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Seifert ME, Mannon RB, Nellore A, Young J, Wiseman AC, Cohen DJ, Peddi VR, Brennan DC, Morgan CJ, Peri K, Aban I, Whitley RJ, Gnann JW. A multicenter prospective study to define the natural history of BK viral infections in kidney transplantation. Transpl Infect Dis 2024; 26:e14237. [PMID: 38341645 DOI: 10.1111/tid.14237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND BK polyomavirus (BKV) can cause permanent loss of allograft function due to BKV-associated nephropathy (BKVN) in kidney transplant recipients. Besides immunosuppression reduction, there are no consistently effective interventions for BKV infection. Study purpose was to define natural history of BKV infection, identify risk factors for BKV reactivation and BKVN in kidney transplant recipients, and inform the design/conduct of future clinical trials of BKV-targeted therapeutics. METHODS We conducted a multicenter prospective observational study of incident kidney transplant recipients at six U.S. transplant centers. Participants were monitored every 4 weeks for BKV reactivation and followed for up to 24 months post-transplant. We used regression models (logistic, survival, mixed models) to study relationships between BK viremia/BKVN, clinical characteristics, and allograft function. RESULTS We enrolled 335 participants. Fifty-eight (17%) developed BK viremia, 6 (2%) developed biopsy-proven BKVN, and 29 (9%) developed suspected/presumed BKVN (defined as BKV viral load > 10,000 copies/mL without biopsy). Male donor sex was associated with lower odds for BK viremia, whereas recipient Black race was associated with two-fold increased odds for BK viremia. Recipient female sex was associated with more rapid clearance of BK viremia. Persistent BK viremia/BKVN was associated with poorer allograft function by 24 months post-transplant. CONCLUSIONS We identified multiple donor and recipient demographic factors associated with risk for BKV infection and poorer allograft function by 24 months post-transplant. This may help design future clinical trials of therapies to prevent or mitigate the deleterious impact of BKV reactivation on kidney transplant outcomes.
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Affiliation(s)
- Michael E Seifert
- Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Roslyn B Mannon
- Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Anoma Nellore
- Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA
| | - JoAnne Young
- School of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - David J Cohen
- Columbia University Medical Center, New York, New York, USA
| | - V Ram Peddi
- California Pacific Medical Center, San Francisco, California, USA
| | - Daniel C Brennan
- School of Medicine, Washington University, St. Louis, Missouri, USA
| | - Charity J Morgan
- Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kalyani Peri
- Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Inmaculada Aban
- Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Richard J Whitley
- Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA
| | - John W Gnann
- Medical University of South Carolina, Charleston, South Carolina, USA
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2
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Kimberlin DW, Aban I, Peri K, Nishikawa JK, Bernatoniene J, Emonts M, Klein N, Bamford A, DeBiasi RL, Faust SN, Jones CE, McMaster P, Caserta M, Ahmed A, Sharland M, Demmler-Harrison G, Hackett S, Sánchez PJ, Shackley F, Kelly D, Dennehy PH, Storch GA, Whitley RJ, Griffiths P. Oral Valganciclovir Initiated Beyond 1 Month of Age as Treatment of Sensorineural Hearing Loss Caused by Congenital Cytomegalovirus Infection: A Randomized Clinical Trial. J Pediatr 2024; 268:113934. [PMID: 38309519 DOI: 10.1016/j.jpeds.2024.113934] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/29/2023] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE The objective of this study was to determine if valganciclovir initiated after 1 month of age improves congenital cytomegalovirus-associated sensorineural hearing loss. STUDY DESIGN We conducted a randomized, double-blind, placebo-controlled phase 2 trial of 6 weeks of oral valganciclovir at US (n = 12) and UK (n = 9) sites. Patients of ages 1 month through 3 years with baseline sensorineural hearing loss were enrolled. The primary outcome was change in total ear hearing between baseline and study month 6. Secondary outcome measures included change in best ear hearing and reduction in cytomegalovirus viral load in blood, saliva, and urine. RESULTS Of 54 participants enrolled, 35 were documented to have congenital cytomegalovirus infection and were randomized (active group: 17; placebo group: 18). Mean age at enrollment was 17.8 ± 15.8 months (valganciclovir) vs 19.5 ± 13.1 months (placebo). Twenty (76.9%) of the 26 ears from subjects in the active treatment group did not have worsening of hearing, compared with 27 (96.4%) of 28 ears from subjects in the placebo group (P = .09). All other comparisons of total ear or best ear hearing outcomes were also not statistically significant. Saliva and urine viral loads decreased significantly in the valganciclovir group but did not correlate with change in hearing outcome. CONCLUSIONS In this randomized controlled trial, initiation of antiviral therapy beyond the first month of age did not improve hearing outcomes in children with congenital cytomegalovirus-associated sensorineural hearing loss. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier NCT01649869.
