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Baker MC, Sheth K, Lu R, Lu D, von Kaeppler EP, Bhat A, Felson DT, Robinson WH. Increased risk of osteoarthritis in patients with atopic disease. Ann Rheum Dis 2023; 82:866-872. [PMID: 36987654 PMCID: PMC10314085 DOI: 10.1136/ard-2022-223640] [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: 11/17/2022] [Accepted: 02/16/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVES To determine the incidence of osteoarthrits (OA) in patients with atopic disease compared with matched non-exposed patients. METHODS We conducted a retrospective cohort study with propensity score matching using claims data from Optum's de-identified Clinformatics Data Mart (CDM) (January 2003 to June 2019) and electronic health record data from the Stanford Research Repository (STARR) (January 2010 to December 2020). We included adult patients without pre-existing OA or inflammatory arthritis who were exposed to atopic disease or who were non-exposed. The primary outcome was the development of incident OA. RESULTS In Optum CDM, we identified 117 346 exposed patients with asthma or atopic dermatitis (mean age 52 years; 60% female) and 1 247 196 non-exposed patients (mean age 50 years; 48% female). After propensity score matching (n=1 09 899 per group), OA incidence was higher in patients with asthma or atopic dermatitis (26.9 per 1000 person-years) compared with non-exposed patients (19.1 per 1000 person-years), with an adjusted odds ratio (aOR) of 1.58 (95% CI 1.55 to 1.62) for developing OA. This effect was even more pronounced in patients with both asthma and atopic dermatitis compared with non-exposed patients (aOR=2.15; 95% CI 1.93 to 2.39) and in patients with asthma compared with patients with chronic obstructive pulmonary disease (aOR=1.83; 95% CI 1.73 to 1.95). We replicated our results in an independent dataset (STARR), which provided the added richness of body mass index data. The aOR of developing OA in patients with asthma or atopic dermatitis versus non-exposed patients in STARR was 1.42 (95% CI 1.36 to 1.48). CONCLUSIONS This study demonstrates an increased incidence of OA in patients with atopic disease. Future interventional studies may consider targeting allergic pathways for the prevention or treatment of OA.
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Affiliation(s)
- Matthew C Baker
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, California, USA
| | - Khushboo Sheth
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, California, USA
- Chinook Therapeutics Inc, Berkeley, California, USA
| | - Rong Lu
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, California, USA
| | - Di Lu
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, California, USA
| | - Ericka P von Kaeppler
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California, USA
| | - Archana Bhat
- Research Informatics Center, Stanford University, Stanford, California, USA
| | - David T Felson
- Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - William H Robinson
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, California, USA
- Division of Rheumatology, Palo Alto VA Medical Center, Palo Alto, California, USA
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Abstract
IMPORTANCE Metformin may have a protective association against developing osteoarthritis (OA), but robust epidemiological data are lacking. OBJECTIVE To determine the risk of OA and joint replacement in individuals with type 2 diabetes treated with metformin compared with a sulfonylurea. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used claims data from the Optum deidentified Clinformatics Data Mart Database between December 2003 and December 2019. Participants included individuals aged 40 years or older with at least 1 year of continuous enrollment and type 2 diabetes. Individuals with type 1 diabetes or a prior diagnosis of OA, inflammatory arthritis, or joint replacement were excluded. Time-conditional propensity score matching was conducted using age, sex, race, Charlson comorbidity score, and treatment duration to create a prevalent new-user cohort. Data were analyzed from April to December 2021. EXPOSURES Treatment with metformin or a sulfonylurea. MAIN OUTCOMES AND MEASURES The outcomes of interest were incident OA and joint replacement. Cox proportional hazard models were used to calculate adjusted hazard ratios (aHRs) of incident OA and joint replacement. In a sensitivity analysis, individuals only ever treated with metformin were compared with individuals only ever treated with a sulfonylurea, allowing for longer-term follow up of the outcome (even after stopping the medication of interest). RESULTS After time-conditional propensity score matching, the metformin and control groups each included 20 937 individuals (mean [SD] age 62.0 [11.5] years; 24 379 [58.2%] males). In the adjusted analysis, the risk of developing OA was reduced by 24% for individuals treated with metformin compared with a sulfonylurea (aHR, 0.76; 95% CI, 0.68-0.85; P < .001), but there was no significant difference for risk of joint replacement (aHR, 0.80; 95% CI, 0.50-1.27; P = .34). In the sensitivity analysis, the risk of developing OA remained lower in individuals treated with metformin compared with a sulfonylurea (aHR, 0.77; 95% CI, 0.65-0.90; P < .001) and the risk of joint replacement remained not statistically significant (aHR, 1.04; 95% CI, 0.60-1.82; P = .89). CONCLUSIONS AND RELEVANCE In this cohort study of individuals with diabetes, metformin treatment was associated with a significant reduction in the risk of developing OA compared with sulfonylurea treatment. These results further support preclinical and observational data that suggest metformin may have a protective association against the development of OA; future interventional studies with metformin for the treatment or prevention of OA should be considered.
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Affiliation(s)
- Matthew C Baker
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, California
| | - Khushboo Sheth
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, California
- Chinook Therapeutics, Seattle, Washington
- The VA Palo Alto Health Care System, Palo Alto, California
| | - Yuhan Liu
- The Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, California
| | - Di Lu
- The Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, California
| | - Rong Lu
- The Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, California
| | - William H Robinson
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, California
- The VA Palo Alto Health Care System, Palo Alto, California
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3
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Moon JS, Younis S, Ramadoss NS, Iyer R, Sheth K, Sharpe O, Rao NL, Becart S, Carman JA, James EA, Buckner JH, Deane KD, Holers VM, Goodman SM, Donlin LT, Davis MM, Robinson WH. Cytotoxic CD8 + T cells target citrullinated antigens in rheumatoid arthritis. Nat Commun 2023; 14:319. [PMID: 36658110 PMCID: PMC9852471 DOI: 10.1038/s41467-022-35264-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 01/10/2022] [Accepted: 11/25/2022] [Indexed: 01/20/2023] Open
Abstract
The immune mechanisms that mediate synovitis and joint destruction in rheumatoid arthritis (RA) remain poorly defined. Although increased levels of CD8+ T cells have been described in RA, their function in pathogenesis remains unclear. Here we perform single cell transcriptome and T cell receptor (TCR) sequencing of CD8+ T cells derived from anti-citrullinated protein antibodies (ACPA)+ RA blood. We identify GZMB+CD8+ subpopulations containing large clonal lineage expansions that express cytotoxic and tissue homing transcriptional programs, while a GZMK+CD8+ memory subpopulation comprises smaller clonal expansions that express effector T cell transcriptional programs. We demonstrate RA citrullinated autoantigens presented by MHC class I activate RA blood-derived GZMB+CD8+ T cells to expand, express cytotoxic mediators, and mediate killing of target cells. We also demonstrate that these clonally expanded GZMB+CD8+ cells are present in RA synovium. These findings suggest that cytotoxic CD8+ T cells targeting citrullinated antigens contribute to synovitis and joint tissue destruction in ACPA+ RA.
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Affiliation(s)
- Jae-Seung Moon
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA.,VA Palo Alto Health Care System, Palo Alto, CA, 94304, USA
| | - Shady Younis
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA.,VA Palo Alto Health Care System, Palo Alto, CA, 94304, USA.,Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA, USA
| | - Nitya S Ramadoss
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA.,VA Palo Alto Health Care System, Palo Alto, CA, 94304, USA
| | - Radhika Iyer
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA.,VA Palo Alto Health Care System, Palo Alto, CA, 94304, USA
| | - Khushboo Sheth
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA.,VA Palo Alto Health Care System, Palo Alto, CA, 94304, USA
| | - Orr Sharpe
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA.,VA Palo Alto Health Care System, Palo Alto, CA, 94304, USA
| | - Navin L Rao
- Immunology Discovery, Janssen Research and Development LLC, Spring House, PA, 19477, USA
| | - Stephane Becart
- Immunology Discovery, Janssen Research and Development LLC, San Diego, CA, 92121, USA
| | - Julie A Carman
- Immunology Discovery, Janssen Research and Development LLC, Spring House, PA, 19477, USA
| | - Eddie A James
- Center for Translational Immunology, Benaroya Research Institute, Seattle, WA, 98101, USA
| | - Jane H Buckner
- Center for Translational Immunology, Benaroya Research Institute, Seattle, WA, 98101, USA
| | - Kevin D Deane
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - V Michael Holers
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Susan M Goodman
- Hospital for Special Surgery, New York, NY, 10021, USA.,Weill Cornell Medicine, New York, NY, 10021, USA
| | - Laura T Donlin
- Hospital for Special Surgery, New York, NY, 10021, USA.,Weill Cornell Medicine, New York, NY, 10021, USA
| | - Mark M Davis
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA, USA.,Department of Microbiology and Immunology, Stanford University, Stanford, CA, 94305, USA
| | - William H Robinson
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA. .,VA Palo Alto Health Care System, Palo Alto, CA, 94304, USA. .,Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA, USA.
