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Laughlin BS, Anderson JD, Hobbis D, Armstrong M, Vargas CE, Rong Y, Yu NY. Energy use in moderate hypofractionation and stereotactic body radiotherapy for prostate cancer. BJU Int 2023; 132:648-650. [PMID: 37553875 DOI: 10.1111/bju.16151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Affiliation(s)
| | | | - Dean Hobbis
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | | | - Carlos E Vargas
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Yi Rong
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
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Anderson JD, Davis BH, Giang G, Jones A, Lee CR, Parker K, Searcy H, Benner K, Limdi N, Guimbellot JS. Pharmacogenetic actionability and medication prescribing in people with cystic fibrosis. Clin Transl Sci 2023; 16:662-672. [PMID: 36760155 PMCID: PMC10087076 DOI: 10.1111/cts.13479] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 02/11/2023] Open
Abstract
Although major advancements have been made in the therapeutics for people with cystic fibrosis (PwCF), many still require the use of multiple medications to manage acute exacerbations of disease and maintain health. Iterative trial and error processes of pharmacotherapeutic management can be optimized by assessing and incorporating pharmacogenetics. For 82 PwCF, we reviewed 2 years of medication use and response history and interrogated metabolizer status for common pharmacogenes, revealing 3336 medication exposure events (MEEs) to 286 unique medications. As expected, the more frequent MEEs were those commonly used to treat cystic fibrosis (CF), such as antibiotics and respiratory medications. Antibiotics also comprised 56.7% of the undesirable drug responses. The impact of gene variants on drug responses was assessed using Pharmacogenomics Knowledgebase (PharmGKB) and Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines. Thirty-three (11.5%) medications have strong evidence of genetic influence on response as evidenced by gene-based dosing guidelines. 110 (38.5%) unique medications had at least one association with a very important pharmacogene, whereas 143 (50%) were associated with at least one clinical or variant annotation. Over 97% of participants had at least one actionable genotype. Eleven (13.4%) patients with an actionable genotype, taking the impacted medication, had an undesirable drug response described in the CPIC guidelines that could potentially have been mitigated with a priori knowledge of the genotype. PwCF take many medications for disease management, with frequent dose changes to elicit a desired clinical effect. As CF care evolves, implementing pharmacogenetics testing can improve efficiency and safety of prescribing practices using precision selection and dosing at medication initiation.
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Affiliation(s)
- Justin D. Anderson
- Gregory Fleming James Cystic Fibrosis Research CenterUniversity of Alabama at Birmingham (UAB)BirminghamAlabamaUSA
- Division of Pulmonary and Sleep Medicine, Department of PediatricsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Brittney H. Davis
- Department of Neurology, School of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Gracie Giang
- McWhorter School of PharmacySamford UniversityBirminghamAlabamaUSA
| | - April Jones
- McWhorter School of PharmacySamford UniversityBirminghamAlabamaUSA
| | - Cameron R. Lee
- McWhorter School of PharmacySamford UniversityBirminghamAlabamaUSA
| | - Kennedy Parker
- Gregory Fleming James Cystic Fibrosis Research CenterUniversity of Alabama at Birmingham (UAB)BirminghamAlabamaUSA
- Division of Pulmonary and Sleep Medicine, Department of PediatricsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Heather Searcy
- Division of Pulmonary and Sleep Medicine, Department of PediatricsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Kim Benner
- McWhorter School of PharmacySamford UniversityBirminghamAlabamaUSA
| | - Nita A. Limdi
- Department of Neurology, School of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Jennifer S. Guimbellot
- Gregory Fleming James Cystic Fibrosis Research CenterUniversity of Alabama at Birmingham (UAB)BirminghamAlabamaUSA
- Division of Pulmonary and Sleep Medicine, Department of PediatricsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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Laughlin BS, Bhangoo RS, Niska JR, Thorpe CS, Girardo ME, Anderson JD, Kosiorek HE, McGee LA, Hartsell WF, Chang JH, Rossi CJ, Tsai HK, Choi IJ, Vargas CE. Proton therapy for isolated local regional recurrence of breast cancer after mastectomy alone. Front Oncol 2022; 12:925078. [DOI: 10.3389/fonc.2022.925078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 11/10/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose/ObjectivesTo assess adverse events (AEs) and disease-specific outcomes after proton therapy for isolated local-regional recurrence (LRR) of breast cancer after mastectomy without prior radiotherapy (RT).Materials/MethodsPatients were identified from a multi-institutional prospective registry and included if diagnosed with invasive breast cancer, initially underwent mastectomy without adjuvant RT, experienced an LRR, and subsequently underwent salvage treatment, including proton therapy. Follow-up and cancer outcomes were measured from the date of RT completion.ResultsNineteen patients were included. Seventeen patients were treated with proton therapy to the chest wall and comprehensive regional lymphatics (17/19, 90%). Maximum grade AE was grade 2 in 13 (69%) patients and grade 3 in 4 (21%) patients. All patients with grade 3 AE received > 60 GyE (p=0.04, Spearman correlation coefficient=0.5). At the last follow-up, 90% of patients were alive with no LRR or distant recurrence.ConclusionsFor breast cancer patients with isolated LRR after initial mastectomy without adjuvant RT, proton therapy is well-tolerated in the salvage setting with excellent loco-regional control. All grade 3 AEs occurred in patients receiving > 60 GyE.
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Anderson JD, Voss MM, Laughlin BS, Garda AE, Aziz K, Mullikin TC, Haddock MG, Petersen IA, DeWees TA, Vora SA. Outcomes of Proton Beam Therapy Compared With Intensity-Modulated Radiation Therapy for Uterine Cancer. Int J Part Ther 2022; 9:10-17. [PMID: 36721479 PMCID: PMC9875825 DOI: 10.14338/ijpt-22-00020.1] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose To compare Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) in patients with endometrial cancer receiving adjuvant pelvic radiation therapy with proton beam therapy (PT) versus intensity-modulated radiation therapy (IMRT). Materials and Methods Patients with uterine cancer treated with curative intent who received either adjuvant PT or IMRT between 2014 and 2020 were identified. Patients were enrolled into a prospective registry using a gynecologic-specific subset of PRO-CTCAE designed to assess symptom impact on daily living. Questions included gastrointestinal (GI) symptoms of diarrhea, flatulence, bowel incontinence, and constipation in addition to other pertinent gynecologic, urinary, and other general symptoms. Symptom-based questions were on a 0- to 4-point scale, with grade 3+ symptoms occurring frequently or almost always. Patient-reported toxicity was analyzed at baseline, end of treatment (EOT), and at 3, 6, 9, and 12 months after treatment. Unequal variance t tests were used to determine if treatment type was a significant factor in baseline-adjusted PRO-CTCAE. Results Sixty-seven patients met inclusion criteria. Twenty-two received PT and 45 patients received IMRT. Brachytherapy boost was delivered in 73% of patients. Median external beam dose was 45 Gy for both PT and IMRT (range, 45-58.8 Gy). When comparing PRO-CTCAE, PT was associated with less diarrhea at EOT (P = .01) and at 12 months (P = .24) than IMRT. Loss of bowel control at 12 months was more common in patients receiving IMRT (P = .15). Any patient reporting grade 3+ GI toxicity was noted more frequently with IMRT (31% versus 9%, P = .09). Discussion Adjuvant PT is a promising treatment for patients with uterine cancer and may reduce patient-reported GI toxicity as compared with IMRT.
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Affiliation(s)
| | - Molly M. Voss
- Department of Health Sciences Research, Division of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Allison E. Garda
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Khaled Aziz
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Trey C. Mullikin
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Ivy A. Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Todd A. DeWees
- Department of Health Sciences Research, Division of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | - Sujay A. Vora
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
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Guimbellot JS, Ryan KJ, Anderson JD, Parker KL, Odom LV, Rowe SM, Acosta EP. Plasma and cellular ivacaftor concentrations in patients with cystic fibrosis. Pediatr Pulmonol 2022; 57:2745-2753. [PMID: 35927224 PMCID: PMC9588676 DOI: 10.1002/ppul.26093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/29/2022] [Accepted: 07/25/2022] [Indexed: 11/08/2022]
Abstract
Access to cystic fibrosis transmembrane conductance regulator (CFTR) modulators has been gradually increasing for people with cystic fibrosis, the first of which was ivacaftor, a CFTR potentiator that is part of all clinically available modulator treatments. In this study, we hypothesized that the steady-state concentrations in blood and tissue are highly variable in patients taking ivacaftor in a real-world context, which may have an impact on the treatment approach. We collected nasal epithelial cells to estimate target site concentrations and blood samples to estimate pharmacokinetic parameters at a steady state. We found that patients on ivacaftor monotherapy have variable concentrations well above the maximal effective concentration and may maintain concentrations necessary for the clinical benefit even if dosing is reduced. We also are the first to provide detailed target site concentration data over time, which shows that tissue concentrations do not fluctuate significantly and do not correlate with plasma concentrations. These findings show that some patients may have higher-than-expected concentrations and may benefit from tailored dosing to balance clinical response with side effects or adherence needs.