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Affiliation(s)
| | | | - Kalyani Peri
- University of Alabama at Birmingham, Birmingham, AL
| | | | - Jolanta Bernatoniene
- University Hospitals Bristol & Weston NHS Foundation Trust, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Marieke Emonts
- Great North Children's Hospital, Paediatric Immunology, Infectious Diseases & Allergy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Nigel Klein
- Infection, Immunity and Inflammation Research & Teaching Department, UCL GOS Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom
| | - Alasdair Bamford
- Infection, Immunity and Inflammation Research & Teaching Department, UCL GOS Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom
| | | | - Saul N Faust
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre University Hospital Southampton NHS Foundation Trust and Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Christine E Jones
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre University Hospital Southampton NHS Foundation Trust and Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
| | | | | | | | | | | | - Scott Hackett
- Birmingham Heartlands Hospital, Birmingham, United Kingdom
| | - Pablo J Sánchez
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Fiona Shackley
- Sheffield Children's Hospital, Sheffield, United Kingdom
| | - Dominic Kelly
- Oxford NIHR BRC, OUH NHS Foundation Trust, Oxford, United Kingdom
| | - Penelope H Dennehy
- Alpert Medical School of Brown University and Hasbro Children's Hospital, Providence, RI
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Bebin EM, Peters JM, Porter BE, McPherson TO, O'Kelley S, Sahin M, Taub KS, Rajaraman R, Randle SC, McClintock WM, Koenig MK, Frost MD, Northrup HA, Werner K, Nolan DA, Wong M, Krefting JL, Biasini F, Peri K, Cutter G, Krueger DA. Early Treatment with Vigabatrin Does Not Decrease Focal Seizures or Improve Cognition in Tuberous Sclerosis Complex: The PREVeNT Trial. Ann Neurol 2023; 95:15-26. [PMID: 37638552 PMCID: PMC10899525 DOI: 10.1002/ana.26778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/07/2023] [Accepted: 08/20/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE This study was undertaken to test the hypothesis that early vigabatrin treatment in tuberous sclerosis complex (TSC) infants improves neurocognitive outcome at 24 months of age. METHODS A phase IIb multicenter randomized double-blind placebo-controlled trial was conducted of vigabatrin at first epileptiform electroencephalogram (EEG) versus vigabatrin at seizure onset in infants with TSC. Primary outcome was Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) cognitive assessment score at 24 months. Secondary outcomes were prevalence of drug-resistant epilepsy, additional developmental outcomes, and safety of vigabatrin. RESULTS Of 84 infants enrolled, 12 were screen failures, 4 went straight to open label vigabatrin, and 12 were not randomized (normal EEG throughout). Fifty-six were randomized to early vigabatrin (n = 29) or placebo (n = 27). Nineteen of 27 in the placebo arm transitioned to open label vigabatrin, with a median delay of 44 days after randomization. Bayley-III cognitive composite scores at 24 months were similar for participants randomized to vigabatrin or placebo. Additionally, no significant differences were found between groups in overall epilepsy incidence and drug-resistant epilepsy at 24 months, time to first seizure after randomization, and secondary developmental outcomes. Incidence of infantile spasms was lower and time to spasms after randomization was later in the vigabatrin group. Adverse events were similar across groups. INTERPRETATION Preventative treatment with vigabatrin based on EEG epileptiform activity prior to seizure onset does not improve neurocognitive outcome at 24 months in TSC children, nor does it delay onset or lower the incidence of focal seizures and drug-resistant epilepsy at 24 months. Preventative vigabatrin was associated with later time to onset and lower incidence of infantile spasms. ANN NEUROL 2023.
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Affiliation(s)
| | - Jurriaan M Peters
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brenda E Porter
- Department of Neurology, Stanford University, Stanford, CA, USA
| | - Tarrant O McPherson
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Sarah O'Kelley
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mustafa Sahin
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Rosamund Stone Zander Translational Neuroscience Center, Boston Children's Hospital, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Katherine S Taub
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rajsekar Rajaraman
- Department of Pediatrics and Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Stephanie C Randle
- Department of Pediatrics, Division Pediatric Neurology and Epilepsy, Seattle Children's Hospital, Seattle, WA, USA
| | - William M McClintock
- Department of Pediatrics, Division of Neurology, Children's National Medical Center, Washington, DC, USA
| | - Mary Kay Koenig
- Department of Pediatrics, McGovern Medical School at University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Mike D Frost
- Minnesota Epilepsy Group, P.A., Minnesota Epilepsy Group, Roseville, MN, USA
| | - Hope A Northrup
- Department of Pediatrics, McGovern Medical School at University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Klaus Werner
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Danielle A Nolan
- Beaumont Florence and Richard McBrien Pediatric Neuroscience Center, Beaumont Hospital, Royal Oak, MI, USA
| | - Michael Wong
- Department of Neuroscience, Washington University in Saint Louis, Saint Louis, MO, USA
| | - Jessica L Krefting
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Fred Biasini
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kalyani Peri
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Darcy A Krueger
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
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Lavin KM, Graham ZA, McAdam JS, O'Bryan SM, Drummer D, Bell MB, Kelley CJ, Lixandrão ME, Peoples B, Tuggle SC, Seay RS, Van Keuren-Jensen K, Huentelman MJ, Pirrotte P, Reiman R, Alsop E, Hutchins E, Antone J, Bonfitto A, Meechoovet B, Palade J, Talboom JS, Sullivan A, Aban I, Peri K, Broderick TJ, Bamman MM. Dynamic transcriptomic responses to divergent acute exercise stimuli in young adults. Physiol Genomics 2023; 55:194-212. [PMID: 36939205 PMCID: PMC10110731 DOI: 10.1152/physiolgenomics.00144.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/08/2023] [Accepted: 03/06/2023] [Indexed: 03/21/2023] Open
Abstract