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Kim SG, Vo N, Lee SH, Ranganathan D, Inker L, El-Shahawy M, Spinelli T, Sheth K, Devries T, Camargo M, King A, Glicklich A, Wong M. FC052: Atrasentan for the Treatment of IGA Nephropathy: Interim Results from the Affinity Study. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac107.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
IgA nephropathy (IgAN) is the most common primary glomerulonephritis in the developed world. Up to 40% of patients with IgAN are at risk of progressing to end-stage kidney disease (ESKD), with proteinuria being a strong predictor of disease progression. Treatments that reduce proteinuria in IgAN are accompanied by eGFR preservation and improved kidney outcomes.[1] Endothelin A (ETA) receptor activation is a key driver of proteinuria, inflammation and fibrosis in patients with glomerular diseases.[2] Therefore, ETA receptor blockade has potential to be of therapeutic benefit for patients with proteinuric glomerular diseases, including IgAN. Atrasentan, a potent and selective ETA receptor antagonist that has demonstrated clinically significant reductions in proteinuria and risk of ESKD in a study of over 5300 patients with diabetic kidney disease (DKD), represents a potential therapy to reduce proteinuria and preserve kidney function in patients with IgAN and other glomerular diseases.[3] AFFINITY is a global, phase 2, open-label basket study to evaluate the efficacy and safety of atrasentan in patients with proteinuric glomerular diseases due to IgAN, Alport syndrome, focal segmental glomerulosclerosis and DKD. Here we present interim results from the first 17 patients enrolled in the IgAN cohort of the AFFINITY study, through week 12 of treatment.
METHOD
Approximately 20 patients will be enrolled in the IgAN cohort. They must have biopsy proven IgAN, be receiving a maximally tolerated and stable dose of renin angiotensin system inhibitor and have a urine protein creatinine ratio [UPCR] between 0.5 and <1.0 g/g from a first morning void urine sample. Patients are treated orally with 0.75 mg atrasentan daily. The primary endpoint is the change in 24-h UPCR from baseline to Week 12. Key exploratory endpoints include changes in eGFR from baseline to Week 56.
RESULTS
A total of 17 patients have enrolled in the IgAN cohort as of 4 January 2022. A total of 12 and 8 patients have completed visits through Week 6 and Week 12, respectively. The median age is 47 years and 41% are women. The geometric mean (GM) baseline proteinuria is 1.2 g/day, and median eGFR is 41 mL/min/1.73 m2 (Table 1). The 8 patients on treatment through Week 12 had a GM % reduction from baseline in 24-h UPCR of 43.6% [95% confidence interval (95% CI) 29.0–55.2] (Figure 1). Pharmacokinetic data are currently available for nine patients and showed a mean trough plasma atrasentan concentration in the targeted therapeutic range. Adverse events (AE) were observed in nne patients (53%), all mild or moderate in severity, most of which have resolved. One patient experienced an unrelated serious adverse event of traffic accident without long-term injuries. All patients remain on treatment with study drug except for one patient who discontinued drug due to an unrelated AE at week 13.
CONCLUSION
Treatment of patients with IgAN with atrasentan in addition to standard of care provided a >43% GM reduction in proteinuria after 12 weeks and was well tolerated, strongly supporting a key role of the endothelin pathway in the pathogenesis of IgAN. The ongoing phase 3 ALIGN study for patients with IgAN and proteinuria ≥1g/day will provide further assessment of the proteinuria lowering effects of atrasentan in this high-risk patient population.
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Affiliation(s)
- Sung-Gyun Kim
- Hallym University Sacred Heart Hospital, Dongan-gu, Anyang, Republic of South Korea
| | - Nam Vo
- MTN Kidney and Hypertension, Asheville, NC, USA
| | - Sang-Ho Lee
- Kyung Hee University Medical Center, Republic of South Korea
| | | | | | | | | | | | | | | | | | | | - Muh Wong
- Royal North Shore Hospital, Australia
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5
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Jadhav RR, Hu B, Ye Z, Sheth K, Li X, Greenleaf WJ, Weyand CM, Goronzy JJ. Reduced chromatin accessibility to CD4 T cell super-enhancers encompassing susceptibility loci of rheumatoid arthritis. EBioMedicine 2022; 76:103825. [PMID: 35085847 PMCID: PMC8790491 DOI: 10.1016/j.ebiom.2022.103825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/21/2021] [Accepted: 01/09/2022] [Indexed: 11/27/2022] Open
Abstract
Background Rheumatoid arthritis (RA) is an inflammatory disease that manifests as a preclinical stage of systemic autoimmunity followed by chronic progressive synovitis. Disease-associated genetic SNP variants predominantly map to non-coding, regulatory regions of functional importance in CD4 T cells, implicating these cells as key regulators. A better understanding of the epigenome of CD4 T cells holds the promise of providing information on the interaction between genetic susceptibility and exogenous factors. Methods We mapped regions of chromatin accessibility using ATAC-seq in peripheral CD4 T cell subsets of patients with RA (n=18) and compared them to T cells from patients with psoriatic arthritis (n=11) and age-matched healthy controls (n=10). Transcripts of selected genes were quantified using qPCR. Findings RA-associated epigenetic signatures were identified that in part overlapped between central and effector memory CD4 T cells and that were to a lesser extent already present in naïve cells. Sites more accessible in RA were highly enriched for the motif of the transcription factor (TF) CTCF suggesting differences in the three-dimensional chromatin structure. Unexpectedly, sites with reduced chromatin accessibility were enriched for motifs of TFs pertinent for T cell function. Most strikingly, super-enhancers encompassing RA-associated SNPs were less accessible. Analysis of selected transcripts and published DNA methylation patterns were consistent with this finding. The preferential loss in accessibility at these super-enhancers was seen in patients with high and low disease activity and on a variety of immunosuppressive treatment modalities. Interpretation Disease-associated genes are epigenetically less poised to respond in CD4 T cells from patients with established RA. Funding This work was supported by I01 BX001669 from the Veterans Administration.
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Sheth K, Ritter PL, Lorig K, Steinman L, FallCreek S. Remote Delivery of the Chronic Pain Self-management Program Using Self-directed Materials and Small-group Telephone Support: A Pilot Study. J Appl Gerontol 2021; 41:1329-1335. [PMID: 34965766 DOI: 10.1177/07334648211062805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/02/2023] Open
Abstract
A remote (telephone and tool kit) chronic pain program was studied using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. This 6-week pilot took place in underserved communities in Cleveland, Ohio. We determined reach by the diversity of the population, nearly 50% Black and mostly low income. Effectiveness over 7 weeks was shown with validated instruments (depression, pain, sleep, quality of life, self-rated health, and self-efficacy). Changes in pain, depression, and self-efficacy were significant. (p < .01). Remote implementation was accomplished by sending participants a box of materials (book, exercise and relaxation CDs, a self-test, and tip sheets). Participants also participated in peer-facilitated, weekly, scripted telephone calls. Maintenance was demonstrated as the study site has offered nine additional programs with more plan. In addition, 60 additional organizations are now offering the program. This proof-of-concept study offers an alternate to in-person chronic pain self-management program delivery.
