10.14283/jpad.2024.37] [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] [Indexed: 02/21/2024]
Abstract
The growing prevalence and burden of Alzheimer's disease has catalysed huge investments in research on its causes, diagnosis, treatment and care. After many high-profile failures, recent clinical trials of anti-amyloid drugs have marked a turning point for the field, leading to the approval of the first disease-modifying therapies for Alzheimer's disease by the FDA. It is now up to European regulators to determine whether there is sufficient evidence to approve these drugs for patients with mild cognitive impairment or mild dementia due to Alzheimer's disease. Here, we outline Alzheimer Europe's position on anti-amyloid therapies for Alzheimer's disease, which was adopted by the Board of Alzheimer Europe following consultations with our member associations and with the European Working Group of People with Dementia. Beyond questions of drug efficacy, safety and cost, we highlight important issues that must be addressed by industry, regulators, payers, healthcare systems and governments, to ensure that patients have timely, appropriate and equitable access to innovative treatments, regardless of their socio-economic background, insurance status, or place of residence. We also call for continued investment in research on treatments that might benefit people with more advanced Alzheimer's disease - as well as support and care services that can help people live well with dementia at all stages of the disease.
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Malzbender K, Barbarino P, Barkman Ferrell P, Bradshaw A, Brookes AJ, Díaz C, van der Flier WM, Georges J, Hansson O, Hartmanis M, Jönsson L, Krishnan R, MacLeod T, Mangialasche F, Mecocci P, Minguillon C, Middleton L, Pla S, Sardi SP, Schöll M, Suárez-Calvet M, Weidner W, Visser PJ, Zetterberg H, Bose N, Solomon A, Kivipelto M. Validation, Deployment, and Real-World Implementation of a Modular Toolbox for Alzheimer's Disease Detection and Dementia Risk Reduction: The AD-RIDDLE Project. J Prev Alzheimers Dis 2024; 11:329-338. [PMID: 38374739 DOI: 10.14283/jpad.2024.32] [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] [Indexed: 02/21/2024]
Abstract
The Real-World Implementation, Deployment, and Validation of Early Detection Tools and Lifestyle Enhancement (AD-RIDDLE) project, recently launched with the support of the EU Innovative Health Initiative (IHI) public-private partnership and UK Research and Innovation (UKRI), aims to develop, test, and deploy a modular toolbox platform that can reduce existing barriers to the timely detection, and therapeutic approaches in Alzheimer's disease (AD), thus accelerating AD innovation. By focusing on health system and health worker practices, AD-RIDDLE seeks to improve and smooth AD management at and between each key step of the clinical pathway and across the disease continuum, from at-risk asymptomatic stages to early symptomatic ones. This includes innovation and improvement in AD awareness, risk reduction and prevention, detection, diagnosis, and intervention. The 24 partners in the AD-RIDDLE interdisciplinary consortium will develop and test the AD-RIDDLE toolbox platform and its components individually and in combination in six European countries. Expected results from this cross-sectoral research collaboration include tools for earlier detection and accurate diagnosis; validated, novel digital cognitive and blood-based biomarkers; and improved access to individualized preventative interventions (including multimodal interventions and symptomatic/disease-modifying therapies) across diverse populations, within the framework of precision medicine. Overall, AD-RIDDLE toolbox platform will advance management of AD, improving outcomes for patients and their families, and reducing costs.
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Affiliation(s)
- K Malzbender
- Miia Kivipelto, MD, PhD, Center for Alzheimer's Research, Karolinska Universitetssjukhuset, Karolinska Vägen 37 A, QA32, 171 64 Solna, Sweden, , Phone: +46 73 99 409 22
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Wang L, Oill AT, Blanchard M, Wu M, Hibbard J, Sepulveda S, Peter L, Kilpatrick J, Munoz M, Stiller T, Shulkin N, Wagner J, Dolatabadi A, Nisis M, Shepphird J, Sanchez G, Lingaraju C, Manchanda M, Natri H, Kouakanou L, Sun G, Oliver-Cervantes C, Georges J, Aftabizadeh M, Forman S, Priceman S, Ressler J, Arvanitis L, Cotter J, D'Apuzzo M, Tamrazi B, Badie B, Davidson T, Banovich N, Brown C. Expansion of endogenous T cells in CSF of pediatric CNS tumor patients undergoing locoregional delivery of IL13R〿2-targeting CAR T cells: an interim analysis. Res Sq 2023:rs.3.rs-3454977. [PMID: 37961215 PMCID: PMC10635314 DOI: 10.21203/rs.3.rs-3454977/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Outcomes for pediatric brain tumor patients remain poor, and there is optimism that chimeric antigen receptor (CAR) T cell therapy can improve prognosis. Here, we present interim results from the first six pediatric patients treated on an ongoing phase I clinical trial (NCT04510051) of IL13BBζ-CAR T cells delivered weekly into the lateral cerebral ventricles, identifying clonal expansion of endogenous CAR-negative CD8+ T cells in the cerebrospinal fluid (CSF) over time. Additionally, of the five patients evaluable for disease response, three experienced transient radiographic and/or clinical benefit not meeting protocol criteria for response. The first three patients received CAR T cells alone; later patients received lymphodepletion before the first infusion. There were no dose limiting toxicities (DLTs). Aside from expected cytopenias in patients receiving lymphodepletion, serious adverse events possibly attributed to CAR T cell infusion were limited to one episode of headache and one of liver enzyme elevation. One patient withdrew from treatment during the DLT period due to a Grade 3 catheter-related infection and was not evaluable for disease response, although this was not attributed to CAR T cell infusion. Importantly, scRNA- and scTCR-sequence analyses provided insights into CAR T cell interaction with the endogenous immune system. In particular, clonally expanded endogenous CAR- T cells were recovered from the CSF, but not the peripheral blood, of patients who received intraventricular IL13BBζ-CAR T cell therapy. Additionally, although immune infiltrates in CSF and post-therapy tumor did not generally correlate, a fraction of expanded T cell receptors (TCRs) was seen to overlap between CSF and tumor. This has important implications for what samples are collected on these trials and how they are analyzed. These initial findings provide support for continued investigation into locoregionally-delivered IL13BBζ-CAR T cells for children with brain tumors.
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Affiliation(s)
| | | | | | - Melody Wu
- City of Hope National Medical Center
| | - Jonathan Hibbard
- Beckman Research Institute, City of Hope National Medical Center
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- The Translational Genomics Research Institute
| | | | - Grace Sun
- City of Hope National Medical Center
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Cavagnaro MJ, Orenday-Barraza JM, Jabre R, Georges J, Lee M, Nakaji P. Subtemporal Transcollateral Sulcus Approach for Temporal Horn Tumors: 2-Dimensional Operative Video and Description of the Technique. Oper Neurosurg (Hagerstown) 2022; 23:e10-e15. [PMID: 35726930 DOI: 10.1227/ons.0000000000000217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/27/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Purely temporal intraventricular tumors are uncommon. Given their deep location, access to these brain tumors can be challenging in terms of preserving brain tissue. The subtemporal approach spares the lateral temporal cortex and is a less traumatic corridor to reach intraventricular temporal tumors. OBJECTIVE To describe and assess the feasibility of the subtemporal transcollateral approach for the removal of a temporal horn tumor. METHODS We describe the subtemporal transcollateral sulcus operative technique detailed step-by-step and depicted through both video and illustrations to surgically resect a left intraventricular temporal mass in a 44-year-old woman who presented with worsening memory deficits. The surgery was performed under general anesthesia and with the use of a microscope and neuronavigation. RESULTS The patient did not suffer from any postoperative complications. Her vision was intact, and her memory deficit was unchanged. A brain MRI showed complete removal of the tumor. The pathological examination revealed a World Health Organization grade I meningioma. CONCLUSION The subtemporal transsulcal approach seems to be an efficient and safe way to access intraventricular lesions within the temporal horn while avoiding any disruption of the optic radiations and temporal language areas.
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Affiliation(s)
- María José Cavagnaro
- Department of Neurosurgery, The University of Arizona College of Medicine, Phoenix, Arizona, USA
- Department of Neurosurgery Banner University Medical Center, Phoenix, Arizona, USA
| | - José Manuel Orenday-Barraza
- Department of Neurosurgery, The University of Arizona College of Medicine, Phoenix, Arizona, USA
- Department of Neurosurgery Banner University Medical Center, Phoenix, Arizona, USA
| | - Roland Jabre
- Department of Neurosurgery, The University of Arizona College of Medicine, Phoenix, Arizona, USA
- Department of Neurosurgery Banner University Medical Center, Phoenix, Arizona, USA
| | - Joseph Georges
- Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Michaela Lee
- Department of Neurosurgery, The University of Arizona College of Medicine, Phoenix, Arizona, USA
- Department of Neurosurgery Banner University Medical Center, Phoenix, Arizona, USA
| | - Peter Nakaji
- Department of Neurosurgery, The University of Arizona College of Medicine, Phoenix, Arizona, USA
- Department of Neurosurgery Banner University Medical Center, Phoenix, Arizona, USA
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Jessen F, Georges J, Wortmann M, Benham-Hermetz S. What Matters to Patients with Alzheimer's Disease and Their Care Partners? Implications for Understanding the Value of Future Interventions. J Prev Alzheimers Dis 2022; 9:550-555. [PMID: 35841256 DOI: 10.14283/jpad.2022.22] [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] [Indexed: 06/15/2023]
Abstract
Alzheimer's Disease (AD) is the most common cause of dementia. Recent thinking portrays AD as a continuum consisting of three stages: an asymptomatic preclinical period, a mild cognitive impairment phase, and dementia, which can be further classified as mild, moderate or severe. While many studies explore the cognitive and functional aspects of AD, fully understanding AD pathophysiology, as well as the potential value of pharmacological and psycho-social interventions, requires a deeper understanding of patient and care partner priorities, particularly in the early stages where such interventions may have the greatest impact in slowing or delaying progression. Available studies highlight a diverse range of patient and care partner priorities, including impacts on their emotions, moods, and social lives. These priorities have not been systematically incorporated in the clinical and value assessments of potential interventions. We propose approaches to better understand the humanistic impact of AD including conducting additional research into the impacts of interventions from the point of view of patients and care partners, expanding notions of 'value' and improving health system capacity for diagnosis.
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Affiliation(s)
- F Jessen
- Samantha Benham-Hermetz, Alzheimer's Research UK, 3 Riverside, Granta Park, Cambridge, United Kingdom CB21 6AD, , +44 (0)300 111 5666
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Rochdi S, Lacaze L, Couvert A, Touboulic S, Delamarre J, Georges J, Le Gouevec F, Chauvin A, Malbert CH, Val-laillet D, Derbé F, Thibault R. Muscle phenotyping of a minipig model of malnutrition. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.146] [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: 10/19/2022]
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Belykh E, Jubran J, George L, Bardonova L, Healey D, Georges J, Quarles C, Eschbacher J, Mehta S, Scheck A, Nakaji P, Lawton M, Preul M. BIMG-03. MOLECULAR IMAGING OF GLUCOSE METABOLISM FOR INTRAOPERATIVE FLUORESCENCE GUIDANCE DURING GLIOMA SURGERY. Neurooncol Adv 2021. [PMCID: PMC7992255 DOI: 10.1093/noajnl/vdab024.002] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE This study evaluated the utility of using molecular imaging of fluorescent glucose analog 2-(N-(7-Nitrobenz-2-oxa-1,3-diazol-4-yl)Amino)-2-Deoxyglucose (2-NBDG) as a discriminatory marker for intraoperative tumor border identification in a mouse glioma model. PROCEDURES 2-NBDG and were assessed in GL261 and U251 orthotopic tumor bearing mice. Intraoperative fluorescence of 2-NBDG administered topical and intravenous in normal and tumor regions was assessed with operating microscope, handheld confocal laser scanning endomicroscope (CLE) and benchtop confocal laser scanning microscope (LSM). Additionally, 2-NBDG fluorescence in tumors was compared to 5-aminolevulinic acid-induced protoporphyrin IX fluorescence. RESULTS Intravenously administered 2-NBDG was detectable in brain tumor and absent in contralateral normal brain parenchyma on wide field operating microscopy imaging. Intraoperative and benchtop CLE showed preferential 2-NBDG accumulation in the cytoplasm of glioma cells (tumor-background ratio of 2.76±0.43). Topically administered 2-NBDG did not create a sufficient tumor-background contrast for white field operating microscopy imaging, or under benchtop LSM (tumor-background ratio 1.42 ± 0.72). However, topical 2-NBDG did create sufficient contrast to evaluate cellular tissue architecture and differentiate tumor cells from normal brain parenchyma. PpIX imaging resulted in a more specific delineation of gross tumor margins than IV or topical 2-NBDG, and a significantly higher tumor-normal brain fluorescence intensity ratio. CONCLUSION After intravenous administration, 2-NBDG selectively accumulated in the experimental brain tumors and provided bright contrast under wide field fluorescence imaging with a clinical grade operating microscope. Topical 2-NBDG was able to create a sufficient contrast to differentiate tumor from normal brain cells based on visualization of cellular architecture with CLE. 5-ALA demonstrated superior specificity in outlining tumor margins and significantly higher tumor-background contrast. Given its non-toxicity, using 2-NBDG as a topical molecular marker for noninvasive in vivo intraoperative microscopy is encouraging, and warrants further clinical evaluation.