Acute exercise elicits dynamic transcriptional changes that, when repeated, form the fundamental basis of health, resilience, and performance adaptations. While moderate-intensity endurance training combined with conventional resistance training (traditional, TRAD) is often prescribed and recommended by public health guidance, high-intensity training combining maximal-effort intervals with intensive, limited-rest resistance training is a time-efficient alternative that may be used tactically (HITT) to confer similar benefits. Mechanisms of action of these distinct stimuli are incompletely characterized and have not been directly compared. We assessed transcriptome-wide responses in skeletal muscle and circulating extracellular vesicles (EVs) to a single exercise bout in young adults randomized to TRAD (n = 21, 12 M/9 F, 22 ± 3 yr) or HITT (n = 19, 11 M/8 F, 22 ± 2 yr). Next-generation sequencing captured small, long, and circular RNA in muscle and EVs. Analysis identified differentially expressed transcripts (|log2FC|>1, FDR ≤ 0.05) immediately (h0, EVs only), h3, and h24 postexercise within and between exercise protocols. In aaddition, all apparently responsive transcripts (FDR < 0.2) underwent singular value decomposition to summarize data structures into latent variables (LVs) to deconvolve molecular expression circuits and interregulatory relationships. LVs were compared across time and exercise protocol. TRAD, a longer but less intense stimulus, generally elicited a stronger transcriptional response than HITT, but considerable overlap and key differences existed. Findings reveal shared and unique molecular responses to the exercise stimuli and lay groundwork toward establishing relationships between protein-coding genes and lesser-understood transcripts that serve regulatory roles following exercise. Future work should advance the understanding of these circuits and whether they repeat in other populations or following other types of exercise/stress.NEW & NOTEWORTHY We examined small and long transcriptomics in skeletal muscle and serum-derived extracellular vesicles before and after a single exposure to traditional combined exercise (TRAD) and high-intensity tactical training (HITT). Across 40 young adults, we found more consistent protein-coding gene responses to TRAD, whereas HITT elicited differential expression of microRNA enriched in brain regions. Follow-up analysis revealed relationships and temporal dynamics across transcript networks, highlighting potential avenues for research into mechanisms of exercise response and adaptation.
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Affiliation(s)
- Kaleen M Lavin
- Healthspan, Resilience, and Performance, Florida Institute for Human and Machine Cognition, Pensacola, Florida, United States
- UAB Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Zachary A Graham
- Healthspan, Resilience, and Performance, Florida Institute for Human and Machine Cognition, Pensacola, Florida, United States
- UAB Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, United States
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, United States
| | - Jeremy S McAdam
- Healthspan, Resilience, and Performance, Florida Institute for Human and Machine Cognition, Pensacola, Florida, United States
- UAB Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Samia M O'Bryan
- UAB Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Devin Drummer
- UAB Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Margaret B Bell
- UAB Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Christian J Kelley
- UAB Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Manoel E Lixandrão
- UAB Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Brandon Peoples
- UAB Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - S Craig Tuggle
- Healthspan, Resilience, and Performance, Florida Institute for Human and Machine Cognition, Pensacola, Florida, United States
- UAB Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Regina S Seay
- UAB Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | | | - Matthew J Huentelman
- Cancer & Cell Biology, Translational Genomics Research Institute, Phoenix, Arizona, United States
| | - Patrick Pirrotte
- Cancer & Cell Biology, Translational Genomics Research Institute, Phoenix, Arizona, United States
- Integrated Mass Spectrometry Shared Resource, City of Hope Comprehensive Cancer Center, Duarte, California, United States
| | - Rebecca Reiman
- Cancer & Cell Biology, Translational Genomics Research Institute, Phoenix, Arizona, United States
| | - Eric Alsop
- Cancer & Cell Biology, Translational Genomics Research Institute, Phoenix, Arizona, United States
| | - Elizabeth Hutchins
- Cancer & Cell Biology, Translational Genomics Research Institute, Phoenix, Arizona, United States
| | - Jerry Antone
- Cancer & Cell Biology, Translational Genomics Research Institute, Phoenix, Arizona, United States
| | - Anna Bonfitto
- Cancer & Cell Biology, Translational Genomics Research Institute, Phoenix, Arizona, United States
| | - Bessie Meechoovet
- Cancer & Cell Biology, Translational Genomics Research Institute, Phoenix, Arizona, United States
| | - Joanna Palade
- Cancer & Cell Biology, Translational Genomics Research Institute, Phoenix, Arizona, United States
| | - Joshua S Talboom
- Cancer & Cell Biology, Translational Genomics Research Institute, Phoenix, Arizona, United States
| | - Amber Sullivan
- UAB Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Inmaculada Aban
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Kalyani Peri
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Timothy J Broderick
- Healthspan, Resilience, and Performance, Florida Institute for Human and Machine Cognition, Pensacola, Florida, United States
| | - Marcas M Bamman
- Healthspan, Resilience, and Performance, Florida Institute for Human and Machine Cognition, Pensacola, Florida, United States
- UAB Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, United States
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Parsons J, Waters DL, Binns E, Burholt V, Cheung G, Clare S, Duncan R, Fox C, Gibson R, Grant A, Guy G, Jackson T, Kerse N, Logan R, Peri K, Petagna C, Stephens F, Taylor D, Teh R, Wall C. Letter to the Editor: Healthy for Life: An Innovative and Collaborative Approach to COVID 19 Lockdown in New Zealand. J Frailty Aging 2020; 10:72. [PMID: 33331626 PMCID: PMC7782046 DOI: 10.14283/jfa.2020.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Recently Boreskie and colleagues published an editorial in the Journal of Frailty and Aging on Preventing Frailty Progression During the COVID-19 Pandemic (1). In it they proposed the SAVE programme (Socialization, Adequate nutrition, Vitamin D, Exercise) to prevent frailty. They concluded that creative thinking and concerted efforts would be needed to disseminate health recommendations to maintain the health of pre-frail and frail older adults in unprecedented times, such as those posed by the COVID-19 pandemic.
