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Halder GE, Guo F, Harvie H, White AB, Caldwell L, Giles DL, Bilagi D, Rogers RG. Cost Effectiveness of Additional Preoperative Telephone Call to Increase Surgical Preparedness: Analysis of a Randomized Clinical Trial. Int Urogynecol J 2024; 35:527-536. [PMID: 38189853 DOI: 10.1007/s00192-023-05719-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/09/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION AND HYPOTHESIS There is a need for cost effective interventions that increase surgical preparedness in urogynecology. METHODS We performed an ancillary prospective economic evaluation of the Telehealth Intervention to Increase Patient Preparedness for Surgery (TIPPS) Trial, a randomized multicenter trial that evaluated the impact of a preoperative telehealth call on surgical preparedness in women undergoing urogynecologic surgery. A within-trial analysis from the health care sector and societal perspective was performed. Cost-effectiveness was computed from health care sector and societal perspectives, with an 8-week time horizon. RESULTS A total of 126 women were included in our analysis. QALYs gained were similar between groups (telehealth 0.1414 + 0.0249; usual care 0.1409 + 0.0179). The cumulative mean per-person costs at 8 weeks from the healthcare sector perspective were telehealth call: $8696 +/- 3341; usual care: $8473 +/- 3118 (p = 0.693) and from the societal perspective were telehealth call: $11,195 + 5191; usual care: $11,213 +/- 4869 (p = 0.944). The preoperative telehealth call intervention was not cost effective from the health care sector perspective with an ICER of $460,091/QALY (95%CI -$7,382,608/QALY, $7,673,961) using the generally accepted maximum willingness to pay threshold of $150,000/QALY (Neumann et al. N Engl J Med. 371(9):796-7, 2014). From the societal perspective, because incremental costs per QALY gained were negative $-35,925/QALY (95%CI, -$382,978/QALY, $317,226), results suggest that preoperative telehealth call dominated usual care. CONCLUSIONS A preoperative telehealth call is cost effective from the society perspective. CLINICAL TRIAL REGISTRATION Registered with http://ClinicalTrials.gov . Date of registration: March 26, 2019 Date of initial participant enrollment: June 5, 2019 URL: https://clinicaltrials.gov/ct2/show/record/NCT03890471 Clinical trial identification number: NCT03890471.
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Affiliation(s)
- Gabriela E Halder
- Department of Women's Health, The University of Texas Austin Dell Medical School, Austin, TX, USA.
- Division of Urogynecology, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX, USA.
| | - Fangjian Guo
- Division of Population and Preventive Health, Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
- Center for Interdisciplinary Research in Women's Health, School of Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Heidi Harvie
- Department of Obstetrics and Gynecology, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Amanda B White
- Department of Women's Health, The University of Texas Austin Dell Medical School, Austin, TX, USA
| | - Lauren Caldwell
- Department of Women's Health, The University of Texas Austin Dell Medical School, Austin, TX, USA
| | - Dobie L Giles
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, The University of Wisconsin-Maddison, Maddison, WI, USA
| | - Daksha Bilagi
- Department of Women's Health, The University of Texas Austin Dell Medical School, Austin, TX, USA
| | - Rebecca G Rogers
- Department of Women's Health, The University of Texas Austin Dell Medical School, Austin, TX, USA
- Department of Obstetrics and Gynecology, Albany Medical Center, Albany, NY, USA
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Caldwell L, Bhakta R, Naik N, Knowles BD, Parker J, Van Berkel Patel M. Comparison of Low Dose Recombinant Factor VIIa and 4-Factor Prothrombin Complex Concentrate for Treatment of Bleeding Related to Cardiac Surgery. J Pharm Pract 2024:8971900241228766. [PMID: 38261533 DOI: 10.1177/08971900241228766] [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] [Indexed: 01/25/2024]