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Affiliation(s)
- Evgenii Belykh
- Barrow Neurological Institute, Phoenix, Arizona, USA
- Rutgers University, New Brunswick, New Jersey, USA
| | - Jubran Jubran
- Barrow Neurological Institute, Phoenix, Arizona, USA
- University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, USA
| | - Laeth George
- Barrow Neurological Institute, Phoenix, Arizona, USA
- University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, USA
| | | | | | - Joseph Georges
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Chad Quarles
- Barrow Neurological Institute, Phoenix, Arizona, USA
| | | | - Shwetal Mehta
- Barrow Neurological Institute, Phoenix, Arizona, USA
| | | | - Peter Nakaji
- University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, USA
| | | | - Mark Preul
- Barrow Neurological Institute, Phoenix, Arizona, USA
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Patel HN, Syed A, Lobel JS, Galler R, Georges J, Carmody M, Puumala M. Cerebellar infarction requiring surgical decompression in patient with COVID 19 pathological analysis and brief review. Interdiscip Neurosurg 2020; 22:100850. [PMID: 32835021 PMCID: PMC7387273 DOI: 10.1016/j.inat.2020.100850] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/26/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND This report and literature review describes a case of a COVID-19 patient who suffered a cerebellar stroke requiring neurosurgical decompression. This is the first reported case of a sub-occipital craniectomy with brain biopsy in a COVID-19 patient showing leptomeningeal venous intimal inflammation. CLINICAL DESCRIPTION The patient is a 48-year-old SARS-COV-2 positive male with multiple comorbidities, who presented with fevers and respiratory symptoms, and imaging consistent with multifocal pneumonia. On day 5 of admission, the patient had sudden change in mental status, increased C-Reactive Protein, ferritin and elevated Interleukin-6 levels. Head CT showed cerebral infarction from vertebral artery occlusion. Given subsequent rapid neurologic decline from cerebellar swelling and mass effect on his brainstem emergent neurosurgical intervention was performed. Brain biopsy found a vein with small organizing thrombus adjacent to focally proliferative intima with focal intimal neutrophils. CONCLUSION A young man with COVID-19 and suspected immune dysregulation, complicated by a large cerebrovascular ischemic stroke secondary to vertebral artery thrombosis requiring emergent neurosurgical intervention for decompression with improved neurological outcomes. Brain biopsy was suggestive of inflammation from thrombosed vessel, and neutrophilic infiltration of cerebellar tissue.
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Key Words
- ARDS, acute respiratory distress syndrome
- BiPaP, Bilevel positive airway pressure
- COVID 19, Corona Virus Disease 2019
- COVID-19
- CP, cerebellopontine
- CRP, C-reactive protein
- CT, computed tomography
- CTA, CT angiography
- CXR, chest X-ray
- Coronavirus
- FiO2, fraction of inspired oxygen
- Ischemic stroke
- Phlebitis
- SARS-COV-2
- SARS-COV-2, severe acute respiratory syndrome coronavirus 2
- STAT, statum which is Latin meaning immediately
- Sub-occipital craniectomy
- Vasculitis
- WHO, World Health Organization
- t-PA, tissue plasminogen activator
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Affiliation(s)
- Hiren N Patel
- Avera McKennan Hospital, Department of Neurosurgery, USA
- Newton-Wellesley Hospital, Department of Neurosurgery, 2014 Washington St, Newton, MA, USA
| | - Asma Syed
- Infectious Disease, 1301 S Cliff Ave Ste 610, Sioux Falls, SD, USA
| | - Jeffrey S Lobel
- Lima Memorial Hospital, Department of Neurosurgery, 1001 Bellefontaine Ave, Lima, OH, USA
| | - Robert Galler
- Northwell Health, Department of Neurosurgery, 1300 Roanoke Ave, Riverhead, NY 11901, USA
| | - Joseph Georges
- Cooper University Hospital, Department Neurosurgery, 1 Cooper Plaza, Camden, NJ, USA
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11
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Frederiksen KS, Cooper C, Frisoni GB, Frölich L, Georges J, Kramberger MG, Nilsson C, Passmore P, Mantoan Ritter L, Religa D, Schmidt R, Stefanova E, Verdelho A, Vandenbulcke M, Winblad B, Waldemar G. A European Academy of Neurology guideline on medical management issues in dementia. Eur J Neurol 2020; 27:1805-1820. [PMID: 32713125 PMCID: PMC7540303 DOI: 10.1111/ene.14412] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/12/2020] [Accepted: 06/13/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Dementia is one of the most common disorders and is associated with increased morbidity, mortality and decreased quality of life. The present guideline addresses important medical management issues including systematic medical follow-up, vascular risk factors in dementia, pain in dementia, use of antipsychotics in dementia and epilepsy in dementia. METHODS A systematic review of the literature was carried out. Based on the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework, we developed a guideline. Where recommendations based on GRADE were not possible, a good practice statement was formulated. RESULTS Systematic management of vascular risk factors should be performed in patients with mild to moderate dementia as prevention of cerebrovascular pathology may impact on the progression of dementia (Good Practice statement). Individuals with dementia (without previous stroke) and atrial fibrillation should be treated with anticoagulants (weak recommendation). Discontinuation of opioids should be considered in certain individuals with dementia (e.g. for whom there are no signs or symptoms of pain or no clear indication, or suspicion of side effects; Good Practice statement). Behavioral symptoms in persons with dementia should not be treated with mild analgesics (weak recommendation). In all patients with dementia treated with opioids, assessment of the individual risk-benefit ratio should be performed at regular intervals. Regular, preplanned medical follow-up should be offered to all patients with dementia. The setting will depend on the organization of local health services and should, as a minimum, include general practitioners with easy access to dementia specialists (Good Practice statement). Individuals with dementia and agitation and/or aggression should be treated with atypical antipsychotics only after all non-pharmacological measures have been proven to be without benefit or in the case of severe self-harm or harm to others (weak recommendation). Antipsychotics should be discontinued after cessation of behavioral disturbances and in patients in whom there are side effects (Good Practice statement). For treatment of epilepsy in individuals with dementia, newer anticonvulsants should be considered as first-line therapy (Good Practice statement). CONCLUSION This GRADE-based guideline offers recommendations on several important medical issues in patients with dementia, and thus adds important guidance for clinicians. For some issues, very little or no evidence was identified, highlighting the importance of further studies within these areas.
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Affiliation(s)
- K. S. Frederiksen
- Department of NeurologyDanish Dementia Research CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - C. Cooper
- Department of Clinical Educational and Health PsychologyUniversity College LondonLondonUK
| | - G. B. Frisoni
- Memory ClinicUniversity Hospital of GenevaUniversity of GenevaGenevaSwitzerland
| | - L. Frölich
- Department of Geriatric PsychiatryZentralinstitut für Seelische Gesundheit MannheimMedical Faculty MannheimUniversity of HeidelbergMannheimGermany
| | | | - M. G. Kramberger
- Department of NeurologyCenter for Cognitive ImpairmentsUniversity Medical Center Ljubljana, and Medical facultyUniversity of LjubljanaLjubljanaSlovenia
| | - C. Nilsson
- Department of Neurology and Rehabilitation MedicineSkåne University HospitalLundSweden
- Clinical Memory Research UnitDepartment of Clinical SciencesLund UniversityMalmöSweden
| | | | - L. Mantoan Ritter
- Epilepsy CentreKing's College NHS Foundation TrustKing´s College LondonLondonUK
| | - D. Religa
- Division of Clinical GeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetNeo, StockholmSweden
- Karolinska University HospitalTheme AgingHuddingeSweden
| | - R. Schmidt
- University Clinic for NeurologyMedical University of GrazGrazAustria
| | - E. Stefanova
- Medical FacultyNeurology clinic CCSUniversity of BelgradeBelgradeSerbia
| | - A. Verdelho
- Department of Neurosciences and Mental HealthCHLNorte‐Hospital de Santa MariaIMMISAMBFaculty of MedicineUniversity of LisbonLisbonPortugal
| | - M. Vandenbulcke
- Department of NeurosciencesKU LeuvenGeriatric PsychiatryUniversity Hospitals LeuvenLeuvenBelgium
| | - B. Winblad
- Karolinska University HospitalTheme AgingHuddingeSweden
- Division of NeurogeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetBioClinicumSolnaSweden
| | - G. Waldemar
- Department of NeurologyDanish Dementia Research CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
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12
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Georges J, Qi X, Liu X, Zhou Y, Woolf EC, Valeri A, Al-Atrache Z, Belykh E, Feuerstein BG, Preul M, Scheck AC, Reiser M, Anderson T, Gopez J, Appelt D, Yocom S, Eschbacher J, Yan H, Nakaji P. Provision of rapid and specific ex vivo diagnosis of central nervous system lymphoma from rodent xenograft biopsies by a fluorescent aptamer. J Neurosurg 2020; 134:1783-1790. [PMID: 32707545 DOI: 10.3171/2020.4.jns192476] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 04/23/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Differentiating central nervous system (CNS) lymphoma from other intracranial malignancies remains a clinical challenge in surgical neuro-oncology. Advances in clinical fluorescence imaging contrast agents and devices may mitigate this challenge. Aptamers are a class of nanomolecules engineered to bind cellular targets with antibody-like specificity in a fraction of the staining time. Here, the authors determine if immediate ex vivo fluorescence imaging with a lymphoma-specific aptamer can rapidly and specifically diagnose xenografted orthotopic human CNS lymphoma at the time of biopsy. METHODS The authors synthesized a fluorescent CNS lymphoma-specific aptamer by conjugating a lymphoma-specific aptamer with Alexa Fluor 488 (TD05-488). They modified human U251 glioma cells and Ramos lymphoma cells with a lentivirus for constitutive expression of red fluorescent protein and implanted them intracranially into athymic nude mice. Three to 4 weeks postimplantation, acute slices (biopsies, n = 28) from the xenografts were collected, placed in aptamer solution, and imaged with a Zeiss fluorescence microscope. Three aptamer staining concentrations (0.3, 1.0, and 3.0 μM) and three staining times (5, 10, and 20 minutes) followed by a 1-minute wash were tested. A file of randomly selected images was distributed to neurosurgeons and neuropathologists, and their ability to distinguish CNS lymphoma from negative controls was assessed. RESULTS The three staining times and concentrations of TD05-488 were tested to determine the diagnostic accuracy of CNS lymphoma within a frozen section time frame. An 11-minute staining protocol with 1.0-μM TD05-488 was most efficient, labeling 77% of positive control lymphoma cells and less than 1% of negative control glioma cells (p < 0.001). This protocol permitted clinicians to positively identify all positive control lymphoma images without misdiagnosing negative control images from astrocytoma and normal brain. CONCLUSIONS Ex vivo fluorescence imaging is an emerging technique for generating rapid histopathological diagnoses. Ex vivo imaging with a novel aptamer-based fluorescent nanomolecule could provide an intraoperative tumor-specific diagnosis of CNS lymphoma within 11 minutes of biopsy. Neurosurgeons and neuropathologists interpreted images generated with this molecular probe with high sensitivity and specificity. Clinical application of TD05-488 may permit specific intraoperative diagnosis of CNS lymphoma in a fraction of the time required for antibody staining.