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Affiliation(s)
- J Parsons
- A/Prof John Parsons Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand. Email
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6
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Peri K, Broad JB, Hikaka J, Boyd M, Bloomfield K, Wu Z, Calvert C, Tatton A, Higgins AM, Bramley D, Connolly MJ. Study protocol: older people in retirement villages. A survey and randomised trial of a multi-disciplinary invention designed to avoid adverse outcomes. BMC Geriatr 2020; 20:247. [PMID: 32680465 PMCID: PMC7367387 DOI: 10.1186/s12877-020-01640-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 07/03/2020] [Indexed: 12/02/2022] Open
Abstract
Background There is increasing interest among older people in moving into retirement villages (RVs), an attractive option for those seeking a supportive community as they age, while still maintaining independence. Currently in New Zealand there is limited knowledge of the medical, service supports, social status and needs of RV residents. The objective of this study is to explore RV facilities and services, the health and functional status of RV residents, prospectively study their healthcare trajectories and to implement a multidisciplinary team intervention to potentially decrease dependency and impact healthcare utilization. Methods All RVs located in two large district health boards in Auckland, New Zealand were eligible to participate. This three-year project comprised three phases: The survey phase provided a description of RVs, residents’ characteristics and health and functional status. RV managers completed a survey of size, facilities and recreational and healthcare services provided in the village. Residents were surveyed to establish reasons for entry to the village and underwent a Gerontology Nurse Specialist (GNS) assessment providing details of demographics, social engagement, health and functional status. The cohort study phase examines residents’ healthcare trajectories and adverse outcomes, over three years. The final phase is a randomised controlled trial of a multidisciplinary team intervention aimed to improve health outcomes for more vulnerable residents. Residents who triggered potential unmet health needs during the assessment in the survey phase were randomised to intervention or usual care groups. Multidisciplinary team meetings included the resident and support person, a geriatrician or gerontology nurse practitioner, GNS, pharmacist and General Practitioner. The primary outcome of the randomised controlled trial will be first acute hospitalization. Secondary outcomes include all acute hospitalizations, long-term care admissions, and all-cause mortality. Discussion This paper describes the study protocol of this complex study. The study aims to inform policies and practices around health care services for residents in retirement villages. The results of this trial are expected early 2020 with publication subsequently. Trial registration Australia and New Zealand Clinical Trials Registry: ACTRN12616000685415. Registered 25.5.2016. Universal Trial Number (UTN): U111–1173-6083.
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Affiliation(s)
- K Peri
- School of Nursing, University of Auckland, Private Bag 92 019, Auckland, 1142, New Zealand
| | - J B Broad
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - J Hikaka
- Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - M Boyd
- School of Nursing, University of Auckland, Private Bag 92 019, Auckland, 1142, New Zealand.,Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - K Bloomfield
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand.,Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - Z Wu
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - C Calvert
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand.,Auckland District Health Board, Private Bag 92 024, Auckland Mail Centre, Auckland, 1142, New Zealand
| | - A Tatton
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand.,Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - A-M Higgins
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - D Bramley
- Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - M J Connolly
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand. .,Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand.
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7
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Ferguson C, Thomson W, Smith M, Kerse N, Peri K, Gribben B. Medication taking in a national sample of dependent older people. Res Social Adm Pharm 2020; 16:299-307. [DOI: 10.1016/j.sapharm.2019.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 05/01/2019] [Accepted: 05/19/2019] [Indexed: 01/17/2023]
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8
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Connolly MJ, Hikaka J, Bloomfield K, Broad JB, Wu Z, Boyd M, Peri K, Calvert C, Tatton A, Higgins AM, Bramley D. 83RESEARCH IN THE RETIREMENT VILLAGE COMMUNITY: DOES THE RECRUITED SAMPLE REFLECT THE RESIDENT POPULATION? Age Ageing 2019. [DOI: 10.1093/ageing/afz061.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M J Connolly
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
- Waitemata District Health Board, Auckland, New Zealand
| | - J Hikaka
- Waitemata District Health Board, Auckland, New Zealand
| | - K Bloomfield
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
- Waitemata District Health Board, Auckland, New Zealand
| | - J B Broad
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
| | - Z Wu
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
| | - M Boyd
- School of Nursing, University of Auckland, Grafton, New Zealand
| | - K Peri
- School of Nursing, University of Auckland, Grafton, New Zealand
| | - C Calvert
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - A Tatton
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
- Waitemata District Health Board, Auckland, New Zealand
| | - A -M Higgins
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
| | - D Bramley
- Waitemata District Health Board, Auckland, New Zealand