Abstract
Background: Recombinant factor VIIa (rFVIIa) and prothrombin concentrate complex (PCC) are used for uncontrolled bleeding in cardiac surgery (CS), however, there are limited direct comparisons of these agents. Objective: To evaluate the efficacy and safety of rFVIIa and PCC in CS related bleeding. Methods: This retrospective study included adult CS patients who received either low dose rFVIIa (<30 mcg/kg) or 4-factor PCC. The primary outcome was transfusion requirements of packed red blood cells (pRBC) within 6 hours of factor administration. Secondary efficacy outcomes included transfusion requirements 0-18 hours, doses of additional factor product, thrombotic events, and acute kidney injury (AKI). Results: A total of 179 patients were included (n = 78 rFVIIa; n = 101 PCC). Of patients who received blood products, there was no difference in the requirement of pRBCs within 6 hours (73.8 vs 68.9%, P = .5359) or in the median amount of pRBC transfused (500 mL vs 640 mL, P = .0723) in the rFVIIa and PCC groups respectively. Patients in the PCC group were more likely to require additional factor products (24.4% vs 47.5%, P = .0015), develop AKI (12.8% vs 25.7%, P = .0325), have longer ICU lengths of stay [2 (IQR 1-5) vs 4 (IQR 2-6), P = .0487] and greater in-hospital mortality (2.6% vs 10.9%, P = .033). There was no difference in thrombotic events. Conclusion: Although, there was no difference in pRBC transfusion requirements between PCC and rFVIIa, more patients in the PCC group required additional factor products and had increased adverse effects. Further comparisons of PCC and rFVIIa are warranted.
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Affiliation(s)
| | - Rima Bhakta
- Erlanger Health System, Chattanooga, TN, USA
| | - Neha Naik
- Erlanger Health System, Chattanooga, TN, USA
| | - B D Knowles
- Erlanger Health System, Chattanooga, TN, USA
| | - Jessica Parker
- Office of Research and Education, Spectrum Health, Grand Rapids, MI, USA
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Kent LM, Vinas EK, Rieger MM, Caldwell L, White AB, High RA. Vesicovaginal Fistula Repair Simulation Model and Hierarchical Task Analysis. Urogynecology (Phila) 2024:02273501-990000000-00173. [PMID: 38302437 DOI: 10.1097/spv.0000000000001445] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
IMPORTANCE There is a need for surgeons skilled in vesicovaginal fistula (VVF) repair, yet training opportunities are limited. OBJECTIVES This study aimed to create a low-fidelity simulation model for transvaginal VVF repair, identify essential steps of VVF repair, and evaluate the model's ability to replicate essential steps. STUDY DESIGN First, a low-fidelity VVF repair simulation model was designed and built by the authors. Next, a hierarchical task analysis was performed by urogynecologic surgeons with expertise in VVF repair. Each expert submitted an outline of tasks required to perform VVF repair. To control for bias, an education specialist de-identified, reviewed, and collated the submitted outlines. The education specialist then led a focus group, and through a modified Delphi process, the experts reached consensus on the essential steps. A separate group of urogynecologic surgeons then tested the model and completed an anonymous questionnaire assessing how well the model replicated the essential steps. Descriptive analyses were performed. RESULTS Five experts submitted an outline of steps for transvaginal VVF repair, and 4 experts participated in a focus group to reach consensus on the essential steps. Nine urogynecologic surgeons, with a median of 10 years in practice (interquartile range, 7-12 years), tested the model and completed the postsimulation questionnaire. Most testers thought that tasks involving identification and closure of the fistula were replicated by the model. Testers thought that tasks involving cystoscopy or bladder filling were not replicated by the model. CONCLUSIONS We developed a novel, low-fidelity transvaginal VVF repair simulation model that consistently replicated tasks involving identification and closure of the fistula.