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Affiliation(s)
- Jennifer S. Guimbellot
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham (UAB), Birmingham, AL
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, UAB, Birmingham, AL
| | - Kevin J. Ryan
- Department of Pharmacology and Toxicology, Division of Clinical Pharmacology, UAB, Birmingham, AL
| | - Justin D. Anderson
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, UAB, Birmingham, AL
| | - Kennedy L. Parker
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, UAB, Birmingham, AL
| | - L. Victoria Odom
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, UAB, Birmingham, AL
| | - Steven M. Rowe
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham (UAB), Birmingham, AL
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, UAB, Birmingham, AL
- Departments of Medicine and Cell Developmental and Integrative Biology, UAB, Birmingham, AL
| | - Edward P. Acosta
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham (UAB), Birmingham, AL
- Department of Pharmacology and Toxicology, Division of Clinical Pharmacology, UAB, Birmingham, AL
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Ryan KJ, Guimbellot JS, Dowell AE, Reed-Walker KD, Kerstner-Wood CD, Anderson JD, Liu Z, Acosta EP. Quantitation of Cystic Fibrosis Triple Combination Therapy, Elexacaftor/Tezacaftor/Ivacaftor, in Human Plasma and Cellular Lysate. J Chromatogr B Analyt Technol Biomed Life Sci 2022; 1213:123518. [DOI: 10.1016/j.jchromb.2022.123518] [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] [Received: 07/28/2022] [Revised: 10/07/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
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Laughlin BS, Bhangoo RS, Thorpe CS, Golafshar MA, DeWees TA, Anderson JD, Vern-Gross TZ, McGee LA, Wong WW, Halyard MY, Keole SR, Vargas CE. Patient-reported outcomes for patients with breast cancer undergoing radiotherapy: A single-center registry experience. Front Oncol 2022; 12:920739. [PMID: 36091145 PMCID: PMC9458857 DOI: 10.3389/fonc.2022.920739] [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] [Received: 04/15/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background We present Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) for patients undergoing adjuvant radiotherapy for breast cancer with curative intent. We describe the frequency and severity of PRO-CTCAE and analyze them with respect to dose fractionation. Methods Patients were included in this study if they were treated with curative intent for breast cancer and enrolled on a prospective registry. Patients must have completed at least one baseline and one post-radiation survey that addressed PRO-CTCAE. For univariate and multivariate analysis, categorical variables were analyzed by Fisher’s exact test and continuous variables by Wilcoxon rank sum test. PRO-CTCAE items graded ≥2 and ≥3 were analyzed between patients who received hypofractionation (HF) versus standard conventional fractionation (CF) therapy by the Chi-square test. Results Three hundred thirty-one patients met inclusion criteria. Pathologic tumor stage was T1–T2 in 309 (94%) patients. Eighty-seven (29%) patients were node positive. Two hundred forty-seven patients (75%) experienced any PRO-CTCAE grade ≥2, and 92 (28%) patients experienced any PRO-CTCAE grade ≥3. CF was found to be associated with an increased risk of grade ≥3 skin toxicity, swallowing, and nausea (all p < 0.01). HF (OR 0.48, p < 0.01) was significant in the multivariate model for decreased risk of any occurrence of PRO-CTCAE ≥3. Conclusions Our study reports one of the first clinical experiences utilizing multiple PRO-CTCAE items for patients with breast cancer undergoing radiation therapy with curative intent. Compared with CF, HF was associated with a significant decrease in any PRO-CTCAE ≥3 after multivariate analysis.
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Affiliation(s)
- Brady S. Laughlin
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - Ronik S. Bhangoo
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - Cameron S. Thorpe
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - Michael A. Golafshar
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ, United States
| | - Todd A. DeWees
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ, United States
| | - Justin D. Anderson
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | | | - Lisa A. McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - William W. Wong
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - Michele Y. Halyard
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - Sameer R. Keole
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - Carlos E. Vargas
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
- *Correspondence: Carlos E. Vargas,
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Laughlin BS, Golafshar MA, Ahmed S, Prince M, Anderson JD, Vern-Gross T, Seetharam M, Goulding K, Petersen I, DeWees T, Ashman JB. Early Experience Using Proton Beam Therapy for Extremity Soft Tissue Sarcoma: A Multicenter Study. Int J Part Ther 2022; 9:1-11. [PMID: 35774491 PMCID: PMC9238125 DOI: 10.14338/ijpt-21-00037.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/21/2022] [Indexed: 11/21/2022] Open
Abstract
Abstract
Purpose
Proton beam therapy (PBT) may provide an advantage when planning well-selected patients with extremity soft tissue sarcoma (eSTS), specifically for large, anatomically challenging cases. We analyzed our early experience with PBT on toxicity and outcomes.
Materials and Methods
A retrospective study was performed for eSTS treated between June 2016 and October 2020 with pencil beam scanning PBT at 2 institutions. Diagnostic, treatment, and toxicity characteristics were gathered from baseline to last follow-up or death. Wound complications were defined as secondary operations for wound repair (debridement, drainage, skin graft, and muscle flap) or nonoperative management requiring hospitalization. Statistical analysis was performed with R software.
Results
Twenty consecutive patients with a median age 51.5 years (range, 19–78 years) were included. Median follow-up was 13.7 months (range, 1.7–48.1 months). Tumor presentation was primary (n = 17) or recurrent after prior combined modality therapy (n = 3). Tumor location was either lower extremity (n = 16) or upper extremity (n = 4). Radiation was delivered preoperatively in most patients (n = 18). Median pretreatment tumor size was 7.9 cm (range, 1.3 –30.0 cm). The 1-year locoregional control was 100%. Four patients (20%) had developed metastatic disease by end of follow-up. Maximum toxicity for acute dermatitis was grade 2 in 8 patients (40%) and grade 3 in 3 patients (15%). After preoperative radiation and surgical resection, acute wound complications occurred in 6 patients (35%). Tumor size was larger in patients with acute wound complications compared with those without (medians 16 cm, range [12–30.0 cm] vs 6.3 cm, [1.3–14.4 cm], P = .003).
Conclusion
PBT for well selected eSTS cases demonstrated excellent local control and similar acute wound complication rate comparable to historic controls. Long-term follow-up and further dosimetric analyses will provide further insight into potential advantages of PBT in this patient population.
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Affiliation(s)
| | | | - Safia Ahmed
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Matthew Prince
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | | | | | - Mahesh Seetharam
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Krista Goulding
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Ivy Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Todd DeWees
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
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Bhangoo RS, Cheng TW, Petersen MM, Thorpe CS, DeWees TA, Anderson JD, Vargas CE, Patel SH, Halyard MY, Schild SE, Wong WW. Radiation recall dermatitis: A review of the literature. Semin Oncol 2022; 49:152-159. [DOI: 10.1053/j.seminoncol.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/20/2021] [Accepted: 04/01/2022] [Indexed: 12/28/2022]
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Yang Y, Muller OM, Shiraishi S, Harper M, Amundson AC, Wong WW, McGee LA, Rwigema JCM, Schild SE, Bues M, Fatyga M, Anderson JD, Patel SH, Foote RL, Liu W. Empirical Relative Biological Effectiveness (RBE) for Mandible Osteoradionecrosis (ORN) in Head and Neck Cancer Patients Treated With Pencil-Beam-Scanning Proton Therapy (PBSPT): A Retrospective, Case-Matched Cohort Study. Front Oncol 2022; 12:843175. [PMID: 35311159 PMCID: PMC8928456 DOI: 10.3389/fonc.2022.843175] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 12/25/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To retrospectively investigate empirical relative biological effectiveness (RBE) for mandible osteoradionecrosis (ORN) in head and neck (H&N) cancer patients treated with pencil-beam-scanning proton therapy (PBSPT). Methods We included 1,266 H&N cancer patients, of which, 931 patients were treated with volumetric-modulated arc therapy (VMAT) and 335 were treated with PBSPT. Among them, 26 VMAT and 9 PBSPT patients experienced mandible ORN (ORN group), while all others were included in the control group. To minimize the impact of the possible imbalance in clinical factors between VMAT and PBSPT patients in the dosimetric comparison between these two modalities and the resulting RBE quantification, we formed a 1:1 case-matched patient cohort (335 VMAT patients and 335 PBSPT patients including both the ORN and control groups) using the greedy nearest neighbor matching of propensity scores. Mandible dosimetric metrics were extracted from the case-matched patient cohort and statistically tested to evaluate the association with mandibular ORN to derive dose volume constraints (DVCs) for VMAT and PBSPT, respectively. We sought the equivalent constraint doses for VMAT so that the critical volumes of VMAT were equal to those of PBSPT at different physical doses. Empirical RBEs of PBSPT for ORN were obtained by calculating the ratio between the derived equivalent constraint doses and physical doses of PBSPT. Bootstrapping was further used to get the confidence intervals. Results Clinical variables of age, gender, tumor stage, prescription dose, chemotherapy, hypertension or diabetes, dental extraction, smoking history, or current smoker were not statistically related to the incidence of ORN in the overall patient cohort. Smoking history was found to be significantly associated with the ORN incidence in PBSPT patients only. V40Gy[RBE], V50Gy[RBE], and V60Gy[RBE] were statistically different (p<0.05) between the ORN and control group for VMAT and PBSPT. Empirical RBEs of 1.58(95%CI: 1.34-1.64), 1.34(95%CI: 1.23-1.40), and 1.24(95%: 1.15-1.26) were obtained for proton dose at 40 Gy[RBE=1.1], 50 Gy[RBE=1.1] and 60 Gy[RBE=1.1], respectively. Conclusions Our study suggested that RBEs were larger than 1.1 at moderate doses (between 40 and 60 Gy[RBE=1.1]) with high LET for mandible ORN. RBEs are underestimated in current clinical practice in PBSPT. The derived DVCs can be used for PBSPT plan evaluation and optimization to minimize the incidence rate of mandible ORN.
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Affiliation(s)
- Yunze Yang
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Olivia M Muller
- Department of Dental Specialties, Mayo Clinic Rochester, Rochester, MN, United States
| | - Satomi Shiraishi
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, United States
| | - Matthew Harper
- School of Dentistry, West Virginia University, Morgantown, WV, United States
| | - Adam C Amundson
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, United States
| | - William W Wong
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, United States
| | | | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Martin Bues
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Mirek Fatyga
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Justin D Anderson
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, United States
| | - Wei Liu
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, United States
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Laughlin BS, Anderson JD, Gagneur JD, Chungbin SJ, Bues M, Hobbis D, Fatyga M, Korte SM, Carroll SE, Vora S, Sio TT, Wong WW, Keole SR, Rong Y. Implementation of Photon Treatment Back-Up Workflow at a High-Volume Proton Center: Safety, Quality, and Patient Considerations. Pract Radiat Oncol 2022; 12:e453-e459. [PMID: 35272078 DOI: 10.1016/j.prro.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/11/2022] [Accepted: 01/19/2022] [Indexed: 11/30/2022]
Abstract
A successful proton beam therapy (PBT) center relies heavily on the proper function and maintenance of a proton beam therapy machine. However, when a PBT machine is non-operational, a proton facility is hindered with delays that can potentially lead to inferior treatment outcome due to treatment interruption. The implementation of a workflow for which proton plans are converted to photon plans so that patients can be treated using photon has been a successful strategy to reduce delays and mitigate its impact on patient care. This workflow was established through collaboration of physicians, physicists, dosimetrists, therapists, nurses, and schedulers. A tiered system established by disease site, number of fractions, and individualized circumstances is used to prioritize patients. This article provides an overview of workflow of conversion of PBT to photon when the PBT machine is down. Specific needs of patients undergoing proton beam therapy are addressed.
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Affiliation(s)
- Brady S Laughlin
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - Justin D Anderson
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - Justin D Gagneur
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - Suzanne J Chungbin
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - Martin Bues
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - Dean Hobbis
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - Mirek Fatyga
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - Shawn M Korte
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - Sarah E Carroll
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - Sujay Vora
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - William W Wong
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - Sameer R Keole
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - Yi Rong
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054.
