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Liu Z, Alexander JL, Yee Eng K, Ibraheim H, Anandabaskaran S, Saifuddin A, Constable L, Castro Seoane R, Bewshea C, Nice R, D’Mello A, Jones GR, Balarajah S, Fiorentino F, Sebastian S, Irving PM, Hicks LC, Williams HRT, Kent AJ, Linger R, Parkes M, Kok K, Patel KV, Teare JP, Altmann DM, Boyton RJ, Hart AL, Lees CW, Goodhand JR, Kennedy NA, Pollock KM, Ahmad T, Powell N. Antibody Responses to Influenza Vaccination are Diminished in Patients With Inflammatory Bowel Disease on Infliximab or Tofacitinib. J Crohns Colitis 2024; 18:560-569. [PMID: 37941436 PMCID: PMC11037107 DOI: 10.1093/ecco-jcc/jjad182] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND AND AIMS We sought to determine whether six commonly used immunosuppressive regimens were associated with lower antibody responses after seasonal influenza vaccination in patients with inflammatory bowel disease [IBD]. METHODS We conducted a prospective study including 213 IBD patients and 53 healthy controls: 165 who had received seasonal influenza vaccine and 101 who had not. IBD medications included infliximab, thiopurines, infliximab and thiopurine combination therapy, ustekinumab, vedolizumab, or tofacitinib. The primary outcome was antibody responses against influenza/A H3N2 and A/H1N1, compared to controls, adjusting for age, prior vaccination, and interval between vaccination and sampling. RESULTS Lower antibody responses against influenza A/H3N2 were observed in patients on infliximab (geometric mean ratio 0.35 [95% confidence interval 0.20-0.60], p = 0.0002), combination of infliximab and thiopurine therapy (0.46 [0.27-0.79], p = 0.0050), and tofacitinib (0.28 [0.14-0.57], p = 0.0005) compared to controls. Lower antibody responses against A/H1N1 were observed in patients on infliximab (0.29 [0.15-0.56], p = 0.0003), combination of infliximab and thiopurine therapy (0.34 [0.17-0.66], p = 0.0016), thiopurine monotherapy (0.46 [0.24-0.87], p = 0.017), and tofacitinib (0.23 [0.10-0.56], p = 0.0013). Ustekinumab and vedolizumab were not associated with reduced antibody responses against A/H3N2 or A/H1N1. Vaccination in the previous year was associated with higher antibody responses to A/H3N2. Vaccine-induced anti-SARS-CoV-2 antibody concentration weakly correlated with antibodies against H3N2 [r = 0.27; p = 0.0004] and H1N1 [r = 0.33; p < 0.0001]. CONCLUSIONS Vaccination in both the 2020-2021 and 2021-2022 seasons was associated with significantly higher antibody responses to influenza/A than no vaccination or vaccination in 2021-2022 alone. Infliximab and tofacitinib are associated with lower binding antibody responses to influenza/A, similar to COVID-19 vaccine-induced antibody responses.
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Affiliation(s)
- Zhigang Liu
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - James L Alexander
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
- Department of Gastroenterology, St Marks Hospital and Academic Institute, Gastroenterology, London, UK
| | - Kai Yee Eng
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Hajir Ibraheim
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Sulak Anandabaskaran
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology, St Marks Hospital and Academic Institute, Gastroenterology, London, UK
| | - Aamir Saifuddin
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology, St Marks Hospital and Academic Institute, Gastroenterology, London, UK
| | - Laura Constable
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Rocio Castro Seoane
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Claire Bewshea
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Rachel Nice
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
- Department of Clinical Chemistry, Exeter Clinical Laboratory International, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Andrea D’Mello
- Division of Medicine & Integrated Care, Imperial College Healthcare NHS Trust, London, UK
| | - Gareth R Jones
- Department of Gastroenterology, Western General Hospital, NHS Lothian, Edinburgh, UK
- Centre for Inflammation Research, The Queen’s Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Sharmili Balarajah
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Francesca Fiorentino
- Department of Surgery and Cancer, Imperial College London, London, UK
- Nightingale-Saunders Clinical Trials & Epidemiology Unit [King’s Clinical Trials Unit], King’s College London, London, UK
| | - Shaji Sebastian
- Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, UK
- Hull York Medical School, University of Hull, Hull, UK
| | - Peter M Irving
- Department of Gastroenterology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- School of Immunology & Microbial Sciences, King’s College London, London, UK
| | - Lucy C Hicks
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Horace R T Williams
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Alexandra J Kent
- Department of Gastroenterology, King’s College Hospital, London, UK
| | - Rachel Linger
- The NIHR Bioresource, University of Cambridge, Cambridge, UK
| | - Miles Parkes
- The NIHR Bioresource, University of Cambridge, Cambridge, UK
- Department of Gastroenterology, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Klaartje Kok
- Department of Gastroenterology, Bart’s Health NHS Trust, London, UK
| | - Kamal V Patel
- Department of Gastroenterology, St George’s Hospital NHS Trust, London, UK
| | - Julian P Teare
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Daniel M Altmann
- Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Rosemary J Boyton
- Department of Infectious Disease, Imperial College London, London, UK
- Lung Division, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Ailsa L Hart
- Department of Gastroenterology, St Marks Hospital and Academic Institute, Gastroenterology, London, UK
| | - Charlie W Lees
- Department of Gastroenterology, Western General Hospital, NHS Lothian, Edinburgh, UK
- Centre for Inflammation Research, The Queen’s Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - James R Goodhand
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Nicholas A Kennedy
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Katrina M Pollock
- Department of Infectious Disease, Imperial College London, London, UK
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | - Tariq Ahmad
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Nick Powell
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
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2
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Patel PS, Fragkos K, Keane N, Wilkinson D, Johnson A, Chan D, Roberts B, Neild P, Yalcin M, Allan P, FitzPatrick MEB, Gomez M, Williams S, Kok K, Sharkey L, Swift C, Mehta S, Naghibi M, Mountford C, Forbes A, Rahman F, Di Caro S. Nutritional care pathways in cancer patients with malignant bowel obstruction: A retrospective multi-centre study. Clin Nutr ESPEN 2024; 59:118-125. [PMID: 38220364 DOI: 10.1016/j.clnesp.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Variation in access to parenteral nutrition (PN) in patients with intestinal failure secondary to malignant bowel obstruction (MBO) exists due to differing practice, beliefs and resource access. We aimed to examine differences in nutritional care pathways and outcomes, by referral to nutrition team for PN in patients with MBO. METHODS This is a retrospective cohort study of MBO adults admitted to eight UK hospitals within a year and 1 year follow-up. Demographic, nutritional and medical data were analysed by comparing patients referred (R) or not referred (NR) for PN. Differences between groups were tested by Kruskal-Wallis, Chi-Squared tests and multi-level regression and survival using Cox regression. RESULTS 232 patients with 347 MBO admissions [median 66yr, (IQR: 55-74yrs), 67 % female], 79/232 patients were referred for PN (R group). Underlying primary malignancies of gynaecological and gastrointestinal origin predominated (71 %) and 78 % with metastases. Those in the NR group were found to be older, weigh more on admission, and more likely to be treated conservatively compared to those in the R group. For 123 (35 %) admissions, patients were referred to a nutrition team, and for 204 (59 %) admissions, patients were reviewed by a dietician. Multi-disciplinary team discussion and dietetic contact were more likely to occur in the R group-123/347 admissions (R vs NR group: 27 % vs. 7 %, P = 0.001; 95 % vs 39 %, P < 0.0001). Median admission weight loss was 8 % (IQR: 0 to 14). 43/123 R group admissions received inpatient PN only, with 32 patients discharged or already established on home parenteral nutrition. Overall survival was 150 days (126-232) with no difference between R/NR groups. CONCLUSION In this multi-centre study evaluating nutritional care management of patients with malignant bowel obstruction, only 1 in 3 admissions resulted in a referral to the nutrition team for PN, and just over half were reviewed by a dietician. Further prospective research is required to evaluate possible consequences of these differential care pathways on clinical outcomes and quality of life.
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Affiliation(s)
- Pinal S Patel
- Intestinal Failure Unit, University College London Hospitals, London, United Kingdom; Cambridge Centre for Intestinal Rehabilitation and Transplant, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
| | - Konstantinos Fragkos
- Intestinal Failure Unit, University College London Hospitals, London, United Kingdom; University College London, London, United Kingdom
| | - Niamh Keane
- Intestinal Failure Unit, University College London Hospitals, London, United Kingdom; University College London, London, United Kingdom
| | - David Wilkinson
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom
| | - Amy Johnson
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom
| | - Derek Chan
- Intestinal Failure Unit, St Mark's and Northwick Park Hospital, London, United Kingdom
| | - Bradley Roberts
- Intestinal Failure Unit, St Mark's and Northwick Park Hospital, London, United Kingdom
| | - Penny Neild
- Department of Gastroenterology, St George's University Hospitals, London, United Kingdom
| | - Metin Yalcin
- Department of Gastroenterology, St George's University Hospitals, London, United Kingdom
| | - Philip Allan
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Michael E B FitzPatrick
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Michael Gomez
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Sarah Williams
- Department of Gastroenterology, St Bartholomew's Hospital, London, United Kingdom
| | - Klaartje Kok
- Department of Gastroenterology, St Bartholomew's Hospital, London, United Kingdom
| | - Lisa Sharkey
- Cambridge Centre for Intestinal Rehabilitation and Transplant, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Carla Swift
- Cambridge Centre for Intestinal Rehabilitation and Transplant, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Shameer Mehta
- Intestinal Failure Unit, University College London Hospitals, London, United Kingdom; Department of Gastroenterology, St Bartholomew's Hospital, London, United Kingdom
| | - Mani Naghibi
- Intestinal Failure Unit, St Mark's and Northwick Park Hospital, London, United Kingdom
| | - Christopher Mountford
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom
| | - Alastair Forbes
- Department of Gastroenterology, Norfolk & Norwich University Hospital, Norwich, United Kingdom; University of Tartu, Estonia
| | - Farooq Rahman
- Intestinal Failure Unit, University College London Hospitals, London, United Kingdom; University College London, London, United Kingdom
| | - Simona Di Caro
- Intestinal Failure Unit, University College London Hospitals, London, United Kingdom; University College London, London, United Kingdom
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3
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Carlson SL, Mathew L, Savage M, Kok K, Lindsay JO, Munro CA, McCarthy NE. Mucosal Immunity to Gut Fungi in Health and Inflammatory Bowel Disease. J Fungi (Basel) 2023; 9:1105. [PMID: 37998910 PMCID: PMC10672531 DOI: 10.3390/jof9111105] [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: 09/29/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 11/25/2023] Open
Abstract
The gut microbiome is a diverse microbial community composed of bacteria, viruses, and fungi that plays a major role in human health and disease. Dysregulation of these gut organisms in a genetically susceptible host is fundamental to the pathogenesis of inflammatory bowel disease (IBD). While bacterial dysbiosis has been a predominant focus of research for many years, there is growing recognition that fungal interactions with the host immune system are an important driver of gut inflammation. Candida albicans is likely the most studied fungus in the context of IBD, being a near universal gut commensal in humans and also a major barrier-invasive pathogen. There is emerging evidence that intra-strain variation in C. albicans virulence factors exerts a critical influence on IBD pathophysiology. In this review, we describe the immunological impacts of variations in C. lbicans colonisation, morphology, genetics, and proteomics in IBD, as well as the clinical and therapeutic implications.