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Affiliation(s)
- Khushboo Sheth
- Division of Immunology and Rheumatology, Department of Medicine, 6429Stanford University, Stanford, CA, USA.,19977VA Palo Alto Health Care System, Palo Alto, CA, USA.,Chinook Therapeutics, Seattle, WA, USA
| | - Philip L Ritter
- Division of Immunology and Rheumatology, Department of Medicine, 6429Stanford University, Stanford, CA, USA
| | - Kate Lorig
- Division of Immunology and Rheumatology, Department of Medicine, 6429Stanford University, Stanford, CA, USA
| | - Lesley Steinman
- Health Promotion Research Center, Department of Health Services, 7284University of Washington, Seattle, WA, USA
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Hoppenfeld MS, Kennedy V, Sheth K, Chang A, Nelson J, Fairchild RM. Strongyloides Hyperinfection After Immunosuppression in an Immigrant From El Salvador: A Case for Early Diagnosis and Treatment. J Clin Rheumatol 2021; 27:e128-e131. [PMID: 30074914 DOI: 10.1097/rhu.0000000000000884] [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: 11/26/2022]
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Fairchild R, Horomanski A, Sharpless L, Chung M, Li S, Hong J, Sheth K, Chung L. Ultrasound evaluation of the hands and wrists in patients with systemic sclerosis: Osteophytosis is a major contributor to tender joints. Semin Arthritis Rheum 2021; 51:735-740. [PMID: 34144383 DOI: 10.1016/j.semarthrit.2021.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the prevalence and clinical associations of ultrasound (US) findings of inflammatory arthritis and joint and soft tissue pathology in patients with systemic sclerosis (SSc). METHODS The hands and wrists of 43 SSc patients and 35 age-balanced controls were evaluated by clinical exam and musculoskeletal US. Synovial and tenosynovial pathology were assessed using semi-quantitative Gray Scale (GS) and Power Doppler (PD) scoring. US evaluation for osteophytes, erosions, ulnar artery occlusion, and median nerve cross-sectional areas was performed. Tender joints (TJ), swollen joints (SJ), modified Rodnan skin score (mRSS), digital ulcers, contractures, and calcinosis were evaluated. Concordance between US and physical exam findings at each joint region were assessed, and associations between their severity were analyzed. RESULTS TJs and SJs were present in 44.2% and 62.8% of SSc patients, respectively. Inflammatory arthritis, defined as having both GS>0 and PD>0, was observed in 18.6% of SSc patients and no controls. There was a high concordance by joint region between GS synovial hypertrophy and osteophytes (κ=0.88) as well as TJs (κ=0.72). SSc patients had more osteophytes compared to controls (48.8% vs 22.9%, p = 0.018) as well as higher osteophyte severity (p = 0.033). CONCLUSIONS Despite a high percentage of tender and swollen joints, less than 20% of SSc patients met criteria for inflammatory arthritis on US. The high concordance of osteophytes with GS synovial hypertrophy and tender joints suggest that osteophytosis may be a significant contributor to joint pain in SSc patients.
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Affiliation(s)
- Robert Fairchild
- Division of Immunology and Rheumatology, Stanford University Medical Center, USA.
| | - Audra Horomanski
- Division of Immunology and Rheumatology, Stanford University Medical Center, USA
| | - Laurel Sharpless
- Division of Immunology and Rheumatology, Stanford University Medical Center, USA
| | - Melody Chung
- Division of Immunology and Rheumatology, Stanford University Medical Center, USA
| | - Shufeng Li
- Departments of Dermatology and Urology, Stanford University Medical Center, USA
| | - Jison Hong
- Division of Immunology and Rheumatology, Stanford University Medical Center, USA
| | - Khushboo Sheth
- Division of Immunology and Rheumatology, Stanford University Medical Center, USA; Division of Rheumatology, Palo Alto VA Healthcare System, USA
| | - Lorinda Chung
- Division of Immunology and Rheumatology, Stanford University Medical Center, USA; Division of Rheumatology, Palo Alto VA Healthcare System, USA
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9
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Ye Z, Shen Y, Jin K, Qiu J, Hu B, Jadhav RR, Sheth K, Weyand CM, Goronzy JJ. Arachidonic acid-regulated calcium signaling in T cells from patients with rheumatoid arthritis promotes synovial inflammation. Nat Commun 2021; 12:907. [PMID: 33568645 PMCID: PMC7875984 DOI: 10.1038/s41467-021-21242-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 09/11/2019] [Accepted: 01/18/2021] [Indexed: 12/13/2022] Open
Abstract
Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are two distinct autoimmune diseases that manifest with chronic synovial inflammation. Here, we show that CD4+ T cells from patients with RA and PsA have increased expression of the pore-forming calcium channel component ORAI3, thereby increasing the activity of the arachidonic acid-regulated calcium-selective (ARC) channel and making T cells sensitive to arachidonic acid. A similar increase does not occur in T cells from patients with systemic lupus erythematosus. Increased ORAI3 transcription in RA and PsA T cells is caused by reduced IKAROS expression, a transcriptional repressor of the ORAI3 promoter. Stimulation of the ARC channel with arachidonic acid induces not only a calcium influx, but also the phosphorylation of components of the T cell receptor signaling cascade. In a human synovium chimeric mouse model, silencing ORAI3 expression in adoptively transferred T cells from patients with RA attenuates tissue inflammation, while adoptive transfer of T cells from healthy individuals with reduced expression of IKAROS induces synovitis. We propose that increased ARC activity due to reduced IKAROS expression makes T cells more responsive and contributes to chronic inflammation in RA and PsA. ORAI3 is part of pore forming calcium channels involved in T cell activation. Here the authors show that there is increased expression of ORAI3 in T cells from patients with rheumatoid arthritis and that the transcription factor IKAROS negatively regulates the ORAI3 promoter, indicating a regulatory loop that can control auto-reactivity of T cells in these patients.
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Affiliation(s)
- Zhongde Ye
- Department of Medicine, Palo Alto Veterans Administration Healthcare System, Palo Alto, CA, USA.,Department of Medicine, Stanford University, Stanford, CA, USA
| | - Yi Shen
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Ke Jin
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Jingtao Qiu
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Bin Hu
- Department of Medicine, Palo Alto Veterans Administration Healthcare System, Palo Alto, CA, USA.,Department of Medicine, Stanford University, Stanford, CA, USA
| | - Rohit R Jadhav
- Department of Medicine, Palo Alto Veterans Administration Healthcare System, Palo Alto, CA, USA.,Department of Medicine, Stanford University, Stanford, CA, USA
| | - Khushboo Sheth
- Department of Medicine, Palo Alto Veterans Administration Healthcare System, Palo Alto, CA, USA
| | - Cornelia M Weyand
- Department of Medicine, Palo Alto Veterans Administration Healthcare System, Palo Alto, CA, USA.,Department of Medicine, Stanford University, Stanford, CA, USA
| | - Jörg J Goronzy
- Department of Medicine, Palo Alto Veterans Administration Healthcare System, Palo Alto, CA, USA. .,Department of Medicine, Stanford University, Stanford, CA, USA.
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10
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Ritter PL, Sheth K, Stewart AL, Gallagher-Thompson D, Lorig K. Development and Evaluation of the 8-item Caregiver Self-Efficacy Scale (CSES-8). Gerontologist 2020; 62:e140-e149. [PMID: 33146727 DOI: 10.1093/geront/gnaa174] [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: 05/19/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This paper describes the development and evaluation of a short caregiving self-efficacy measure. The self-administered 8-item Caregiver Self-efficacy Scale (CSES-8) was developed to reflect components of typical caregiver-support interventions and to be practical for inclusion in future self-efficacy and caregiving research. RESEARCH DESIGN AND METHODS We administered the CSES-8 in two samples: participants in an intervention for caregivers of persons with cognitive disabilities, and a voluntary on-line survey for caregivers of adults. We evaluated the completion rate, item-scale correlations, reliability, descriptive statistics, and preliminary construct validity of the CSES-8 in both samples, and sensitivity to change in the intervention sample. RESULTS The intervention caregivers' sample (N=158) was 85% female (mean age=65 years). The on-line survey sample (N=138) was 90% female (mean age=78). In both samples, the CSES-8 had excellent internal-consistency reliability (0.89 and 0.88) and good distribution with sufficient variability to detect change. Test-retest reliability was good in the on-line sample (0.73). As evidence of construct validity, most hypotheses were confirmed in both samples. The CSES-8 was sensitive to change at 6 months for caregivers in the intervention program (p < .001). DISCUSSION AND IMPLICATIONS The CSES-8 is short, comprehensive with respect to common components of interventions to improve caregivers' quality of life, and sensitive to change. It can serve a useful role exploring mechanisms by which caregiver intervention studies work, and it can be helpful in examining whether self-efficacy mediates the effect of these intervention on various outcomes such as psychological well-being.