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Laughlin BS, Petersen MM, Yu NY, Anderson JD, Rule WG, Borad MJ, Aqel BA, Sonbol MB, Mathur AK, Moss AA, Bekaii-Saab TS, Ahn DH, DeWees TA, Sio TT, Ashman JB. Clinical outcomes for hilar and extrahepatic cholangiocarcinoma with adjuvant, definitive, or liver transplant-based neoadjuvant chemoradiotherapy strategies: a single-center experience. J Gastrointest Oncol 2022; 13:288-297. [PMID: 35284111 PMCID: PMC8899753 DOI: 10.21037/jgo-21-615] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/11/2022] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND We report our experience with 3 strategies for treating hilar and extrahepatic cholangiocarcinoma (CCA) including chemoradiotherapy: neoadjuvant chemoradiotherapy (nCRT) and orthotopic liver transplant, surgical resection and adjuvant chemoradiotherapy (aCRT), and definitive chemoradiotherapy (dCRT). METHODS We included patients treated from 1998 through 2019. Kaplan-Meier estimates, log-rank testing, and univariate/multivariate Cox models were used to assess outcomes (local progression-free survival, disease-free survival, and overall survival). RESULTS Sixty-five patients (nCRT, n=20; aCRT, n=16; dCRT, n=29) met inclusion criteria [median (range) age 65 years (27-84 years)]. Median posttreatment follow-up was 19.1 months (0.8-164.8 months) for all patients and 38.6, 24.3, and 9.0 months for the nCRT, aCRT, and dCRT groups, respectively. At 3 and 5 years, overall survival was 78% and 59% for the nCRT group; 47% and 35%, aCRT group; and 11% and 0%, dCRT group. Compared with the dCRT group, the nCRT group (hazard ratio =0.13, 95% CI: 0.05-0.33) and the aCRT group (hazard ratio =0.29, 95% CI: 0.14-0.64) had significantly improved overall survival (P<0.001). The 5-year local progression-free survival (50% nCRT vs. 30% aCRT vs. 0% dCRT, P<0.001) and 5-year disease-free survival (61% nCRT vs. 30% aCRT vs. 0% dCRT, P=0.01) were significantly better for strategies combined with surgery. CONCLUSIONS Outcomes for patients with extrahepatic CCA were superior for those who underwent nCRT/orthotopic liver transplant or postsurgical aCRT than for patients treated with dCRT. The excellent outcomes after nCRT/orthotopic liver transplant provide additional independent data supporting the validity of this strategy. The poor survival of patients treated with dCRT highlights a need for better therapies when surgery is not possible.
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Affiliation(s)
- Brady S. Laughlin
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA
| | - Molly M. Petersen
- Clinical Trials and Biostatistics, Mayo Clinic, Scottsdale, Arizona, USA
| | - Nathan Y. Yu
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA
| | - Justin D. Anderson
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA
| | - William G. Rule
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Mitesh J. Borad
- Division of Hematology and Medical Oncology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Bashar A. Aqel
- Division of Gastroenterology and Hepatology, Mayo Clinic Hospital, Phoenix, Arizona, USA
- Transplant Center, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Mohamad B. Sonbol
- Division of Hematology and Medical Oncology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Amit K. Mathur
- Transplant Center, Mayo Clinic Hospital, Phoenix, Arizona, USA
- Division of Transplant and Hepatobiliary Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Adyr A. Moss
- Transplant Center, Mayo Clinic Hospital, Phoenix, Arizona, USA
- Division of Transplant and Hepatobiliary Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Tanios S. Bekaii-Saab
- Division of Hematology and Medical Oncology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Daniel H. Ahn
- Division of Hematology and Medical Oncology, Mayo Clinic Hospital, Phoenix, Arizona, USA
- Mayo Clinic Cancer Center, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Todd A. DeWees
- Clinical Trials and Biostatistics, Mayo Clinic, Scottsdale, Arizona, USA
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Terence T. Sio
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Jonathan B. Ashman
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona, USA
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Liu Z, Anderson JD, Natt J, Guimbellot JS. Culture and Imaging of Human Nasal Epithelial Organoids. J Vis Exp 2021. [PMID: 34978285 DOI: 10.3791/63064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Individualized therapy for cystic fibrosis (CF) patients can be achieved with an in vitro disease model to understand baseline Cystic Fibrosis Transmembrane conductance Regulator (CFTR) activity and restoration from small molecule compounds. Our group recently focused on establishing a well-differentiated organoid model directly derived from primary human nasal epithelial cells (HNE). Histology of sectioned organoids, whole-mount immunofluorescent staining, and imaging (using confocal microscopy, immunofluorescent microscopy, and bright field) are essential to characterize organoids and confirm epithelial differentiation in preparation for functional assays. Furthermore, HNE organoids produce lumens of varying sizes that correlate with CFTR activity, distinguishing between CF and non-CF organoids. In this manuscript, the methodology for culturing HNE organoids are described in detail, focusing on the assessment of differentiation using the imaging modalities, including the measurement of baseline lumen area (a method of CFTR activity measurement in organoids that any laboratory with a microscope can employ) as well as the developed automated approach to a functional assay (which requires more specialized equipment).
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Affiliation(s)
- Zhongyu Liu
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham (UAB); Department of Pediatrics, Division of Pulmonary and Sleep Medicine, UAB
| | - Justin D Anderson
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham (UAB); Department of Pediatrics, Division of Pulmonary and Sleep Medicine, UAB
| | - Jennifer Natt
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham (UAB); Department of Pediatrics, Division of Pulmonary and Sleep Medicine, UAB
| | - Jennifer S Guimbellot
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham (UAB); Department of Pediatrics, Division of Pulmonary and Sleep Medicine, UAB;
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14
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Feng H, Shan J, Anderson JD, Wong WW, Schild SE, Foote RL, Patrick CL, Tinnon KB, Fatyga M, Bues M, Patel SH, Liu W. Per-voxel constraints to minimize hot spots in linear energy transfer-guided robust optimization for base of skull head and neck cancer patients in IMPT. Med Phys 2021; 49:632-647. [PMID: 34843119 DOI: 10.1002/mp.15384] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 08/20/2021] [Revised: 11/03/2021] [Accepted: 11/16/2021] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Due to the employment of quadratic programming using soft constraints to implement dose volume constraints and the "trial-and-error" procedure needed to achieve a clinically acceptable plan, conventional dose volume constraints (upper limit) are not adequately effective in controlling small and isolated hot spots in the dose/linear energy transfer (LET) distribution. Such hot spots can lead to adverse events. In order to mitigate the risk of brain necrosis, one of the most clinically significant adverse events in patients receiving intensity-modulated proton therapy (IMPT) for base of skull (BOS) cancer, we propose per-voxel constraints to minimize hot spots in LET-guided robust optimization. METHODS AND MATERIALS Ten BOS cancer patients treated with IMPT were carefully selected by meeting one of the following conditions: (1) diagnosis of brain necrosis during follow-up; and (2) considered high risk for brain necrosis by not meeting dose constraints to the brain. An optimizing structure (BrainOPT) and an evaluating structure (BrainROI) that both contained the aforementioned hot dose regions in the brain were generated for optimization and evaluation, respectively. Two plans were generated for every patient: one using conventional dose-only robust optimization, the other using LET-guided robust optimization. The impact of LET was integrated into the optimization via a term of extra biological dose (xBD). A novel optimization tool of per-voxel constraints to control small and isolated hot spots in either the dose, LET, or combined (dose/LET) distribution was developed and used to minimize dose/LET hot spots of the selected structures. Indices from dose-volume histogram (DVH) and xBD dose-volume histogram (xBDVH) were used in the plan evaluation. A newly developed tool of the dose-LET-volume histogram (DLVH) was also adopted to illustrate the underlying mechanism. Wilcoxon signed-rank test was used for statistical comparison of the DVH and xBDVH indices between the conventional dose-only and the LET-guided robustly optimized plans. RESULTS Per-voxel constraints effectively and efficiently minimized dose hot spots in both dose-only and LET-guided robust optimization and LET hot spots in LET-guided robust optimization. Compared to the conventional dose-only robust optimization, the LET-guided robust optimization could generate plans with statistically lower xBD hot spots in BrainROI (VxBD,50 Gy[RBE], p = 0.009; VxBD,60 Gy[RBE], p = 0.025; xBD1cc, p = 0.017; xBD2cc, p = 0.022) with comparable dose coverage, dose hot spots in the target, and dose hot spots in BrainROI. DLVH analysis indicated that LET-guided robust optimization could either reduce LET at the same dose level or redistribute high LET from high dose regions to low dose regions. CONCLUSION Per-voxel constraint is a powerful tool to minimize dose/LET hot spots in IMPT. The LET-guided robustly optimized plans outperformed the conventional dose-only robustly optimized plans in terms of xBD hot spots control.
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Affiliation(s)
- Hongying Feng
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Jie Shan
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Justin D Anderson
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - William W Wong
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kathryn B Tinnon
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Mirek Fatyga
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Martin Bues
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Wei Liu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
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Anderson JD, Hu J, Li J, Schild SE, Fatyga M. Impact of Cardiac Dose on Overall Survival in Lung Stereotactic Body Radiotherapy (SBRT) Compared to Conventionally Fractionated Radiotherapy for Locally Advanced Non-Small Cell Lung Cancer (LA-NSCLC). J Cancer Ther 2021; 12:409-423. [PMID: 34367717 PMCID: PMC8341170 DOI: 10.4236/jct.2021.127036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To examine possible association between heart irradiation and Overall Survival (OS) in lung SBRT patients and to compare observed associations with cardiac toxicity models previously derived in LA-NSCLC patient studies. MATERIALS AND METHODS 197 Patients treated with lung SBRT at Mayo Clinic Arizona were selected for this IRB-approved study. Multivariate Cox model with Akaike Information Criterion (AIC) was used to select patient specific covariates associated with OS. Heart dosimetry was represented by VD indices, which is a percentage of volume exposed to dose D or greater. Multivariate Cox models with patient specific covariates and single VD index per model was used to find a range of doses which were predictive for OS. A digital subdivision of the heart was further used to determine the spatial distribution of doses which were predictive for OS. A coarse subdivision divided heart into 4 segments, while the fine subdivision divided heart into 64 segments. Knowledge constrained Fused Lasso operator was used to derive a more complete model which correlated heart dosimetry with OS. Results of statistical analysis were compared to predictions of a model of cardiac toxicity in LA-NSCLC patients. RESULTS Higher age (p < 0.001), higher stage (p < 0.001) and squamous cell histology (p = 0.001) were associated with reduced OS. Whole heart DVH analysis did not reveal associations between heart irradiation and reduced OS. Coarse subdivision of the heart into four segments revealed that the irradiation of two inferior segments of the heart with low doses was associated with reduced OS, V 2Gy in the right-inferior segment (HR = 1.012/1%, p = 0.02), and V 1Gy in the left-inferior segment (HR = 1.01/1%, p = 0.04). Maximum dose in the right-inferior segment of the heart was also associated with reduced OS (HR = 1.02/Gy, p = 0.02). Fine subdivision of the heart into 64 segments revealed that approximately 25% of heart volume in the inferior part of the heart (15/64 segments), when irradiated to doses in the 1 Gy - 5 Gy range, were predictive for reduced OS (HR = 1.01/1%, p = 0.01). A previously derived model of cardiac toxicity in LA-NSCLC patients did not predict a reduction of OS due to heart irradiation in lung SBRT patients, because of relatively low doses to the heart in most lung SBRT patients. CONCLUSIONS Doses lower than 5 Gy in the inferior segments of the heart may be associated with reduced overall survival in patients treated for lung lesions with SBRT. Stage and histology of the disease, as well as patients' age, were also associated with overall survival. Comparisons of cardiac toxicity patterns in LA-NSCLC patients and lung SBRT patients suggest different etiology of cardiac toxicity in the two groups.