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Affiliation(s)
- Sean L. Carlson
- Centre for Immunobiology, The Blizard Institute, Queen Mary University of London, London E1 2AT, UK
- Gastroenterology Department, Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
| | - Liya Mathew
- Centre for Immunobiology, The Blizard Institute, Queen Mary University of London, London E1 2AT, UK
| | - Michael Savage
- Centre for Immunobiology, The Blizard Institute, Queen Mary University of London, London E1 2AT, UK
| | - Klaartje Kok
- Centre for Immunobiology, The Blizard Institute, Queen Mary University of London, London E1 2AT, UK
- Gastroenterology Department, Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
| | - James O. Lindsay
- Centre for Immunobiology, The Blizard Institute, Queen Mary University of London, London E1 2AT, UK
- Gastroenterology Department, Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
| | - Carol A. Munro
- Aberdeen Fungal Group, Institute of Medical Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - Neil E. McCarthy
- Centre for Immunobiology, The Blizard Institute, Queen Mary University of London, London E1 2AT, UK
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4
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Zwierenga F, van Veggel BAMH, van den Berg A, Groen HJM, Zhang L, Groves MR, Kok K, Smit EF, Hiltermann TJN, de Langen AJ, van der Wekken AJ. A comprehensive overview of the heterogeneity of EGFR exon 20 variants in NSCLC and (pre)clinical activity to currently available treatments. Cancer Treat Rev 2023; 120:102628. [PMID: 37797348 DOI: 10.1016/j.ctrv.2023.102628] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023]
Abstract
Activating EGFR mutations are commonly observed in non-small cell lung cancer (NSCLC). About 4-10 % of all activating epidermal growth factor receptor (EGFR) mutations are heterogenous in-frame deletion and/or insertion mutations clustering within exon 20 (EGFRex20+). NSCLC patients with EGFRex20+ mutations are treated as a single disease entity, irrespective of the type and location of the mutation. Here, we provide a comprehensive assessment of the literature reporting both in vitro and clinical drug sensitivity across different EGFRex20+ mutations. The activating A763_Y764insFQEA mutation has a better tumor response in comparison with mutations in the near- and far regions directly following the C-helix and should therefore be treated differently. For other EGFRex20+ mutations marked differences in treatment responses have been reported indicating the need for a classification beyond the exon-based classification. A further classification can be achieved using a structure-function modeling approach and experimental data using patient-derived cell lines. The detailed overview of TKI responses for each EGFRex20+ mutation can assist treating physicians to select the most optimal drug for individual NSCLC patients.
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Affiliation(s)
- Fenneke Zwierenga
- Department of Pulmonary Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Bianca A M H van Veggel
- Department of Thoracic Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Anke van den Berg
- Department of Pathology and Molecular Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harry J M Groen
- Department of Pulmonary Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lili Zhang
- Structural Biology in Drug Design, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Matthew R Groves
- Structural Biology in Drug Design, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - K Kok
- Department of Genetics, University of Groningen, University Medical Center Groningen, The Netherlands
| | - E F Smit
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - T Jeroen N Hiltermann
- Department of Pulmonary Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adrianus J de Langen
- Department of Thoracic Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Anthonie J van der Wekken
- Department of Pulmonary Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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5
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Liu Z, Alexander JL, Le K, Zhou X, Ibraheim H, Anandabaskaran S, Saifuddin A, Lin KW, McFarlane LR, Constable L, Seoane RC, Anand N, Bewshea C, Nice R, D'Mello A, Jones GR, Balarajah S, Fiorentino F, Sebastian S, Irving PM, Hicks LC, Williams HRT, Kent AJ, Linger R, Parkes M, Kok K, Patel KV, Teare JP, Altmann DM, Boyton RJ, Hart AL, Lees CW, Goodhand JR, Kennedy NA, Pollock KM, Ahmad T, Powell N. Neutralising antibody responses against SARS-CoV-2 Omicron BA.4/5 and wild-type virus in patients with inflammatory bowel disease following three doses of COVID-19 vaccine (VIP): a prospective, multicentre, cohort study. EClinicalMedicine 2023; 64:102249. [PMID: 37842172 PMCID: PMC10570718 DOI: 10.1016/j.eclinm.2023.102249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Background Patients with inflammatory bowel disease (IBD) receiving anti-TNF and JAK-inhibitor therapy have attenuated responses to COVID-19 vaccination. We aimed to determine how IBD treatments affect neutralising antibody responses against the Omicron BA.4/5 variant. Methods In this multicentre cohort study, we prospectively recruited 340 adults (69 healthy controls and 271 IBD) at nine UK hospitals between May 28, 2021 and March 29, 2022. The IBD study population was established (>12 weeks therapy) on either thiopurine (n = 63), infliximab (n = 45), thiopurine and infliximab combination therapy (n = 48), ustekinumab (n = 45), vedolizumab (n = 46) or tofacitinib (n = 24). Patients were excluded if they were being treated with any other immunosuppressive therapies. Participants had two doses of either ChAdOx1 nCoV-19 or BNT162b2 vaccines, followed by a third dose of either BNT162b2 or mRNA1273. Pseudo-neutralisation assays against SARS-CoV-2 wild-type and BA.4/5 were performed. The half maximal inhibitory concentration (NT50) of participant sera was calculated. The primary outcome was anti-SARS-CoV-2 neutralising response against wild-type virus and Omicron BA.4/5 variant after the second and third doses of anti-SARS-CoV-2 vaccine, stratified by immunosuppressive therapy, adjusting for prior infection, vaccine type, age, and interval between vaccination and blood collection. This study is registered with ISRCTN (No. 13495664). Findings Both heterologous (first two doses adenovirus vaccine, third dose mRNA vaccine) and homologous (three doses mRNA vaccine) vaccination strategies significantly increased neutralising titres against both wild-type SARS-CoV-2 virus and the Omicron BA.4/5 variant in healthy participants and patients with IBD. Antibody titres against BA.4/5 were significantly lower than antibodies against wild-type virus in both healthy participants and patients with IBD (p < 0.0001). Multivariable models demonstrated that neutralising antibodies against BA.4/5 after three doses of vaccine were significantly lower in patients with IBD on infliximab (Geometric Mean Ratio (GMR) 0.19 [0.10, 0.36], p < 0.0001), infliximab and thiopurine combination (GMR 0.25 [0.13, 0.49], p < 0.0001) or tofacitinib (GMR 0.43 [0.20, 0.91], p = 0.028), but not in patients on thiopurine monotherapy, ustekinumab, or vedolizumab. Breakthrough infection was associated with lower neutralising antibodies against wild-type (p = 0.037) and BA.4/5 (p = 0.045). Interpretation A third dose of a COVID-19 mRNA vaccine based on the wild-type spike glycoprotein significantly boosts neutralising antibody titres in patients with IBD. However, responses are lower against the Omicron variant BA.4/5, particularly in patients taking anti-TNF and JAK-inhibitor therapy. Breakthrough infections are associated with lower neutralising antibodies and immunosuppressed patients with IBD may receive additional benefit from bivalent vaccine boosters which target Omicron variants. Funding Pfizer.
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Affiliation(s)
- Zhigang Liu
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - James L. Alexander
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Kaixing Le
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Xin Zhou
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Hajir Ibraheim
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Sulak Anandabaskaran
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology, St Marks Hospital and Academic Institute, Gastroenterology, London, UK
| | - Aamir Saifuddin
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology, St Marks Hospital and Academic Institute, Gastroenterology, London, UK
| | - Kathy Weitung Lin
- Department of Infectious Disease, Imperial College London, London, UK
| | - Leon R. McFarlane
- Department of Infectious Disease, Imperial College London, London, UK
| | - Laura Constable
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Rocio Castro Seoane
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Nikhil Anand
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Claire Bewshea
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Rachel Nice
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
- Department of Clinical Chemistry, Exeter Clinical Laboratory International, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Andrea D'Mello
- Division of Medicine & Integrated Care, Imperial College Healthcare NHS Trust, London, UK
| | - Gareth R. Jones
- Department of Gastroenterology, Western General Hospital, NHS Lothian, Edinburgh, UK
- Centre for Inflammation Research, The Queen’s Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Sharmili Balarajah
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Francesca Fiorentino
- Department of Surgery and Cancer, Imperial College London, London, UK
- Nightingale-Saunders Clinical Trials & Epidemiology Unit (King’s Clinical Trials Unit), King’s College London, London, UK
| | - Shaji Sebastian
- Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, UK
- Hull York Medical School, University of Hull, Hull, UK
| | - Peter M. Irving
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Lucy C. Hicks
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Horace RT. Williams
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Rachel Linger
- The NIHR Bioresource, University of Cambridge, Cambridge, UK
| | - Miles Parkes
- The NIHR Bioresource, University of Cambridge, Cambridge, UK
- Department of Gastroenterology, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Klaartje Kok
- Department of Gastroenterology, Bart's Health NHS Trust, London, UK
| | - Kamal V. Patel
- Department of Gastroenterology, St George's Hospital NHS Trust, London, UK
| | - Julian P. Teare
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Daniel M. Altmann
- Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Rosemary J. Boyton
- Department of Infectious Disease, Imperial College London, London, UK
- Lung Division, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Ailsa L. Hart
- Department of Gastroenterology, St Marks Hospital and Academic Institute, Gastroenterology, London, UK
| | - Charlie W. Lees
- Department of Gastroenterology, Western General Hospital, NHS Lothian, Edinburgh, UK
- Centre for Inflammation Research, The Queen’s Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - James R. Goodhand
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Nicholas A. Kennedy
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Katrina M. Pollock
- Department of Infectious Disease, Imperial College London, London, UK
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | - Tariq Ahmad
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Nick Powell
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
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Liu Z, Le K, Zhou X, Alexander JL, Lin S, Bewshea C, Chanchlani N, Nice R, McDonald TJ, Lamb CA, Sebastian S, Kok K, Lees CW, Hart AL, Pollok RC, Boyton RJ, Altmann DM, Pollock KM, Goodhand JR, Kennedy NA, Ahmad T, Powell N. Neutralising antibody potency against SARS-CoV-2 wild-type and omicron BA.1 and BA.4/5 variants in patients with inflammatory bowel disease treated with infliximab and vedolizumab after three doses of COVID-19 vaccine (CLARITY IBD): an analysis of a prospective multicentre cohort study. Lancet Gastroenterol Hepatol 2023; 8:145-156. [PMID: 36481043 PMCID: PMC9757903 DOI: 10.1016/s2468-1253(22)00389-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Anti-TNF drugs, such as infliximab, are associated with attenuated antibody responses after SARS-CoV-2 vaccination. We aimed to determine how the anti-TNF drug infliximab and the anti-integrin drug vedolizumab affect vaccine-induced neutralising antibodies against highly transmissible omicron (B.1.1.529) BA.1, and BA.4 and BA.5 (hereafter BA.4/5) SARS-CoV-2 variants, which possess the ability to evade host immunity and, together with emerging sublineages, are now the dominating variants causing current waves of infection. METHODS CLARITY IBD is a prospective, multicentre, observational cohort study investigating the effect of infliximab and vedolizumab on SARS-CoV-2 infection and vaccination in patients with inflammatory bowel disease (IBD). Patients aged 5 years and older with a diagnosis of IBD and being treated with infliximab or vedolizumab for 6 weeks or longer were recruited from infusion units at 92 hospitals in the UK. In this analysis, we included participants who had received uninterrupted biological therapy since recruitment and without a previous SARS-CoV-2 infection. The primary outcome was neutralising antibody responses against SARS-CoV-2 wild-type and omicron subvariants BA.1 and BA.4/5 after three doses of SARS-CoV-2 vaccine. We constructed Cox proportional hazards models to investigate the risk of breakthrough infection in relation to neutralising antibody titres. The study is registered with the ISRCTN registry, ISRCTN45176516, and is closed to accrual. FINDINGS Between Sept 22 and Dec 23, 2020, 7224 patients with IBD were recruited to the CLARITY IBD study, of whom 1288 had no previous SARS-CoV-2 infection after three doses of SARS-CoV-2 vaccine and were established on either infliximab (n=871) or vedolizumab (n=417) and included in this study (median age was 46·1 years [IQR 33·6-58·2], 610 [47·4%] were female, 671 [52·1%] were male, 1209 [93·9%] were White, and 46 [3·6%] were Asian). After three doses of SARS-CoV-2 vaccine, 50% neutralising titres (NT50s) were significantly lower in patients treated with infliximab than in those treated with vedolizumab, against wild-type (geometric mean 2062 [95% CI 1720-2473] vs 3440 [2939-4026]; p<0·0001), BA.1 (107·3 [86·40-133·2] vs 648·9 [523·5-804·5]; p<0·0001), and BA.4/5 (40·63 [31·99-51·60] vs 223·0 [183·1-271·4]; p<0·0001) variants. Breakthrough infection was significantly more frequent in patients treated with infliximab (119 [13·7%; 95% CI 11·5-16·2] of 871) than in those treated with vedolizumab (29 [7·0% [4·8-10·0] of 417; p=0·00040). Cox proportional hazards models of time to breakthrough infection after the third dose of vaccine showed infliximab treatment to be associated with a higher hazard risk than treatment with vedolizumab (hazard ratio [HR] 1·71 [95% CI 1·08-2·71]; p=0·022). Among participants who had a breakthrough infection, we found that higher neutralising antibody titres against BA.4/5 were associated with a lower hazard risk and, hence, a longer time to breakthrough infection (HR 0·87 [0·79-0·95]; p=0·0028). INTERPRETATION Our findings underline the importance of continued SARS-CoV-2 vaccination programmes, including second-generation bivalent vaccines, especially in patient subgroups where vaccine immunogenicity and efficacy might be reduced, such as those on anti-TNF therapies. FUNDING Royal Devon University Healthcare NHS Foundation Trust; Hull University Teaching Hospital NHS Trust; NIHR Imperial Biomedical Research Centre; Crohn's and Colitis UK; Guts UK; National Core Studies Immunity Programme, UK Research and Innovation; and unrestricted educational grants from F Hoffmann-La Roche, Biogen, Celltrion Healthcare, Takeda, and Galapagos.