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Affiliation(s)
- Joseph Georges
- 7Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania.,8Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey.,9Department of Neurosurgery
| | - Xiaodong Qi
- 4The Biodesign Institute.,5School of Molecular Sciences
| | | | - Yu Zhou
- 4The Biodesign Institute.,5School of Molecular Sciences
| | | | - Amber Valeri
- 7Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania.,8Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey
| | - Zein Al-Atrache
- 7Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | | | - Burt G Feuerstein
- 2Neurology, and.,3Child Health, University of Arizona, College of Medicine, Phoenix, Arizona
| | - Mark Preul
- 9Department of Neurosurgery.,10Neuro-Oncology Research
| | - Adrienne C Scheck
- 3Child Health, University of Arizona, College of Medicine, Phoenix, Arizona
| | - Mark Reiser
- 6School of Mathematics and Statistical Sciences, Arizona State University, Tempe, Arizona
| | | | - Jonas Gopez
- 12Department of Neurosurgery, Abington Hospital-Jefferson Health, Abington, Pennsylvania
| | - Denah Appelt
- 7Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Steven Yocom
- 7Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania.,8Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey
| | - Jennifer Eschbacher
- 11Division of Neuropathology, Barrow Neurological Institute, Phoenix, Arizona; and
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13
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Lacaze L, Touboulic S, Georges J, Le Gouevec F, Chauvin A, Boudjema K, Thibault R, Val-Laillet D. Modèle de mini-porcs du Yucatan dénutris : composition corporelle, phénotypage moléculaire et analyse du microbiote. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.02.399] [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: 11/24/2022]
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14
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Lynagh R, Ishak M, Georges J, Lopez D, Osman H, Kakareka M, Boyer B, Goldman HW, Eschbacher J, Preul MC, Nakaji P, Turtz A, Yocom S, Appelt D. Fluorescence-guided stereotactic biopsy: a proof-of-concept study. J Neurosurg 2020. [DOI: 10.3171/2018.11.jns18629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVEAccurate histopathological diagnoses are often necessary for treating neuro-oncology patients. However, stereotactic biopsy (STB), a common method for obtaining suspicious tissue from deep or eloquent brain regions, fails to yield diagnostic tissue in some cases. Failure to obtain diagnostic tissue can delay initiation of treatment and may result in further invasive procedures for patients. In this study, the authors sought to determine if the coupling of in vivo optical imaging with an STB system is an effective method for identification of diagnostic tissue at the time of biopsy.METHODSA minimally invasive fiber optic imaging system was developed by coupling a 0.65-mm-diameter coherent fiber optic fluorescence microendoscope to an STB system. Human U251 glioma cells were transduced for stable expression of blue fluorescent protein (BFP) to produce U251-BFP cells that were utilized for in vitro and in vivo experiments. In vitro, blue fluorescence was confirmed, and tumor cell delineation by fluorescein sodium (FNa) was quantified with fluorescence microscopy. In vivo, transgenic athymic rats implanted with U251-BFP cells (n = 4) were utilized for experiments. Five weeks postimplantation, the rats received 5–10 mg/kg intravenous FNa and underwent craniotomies overlying the tumor implantation site and contralateral normal brain. A clinical STB needle containing our 0.65-mm imaging fiber was passed through each craniotomy and images were collected. Fluorescence images from regions of interest ipsilateral and contralateral to tumor implantation were obtained and quantified.RESULTSLive-cell fluorescence imaging confirmed blue fluorescence from transduced tumor cells and revealed a strong correlation between tumor cells quantified by blue fluorescence and FNa contrast (R2 = 0.91, p < 0.001). Normalized to background, in vivo FNa-mediated fluorescence intensity was significantly greater from tumor regions, verified by blue fluorescence, compared to contralateral brain in all animals (301.7 ± 34.18 relative fluorescence units, p < 0.001). Fluorescence intensity measured from the tumor margin was not significantly greater than that from normal brain (p = 0.89). Biopsies obtained from regions of strong fluorescein contrast were histologically consistent with tumor.CONCLUSIONSThe authors found that in vivo fluorescence imaging with an STB needle containing a submillimeter-diameter fiber optic fluorescence microendoscope provided direct visualization of neoplastic tissue in an animal brain tumor model prior to biopsy. These results were confirmed in vivo with positive control cells and by post hoc histological assessment. In vivo fluorescence guidance may improve the diagnostic yield of stereotactic biopsies.
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Affiliation(s)
- Robert Lynagh
- Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Mark Ishak
- Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Joseph Georges
- Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Danielle Lopez
- Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Hany Osman
- Massachusetts General Hospital, Wellman Center for Photomedicine, Boston, Massachusetts
| | - Michael Kakareka
- Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Brandon Boyer
- Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - H. Warren Goldman
- Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
- Department of Neurosurgery, Cooper University Hospital, Camden, New Jersey; and
| | | | - Mark C. Preul
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Alan Turtz
- Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
- Department of Neurosurgery, Cooper University Hospital, Camden, New Jersey; and
| | - Steven Yocom
- Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
- Department of Neurosurgery, Cooper University Hospital, Camden, New Jersey; and
| | - Denah Appelt
- Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
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15
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Osman H, Elsahy D, Slivova V, Thompson C, Georges J, Yocom S, Cohen-Gadol AA. Neurosurgical Flexible Probe Microscopy with Enhanced Architectural and Cytological Detail. World Neurosurg 2019; 128:e929-e937. [PMID: 31100529 DOI: 10.1016/j.wneu.2019.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/03/2019] [Accepted: 05/04/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Microscopic delineation and clearance of tumor cells at neurosurgical excision margins potentially reduce tumor recurrence and increase patient survival. Probe-based in vivo fluorescence microscopy technologies are promising for neurosurgical in vivo microscopy. OBJECTIVE We sought to demonstrate a flexible fiberoptic epifluorescence microscope capable of enhanced architectural and cytological imaging for in vivo microscopy during neurosurgical procedures. METHODS Eighteen specimens were procured from neurosurgical procedures. These specimens were stained with acridine orange and imaged with a 3-dimensional (3D)-printed epifluorescent microscope that incorporates a flexible fiberoptic probe. Still images and video sequence frames were processed using frame alignment, signal projection, and pseudo-coloring, resulting in resolution enhancement and an increased field of view. RESULTS Images produced displayed good nuclear contrast and architectural detail. Grade 1 meningiomas demonstrated 3D chords and whorls. Low-grade meningothelial nuclei showed streaming and displayed regularity in size, shape, and distribution. Oligodendrogliomas showed regular round nuclei and a variably staining background. Glioblastomas showed high degrees of nuclear pleomorphism and disarray. Mitoses, vascular proliferation, and necrosis were evident. CONCLUSIONS We demonstrate the utility of a 3D-printed, flexible probe microscope for high-resolution microscopic imaging with increased architectural detail. Enhanced in vivo imaging using this device may improve our ability to detect and decrease microscopic tumor burden at excision margins during neurosurgical procedures.
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Affiliation(s)
- Hany Osman
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Deena Elsahy
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Veronika Slivova
- Enterprise Clinical Research Operations Biorepository, Indiana University Health, Indianapolis, Indiana, USA
| | - Corey Thompson
- Enterprise Clinical Research Operations Biorepository, Indiana University Health, Indianapolis, Indiana, USA
| | - Joseph Georges
- Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Steven Yocom
- Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Aaron A Cohen-Gadol
- Goodman Campbell Brain and Spine and Indiana University Department of Neurological Surgery, Indianapolis, Indiana, USA.
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16
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Kakareka M, Moncman R, Georges J, Yocom S, Storm PB, Kennedy B. Pediatric spinal cord biopsy: A case series from a high-volume referral center. J Clin Neurosci 2019; 65:34-40. [PMID: 31053399 DOI: 10.1016/j.jocn.2019.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/16/2019] [Accepted: 04/12/2019] [Indexed: 12/01/2022]
Abstract
Pediatric patients presenting with intramedullary spinal cord lesions often require specific diagnoses to guide their treatment plans. Though results from magnetic resonance imaging and lumbar puncture may narrow the differential diagnosis, these tests cannot always provide a definitive diagnosis. In such cases, spinal cord biopsy may be undertaken to provide a specific histopathologic diagnosis for guiding treatment. Data from the adult population show 24% of spinal cord biopsies can be nondiagnostic and the procedure may carry a 21% complication rate. Therefore, spinal cord biopsy may portend a similar high risk-to-benefit ratio in the pediatric population. Here, we review spinal cord biopsy cases scheduled for diagnosis, and not debulking, at a high volume pediatric referral center during a seventeen-year period. We report our experience with five patients who met our inclusion criteria. Due to the rarity of the procedure, statistically significant factors associated with improved diagnostic yield or peri-operative complication could not be identified. A definitive diagnosis which guided the post-operative treatment plan was obtained in four of our five patients. None of our patients developed post-operative motor deficits. However, these patients were susceptible to the same risks of open spine surgery, such as wound infections and spinal deformities. Our case series shows that intramedullary spinal cord biopsies may provide tissue for obtaining histopatholgic diagnoses. However, the potential risks of complication, and the possibility of obtaining nondiagnostic tissue, should be discussed with patients, families and their medical treatment teams.
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Affiliation(s)
- Michael Kakareka
- Philadelphia College of Osteopathic Medicine, Department of Neurosurgery, Philadelphia, PA, USA; Cooper University Hospital, Department of Neurosurgery, Camden, NJ, USA
| | - Ryan Moncman
- Philadelphia College of Osteopathic Medicine, Department of Neurosurgery, Philadelphia, PA, USA; Cooper University Hospital, Department of Neurosurgery, Camden, NJ, USA
| | - Joseph Georges
- Philadelphia College of Osteopathic Medicine, Department of Neurosurgery, Philadelphia, PA, USA; Cooper University Hospital, Department of Neurosurgery, Camden, NJ, USA.
| | - Steven Yocom
- Philadelphia College of Osteopathic Medicine, Department of Neurosurgery, Philadelphia, PA, USA; Cooper University Hospital, Department of Neurosurgery, Camden, NJ, USA
| | - Philip B Storm
- Children's Hospital of Philadelphia, Department of Neurosurgery, Philadelphia, PA, USA
| | - Benjamin Kennedy
- Children's Hospital of Philadelphia, Department of Neurosurgery, Philadelphia, PA, USA
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17
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Finneran MM, Georges J, Kakareka M, Moncman R, Enriquez M, Siegal T, Kubicek G, Turtz A, Yocom S, Goldman HW, Barrese J. Epithelioid glioblastoma presenting as aphasia in a young adult with ovarian cancer: A case report. Clin Case Rep 2019; 7:821-825. [PMID: 30997093 PMCID: PMC6452522 DOI: 10.1002/ccr3.2088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/11/2018] [Accepted: 12/18/2018] [Indexed: 12/23/2022] Open
Abstract
Our patient's clinical history and preoperative radiographic evaluation suggested central nervous system (CNS) metastatic disease. Ultimately, final pathology revealed epithelioid glioblastoma (eGBM), a newly classified CNS primary tumor. This reinforces the importance of direct tissue sampling and including eGBM on the differential for young patients with histories of systemic cancer presenting with new CNS lesions.
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Affiliation(s)
- Megan M. Finneran
- Department of Clinical MedicineChicago College of Osteopathic MedicineChicagoIllinois
| | - Joseph Georges
- Department of NeurosurgeryPhiladelphia College of Osteopathic MedicinePhiladelphiaPennsylvania
- Department of NeurosurgeryCooper University HospitalCamdenNew Jersey
| | - Michael Kakareka
- Department of NeurosurgeryPhiladelphia College of Osteopathic MedicinePhiladelphiaPennsylvania
- Department of NeurosurgeryCooper University HospitalCamdenNew Jersey
| | - Ryan Moncman
- Department of NeurosurgeryPhiladelphia College of Osteopathic MedicinePhiladelphiaPennsylvania
- Department of NeurosurgeryCooper University HospitalCamdenNew Jersey
| | - Miriam Enriquez
- Department of PathologyCooper University HospitalCamdenNew Jersey
| | - Todd Siegal
- Department of RadiologyCooper University HospitalCamdenNew Jersey
| | - Gregory Kubicek
- Department of Radiation OncologyCooper University HospitalCamdenNew Jersey
| | - Alan Turtz
- Department of NeurosurgeryCooper University HospitalCamdenNew Jersey
| | - Steven Yocom
- Department of NeurosurgeryPhiladelphia College of Osteopathic MedicinePhiladelphiaPennsylvania
- Department of NeurosurgeryCooper University HospitalCamdenNew Jersey
| | - H. Warren Goldman
- Department of NeurosurgeryCooper University HospitalCamdenNew Jersey
| | - James Barrese
- Department of NeurosurgeryCooper University HospitalCamdenNew Jersey
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18
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Lynagh R, Ishak M, Georges J, Lopez D, Osman H, Kakareka M, Boyer B, Goldman HW, Eschbacher J, Preul MC, Nakaji P, Turtz A, Yocom S, Appelt D. Fluorescence-guided stereotactic biopsy: a proof-of-concept study. J Neurosurg 2019:1-7. [PMID: 30797218 DOI: 0.3171/2018.11.jns18629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 11/15/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVEAccurate histopathological diagnoses are often necessary for treating neuro-oncology patients. However, stereotactic biopsy (STB), a common method for obtaining suspicious tissue from deep or eloquent brain regions, fails to yield diagnostic tissue in some cases. Failure to obtain diagnostic tissue can delay initiation of treatment and may result in further invasive procedures for patients. In this study, the authors sought to determine if the coupling of in vivo optical imaging with an STB system is an effective method for identification of diagnostic tissue at the time of biopsy.METHODSA minimally invasive fiber optic imaging system was developed by coupling a 0.65-mm-diameter coherent fiber optic fluorescence microendoscope to an STB system. Human U251 glioma cells were transduced for stable expression of blue fluorescent protein (BFP) to produce U251-BFP cells that were utilized for in vitro and in vivo experiments. In vitro, blue fluorescence was confirmed, and tumor cell delineation by fluorescein sodium (FNa) was quantified with fluorescence microscopy. In vivo, transgenic athymic rats implanted with U251-BFP cells (n = 4) were utilized for experiments. Five weeks postimplantation, the rats received 5-10 mg/kg intravenous FNa and underwent craniotomies overlying the tumor implantation site and contralateral normal brain. A clinical STB needle containing our 0.65-mm imaging fiber was passed through each craniotomy and images were collected. Fluorescence images from regions of interest ipsilateral and contralateral to tumor implantation were obtained and quantified.RESULTSLive-cell fluorescence imaging confirmed blue fluorescence from transduced tumor cells and revealed a strong correlation between tumor cells quantified by blue fluorescence and FNa contrast (R2 = 0.91, p < 0.001). Normalized to background, in vivo FNa-mediated fluorescence intensity was significantly greater from tumor regions, verified by blue fluorescence, compared to contralateral brain in all animals (301.7 ± 34.18 relative fluorescence units, p < 0.001). Fluorescence intensity measured from the tumor margin was not significantly greater than that from normal brain (p = 0.89). Biopsies obtained from regions of strong fluorescein contrast were histologically consistent with tumor.CONCLUSIONSThe authors found that in vivo fluorescence imaging with an STB needle containing a submillimeter-diameter fiber optic fluorescence microendoscope provided direct visualization of neoplastic tissue in an animal brain tumor model prior to biopsy. These results were confirmed in vivo with positive control cells and by post hoc histological assessment. In vivo fluorescence guidance may improve the diagnostic yield of stereotactic biopsies.