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Affiliation(s)
| | - Jiuyun Hu
- School of Computing, Informatics, and Decision Systems Engineering, Tempe, Arizona, USA
| | - Jing Li
- School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Steven E. Schild
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Mirek Fatyga
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
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16
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Anderson JD, Liu Z, Odom LV, Kersh L, Guimbellot JS. CFTR function and clinical response to modulators parallel nasal epithelial organoid swelling. Am J Physiol Lung Cell Mol Physiol 2021; 321:L119-L129. [PMID: 34009038 DOI: 10.1152/ajplung.00639.2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
In vitro biomarkers to assess cystic fibrosis transmembrane conductance regulator activity are desirable for precision modulator selection and as a tool for clinical trials. Here, we describe an organoid swelling assay derived from human nasal epithelia using commercially available reagents and equipment and an automated imaging process. Cells were collected in nasal brush biopsies, expanded in vitro, and cultured as spherical organoids or as monolayers. Organoids were used in a functional swelling assay with automated measurements and analysis, whereas monolayers were used for short-circuit current measurements to assess ion channel activity. Clinical data were collected from patients on modulators. Relationships between swelling data and short-circuit current, as well as between swelling data and clinical outcome measures, were assessed. The organoid assay measurements correlated with short-circuit current measurements for ion channel activity. The functional organoid assay distinguished individual responses as well as differences between groups. The organoid assay distinguished incremental drug responses to modulator monotherapy with ivacaftor and combination therapy with ivacaftor, tezacaftor, and elexacaftor. The swelling activity paralleled the clinical response. In conclusion, an in vitro biomarker derived from patients' cells can be used to predict responses to drugs and is likely to be useful as a preclinical tool to aid in the development of novel treatments and as a clinical trial outcome measure for a variety of applications, including gene therapy or editing.
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Affiliation(s)
- Justin D Anderson
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama.,Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Zhongyu Liu
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama.,Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - L Victoria Odom
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Latona Kersh
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jennifer S Guimbellot
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama.,Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
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17
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Anderson JD, Hammond JB, Kosiorek HE, Thorpe CS, Bhangoo RS, Pockaj BA, Gray RJ, Cronin PA, Rebecca AM, Casey WJ, Wong WW, Keole SR, Vern-Gross TZ, McGee LA, Halyard MY, DeWees TA, Vargas CE. Unplanned implant removal in locally advanced breast cancer. Breast J 2021; 27:466-471. [PMID: 33715231 DOI: 10.1111/tbj.14224] [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: 12/09/2020] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 11/28/2022]
Abstract
Study conducted to determine frequency and timing of unplanned breast implant removal after mastectomy, reconstruction, and postmastectomy radiation (PMRT). From 2010-2017, 52 patients underwent mastectomy, reconstruction, and PMRT. With median follow-up of 3.1 years, 23 patients (44%) experienced implant removal. Implant removal occurred in 9 (17%) patients before starting PMRT and 14 (27%) patients after starting PMRT. Implant removal rates were similar for hypofractionated PMRT compared with standard fractionation and for proton compared with photon PMRT. Implant removal is common for women undergoing mastectomy and reconstruction followed by PMRT. The risk is clinically significant even before starting radiation.
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Affiliation(s)
| | - Jacob B Hammond
- Department of General Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Heidi E Kosiorek
- Department of Health Sciences Research, Division of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Ronik S Bhangoo
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | | | - Richard J Gray
- Department of General Surgery, Mayo Clinic, Phoenix, AZ, USA
| | | | | | - William J Casey
- Department of Plastic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - William W Wong
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Sameer R Keole
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | | | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | | | - Todd A DeWees
- Department of Health Sciences Research, Division of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | - Carlos E Vargas
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
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18
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Goodman CR, Sim AJ, Jeans EB, Anderson JD, Dooley S, Agarwal A, Tye K, Albert A, Gillespie EF, Tendulkar RD, Fuller CD, Kavanagh BD, Campbell SR. No Longer a Match: Trends in Radiation Oncology National Resident Matching Program (NRMP) Data from 2010-2020 and Comparison Across Specialties. Int J Radiat Oncol Biol Phys 2021; 110:278-287. [PMID: 33716120 DOI: 10.1016/j.ijrobp.2021.03.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To report trends in the number and types of applicants and matched trainees to radiation oncology in comparison to other specialties participating in the National Resident Matching Program (NRMP) between 2010 and 2020. METHODS AND MATERIALS Data from the NRMP and Electronic Residency Application System (ERAS) were obtained for 18 medical specialties between 2010 and 2020. We assessed the numbers and types of applicants and matched trainees relative to available positions in the NRMP and Supplemental Offer and Acceptance Program (SOAP). RESULTS In the 2020 NRMP, 122 US MD senior graduates preferentially ranked radiation oncology, a significant decrease from a median of 187 between 2010 to 2019 (interquartile range [IQR], 170-192; P < .001). Across all 18 specialties, radiation oncology experienced the greatest declines in the 2020 NRMP cycle relative to 2010 to 2019, in both the number of ERAS applicants from the United States and Canada (-31%) and the percentage of positions filled by US MD or DO senior graduates (-28%). Of 189 available positions, 81% (n = 154) filled in the NRMP prior to the SOAP, of which 65% (n = 122) were "matched" by US MD senior graduates who preferentially ranked radiation oncology as their top choice of specialty, representing a significant decrease from a median of 92% between 2010 to 2019 (IQR, 88%-94%; P = .002). The percentages of radiation oncology programs and positions unfilled in the NRMP prior to the SOAP were significantly increased in 2020 compared with 2010 to 2019 (programs: 29% vs 8% [IQR, 5%-8%; P < .001]; positions: 19% vs 4% [IQR, 2%-4%; P <.001]). Despite >99% (n = 127 of 128) of US MD or DO senior applicants preferring radiation oncology successfully matching to a radiation oncology position in the 2020 NRMP, 16 of 35 remaining unfilled positions were filled via the SOAP. Radiation oncology was the top user of the SOAP across all specialties participating in the 2020 NRMP, filling 15% of total positions versus a median of 0.9% (IQR, 0.3%-2.3%; P <.001). CONCLUSIONS The supply of radiation oncology residency positions now far exceeds demand by graduating US medical students. Efforts to nullify a market correction revealed by medical student behavior via continued reliance on the SOAP to fill historical levels of training positions may not be in the best of interest of trainees, individual programs, or the specialty as a whole.
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Affiliation(s)
- Chelain R Goodman
- Department of Radiation Oncology, Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Austin J Sim
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | | | - Sarah Dooley
- Department of Radiation Oncology, University of Miami, Miami, Florida
| | - Ankit Agarwal
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Karen Tye
- Department of Radiation Oncology, University of California, San Diego, La Jolla, California
| | - Ashley Albert
- Radiation Oncology, Arizona Center for Cancer Care, Peoria, Arizona
| | - Erin F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Clifton D Fuller
- Department of Radiation Oncology, Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brian D Kavanagh
- Department of Radiation Oncology, University of Colorado at Denver and Health Sciences Center, Aurora, Colorado
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Dooley S, Sim AJ, Campbell SR, Jeans EB, Anderson JD, Tye K, Goodman CR. In Reply to Taunk et al. Int J Radiat Oncol Biol Phys 2021; 109:835-836. [PMID: 33516445 DOI: 10.1016/j.ijrobp.2020.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Sarah Dooley
- Department of Radiation Oncology, University of Miami, Miami, Florida
| | - Austin J Sim
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | | | | | - Karen Tye
- Department of Radiation Oncology, University of California, San Diego, La Jolla, California
| | - Chelain R Goodman
- Department of Radiation Oncology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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20
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Guimbellot JS, Ryan KJ, Anderson JD, Liu Z, Kersh L, Esther CR, Rowe SM, Acosta EP. Variable cellular ivacaftor concentrations in people with cystic fibrosis on modulator therapy. J Cyst Fibros 2020; 19:742-745. [PMID: 32044246 PMCID: PMC7706073 DOI: 10.1016/j.jcf.2020.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 11/08/2019] [Revised: 01/10/2020] [Accepted: 01/26/2020] [Indexed: 12/17/2022]
Abstract
The development of CFTR modulators has transformed the care of patients with cystic fibrosis (CF). Although the clinical efficacy of modulators depends on their concentrations in target tissues, the pharmacokinetic properties of these drugs in epithelia are not utilized to guide patient care. We developed assays to quantitate ivacaftor in cells and plasma from patients on modulator therapy, and our analyses revealed that cellular ivacaftor concentrations differ from plasma concentrations measured concurrently, with evidence of in vivo accumulation of ivacaftor in the cells of patients. While the nature of this study is exploratory and limited by a small number of patients, these findings suggest that techniques to measure modulator concentrations in vivo will be essential to interpreting their clinical impact, particularly given the evidence that ivacaftor concentrations influence the activity and stability of restored CFTR protein.