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Affiliation(s)
- Zhigang Liu
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Kaixing Le
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Xin Zhou
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - James L Alexander
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Simeng Lin
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK; Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Claire Bewshea
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Neil Chanchlani
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK; Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Rachel Nice
- Department of Biochemistry, Exeter Clinical Laboratory International, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK; Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Timothy J McDonald
- Department of Biochemistry, Exeter Clinical Laboratory International, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Christopher A Lamb
- Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Shaji Sebastian
- Hull York Medical School, University of Hull, Hull, UK; Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Klaartje Kok
- Department of Gastroenterology, Bart's Health NHS Trust, London, UK
| | - Charlie W Lees
- Department of Gastroenterology, Western General Hospital, NHS Lothian, Edinburgh, UK; Centre for Inflammation Research, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Ailsa L Hart
- Department of Gastroenterology, St Marks Hospital and Academic Institute, London, UK
| | - Richard C Pollok
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK; Institute for Infection and Immunity, St George's University of London, London, UK
| | - Rosemary J Boyton
- Department of Infectious Disease, Imperial College London, London, UK; Lung Division, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Daniel M Altmann
- Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Katrina M Pollock
- Department of Infectious Disease, Imperial College London, London, UK; NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | - James R Goodhand
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK; Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Nicholas A Kennedy
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK; Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Tariq Ahmad
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK; Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Nick Powell
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK.
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Alexander JL, Liu Z, Muñoz Sandoval D, Reynolds C, Ibraheim H, Anandabaskaran S, Saifuddin A, Castro Seoane R, Anand N, Nice R, Bewshea C, D'Mello A, Constable L, Jones GR, Balarajah S, Fiorentino F, Sebastian S, Irving PM, Hicks LC, Williams HRT, Kent AJ, Linger R, Parkes M, Kok K, Patel KV, Teare JP, Altmann DM, Goodhand JR, Hart AL, Lees CW, Boyton RJ, Kennedy NA, Ahmad T, Powell N. COVID-19 vaccine-induced antibody and T-cell responses in immunosuppressed patients with inflammatory bowel disease after the third vaccine dose (VIP): a multicentre, prospective, case-control study. Lancet Gastroenterol Hepatol 2022; 7:1005-1015. [PMID: 36088954 PMCID: PMC9458592 DOI: 10.1016/s2468-1253(22)00274-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND COVID-19 vaccine-induced antibody responses are reduced in patients with inflammatory bowel disease (IBD) taking anti-TNF or tofacitinib after two vaccine doses. We sought to assess whether immunosuppressive treatments were associated with reduced antibody and T-cell responses in patients with IBD after a third vaccine dose. METHODS VIP was a multicentre, prospective, case-control study done in nine centres in the UK. We recruited immunosuppressed patients with IBD and non-immunosuppressed healthy individuals. All participants were aged 18 years or older. The healthy control group had no diagnosis of IBD and no current treatment with systemic immunosuppressive therapy for any other indication. The immunosuppressed patients with IBD had an established diagnosis of Crohn's disease, ulcerative colitis, or unclassified IBD using standard definitions of IBD, and were receiving established treatment with one of six immunosuppressive regimens for at least 12 weeks at the time of first dose of SARS-CoV-2 vaccination. All participants had to have received three doses of an approved COVID-19 vaccine. SARS-CoV-2 spike antibody binding and T-cell responses were measured in all participant groups. The primary outcome was anti-SARS-CoV-2 spike (S1 receptor binding domain [RBD]) antibody concentration 28-49 days after the third vaccine dose, adjusted by age, homologous versus heterologous vaccine schedule, and previous SARS-CoV-2 infection. The primary outcome was assessed in all participants with available data. FINDINGS Between Oct 18, 2021, and March 29, 2022, 352 participants were included in the study (thiopurine n=65, infliximab n=46, thiopurine plus infliximab combination therapy n=49, ustekinumab n=44, vedolizumab n=50, tofacitinib n=26, and healthy controls n=72). Geometric mean anti-SARS-CoV-2 S1 RBD antibody concentrations increased in all groups following a third vaccine dose, but were significantly lower in patients treated with infliximab (2736·8 U/mL [geometric SD 4·3]; p<0·0001), infliximab plus thiopurine (1818·3 U/mL [6·7]; p<0·0001), and tofacitinib (8071·5 U/mL [3·1]; p=0·0018) compared with the healthy control group (16 774·2 U/mL [2·6]). There were no significant differences in anti-SARS-CoV-2 S1 RBD antibody concentrations between the healthy control group and patients treated with thiopurine (12 019·7 U/mL [2·2]; p=0·099), ustekinumab (11 089·3 U/mL [2·8]; p=0·060), or vedolizumab (13 564·9 U/mL [2·4]; p=0·27). In multivariable modelling, lower anti-SARS-CoV-2 S1 RBD antibody concentrations were independently associated with infliximab (geometric mean ratio 0·15 [95% CI 0·11-0·21]; p<0·0001), tofacitinib (0·52 [CI 0·31-0·87]; p=0·012), and thiopurine (0·69 [0·51-0·95]; p=0·021), but not with ustekinumab (0·64 [0·39-1·06]; p=0·083), or vedolizumab (0·84 [0·54-1·30]; p=0·43). Previous SARS-CoV-2 infection (1·58 [1·22-2·05]; p=0·0006) was independently associated with higher anti-SARS-CoV-2 S1 RBD antibody concentrations and older age (0·88 [0·80-0·97]; p=0·0073) was independently associated with lower anti-SARS-CoV-2 S1 RBD antibody concentrations. Antigen-specific T-cell responses were similar in all groups, except for recipients of tofacitinib without evidence of previous infection, where T-cell responses were significantly reduced relative to healthy controls (p=0·021). INTERPRETATION A third dose of COVID-19 vaccine induced a boost in antibody binding in immunosuppressed patients with IBD, but these responses were reduced in patients taking infliximab, infliximab plus thiopurine, and tofacitinib. Tofacitinib was also associated with reduced T-cell responses. These findings support continued prioritisation of immunosuppressed groups for further vaccine booster dosing, particularly patients on anti-TNF and JAK inhibitors. FUNDING Pfizer.
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Affiliation(s)
- James L Alexander
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Zhigang Liu
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | | | | | - Hajir Ibraheim
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Sulak Anandabaskaran
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK
| | - Aamir Saifuddin
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK
| | - Rocio Castro Seoane
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Nikhil Anand
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Rachel Nice
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK; Department of Clinical Chemistry, Biochemistry, Exeter Clinical Laboratory International, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Claire Bewshea
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Andrea D'Mello
- Division of Medicine and Integrated Care, Imperial College Healthcare NHS Trust, London, UK
| | - Laura Constable
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Gareth R Jones
- Department of Gastroenterology, Western General Hospital, NHS Lothian, Edinburgh, UK; Centre for Inflammation Research, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Sharmili Balarajah
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Francesca Fiorentino
- Department of Surgery and Cancer, Imperial College London, London, UK; Nightingale-Saunders Clinical Trials and Epidemiology Unit, King's Clinical Trials Unit, King's College London, London, UK
| | - Shaji Sebastian
- Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, UK; Hull York Medical School, University of Hull, Hull, UK
| | - Peter M Irving
- School of Immunology and Microbial Sciences, King's College London, London, UK; Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lucy C Hicks
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Horace R T Williams
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Alexandra J Kent
- Department of Gastroenterology, King's College Hospital, London, UK
| | - Rachel Linger
- The NIHR Bioresource, University of Cambridge, Cambridge, UK
| | - Miles Parkes
- The NIHR Bioresource, University of Cambridge, Cambridge, UK; Department of Gastroenterology, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Klaartje Kok
- Department of Gastroenterology, Bart's Health NHS Trust, London, UK
| | - Kamal V Patel
- Department of Gastroenterology, St George's Hospital NHS Trust, London, UK
| | - Julian P Teare
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Daniel M Altmann
- Department of Immunology and Inflammation, Imperial College London, London, UK
| | - James R Goodhand
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK; Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Ailsa L Hart
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK
| | - Charlie W Lees
- Department of Gastroenterology, Western General Hospital, NHS Lothian, Edinburgh, UK; Centre for Inflammation Research, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Rosemary J Boyton
- Department of Infectious Disease, Imperial College London, London, UK; Lung Division, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nicholas A Kennedy
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK; Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Tariq Ahmad
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK; Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Nick Powell
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK.