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Affiliation(s)
- Laura M Kent
- From the University of Texas at Austin Dell Medical School, Austin, TX
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Caldwell L, Kim-Fine S, Antosh DD, Husk K, Meriwether KV, Long JB, Heisler CA, Hudson PL, Lozo S, Iyer S, Rogers RG. Surgeon Counseling Regarding Return to Sexual Activity After Pelvic Reconstructive Surgery. Urogynecology (Phila) 2023; 29:725-731. [PMID: 37607308 DOI: 10.1097/spv.0000000000001338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
IMPORTANCE Patients highly value surgeon counseling regarding the first sexual encounters after pelvic reconstructive surgery. OBJECTIVES We performed a qualitative analysis of usual surgeon counseling regarding return to sexual activity after surgery for pelvic organ prolapse and/or urinary incontinence. METHODS Participating surgeons provided a written description of their usual patient counseling regarding return to sexual activity after pelvic organ prolapse or urinary incontinence surgery. Counseling narratives were coded for major themes by 2 independent reviewers; disagreements were arbitrated by the research team. Analysis was performed utilizing Dedoose software and continued until thematic saturation was reached. RESULTS Twenty-two surgeons participated, and thematic saturation was reached. Six major themes were identified: "Safety of Intercourse," "Specific Suggestions," "Surgical Sequelae," "Patient Control," "Partner Related," "Changes in Experience," and "No Communication." Nearly all participating surgeons included counseling on the safety of intercourse and reassurance that intercourse would not harm the surgical repair. Specific suggestions included different positions, use of lubrication, vaginal estrogen use, specific products/vendors, alternatives to (vaginal) intercourse, and the importance of foreplay. Surgical sequelae discussion included possible interventions for complications, such as persistent sutures in the vagina, abnormal bleeding, or de novo dyspareunia. Counseling regarding changes to the patient's sexual experience ranged from suggestion of improvement to an anticipated negative experience. Surgeons more commonly advised patients that their sexual experience would be worsened or different from baseline; discussion of improvement was less frequent. CONCLUSIONS Surgeon counseling regarding the postoperative return to sexual activity varies among pelvic reconstructive surgeons. Most reassure patients that intercourse is safe after surgery.
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Affiliation(s)
- Lauren Caldwell
- From the The University of Texas at Austin Dell Medical School, Austin, TX
| | | | | | | | | | | | | | - Patricia L Hudson
- Wellspan Urogynecology and Pelvic Reconstructive Surgery, WellSpan Health, York, PA
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Caldwell L, Halder GE, White AB, High RA, Wright ML, Rogers RG. The Impact of Language Discordance on Patients' Perception of a Clinical Encounter and Trust in Provider. Urogynecology (Phila) 2023; 29:443-451. [PMID: 36329559 DOI: 10.1097/spv.0000000000001283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
IMPORTANCE The impact of language discordance on care for Spanish-speaking patients with pelvic floor disorders is unknown. OBJECTIVE The aim of this study was to compare the impact of language concordance with the impact of language discordance on the patient experience and trust in their provider. METHODS This cross-sectional cohort study enrolled English- and Spanish-speaking patients during initial evaluation in a urogynecology clinic. English- and Spanish-speaking patients seen by native English- or Spanish-speaking providers were recruited to the language-concordant group. The language-discordant group included Spanish-speaking patients seen with a translator or by nonnative Spanish-speaking providers. Patients completed the Trust in Physician Scale and the Consumer Assessment of Healthcare Providers and Systems Clinician and Group Survey (CG-CAHPS). Patients and providers rated the provider's Spanish proficiency on a 10-point scale from 0 (low) to 10 (high). Symptom bother questionnaires were completed 4-6 months after enrollment. RESULTS Eighty women were recruited, with 40 in each group. Mean age was 55.4 ± 12.9 years. The majority identified as White (75%) and Hispanic (77.5%). Trust in Physician Scale scores were similar between groups (46.2 ± 8.5 vs 44.4 ± 7.5, P > 0.05). The provider communication, provider rating, and recommendation domains of the CG-CAHPS did not differ between groups (all P > 0.05). Provider self-rating of Spanish proficiency was lower than patient ratings (7.5 ± 1.8 vs 9.8 ± 0.5, P < 0.001). There was no difference between groups in symptom bother at 4-6 months (all P > 0.05). CONCLUSIONS Patient-provider language discordance does not affect patient trust in the provider or perception of the encounter as measured by the Trust in Physician Scale and CG-CAHPS questionnaires.