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Affiliation(s)
- Jennifer S Guimbellot
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham (UAB), Birmingham, AL, United States; Department of Pediatrics, Division of Pulmonary and Sleep Medicine, UAB, Birmingham, AL, United States.
| | - Kevin J Ryan
- Department of Pharmacology and Toxicology, Division of Clinical Pharmacology, UAB, Birmingham, AL, United States
| | - Justin D Anderson
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, UAB, Birmingham, AL, United States
| | - Zhongyu Liu
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, UAB, Birmingham, AL, United States
| | - Latona Kersh
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
| | - Charles R Esther
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, United States
| | - Steven M Rowe
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham (UAB), Birmingham, AL, United States; Department of Pediatrics, Division of Pulmonary and Sleep Medicine, UAB, Birmingham, AL, United States; Departments of Medicine and Cell Developmental and Integrative Biology, UAB, Birmingham, AL, United States
| | - Edward P Acosta
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham (UAB), Birmingham, AL, United States; Department of Pharmacology and Toxicology, Division of Clinical Pharmacology, UAB, Birmingham, AL, United States
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21
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Liu Z, Anderson JD, Deng L, Mackay S, Bailey J, Kersh L, Rowe SM, Guimbellot JS. Human Nasal Epithelial Organoids for Therapeutic Development in Cystic Fibrosis. Genes (Basel) 2020; 11:genes11060603. [PMID: 32485957 PMCID: PMC7349680 DOI: 10.3390/genes11060603] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022] Open
Abstract
We describe a human nasal epithelial (HNE) organoid model derived directly from patient samples that is well-differentiated and recapitulates the airway epithelium, including the expression of cilia, mucins, tight junctions, the cystic fibrosis transmembrane conductance regulator (CFTR), and ionocytes. This model requires few cells compared to airway epithelial monolayer cultures, with multiple outcome measurements depending on the application. A novel feature of the model is the predictive capacity of lumen formation, a marker of baseline CFTR function that correlates with short-circuit current activation of CFTR in monolayers and discriminates the cystic fibrosis (CF) phenotype from non-CF. Our HNE organoid model is amenable to automated measurements of forskolin-induced swelling (FIS), which distinguishes levels of CFTR activity. While the apical side is not easily accessible, RNA- and DNA-based therapies intended for systemic administration could be evaluated in vitro, or it could be used as an ex vivo biomarker of successful repair of a mutant gene. In conclusion, this highly differentiated airway epithelial model could serve as a surrogate biomarker to assess correction of the mutant gene in CF or other diseases, recapitulating the phenotypic and genotypic diversity of the population.
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Affiliation(s)
- Zhongyu Liu
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (Z.L.); (J.D.A.); (S.M.); (L.K.); (S.M.R.)
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, UAB, Birmingham, AL 35233, USA; (L.D.); (J.B.)
| | - Justin D. Anderson
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (Z.L.); (J.D.A.); (S.M.); (L.K.); (S.M.R.)
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, UAB, Birmingham, AL 35233, USA; (L.D.); (J.B.)
| | - Lily Deng
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, UAB, Birmingham, AL 35233, USA; (L.D.); (J.B.)
| | - Stephen Mackay
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (Z.L.); (J.D.A.); (S.M.); (L.K.); (S.M.R.)
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, UAB, Birmingham, AL 35233, USA; (L.D.); (J.B.)
| | - Johnathan Bailey
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, UAB, Birmingham, AL 35233, USA; (L.D.); (J.B.)
| | - Latona Kersh
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (Z.L.); (J.D.A.); (S.M.); (L.K.); (S.M.R.)
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, UAB, Birmingham, AL 35294, USA
| | - Steven M. Rowe
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (Z.L.); (J.D.A.); (S.M.); (L.K.); (S.M.R.)
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, UAB, Birmingham, AL 35233, USA; (L.D.); (J.B.)
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, UAB, Birmingham, AL 35294, USA
- Department of Cell, Developmental and Integrative Biology, UAB, Birmingham, AL 35294, USA
| | - Jennifer S. Guimbellot
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (Z.L.); (J.D.A.); (S.M.); (L.K.); (S.M.R.)
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, UAB, Birmingham, AL 35233, USA; (L.D.); (J.B.)
- Correspondence: ; Tel.: +1-205-234-0250; Fax: +1-205-975-5983
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Thorpe CS, Niska JR, Anderson JD, Girardo ME, McGee LA, Hartsell WF, Larson GL, Tsai HK, Rossi CJ, Rosen LR, Vargas CE. Acute toxicities after proton beam therapy following breast-conserving surgery for breast cancer: Multi-institutional prospective PCG registry analysis. Breast J 2020; 26:1760-1764. [PMID: 32297453 DOI: 10.1111/tbj.13812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/27/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 11/29/2022]
Abstract
We investigated adverse events (AEs) and clinical outcomes for proton beam therapy (PBT) after breast-conserving surgery (BCS) for breast cancer. From 2012 to 2016, 82 patients received PBT in the prospective multi-institutional Proton Collaborative Group registry. AEs were recorded prospectively at each institution. Median follow-up was 8.1 months. Median dose was 50.4 Gy in 28 fractions. Most patients received a lumpectomy bed boost (90%) and regional nodal irradiation (RNI)(83%). Six patients (7.3%) experienced grade 3 AEs (5 with dermatitis, 5 with breast pain). Body mass index (BMI) was associated with grade 3 dermatitis (P = .015). Fifty-eight patients (70.7%) experienced grade ≥2 dermatitis. PBT including RNI after BCS is well-tolerated. Elevated BMI is associated with grade 3 dermatitis.
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Affiliation(s)
| | - Joshua R Niska
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | | | - Marlene E Girardo
- Health Sciences Research, Division of Biostatistics, Mayo Clinic, Scottsdale, Arizona
| | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | | | - Gary L Larson
- ProCure Proton Therapy Center, Oklahoma City, Oklahoma
| | - Henry K Tsai
- ProCure Proton Therapy Center, Somerset, New Jersey
| | - Carl J Rossi
- Scripps Proton Therapy Center, San Diego, California
| | - Lane R Rosen
- Willis-Knighton Proton Therapy Center, Shreveport, Louisiana
| | - Carlos E Vargas
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
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Liu Z, Mackay S, Gordon DM, Anderson JD, Haithcock DW, Garson CJ, Tearney GJ, Solomon GM, Pant K, Prabhakarpandian B, Rowe SM, Guimbellot JS. Co-cultured microfluidic model of the airway optimized for microscopy and micro-optical coherence tomography imaging. Biomed Opt Express 2019; 10:5414-5430. [PMID: 31646055 PMCID: PMC6788592 DOI: 10.1364/boe.10.005414] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/12/2019] [Accepted: 09/20/2019] [Indexed: 05/12/2023]
Abstract
We have developed a human bronchial epithelial (HBE) cell and endothelial cell co-cultured microfluidic model to mimic the in vivo human airway. This airway-on-a-chip was designed with a central epithelial channel and two flanking endothelial channels, with a three-dimensional monolayers of cells growing along the four walls of the channel, forming central clear lumens. These cultures mimic airways and microvasculature in vivo. The central channel cells are grown at air-liquid interface and show features of airway differentiation including tight-junction formation, mucus production, and ciliated cells. Combined with novel micro-optical coherence tomography, this chip enables functional imaging of the interior of the lumen, which includes quantitation of cilia motion including beat frequency and mucociliary transport. This airway-on-a chip is a significant step forward in the development of microfluidics models for functional imaging.
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Affiliation(s)
- Zhongyu Liu
- Department of Pediatrics, University of Alabama at Birmingham, Lowder Building Suite 620, 1600 7th Avenue South, Birmingham, AL 35233, USA
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, MCLM 706, 1918 University Blvd, Birmingham, AL 35294, USA
| | - Stephen Mackay
- Department of Pediatrics, University of Alabama at Birmingham, Lowder Building Suite 620, 1600 7th Avenue South, Birmingham, AL 35233, USA
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, MCLM 706, 1918 University Blvd, Birmingham, AL 35294, USA
| | - Dylan M. Gordon
- Biomedical Technology, CFD Research Corporation, 701 McMillian Way NW, Huntsville, AL 35806, USA
| | - Justin D. Anderson
- Department of Pediatrics, University of Alabama at Birmingham, Lowder Building Suite 620, 1600 7th Avenue South, Birmingham, AL 35233, USA
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, MCLM 706, 1918 University Blvd, Birmingham, AL 35294, USA
| | - Dustin W. Haithcock
- Biomedical Technology, CFD Research Corporation, 701 McMillian Way NW, Huntsville, AL 35806, USA
| | - Charles J. Garson
- Biomedical Technology, CFD Research Corporation, 701 McMillian Way NW, Huntsville, AL 35806, USA
| | - Guillermo J. Tearney
- Department of Pathology, Wellman Center for Photomedicine, Massachusetts General Hospital, & Harvard Medical School, 55 Fruit St., Boston, MA 02114, USA
| | - George M. Solomon
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, MCLM 706, 1918 University Blvd, Birmingham, AL 35294, USA
- Department of Medicine, University of Alabama at Birmingham, THT 422, 1900 University Blvd, Birmingham, AL 35294, USA
| | - Kapil Pant
- Biomedical Technology, CFD Research Corporation, 701 McMillian Way NW, Huntsville, AL 35806, USA
| | | | - Steven M. Rowe
- Department of Pediatrics, University of Alabama at Birmingham, Lowder Building Suite 620, 1600 7th Avenue South, Birmingham, AL 35233, USA
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, MCLM 706, 1918 University Blvd, Birmingham, AL 35294, USA
- Department of Medicine, University of Alabama at Birmingham, THT 422, 1900 University Blvd, Birmingham, AL 35294, USA
| | - Jennifer S. Guimbellot
- Department of Pediatrics, University of Alabama at Birmingham, Lowder Building Suite 620, 1600 7th Avenue South, Birmingham, AL 35233, USA
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, MCLM 706, 1918 University Blvd, Birmingham, AL 35294, USA
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Abstract
BACKGROUND Historically, management of pancreatic cancer has been determined based on whether the tumor was amenable to resection and all patients deemed resectable received curative intent surgery followed by adjuvant therapy with chemotherapy (CT) ± RT. However, patients who undergo resection with microscopic (R1) positive margins have inferior rates of survival. The purpose of this study is to identify patients who have undergone pancreatectomy for pancreatic cancer, determine the surgical margins, types of adjuvant therapies given and patterns of failure. Our hypothesis was that in patients who have surgery without pre-operative therapy, there is a high rate of R1 resections and subsequent local recurrence, despite adjuvant therapy. METHODS Seventy-one patients with curative resections for pancreatic cancer between 2003 and 2015 were reviewed. Tumor stage, margin status, distance to closest margin, receipt of adjuvant therapy and length of survival were collected. Patients were divided into two groups based on whether they received adjuvant CT + RT (n=37) or CT alone (n=37). Patients were further divided based on whether resection was R1 (n=29) or R0 (n=42). Wilcoxon survival tests and Cox proportional hazards regression models were performed to determine the effects of CT + RT vs. CT alone, stratified by surgical margin status. RESULTS Of the 29 patients (39%) who had R1, 15 received CT + RT and 14 received only CT. Patients who received CT + RT experienced a significantly longer period of PFS (13 vs. 7.5 mos, P=0.03) than patients who received CT alone. However, there was no significant difference found in time to death post cancer resection between CT + RT vs. CT alone (P=0.73). Of the 42 patients with R0, 21 received CT + RT and 21 received CT. There was a trend towards increase in PFS in patients treated with CT + RT (25 vs. 17 months, P=0.05), but there was no significant increase in time to death compared to patients treated with CT alone (P=0.53. Of the 36 patients with CT + RT, 21 had R0 and 15 had R1. Patients with R0 were more likely to have longer PFS (25 vs. 13 months, P=0.06), but there was no significant difference in time to death compared to patients with CT alone (P=0.68). CONCLUSIONS After curative resection, the addition of RT to CT improves PFS in both R0 and R1 settings. However, patients with R1 have significantly worse PFS and OS compared to patients with R0 and even aggressive adjuvant therapy does not make up for the difference. The paradigm has shifted and now for patients with resectable pancreatic cancers we recommend neoadjuvant CT + RT to improve RT targeting and treatment response assessment and most importantly, improve chances of obtaining R0.