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Alexander JL, Kennedy NA, Ibraheim H, Anandabaskaran S, Saifuddin A, Castro Seoane R, Liu Z, Nice R, Bewshea C, D'Mello A, Constable L, Jones GR, Balarajah S, Fiorentino F, Sebastian S, Irving PM, Hicks LC, Williams HRT, Kent AJ, Linger R, Parkes M, Kok K, Patel KV, Teare JP, Altmann DM, Boyton RJ, Goodhand JR, Hart AL, Lees CW, Ahmad T, Powell N. COVID-19 vaccine-induced antibody responses in immunosuppressed patients with inflammatory bowel disease (VIP): a multicentre, prospective, case-control study. Lancet Gastroenterol Hepatol 2022; 7:342-352. [PMID: 35123676 PMCID: PMC8813209 DOI: 10.1016/s2468-1253(22)00005-x] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The effects that therapies for inflammatory bowel disease (IBD) have on immune responses to SARS-CoV-2 vaccination are not yet fully known. Therefore, we sought to determine whether COVID-19 vaccine-induced antibody responses were altered in patients with IBD on commonly used immunosuppressive drugs. METHODS In this multicentre, prospective, case-control study (VIP), we recruited adults with IBD treated with one of six different immunosuppressive treatment regimens (thiopurines, infliximab, a thiopurine plus infliximab, ustekinumab, vedolizumab, or tofacitinib) and healthy control participants from nine centres in the UK. Eligible participants were aged 18 years or older and had received two doses of COVID-19 vaccines (either ChAdOx1 nCoV-19 [Oxford-AstraZeneca], BNT162b2 [Pfizer-BioNTech], or mRNA1273 [Moderna]) 6-12 weeks apart (according to scheduling adopted in the UK). We measured antibody responses 53-92 days after a second vaccine dose using the Roche Elecsys Anti-SARS-CoV-2 spike electrochemiluminescence immunoassay. The primary outcome was anti-SARS-CoV-2 spike protein antibody concentrations in participants without previous SARS-CoV-2 infection, adjusted by age and vaccine type, and was analysed by use of multivariable linear regression models. This study is registered in the ISRCTN Registry, ISRCTN13495664, and is ongoing. FINDINGS Between May 31 and Nov 24, 2021, we recruited 483 participants, including patients with IBD being treated with thiopurines (n=78), infliximab (n=63), a thiopurine plus infliximab (n=72), ustekinumab (n=57), vedolizumab (n=62), or tofacitinib (n=30), and 121 healthy controls. We included 370 participants without evidence of previous infection in our primary analysis. Geometric mean anti-SARS-CoV-2 spike protein antibody concentrations were significantly lower in patients treated with infliximab (156·8 U/mL [geometric SD 5·7]; p<0·0001), infliximab plus thiopurine (111·1 U/mL [5·7]; p<0·0001), or tofacitinib (429·5 U/mL [3·1]; p=0·0012) compared with controls (1578·3 U/mL [3·7]). There were no significant differences in antibody concentrations between patients treated with thiopurine monotherapy (1019·8 U/mL [4·3]; p=0·74), ustekinumab (582·4 U/mL [4·6]; p=0·11), or vedolizumab (954·0 U/mL [4·1]; p=0·50) and healthy controls. In multivariable modelling, lower anti-SARS-CoV-2 spike protein antibody concentrations were independently associated with infliximab (geometric mean ratio 0·12, 95% CI 0·08-0·17; p<0·0001) and tofacitinib (0·43, 0·23-0·81; p=0·0095), but not with ustekinumab (0·69, 0·41-1·19; p=0·18), thiopurines (0·89, 0·64-1·24; p=0·50), or vedolizumab (1·16, 0·74-1·83; p=0·51). mRNA vaccines (3·68, 2·80-4·84; p<0·0001; vs adenovirus vector vaccines) were independently associated with higher antibody concentrations and older age per decade (0·79, 0·72-0·87; p<0·0001) with lower antibody concentrations. INTERPRETATION For patients with IBD, the immunogenicity of COVID-19 vaccines varies according to immunosuppressive drug exposure, and is attenuated in recipients of infliximab, infliximab plus thiopurines, and tofacitinib. Scheduling of third primary, or booster, doses could be personalised on the basis of an individual's treatment, and patients taking anti-tumour necrosis factor and tofacitinib should be prioritised. FUNDING Pfizer.
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Affiliation(s)
- James L Alexander
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Nicholas A Kennedy
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK; Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Hajir Ibraheim
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Sulak Anandabaskaran
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK
| | - Aamir Saifuddin
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK
| | - Rocio Castro Seoane
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Zhigang Liu
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Rachel Nice
- Department of Clinical Chemistry, Biochemistry-Exeter Clinical Laboratory International, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK; Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Claire Bewshea
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Andrea D'Mello
- Division of Medicine and Integrated Care, Imperial College Healthcare NHS Trust, London, UK
| | - Laura Constable
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Gareth R Jones
- Department of Gastroenterology, Western General Hospital, NHS Lothian, Edinburgh, UK; Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Sharmili Balarajah
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Francesca Fiorentino
- Department of Surgery and Cancer, Imperial College London, London, UK; Nightingale-Saunders Clinical Trials and Epidemiology Unit, King's Clinical Trials Unit, King's College London, London, UK
| | - Shaji Sebastian
- Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, UK; Hull York Medical School, University of Hull, Hull, UK
| | - Peter M Irving
- School of Immunology and Microbial Sciences, King's College London, London, UK; Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lucy C Hicks
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Horace R T Williams
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Alexandra J Kent
- Department of Gastroenterology, King's College Hospital, London, UK
| | - Rachel Linger
- The NIHR Bioresource, University of Cambridge, Cambridge, UK
| | - Miles Parkes
- The NIHR Bioresource, University of Cambridge, Cambridge, UK; Department of Gastroenterology, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Klaartje Kok
- Department of Gastroenterology, Bart's Health NHS Trust, London, UK
| | - Kamal V Patel
- Department of Gastroenterology, St George's Hospital NHS Trust, London, UK
| | - Julian P Teare
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Daniel M Altmann
- Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Rosemary J Boyton
- Department of Infectious Disease, Imperial College London, London, UK
| | - James R Goodhand
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK; Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Ailsa L Hart
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK
| | - Charlie W Lees
- Department of Gastroenterology, Western General Hospital, NHS Lothian, Edinburgh, UK; Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Tariq Ahmad
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK; Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Nick Powell
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK.
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Yong HJ, Lim MA, Kok K, Juanda N, Johar S. Transit time flow measurement (TTFM) as a predictor of graft failure and major adverse cardiac events following coronary artery bypass grafting (CABG). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Post coronary artery bypass grafting (CABG), coronary angiography (CAG) is the gold standard for graft assessment to check the presence of occlusion or stenosis. Despite this, CAGs after a CABG in the nation are only conducted if patients show ischemic signs. Alternative to CAG, transit time flow measurement (TTFM) can be utilized to determine overall quality of blood flow in grafts. TTFM has yet been utilized to assess graft patency despite its availability in the nation.
Purpose
This study aims to provide TTFM profiles from CABG surgeries, including characterizing the differences in TTFM parameters between failed and normal grafts, as well as determining the association of TTFM parameters and related clinical factors to the likelihood of graft failure and major adverse cardiac events (MACE).
Methods
279 patients were admitted to the cardiology centre from 1 January 2017 to 31 December 2019. Mann-Whitney test was used to compare the differences in TTFM parameters across different graft types, as well as between failed and normal grafts. To determine the likelihood of a graft being normal or failed based on established TTFM parameter cutoffs, χ² test was used. Lastly, multivariate logistic regression was used to determine the association between TTFM parameters and MACE, specifically angina, myocardial infarction, and death.
Results
Different graft types exhibited significant differences in TTFM parameters, particularly pulsatility index (PI) and diastolic filling (%DF). Arterial grafts presented with higher quality of blood flow compared to venous grafts, with left-sided grafts (especially LIMA-LAD) being the graft type of highest quality (Refer to Fig.1).
However, there were no differences in TTFM parameters between failed and normal grafts (PI P = 0.893; DF% P = 0.143). Despite this, there was a greater number of failed grafts with PI > 5 (6.6%) compared to PI < 5 (2.6%) (χ²=4.021, P = 0.045).
Multivariate analysis showed no significant association between TTFM parameters and prevalence of MACE. Instead, an increased risk of graft failure is associated with the female gender (P = 0.031), history of congestive heart failure (P = 0.025) and poor renal function (P = 0.034). Also, an increased risk of MACE is associated with a history of coronary intervention (P = 0.041), left coronary dominance (P = 0.018) and renal function (P = 0.009).
Conclusion
This study provides an overview of the TTFM profiles among different graft types used in CABG surgeries. While TTFM are not indicative of failed grafts upon ischemic signs, patient comorbidities were informative. Follow-up studies should include a larger sample size of patients from an earlier timeframe to assess correlation of graft failure over a 5-to-10-year span post-CABG. Regardless of ischemic signs, routine CAG for all patients should be considered to determine the true prevalence of graft failure among CABG patients in the nation. Abstract Figure. Fig1.Median comparison TTFM Parameters Abstract Figure. Fig2. Multivariate analysis models
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Affiliation(s)
- H J Yong
- Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam
| | - M A Lim
- Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam
| | - K Kok
- Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam
| | - N Juanda
- Gleneagles JPMC, Cardiothoracic Surgery, Bandar Seri Begawan, Brunei Darussalam
| | - S Johar
- Gleneagles JPMC, Cardiology - Electrophysiology, Bandar Seri Begawan, Brunei Darussalam
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10
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Kaler MK, Malina M, Kok K, Khan R. Inflammatory bowel disease in pregnancy: Developing a multidisciplinary care pathway in East London. Obstet Med 2021; 14:235-241. [PMID: 34880937 DOI: 10.1177/1753495x211009747] [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: 10/12/2020] [Revised: 02/28/2021] [Accepted: 03/20/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives Evaluate the management of pregnant women with inflammatory bowel disease. Method We collected data from maternity records for women with IBD who gave birth at The Royal London Hospital between January 2018 and February 2019. Results Twenty-three pregnancies were identified where 8/23 (35%) women had a peri-conception flare and 7/23 (30%) had a flare during pregnancy. Two women received pre-conception counselling. The obstetric medicine team reviewed a patient on average three times and the gastroenterologists twice, during pregnancy. Nine women (39%) gave birth pre-term. Mean birthweight was lower in the group with active disease at conception compared with those in remission (2173 g vs. 2807 g, p = 0.03). Conclusions Women with IBD should all receive pre-conception counselling to reduce the risk of pregnancy complications. By developing a multidisciplinary care pathway for pregnant women with IBD (which includes a joint obstetric/gastroenterology clinic), this will ensure care is standardised throughout the pregnancy and puerperium.
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11
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Pedersen L, Gerbek T, Muhic E, Christiansen T, Kok K, Sørensen K, Mølgaard C, Müller K. Are cardio-metabolic late-effects modifiable through a low-fat diet in long-term survivors of pediatric allogeneic stem cell transplantation? Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.609] [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: 11/30/2022]
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12
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Crooks B, Misra R, Arebi N, Kok K, Brookes MJ, McLaughlin J, Limdi JK. The dietary practices and beliefs of British South Asian people living with inflammatory bowel disease: a multicenter study from the United Kingdom. Intest Res 2021; 20:53-63. [PMID: 33396977 PMCID: PMC8831772 DOI: 10.5217/ir.2020.00079] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/24/2020] [Indexed: 11/17/2022] Open
Abstract
Background/Aims Epidemiological associations have implicated factors associated with Westernization, including the Western diet, in the development of inflammatory bowel disease (IBD). The role of diet in IBD etiopathogenesis, disease control and symptom management remains incompletely understood. Few studies have collected data on the dietary habits of immigrant populations living with IBD. Our aim was to describe the dietary practices and beliefs of British South Asians with IBD. Methods A 30-item questionnaire was developed and consecutively administered to 255 British South Asians with IBD attending gastroenterology clinics in the United Kingdom. Results Fifty-one percent of participants believed diet was the initiating factor for their IBD and 63% felt diet had previously triggered disease relapse. Eighty-nine percent avoided certain dietary items in the belief that this would prevent relapse. The most commonly avoided foods and drinks were spicy and fatty foods, carbonated drinks, milk products, alcohol, coffee, and red meat. A third of patients had tried a whole food exclusion diet, most commonly lactose- or gluten-free, and this was most frequently reported amongst those with clinically active IBD (P = 0.02). Almost 60% of participants avoided eating the same menu as their family, or eating out, at least sometimes, to prevent IBD relapse. Conclusions British South Asians with IBD demonstrate significant dietary beliefs and food avoidance behaviors with increased frequency compared to those reported in Caucasian IBD populations. Studies in immigrant populations may offer valuable insights into the interaction between diet, Westernization and cultural drift in IBD pathogenesis and symptomatology.