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Affiliation(s)
- Lauren Caldwell
- From the The University of Texas at Austin Dell Medical School, Austin, TX
| | | | - Amanda B White
- From the The University of Texas at Austin Dell Medical School, Austin, TX
| | - Rachel A High
- From the The University of Texas at Austin Dell Medical School, Austin, TX
| | - Michelle L Wright
- From the The University of Texas at Austin Dell Medical School, Austin, TX
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Halder GE, Rogers RG, Brown HW, Kenton KS, Carlsson E, White A, Caldwell L, High R, Constantine ML. Validation of the Surgical Preparedness Assessment in women with pelvic floor disorders. Int Urogynecol J 2022:10.1007/s00192-022-05418-9. [DOI: 10.1007/s00192-022-05418-9] [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] [Received: 07/25/2022] [Accepted: 10/24/2022] [Indexed: 12/13/2022]
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Zhang T, He X, Caldwell L, Goru SK, Ulloa Severino L, Tolosa MF, Misra PS, McEvoy CM, Christova T, Liu Y, Atin C, Zhang J, Hu C, Vukosa N, Chen X, Krizova A, Kirpalani A, Gregorieff A, Ni R, Chan K, Gill MK, Attisano L, Wrana JL, Yuen DA. NUAK1 promotes organ fibrosis via YAP and TGF-β/SMAD signaling. Sci Transl Med 2022; 14:eaaz4028. [PMID: 35320001 DOI: 10.1126/scitranslmed.aaz4028] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Fibrosis is a central pathway that drives progression of multiple chronic diseases, yet few safe and effective clinical antifibrotic therapies exist. In most fibrotic disorders, transforming growth factor-β (TGF-β)-driven scarring is an important pathologic feature and a key contributor to disease progression. Yes-associated protein (YAP) and transcriptional coactivator with PDZ-binding motif (TAZ) are two closely related transcription cofactors that are important for coordinating fibrogenesis after organ injury, but how they are activated in response to tissue injury has, so far, remained unclear. Here, we describe NUAK family kinase 1 (NUAK1) as a TGF-β-inducible profibrotic kinase that is up-regulated in multiple fibrotic organs in mice and humans. Mechanistically, we show that TGF-β induces a rapid increase in NUAK1 in fibroblasts. NUAK1, in turn, can promote profibrotic YAP and TGF-β/SMAD signaling, ultimately leading to organ scarring. Moreover, activated YAP and TAZ can induce further NUAK1 expression, creating a profibrotic positive feedback loop that enables persistent fibrosis. Using mouse models of kidney, lung, and liver fibrosis, we demonstrate that this fibrogenic signaling loop can be interrupted via fibroblast-specific loss of NUAK1 expression, leading to marked attenuation of fibrosis. Pharmacologic NUAK1 inhibition also reduced scarring, either when initiated immediately after injury or when initiated after fibrosis was already established. Together, our data suggest that NUAK1 plays a critical, previously unrecognized role in fibrogenesis and represents an attractive target for strategies that aim to slow fibrotic disease progression.
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Affiliation(s)
- Tianzhou Zhang
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, University of Toronto, Toronto, Ontario M5B 1T8, Canada
| | - Xiaolin He
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, University of Toronto, Toronto, Ontario M5B 1T8, Canada
| | - Lauren Caldwell
- Center for Systems Biology, Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital and Department of Molecular Genetics, University of Toronto, Toronto, Ontario M5G 1X5, Canada
| | - Santosh Kumar Goru
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, University of Toronto, Toronto, Ontario M5B 1T8, Canada
| | - Luisa Ulloa Severino
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, University of Toronto, Toronto, Ontario M5B 1T8, Canada
| | - Monica F Tolosa
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, University of Toronto, Toronto, Ontario M5B 1T8, Canada
| | - Paraish S Misra
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, University of Toronto, Toronto, Ontario M5B 1T8, Canada
| | - Caitríona M McEvoy
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, University of Toronto, Toronto, Ontario M5B 1T8, Canada