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White CL, Szychowski JM, Pergola PE, Field TS, Talbert R, Lau H, Peri K, Benavente OR. Can blood pressure be lowered safely in older adults with lacunar stroke? The Secondary Prevention of Small Subcortical Strokes study experience. J Am Geriatr Soc 2015; 63:722-9. [PMID: 25850462 DOI: 10.1111/jgs.13349] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To determine safety and tolerability of lowering blood pressure in older adults with lacunar stroke. DESIGN Cohort study. SETTING The Secondary Prevention of Small Subcortical Strokes (SPS3) Trial, which compared the efficacy of two systolic blood pressure (SBP) targets (<130 mmHg and 130-149 mmHg) for secondary stroke prevention. PARTICIPANTS Of 3,020 SPS3 participants, 494 aged 75 and older at baseline were used in these analyses. MEASUREMENTS Rates of side effects related to lowering SBP and clinical outcomes, including stroke recurrence and vascular death, were examined. RESULTS Older participants achieved SBP levels similar to those of younger participants (mean SBP of 125 mmHg and 137 mmHg in lower and higher SBP target groups, respectively). At least once during the approximately 3.5 years of follow-up, 21% reported dizziness, and 15% reported lightheadedness when standing; the only significant difference between the younger and older groups was unsteadiness when standing (23% vs 32% respectively, P < .001). There was no difference according to treatment group. In younger adults, recurrent stroke was less likely in the lower than the higher SBP group (hazard ratio (HR) = 0.77, 95% confidence interval (CI) = 0.59-1.01) but not in older participants (HR = 1.01, 95% CI = 0.59-1.73), although the interaction was not significant (P = .39). The lower SBP target was associated with a significant reduction in vascular death in older participants (HR = 0.42, 95% CI = 0.18-0.98), with a significant interaction between age and SBP group (P = .049). CONCLUSION Except for unsteadiness when standing, there was no difference according to age in individuals with lacunar stroke with respect to side effects potentially related to lowering blood pressure. Although the lower SBP target was not associated with lower likelihood of recurrent stroke, these exploratory analyses suggested a possible benefit related to vascular death.
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Affiliation(s)
- Carole L White
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Abstract
OBJECTIVES To determine the nutrition risk status and factors associated with nutrition risk among older adults enrolled in the Brief Risk Identification Geriatric Health Tool (BRIGHT Trial). DESIGN A cluster randomised controlled trial. SETTING Three main centres in New Zealand. PARTICIPANTS A total of 3,893 older adults were recruited from 60 general practices in three of the District Health Board (DHB) regions aged 75 years and older (or 65 years and older if Māori). MEASUREMENTS Nutrition risk was assessed using the Australian Nutrition Screening Initiative (ANSI). Validated questionnaires were used to establish quality of life (WHOQOL-BREF), physical function (the Nottingham Extended Activities of Daily Living) and depressive symptoms (15 item Geriatric Depression Scale). Demographic, standard of living and health data were established. RESULTS Sixty two percent of participants were identified to be at moderate or high nutrition risk. The mean ANSI score was 4.9 (range 0-21, maximum 29). Factors which independently predicted moderate or high nutrition risk were female gender, being Māori and other ethnicities versus European, not being married, taking multiple medications, having more depressive symptoms, cardiovascular disease and diabetes. Protective factors independently related to low nutrition risk were living with others, higher physical and social health related QOL and higher functional status. WHOQOL environmental and psychological factors were not associated with nutrition risk when other predictive factors were taken into account. CONCLUSION Nearly two thirds of participants were identified to be at higher nutrition risk. Women, living alone, taking multiple medications, with depressive symptoms, cardiovascular disease and ndiabetes were factors associated with higher nutrition risk. Those at low nutrition risk had a better functional status and physical and social health related QOL.
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Affiliation(s)
- C A Wham
- C.A. Wham, Massey University, Institute of Food Nutrition and Human Health, Auckland, New Zealand,
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11
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White CL, Szychowski JM, Roldan A, Benavente MF, Pretell EJ, Del Brutto OH, Kase CS, Arauz A, Meyer BC, Meissner I, Demaerschalk BM, McClure LA, Coffey CS, Pearce LA, Conwit R, Irby LH, Peri K, Pergola PE, Hart RG, Benavente OR. Clinical features and racial/ethnic differences among the 3020 participants in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial. J Stroke Cerebrovasc Dis 2012; 22:764-74. [PMID: 22516427 DOI: 10.1016/j.jstrokecerebrovasdis.2012.03.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 02/28/2012] [Accepted: 03/03/2012] [Indexed: 02/05/2023] Open
Abstract
This study examined the baseline characteristics, racial/ethnic differences, and geographic differences among participants in the Secondary Prevention of Small Subcortical Strokes (SPS3) study. The SPS3 trial enrolled patients who experienced a symptomatic small subcortical stroke (lacunar stroke) within the previous 6 months and an eligible lesion on detected on magnetic resonance imaging. The patients were randomized, in a factorial design, to antiplatelet therapy (aspirin 325 mg daily plus clopidogrel 75 mg daily vs aspirin 325 mg daily plus placebo) and to one of two levels of systolic blood pressure targets ("intensive" [<130 mmHg] or "usual" [130-149 mmHg]). A total of 3020 participants were recruited from 81 clinical sites in 8 countries. In this cohort, the mean age was 63 years, 63% were men, 75% had a history of hypertension, and 37% had diabetes. The racial distribution was 51% white, 30% Hispanic, and 16% black. Compared with white subjects, black subjects were younger (mean age, 58 years vs 64 years; P <.001) and had a higher prevalence of hypertension (87% vs 70%; P <.001). The prevalence of diabetes was higher in the Hispanic and black subjects compared with the white subjects (42% and 40% vs 32%; both P <.001). Tobacco smoking at the time of qualifying stroke was much more frequent in the Spanish participants than in subjects from North America and from Latin America (32%, 22%, and 9%, respectively; P <.001). Mean systolic blood pressure at study entry was 4 mmHg lower in the Spanish subjects compared with the North American subjects (P <.01). The SPS3 cohort is the largest magnetic resonance imaging-defined series of patients with S3. Among the racially/ethnically diverse SPS3 participants, important differences in patient features and vascular risk factors could influence prognosis for recurrent stroke and response to interventions.