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Affiliation(s)
- Benjamin Crooks
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Department of Gastroenterology, Salford Royal NHS Foundation Trust, Salford, UK.,Section of IBD, Division of Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Ravi Misra
- Department of IBD, St Mark's Hospital and Imperial College, London, UK
| | - Naila Arebi
- Department of IBD, St Mark's Hospital and Imperial College, London, UK
| | - Klaartje Kok
- Gastroenterology Department, Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - Matthew J Brookes
- Gastroenterology Unit, Royal Wolverhampton NHS Trust, Wolverhampton, UK.,Research Institute in Healthcare Science (RIHS), University of Wolverhampton, Wolverhampton, UK
| | - John McLaughlin
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Department of Gastroenterology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Jimmy K Limdi
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Section of IBD, Division of Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester, UK
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13
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Steele L, Jeetle S, Kok K, Cunningham M, Goldsmith P. Pyodermatitis vegetans-pyostomatitis vegetans with ocular involvement. Clin Exp Dermatol 2020; 46:223-226. [PMID: 32975854 DOI: 10.1111/ced.14446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 08/26/2020] [Indexed: 11/30/2022]
Affiliation(s)
- L Steele
- Departments of, Department of, Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - S Jeetle
- Department of, Histopathology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - K Kok
- Department of, Gastroenterology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M Cunningham
- Departments of, Department of, Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - P Goldsmith
- Departments of, Department of, Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, UK
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14
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Curciarello R, Sobande T, Jones S, Giuffrida P, Di Sabatino A, Docena GH, MacDonald TT, Kok K. Human Neutrophil Elastase Proteolytic Activity in Ulcerative Colitis Favors the Loss of Function of Therapeutic Monoclonal Antibodies. J Inflamm Res 2020; 13:233-243. [PMID: 32547155 PMCID: PMC7251227 DOI: 10.2147/jir.s234710] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/15/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose Proteases play an essential role in the pathophysiology of inflammatory bowel disease (IBD), contributing to the intestinal mucosal lesions through the degradation of the extracellular matrix and alteration of the barrier function. Ulcerative colitis (UC) is characterized by an extensive infiltrate of neutrophils into the mucosa and hence, increased proteolytic activity. Human neutrophil elastase (HNE) is a serine protease that has been reported to be increased in UC patients’ intestinal mucosa. Based on our previous studies, we hypothesized that HNE might induce proteolytic degradation and loss of function of therapeutic monoclonal antibodies in IBD patients. Patients and Methods Elastase expression and elastinolytic activity were determined in mucosal explants from ulcerative colitis patients (n=6) and cultured ex vivo in the presence or absence of recombinant elafin. Enzymatic digestions of therapeutic monoclonal antibodies were performed using recombinant HNE and elafin. The integrity of the therapeutic antibodies was evaluated by immunoblotting and protein G binding assay, whereas their TNF-neutralizing activity was assessed with a reporter cell line. Results We found that HNE and its elastinolytic activity were increased in the gut mucosa of UC patients. We also demonstrated that HNE cleaved biological drugs, impairing the TNF-α neutralizing capacity of anti-TNF monoclonal antibodies. This proteolytic degradation was inhibited by the addition of the specific inhibitor, elafin. Conclusion Our results suggest that the high level of proteolytic degradation by mucosal neutrophil elastase, along with a potential imbalance with elafin, contributes to the loss of function of biologic agents, which are currently used in patients with IBD. These findings might explain the non-responsiveness of UC patients to therapeutic monoclonal antibodies and suggest the potential beneficial concomitant use of elafin in this treatment.
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Affiliation(s)
- Renata Curciarello
- Instituto de Estudios Inmunológicos y Fisiopatológicos IIFP-CONICET, Universidad Nacional de La Plata, La Plata, Buenos Aires, Argentina.,Centre for Immunobiology, The Blizard Institute, Queen Mary University of London, London, UK
| | - Toni Sobande
- Centre for Immunobiology, The Blizard Institute, Queen Mary University of London, London, UK
| | - Samantha Jones
- Centre for Immunobiology, The Blizard Institute, Queen Mary University of London, London, UK
| | - Paolo Giuffrida
- Centre for Immunobiology, The Blizard Institute, Queen Mary University of London, London, UK.,First Department of Internal Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Di Sabatino
- First Department of Internal Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Guillermo H Docena
- Instituto de Estudios Inmunológicos y Fisiopatológicos IIFP-CONICET, Universidad Nacional de La Plata, La Plata, Buenos Aires, Argentina
| | - Thomas T MacDonald
- Centre for Immunobiology, The Blizard Institute, Queen Mary University of London, London, UK
| | - Klaartje Kok
- Centre for Immunobiology, The Blizard Institute, Queen Mary University of London, London, UK.,Barts Health NHS Trust, Royal London Hospital, London, UK
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15
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Ong J, Faiz A, Timens W, van den Berge M, Terpstra MM, Kok K, van den Berg A, Kluiver J, Brandsma CA. Marked TGF-β-regulated miRNA expression changes in both COPD and control lung fibroblasts. Sci Rep 2019; 9:18214. [PMID: 31796837 PMCID: PMC6890791 DOI: 10.1038/s41598-019-54728-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 11/14/2019] [Indexed: 12/11/2022] Open
Abstract
COPD is associated with disturbed tissue repair, possibly due to TGF-β-regulated miRNA changes in fibroblasts. Our aim was to identify TGF-β-regulated miRNAs and their differential regulation and expression in COPD compared to control fibroblasts. Small RNA sequencing was performed on TGF-β-stimulated and unstimulated lung fibroblasts from 15 COPD patients and 15 controls. Linear regression was used to identify TGF-β-regulated and COPD-associated miRNAs. Interaction analysis was performed to compare miRNAs that responded differently to TGF-β in COPD and control. Re-analysis of previously generated Ago2-IP data and Enrichr were used to identify presence and function of potential target genes in the miRNA-targetome of lung fibroblasts. In total, 46 TGF-β-regulated miRNAs were identified in COPD and 86 in control fibroblasts (FDR < 0.05). MiR-27a-5p was the most significantly upregulated miRNA. MiR-148b-3p, miR-589-5p and miR-376b-3p responded differently to TGF-β in COPD compared to control (FDR < 0.25). MiR-660-5p was significantly upregulated in COPD compared to control (FDR < 0.05). Several predicted targets of miR-27a-5p, miR-148b-3p and miR-660-5p were present in the miRNA-targetome, and were mainly involved in the regulation of gene transcription. In conclusion, altered TGF-β-induced miRNA regulation and differential expression of miR-660-5p in COPD fibroblasts, may represent one of the mechanisms underlying aberrant tissue repair and remodelling in COPD.
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Affiliation(s)
- J Ong
- University of Groningen, University Medical Centre Groningen, Department of Pathology and Medical Biology, Groningen, The Netherlands.,University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - A Faiz
- University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.,University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands.,University of Technology Sydney, Respiratory Bioinformatics and Molecular Biology (RBMB) Faculty of Science, Ultimo, NSW, 2007, Australia
| | - W Timens
- University of Groningen, University Medical Centre Groningen, Department of Pathology and Medical Biology, Groningen, The Netherlands.,University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - M van den Berge
- University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.,University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
| | - M M Terpstra
- University of Groningen, University Medical Centre Groningen, Department of Genetics, Groningen, The Netherlands
| | - K Kok
- University of Groningen, University Medical Centre Groningen, Department of Genetics, Groningen, The Netherlands
| | - A van den Berg
- University of Groningen, University Medical Centre Groningen, Department of Pathology and Medical Biology, Groningen, The Netherlands
| | - J Kluiver
- University of Groningen, University Medical Centre Groningen, Department of Pathology and Medical Biology, Groningen, The Netherlands
| | - C A Brandsma
- University of Groningen, University Medical Centre Groningen, Department of Pathology and Medical Biology, Groningen, The Netherlands. .,University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.
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16
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Meng P, Rybczynska A, Wei J, Terpstra M, Timens W, Schuuring E, Hiltermann T, Groen H, Kok K, Van der Wekken A, Van den Berg A. Detecting therapy-guiding aberrations in platelets and plasma at the transcriptome level in non-small-cell lung cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz413.025] [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: 11/12/2022] Open
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17
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Patel P, Fragkos K, Keane N, Mountford C, Wilkinson D, Johnson A, Naghibi M, Chan D, Roberts B, Neild P, Yalcin M, Allan P, Fitzpatrick M, Gomez M, Williams S, Kok K, Sharkey L, Swfit C, Forbes A, Mehta S, Rahman F, Di Caro S. MON-PO399: Nutritional Care Pathways of Patients with Malignant Bowel Obstruction: Preliminary Findings from 8 UK Centres. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32232-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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18
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Patel P, Fragkos K, Keane N, Mountford C, Wilkinson D, Johnson A, Naghibi M, Chan D, Roberts B, Neild P, Yalcin M, Allan P, Fitzpatrick M, Gomez M, Williams S, Kok K, Sharkey L, Swfit C, Forbes A, Mehta S, Rahman F, Di Caro S. MON-PO400: Parenteral Nutrition in Patients with Malignant Bowel Obstruction: Preliminary Findings from 8 UK Centres: Are all Patients Referred Appropriately? Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32233-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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19
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Patel PS, Fragkos K, Keane N, Mountford C, Wilkinson D, Johnson A, Naghibi M, Chan D, Roberts B, Neild P, Metin Devrim Y, Allan P, Fitzpatrick M, Gomez M, Williams S, Kok K, Sharkey L, Swift C, Forbes A, Mehta S, Rahman F, Di Caro S. OWE-17 Nutritional care pathways of patients with malignant bowel obstruction: preliminary findings from 8 UK Centres. Nutrition 2019. [DOI: 10.1136/gutjnl-2019-bsgabstracts.328] [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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20
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Samaan MA, Forsyth K, Segal JP, De Jong D, Vleugels JLA, Elkady S, Kabir M, Campbell S, Kok K, Armstrong DG, Penez L, Arenaza AP, Seward E, Vega R, Mehta S, Rahman F, McCartney S, Bloom S, Patel K, Pollok R, Westcott E, Darakhshan A, Williams A, Koumoutsos I, Ray S, Mawdsley J, Anderson S, Sanderson JD, Dekker E, D'Haens GR, Hart A, Irving PM. Current Practices in Ileal Pouch Surveillance for Patients With Ulcerative Colitis: A Multinational, Retrospective Cohort Study. J Crohns Colitis 2019; 13:735-743. [PMID: 30590513 DOI: 10.1093/ecco-jcc/jjy225] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS There are no universally accepted guidelines regarding surveillance of ulcerative colitis [UC] patients after restorative proctocolectomy and ileal pouch-anal anastomosis [IPAA]. There also exists a lack of validated quality assurance standards for performing pouchoscopy. To better understand IPAA surveillance practices in the face of this clinical equipoise, we carried out a retrospective cohort study at five inflammatory bowel disease [IBD] referral centres. METHODS Records of patients who underwent IPAA for UC or IBD unclassified [IBDU] were reviewed, and patients with <1-year follow-up after restoration of intestinal continuity were excluded. Criteria for determining the risk of pouch dysplasia formation were collected as well as the use of pouchoscopy, biopsies, and completeness of reports. RESULTS We included 272 patients. Median duration of pouch follow-up was 10.5 [3.3-23.6] years; 95/272 [35%] had never undergone pouchoscopy for any indication; 191/272 [70%] had never undergone pouchoscopy with surveillance as the specific indication; and 3/26 [12%] high-risk patients had never undergone pouchoscopy. Two cases of adenocarcinoma were identified, occurring in the rectal cuff of low-risk patients. Patients under the care of surgeons appeared more likely to undergo surveillance, but rates of incomplete reporting were higher among surgeons [78%] than gastroenterologists [54%, p = 0.002]. CONCLUSIONS We observed wide variation in surveillance of UC/IBDU-IPAA patients. In addition, the rate of neoplasia formation among 'low-risk' patients was higher than may have been expected. We therefore concur with previous recommendations that pouchoscopy be performed at 1 year postoperatively, to refine risk-stratification based on clinical factors alone. Reports should document findings in all regions of the pouch and biopsies should be taken.