| | - Tania Christova
- Donnelly Centre and Department of Biochemistry, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Yong Liu
- Ontario Institute of Cancer Research, Toronto, Ontario M5G OA3, Canada
| | - Cassandra Atin
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, University of Toronto, Toronto, Ontario M5B 1T8, Canada
| | - Johnny Zhang
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, University of Toronto, Toronto, Ontario M5B 1T8, Canada
| | - Catherine Hu
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, University of Toronto, Toronto, Ontario M5B 1T8, Canada
| | - Noah Vukosa
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, University of Toronto, Toronto, Ontario M5B 1T8, Canada
| | - Xiaolan Chen
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, University of Toronto, Toronto, Ontario M5B 1T8, Canada
| | - Adriana Krizova
- Department of Laboratory Medicine and Pathobiology, School of Graduate Studies, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Anish Kirpalani
- Department of Medical Imaging, St. Michael's Hospital (Unity Health Toronto) and University of Toronto, Toronto, Ontario M5B 1W8, Canada
| | - Alex Gregorieff
- Center for Systems Biology, Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital and Department of Molecular Genetics, University of Toronto, Toronto, Ontario M5G 1X5, Canada
| | - Ruoyu Ni
- Center for Systems Biology, Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital and Department of Molecular Genetics, University of Toronto, Toronto, Ontario M5G 1X5, Canada
| | - Kin Chan
- Center for Systems Biology, Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital and Department of Molecular Genetics, University of Toronto, Toronto, Ontario M5G 1X5, Canada
| | - Mandeep K Gill
- Donnelly Centre and Department of Biochemistry, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Liliana Attisano
- Donnelly Centre and Department of Biochemistry, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Jeffrey L Wrana
- Center for Systems Biology, Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital and Department of Molecular Genetics, University of Toronto, Toronto, Ontario M5G 1X5, Canada
| | - Darren A Yuen
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, University of Toronto, Toronto, Ontario M5B 1T8, Canada
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He X, Tolosa MF, Zhang T, Goru SK, Ulloa Severino L, Misra PS, McEvoy CM, Caldwell L, Szeto SG, Gao F, Chen X, Atin C, Ki V, Vukosa N, Hu C, Zhang J, Yip C, Krizova A, Wrana JL, Yuen DA. Myofibroblast YAP/TAZ activation is a key step in organ fibrogenesis. JCI Insight 2022; 7:146243. [PMID: 35191398 PMCID: PMC8876427 DOI: 10.1172/jci.insight.146243] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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: 11/19/2020] [Accepted: 01/12/2022] [Indexed: 12/13/2022] Open
Abstract
Fibrotic diseases account for nearly half of all deaths in the developed world. Despite its importance, the pathogenesis of fibrosis remains poorly understood. Recently, the two mechanosensitive transcription cofactors YAP and TAZ have emerged as important profibrotic regulators in multiple murine tissues. Despite this growing recognition, a number of important questions remain unanswered, including which cell types require YAP/TAZ activation for fibrosis to occur and the time course of this activation. Here, we present a detailed analysis of the role that myofibroblast YAP and TAZ play in organ fibrosis and the kinetics of their activation. Using analyses of cells, as well as multiple murine and human tissues, we demonstrated that myofibroblast YAP and TAZ were activated early after organ injury and that this activation was sustained. We further demonstrated the critical importance of myofibroblast YAP/TAZ in driving progressive scarring in the kidney, lung, and liver, using multiple transgenic models in which YAP and TAZ were either deleted or hyperactivated. Taken together, these data establish the importance of early injury-induced myofibroblast YAP and TAZ activation as a key event driving fibrosis in multiple organs. This information should help guide the development of new antifibrotic YAP/TAZ inhibition strategies.