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Affiliation(s)
- Carole L White
- School of Nursing, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, USA
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12
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Wright DH, Abran D, Bhattacharya M, Hou X, Bernier SG, Bouayad A, Fouron JC, Vazquez-Tello A, Beauchamp MH, Clyman RI, Peri K, Varma DR, Chemtob S. Prostanoid receptors: ontogeny and implications in vascular physiology. Am J Physiol Regul Integr Comp Physiol 2001; 281:R1343-60. [PMID: 11641101 DOI: 10.1152/ajpregu.2001.281.5.r1343] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [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: 11/22/2022]
Abstract
Prostanoids exert significant effects on circulatory beds. They play a role in the response of the vasculature to adjustments in perfusion pressure and oxygen and carbon dioxide tension, and they mediate the actions of numerous factors. The role of prostanoids in governing circulation of the perinate is suggested to surpass that in the adult. Prostanoids are abundantly generated in the perinate. They have been implicated in autoregulation of blood flow as studied in brain and eyes. Prostaglandins are also dominant regulators of ductus arteriosus tone. The effects of these autacoids are mediated through specific G protein-coupled receptors. In addition to the pharmacological characterization of the prostanoid receptors, important advances in understanding the biology of these receptors have been made in the last decade. Their cloning and the development of animals with disrupted genes of these receptors have been very informative. The involvement of prostanoid receptors in the developing subject, especially on brain and ocular vasculature and on ductus arteriosus, has also begun to be investigated; the expression of these receptors changes with development. Some but not all of the ontogenic changes in these receptors are attributed to homologous regulation. Interestingly, in the process of elucidating their effects, functional perinuclear prostaglandin E2 receptors have been uncovered. This article reviews prostanoid receptors and addresses implications on the developing subject with attention to vascular physiology.
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Affiliation(s)
- D H Wright
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec H3G-1Y6, Canada
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Najarian T, Marrache AM, Dumont I, Hardy P, Beauchamp MH, Hou X, Peri K, Gobeil F, Varma DR, Chemtob S. Prolonged hypercapnia-evoked cerebral hyperemia via K(+) channel- and prostaglandin E(2)-dependent endothelial nitric oxide synthase induction. Circ Res 2000; 87:1149-56. [PMID: 11110772 DOI: 10.1161/01.res.87.12.1149] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mechanisms for secondary sustained increase in cerebral blood flow (CBF) during prolonged hypercapnia are unknown. We show that induction of endothelial NO synthase (eNOS) by an increase in prostaglandins (PGs) contributes to the secondary CBF increase during hypercapnic acidosis. Ventilation of pigs with 6% CO(2) (PaCO(2 approximately)65 mm Hg; pH approximately 7.2) caused a approximately 2.5-fold increase in CBF at 30 minutes, which declined to basal values at 3 hours and gradually rose again at 6 and 8 hours; the latter increase was associated with PG elevation, nitrite formation, eNOS mRNA expression, and in situ NO synthase (NOS) reactivity (NADPH-diaphorase staining). Subjecting free-floating brain sections to acidotic conditions increased eNOS expression, the time course of which was similar to that of CBF increase. Treatment of pigs with the cyclooxygenase inhibitor diclofenac or the NOS inhibitor Nomega-nitro-L-arginine blunted the initial rise and prevented the secondary CBF increase during hypercapnic acidosis; neuronal NOS blockers 1-(2-trifluoromethylphenyl) imidazole and 3-bromo-7-nitroindazole were ineffective. Diclofenac abolished the hypercapnia-induced rise in cerebrovascular nitrite production, eNOS mRNA expression, and NADPH-diaphorase reactivity. Acidosis (pH approximately 7.15, PCO(2 approximately )40 mm Hg; 6 hours) produced similar increases in prostaglandin E(2) (PGE(2)) and eNOS mRNA levels in isolated brain microvessels and in NADPH-diaphorase reactivity of brain microvasculature; these changes were prevented by diclofenac, by the receptor-operated Ca(2+) channel blocker SK&F96365, and by the K(ATP) channel blocker glybenclamide. Acidosis increased Ca(2+) transients in brain endothelial cells, which were blocked by glybenclamide and SK&F96365 but not by diclofenac. Increased PG-related eNOS mRNA and NO-dependent vasorelaxation to substance P was detected as well in rat brain exposed to 6 hours of hypercapnia. PGE(2) was the only major prostanoid that modulated brain eNOS expression during acidosis. Thus, in prolonged hypercapnic acidosis, the secondary CBF rise is closely associated with induction of eNOS expression; this seems to be mediated by PGE(2) generated by a K(ATP) and Ca(2+) channel-dependent process.