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Affiliation(s)
- Philip L Ritter
- Department of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA
| | - Khushboo Sheth
- VA Palo Alto Healthcare System, Palo Alto, VA, Department of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA
| | - Anita L Stewart
- Institute for Health and Aging, Center for Aging in Diverse Communities, University of California San Francisco, San Francisco, CA
| | | | - Kate Lorig
- Department of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA
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Sheth K, Lorig K, Stewart A, Parodi JF, Ritter PL. Effects of COVID-19 on Informal Caregivers and the Development and Validation of a Scale in English and Spanish to Measure the Impact of COVID-19 on Caregivers. J Appl Gerontol 2020; 40:235-243. [PMID: 33143545 DOI: 10.1177/0733464820971511] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To understand how the COVID-19 pandemic has affected caregivers, we assessed its perceived impact on caregiving through a new measure: the Caregiver COVID-19 Limitations Scale (CCLS-9), in Spanish and English. We also compared levels of caregiver self-efficacy and burden pre-COVID-19 and early in the pandemic. We administered surveys via internet to a convenience sample of caregivers in January 2020 (pre-pandemic, n = 221) and in April-June 2020 (English, n = 177 and Spanish samples, n = 144) to assess caregiver self-efficacy, depression, pain, and stress. We used the early pandemic surveys to explore the validity of the CCLS-9. The pre-COVID-19 survey and the April English surveys were compared to determine how the COVID-19 pandemic affected caregivers. The CCLS-9 had strong construct and divergent validity in both languages. Compared to pre-COVID-19, caregiver stress (p = .002) and pain (p = .009) were significantly greater early in COVID-19, providing evidence of its validity. COVID-19 added to caregiver stress and pain.
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Affiliation(s)
- Khushboo Sheth
- VA Palo Alto Healthcare System, CA, USA
- Stanford University, CA, USA
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Sheth K, Simard J, Ritter P, Lorig K. AB1195 CO-RELATION BETWEEN SELF EFFICACY, DEPRESSION AND PAIN AMONG CAREGIVERS WITH AND WITHOUT ARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3970] [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] [Indexed: 11/04/2022]
Abstract
Background:People with arthritis, like others, are often informal caregivers. Caregiving adds burdens of stress and depression. Caregiver studies have shown these to be mitigated by self-efficacy or the confidence to achieve specific caregiving behaviors. Caregivers with arthritis have seldom been studied. We have been unable to find studies specific to caregiving and self-efficacy as they apply to those with and without arthritis. In this study, we evaluated the relationship between self-efficacy, pain, and depression among caregivers with and without arthritis.Objectives:1)To examine the correlation between caregiver self-efficacy and depression and pain. 2). To examine how these correlation differ for caregivers with and without arthritis.Methods:A caregiver questionnaire was distributed via social media, mainly list serves and blogs to a convenience sample. Those receiving the links were urged to send them to other populations. Respondents self-reported arthritis and weekly hours spent caregiving. They reported pain using a pain (visual numeric scale (1-10)), depression with the Patient Health Questionnaire (PHQ-8), and Self-Efficacy was reported with the short caregiver self-efficacy scale). For caregivers and non-caregivers we compared caregiving hours, pain, depression and self-efficacy. We examined the distribution of caregiving hours by arthritis status and plotted mean pain scores by caregiving hours for caregivers with and without arthritis. The correlation between depression and self-efficacy was measured using Pearson correlation coefficient overall and by arthritis status.Results:Over two weeks 155 individuals responded, with data on self-reported arthritis status. Of the respondents, 88% were female and 64% were 50-69 years of age. 46% self-reported arthritis (osteoarthritis was the most common type). Nearly 25% of caregivers reported spending less than 10 hours weekly on caregiving, while approximately 23% reported at the other end of the extreme (at least 40 hours weekly). The distribution by arthritis status of the caregiver is provided in Table 1.Table 1.Caregiving hoursArthritis0-9 hrs10-19 hrs20-29 hrs30-35 hrs40+ hrsMissingAllNo26 (31%)26 (31%)11 (13%)5 (6%)15 (18%)1 (1%)84 (54.2%)Yes12 (17%)21 (30%)11 (15.5%)7 (9.9%)20 (28%)071 (45.8%)Total38 (24.5%)47 (30.3%)22 (14.2%)12 (7.7%)35 (22.6%)1 (0.7%)155Caregivers with arthritis reported higher pain in the past week. Mean pain score among caregivers with arthritis was 4.4 (SD 2.2) compared to 2.7 (SD 1.7) among caregivers without arthritis (figure 1). This divergence widened for caregivers with 40 or more hours of caregiving. There was a strong negative correlation (Pearson correlation= – 0.473, p-value <0.0001) between depression and self-efficacy. The correlation was -0.59 for caregivers without arthritis (p=<0.0001, n=74 with data on all three variables) compared to the caregivers self-reporting arthritis (r=-0.35, p=0.006, n=60 with data on all three variables).Figure 1.Conclusion:This study suggests that lower caregiver self-efficacy has a direct and strong association with higher depressive symptoms and that this is more pronounced among caregivers with arthritis. This study also shows that caregivers with arthritis have more pain than caregivers without arthritis, and that this peaks and remains consistent for those doing twenty or more hours of caregiving weekly.. The stronger negative correlation of depression and self-efficacy among patients without arthritis may be explained by other independent contributors (such as pain) to depression in caregivers with arthritis.References:[1]Lorig K, Ritter PL, Laurent DD, Yank V. Building Better Caregivers: A Pragmatic 12-Month Trial of a Community-Based Workshop for Caregivers of Cognitively Impaired Adults.J Appl Gerontol. 2019;38(9):1228–1252. doi:10.1177/0733464817741682Disclosure of Interests:None declared
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Sheth K. Finding time. Lancet Rheumatol 2020; 2:e10. [PMID: 38258268 DOI: 10.1016/s2665-9913(19)30111-0] [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] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/31/2019] [Indexed: 01/24/2024]
Affiliation(s)
- Khushboo Sheth
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA; Stanford University, Palo Alto, CA, USA.
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Sheth K, Valenzuela A, Shoor S, Ritter PL, Lorig K. Development and validation of a rheumatologist satisfaction with practice scale: The rheumatologist satisfaction scale. Medicine (Baltimore) 2019; 98:e18114. [PMID: 31770236 PMCID: PMC6890303 DOI: 10.1097/md.0000000000018114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
There is a paucity of succinct measures of physician satisfaction. As part of a Performance Improvement Project, we developed and piloted a simple questionnaire to determine rheumatologists satisfaction.Thirty 5 rheumatologists in the academic or private setting were sent opened-ended questions to determine the factors that made them satisfied or dissatisfied with respect to their rheumatology practice. From the responses we formed 14 questions 1 to 10 scale centering on satisfaction and dissatisfaction that was piloted in 30 rheumatologists and subsequently validated in 173 rheumatologists within the US and Latin America.Our combined sample included 173 rheumatologists (55 English and 118 Spanish-speaking respondents). The mean satisfaction for the combined sample was 6.92 (standard deviation=1.1, range 4.08-9.62). The strongest contributors to physician satisfaction were "Seeing interesting and challenging cases" (8.6 ± 1.5) and "The ability to make a difference in patient's life" as well as "Establishing long term relationship with patients" (8.39 ± 1.5). The strongest contributors to physician dissatisfaction were "Getting inappropriate referrals not in the scope of practice" (4.3 ± 2.13) and "Time spent on documentation" (4.5 ± 2.59). The scale had good reliability, relatively normal distribution, and little or no redundancy among items.A simple and practical questionnaire to measure physician satisfaction, in particular rheumatologists satisfaction, was developed, piloted and successfully validated on a predominately academic sample of rheumatologists within the US and Latin America. This scale will serve as a means to identifying potential barriers to the implementation of performance improvement projects in the practice of Rheumatology.
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Affiliation(s)
- Khushboo Sheth
- Stanford University, Division of Immunology & Rheumatology
- Palo Alto VA Health Care System, Department of Immunology and Rheumatology, Palo Alto, CA
| | - Antonia Valenzuela
- Pontificia Universidad Católica de Chile, Division of Immunology & Rheumatology, Santiago, Chile
| | - Stanford Shoor
- Stanford University, Division of Immunology & Rheumatology
| | | | - Kate Lorig
- Stanford University, Division of Immunology & Rheumatology
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Mehta T, Hussain M, Sheth K, Ding Y, McCullough LD. Risk of hemorrhagic transformation after ischemic stroke in patients with antiphospholipid antibody syndrome. Neurol Res 2017; 39:477-483. [PMID: 28475479 DOI: 10.1080/01616412.2017.1323382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE Several rheumatologic conditions including systemic lupus erythematosus, antiphospholipid antibody (APS) syndrome, rheumatoid arthritis, and scleroderma are known risk factors for stroke. The risk of hemorrhagic transformation after an acute ischemic stroke (AIS) in these patients is not known. METHODS We queried the Nationwide Inpatient Sample (NIS) data between 2010 and 2012 with ICD 9 diagnostic codes for AIS. The primary outcome was the development of hemorrhagic transformation. Multivariate predictors for hemorrhagic transformation were identified with a logistic regression model. Using SAS 9.2, Survey procedures were used to accommodate for hierarchical two stage cluster design of NIS. RESULTS APS (OR 2.57, 95% CI 1.14-5.81, p = 0.0228) independently predicted risk of hemorrhagic transformation in multivariate regression analysis. Similarly, in multivariate regression models for the outcome variables of total charges of the hospitalization and length of stay (LOS), patients with APS had the highest charges ($56,286, p = 0.0228) and LOS (3.87 days, p = 0.0164) compared to other co-variates. Univariate analysis showed increased mortality in the APS compared to the non-APS group (11.68% vs. 7.16%, p = 0.0024). CONCLUSION APS is an independent risk factor for hemorrhagic transformation in both thrombolytic and non-thrombolytic treated patients. APS is also associated with longer length and cost of hospital stay. Further research is warranted to identify the unique risk factors in these patients to identify strategies to reduce the risk of hemorrhagic transformation in this subgroup of the population.