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Affiliation(s)
- Mark A Samaan
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Katrina Forsyth
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jonathan P Segal
- Department of Gastroenterology, St Mark's Hospital, London, UK.,Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Djuna De Jong
- Department of Gastroenterology, Amsterdam University Medical Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Jasper L A Vleugels
- Department of Gastroenterology, Amsterdam University Medical Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Soad Elkady
- Department of Gastroenterology, St Mark's Hospital, London, UK.,Faculty of Medicine, Department of Internal Medicine, Gastroenterology unit, University of Alexandria, Alexandria, Egypt
| | - Misha Kabir
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Samantha Campbell
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Klaartje Kok
- Department of Gastroenterology, Barts Health NHS Foundation Trust, London, UK
| | - David G Armstrong
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Lawrence Penez
- Department of Gastroenterology, St Mark's Hospital, London, UK
| | - Aitor P Arenaza
- Department of Gastroenterology, St Mark's Hospital, London, UK
| | - Edward Seward
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Roser Vega
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Shameer Mehta
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Farooq Rahman
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sara McCartney
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stuart Bloom
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kamal Patel
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Richard Pollok
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Edward Westcott
- Department of Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Amir Darakhshan
- Department of Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew Williams
- Department of Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ioannis Koumoutsos
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Shuvra Ray
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joel Mawdsley
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Simon Anderson
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jeremy D Sanderson
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Evelien Dekker
- Department of Gastroenterology, Amsterdam University Medical Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Geert R D'Haens
- Department of Gastroenterology, Amsterdam University Medical Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Ailsa Hart
- Department of Gastroenterology, St Mark's Hospital, London, UK.,Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Peter M Irving
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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21
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Pararasa C, Zhang N, Tull TJ, Chong MHA, Siu JHY, Guesdon W, Chavele KM, Sanderson JD, Langmead L, Kok K, Spencer J, Vossenkamper A. Reduced CD27 -IgD - B Cells in Blood and Raised CD27 -IgD - B Cells in Gut-Associated Lymphoid Tissue in Inflammatory Bowel Disease. Front Immunol 2019; 10:361. [PMID: 30891036 PMCID: PMC6411645 DOI: 10.3389/fimmu.2019.00361] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/12/2019] [Indexed: 12/16/2022] Open
Abstract
The intestinal mucosa in inflammatory bowel disease (IBD) contains increased frequencies of lymphocytes and a disproportionate increase in plasma cells secreting immunoglobulin (Ig)G relative to other isotypes compared to healthy controls. Despite consistent evidence of B lineage cells in the mucosa in IBD, little is known of B cell recruitment to the gut in IBD. Here we analyzed B cells in blood of patients with Crohn's disease (CD) and ulcerative colitis (UC) with a range of disease activities. We analyzed the frequencies of known B cell subsets in blood and observed a consistent reduction in the proportion of CD27-IgD- B cells expressing all Ig isotypes in the blood in IBD (independent of severity of disease and treatment) compared to healthy controls. Successful treatment of patients with biologic therapies did not change the profile of B cell subsets in blood. By mass cytometry we demonstrated that CD27-IgD- B cells were proportionately enriched in the gut-associated lymphoid tissue (GALT) in IBD. Since production of TNFα is a feature of IBD relevant to therapies, we sought to determine whether B cells in GALT or the CD27-IgD- subset in particular could contribute to pathology by secretion of TNFα or IL-10. We found that donor matched GALT and blood B cells are capable of producing TNFα as well as IL-10, but we saw no evidence that CD27-IgD- B cells from blood expressed more TNFα compared to other subsets. The reduced proportion of CD27-IgD- B cells in blood and the increased proportion in the gut implies that CD27-IgD- B cells are recruited from the blood to the gut in IBD. CD27-IgD- B cells have been implicated in immune responses to intestinal bacteria and recruitment to GALT, and may contribute to the intestinal inflammatory milieu in IBD.
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Affiliation(s)
- Chathyan Pararasa
- Peter Gorer Department of Immunobiology, King's College London, Guy's Hospital, London, United Kingdom
| | - Na Zhang
- Peter Gorer Department of Immunobiology, King's College London, Guy's Hospital, London, United Kingdom.,Obstetrics and Gynecology Hospital, Institutes of Biomedical Sciences (IBS), Fudan University, Shanghai, China
| | - Thomas J Tull
- Peter Gorer Department of Immunobiology, King's College London, Guy's Hospital, London, United Kingdom
| | - Ming H A Chong
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, United Kingdom
| | - Jacqueline H Y Siu
- Department of Surgery, Addenbrookes Hospital, University of Cambridge, Cambridge, United Kingdom
| | - William Guesdon
- Peter Gorer Department of Immunobiology, King's College London, Guy's Hospital, London, United Kingdom
| | - Konstantia Maria Chavele
- Peter Gorer Department of Immunobiology, King's College London, Guy's Hospital, London, United Kingdom
| | - Jeremy D Sanderson
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Louise Langmead
- Department of Gastroenterology, Royal London Hospital, Barts Health, London, United Kingdom
| | - Klaartje Kok
- Department of Gastroenterology, Royal London Hospital, Barts Health, London, United Kingdom
| | - Jo Spencer
- Peter Gorer Department of Immunobiology, King's College London, Guy's Hospital, London, United Kingdom
| | - Anna Vossenkamper
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, United Kingdom
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Ferronika P, van den Bos H, Taudt A, Spierings DCJ, Saber A, Hiltermann TJN, Kok K, Porubsky D, van der Wekken AJ, Timens W, Foijer F, Colomé-Tatché M, Groen HJM, Lansdorp PM, van den Berg A. Copy number alterations assessed at the single-cell level revealed mono- and polyclonal seeding patterns of distant metastasis in a small-cell lung cancer patient. Ann Oncol 2018; 28:1668-1670. [PMID: 28419234 DOI: 10.1093/annonc/mdx182] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- P Ferronika
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Department of Pathology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - H van den Bos
- European Research Institute for the Biology of Ageing, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - A Taudt
- European Research Institute for the Biology of Ageing, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - D C J Spierings
- European Research Institute for the Biology of Ageing, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - A Saber
- Department of Pathology and Medical Biology
| | - T J N Hiltermann
- Department of Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - K Kok
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - D Porubsky
- European Research Institute for the Biology of Ageing, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - A J van der Wekken
- Department of Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - W Timens
- Department of Pathology and Medical Biology
| | - F Foijer
- European Research Institute for the Biology of Ageing, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - M Colomé-Tatché
- European Research Institute for the Biology of Ageing, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - H J M Groen
- Department of Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - P M Lansdorp
- European Research Institute for the Biology of Ageing, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Department of Medical Genetics, University of British Columbia and Terry Fox Laboratory, BC Cancer Research Centre, Vancouver, Canada
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Abstract
Calprotectin is a 36kDa member of the S100 family of proteins. It is derived predominantly from neutrophils and has direct antimicrobial effects and a role within the innate immune response. Calprotectin is found in various body fluids in proportion to the degree of any existing inflammation and its concentration in feces is about six times that of plasma. Measurement of fecal calprotectin is a useful surrogate marker of gastrointestinal inflammation. It has a high negative predictive value in ruling out inflammatory bowel disease (IBD) in undiagnosed, symptomatic patients and a high sensitivity for diagnosing the disease making it useful as a tool for prioritising endoscopy. In patients with known IBD, fecal calprotectin can be a useful tool to assist management, providing evidence of relapse or mucosal healing to enable therapy to be intensified or reduced. There are a number of commercial calprotectin assays with marked difference in performance as judged by external quality assessment and at present no standardised reference material exists. Various factors may affect results including age, medication and day to day variation. Laboratories should therefore be mindful of the characteristics of their own assay and factors that may affect results.
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Affiliation(s)
- Ruth M Ayling
- FRCPath Consultant Chemical Pathologist, Clinical Biochemistry, Pathology and Pharmacy Building, Royal London Hospital, London, United Kingdom
| | - Klaartje Kok
- MRCP Consultant Gastroenterologist, Barts Health NHS Trust, London, United Kingdom
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Ferronika P, Hof J, Kats-Ugurlu G, Terpstra M, De Lange K, Leliveld-Kors A, Sijmons R, Kok K. DNA and RNA analysis of intratumour heterogeneity in metastatic clear cell renal cell carcinoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx510.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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25
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Wei J, Rybczynska A, van der Wekken A, Saber A, Terpstra M, Schuuring E, Timens W, Hiltermann T, Groen H, van den Berg A, Kok K. All-in-one RNA-based assay to detect therapeutic biomarkers in lung cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx508.023] [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: 11/12/2022] Open
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26
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van der Wekken AJ, Kuiper JL, Saber A, Terpstra MM, Wei J, Hiltermann TJN, Thunnissen E, Heideman DAM, Timens W, Schuuring E, Kok K, Smit EF, van den Berg A, Groen HJM. Overall survival in EGFR mutated non-small-cell lung cancer patients treated with afatinib after EGFR TKI and resistant mechanisms upon disease progression. PLoS One 2017; 12:e0182885. [PMID: 28854272 PMCID: PMC5576694 DOI: 10.1371/journal.pone.0182885] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/26/2017] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To determine survival in afatinib-treated patients after treatment with first-generation EGFR tyrosine kinase inhibitors (TKIs) and to study resistance mechanisms in afatinib-resistant tumors. METHODS Characteristics and survival of patients treated with afatinib after resistance to erlotinib or gefitinib in two large Dutch centers were collected. Whole exome sequencing (WES) and pathway analysis was performed on available pre- and post-afatinib tumor biopsies and normal tissue. RESULTS A total of 38 patients were treated with afatinib. T790M mutations were identified in 22/29 (76%) pre-afatinib treatment tumor samples. No difference in median progression-free-survival (2.8 months (95% CI 2.3-3.3) and 2.7 months (95% CI 0.9-4.6), p = 0.55) and median overall-survival (8.8 months (95% CI 4.2-13.4) and 3.6 months (95% CI 2.3-5.0), p = 0.14) were observed in T790M+ patients compared to T790M- mutations. Somatic mutations in TP53, ADAMTS2, CNN2 and multiple genes in the Wnt and PI3K-AKT pathway were observed in post-afatinib tumors of six afatinib-responding and in one non-responding patient. No new EGFR mutations were found in the post-afatinib samples of the six responding patients. Further analyses of post-afatinib progressive tumors revealed 28 resistant specific mutations in six genes (HLA-DRB1, AQP7, FAM198A, SEC31A, CNTLN, and ESX1) in three afatinib responding patients. No known EGFR-TKI resistant-associated copy number gains were acquired in the post-afatinib samples. CONCLUSION No differences in survival were observed in patients with EGFR-T790M treated with afatinib compared to those without T790M. Tumors from patients who had progressive disease during afatinib treatment were enriched for mutations in genes involved in Wnt and PI3K-AKT pathways.