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Affiliation(s)
- Robert Lynagh
- 1Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Mark Ishak
- 1Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Joseph Georges
- 1Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Danielle Lopez
- 1Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Hany Osman
- 2Massachusetts General Hospital, Wellman Center for Photomedicine, Boston, Massachusetts
| | - Michael Kakareka
- 1Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Brandon Boyer
- 1Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - H Warren Goldman
- 1Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
- 3Department of Neurosurgery, Cooper University Hospital, Camden, New Jersey; and
| | - Jennifer Eschbacher
- 4Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Mark C Preul
- 4Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Peter Nakaji
- 4Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Alan Turtz
- 1Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
- 3Department of Neurosurgery, Cooper University Hospital, Camden, New Jersey; and
| | - Steven Yocom
- 1Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
- 3Department of Neurosurgery, Cooper University Hospital, Camden, New Jersey; and
| | - Denah Appelt
- 1Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
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Osman H, Georges J, Elsahy D, Hattab EM, Yocom S, Cohen-Gadol AA. In Vivo Microscopy in Neurosurgical Oncology. World Neurosurg 2018; 115:110-127. [PMID: 29653276 DOI: 10.1016/j.wneu.2018.03.218] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/29/2018] [Accepted: 03/30/2018] [Indexed: 10/17/2022]
Abstract
Intraoperative neurosurgical histopathologic diagnoses rely on evaluation of rapid tissue preparations such as frozen sections and smears with conventional light microscopy. Although useful, these techniques are time consuming and therefore cannot provide real-time intraoperative feedback. In vivo molecular imaging techniques are emerging as novel methods for generating real-time diagnostic histopathologic images of tumors and their surrounding tissues. These imaging techniques rely on contrast generated by exogenous fluorescent dyes, autofluorescence of endogenous molecules, fluorescence decay of excited molecules, or light scattering. Large molecular imaging instruments are being miniaturized for clinical in vivo use. This review discusses pertinent imaging systems that have been developed for neurosurgical use and imaging techniques currently under development for neurosurgical molecular imaging.
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Affiliation(s)
- Hany Osman
- Massachusetts General Hospital and Harvard Medical School, Wellman Center for Photomedicine, Boston, Massachusetts, USA
| | - Joseph Georges
- Philadelphia College of Osteopathic Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania, USA
| | - Deena Elsahy
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Eyas M Hattab
- University of Louisville, Department of Pathology and Laboratory Medicine, Louisville, Kentucky, USA
| | - Steven Yocom
- Philadelphia College of Osteopathic Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania, USA
| | - Aaron A Cohen-Gadol
- Goodman Campbell Brain and Spine and Indiana University Department of Neurological Surgery, Indianapolis, Indiana, USA.
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Martirosyan NL, Georges J, Eschbacher JM, Belykh E, Carotenuto A, Spetzler RF, Nakaji P, Preul MC. Confocal scanning microscopy provides rapid, detailed intraoperative histological assessment of brain neoplasms: Experience with 106 cases. Clin Neurol Neurosurg 2018; 169:21-28. [PMID: 29604507 DOI: 10.1016/j.clineuro.2018.03.015] [Citation(s) in RCA: 19] [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] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/12/2018] [Accepted: 03/17/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Frozen section histological analysis is currently the mainstay for intraprocedural tissue diagnosis during the resection of intracranial neoplasms and for evaluating tumor margins. However, frozen sections are time-consuming and often do not reveal the histological features needed for final diagnosis when compared with permanent sections. Confocal scanning microscopy (CSM) with certain stains may be a valuable technology that can add rapid and detailed histological assessment advantage for the neurosurgical operating room. This study describes potential advantages of CSM imaging of fresh human brain tumor tissues labeled with acriflavine (AF), acridine orange (AO), cresyl violet (CV), methylene blue (MB), and indocyanine green (ICG) within the neurosurgical operating room facility. PATIENTS AND METHODS Acute slices from orthotopic human intracranial neoplasms were incubated with AF/AO and CV solutions for 10 s and 1 min respectively. Staining was also attempted with MB and ICG. Samples were imaged using a bench-top CSM system. Histopathologic features of corresponding CSM and permanent hematoxylin and eosin images were reviewed for each case. RESULTS Of 106 cases, 30 were meningiomas, 19 gliomas, 13 pituitary adenomas, 9 metastases, 6 schwannomas, 4 ependymomas, and 25 other pathologies. CSM using rapid fluorophores (AF, AO, CV) revealed striking microvascular, cellular and subcellular structures that correlated with conventional histology. By rapidly staining and optically sectioning freshly resected tissue, images were generated for intraoperative consultations in less than one minute. With this technique, an entire resected tissue sample was imaged and digitally stored for tele-pathology and archiving. CONCLUSION CSM of fresh human brain tumor tissue provides clinically meaningful and rapid histopathological assessment much faster than frozen section. With appropriate stains, including specific cellular structure or antibody staining, CSM could improve the timeliness of intraoperative decision-making, and the neurosurgical-pathology workflow during resection of human brain tumors, ultimately improving patient care.
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Affiliation(s)
- Nikolay L Martirosyan
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA; Division of Neurosurgery, University of Arizona, Tucson, AZ, USA
| | - Joseph Georges
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA
| | - Jennifer M Eschbacher
- Division of Neuropathology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA
| | - Evgenii Belykh
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA; Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
| | | | - Robert F Spetzler
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA
| | - Peter Nakaji
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA
| | - Mark C Preul
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA.
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Unger MD, Georges J, Shaikh HA, Kavi T. Moyamoya tipping point: fatal bilateral MCA territory infarction following cocaine abuse. BMJ Case Rep 2018; 2018:bcr-2017-222883. [PMID: 29351941 DOI: 10.1136/bcr-2017-222883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Mark Daniel Unger
- Department of Anatomy, University of New England College of Osteopathic Medicine, Biddeford, Maine, USA
| | | | | | - Tapan Kavi
- Department of Neurology and Neurosurgery, Cooper University Hospital, Camden, NJ, USA
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Berthod A, Georges J. Etude de microémulsions eau-dichlorométhane : diagramme de phases, viscosité, propriétés électrochimiques. ACTA ACUST UNITED AC 2017. [DOI: 10.1051/jcp/1983800245] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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23
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Mooney MA, Georges J, Yazdanabadi MI, Goehring KY, White WL, Little AS, Preul MC, Coons SW, Nakaji P, Eschbacher JM. Immediate ex-vivo diagnosis of pituitary adenomas using confocal reflectance microscopy: a proof-of-principle study. J Neurosurg 2017; 128:1072-1075. [PMID: 28548594 DOI: 10.3171/2016.11.jns161651] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 12/21/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the feasibility of using confocal reflectance microscopy (CRM) ex vivo to differentiate adenoma from normal pituitary gland in surgical biopsy specimens. CRM allows for rapid, label-free evaluation of biopsy specimens with cellular resolution while avoiding some limitations of frozen section analysis. METHODS Biopsy specimens from 11 patients with suspected pituitary adenomas were transported directly to the pathology department. Samples were immediately positioned and visualized with CRM using a confocal microscope located in the same area of the pathology department where frozen sections are prepared. An H & E-stained slide was subsequently prepared from imaged tissue. A neuropathologist compared the histopathological characteristics of the H & E-stained slide and the matched CRM images. A second neuropathologist reviewed images in a blinded fashion and assigned diagnoses of adenoma or normal gland. RESULTS For all specimens, CRM contrasted cellularity, tissue architecture, nuclear pleomorphism, vascularity, and stroma. Pituitary adenomas demonstrated sheets and large lobules of cells, similar to the matched H & E-stained slides. CRM images of normal tissue showed scattered small lobules of pituitary epithelial cells, consistent with matched H & E-stained images of normal gland. Blinded review by a neuropathologist confirmed the diagnosis in 15 (94%) of 16 images of adenoma versus normal gland. CONCLUSIONS CRM is a simple, reliable approach for rapidly evaluating pituitary adenoma specimens ex vivo. This technique can be used to accurately differentiate between pituitary adenoma and normal gland while preserving biopsy tissue for future permanent analysis, immunohistochemical studies, and molecular studies.
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Affiliation(s)
| | | | | | - Katherine Y Goehring
- 2Neuropathology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | | | | | | | - Stephen W Coons
- 2Neuropathology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | | | - Jennifer M Eschbacher
- 2Neuropathology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Martirosyan NL, Georges J, Kalani MYS, Nakaji P, Spetzler RF, Feuerstein BG, Preul MC. Handheld confocal laser endomicroscopic imaging utilizing tumor-specific fluorescent labeling to identify experimental glioma cells in vivo. Surg Neurol Int 2016; 7:S995-S1003. [PMID: 28144472 PMCID: PMC5234279 DOI: 10.4103/2152-7806.195577] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 07/11/2016] [Indexed: 01/02/2023] Open
Abstract
Background: We have reported that handheld confocal laser endomicroscopy (CLE) can be used with various nonspecific fluorescent dyes to improve the microscopic identification of brain tumor and its boundaries. Here, we show that CLE can be used experimentally with tumor-specific fluorescent labeling to define glioma margins in vivo. Methods: Thirteen rats underwent craniectomy and in vivo imaging 21 days after implantation with green fluorescent protein (GFP)-labeled U251 (n = 7) cells or epidermal growth factor receptor (EGFR) overexpressing F98 cells (n = 6). Fluorescein isothiocyanate (FITC) conjugated EGFR fluorescent antibody (FITC-EGFR) was applied for contrast in F98 tumors. Confocal images of normal brain, obvious tumor, and peritumoral zones were collected using the CLE system. Bench-top confocal microscopy and hematoxylin and eosin-stained sections were correlated with CLE images. Results: GFP and FITC-EGFR fluorescence of glioma cells were detected by in vivo visible-wavelength fluorescence CLE. CLE of GFP-labeled tumors revealed bright individual satellite tumor cells within peritumoral tissue, a definitive tumor border, and subcellular structures. Imaging with FITC-EGFR labeling provided weaker contrast in F98-EGFR tumors but was able to delineate tumor cells. Imaging with both methods in various tumor regions correlated with standard confocal imaging and clinical histology. Conclusions: These data suggest that in vivo CLE of selectively tagged neoplasms could allow specific interactive identification of tumoral areas. Imaging of GFP and FITC-EGFR provides real-time histologic information precisely related to the site of microscopic imaging of tumor.