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Affiliation(s)
- Tapan Mehta
- a Department of Neurology , University of Connecticut Health Center-Hartford Hospital , Hartford , CT , USA
| | - Mohammed Hussain
- a Department of Neurology , University of Connecticut Health Center-Hartford Hospital , Hartford , CT , USA
| | - Khushboo Sheth
- b Department of Internal Medicine , University of Connecticut , Farmington , CT , USA
| | - Yuchuan Ding
- c Department of Neurosurgery , Wayne State University , Detroit , MI , USA
| | - Louise D McCullough
- d Department of Neurology , McGovern Medical School, University of Texas Health Science Center , Houston , TX , USA
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Sheth K, Kuo CL, Modi D, Nanavaty S, Scola C. AB1015 Mortality Rate According To Cause in Patients with Hemophagocytic Lymphohistiocytosis: A Meta-Analysis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sheth K, Parke A. Cutaneous Vasculitis in a Patient with Antiphospholipid Antibody Syndrome. Conn Med 2016; 80:75-79. [PMID: 27024977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Antiphospholipid antibody syndrome (APS) is an acquired thrombophilia, caused by autoantibodies to anticardiolipin (aCL), or antibeta 2 glycoprotein I, or the presence of lupus anticoagulant (LA) in plasma. It is characterized by recurrent venous and/or arterial thrombi and/or pregnancy related morbidities. We present the case of a 52-year-old female with long-standing APS, who developed cutaneous vasculitis following a common cold. Most of the cutaneous manifestations of APS have been found to be thrombotic on histopathology without evidence of perivascular inflammation. Vasculitis is usually seen in APS patients with coexistent Systemic Lupus Erythematosus (SLE). However, our patient had evidence of vasculitis on skin biopsy and did not have SLE. Though rare, this is a disease process which must be considered in patients with primary APS which must be closely monitored for other vasculitic complications of APS, particularly diffuse alveolar hemorrhage.
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Sheth K, Snyder A, Wu U, Lahiri B, Grover P. Autosplenectomy Causing Catastrophic Pneumococcal Meningitis in a Patient with Lupus/Antiphospholipid Antibody Syndrome. Conn Med 2016; 80:37-38. [PMID: 26882790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We present the case ofa26-year-old female who presented to the hospital with pneumococcal meningitis. A review of her records showed atrophic spleen, and a hypercoagulable workup was positive for Systemic Lupus Erythematous (SLE)/Antiphospholipid Antibody Syndrome (APS). An autosplenectomy from thrombotic occlusion of the splenic artery made her susceptible to pneumococcal meningitis. Autoimmune conditions, particularly SLE and APS, are important causes of hypercoagulable states in a young population, and earlier detection of these conditions and appropriate treatment helps to decrease morbidity and mortality among these patients.
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Sheth K, Mehta T, Sheth V, Soni R, Puri S, Parke A. SAT0405 Risk of Status Epilepticus and Intractable Epilepsy in Systemic Lupus Erythematosus Patients with Antiphospholipid Antibodies. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5335] [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: 11/03/2022]
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Mehta T, Sheth K, Puri S, Soni R, Sheth V, Parke A. THU0352 Risk of Status Epilepticus and Intractable Epilepsy in Systemic Lupus Erythematosus Patients with Lupus Nephritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5371] [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: 11/04/2022]
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Puri S, Mehta T, Patel P, Sheth K, Joshi J, Vredenburgh JJ. Factors affecting in-hospital mortality in primary malignant brain tumor patients with grand mal status epilepticus. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e13002] [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: 11/20/2022] Open
Affiliation(s)
- Sonam Puri
- University of Connecticut Health Center, Farmington, CT
| | - Tapan Mehta
- University of Connecticut Health Center, Farmington, CT
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Mehta T, Puri S, Patel P, Sheth K, Joshi J, Vredenburgh JJ. Risk of grand mal status epilepticus in primary malignant brain tumor patients treated with anti-neoplastic therapy. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e13018] [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: 11/20/2022] Open
Affiliation(s)
- Tapan Mehta
- University of Connecticut Health Center, Farmington, CT
| | - Sonam Puri
- University of Connecticut Health Center, Farmington, CT
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Sheth K, Bockorny M, Elaba Z, Scola C. Adult Onset Henoch-Schönlein Purpura: Case Report and Review of Literature. Conn Med 2015; 79:81-85. [PMID: 26244205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Henoch-Schönlein purpura (HSP) is an IgA mediated small-vessel vasculitis, more common in children than adults. We present the case of a 37-year-old male who presented with complaints of nausea, vomiting, abdominal pain, purpuric rash over lower extremities, and migratory polyarthralgia five days after being treated with antibiotics for bronchitis. In addition to the abdominal pain, he developed diarrhea and colonic biopsy findings were suggestive of inflammatory bowel disease (IBD). Skin biopsy revealed leukocytoclastic vasculitis with direct immunofluorescence studies (DIF) staining of IgA deposition confirming the diagnosis of HSP. The clinical features of cutaneous eruption with abdominal complaints can be seen with either HSP or IBD; however the specific skin biopsy findings on DIF can distinguish between the two disease processes. Though HSP is primarily seen in the pediatric population, it is a disease process that must be considered in adults presenting with vasculitic skin rashes and abdominal complaints.
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Mehta T, Sheth K, Soni R, Mehta K. Abstract W P174: Risk of Intracranial Hemorrhage after Acute Ischemic Stroke in Patients with Systemic Rheumatologic Conditions: A Nationwide Analysis. Stroke 2015. [DOI: 10.1161/str.46.suppl_1.wp174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Rheumatologic conditions like Systemic Lupus Erythematosus (SLE), Antiphospholipid antibody (ApL) syndrome, Rheumatoid Arthritis (RA) and scleroderma are known risk factors of CVA. The data on impact of these conditions on risk of intracranial hemorrhage (ICH) in patients of acute ischemic stroke is limited.
Methods:
We queried the Healthcare Cost and Utilization Project's (HCUP) Nationwide Inpatient Sample (NIS) data between 2004 and 2010 with ICD 9 diagnostic codes for acute ischemic stroke published by HCUP. Severity of co-morbidities was determined using Deyo modification of Charlson co-morbidity index (CCI). Primary outcome of the study was development of ICH. Multivariate predictors for ICH were identified by logistic regression model. Using SAS 9.2, Survey procedures were used to accommodate for hierarchical two stage cluster design of NIS.
Results:
A total of 791,015 (weighted N= 3,900,707) patients hospitalized with acute ischemic stroke were available for analysis. After controlling for confounders (thrombolytic therapy, age, sex, atrial fibrillation, chronic kidney disease, diabetes mellitus, rheumatic heart disease, diseases of endocardium, CCI, hospital region, and hospital teaching status ), presence of SLE (OR=0.775, 95% CI=0.575-1.044), and scleroderma (OR=1.060, 95% CI= 0.545-2.063) were not associated with risk of ICH; whereas, presence of ApL syndrome was associated with significantly increased risk of ICH (OR= 1.889, 95% CI=1.672-2.156). In subgroup analysis, patients with ApL syndrome, had higher risk of ICH with thrombolytics (OR=2.464, 95% CI=1.722-3.528), as well as without thrombolytics (OR=1.860, 95%CI= 1.626-2.127). In contrast, patients with RA had lower risk (OR=0.793, 95%CI=0.658-0.955) of ICH; but in patients who received thrombolytics, RA had no impact on risk of ICH (OR=0.716, 95%CI=0.086-5.923).