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Affiliation(s)
- T Najarian
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Canada
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14
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Hou X, Gobeil F, Peri K, Speranza G, Marrache AM, Lachapelle P, Roberts J, Varma DR, Chemtob S, Ellis EF. Augmented vasoconstriction and thromboxane formation by 15-F(2t)-isoprostane (8-iso-prostaglandin F(2alpha)) in immature pig periventricular brain microvessels. Stroke 2000; 31:516-24; discussion 525. [PMID: 10657431 DOI: 10.1161/01.str.31.2.516] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [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: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Oxidant stress, especially in the premature, plays a major role in the pathogenesis of hypoxic-ischemic encephalopathies mostly manifested in the periventricular region. We studied the vasomotor mode of actions of the peroxidation product 15-F(2t)-isoprostane (15-F(2t)-IsoP) (8-iso-prostaglandin F(2alpha)) on periventricular region during development. METHODS Effects of 15-F(2t)-IsoP on periventricular microvessels of fetal, newborn, and juvenile pigs were studied by video imaging and digital analysis techniques. Thromboxane formation and intracellular Ca(2+) were measured by radioimmunoassay and by using the fluorescent indicator fura 2-AM. RESULTS 15-F(2t)-IsoP-mediated constriction of periventricular microvessels decreased as a function of age such that in the fetus it was approximately 2.5-fold greater than in juvenile pigs. 15-F(2t)-IsoP evoked more thromboxane formation in the fetus than in the newborn, which was greater than that in the juvenile periventricular region; this was associated with immunoreactive thromboxane A(2) (TXA(2)) synthase expression in the fetus that was greater than that in newborn pigs, which was greater than that in juvenile pigs. 15-F(2t)-IsoP-induced vasoconstriction was markedly inhibited by TXA(2) synthase and receptor blockers (CGS12970 and L670596). Vasoconstrictor effects of the TXA(2) mimetic U46619 on fetal, neonatal, and juvenile periventricular microvessels did not differ. 15-F(2t)-IsoP increased TXA(2) synthesis by activating Ca(2+) influx through non-voltage-gated channels in endothelial cells (SK&F96365 sensitive) and N-type voltage-gated channels (omega-conotoxin sensitive) in astrocytes; smooth muscle cells were not responsive to 15-F(2t)-IsoP but generated Ca(2+) transients to U46619 via L-type voltage-sensitive channels. CONCLUSIONS 15-F(2t)-IsoP causes periventricular brain region vasoconstriction in the fetus that is greater than that in the newborn, which in turn is greater than that in the juvenile due to greater TXA(2) formation generated through distinct stimulatory pathways, including from endothelial and astroglial cells. The resulting hemodynamic compromise may contribute to the increased vulnerability of the periventricular brain areas to oxidant stress-induced injury in immature subjects.
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Affiliation(s)
- X Hou
- Centre de Recherche de l'Hôpital Sainte-Justine, Department of Pediatrics and Pharmacology, Université de Montréal, Montréal, Québec, Canada
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Bhattacharya M, Peri K, Ribeiro-da-Silva A, Almazan G, Shichi H, Hou X, Varma DR, Chemtob S. Localization of functional prostaglandin E2 receptors EP3 and EP4 in the nuclear envelope. J Biol Chem 1999; 274:15719-24. [PMID: 10336471 DOI: 10.1074/jbc.274.22.15719] [Citation(s) in RCA: 175] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The effects of prostaglandin E2 are thought to be mediated via G protein-coupled plasma membrane receptors, termed EP. However recent data implied that prostanoids may also act intracellularly. We investigated if the ubiquitous EP3 and the EP4 receptors are localized in nuclear membranes. Radioligand binding studies on isolated nuclear membrane fractions of neonatal porcine brain and adult rat liver revealed the presence of EP3 and EP4. A perinuclear localization of EP3alpha and EP4 receptors was visualized by indirect immunocytofluorescence and confocal microscopy in porcine cerebral microvascular endothelial cells and in transfected HEK 293 cells that stably overexpress these receptors. Immunoelectron microscopy clearly revealed EP3alpha and EP4 receptors localization in the nuclear envelope of endothelial cells; this is the first demonstration of the nuclear localization of these receptors. Data also reveal that nuclear EP receptors are functional as they affect transcription of genes such as inducible nitric-oxide synthase and intranuclear calcium transients; this appears to involve pertussis toxin-sensitive G proteins. These results define a possible molecular mechanism of action of nuclear EP3 receptors.