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Affiliation(s)
- Nikolay L Martirosyan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center Phoenix, Arizona, USA
| | - Joseph Georges
- School of Life Sciences, Arizona State University, Tempe, Arizona, USA
| | - M Yashar S Kalani
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center Phoenix, Arizona, USA
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center Phoenix, Arizona, USA
| | - Robert F Spetzler
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center Phoenix, Arizona, USA
| | - Burt G Feuerstein
- School of Life Sciences, Arizona State University, Tempe, Arizona, USA; College of Medicine, University of Arizona, Phoenix, Arizona, USA
| | - Mark C Preul
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center Phoenix, Arizona, USA
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Joy A, Kapoor M, Georges J, Butler L, Chang Y, Li C, Crouch A, Smirnov I, Nakada M, Hepler J, Marty M, Feuerstein BG. The role of AKT isoforms in glioblastoma: AKT3 delays tumor progression. J Neurooncol 2016; 130:43-52. [PMID: 27422127 DOI: 10.1007/s11060-016-2220-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/09/2016] [Indexed: 02/02/2023]
Abstract
The growth factor receptor/PI3K/AKT pathway is an important drug target in many cancers including Glioblastoma. AKT, a key node in the pathway, has 3 isoforms, AKT1, AKT2 and AKT3. Here we investigate their role in GBM. We find each activated, ser473 phosphorylated isoform is present in some GBMs but expression patterns vary. There is a direct relationship between human GBM patient outcome and both AKT1 and AKT2 mRNA levels, but an inverse relationship with AKT3 mRNA. Furthermore, AKT3 mRNA levels were high in a less aggressive GBM subtype. Overexpressing AKT3 improves survival in a rodent model of GBM and decreases colony forming efficiency, but not growth rate, in glioma cells. Silencing AKT3 slows cell cycle progression in one cell line and increases apoptosis in another. Our studies of AKT3 substrates indicate (1) silencing both AKT2 and AKT3 reduces GSK3 phosphorylation (2) only AKT2 silencing reduces S6 phosphorylation. Since S6 phosphorylation is a marker of mTORC1 activity this indicates that AKT2 activates mTORC1, but AKT3 does not. Our results indicate AKT isoforms have different roles and downstream substrates in GBM. Unexpectedly, they indicate AKT3 delays tumor progression. Therefore strategies that inhibit AKT3 may be unhelpful in some GBM patients.
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Affiliation(s)
- Anna Joy
- St. Josephs Hospital and Medical Center, Downtown campus, 445 N 5th Street, Suite 110, Phoenix, AZ, 85004, USA. .,, 318 E Kaler, Phoenix, AZ, 85020, USA.
| | - Manisha Kapoor
- St. Josephs Hospital and Medical Center, Downtown campus, 445 N 5th Street, Suite 110, Phoenix, AZ, 85004, USA
| | - Joseph Georges
- St. Josephs Hospital and Medical Center, Downtown campus, 445 N 5th Street, Suite 110, Phoenix, AZ, 85004, USA
| | - Lacy Butler
- St. Josephs Hospital and Medical Center, Downtown campus, 445 N 5th Street, Suite 110, Phoenix, AZ, 85004, USA
| | - Yongchang Chang
- St. Josephs Hospital and Medical Center, Downtown campus, 445 N 5th Street, Suite 110, Phoenix, AZ, 85004, USA
| | - Chaokun Li
- St. Josephs Hospital and Medical Center, Downtown campus, 445 N 5th Street, Suite 110, Phoenix, AZ, 85004, USA
| | - Acacia Crouch
- St. Josephs Hospital and Medical Center, Downtown campus, 445 N 5th Street, Suite 110, Phoenix, AZ, 85004, USA
| | - Ivan Smirnov
- University of California at San Francisco, San Francisco, CA, USA
| | - Mitsitoshi Nakada
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - James Hepler
- St. Josephs Hospital and Medical Center, Downtown campus, 445 N 5th Street, Suite 110, Phoenix, AZ, 85004, USA
| | - Max Marty
- St. Josephs Hospital and Medical Center, Downtown campus, 445 N 5th Street, Suite 110, Phoenix, AZ, 85004, USA
| | - Burt G Feuerstein
- Department of Neurology, University of Arizona College of Medicine, 550 E. Van Buren St, Phoenix, AZ, 85004, USA
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Schmidt R, Hofer E, Bouwman FH, Buerger K, Cordonnier C, Fladby T, Galimberti D, Georges J, Heneka MT, Hort J, Laczó J, Molinuevo JL, O'Brien JT, Religa D, Scheltens P, Schott JM, Sorbi S. EFNS-ENS/EAN Guideline on concomitant use of cholinesterase inhibitors and memantine in moderate to severe Alzheimer's disease. Eur J Neurol 2015; 22:889-98. [DOI: 10.1111/ene.12707] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/06/2015] [Indexed: 12/17/2022]
Affiliation(s)
- R. Schmidt
- Department of Neurology; Medical University of Graz; Graz Austria
| | - E. Hofer
- Department of Neurology; Medical University of Graz; Graz Austria
- Institute for Medical Informatics; Statistics and Documentation; Medical University of Graz; Graz Austria
| | - F. H. Bouwman
- Alzheimer Centre; VU University Medical Centre; Amsterdam The Netherlands
| | - K. Buerger
- Institute for Stroke and Dementia Research (ISD); Klinikum der Universität München; Campus Großhadern; Munich Germany
| | - C. Cordonnier
- Department of Neurology; Univ Lille Nord de France; UDSL; CHU Lille; Lille France
| | - T. Fladby
- Department of Neurology; Akershus University Hospital; Ahus Norway
| | - D. Galimberti
- Neurology Unit; Department of Pathophysiology and Transplantation; University of Milan; IRCCS Ospedale Maggiore Policlinico; Fondazione Cà Granda; Milan Italy
| | - J. Georges
- Alzheimer Europe; Luxembourg City Luxembourg
| | - M. T. Heneka
- Clinic and Polyclinic for Neurology; Clinical Neuroscience Unit; German Centre for Neurodegenerative Diseases (DZNE); Bonn Germany
| | - J. Hort
- Second Faculty of Medicine; Department of Neurology; Charles University in Prague and Motol University Hospital; Prague 5 Czech Republic
- International Clinical Research Centre; St Anne's University Hospital; Brno Czech Republic
| | - J. Laczó
- Second Faculty of Medicine; Department of Neurology; Charles University in Prague and Motol University Hospital; Prague 5 Czech Republic
- International Clinical Research Centre; St Anne's University Hospital; Brno Czech Republic
| | - J. L Molinuevo
- Alzheimer's Disease and other Cognitive Disorders Unit; Department of Neurology; Hospital Clínic; IDIBAPS; Barcelona Spain
| | - J. T. O'Brien
- Department of Psychiatry; University of Cambridge; Level E4 Cambridge Biomedical Campus; Cambridge UK
| | - D. Religa
- Karolinska Institutet Alzheimer Disease Research Centre; Karolinska University Hospital; Stockholm Sweden
- Mossakowski Medical Research Centre; Polish Academy of Sciences; Warsaw Poland
| | - P. Scheltens
- Alzheimer Centre; VU University Medical Centre; Amsterdam The Netherlands
| | - J. M. Schott
- Dementia Research Centre; Institute of Neurology; UCL Queen Square; London UK
| | - S. Sorbi
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA); University of Florence; Florence Italy
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Besson M, Génissel M, Georges J, Janvier R, Val-Laillet D. O56: Impact d’une exposition périnatale au sucre et au gras via le régime maternel sur les capacités cognitives, les préférences et la motivation alimentaires de porcelets Yucatan. NUTR CLIN METAB 2014. [DOI: 10.1016/s0985-0562(14)70632-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Georges J, Zehri A, Carlson E, Nichols J, Mooney MA, Martirosyan NL, Ghaffari L, Kalani MYS, Eschbacher J, Feuerstein B, Anderson T, Preul MC, Van Keuren-Jensen K, Nakaji P. Label-free microscopic assessment of glioblastoma biopsy specimens prior to biobanking [corrected]. Neurosurg Focus 2014; 36:E8. [PMID: 24484261 DOI: 10.3171/2013.11.focus13478] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Glioblastoma is the most common primary brain tumor with a median 12- to 15-month patient survival. Improving patient survival involves better understanding the biological mechanisms of glioblastoma tumorigenesis and seeking targeted molecular therapies. Central to furthering these advances is the collection and storage of surgical biopsies (biobanking) for research. This paper addresses an imaging modality, confocal reflectance microscopy (CRM), for safely screening glioblastoma biopsy samples prior to biobanking to increase the quality of tissue provided for research and clinical trials. These data indicate that CRM can immediately identify cellularity of tissue biopsies from animal models of glioblastoma. When screening fresh human biopsy samples, CRM can differentiate a cellular glioblastoma biopsy from a necrotic biopsy without altering DNA, RNA, or protein expression of sampled tissue. These data illustrate CRM's potential for rapidly and safely screening clinical biopsy samples prior to biobanking, which demonstrates its potential as an effective screening technique that can improve the quality of tissue biobanked for patients with glioblastoma.
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Eschbacher J, Georges J, Zehri A, Mooney M, Carlson E, Nichols J, Farhat K, Anderson T, Preul M, Jensen K, Nakaji P. NI-24 * IMPROVING BIOBANKED SPECIMEN QUALITY: LABEL-FREE MICROSCOPIC ASSESSMENT OF HUMAN BRAIN TUMOR BIOPSIES PRIOR TO BIOBANKING. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou264.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Geller T, Prakash V, Batanian J, Guzman M, Duncavage E, Gershon T, Crowther A, Wu J, Liu H, Fang F, Davis I, Tripolitsioti D, Ma M, Kumar K, Grahlert J, Egli K, Fiaschetti G, Shalaby T, Grotzer M, Baumgartner M, Braoudaki M, Lambrou GI, Giannikou K, Millionis V, Papadodima SA, Settas N, Sfakianos G, Stefanaki K, Kattamis A, Spiliopoulou CA, Tzortzatou-Stathopoulou F, Kanavakis E, Gholamin S, Mitra S, Feroze A, Zhang M, Esparza R, Kahn S, Richard C, Achrol A, Volkmer A, Liu J, Volkmer J, Majeti R, Weissman I, Cheshier S, Bhatia K, Brown N, Teague J, Lo P, Challis J, Beshay V, Sullivan M, Mechinaud F, Hansford J, Arifin MZ, Dahlan RH, Sobana M, Saputra P, Tisell MT, Danielsson A, Caren H, Bhardwaj R, Chakravadhanula M, Hampton C, Ozals V, Georges J, Decker W, Kodibagkar V, Nguyen A, Legrain M, Gaub MP, Pencreach E, Chenard MP, Guenot D, Entz-Werle N, Kanemura Y, Ichimura K, Shofuda T, Nishikawa R, Yamasaki M, Shibui S, Arai H, Xia J, Brian A, Prins R, Pennell C, Moertel C, Olin M, Bie L, Zhang X, Liu H, Olsson M, Kling T, Nelander S, Biassoni V, Bongarzone I, Verderio P, Massimino M, Magni R, Pizzamiglio S, Ciniselli C, Taverna E, De Bortoli M, Luchini A, Liotta L, Barzano E, Spreafico F, Visse E, Sanden E, Darabi A, Siesjo P, Jackson S, Cohen K, Lin D, Burger P, Rodriguez F, Yao X, Liucheng R, Qin L, Na T, Meilin W, Zhengdong Z, Yongjun F, Pfeifer S, Nister M, de Stahl TD, Basmaci E, Orphanidou-Vlachou E, Brundler MA, Sun Y, Davies N, Wilson M, Pan X, Arvanitis T, Grundy R, Peet A, Eden C, Ju B, Phoenix T, Nimmervoll B, Tong Y, Ellison D, Lessman C, Taylor M, Gilbertson R, Folgiero V, del Bufalo F, Carai A, Cefalo MG, Citti A, Rutella S, Locatelli F, Mastronuzzi A, Maher O, Khatua S, Zaky W, Lourdusamy A, Meijer L, Layfield R, Grundy R, Jones DTW, Capper D, Sill M, Hovestadt V, Schweizer L, Lichter P, Zagzag D, Karajannis MA, Aldape KD, Korshunov A, von Deimling A, Pfister S, Chakrabarty A, Feltbower R, Sheridon E, Hassan H, Shires M, Picton S, Hatziagapiou K, Braoudaki M, Lambrou GI, Tsorteki F, Tzortzatou-Stathopoulou F, Bethanis K, Gemou-Engesaeth V, Chi SN, Bandopadhayay P, Janeway K, Pinches N, Malkin H, Kieran MW, Manley PE, Green A, Goumnerova L, Ramkissoon S, Harris MH, Ligon KL, Kahlert U, Suarez M, Maciaczyk J, Bar E, Eberhart C, Kenchappa R, Krishnan N, Forsyth P, McKenzie B, Pisklakova A, McFadden G, Kenchappa R, Forsyth P, Pan W, Rodriguez L, Glod J, Levy JM, Thompson J, Griesinger A, Amani V, Donson A, Birks D, Morgan M, Handler M, Foreman N, Thorburn A, Lulla RR, Laskowski J, Fangusaro J, DiPatri AJ, Alden T, Tomita T, Vanin EF, Goldman S, Soares MB, Remke M, Ramaswamy V, Wang X, Jorgensen F, Morrissy AS, Marra M, Packer R, Bouffet E, Pfister S, Jabado N, Taylor M, Cole B, Rudzinski E, Anderson M, Bloom K, Lee A, Leary S, Leprivier G, Remke M, Rotblat B, Agnihotri S, Kool M, Derry B, Pfister S, Taylor MD, Sorensen PH, Dobson T, Busschers E, Taylor H, Hatcher R, Fangusaro J, Lulla R, Goldman S, Rajaram V, Das C, Gopalakrishnan V. TUMOUR BIOLOGY. Neuro Oncol 2014; 16:i137-i145. [PMCID: PMC4046298 DOI: 10.1093/neuonc/nou082] [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: 07/22/2023] Open
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Martirosyan NL, Georges J, Eschbacher JM, Cavalcanti DD, Elhadi AM, Abdelwahab MG, Scheck AC, Nakaji P, Spetzler RF, Preul MC. Potential application of a handheld confocal endomicroscope imaging system using a variety of fluorophores in experimental gliomas and normal brain. Neurosurg Focus 2014; 36:E16. [DOI: 10.3171/2013.11.focus13486] [Citation(s) in RCA: 50] [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] [Indexed: 11/06/2022]
Abstract
Object
The authors sought to assess the feasibility of a handheld visible-wavelength confocal endomicroscope imaging system (Optiscan 5.1, Optiscan Pty., Ltd.) using a variety of rapid-acting fluorophores to provide histological information on gliomas, tumor margins, and normal brain in animal models.