Conclusion:
There is increased risk of ICH after ischemic stroke, in patients with ApL Syndrome. The risk of ICH further increases when they receive thrombolytic therapy. The risk of ICH after ischemic stroke is low in RA population; however there is no difference in risk of ICH if they receive thrombolytics. SLE and scleroderma are not associated with ICH in patients of ischemic stroke.
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Affiliation(s)
- Tapan Mehta
- Neurology, Univ of Connecticut Sch of Medicine, Hartford, CT
| | - Khushboo Sheth
- Internal Medicine, Univ of Connecticut Sch of Medicine, Hartford, CT
| | - Ronak Soni
- Government Med College, Surat, Surat, India
| | - Kathan Mehta
- Internal Medicine, Univ of Pittsburgh Med Cntr, Pittsburgh, PA
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Soni R, Mehta K, Mehta T, Sheth K, Mansuri Z, Liu L. Influence of Ventilator-Associated Pneumonia on Length of Stay for Hospitalized Patient Requiring Mechanical Ventilation: A Nationwide Analysis. Chest 2014. [DOI: 10.1378/chest.1994914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Soni R, Mehta K, Mehta T, Sheth K, Mansuri Z, Liu L. Influence of Ventilator Associated Pneumonia on Cost of Hospitalization for Patient Requiring Mechanical Ventilation: A Nationwide Analysis. Chest 2014. [DOI: 10.1378/chest.1994797] [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: 11/01/2022] Open
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Mehta K, Soni R, Mehta T, Sheth K, Mansuri Z, Liu L. Influence of Epidemiological Risk Factors in Development of Ventilator Associated Pneumonia in Hospitalized Patient Requiring Mechanical Ventilation: A Nationwide Analysis. Chest 2014. [DOI: 10.1378/chest.1995231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Mehta T, Soni R, Sheth K, Mehta K. Influence of Epidemiological Risk Factors on Mortality in Patients Receiving Therapeutic Hypothermia After Cardiac Arrest. Chest 2014. [DOI: 10.1378/chest.1995051] [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: 11/01/2022] Open
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Mehta T, Soni R, Sheth K, Mehta K. Influence of Epidemiological Risk Factors in Development of Hypoxic Brain Injury in Patients Receiving Therapeutic Hypothermia After Cardiac Arrest: A Nationwide Analysis. Chest 2014. [DOI: 10.1378/chest.1994993] [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: 11/01/2022] Open
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Deshpande HA, Sheth K, Sosa JA, Roman S. Efficacy and tolerability of pharmacotherapy options for the treatment of medullary thyroid cancer. Clin Med Insights Oncol 2012; 6:355-62. [PMID: 23133319 PMCID: PMC3489097 DOI: 10.4137/cmo.s8305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Metastatic and unresectable medullary thyroid carcinoma (MTC) is often difficult to treat as it is relatively unresponsive to radiation and conventional chemotherapy. This emphasizes the importance of the development of targeted therapies for advanced MTC. Vandetanib was approved by the US Food and Drug Administration for the treatment of symptomatic or progressive MTC in patients with advanced disease in April 2011. This therapy proved to be a breakthrough in the management of MTC. We review the efficacy and safety of this novel treatment and other treatments that are being evaluated in this disease.
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Affiliation(s)
- H A Deshpande
- Yale University School of Medicine, New Haven, Connecticut, USA
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Park H, Stein D, Kufera J, Aarabi B, Scalea T, Sheth K. Penetrating Traumatic Brain Injury: A 10-Year Experience (P06.265). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Sheth K, Yoo A, Gonzalez R, Kimberly W, Chaudhry Z, Elm J, Jacobson S, Davis S, Donnan G, Albers G, Stern B. Hemisphere Volume Is Associated with Neurological Deterioration and Outcome after Malignant Infarction (P07.034). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Park H, Stein D, Kufera J, Aarabi B, Scalea T, Sheth K. Mortality and Penetrating Traumatic Brain Injury: Analysis of a 10 Year Cohort (P06.267). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Sheth K, Koch S, Elkind M, Sung G, Kittner S, Frankel M, Rosand J, Langefeld C, Comeau M, Waddy S, Osborne J, Woo D, For the ERICH Investigators. Anti-Epileptic Drug Use and Outcome in the Ethnic and Racial Variations in Intracerebral Hemorrhage (ERICH) Study (S23.005). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s23.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Pugach MK, Ozer F, Li Y, Sheth K, Beasley R, Resnick A, Daneshmehr L, Kulkarni AB, Bartlett JD, Gibson CW, Lindemeyer RG. The use of mouse models to investigate shear bond strength in amelogenesis imperfecta. J Dent Res 2011; 90:1352-7. [PMID: 21917602 DOI: 10.1177/0022034511421929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Patients with amelogenesis imperfecta (AI) have defective enamel; therefore, bonded restorations of patients with AI have variable success rates. To distinguish which cases of AI may have good clinical outcomes with bonded materials, we evaluated etching characteristics and bond strength of enamel in mouse models, comparing wild-type (WT) with those having mutations in amelogenin (Amelx) and matrix metalloproteinase-20 (Mmp20), which mimic 2 forms of human AI. Etched enamel surfaces were compared for roughness by scanning electron microscopy (SEM) images. Bonding was compared through shear bond strength (SBS) studies with 2 different systems (etch-and-rinse and self-etch). Etched enamel surfaces of incisors from Amelx knock-out (AmelxKO) mice appeared randomly organized and non-uniform compared with WT. Etching of Mmp20KO surfaces left little enamel, and the etching pattern was indistinguishable from unetched surfaces. SBS results were significantly different when AmelxKO and Mmp20KO enamel surfaces were compared. A significant increase in SBS was measured for all samples when the self-etch system was compared with the etch-and-rinse system. We have developed a novel system for testing shear bond strength of mouse incisors with AI variants, and analysis of these data may have important clinical implications for the treatment of patients with AI.
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Affiliation(s)
- M K Pugach
- Department of Anatomy and Cell Biology University of Pennsylvania School of Dental Medicine, Philadelphia, PA 19104, USA
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37
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Abstract
Paroxetine (Paxil) is a selective serotonin reuptake inhibitor (SSRI) and anxiolytic that is approved to treat numerous mood disorders. Serotonin syndrome, defined as a triad of mental status changes, autonomic instability, and neuromuscular abnormalities, is a potentially life-threatening complication of administering such serotonin-modifying drugs. Most cases of serotonin syndrome that have occurred with paroxetine administration are due to inadvertent drug interactions, most notably between SSRIs and monamine oxidase inhibitors, or intentional overdoses. The authors present the case of an 80-year-old woman who presented with serotonin syndrome while on a therapeutic dose of paroxetine. Paroxetine was stopped, and aggressive hydration with fluids and treatment with cyproheptadine was followed by remarkable improvement and return to baseline status in 4 days. This case illustrates the importance for physicians to have a heightened sense of suspicion of the serotonin syndrome in any patient known to be on serotonin-modifying agents presenting with altered sensorium and cholinergic symptoms. Consequently, they will be able to start timely treatment without subjecting the patient to unnecessary and potentially harmful tests.
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Affiliation(s)
- P Paruchuri
- St. George's University School of Medicine, Brooklyn, New York, USA
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38
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Sheth K, Wasserman RL, Lincourt WR, Locantore NW, Carranza-Rosenzweig J, Crim C. Fluticasone propionate/salmeterol hydrofluoroalkane via metered-dose inhaler with integrated dose counter: Performance and patient satisfaction. Int J Clin Pract 2006; 60:1218-24. [PMID: 16981966 DOI: 10.1111/j.1742-1241.2006.01138.x] [Citation(s) in RCA: 23] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Currently, patients have to keep track of doses to determine when to replace their metered-dose inhalers (MDIs). This study evaluated the performance and patient satisfaction of a novel MDI with an integrated dose counter. In an open-label study at 38 outpatient centres, patients > or =12 years old with asthma or chronic obstructive pulmonary disease (COPD) received two actuations of fluticasone propionate/salmeterol 125/25 microg (115/21 microg ex-actuator) hydrofluoroalkane (ADVAIR) HFA) via MDI with counter twice a day until all 120 actuations were completed. Concordance between counter and diary recordings in patients who reported use of > or =90% of labelled actuations (completer population, n = 228) was high (discrepancy rate of 0.94%) and the incidence of device firing without changes in counter readings was low (0.13%). Mean expected actuations based on canister weights (114) were slightly lower than mean counter (121) and diary reported actuations (120). Upon study completion, 95% of patients were satisfied with the dose counter and 92% agreed it would help prevent them from running out of medication. Safety assessments (intent-to-treat population, n = 237) indicated that the drug was well tolerated. This integrated MDI counter may help patients maintain better disease control by enabling them to accurately track their medication supply.