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Affiliation(s)
- Justin D Anderson
- Department of Radiation Oncology, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Wen Wan
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Brian J Kaplan
- Department of Surgical Oncology, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Jennifer Myers
- Department of Hematology Oncology, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Emma C Fields
- Department of Radiation Oncology, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA 23298, USA
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West AM, Anderson JD, Epstein FH, Meyer CH, Hagspiel KD, Berr SS, Harthun NL, Weltman AL, Annex BH, Kramer CM. Percutaneous intervention in peripheral artery disease improves calf muscle phosphocreatine recovery kinetics: a pilot study. Vasc Med 2012; 17:3-9. [PMID: 22363013 DOI: 10.1177/1358863x11431837] [Citation(s) in RCA: 18] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We hypothesized that percutaneous intervention in the affected lower extremity artery would improve calf muscle perfusion and cellular metabolism in patients with claudication and peripheral artery disease (PAD) as measured by magnetic resonance imaging (MRI) and spectroscopy (MRS). Ten patients with symptomatic PAD (mean ± SD: age 57 ± 9 years; ankle-brachial index (ABI) 0.62 ± 0.17; seven males) were studied 2 months before and 10 months after lower extremity percutaneous intervention. Calf muscle phosphocreatine recovery time constant (PCr) in the revascularized leg was measured by (31)P MRS immediately after symptom-limited exercise on a 1.5-T scanner. Calf muscle perfusion was measured using first-pass gadolinium-enhanced MRI at peak exercise. A 6-minute walk and treadmill test were performed. The PCr recovery time constant improved significantly following intervention (91 ± 33 s to 52 ± 34 s, p < 0.003). Rest ABI also improved (0.62 ± 0.17 to 0.93 ± 0.25, p < 0.003). There was no difference in MRI-measured tissue perfusion or exercise parameters, although the study was underpowered for these endpoints. In conclusion, in this pilot study, successful large vessel percutaneous intervention in patients with symptomatic claudication, results in improved ABI and calf muscle phosphocreatine recovery kinetics.
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Affiliation(s)
- Amy M West
- Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, VA 22908, USA
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West AM, Pesch AJ, Mehta N, Anderson JD, Epstein FH, Meyer CH, Hagspiel KD, Berr SS, Harthun NL, Hunter JR, DiMaria JM, Christopher JM, Kramer CM. Changes in atherosclerotic plaque composition assessed by MRI in the superficial femoral artery with two years of lipid lowering therapy. J Cardiovasc Magn Reson 2011. [PMCID: PMC3106898 DOI: 10.1186/1532-429x-13-s1-p382] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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West AM, Anderson JD, Meyer CH, Epstein FH, Wang H, Hagspiel KD, Berr SS, Harthun NL, DiMaria JM, Hunter JR, Christopher JM, Chew JD, Winberry GB, Kramer CM. The effect of ezetimibe on peripheral arterial atherosclerosis depends upon statin use at baseline. Atherosclerosis 2011; 218:156-62. [PMID: 21570685 PMCID: PMC3157540 DOI: 10.1016/j.atherosclerosis.2011.04.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 03/22/2011] [Accepted: 04/04/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND Both statins and ezetimibe lower LDL-C, but ezetimibe's effect on atherosclerosis is controversial. We hypothesized that lowering LDL-C cholesterol by adding ezetimibe to statin therapy would regress atherosclerosis measured by magnetic resonance imaging (MRI) in the superficial femoral artery (SFA) in peripheral arterial disease (PAD). METHODS Atherosclerotic plaque volume was measured in the proximal 15-20 cm of the SFA in 67 PAD patients (age 63 ± 10, ABI 0.69 ± 0.14) at baseline and annually × 2. Statin-naïve patients (n=34) were randomized to simvastatin 40 mg (S, n=16) or simvastatin 40 mg+ezetimibe 10mg (S+E, n=18). Patients already on statins but with LDL-C >80 mg/dl had open-label ezetimibe 10mg added (E, n=33). Repeated measures models estimated changes in plaque parameters over time and between-group differences. RESULTS LDL-C was lower at year 1 in S+E (67 ± 7 mg/dl) than S (91 ± 8 mg/dl, p<0.05), but similar at year 2 (68 ± 10 mg/dl vs. 83 ± 11 mg/dl, respectively). Plaque volume did not change from baseline to year 2 in either S+E (11.5 ± 1.4-10.5 ± 1.3 cm(3), p=NS) or S (11.0 ± 1.5-10.5 ± 1.4 cm(3), p=NS). In E, plaque progressed from baseline to year 2 (10.0 ± 0.8-10.8 ± 0.9, p<0.01) despite a 22% decrease in LDL-C. CONCLUSIONS Statin initiation with or without ezetimibe in statin-naïve patients halts progression of peripheral atherosclerosis. When ezetimibe is added to patients previously on statins, peripheral atherosclerosis progressed. Thus, ezetimibe's effect on peripheral atherosclerosis may depend upon relative timing of statin therapy.
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Affiliation(s)
- Amy M. West
- Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, VA
| | - Justin D. Anderson
- Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, VA
| | - Craig H. Meyer
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, VA
- Department of Biomedical Engineering, University of Virginia Health System, University of Virginia, Charlottesville, VA
| | - Frederick H. Epstein
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, VA
- Department of Biomedical Engineering, University of Virginia Health System, University of Virginia, Charlottesville, VA
| | - Hongkun Wang
- Department of Public Health Sciences, University of Virginia Health System, University of Virginia, Charlottesville, VA
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC
| | - Klaus D. Hagspiel
- Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, VA
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, VA
| | - Stuart S. Berr
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, VA
- Department of Biomedical Engineering, University of Virginia Health System, University of Virginia, Charlottesville, VA
| | - Nancy L. Harthun
- Department of Surgery and the Cardiovascular Imaging Center, University of Virginia Health System, University of Virginia, Charlottesville, VA
- Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - Joseph M. DiMaria
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, VA
| | - Jennifer R. Hunter
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, VA
| | - John M. Christopher
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, VA
| | - Joshua D. Chew
- Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, VA
| | - Gabriel B. Winberry
- Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, VA
| | - Christopher M. Kramer
- Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, VA
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, VA
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West AM, Anderson JD, Epstein FH, Meyer CH, Wang H, Hagspiel KD, Berr SS, Harthun NL, Weltman AL, DiMaria JM, Hunter JR, Christopher JM, Kramer CM. Low-density lipoprotein lowering does not improve calf muscle perfusion, energetics, or exercise performance in peripheral arterial disease. J Am Coll Cardiol 2011; 58:1068-76. [PMID: 21867844 PMCID: PMC3182461 DOI: 10.1016/j.jacc.2011.04.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 03/02/2011] [Accepted: 04/19/2011] [Indexed: 01/12/2023]
Abstract
OBJECTIVES We hypothesized that low-density lipoprotein (LDL) reduction regardless of mechanism would improve calf muscle perfusion, energetics, or walking performance in peripheral arterial disease (PAD) as measured by magnetic resonance imaging and magnetic resonance spectroscopy. BACKGROUND Statins improve cardiovascular outcome in PAD, and some studies suggest improved walking performance. METHODS Sixty-eight patients with mild to moderate symptomatic PAD (age 65 ± 11 years; ankle-brachial index [ABI] 0.69 ± 0.14) were studied at baseline and annually for 2 years after beginning simvastatin 40 mg (n = 20) or simvastatin 40 mg/ezetimibe 10 mg (n = 18) if statin naïve, or ezetimibe 10 mg (n = 30) if taking a statin. Phosphocreatine recovery time was measured by (31)P magnetic resonance spectroscopy immediately after symptom-limited calf exercise on a 1.5-T scanner. Calf perfusion was measured using first-pass contrast-enhanced magnetic resonance imaging with 0.1 mM/kg gadolinium at peak exercise. Gadolinium-enhanced magnetic resonance angiography was graded. A 6-min walk and a standardized graded Skinner-Gardner exercise treadmill test with peak Vo(2) were performed. A repeated-measures model compared changes over time. RESULTS LDL reduction from baseline to year 2 was greater in the simvastatin 40 mg/ezetimibe 10 mg group (116 ± 42 mg/dl to 56 ± 21 mg/dl) than in the simvastatin 40 mg group (129 ± 40 mg/dl to 90 ± 30 mg/dl, p < 0.01). LDL also decreased in the ezetimibe 10 mg group (102 ± 28 mg/dl to 79 ± 27 mg/dl, p < 0.01). Despite this, there was no difference in perfusion, metabolism, or exercise parameters between groups or over time. Resting ABI did improve over time in the ezetimibe 10 mg group and the entire study group of patients. CONCLUSIONS Despite effective LDL reduction in PAD, neither tissue perfusion, metabolism, nor exercise parameters improved, although rest ABI did. Thus, LDL lowering does not improve calf muscle physiology or functional capacity in PAD. (Comprehensive Magnetic Resonance of Peripheral Arterial Disease; NCT00587678).