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Affiliation(s)
- A. J. van der Wekken
- Department of Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - J. L. Kuiper
- Department of Pulmonary Diseases, VU University Medical Centre, Amsterdam, Netherlands
| | - A. Saber
- Department of Pathology and Medical Biology, Groningen, University of Groningen, Groningen, Netherlands
| | - M. M. Terpstra
- University of Groningen, Department of Genetics, Groningen, Netherlands
| | - J. Wei
- University of Groningen, Department of Genetics, Groningen, Netherlands
| | - T. J. N. Hiltermann
- Department of Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - E. Thunnissen
- Department of Pathology, VU University Medical Centre, Amsterdam, Netherlands
| | - D. A. M. Heideman
- Department of Pathology, VU University Medical Centre, Amsterdam, Netherlands
| | - W. Timens
- Department of Pathology and Medical Biology, Groningen, University of Groningen, Groningen, Netherlands
| | - E. Schuuring
- Department of Pathology and Medical Biology, Groningen, University of Groningen, Groningen, Netherlands
| | - K. Kok
- University of Groningen, Department of Genetics, Groningen, Netherlands
| | - E. F. Smit
- Department of Pulmonary Diseases, VU University Medical Centre, Amsterdam, Netherlands
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - A. van den Berg
- Department of Pathology and Medical Biology, Groningen, University of Groningen, Groningen, Netherlands
| | - H. J. M. Groen
- Department of Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
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Dzikiewicz-Krawczyk A, Kok K, Slezak-Prochazka I, Robertus JL, Bruining J, Tayari MM, Rutgers B, de Jong D, Koerts J, Seitz A, Li J, Tillema B, Guikema JE, Nolte IM, Diepstra A, Visser L, Kluiver J, van den Berg A. ZDHHC11 and ZDHHC11B are critical novel components of the oncogenic MYC-miR-150-MYB network in Burkitt lymphoma. Leukemia 2017; 31:1470-1473. [PMID: 28331227 DOI: 10.1038/leu.2017.94] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- A Dzikiewicz-Krawczyk
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,lnstitute of Human Genetics, Polish Academy of Sciences, Poznan, Poland
| | - K Kok
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - I Slezak-Prochazka
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Biosystems Group, Institute of Automatic Control, Silesian University of Technology, Gliwice, Poland
| | - J-L Robertus
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Bruining
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M M Tayari
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - B Rutgers
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - D de Jong
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Koerts
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A Seitz
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Li
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - B Tillema
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J E Guikema
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - I M Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A Diepstra
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - L Visser
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Kluiver
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A van den Berg
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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van der -->Wekken A, Saber A, Hiltermann T, Kok K, van den -->Berg A, Groen H. Resistance mechanisms after tyrosine kinase inhibitors afatinib and crizotinib in non-small cell lung cancer, a review of the literature. Crit Rev Oncol Hematol 2016; 100:107-16. [DOI: 10.1016/j.critrevonc.2016.01.024] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/20/2015] [Accepted: 01/20/2016] [Indexed: 12/12/2022] Open
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Kok K, Whitney J, Jackson S. 62PSYCHOTROPIC MEDICATIONS AND FALLS-SPECIFIC HOSPITAL ATTENDANCES. Age Ageing 2015. [DOI: 10.1093/ageing/afv113.03] [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: 11/12/2022] Open
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30
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Li J, Osinga J, Ferronika P, Van Werkhoven M, Terpstra M, Van der Vlies P, Duns G, Westers H, Sijmons R, Kok K. 450: The consequence of SETD2 mutation in clear cell renal cell carcinoma progenitor cells. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)50402-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Liu Y, Abdul Razak FR, Terpstra M, Chan FC, Saber A, Nijland M, van Imhoff G, Visser L, Gascoyne R, Steidl C, Kluiver J, Diepstra A, Kok K, van den Berg A. The mutational landscape of Hodgkin lymphoma cell lines determined by whole-exome sequencing. Leukemia 2014; 28:2248-51. [PMID: 24947018 DOI: 10.1038/leu.2014.201] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Y Liu
- Department of Pathology & Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - F R Abdul Razak
- Department of Pathology & Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M Terpstra
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - F C Chan
- Centre for Lymphoid Cancer, Department of Experimental Therapeutics, The BC Cancer Agency, Vancouver, British Columbia, Canada
| | - A Saber
- Department of Pathology & Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M Nijland
- Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G van Imhoff
- Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - L Visser
- Department of Pathology & Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R Gascoyne
- Centre for Lymphoid Cancer, Department of Experimental Therapeutics, The BC Cancer Agency, Vancouver, British Columbia, Canada
| | - C Steidl
- Centre for Lymphoid Cancer, Department of Experimental Therapeutics, The BC Cancer Agency, Vancouver, British Columbia, Canada
| | - J Kluiver
- Department of Pathology & Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A Diepstra
- Department of Pathology & Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - K Kok
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A van den Berg
- Department of Pathology & Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Kok K, Moncrieff M, Garioch J, Ramaiya A. The inking brush in Mohs micrographic surgery: a potential source of malignant cell contamination. Clin Exp Dermatol 2014; 39:650-1. [PMID: 24766031 DOI: 10.1111/ced.12321] [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] [Accepted: 01/03/2014] [Indexed: 11/30/2022]
Affiliation(s)
- K Kok
- Department of Plastic Surgery, Norfolk and Norwich University Hospital, Norwich, UK.
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van den Berg A, Tayari M, Kortman G, Sietzema J, de Jong D, Terpstra M, Visser L, Diepstra A, Kok K, Kluiver J. Long Non-Coding RNAs Are Commonly Deregulated in Hodgkin Lymphoma. Klin Padiatr 2014. [DOI: 10.1055/s-0034-1371101] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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van der Plas EV, Wichers Schreur B, Kok K. A quantitative evaluation of the high resolution HARMONIE model for critical weather phenomena. Adv Sci Res 2012. [DOI: 10.5194/asr-8-149-2012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract. The high resolution non-hydrostatic Harmonie model (Seity et al., 2012) seems capable of delivering high quality precipitation forecasts. The quality with respect to the European radar composite is assessed using the Model Evaluation Tool, as distributed by the NCAR DTC (Developmental Testbed Center, 2012), and compared to that of the reference run of Hirlam (Unden et al., 2002), the current operational NWP model at KNMI. Both neighbourhood and object-based verification methods are compared for a week with several high intensity precipitation events in July 2010. It is found that Hirlam scores very well in most metrics, and that in spite of the higher resolution the added value of the Harmonie model is sometimes hard to quantify. However, higher precipitation intensities are better represented in the Harmonie model with its higher resolution. Object-based methods do not yet yield a sharp distinction between the different models, as it proves difficult to construct a meaningful and distinguishing metric with a solid physical basis for the many settings that can be varied.
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Abstract
Chronic hidradenitis suppurativa (HS) can cause lymphoedema, leading to novel presentations. We present the case of a man with chronic HS causing penile oedema and subsequent degloving. He underwent direct excision with a good result. Chronic HS patients should be warned about problems related to lymphoedema and reviewed regularly to resolve problems early.
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Affiliation(s)
- K Kok
- University Hospitals Birmingham NHS Foundation Trust, UK.
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Masood MM, Kok K, Lester R. The 'baby straightjacket': a bandage for under 3 year olds. J Hand Surg Eur Vol 2011; 36:330-2. [PMID: 21372054 DOI: 10.1177/1753193410397859] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Crippa A, Magli MC, Robles F, Capoti A, Ferraretti AP, Gianaroli L, Gallina A, Bonaparte E, Moretti M, Colpi GM, Nerva F, Contalbi G, Vacalluzzo L, Tabano S, Grati FR, Gazzano G, Sirchia SM, Simoni G, Miozzo M, Handyside A, Gabriel A, Thornhill AR, Clemente E, Reitter C, Affara N, Griffin DK, Macek M, Feldmar P, Kluckova H, Hrehorcak M, Diblik J, Paulasova P, Turnovec M, Vilimova S, Macek M, Fontes L, Haddad L, Borges E, Iaconelli A, Braga DPAF, Vianna-Morgante AM, Komsky A, Kasterstein E, Komarovsky D, Bern O, Maslansky B, Kaplan T, Raziel A, Friedler S, Gidoni Y, Ben-Ami I, Ron-El R, Strassburger D, Maggiulli R, Monahan D, Neri QV, Hu JCY, Rosenwaks Z, Palermo GD, Beyazyurek C, Ekmekci GC, Tac HA, Ajredin N, Verlinsky O, Fiorentino F, Kahraman S, Camp M, Hesters L, Le Lorc'h M, Frydman R, Romana S, Frydman N, Perez Sanz J, Matorras R, Arluzea J, Romin Y, Bilbao J, Gonzalez-Santiago N, Manova-Todorova K, Koff A, Rivera-Pomar JM, de la Hoz-Torres C, Xanthopoulou L, Ghevaria H, Mantzouratou A, Serhal P, Doshi A, Delhanty JD, Ye Y, Qian Y, Jin F, Munne S, Gutierrez C, Wagner C, Hill D, Wiemer K, Fischer J, Kaplan B, Danzer H, Surrey M, Opsahl M, Hladikova B, Sobek A, Tkadlec E, Kyselova K, Sobek A, Nichi M, Figueira RCS, Braga DPAF, Setti AS, Iaconelli A, Borges E, Colturato SS, Setti AS, Figueira RCS, Braga DPAF, Iaconelli A, Borges E, Rubio C, Domingo J, Rodrigo L, Mercader A, De los Santos MJ, Pehlivan T, Bosch E, Fernandez M, Simon C, Remohi J, Pellicer A, Perez-Nevot B, Lendinez AM, Palomares AR, Polo M, Rodriguez A, Reche A, Ruiz-Galdon M, Reyes-Engel A, Knauff EAH, Blauw HM, Kok K, Wijmenga C, Fauser BCJM, Franke L, Paffoni A, Paracchini V, Ferrari S, Restelli L, Coviello DA, Scarduelli C, Seia M, Ragni G, Aoyama N, Takehara Y, Kawachiya S, Kuroda T, Kawasaki N, Yamadera R, Suzuki T, Kato K, Kato O, Xu QH, Zhang ZG, Zhou P, Wei ZL, Huang DK, Xing Q, Cao YX, Fauque P, Ripoche MA, Tost J, Journot L, Jouannet P, Vaiman D, Dandolo L, Jammes H, Hellani A, Elsheikh A, Abuamero KK, Elakoum S, Palomares AR, Lendinez AM, Perez-Nevot B, Martinez F, Perez de la Blanca E, Ruiz-Galdon M, Reyes-Engel A, Sobek A, Hladikova B, Tkadlec E, Koutna O, Cepelak T, Kyselova K, Sobek AJR. Posters * Reproductive Genetics (PGD/PGS). Hum Reprod 2010. [DOI: 10.1093/humrep/de.25.s1.534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Naaktgeboren C, Vries I, Stegeman JH, Kok K, Beelen R. Developmental influences on the composition of fetal fluids in sheep, with special reference to dysmaturity. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1439-0388.1975.tb00514.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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van Hasselt PM, Kok K, Vorselaars ADM, van Vlerken L, Nieuwenhuys E, de Koning TJ, de Vries RA, Houwen RHJ. Vitamin K deficiency bleeding in cholestatic infants with alpha-1-antitrypsin deficiency. Arch Dis Child Fetal Neonatal Ed 2009; 94:F456-60. [PMID: 19414430 DOI: 10.1136/adc.2008.148239] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Exclusively breastfed infants with unrecognised cholestatic jaundice are at high risk of a vitamin K deficiency (VKD) bleeding. It is presently unknown whether (the size of) this risk depends on the degree of cholestasis. Since alpha-1-antitrypsin deficiency (A1AD) induces a variable degree of cholestasis, we assessed the risk of VKD bleeding in infants with cholestatic jaundice due to A1AD. PATIENTS AND METHODS Infants with a ZZ or SZ phenotype born in The Netherlands between January 1991 and December 2006 were identified from the databases of the five Dutch diagnostic centres for alpha-1-antitrypsin phenotyping and/or genotyping. We determined the risk of VKD bleeding upon diagnosis of A1AD in breastfed and formula fed infants and searched for correlations between serum levels of conjugated bilirubin and the risk of bleeding. RESULTS A total of 40 infants with A1AD were studied. VKD bleeding was noted in 15/20 (75%) of breastfed infants, compared with 0/20 of formula fed infants with A1AD. The relative risk for VKD bleeding in breastfed versus formula fed infants was at least 15.8 (95% CI 2.3 to 108). Conjugated bilirubin levels at diagnosis did not correlate with the risk of VKD bleeding. CONCLUSIONS The risk of VKD bleeding in breastfed infants with A1AD was high and did not correlate with serum level of conjugated bilirubin at diagnosis. A similar absolute risk was previously reported in breastfed infants with biliary atresia under the same prophylactic regimen. This confirms that-without adequate prophylaxis-the risk of VKD bleeding is uniformly high in exclusively breastfed infants with cholestatic jaundice, irrespective of underlying aetiology.