Methods
Mice (n = 25) implanted with GL261 cells were used to image fluorescein sodium (FNa), 5-aminolevulinic acid (5-ALA), acridine orange (AO), acriflavine (AF), and cresyl violet (CV). A U251 glioma xenograft model in rats (n = 5) was used to image sulforhodamine 101 (SR101). A swine (n = 3) model with AO was used to identify confocal features of normal brain. Images of normal brain, obvious tumor, and peritumoral zones were collected using the handheld confocal endomicroscope. Histological samples were acquired through biopsies from matched imaging areas. Samples were visualized with a benchtop confocal microscope. Histopathological features in corresponding confocal images and photomicrographs of H & E–stained tissues were reviewed.
Results
Fluorescence induced by FNa, 5-ALA, AO, AF, CV, and SR101 and detected with the confocal endomicroscope allowed interpretation of histological features. Confocal endomicroscopy revealed satellite tumor cells within peritumoral tissue, a definitive tumor border, and striking fluorescent cellular and subcellular structures. Fluorescence in various tumor regions correlated with standard histology and known tissue architecture. Characteristic features of different areas of normal brain were identified as well.
Conclusions
Confocal endomicroscopy provided rapid histological information precisely related to the site of microscopic imaging with imaging characteristics of cells related to the unique labeling features of the fluorophores. Although experimental with further clinical trial validation required, these data suggest that intraoperative confocal imaging can help to distinguish normal brain from tumor and tumor margin and may have application in improving intraoperative decisions during resection of brain tumors.
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Affiliation(s)
| | - Joseph Georges
- 4School of Life Sciences, Arizona State University, Tempe, Arizona
| | | | | | | | - Mohammed G. Abdelwahab
- 3Neuro-Oncology Research, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and
| | - Adrienne C. Scheck
- 3Neuro-Oncology Research, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and
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Lambert MA, Bickel H, Prince M, Fratiglioni L, Von Strauss E, Frydecka D, Kiejna A, Georges J, Reynish EL. Estimating the burden of early onset dementia; systematic review of disease prevalence. Eur J Neurol 2014; 21:563-9. [DOI: 10.1111/ene.12325] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 11/01/2013] [Indexed: 11/29/2022]
Affiliation(s)
- M. A. Lambert
- Department of Cardiovascular and Diabetes Medicine; University of Dundee; Dundee UK
| | - H. Bickel
- Klinik und Poliklinik für Psychiatrie und Psychotherapie der Technischen Universität München; Klinikum rechts der Isar; Munchen Germany
| | - M. Prince
- King's College London; Institute of Psychiatry; London UK
| | | | | | - D. Frydecka
- Department of Psychiatry; Wroclaw Medical University; Wroclaw Poland
| | - A. Kiejna
- Department of Psychiatry; Wroclaw Medical University; Wroclaw Poland
| | | | - E. L. Reynish
- Department of Geriatric Medicine; NHS Fife; Kirkcaldy UK
- Dementia Services Development Centre; University of Stirling; Stirling UK
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Truran S, Weissig V, Ramirez-Alvarado M, Franco DA, Burciu C, Georges J, Murarka S, Okoth WA, Schwab S, Hari P, Migrino RQ. Nanoliposomes protect against AL amyloid light chain protein-induced endothelial injury. J Liposome Res 2013; 24:69-73. [PMID: 24236475 DOI: 10.3109/08982104.2013.838258] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT A newly-recognized pathogenic mechanism underlying light chain amyloidosis (AL) involves endothelial dysfunction and cell injury caused by misfolded light chain proteins (LC). Nanoliposomes (NL) are artificial phospholipid vesicles that could attach to misfolded proteins and reduce tissue injury. OBJECTIVE To test whether co-treatment with NL reduces LC-induced endothelial dysfunction and cell death. METHODS Abdominal subcutaneous adipose arterioles from 14 non-AL subjects were cannulated; dilator response to acetylcholine and papaverine were measured at baseline and following 1-hour exposure to LC (20 µg/mL, 2 purified from AL subjects' urine, 1 from human recombinant LC [AL-09]) ± NL (phosphatidylcholine/cholesterol/phosphatidic acid 70/25/5 molar ratio) or NL alone. Human aortic artery endothelial cells (HAEC) were exposed to Oregon Green-labeled LC ± NL for 24 hours and intracellular LC and apoptosis (Hoechst stain) were measured. Circular dichroism spectroscopy was performed on AL-09 LC ± NL to follow changes in secondary structure and protein thermal stability. RESULTS LC caused impaired dilation to acetylcholine that was restored by NL (control - 94.0 ± 1.8%, LC - 65.0 ± 7.1%, LC + NL - 95.3 ± 1.8%, p ≤ 0.001 LC versus control or LC + NL). NL protection was inhibited by L-NG-nitroarginine methyl ester. NL increased the beta sheet structure of LC, reduced endothelial cell internalization of LC and protected against LC-induced endothelial cell death. CONCLUSIONS LC induced human adipose arteriole endothelial dysfunction and endothelial cell death, which were reversed by co-treatment with NL. This protection may partly be due to enhancing LC protein structure and reducing LC internalization. Nanoliposomes represent a promising new class of agents to ameliorate tissue injury from protein misfolding diseases such as AL.
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Affiliation(s)
- Seth Truran
- Phoenix Veterans Affairs , Phoenix, AZ , USA
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Campian J, Gladstone D, Ambady P, Ye X, King K, Borrello I, Petrik S, Golightly M, Holdhoff M, Grossman S, Bhardwaj R, Chakravadhanula M, Ozols V, Georges J, Carlson E, Hampton C, Decker W, Chiba Y, Hashimoto N, Kagawa N, Hirayama R, Tsuboi A, Oji Y, Oka Y, Sugiyama H, Yoshimine T, Choi B, Gedeon P, Herndon J, Sanchez-Perez L, Mitchell D, Bigner D, Sampson J, Choi YA, Pandya H, Gibo DM, Debinski W, Cloughesy TF, Liau LM, Chiocca EA, Jolly DJ, Robbins JM, Ostertag D, Ibanez CE, Gruber HE, Kasahara N, Vogelbaum MA, Kesari S, Mikkelsen T, Kalkanis S, Landolfi J, Bloomfield S, Foltz G, Pertschuk D, Everson R, Jin R, Safaee M, Lisiero D, Odesa S, Liau L, Prins R, Gholamin S, Mitra SS, Richard CE, Achrol A, Kahn SA, Volkmer AK, Volkmer JP, Willingham S, Kong D, Shin JJ, Monje-Deisseroth M, Cho YJ, Weissman I, Cheshier SH, Kanemura Y, Sumida M, Yoshioka E, Yamamoto A, Kanematsu D, Takada A, Nonaka M, Nakajima S, Goto S, Kamigaki T, Takahara M, Maekawa R, Shofuda T, Moriuchi S, Yamasaki M, Kebudi R, Cakir FB, Gorgun O, Agaoglu FY, Darendeliler E, Lin Y, Wang Y, Qiu X, Jiang T, Lin Y, Wang Y, Jiang T, Zhang G, Wang J, Okada H, Butterfield L, Hamilton R, Drappatz J, Engh J, Amankulor N, Lively M, Chan M, Salazar A, Potter D, Shaw E, Lieberman F, Pandya H, Choi Y, Park J, Phuphanich S, Wheeler C, Rudnick J, Hu J, Mazer M, Wang H, Nuno M, Guevarra A, Sanchez C, Fan X, Ji J, Chu R, Bender J, Hawkins E, Black K, Yu J, Reap E, Archer G, Sanchez-Perez L, Norberg P, Schmittling R, Nair S, Cui X, Snyder D, Chandramohan V, Choi B, Kuan CT, Mitchell D, Bigner D, Yan H, Sampson J, Reardon D, Li G, Recht L, Fink K, Nabors L, Tran D, Desjardins A, Chandramouli N, Duic JP, Groves M, Clarke A, Hawthorne T, Green J, Yellin M, Sampson J, Rigakos G, Spyri O, Nomikos P, Stavridi F, Grossi I, Theodorakopoulou I, Assi A, Kouvatseas G, Papadopoulou E, Nasioulas G, Labropoulos S, Razis E, Rudnick J, Ravi A, Sanchez C, Tang DN, Hu J, Yu J, Sharma P, Black K, Sengupta S, Sampath P, Soto H, Erickson K, Malone C, Hickey M, Ha E, Young E, Ellingson B, Prins R, Liau L, Kruse C, Sul J, Hilf N, Kutscher S, Schoor O, Lindner J, Reinhardt C, Kreisl T, Iwamoto F, Fine H, Singh-Jasuja H, Teijeira L, Gil-Arnaiz I, Hernandez-Marin B, Martinez-Aguillo M, Sanchez SDLC, Viudez A, Hernandez-Garcia I, Lecumberri MJ, Grandez R, de Lascoiti AF, Garcia RV, Thomas A, Fisher J, Baron U, Olek S, Rhodes H, Gui J, Hampton T, Tafe L, Tsongalis G, Lefferts J, Wishart H, Kleen J, Miller M, Ernstoff M, Fadul C, Vlahovic G, Desjardins A, Peters K, Ranjan T, Herndon J, Friedman A, Friedman H, Bigner D, Archer G, Lally-Goss D, Sampson J, Wainwright D, Dey M, Chang A, Cheng Y, Han Y, Lesniak M, Weller M, Kaulich K, Hentschel B, Felsberg J, Gramatzki D, Pietsch T, Simon M, Westphal M, Schackert G, Tonn JC, Loeffler M, Reifenberger G, Yu J, Rudnick J, Hu J, Phuphanich S, Mazer M, Wang H, Xu M, Nuno M, Patil C, Chu R, Black K, Wheeler C. IMMUNOTHERAPY/BIOLOGICAL THERAPIES. Neuro Oncol 2013; 15:iii68-iii74. [PMCID: PMC3823893 DOI: 10.1093/neuonc/not178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
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Adachi JI, Totake K, Shirahata M, Mishima K, Suzuki T, Yanagisawa T, Fukuoka K, Nishikawa R, Arimappamagan A, Manoj N, Mahadevan A, Bhat D, Arvinda H, Indiradevi B, Somanna S, Chandramouli B, Petterson SA, Hermansen SK, Dahlrot RH, Hansen S, Kristensen BW, Carvalho F, Jalali S, Singh S, Croul S, Aldape K, Zadeh G, Choi J, Park SH, Khang SK, Suh YL, Kim SP, Lee YS, Kim SH, Coberly S, Samayoa K, Liu Y, Kiaei P, Hill J, Patterson S, Damore M, Dahiya S, Emnett R, Phillips J, Haydon D, Leonard J, Perry A, Gutmann D, Epari S, Ahmed S, Gurav M, Raikar S, Moiyadi A, Shetty P, Gupta T, Jalali R, Georges J, Zehri A, Carlson E, Martirosyan N, Elhadi A, Nichols J, Ighaffari L, Eschbacher J, Feuerstein B, Anderson T, Preul M, Jensen K, Nakaji P, Girardi H, Monville F, Carpentier S, Giry M, Voss J, Jenkins R, Boisselier B, Frayssinet V, Poggionovo C, Catteau A, Mokhtari K, Sanson M, Peyro-Saint-Paul H, Giannini C, Hide T, Nakamura H, Makino K, Yano S, Anai S, Shinojima N, Kuroda JI, Takezaki T, Kuratsu JI, Higuchi F, Matsuda H, Iwata K, Ueki K, Kim P, Kong J, Cooper L, Wang F, Gao J, Teodoro G, Scarpace L, Mikkelsen T, Schniederjan M, Moreno C, Saltz J, Brat D, Cho U, Hong YK, Lee YS, Lober R, Lu L, Gephart MH, Fisher P, Miyazaki M, Nishihara H, Itoh T, Kato M, Fujimoto S, Kimura T, Tanino M, Tanaka S, Nguyen N, Moes G, Villano JL, Nishihara H, Kanno H, Kato Y, Tanaka S, Ohnishi T, Harada H, Ohue S, Kouno S, Inoue A, Yamashita D, Okamoto S, Nitta M, Muragaki Y, Maruyama T, Sawada T, Komori T, Saito T, Okada Y, Omay SB, Gunel JM, Clark VE, Li J, Omay EZE, Serin A, Kolb LE, Hebert RM, Bilguvar K, Ozduman K, Pamir MN, Kilic T, Baehring J, Piepmeier JM, Brennan CW, Huse J, Gutin PH, Yasuno K, Vortmeyer A, Gunel M, Perry A, Pugh S, Rogers CL, Brachman D, McMillan W, Jenrette J, Barani I, Shrieve D, Sloan A, Mehta M, Prabowo A, Iyer A, Veersema T, Anink J, Meeteren ASV, Spliet W, van Rijen P, Ferrier T, Capper D, Thom M, Aronica E, Chharchhodawala T, Sable M, Sharma MC, Sarkar C, Suri V, Singh M, Santosh V, Thota B, Srividya M, Sravani K, Shwetha S, Arivazhagan A, Thennarasu K, Chandramouli B, Hegde A, Kondaiah P, Somasundaram K, Rao M, Santosh V, Kumar VP, Thota B, Shastry A, Arivazhagan A, Thennarasu K, Kondaiah P, Shastry A, Narayan R, Thota B, Somanna S, Thennarasu K, Arivazhagan A, Santosh V, Shastry A, Naz S, Thota B, Thennarasu K, Arivazhagan A, Somanna S, Santosh V, Kondaiah P, Venneti S, Garimella M, Sullivan L, Martinez D, Huse J, Heguy A, Santi M, Thompson C, Judkins A, Voronovich Z, Chen L, Clark K, Walsh M, Mannas J, Horbinski C, Wiestler B, Capper D, Holland-Letz T, Korshunov A, von Deimling A, Pfister SM, Platten M, Weller M, Wick W, Zieman G, Dardis C, Ashby L, Eschbacher J. PATHOLOGY. Neuro Oncol 2013. [DOI: 10.1093/neuonc/not184] [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: 11/13/2022] Open