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Affiliation(s)
- Amy M. West
- Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, Virginia
| | - Justin D. Anderson
- Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, Virginia
| | - Frederick H. Epstein
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, Virginia
- Department of Biomedical Engineering, University of Virginia Health System, University of Virginia, Charlottesville, Virginia
| | - Craig H. Meyer
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, Virginia
- Department of Biomedical Engineering, University of Virginia Health System, University of Virginia, Charlottesville, Virginia
| | - Hongkun Wang
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC
| | - Klaus D. Hagspiel
- Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, Virginia
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, Virginia
| | - Stuart S. Berr
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, Virginia
- Department of Biomedical Engineering, University of Virginia Health System, University of Virginia, Charlottesville, Virginia
| | - Nancy L. Harthun
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Arthur L. Weltman
- Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, Virginia
| | - Joseph M. DiMaria
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, Virginia
| | - Jennifer R. Hunter
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, Virginia
| | - John M. Christopher
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, Virginia
| | - Christopher M. Kramer
- Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, Virginia
- Department of Radiology, University of Virginia Health System, University of Virginia, Charlottesville, Virginia
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Tyler GL, Sweetnam DN, Anderson JD, Campbell JK, Eshleman VR, Hinson DP, Levy GS, Lindal GF, Marouf EA, Simpson RA. Voyager 2 radio science observations of the uranian system: atmosphere, rings, and satellites. Science 2010; 233:79-84. [PMID: 17812893 DOI: 10.1126/science.233.4759.79] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Voyager 2 radio occultation measurements of the Uranian atmosphere were obtained between 2 and 7 degrees south latitude. Initial atmospheric temperature profiles extend from pressures of 10 to 900 millibars over a height range of about 100 kilometers. Comparison of radio and infrared results yields mole fractions near the tropopause of 0.85 and 0.15 +/- 0.05 for molecular hydrogen and helium, respectively, if no other components are present; for this composition the tropopause is at about 52 kelvins and 110 millibars. Distinctive features in the signal intensity measurements for pressures above 900 millibars strongly favor model atmospheres that include a cloud deck of methane ice. Modeling of the intensity measurements for the cloud region and below indicates that the cloud base is near 1,300 millibars and 81 kelvins and yields an initial methane mole fraction of about 0.02 for the deep atmosphere. Scintillations in signal intensity indicate small-scale stucture throughout the stratosphere and upper troposphere. As judged from data obtained during occultation ingress, the ionosphere consists of a multilayer structure that includes two distinct layers at 2,000 and 3,500 kilometers above the 100-millibar level and an extended topside that may reach altitudes of 10,000 kilometers or more. Occultation measurements of the nine previously known rings at wavelengths of 3.6 and 13 centimeters show characteristic values of optical depth between about 0.8 and 8; the maxim value occurs in the outer region of the in ring, near its periapsis. Forward-scattered signals from this ring have properties that differ from those of any of Saturn's rings, and they are inconsistent with a discrete scattering object or local (three-dimensional) assemblies of orbiting objects. These signals suggest a new kdnd of planetary ring feature characterized by highly ordered cylindrical substructures of radial scale on the order of meters and azimuthal scale of kilometers or more. From radio data alone the mass of the Uranian system is GM(sys) = 5,794,547- 60 cubic kilometers per square second; from a combination of radio and optical navigation data the mass of Uranus alone is GM(u) = 5,793,939+/- 60 cubic kilometers per square second. From all available Voyager data, induding imaging radii, the mean uncompressed density of the five major satellites is 1.40+/- 0.07 grams per cubic centimeter; this value is consistent with a solar mix of material and apparently rules out a cometary origin of the satellites.
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Mehta AM, Jordan RL, Anderson JD, Mattoo AK. Identification of a unique isoform of 1-aminocyclopropane-1-carboxylic acid synthase by monoclonal antibody. Proc Natl Acad Sci U S A 2010; 85:8810-4. [PMID: 16593998 PMCID: PMC282596 DOI: 10.1073/pnas.85.23.8810] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
1-Aminocyclopropane-1-carboxylic acid (ACC) synthase (EC 4.4.1.14) is a key enzyme regulating ethylene biosynthesis in higher plants. A monoclonal antibody (mAb T20C) that immunoprecipitates the ACC synthase activity from tomato pericarp tissue extracts revealed that mAb T20C immunodecorates an approximately 67-kDa polypeptide. On isoelectric focusing gels, ACC synthase activity in cell-free preparations was resolved into three distinct activity peaks with pI values 5.3, 7, and 9. mAb T20C specifically recognized the pI 7 form of the enzyme on electrophoretic transfer (Western) blots. When analyzed by sodium dodecyl sulfate gel electrophoresis under reducing conditions, the eluted pI 7 form was confirmed to migrate as a polypeptide of 67 kDa. The 67-kDa pI 7 isoform is a previously undescribed form of ACC synthase.
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Affiliation(s)
- A M Mehta
- Beltsville Agricultural Research Center, U.S. Department of Agriculture, Agricultural Research Service, Beltsville, MD 20705
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West AM, Anderson JD, Meyer CH, Epstein FH, Hagspiel KD, Berr SS, Harthun NL, DiMaria JM, Hunter JR, Christopher JM, Winberry GB, Van Opstal EJ, Chew JD, Kramer CM. Type of lipid lowering therapy impacts atherosclerosis progression in peripheral arterial disease as assessed by CMR. J Cardiovasc Magn Reson 2010. [DOI: 10.1186/1532-429x-12-s1-p130] [Citation(s) in RCA: 2] [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: 11/10/2022] Open
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West AM, Anderson JD, Epstein FH, Meyer CH, Hagspiel KD, Wang H, Berr SS, Harthun NL, Weltman AL, DiMaria JM, Hunter JR, Christopher JM, Kramer CM. Diffferential effects of LDL Lowering on CMR measures of calf muscle perfusion and cellular metabolism in peripheral arterial disease. J Cardiovasc Magn Reson 2010. [DOI: 10.1186/1532-429x-12-s1-o93] [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: 11/10/2022] Open
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Anderson JD, Epstein FH, Meyer CH, Hagspiel KD, Wang H, Berr SS, Harthun NL, Weltman A, Dimaria JM, West AM, Kramer CM. Multifactorial determinants of functional capacity in peripheral arterial disease: uncoupling of calf muscle perfusion and metabolism. J Am Coll Cardiol 2009; 54:628-35. [PMID: 19660694 DOI: 10.1016/j.jacc.2009.01.080] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 01/06/2009] [Accepted: 01/14/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We aimed to investigate the pathophysiology of peripheral arterial disease (PAD) by examining magnetic resonance imaging (MRI) and spectroscopic (MRS) correlates of functional capacity. BACKGROUND Despite the high prevalence, morbidity, and cost of PAD, its pathophysiology is incompletely understood. METHODS Eighty-five patients (age 68 +/- 10 years) with mild-to-moderate PAD (ankle-brachial index 0.69 +/- 0.14) had their most symptomatic leg studied by MRI/MRS. Percent wall volume in the superficial femoral artery was measured with black blood MRI. First-pass contrast-enhanced MRI calf muscle perfusion and (31)P MRS phosphocreatine recovery time constant (PCr) were measured at peak exercise in calf muscle. All patients underwent magnetic resonance angiography (MRA), treadmill testing with maximal oxygen consumption measurement, and a 6-min walk test. RESULTS Mean MRA index of number and severity of stenoses was 0.84 +/- 0.68 (normal 0), % wall volume 74 +/- 11% (normal 46 +/- 7%), tissue perfusion 0.039 +/- 0.015 s(-1) (normal 0.065 +/- 0.013 s(-1)), and PCr 87 +/- 54 s (normal 34 +/- 16 s). MRA index, % wall volume, and ankle-brachial index correlated with most functional measures. PCr was the best correlate of treadmill exercise time, whereas calf muscle perfusion was the best correlate of 6-min walk distance. No correlation was noted between PCr and tissue perfusion. CONCLUSIONS Functional limitations in PAD are multifactorial. As measured by MRI and spectroscopy, atherosclerotic plaque burden, stenosis severity, tissue perfusion, and energetics all play a role. However, cellular metabolism is uncoupled from tissue perfusion. These findings suggest a potential role for therapies that regress plaque, increase tissue perfusion, and/or improve cellular metabolism. (Comprehensive Magnetic Resonance of Peripheral Arterial Disease; NCT00587678).
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Affiliation(s)
- Justin D Anderson
- Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, VA 22908, USA
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West AM, Anderson JD, Meyer CD, Epstein FH, Hagspiel KD, Berr SS, Harthun NL, DiMaria JM, Hunter JR, Christopher JM, Winberry GB, Kramer CM. Initiation of statin therapy halts progression of atherosclerotic plaque burden in peripheral arterial disease. J Cardiovasc Magn Reson 2009. [PMCID: PMC7860780 DOI: 10.1186/1532-429x-11-s1-o19] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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West AM, Anderson JD, Epstein FH, Meyer CH, Hagspiel KD, Berr SS, Harthun NL, Weltman AL, DiMaria JM, Hunter JR, Christopher JM, Kramer CM. Does lipid lowering therapy improve calf muscle perfusion and cellular metabolism in peripheral arterial disease? J Cardiovasc Magn Reson 2009. [PMCID: PMC7860684 DOI: 10.1186/1532-429x-11-s1-o61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Anderson JD. Reports show reforms working. Malpractice lawsuits in state down by 45 percent. W V Med J 2008; 104:28-29. [PMID: 19006902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Anderson JD, Epstein FH, Meyer CH, Hagspiel KD, Berr SS, Weltman AL, Wang H, Harthun NL, Norton PT, Isbell DC, Kramer CM. 1042 Multi-modality magnetic resonance demonstrates factors critical to functional capacity in peripheral arterial disease. J Cardiovasc Magn Reson 2008. [DOI: 10.1186/1532-429x-10-s1-a167] [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: 11/10/2022] Open
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Abstract
Atherosclerosis is a prevalent disease affecting millions of Americans. Despite our advances in diagnosis and treatment, atherosclerosis is the leading cause of death in America. High-resolution magnetic resonance imaging has overcome the limitations of current angiographic techniques and has emerged as a leading noninvasive imaging modality for atherosclerotic disease. Atherosclerosis of the arterial wall of the human carotid, aortic, peripheral and coronary arteries have all been successfully evaluated. In addition, the power of magnetic resonance imaging to differentiate the major components of atherosclerotic plaque has been validated. The ability to image the vessel wall and risk stratify atherosclerotic plaque will create management decisions not previously faced, and has the potential to change the way atherosclerosis is treated.