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Affiliation(s)
- K Sheth
- Lafayette Allergy and Asthma Clinic, Lafayette, IN 47905, USA.
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39
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Jayawardena S, Siddiqi Z, Kong KF, Sheth K, Maini A. 96 RACIAL DIFFERENCES IN PROSTATE-RELATED DISORDERS IN A MULTIETHNIC COMMUNITY. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0008.95] [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: 11/18/2022]
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40
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Godkar D, Paruchuri P, Anandacoomarswamy D, Sheth K, Niranjan S. 122 UNUSUAL CASE OF SEROTONIN SYNDROME WITH THERAPEUTIC DOSE OF PAROXETINE. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0008.121] [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: 11/18/2022]
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41
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Kendler KS, Sheth K, Gardner CO, Prescott CA. Childhood parental loss and risk for first-onset of major depression and alcohol dependence: the time-decay of risk and sex differences. Psychol Med 2002; 32:1187-1194. [PMID: 12420888 DOI: 10.1017/s0033291702006219] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Whereas a number of studies have suggested that parental loss is associated with increased risk for major depression (MD), much less is known about possible gender differences, diagnostic specificity and the time course of the impact of loss. METHOD First-onsets for MD and alcohol dependence (AD) were assessed at personal interviews in 5070 twins from same-sex (SS) and 2118 from opposite-sex (OS) twin pairs ascertained from a population-based registry. Cox Proportional Hazard (PH) and Non-Proportional Hazard (NPH) models, examining first onsets of MD and AD, were used with twins from SS pairs and conditional logistic regression for OS pairs. Parent-child separations prior to age 17 were divided into death and separation from other causes. RESULTS The PH assumptions of constant increased risk were rejected for the impact of loss on risk for MD but not for AD. NPH models found significantly increased risk for MD after both death and separation with the risk lasting much longer for separations. For AD, the PH model found significantly increased risk after parental separation but not death. In both SS and OS twin pairs, no sex differences were seen in the impact of parental loss on risk for MD whereas the association between separation and risk for AD was significantly stronger in females than in males. CONCLUSION Consistent sex differences in the association with parental loss were seen for AD but not MD. The analysis of the time-course of increased risk after loss suggests three different patterns which may reflect different relationships: parental death and MD (return to baseline within approximately 12 years), separation and MD (return to baseline within approximately 30 years) and separation and AD (no change in risk over time).
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Affiliation(s)
- K S Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, USA
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42
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Abstract
Systemic inflammation contributes to significant morbidity in the ICU. With its ability to generate antiinflammatory acute-phase proteins, cytokines via Kupffer cells, and recently acknowledged resident lymphocytes, the liver provides a central regulatory role in inflammation. The liver has constant exposure to foreign material as a result of gut translocation and first-pass metabolism from the bloodstream. Consequently, the balance between hepatic activation and tolerance becomes an important factor in the host response to inflammation. Interventions and therapies that can assess and modulate these hepatic functions can improve outcomes for ICU patients.
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Affiliation(s)
- K Sheth
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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43
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Sheth K, Friel J, Nolan B, Bankey P. Inhibition of p38 mitogen activated protein kinase increases lipopolysaccharide induced inhibition of apoptosis in neutrophils by activating extracellular signal-regulated kinase. Surgery 2001; 130:242-8. [PMID: 11490356 DOI: 10.1067/msy.2001.115902] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Prolonged polymorphonuclear neutrophil (PMN) survival has been implicated in tissue injury after sepsis. Previously we reported that lipopolysaccharide (LPS) inhibits PMN apoptosis via the activation of the extracellular signal-regulated kinase (ERK). Conversely, the p38 mitogen activated protein kinase (MAPK) pathway is involved in the spontaneous apoptosis of PMNs. The interaction between these 2 pathways and their ability to regulate apoptosis during sepsis remain largely undefined. We hypothesize that there is interaction between the ERK and p38 pathways during sepsis. METHODS PMNs were isolated from healthy volunteers by Ficoll gradient centrifugation and red blood cell sedimentation. Cells were then pretreated for 1 hour with the ERK inhibitor (PD98059, 10 micromol/L), p38 inhibitor (SB203580, 1 micromol/L), or vehicle. After treatment with LPS, apoptosis and MAPK activity were correlated. RESULTS LPS stimulation significantly inhibits PMN apoptosis compared with unstimulated cells. Furthermore, inhibition of ERK significantly abrogates this effect, whereas inhibition of p38 augments LPS induced inhibition of apoptosis. Elk-1 phosphorylation (ERK target) is significantly increased by LPS alone and by inhibition of the p38 pathway during LPS stimulation. This correlates with ERK phosphorylation by Western blot. CONCLUSIONS These data show that p38 inhibition enhances ERK activity during endotoxemia. Furthermore, these data suggest that cooperation between ERK and p38 MAPK pathways dictates the apoptotic potential of PMNs during inflammatory states.
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Affiliation(s)
- K Sheth
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA 01655, USA
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44
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Abstract
BACKGROUND Prolonged neutrophil(PMN) survival has been implicated in tissue injury following sepsis. A variety of bacterial products have been identified which inhibit PMN apoptosis including lipopolysaccharide(LPS). Extracellular heat shock proteins(Hsp) have recently been identified as potent regulatory signals for the innate immune system during the inflammatory response. We hypothesized that Hsp 27 can affect PMN phenotype with respect to apoptosis and cytokine profile. MATERIALS AND METHODS PMN were isolated from the peripheral blood of healthy human volunteers by red blood cell sedimentation and gradient centrifugation. Cells were placed in media and cultured for 18 h with and without recombinant human Hsp 27 at various concentrations. In parallel experiments, PMN were stimulated with LPS, a known inhibitor of PMN apoptosis, for comparison. Apoptosis was quantified using annexin V and propidium iodide staining with flow cytometric analysis. Culture supernatants were assayed for secretion of TNF-alpha, IL-10, and IL-12. RESULTS Hsp 27 significantly inhibits PMN apoptosis [control; 81.8 +/- 3.6%, vs Hsp 27, 60.4 +/- 4.1% p < 0.05]. The reduction is similar to that signaled by LPS, alone. Together their effect is not synergistic. The Hsp 27 response is dose-dependent. Hsp 27 does not induce secretion of TNF-alpha, IL-10, or IL-12, whereas LPS does signal IL-12 and TNF-alpha secretion. CONCLUSION These data demonstrate that exogenous Hsp 27 may play a role in neutrophil-mediated tissue injury during trauma and sepsis via its ability to inhibit neutrophil apoptosis. However, Hsp 27 does not significantly alter neutrophil phenotype with respect to cytokine production profile.
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Affiliation(s)
- K Sheth
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, 01655, USA
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45
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Abstract
Neutrophils (PMN) are proposed to contribute to hepatic dysfunction during sepsis. Transmigrating PMN have been demonstrated to adhere to and injure parenchymal cells (hepatocytes); however, the effect of sepsis-activated PMN on hepatic macrophages or Kupffer cells (KC) is poorly characterized. We hypothesize that PMN influence KC inflammatory mediator production, including nitric oxide. Rodent KC were co-cultured with PMN obtained from controls (Norm-PMN) or endotoxemic rats [lipopolysaccharide (LPS)-PMN] for 18 h. After an 18-h incubation, supernatants and cell lysates of the KC were analyzed for nitric oxide (NO) production. Co-cultures with LPS-PMN/KC demonstrated significantly increased production of nitrite and up-regulation of inducible nitric oxide synthase (iNOS) protein compared to KC alone or Norm-PMN/KC co-cultures. Immunohistochemistry revealed preferential iNOS protein staining in the cytoplasm of KC cultured with LPS-PMN compared to controls. Nitrite production in co-cultures of KC and LPS-PMN where cell contact was inhibited by a cell impermeable but diffusable membrane was significantly reduced. These data provide evidence that KC can be stimulated directly by activated PMN for production of NO. Further, they suggest another mechanism by which PMN modulate hepatic function during sepsis.