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Affiliation(s)
- M Bhattacharya
- Department of Pharmacology & Therapeutics, McGill University, Montreal, PQ, Canada, H3G 1Y6
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Abran D, Dumont I, Hardy P, Peri K, Li DY, Molotchnikoff S, Varma DR, Chemtob S. Characterization and regulation of prostaglandin E2 receptor and receptor-coupled functions in the choroidal vasculature of the pig during development. Circ Res 1997; 80:463-72. [PMID: 9118476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Ontogenic changes in choroidal vascular prostaglandin E2 (PGE2) receptors (EP1, EP2, EP3, and EP4), changes in receptor-coupled functions, and the possible role of high perinatal prostaglandin levels in regulating expression and function of these receptors were studied. PGE2 receptors and their functions on choroidal tissues were characterized by radioligand binding; by measurements of second messengers to receptor stimulation; and by vasomotor response to EP1, EP2, EP3, and EP4 ligands on perfused choroidal vascular beds from saline- and ibuprofen-treated (40 mg/kg every 4 every 4 hours for 48 hours) newborn pigs and from adult animals. PGE2 as well as EP2- and EP4-attributed choroidal stimulation elicited greater vasorelaxation in the saline-treated newborn and was associated with higher nitrite (oxidation product of NO, N omega-nitro-L-arginine inhibitable) production than in adult tissues. In contrast, EP1 and EP3 stimulation caused significantly more constriction in the adult than in the newborn, and this was associated with increased production of inositol 1,4,5-trisphosphate (IP3) and greater reduction of cAMP synthesis in the adult. Maximum [3H]PGE2 binding was also higher (3-fold) in adult than in newborn tissues. Competition binding studies revealed that of the PGE2 receptors in the adult choroid, approximately 55% were of the EP1 subtype, 8% were EP2, 22% were EP3, and 15% were EP4. Newborn choroid contained approximately 33% each of EP1 and EP2 receptors, 20% of EP3, and 15% of EP4. Inhibition of endogenous prostaglandin synthesis for 48 hours with ibuprofen in newborns to attain levels found in the adult resulted in an upregulation of [3H]PGE2 binding, EP1- and EP3-mediated vasoconstriction, and increases and decreases in IP3 and cAMP production, respectively, in newborn tissues compared with adult tissues. On the other hand, ibuprofen treatment of newborns led to a decrease in PGE2- and EP4-mediated vasorelaxation and nitrite synthesis (associated with decreased expression of endothelial NO synthase) to levels observed in adults: EP2-elicited responses in newborns were not affected by ibuprofen. In conclusion, fewer EP1 receptors (associated with vasoconstriction), more EP2 receptors, and greater EP4-coupled NO production (coupled to vasorelaxation) seem to be responsible for the increased vasodilation to PGE2 in the newborn. The decrease in prostaglandin levels with age appears to cause, on one hand, upregulation of EP1 and EP3 receptors and receptor-coupled vasoconstriction and, on the other hand, decreased EP4-coupled NO synthesis and choroidal vasodilation. Altogether, these factors result in increased vasorelaxation to PGE2 in the newborn compared with the adult. These findings may help to explain the inability of the newborn to autoregulate choroidal blood flow.
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Affiliation(s)
- D Abran
- Centre de Recherche de l'Hôpital Sainte-Justine, Department of Pediatrics, Montréal, Canada
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Abstract
Prostaglandins exert significant effects on the range of cerebral blood flow autoregulation. However, the newborn exhibits a narrow cerebral blood flow autoregulatory range compared to the adult, and this apparently contributes to the susceptibility of the newborn to major perinatal complications such as intraventricular cerebral haemorrhage. Reduced vasoconstriction in response to prostaglandins due to the fewer prostaglandin receptors, especially for PGE2 (EP) and PGF2 alpha (FP), seems to contribute in part to the narrower range of cerebral blood flow autoregulation in the newborn. Evidence suggests that high levels of prostaglandins in the perinatal period are responsible for the down-regulation of neurovascular EP and FP receptors. We review the pharmacology of prostaglandin receptors, in particular PGE2 and PGF2 alpha receptors, their ontogeny on the neural vasculature, the perinatal regulation of their expression, and how these changes relate to the control of neural blood flow autoregulation.
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Affiliation(s)
- S Chemtob
- Department of Pediatrics, Centre de Recherche de l'Hôpital Sainte-Justine, Montréal, Québec, Canada
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Chemtob S, Hardy P, Abran D, Li DY, Peri K, Cuzzani O, Varma DR. Peroxide-cyclooxygenase interactions in postasphyxial changes in retinal and choroidal hemodynamics. J Appl Physiol (1985) 1995; 78:2039-46. [PMID: 7665397 DOI: 10.1152/jappl.1995.78.6.2039] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
To test the role of reactive oxygen species and cyclooxygenase products in the retinal hemodynamic changes induced by asphyxia, we measured retinal (RBF) and choroidal blood flows (ChBF), malondialdehyde (MDA), prostaglandin E2 (PGE2), 6-ketoprostaglandin F1 alpha (6-keto-PGF1 alpha), and thromboxane B2 (TxB2) in 1- to 3-day-old pigs treated with saline, the free radical scavengers U-74389F or high-dose allopurinol, the cyclooxygenase inhibitors ibuprofen or indomethacin, or the thromboxane synthase blocker CGS-13080 before and 5 and 60 min after a 5-min period of asphyxia. In saline-treated animals, RBF and ChBF increased 5 min after asphyxia and decreased at 60 min. The increases in RBF and ChBF at 5 min postasphyxia were slightly attenuated by cyclooxygenase blockers and free radical scavengers but not by thromboxane synthase inhibition, whereas all drugs prevented the decreases at 60 min. MDA, TxB2, PGE2, and 6-keto-PGF1 alpha increased 5 min after asphyxia; at 60 min, PGE2 and 6-keto-PGF1 alpha returned to nearly preasphyxial levels, but MDA and TxB2 continued to increase. Cyclooxygenase inhibition prevented the asphyxia-induced rise in MDA, and the free radical scavengers prevented that of prostanoids. In isolated eyecup preparations, H2O2 and cumene hydroperoxide constricted retinal arteries; this effect was blocked by cyclooxygenase and thromboxane synthase inhibitors. The data suggest that during oxidative stresses reactive oxygen species are generated from the cyclooxygenase pathway and, in turn, also activate the synthesis of thromboxane; the latter mediates the oxidative stress-induced ocular vasoconstriction that might trigger the neovascularization of retinopathy of prematurity.
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Affiliation(s)
- S Chemtob
- Department of Pediatrics, University of Montreal, Québec, Canada
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