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Affiliation(s)
- P M van Hasselt
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584EA Utrecht, The Netherlands.
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Kok K, Nock GE, Verrall EAG, Mitchell MP, Hommes DW, Peppelenbosch MP, Vanhaesebroeck B. Regulation of p110delta PI 3-kinase gene expression. PLoS One 2009; 4:e5145. [PMID: 19357769 PMCID: PMC2663053 DOI: 10.1371/journal.pone.0005145] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2008] [Accepted: 02/19/2009] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Despite an intense interest in the biological functions of the phosphoinositide 3-kinase (PI3K) signalling enzymes, little is known about the regulation of PI3K gene expression. This also applies to the leukocyte-enriched p110delta catalytic subunit of PI3K, an enzyme that has attracted widespread interest because of its role in immunity and allergy. PRINCIPAL FINDINGS We show that p110delta expression is mainly regulated at the transcriptional level. In fibroblasts, lymphocytes and myeloid cells, p110delta gene transcription appears to be constitutive and not subject to acute stimulation. 5'RACE experiments revealed that p110delta mRNA transcripts contain distinct upstream untranslated exons (named exon -1, -2a, -2b, -2c and -2d), which are located up to 81 kb upstream of the translational start codon in exon 1. The levels of all the different p110delta transcripts are higher in leukocytes compared to non-leukocytes, with the p110delta transcript containing exon -2a most abundantly expressed. We have identified a highly conserved transcription factor (TF) binding cluster in the p110delta gene which has enhanced promoter activity in leukocytes compared to non-leukocytes. In human, this TF cluster is located immediately upstream of exon -2a whilst in mouse, it is located within exon -2a. CONCLUSION This study identifies a conserved PIK3CD promoter region that may account for the predominant leukocyte expression of p110delta.
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Affiliation(s)
- Klaartje Kok
- Centre for Cell Signalling, Institute of Cancer, Queen Mary University of London, Charterhouse Square, London, United Kingdom
- Department of Cell Biology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Gemma E. Nock
- Centre for Cell Signalling, Institute of Cancer, Queen Mary University of London, Charterhouse Square, London, United Kingdom
| | - Elizabeth A. G. Verrall
- Centre for Cell Signalling, Institute of Cancer, Queen Mary University of London, Charterhouse Square, London, United Kingdom
| | - Michael P. Mitchell
- Bioinformatics and Biostatistics, Cancer Research UK London Research Institute, London, United Kingdom
| | - Daan W. Hommes
- Department of Gastroenterology and Hepatology; Leiden University Medical Centre, Leiden, The Netherlands
| | - Maikel P. Peppelenbosch
- Department of Cell Biology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Bart Vanhaesebroeck
- Centre for Cell Signalling, Institute of Cancer, Queen Mary University of London, Charterhouse Square, London, United Kingdom
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Kok K, Geering B, Vanhaesebroeck B. Regulation of phosphoinositide 3-kinase expression in health and disease. Trends Biochem Sci 2009; 34:115-27. [DOI: 10.1016/j.tibs.2009.01.003] [Citation(s) in RCA: 167] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2008] [Revised: 01/08/2009] [Accepted: 01/08/2009] [Indexed: 11/24/2022]
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Monfort S, Rosello M, Orellana C, Oltra S, Blesa D, Kok K, Ferrer I, Cigudosa JC, Martinez F. Detection of known and novel genomic rearrangements by array based comparative genomic hybridisation: deletion of ZNF533 and duplication of CHARGE syndrome genes. J Med Genet 2008; 45:432-7. [DOI: 10.1136/jmg.2008.057596] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [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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Maas NMC, Van Buggenhout G, Hannes F, Thienpont B, Sanlaville D, Kok K, Midro A, Andrieux J, Anderlid BM, Schoumans J, Hordijk R, Devriendt K, Fryns JP, Vermeesch JR. Genotype-phenotype correlation in 21 patients with Wolf-Hirschhorn syndrome using high resolution array comparative genome hybridisation (CGH). J Med Genet 2007; 45:71-80. [PMID: 17873117 DOI: 10.1136/jmg.2007.052910] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [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: 11/03/2022]
Abstract
BACKGROUND The Wolf-Hirschhorn syndrome (WHS) is usually caused by terminal deletions of the short arm of chromosome 4 and is phenotypically defined by growth and mental retardation, seizures, and specific craniofacial manifestations. Large variation is observed in phenotypic expression of these features. In order to compare the phenotype with the genotype, we localised the breakpoints of the 4 pter aberrations using a chromosome 4 specific tiling BAC/PAC array. METHODS In total, DNA from 21 patients was analysed, of which 8 had a cytogenetic visible and 13 a submicroscopic deletion. RESULTS AND CONCLUSION In addition to classical terminal deletions sized between 1.9 and 30 Mb, we observed the smallest terminal deletion (1.4 Mb) ever reported in a patient with mild WHS stigmata. In addition, we identified and mapped interstitial deletions in four patients. This study positions the genes causing microcephaly, intrauterine and postnatal growth retardation between 0.3 and 1.4 Mb and further refines the regions causing congenital heart disease, cleft lip and/or palate, oligodontia, and hypospadias.
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Affiliation(s)
- N M C Maas
- Center for Human Genetics, University Hospital, Catholic University of Leuven, Leuven, Belgium
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Nassab R, Kok K, Constantinides J, Rajaratnam V. The diagnostic accuracy of clinical examination in hand lacerations. Int J Surg 2007; 5:105-8. [DOI: 10.1016/j.ijsu.2006.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Revised: 05/30/2006] [Accepted: 06/02/2006] [Indexed: 11/15/2022]
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Abstract
There has recently been an increase in the usage of the Internet as a source of patient information. It is very difficult for laypersons to establish the accuracy and validity of these medical websites. Although many website assessment tools exist, most of these are not practical.A combination of consumer- and clinician-based website assessment tools was applied to 200 websites on cosmetic surgery. The top-scoring websites were used as links from a portal website that was designed using Microsoft Macromedia Suite.Seventy-one (35.5%) websites were excluded. One hundred fifteen websites (89%) failed to reach an acceptable standard.The provision of new websites has proceeded without quality controls. Patients need to be better educated on the limitations of the Internet. This paper suggests an archetypal model, which makes efficient use of existing resources, validates them, and is easily transferable to different health settings.
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Affiliation(s)
- A R Parikh
- Royal Free Hampstead NHS Trust, London, UK.
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Abstract
The choice of the silver impregnated Acticoat dressing (Smith & Nephew, UK) for burns is well documented due to its recognised sustained bactericidal activity, reduction of inflammation and ability to promote healing. Its use in the burnt hand, however, is a compromise between adequate dressing cover of this injury and the ability to splint and perform hand therapy on the injured limb. Trying to wrap individual fingers, maintaining web spaces and keep a relatively light dressing for the hand therapists is often difficult and time consuming. We introduce a simple, effective method of creating a custom made Acticoat glove which provides a thin, light dressing covering the hands allowing full mobilisation of the wrist and finger joints.
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Affiliation(s)
- K Kok
- Department of Plastic Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B29 6JD, UK.
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McMurtrie A, Georgeu GA, Kok K, Carlin WV, Davison PM. Novel method of closing a tracheo-oesophageal fistula using a de-epithelialized deltopectoral flap. J Laryngol Otol 2006; 119:129-31. [PMID: 15832470 DOI: 10.1258/0022215053420086] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The authors describe a novel use of a de-epithelialized deltopectoral flap for the closure of tracheo-oesophageal fistulae, which have been resistant to other methods of closure.
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Affiliation(s)
- A McMurtrie
- Department of Head and Neck Surgery, University Hospital of North Staffordshire, Stoke on Trent, Staffordshire, UK.
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Diks SH, Kok K, O'Toole T, Hommes DW, van Dijken P, Joore J, Peppelenbosch MP. Kinome profiling for studying lipopolysaccharide signal transduction in human peripheral blood mononuclear cells. J Biol Chem 2004; 279:49206-13. [PMID: 15355981 DOI: 10.1074/jbc.m405028200] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.4] [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: 11/06/2022] Open
Abstract
The DNA array technique allows comprehensive analysis of the genome and transcriptome, but the high throughput array-based assessment of intracellular signal transduction remains troublesome. The goal of this study was to test a new peptide array technology for studying the activity of all kinases of whole cell lysates, the kinome. Cell lysates from human peripheral blood mononuclear cells before and after stimulation with lipopolysaccharide were used for in vitro phosphorylation with [gamma-33P]ATP arrays consisting of 192 peptides (substrates for kinases) spotted on glass. The usefulness of peptide arrays for studying signal transduction was demonstrated by the generation of the first comprehensive description of the temporal kinetics of phosphorylation events induced by lipopolysaccharide stimulation. Furthermore analysis of the signals obtained suggested activation of p21Ras by lipopolysaccharide, and this was confirmed by direct measurement of p21Ras GTP levels in lipopolysaccharide-stimulated human peripheral blood mononuclear cells, which represents the first direct demonstration of p21Ras activation by stimulation of a Toll receptor family member. Further confidence in the usefulness of peptide array technology for studying signal transduction came from Western blot analysis of lipopolysaccharide-stimulated cells, which corroborated the signals obtained using peptide arrays as well as from the demonstration that kinase inhibitors effected peptide array phosphorylation patterns consistent with the expected action of these inhibitors. We conclude that this first metabolic array is a useful method to determine the enzymatic activities of a large group of kinases, offering high throughput analysis of cellular metabolism and signal transduction.
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Affiliation(s)
- Sander H Diks
- Department of Cell Biology, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
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Westra JL, Boven LG, De Boer JP, Van der Vlies P, Hollema H, Buys CH, Plukker JTH, Kok K, Hofstra RM. Determination of the use of CGH array to detect chromosomal instability (CIN). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3740] [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)
- J. L. Westra
- University Hospital Groningen, Groningen, Netherlands
| | - L. G. Boven
- University Hospital Groningen, Groningen, Netherlands
| | - J. P. De Boer
- University Hospital Groningen, Groningen, Netherlands
| | | | - H. Hollema
- University Hospital Groningen, Groningen, Netherlands
| | - C. H. Buys
- University Hospital Groningen, Groningen, Netherlands
| | | | - K. Kok
- University Hospital Groningen, Groningen, Netherlands
| | - R. M. Hofstra
- University Hospital Groningen, Groningen, Netherlands
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