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Georges J. Advantages and limitations of thermal lens spectrometry over conventional spectrophotometry for absorbance measurements. Talanta 2012; 48:501-9. [PMID: 18967490 DOI: 10.1016/s0039-9140(98)00242-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/1998] [Revised: 06/18/1998] [Accepted: 07/01/1998] [Indexed: 10/17/2022]
Abstract
This review considers the advantages and the limitations that thermal lens spectrometry has over conventional spectrophotometry for the measurement of optical absorption in specific applications. The photothermal method is characterized by its intrinsic sensitivity resulting from the indirect nature of the measurement and amplified by physical and thermo-optical parameters which are not effective in absorbance measurements. Other advantages include a weak dependence on light scattering and the complementary nature of photothermal spectra with respect to absorption and emission spectra for speciation studies at very low concentrations. The main drawbacks are the convective noise, the background absorbance and the complexity of the experimental set-up, especially when differential or wavelength scanning measurements are required.
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Affiliation(s)
- J Georges
- Laboratoire des Sciences Analytiques, UMR 5619, Bât. 308, Université Claude Bernard-Lyon 1, 69622 Villeurbanne Cedex, France
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Pati S, Yin JX, Gan Y, Georges J, Jayaram V, Marsh S, Shi FD, Maalouf M, Treiman D. Hypothermia Attenuates Neuro-Glial Injury and Neuroinflammation in Prolonged Status Epilepticus (S56.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s56.004] [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: 11/15/2022] Open
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Pati S, Yin JX, Gan Y, Georges J, Jayaram V, Marsh S, Shi FD, Maalouf M, Treiman D. Hypothermia Attenuates Neuro-Glial Injury and Neuroinflammation in Prolonged Status Epilepticus (IN5-1.002). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.in5-1.002] [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: 11/15/2022] Open
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Hu YL, De Lay M, Rose SD, Carbonell WS, Aghi MK, Rose SD, Carbonell WS, De Lay M, Hu YL, Paquette J, Tokuyasu T, Tsao S, Chaumeil M, Ronen S, Aghi MK, Matlaf LA, Soroceanu L, Cobbs C, Soroceanu L, Matlaf L, Harkins L, Cobbs C, Garzon-Muvdi T, Rhys CA, Smith C, Kim DH, Kone L, Farber H, An S, Levchenko A, Quinones-Hinojosa A, Lemke D, Pfenning PN, Sahm F, Klein AC, Kempf T, Schnolzer M, Platten M, Wick W, Smith SJ, Rahman R, Rahman C, Barrow J, Macarthur D, Rose F, Grundy RG, Kaley TJ, Huse J, Karimi S, Rosenblum M, Omuro A, DeAngelis LM, de Groot JF, Kong LY, Wei J, Wang T, Piao Y, Liang J, Fuller GN, Qiao W, Heimberger AB, Jhaveri N, Cho H, Torres S, Wang W, Schonthal A, Petasis N, Louie SG, Hofman F, Chen TC, Yamada R, Sumual S, Buljan V, Bennett MR, McDonald KL, Weiler M, Pfenning PN, Thiepold AL, Jestaedt L, Gronych J, Dittmann LM, Jugold M, Kosch M, Combs SE, von Deimling A, Weller M, Bendszus M, Platten M, Wick W, Kwiatkowska A, Paulino V, Tran NL, Symons M, Stockham AL, Borden E, Peereboom D, Hu Y, Chaturbedi A, Hamamura M, Mark E, Zhou YH, Abbadi S, Guerrero-Cazares H, Pistollato F, Smith CL, Ruff W, Puppa AD, Basso G, Quinones-Hinojosa A, Monje M, Freret ME, Masek M, Fisher PG, Haddix T, Vogel H, Kijima N, Hosen N, Kagawa N, Hashimoto N, Fujimoto Y, Kinoshita M, Sugiyama H, Yoshimine T, Anneke N, Bob H, Pieter W, Arend H, William L, Eoli M, Calleri A, Cuppini L, Anghileri E, Pellegatta S, Prodi E, Bruzzone MG, Bertolini F, Finocchiaro G, Zhu D, Hunter SB, Vertino PM, Van Meir EG, Cork SM, Kaur B, Cooper L, Saltz JH, Sandberg EM, Van Meir EG, Burrell K, Hill R, Zadeh G, Parker JJ, Dionne K, Massarwa R, Klaassen M, Niswander L, Kleinschmidt-DeMasters BK, Waziri A, Jalali S, Wataya T, Salehi F, Croul S, Gentili F, Zadeh G, Jalali S, Foltz W, Burrell K, Lee JI, Agnihorti S, Menard C, Chung C, Zadeh G, Torres S, Jhaveri N, Wang W, Schonthal AH, Louie SG, Hofman FM, Chen TC, Elena P, Faivre G, Demopoulos A, Taillibert S, Rosenblum M, Omuro A, Kirsch M, Martin KD, Bertram A, uckermann O, Leipnitz E, Weigel P, Temme A, Schackert G, Geiger K, Gerstner E, Jennings D, Chi AS, Plotkin S, Kwon SJ, Pinho M, Polaskova P, Batchelor TT, Sorensen AG, Hossain MB, Gururaj AE, Cortes-Santiago N, Gabrusiewicz K, Yung WKA, Fueyo J, Gomez-Manzano C, Gil OD, Noticewala S, Ivkovic S, Esencay M, Zagzagg D, Rosenfeld S, Bruce JN, Canoll P, Chang JH, Seol HJ, Weeks A, Smith CA, Rutka JT, Georges J, Samuelson G, Misra A, Joy A, Huang Y, McQuilkin M, Yoshihiro A, Carpenter D, Butler L, Feuerstein B, Murphy SF, Vaghaiwalla T, Wotoczek-Obadia M, Albright R, Mack D, Lawn S, Henderson F, Jung M, Dakshanamurthy S, Brown M, Forsyth P, Brem S, Sadr MS, Maret D, Sadr ES, Siu V, Alshami J, Trinh G, Denault JS, Faury D, Jabado N, Nantel A, Del Maestro R. ANGIOGENESIS AND INVASION. Neuro Oncol 2011; 13:iii1-iii9. [PMCID: PMC3222963 DOI: 10.1093/neuonc/nor147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
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Wimo A, Jönsson L, Gustavsson A, McDaid D, Ersek K, Georges J, Gulácsi L, Karpati K, Kenigsberg P, Valtonen H. The economic impact of dementia in Europe in 2008-cost estimates from the Eurocode project. Int J Geriatr Psychiatry 2011; 26:825-32. [PMID: 21744385 DOI: 10.1002/gps.2610] [Citation(s) in RCA: 134] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 07/06/2010] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Care for demented people is very resource demanding, the prevalence is increasing and there is so far no cure. Cost of illness (CoI) studies are important by identifying the distribution of costs between different payers of care. The European Union (EU) funded the European Collaboration on Dementia (Eurocode) as part of the EU's 2005 work plan of the Community public health programme. Eurocode was administered by Alzheimer Europe. The aim was to describe the economic impact of dementia in Europe in 2008. METHODS Eurocode's new estimates for dementia prevalence were included in a cost model based on published European CoI papers. For countries where no CoI figures were available, imputation was used. RESULTS The total CoI of dementia in the EU27 in 2008 was estimated to be €160 billion (€22 000 per demented per year), of which 56% were costs of informal care. The corresponding costs for the whole Europe was €177 billion. In northern Europe, the direct costs are estimated to be considerabe, while the cost of informal care is the major cost component in southern Europe. The sensitivity analysis showed a range for total EU27 costs between €111 and 168 billion. CONCLUSIONS The estimated CoI in this study is higher than in previous studies. There are also large differences in different European regions. Notwithstanding the methodological challenges, the societal costs of dementia in Europe are very high which in turn have substantial resource impacts on the social and health care systems in Europe.
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Affiliation(s)
- A Wimo
- Alzheimeŕs Disease Research Center, NCS, Karolinska Institute, Stockholm, Sweden.
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Shi C, Lu J, Wu W, Ma F, Georges J, Huang H, Balducci J, Chang Y, Huang Y. Endothelial cell-specific molecule 2 (ECSM2) localizes to cell-cell junctions and modulates bFGF-directed cell migration via the ERK-FAK pathway. PLoS One 2011; 6:e21482. [PMID: 21720547 PMCID: PMC3123356 DOI: 10.1371/journal.pone.0021482] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 05/30/2011] [Indexed: 12/27/2022] Open
Abstract
Background Despite its first discovery by in silico cloning of novel endothelial cell-specific genes a decade ago, the biological functions of endothelial cell-specific molecule 2 (ECSM2) have only recently begun to be understood. Limited data suggest its involvement in cell migration and apoptosis. However, the underlying signaling mechanisms and novel functions of ECSM2 remain to be explored. Methodology/Principal Findings A rabbit anti-ECSM2 monoclonal antibody (RabMAb) was generated and used to characterize the endogenous ECSM2 protein. Immunoblotting, immunoprecipitation, deglycosylation, immunostaining and confocal microscopy validated that endogenous ECSM2 is a plasma membrane glycoprotein preferentially expressed in vascular endothelial cells (ECs). Expression patterns of heterologously expressed and endogenous ECSM2 identified that ECSM2 was particularly concentrated at cell-cell contacts. Cell aggregation and transwell assays showed that ECSM2 promoted cell-cell adhesion and attenuated basic fibroblast growth factor (bFGF)-driven EC migration. Gain or loss of function assays by overexpression or knockdown of ECSM2 in ECs demonstrated that ECSM2 modulated bFGF-directed EC motility via the FGF receptor (FGFR)-extracellular regulated kinase (ERK)-focal adhesion kinase (FAK) pathway. The counterbalance between FAK tyrosine phosphorylation (activation) and ERK-dependent serine phosphorylation of FAK was critically involved. A model of how ECSM2 signals to impact bFGF/FGFR-driven EC migration was proposed. Conclusions/Significance ECSM2 is likely a novel EC junctional protein. It can promote cell-cell adhesion and inhibit bFGF-mediated cell migration. Mechanistically, ECSM2 attenuates EC motility through the FGFR-ERK-FAK pathway. The findings suggest that ECSM2 could be a key player in coordinating receptor tyrosine kinase (RTK)-, integrin-, and EC junctional component-mediated signaling and may have important implications in disorders related to endothelial dysfunction and impaired EC junction signaling.