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Affiliation(s)
- Christopher M Kramer
- University of Virginia Health System, Department of Medicine, Lee Street, Box 800170, Charlottesville, VA 22908, USA.
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Affiliation(s)
- Laszlo Littmann
- Department of Internal Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
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Abstract
Females of many invertebrates contain stored sperm or fertilized eggs or both, causing potential genotyping errors. We investigated errors caused by male DNA contamination by amplifying 5 microsatellites in DNA isolated from various tissue types in the nematode Ascaris lumbricoides. We observed additional alleles in 30/135 uterus-derived samples when compared with muscle controls, resulting in 20/135 (15%) incorrect genotypes and an underestimation of inbreeding. In contrast, we observed additional alleles in only 5/143 ovary-derived samples, resulting in 4/143 (3%) incorrect genotypes and no significant influence on inbreeding estimates. Because uterus constitutes approximately 17% of a female's organ weight, a substantial proportion of samples isolated from female tissue may contain male-derived DNA. Male contamination is easily avoided when using large nematodes such as A. lumbricoides. However, we urge caution for studies using DNA isolated from small invertebrates that store sperm or fertilized eggs or both.
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Affiliation(s)
- J D Anderson
- Southwest Foundation for Biomedical Research, P.O. Box 760549, San Antonio, Texas 78245-0549, USA.
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Clarke MP, Wright CM, Hrisos S, Anderson JD, Henderson J, Richardson SR. Randomised controlled trial of treatment of unilateral visual impairment detected at preschool vision screening. BMJ 2003; 327:1251. [PMID: 14644966 PMCID: PMC286242 DOI: 10.1136/bmj.327.7426.1251] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2003] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To test the efficacy of treatment for unilateral visual loss detected by preschool vision screening and the extent to which effectiveness varies with initial severity. DESIGN Randomised controlled trial of full treatment with glasses and patching, if required, compared with glasses only or no treatment. Masked assessment of best corrected acuity after one year of follow up. SETTING Eight UK eye departments. PARTICIPANTS 177 children aged 3-5 years with mild to moderate unilateral impairment of acuity (6/9 to 6/36) detected by screening. RESULTS Children in the full and glasses treatment groups had incrementally better visual acuity at follow up than children who received no treatment, but the mean treatment effect between full and no treatment was equivalent to only one line on a Snellen chart (0.11 log units; 95% confidence interval 0.050 to 0.171; P < 0.0001). The effects of treatment depended on initial acuity: full treatment showed a substantial effect in the moderate acuity group (6/36 to 6/18 at recruitment) and no significant effect in the mild acuity group (6/9 to 6/12 at recruitment) (P = 0.006 for linear regression interaction term). For 64 children with moderate acuity loss the treatment effect was 0.20 log units, equivalent to one to two lines on a Snellen chart. When all children had received treatment, six months after the end of the trial, there was no significant difference in acuity between the groups. CONCLUSIONS Treatment is worth while in children with the poorest acuity, but in children with mild (6/9 to 6/12) unilateral acuity loss there was little benefit. Delay in treatment until the age of 5 did not seem to influence effectiveness.
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Affiliation(s)
- M P Clarke
- Department of Ophthalmology, School of Neurobiology, Neurology and Psychiatry, University of Newcastle upon Tyne, Newcastle NE2 4HH.
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Anderson JD, Thåström A, Widom J. Spontaneous access of proteins to buried nucleosomal DNA target sites occurs via a mechanism that is distinct from nucleosome translocation. Mol Cell Biol 2002; 22:7147-57. [PMID: 12242292 PMCID: PMC139820 DOI: 10.1128/mcb.22.20.7147-7157.2002] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Intrinsic nucleosome dynamics termed "site exposure" provides spontaneous and cooperative access to buried regions of nucleosomal DNA in vitro. Two different mechanisms for site exposure have been proposed, one based on nucleosome translocation, the other on dynamic nucleosome conformational changes in which a stretch of the nucleosomal DNA is transiently released off the histone surface. Here we report on three experiments that distinguish between these mechanisms. One experiment investigates the effects on the accessibilities of restriction enzyme target sites inside nucleosomes when extra DNA (onto which the nucleosome may move at low energetic cost) is appended onto one end. The other two experiments test directly for nucleosome mobility under the conditions used to probe accessibility to restriction enzymes: one on a selected nonnatural nucleosome positioning sequence, the other on the well-studied 5S rRNA gene nucleosome positioning sequence. We find from all three assays that restriction enzymes gain access to sites throughout the entire length of the nucleosomal DNA without contribution from nucleosome translocation. We conclude that site exposure in nucleosomes in vitro occurs via a nucleosome conformational change that leads to transient release of a stretch of DNA from the histone surface, most likely involving progressive uncoiling from an end. Recapture at a distal site along DNA that has partially uncoiled would result in looped structures which are believed to contribute to RNA polymerase elongation and may contribute to spontaneous or ATP-driven nucleosome mobility. Transient open states may facilitate the initial entry of transcription factors and enzymes in vivo.
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Affiliation(s)
- J D Anderson
- Department of Biochemistry, Molecular Biology, and Cell Biology and Department of Chemistry, Northwestern University, Evanston, Illinois 60208-3500, USA
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Anderson JD, Littmann L. Stress single photon emission computed tomography in patients with normal electrocardiograms. Circulation 2002; 106:e71-2; author reply e71-2. [PMID: 12370237 DOI: 10.1161/01.cir.0000033851.52048.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kellersberger KA, Anderson JD, Ward SM, Krakowiak KE, Dearden DV. Encapsulation of N(2), O(2), methanol, or acetonitrile by decamethylcucurbit[5]uril(NH(4)(+))(2) complexes in the gas phase: influence of the guest on "lid" tightness. J Am Chem Soc 2001; 123:11316-7. [PMID: 11697985 DOI: 10.1021/ja017031u] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- K A Kellersberger
- Department of Chemistry and Biochemistry, C100 Benson Science Building, Brigham Young University, Provo, Utah 84602-5700, USA
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Abstract
Polypurine tracts are important elements of eukaryotic promoters. They are believed to somehow destabilize chromatin, but the mechanism of their action is not known. We show that incorporating an A(16) element at an end of the nucleosomal DNA and further inward destabilizes histone-DNA interactions by 0.1 +/- 0.03 and 0.35 +/- 0.04 kcal mol(-1), respectively, and is accompanied by 1.5- +/- 0.1-fold and 1.7- +/- 0.1-fold increases in position-averaged equilibrium accessibility of nucleosomal DNA target sites. These effects are comparable in magnitude to effects of A(16) elements that correlate with transcription in vivo, suggesting that our system may capture most of their physiological role. These results point to two distinct but interrelated models for the mechanism of action of polypurine tract promoter elements in vivo. Given a nucleosome positioned over a promoter region, the presence of a polypurine tract in that nucleosome's DNA decreases the stability of the DNA wrapping, increasing the equilibrium accessibility of other DNA target sites buried inside that nucleosome. Alternatively (if nucleosomes are freely mobile), the presence of a polypurine tract provides a free energy bias for the nucleosome to move to alternative locations, thereby changing the equilibrium accessibilities of other nearby DNA target sites.
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Affiliation(s)
- J D Anderson
- Department of Biochemistry, Molecular Biology, and Cell Biology, Illinois 60208, USA
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Abstract
Posttranslational acetylation of the conserved core histone N-terminal tail domains is linked to gene activation, but the molecular mechanisms involved are not known. In an earlier study we showed that removing the tail domains altogether by trypsin proteolysis (which leaves nucleosomes nevertheless intact) leads to 1.5 to 14-fold increases in the dynamic equilibrium accessibility of nucleosomal DNA target sites. These observations suggested that, by modestly increasing the equilibrium accessibility of buried DNA target sites, histone acetylation could result in an increased occupancy by regulatory proteins, ultimately increasing the probability of transcription initiation. Here, we extend these observations to a more natural system involving intact but hyperacetylated nucleosomes. We find that histone hyperacetylation leads to 1.1 to 1.8-fold increases in position-dependent equilibrium constants for exposure of nucleosomal DNA target sites, with an average increase of 1.4(+/-0.1)-fold. The mechanistic and biological implications of these results are discussed.
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Affiliation(s)
- J D Anderson
- Department of Biochemistry Molecular Biology, and Cell Biology, Northwestern University, Evanston, IL, 60208-3500, USA
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Sloan JA, Tolman DE, Anderson JD, Sugar AW, Wolfaardt JF, Novotny P. Patients with reconstruction of craniofacial or intraoral defects: development of instruments to measure quality of life. Int J Oral Maxillofac Implants 2001; 16:225-45. [PMID: 11324211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Patients with reconstruction of craniofacial or intraoral defects experience a profound impact on their quality of life (QOL). This impact on QOL is influenced by the patients' medical conditions and the treatment interventions. Instruments to measure general QOL have been available for many years. A major criticism of QOL instruments is that too often the questions are not specific to the particular problems of a disease or condition. A search of the literature regarding QOL measurement for patients with maxillofacial implant-supported prostheses produced a short list of instruments, none of which were sufficiently developed or suited to the patients involved in reconstructive treatment. This study was designed to develop pretreatment and posttreatment questionnaires for measuring QOL for patients with reconstruction of a craniofacial defect and patients with reconstruction of loss of specific intraoral structures utilizing an implant-supported prosthesis (e.g., severe resorption of the maxilla or mandible or both). The goal was to develop brief, targeted instruments for this specific patient population. The produced instruments were sensitive and easy to administer and score, and no disruption of clinical care occurred with the administration of the questionnaires. The instruments were used with equal success both in face-to-face interviews and via mail.
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Affiliation(s)
- J A Sloan
- Mayo Medical School, Rochester, Minnesota, USA.
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Heasley VL, Wadley BD, Alexander MD, Anderson JD, Anderson JH, Allen RT, Hernandez ML, Ismail ML, Sigmund GA, Shellhamer DF. A reinvestigation of the synthesis of Hantzsch's acid: comparison of derivatives of Hantzsch's acid with a product from the reaction of 2, 4,6-trichlorophenol and hypochlorite ion in methanol. J Org Chem 2000; 65:8111-3. [PMID: 11073632 DOI: 10.1021/jo0010025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- V L Heasley
- Department of Chemistry, Point Loma Nazarene University, San Diego, California 92106, USA.
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