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Affiliation(s)
- K Sheth
- Department of Surgery, University of Massachusetts, Worcester 01655, USA
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46
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Nolan B, Kim R, Duffy A, Sheth K, De M, Miller C, Chari R, Bankey P. Inhibited neutrophil apoptosis: proteasome dependent NF-kappaB translocation is required for TRAF-1 synthesis. Shock 2000; 14:290-4. [PMID: 11028545 DOI: 10.1097/00024382-200014030-00008] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neutrophil (PMN) apoptosis regulates local and systemic inflammation during sepsis. Tumor necrosis factor receptor-associated factors (TRAFs) have been implicated as mediators of apoptosis; however, the signaling pathways for their production in stimulated PMN are unclear. We hypothesize that NF-kappaB translocation is necessary for the induction of TRAF-1 in PMNs with prolonged survival. Neutrophils were isolated from the blood of healthy volunteers by Ficoll gradient centrifugation and red blood cell sedimentation. Neutrophil NF-kappaB was inhibited with a proteasome inhibitor, PSI-I. Cells were treated with PSI-I (30 microM) or vehicle (DMSO 0.2%) for 50 min then incubated over an 18-h time course with LPS (10 to 1000 ng/mL), tumor necrosis factor alpha (TNFalpha) (2 to 20 ng/mL) or control media. In vitro apoptosis was quantified by propidium iodide FACS analysis. Total cellular TRAF-1 was detected by Western blot analysis of cell lysates. Steady state TRAF-1 mRNA was detected by RPA. NF-kappaB activity was determined by Western blot analysis for nuclear p65. Means and standard errors were calculated; data were analyzed by ANOVA. Lipopolysaccharide (LPS) and TNFalpha increased PMN nuclear p65 and steady state TRAF-1 mRNA. Apoptosis was inhibited by TNFalpha and LPS at 12 and 18 h (P < 0.01). Incubation of cells in the NF-kappaB inhibitor PSI-I blocked LPS and TNFalpha-induced inhibition of apoptosis (P < 0.05) and the induction of both nuclear p65 and TRAF-1 mRNA. These data demonstrate that inhibition of PMN apoptosis and TRAF-1 induction by LPS and TNFalpha is NF-kappaB dependent.
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Affiliation(s)
- B Nolan
- Department of Surgery, University of Massachusetts Medical School, Worcester 01655, USA
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47
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Duffy AJ, Nolan B, Sheth K, Collette H, De M, Bankey PE. Inhibition of alveolar neutrophil immigration in endotoxemia is macrophage inflammatory protein 2 independent. J Surg Res 2000; 90:51-7. [PMID: 10781375 DOI: 10.1006/jsre.2000.5835] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Altered transendothelial migration and delayed apoptosis of neutrophils (PMN) have been implicated as contributing to infection in patients with gram-negative sepsis. Macrophage inflammatory protein 2 (MIP-2) signals PMN immigration and may alter other PMN functions. We tested the hypothesis that sequential endotoxin challenge in vivo alters PMN apoptosis and chemotactic responses. MATERIALS AND METHODS Endotoxemia was induced in male Wistar rats (250 g) via intraperitoneal (IP) administration of LPS (4 mg/kg). After 18 h, intratracheal (IT) injection of LPS (400 microg/kg) was performed. Control animals received saline injections. Four hours after IT-LPS, circulating and bronchoalveolar lavage (BAL) PMN were isolated. PMN yields were calculated, and apoptosis was quantified after 18 h in culture by annexin V-fluorescein isothiocyanate FACS analysis. BAL MIP-2 concentrations were determined by ELISA. PMN chemotaxis to MIP-2 and IL-8 was determined using a fluorescent in vitro migration assay. RESULTS Endotoxemia (IP-LPS) significantly decreases BAL PMN yield in response to an in vivo IT-LPS challenge. IT-LPS inhibits BAL PMN apoptosis to the same extent as sequential IP/IT-LPS. Alveolar MIP-2 concentrations are similar in the two groups. In vitro migration to IL-8 and MIP-2 was inhibited in PMN from endotoxemic versus control animals. CONCLUSIONS These data demonstrate that endotoxemia inhibits PMN migration despite similar MIP-2 concentrations in the alveolus. Sequential insults do not affect the inhibition of apoptosis. In vitro, PMN from endotoxemic animals display impaired chemotaxis to MIP-2 and interleukin-8. This may result in an inadequate host defense that contributes to increased ICU-acquired pneumonia in septic patients.
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Affiliation(s)
- A J Duffy
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA 01655, USA
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48
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Sheth K, Boehmer J, Rohrer V. An evaluation of the yield of chest radiograms in patients undergoing endomyocardial biopsy. J Heart Lung Transplant 1998; 17:737-8. [PMID: 9703242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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49
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Madias JE, Sheth K, Choudry MA, Berger DO, Madias NE. Admission serum magnesium level does not predict the hospital outcome of patients with acute myocardial infarction. Arch Intern Med 1996; 156:1701-8. [PMID: 8694669] [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] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To establish whether hypomagnesemia at admission predicts excessive morbidity, particularly cardiac arrhythmias, and mortality in patients with acute myocardial infarction. METHODS We compared hypomagnesemic and normomagnesemic patients with acute myocardial infarction in 517 patients admitted to the coronary care unit. The serum magnesium concentration, along with a large array of other parameters, was measured on admission to the emergency department. Other baseline attributes and variables related to the patients' hospital course were used to compare the 2 groups. RESULTS The 132 patients (25.9%) with low serum magnesium concentrations at admission (mean +/- SD, 0.61 +/- 0.06 mmol/L [1.48 +/- 0.15 mg/dL]) were comparable to the patients with normal serum magnesium concentrations (0.81 +/- 0.11 mmol/L [1.96 +/- 0.26 mg/dL]) except for a higher rate of prehospital use of diuretic agents (32.6% vs 22.5%, P = .02) and earlier presentation after onset of symptoms (mean +/- SD, 3.2 +/- 4.1 vs 4.8 +/- 6.6 hours, P = .003). There was no correlation between serum magnesium and potassium concentrations in the emergency department (r = 0.14). No difference was detected between the hypomagnesemic and normomagnesemic cohorts in rates of total mortality (18.9% vs 18.5%, P = .91), cardiac mortality (15.2% vs 15.3%, P = .99), atrial fibrillation (13.6% vs 13.8%, P = .97), ventricular tachycardia (18.2% vs 15.3%, P = .44), or ventricular fibrillation (15.2% vs 13.5%, P = .63). Management of the 2 cohorts was not different, except for higher rates of use of magnesium (17.4% vs 1.3%, P < .001) and potassium (59.8% vs 42.1%, P < .001) supplements and antiarrhythmic drugs (62.9% vs 48.7%, P = .005) in the hypomagnesemic patients. An endogenous rise in serum magnesium level was documented in a subgroup of 161 patients who had a repeated measurement (0.74 +/- 0.12 mmol/L [1.79 +/- 0.29 mg/dL] in the emergency department vs 0.77 +/- 0.09 mmol/L [1.88 +/- 0.23 mg/dL] in the coronary care unit, P < .001). CONCLUSIONS We conclude that hypomagnesemia is seen in approximately one fourth of patients with myocardial infarction, is not linked to hypokalemia, has some relationship to preadmission use of diuretic agents, is associated with early presentation to the hospital, and is not a predictor of increased morbidity or mortality.
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Affiliation(s)
- J E Madias
- Mount Sinai School of Medicine, City University of New York, NY, USA
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50
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Abstract
Quinone reductase (QR; EC 1.6.99.2) is recognized as a major antimutagenic/anticarcinogenic enzyme in the organism. Our recent studies demonstrated the presence of significant QR activity in the early human placenta; whether this enzyme is expressed by the mammalian embryo is not known at present. In the investigation reported here, we sought to determine whether or not QR activity is detected in porcine embryonal tissues and if so, how early this expression takes place. In addition, the enzyme activity in the embryo was compared to that present in adult porcine tissue. Enzyme activity was determined by a colorimetric method with menadione as substrate in the presence of tetrazolium salt (MTT). NADH was a preferable cofactor in the embryo, whereas in the adult tissues NADPH was a better cofactor. Results show that the enzyme is present in all the embryonal organs tested from a very early age (30 days of gestation). Among the organs tested, activity was highest in the porcine embryo liver, and the specific activity remained unchanged until Day 70. Activity in the embryonal kidney increased with advancing gestation. The enzyme activity in embryonal tissues was much lower than that measured in the adult liver (30-40-fold). These findings suggest that the embryo has the potential for inactivating carcinogens/mutagens that will subsequently be eliminated by the maternal organism, thus protecting against adverse environmental impacts during the most critical period of development.
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Affiliation(s)
- E R Barnea
- University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Camden Cooper Hospital/University Medical Center, Department of Obstetrics and Gynecology, 08103, USA
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