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Affiliation(s)
- Chunwei Shi
- Department of Obstetrics and Gynecology, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States of America
- Department of Pathogen Biology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia Lu
- Department of Obstetrics and Gynecology, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States of America
- Department of Pathogen Biology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen Wu
- Department of Obstetrics and Gynecology, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States of America
- Department of Pathogen Biology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fanxin Ma
- Department of Obstetrics and Gynecology, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States of America
- State Key Laboratory of Biotherapy, West China Hospital, College of Life Science, Sichuan University, Chengdu, China
| | - Joseph Georges
- Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States of America
| | - Hanju Huang
- Department of Pathogen Biology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - James Balducci
- Department of Obstetrics and Gynecology, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States of America
| | - Yongchang Chang
- Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States of America
| | - Yao Huang
- Department of Obstetrics and Gynecology, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States of America
- * E-mail:
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Kiejna A, Frydecka D, Adamowski T, Bickel H, Reynish E, Prince M, Caracciolo B, Fratiglioni L, Georges J. Epidemiological studies of cognitive impairment and dementia across Eastern and Middle European countries (epidemiology of dementia in Eastern and Middle European Countries). Int J Geriatr Psychiatry 2011; 26:111-7. [PMID: 20632300 DOI: 10.1002/gps.2511] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the availability and the consistency of prevalence findings of epidemiological studies on cognitive impairment and dementia conducted in Eastern and Middle Europe. METHODS We adopted a stepwise multimethod study approach consisting of iterative literature searches for epidemiological articles published between 1990 and 2006 and subsequent data analyses of published material, reanalyses of existing accessible epidemiological data sets and expert inquiries in Eastern and Middle European countries. Systematic computer-assisted searches used the keywords: "dementia", "Alzheimer", "cognitive impairment", "incidence", "prevalence", "epidemiology" in combination with the name of the relevant countries or "Europe" in English and Polish language. We supplemented the literature search with a review of the references in the articles that were identified during the initial search. RESULTS We were able to find few regional and country-specific epidemiological studies of various kinds (population-based, cohort, cross-sectional studies) and conducted on different restricted population groups of patients (from neurological units, out-patients units, residential homes). No studies were identified from most of the countries taken under consideration and the ones we found were characterized by an immense diversity with a considerable degree of clinical and methodological variations. The few studies that there are suggest prevalence rates of dementia in Eastern Europe similar to those in Western Europe. CONCLUSIONS There is strong need for epidemiological studies in Eastern and Middle Europe, as well as for greater coordination and standardization of methods to improve the quality and comparability of epidemiological data to determine the prevalences' rates of dementia in all the EU countries.
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Affiliation(s)
- A Kiejna
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
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Tufail Y, Matyushov A, Baldwin N, Tauchmann ML, Georges J, Yoshihiro A, Tillery SIH, Tyler WJ. Transcranial pulsed ultrasound stimulates intact brain circuits. Neuron 2010; 66:681-94. [PMID: 20547127 DOI: 10.1016/j.neuron.2010.05.008] [Citation(s) in RCA: 556] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2010] [Indexed: 12/13/2022]
Abstract
Electromagnetic-based methods of stimulating brain activity require invasive procedures or have other limitations. Deep-brain stimulation requires surgically implanted electrodes. Transcranial magnetic stimulation does not require surgery, but suffers from low spatial resolution. Optogenetic-based approaches have unrivaled spatial precision, but require genetic manipulation. In search of a potential solution to these limitations, we began investigating the influence of transcranial pulsed ultrasound on neuronal activity in the intact mouse brain. In motor cortex, ultrasound-stimulated neuronal activity was sufficient to evoke motor behaviors. Deeper in subcortical circuits, we used targeted transcranial ultrasound to stimulate neuronal activity and synchronous oscillations in the intact hippocampus. We found that ultrasound triggers TTX-sensitive neuronal activity in the absence of a rise in brain temperature (<0.01 degrees C). Here, we also report that transcranial pulsed ultrasound for intact brain circuit stimulation has a lateral spatial resolution of approximately 2 mm and does not require exogenous factors or surgical invasion.
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Affiliation(s)
- Yusuf Tufail
- School of Life Sciences, Arizona State University, Tempe, AZ 85287, USA
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Georges J. Matrix effects in thermal lens spectrometry: influence of salts, surfactants, polymers and solvent mixtures. Spectrochim Acta A Mol Biomol Spectrosc 2008; 69:1063-72. [PMID: 17904415 DOI: 10.1016/j.saa.2007.07.062] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 07/19/2007] [Accepted: 07/27/2007] [Indexed: 05/17/2023]
Abstract
In this paper, we present an overall view of the matrix effects that can change or alter the signal in thermal lens spectrometry and we report the main works published in this field. The addition of salts, surfactants and polymers in aqueous solutions or the use of solvent mixtures is often needed in a variety of applications either to enhance the sensitivity of the thermal lens method or more generally because such media are required in the separation process prior to thermal lens detection. In most cases, matrix effects result in small changes in the thermo-optical properties of the solution and small signal variations. However, most important signal alterations can arise from the Soret effect. In binary mixtures as well as in solutions with macromolecular species which are initially homogeneous, the temperature gradient will induce the migration of molecules and the formation of a concentration gradient. This results in the formation of a concentration-dependent refractive index gradient which adds to the temperature-dependent refractive index gradient and contributes to the formation of a new signal. This effect can seriously alter the analytical signal and lead to erroneous interpretation of the experimental data. In contrast, time-resolved measurements can help in separating both signal components and have allowed to derive mass-diffusion times and mass-diffusion coefficients for a variety of micelles and polymers.
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Affiliation(s)
- Joseph Georges
- Laboratoire des Sciences Analytiques - UMR 5180, Université Claude Bernard-Lyon 1, Domaine Scientifique de la Doua, Bâtiment CPE-308D, 69622 Villeurbanne Cedex, France.
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Fossette S, Corbel H, Gaspar P, Le Maho Y, Georges J. An alternative technique for the long-term satellite tracking of leatherback turtles. ENDANGER SPECIES RES 2008. [DOI: 10.3354/esr00039] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Waldemar G, Dubois B, Emre M, Georges J, McKeith IG, Rossor M, Scheltens P, Tariska P, Winblad B. Recommendations for the diagnosis and management of Alzheimer's disease and other disorders associated with dementia: EFNS guideline. Eur J Neurol 2007; 14:e1-26. [PMID: 17222085 DOI: 10.1111/j.1468-1331.2006.01605.x] [Citation(s) in RCA: 336] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The aim of this international guideline on dementia was to present a peer-reviewed evidence-based statement for the guidance of practice for clinical neurologists, geriatricians, psychiatrists, and other specialist physicians responsible for the care of patients with dementia. It covers major aspects of diagnostic evaluation and treatment, with particular emphasis on the type of patient often referred to the specialist physician. The main focus is Alzheimer's disease, but many of the recommendations apply to dementia disorders in general. The task force working group considered and classified evidence from original research reports, meta-analysis, and systematic reviews, published before January 2006. The evidence was classified and consensus recommendations graded according to the EFNS guidance. Where there was a lack of evidence, but clear consensus, good practice points were provided. The recommendations for clinical diagnosis, blood tests, neuroimaging, electroencephalography (EEG), cerebrospinal fluid (CSF) analysis, genetic testing, tissue biopsy, disclosure of diagnosis, treatment of Alzheimer's disease, and counselling and support for caregivers were all revised when compared with the previous EFNS guideline. New recommendations were added for the treatment of vascular dementia, Parkinson's disease dementia, and dementia with Lewy bodies, for monitoring treatment, for treatment of behavioural and psychological symptoms in dementia, and for legal issues. The specialist physician plays an important role together with primary care physicians in the multidisciplinary dementia teams, which have been established throughout Europe. This guideline may contribute to the definition of the role of the specialist physician in providing dementia health care.
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Affiliation(s)
- G Waldemar
- Memory Disorders Research Group, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Denmark.
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Quivet E, Faure R, Georges J, Païssé JO, Herbreteau B, Lantéri P. Photochemical degradation of imazamox in aqueous solution: influence of metal ions and anionic species on the ultraviolet photolysis. J Agric Food Chem 2006; 54:3641-3645. [PMID: 19127738 DOI: 10.1021/jf060097u] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Imazamox [5-methoxymethyl-2-(4-isopropyl-4-methyl-5-oxo-2-imidazolin-2-yl) nicotinic acid] is one of the later pesticides of the imidazolinone family. The fate of imazamox has been studied upon UV irradiation. The degradation of a 10 mg L(-1) imazamox solution leads to pyridine derivatives, which remain in solution for 50-100 h. Most of the photoproducts occurring during the photodegradation have been characterized by means of liquid chromatography coupled with mass spectrometry. The degradation scheme is very similar to that observed for the analogous imazapyr pesticide [2-(4-isopropyl-4-methyl-5-oxo-2-imidazolin-2-yl) nicotinic acid]. Nevertheless, imazamox shows a greater stability than imazapyr. More, complexation interactions between imazamox and metal ions such as Cu2+ or Ca2+ increase the persistence of the pesticide.
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Affiliation(s)
- Etienne Quivet
- Laboratoire des Sciences Analytiques UMR 5180, Université Claude Bernard Lyon 1, Bitiment Raulin, 43 Boulevard du 11 Novembre 1918, 69622 Villeurbanne Cedex, France
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Ghaleb KA, Stephan K, Pittet P, Ferrigno R, Georges J. Investigation of the mixing efficiency of a chaotic micromixer using thermal lens spectrometry. Appl Spectrosc 2006; 60:564-7. [PMID: 16756709 DOI: 10.1366/000370206777412211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This work investigates the efficiency of a chaotic micromixer using thermal lens spectrometry. The outlet of the mixing device was connected to a thermal lens detection head integrating the probe beam optical fibers and the sample capillary. The chaotic micromixer consisted of a Y-shaped poly(dimethylsiloxane) (PDMS) microchip in which ribbed herringbone microstructures were etched on the floor of the main channel. Due to the solvent composition dependence of the thermal lens response, the photothermal method was shown to be highly sensitive to nonhomogeneous mixing compared to fluorescence detection. The apparatus was applied to the determination of Fe2+ with 1,10-phenanthroline using flow injection analysis; a limit of detection of 11 microg L(-1) of iron was obtained.
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Affiliation(s)
- Khalil Abbas Ghaleb
- Laboratoire des Sciences Analytiques, UMR 5180, Bât. CPE-308D, Domaine Scientifique de la Doua, Université Claude Bernard-Lyon 1, 69622 Villeurbanne Cedex, France
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Quivet E, Faure R, Georges J, Paissé JO, Lantéri P. Influence of metal salts on the photodegradation of imazapyr, an imidazolinone pesticide. Pest Manag Sci 2006; 62:407-13. [PMID: 16555231 DOI: 10.1002/ps.1179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The behaviour of imazapyr (2-(4-isopropyl-4-methyl-5-oxo-2-imidazolin-2-yl)nicotinic acid), a broad spectrum herbicide of the imidazolinone family, has been studied under UV radiation in the presence of metal salts. Complexation interactions between imazapyr and metal ions decreased imazapyr photolysis. A chemometric study compared the photodegradation of imazapyr in aqueous solutions in the presence of Na+, Ca2+ or Cu2+ and their concomitant anionic species (Cl-, NO3-) at various pesticide/metal ion molar ratios. The study showed the major role of metal ions in the degradation of imazapyr and its main photoproducts. The molecules were strongly stabilised on complexation with metal ions, leading to an increase in persistence of the pesticide.
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Affiliation(s)
- Etienne Quivet
- Laboratoire des Sciences Analytiques, UMR 5180, Université Claude Bernard Lyon 1, Bâtiment Raulin, 43 Boulevard du 11 Novembre 1918, F-69622 Villeurbanne Cedex, France
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