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Affiliation(s)
- Xiaolin He
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, and
| | - Monica F Tolosa
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, and
| | - Tianzhou Zhang
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, and
| | - Santosh Kumar Goru
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, and
| | - Luisa Ulloa Severino
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, and
| | - Paraish S Misra
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, and
| | - Caitríona M McEvoy
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, and
| | - Lauren Caldwell
- Center for Systems Biology, Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital and Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Stephen G Szeto
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, and
| | - Feng Gao
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, and.,Department of Pathology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Xiaolan Chen
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, and.,Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Cassandra Atin
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, and
| | - Victoria Ki
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, and
| | - Noah Vukosa
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, and
| | - Catherine Hu
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, and
| | - Johnny Zhang
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, and
| | - Christopher Yip
- Faculty of Applied Science and Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Adriana Krizova
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, and.,Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital (Unity Health Toronto) and University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey L Wrana
- Center for Systems Biology, Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital and Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Darren A Yuen
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto) and Department of Medicine, and
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Tang X, Sharma A, Pasic M, Brown P, Colwill K, Gelband H, Birnboim HC, Nagelkerke N, Bogoch II, Bansal A, Newcombe L, Slater J, Rodriguez PS, Huang G, Fu SH, Meh C, Wu DC, Kaul R, Langlois MA, Morawski E, Hollander A, Eliopoulos D, Aloi B, Lam T, Abe KT, Rathod B, Fazel-Zarandi M, Wang J, Iskilova M, Pasculescu A, Caldwell L, Barrios-Rodiles M, Mohammed-Ali Z, Vas N, Santhanam DR, Cho ER, Qu K, Jha S, Jha V, Suraweera W, Malhotra V, Mastali K, Wen R, Sinha S, Reid A, Gingras AC, Chakraborty P, Slutsky AS, Jha P. Assessment of SARS-CoV-2 Seropositivity During the First and Second Viral Waves in 2020 and 2021 Among Canadian Adults. JAMA Netw Open 2022; 5:e2146798. [PMID: 35171263 PMCID: PMC8851304 DOI: 10.1001/jamanetworkopen.2021.46798] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE The incidence of infection during SARS-CoV-2 viral waves, the factors associated with infection, and the durability of antibody responses to infection among Canadian adults remain undocumented. OBJECTIVE To assess the cumulative incidence of SARS-CoV-2 infection during the first 2 viral waves in Canada by measuring seropositivity among adults. DESIGN, SETTING, AND PARTICIPANTS The Action to Beat Coronavirus study conducted 2 rounds of an online survey about COVID-19 experience and analyzed immunoglobulin G levels based on participant-collected dried blood spots (DBS) to assess the cumulative incidence of SARS-CoV-2 infection during the first and second viral waves in Canada. A sample of 19 994 Canadian adults (aged ≥18 years) was recruited from established members of the Angus Reid Forum, a public polling organization. The study comprised 2 phases (phase 1 from May 1 to September 30, 2020, and phase 2 from December 1, 2020, to March 31, 2021) that generally corresponded to the first (April 1 to July 31, 2020) and second (October 1, 2020, to March 1, 2021) viral waves. MAIN OUTCOMES AND MEASURES SARS-CoV-2 immunoglobulin G seropositivity (using a chemiluminescence assay) by major geographic and demographic variables and correlation with COVID-19 symptom reporting. RESULTS Among 19 994 adults who completed the online questionnaire in phase 1, the mean (SD) age was 50.9 (15.4) years, and 10 522 participants (51.9%) were female; 2948 participants (14.5%) had self-identified racial and ethnic minority group status, and 1578 participants (8.2%) were self-identified Indigenous Canadians. Among participants in phase 1, 8967 had DBS testing. In phase 2, 14 621 adults completed online questionnaires, and 7102 of those had DBS testing. Of 19 994 adults who completed the online survey in phase 1, fewer had an educational level of some college or less (4747 individuals [33.1%]) compared with the general population in Canada (45.0%). Survey respondents were otherwise representative of the general population, including in prevalence of known risk factors associated with SARS-CoV-2 infection. The cumulative incidence of SARS-CoV-2 infection among unvaccinated adults increased from 1.9% in phase 1 to 6.5% in phase 2. The seropositivity pattern was demographically and geographically heterogeneous during phase 1 but more homogeneous by phase 2 (with a cumulative incidence ranging from 6.4% to 7.0% in most regions). The exception was the Atlantic region, in which cumulative incidence reached only 3.3% (odds ratio [OR] vs Ontario, 0.46; 95% CI, 0.21-1.02). A total of 47 of 188 adults (25.3%) reporting COVID-19 symptoms during phase 2 were seropositive, and the OR of seropositivity for COVID-19 symptoms was 6.15 (95% CI, 2.02-18.69). In phase 2, 94 of 444 seropositive adults (22.2%) reported having no symptoms. Of 134 seropositive adults in phase 1 who were retested in phase 2, 111 individuals (81.8%) remained seropositive. Participants who had a history of diabetes (OR, 0.58; 95% CI, 0.38-0.90) had lower odds of having detectable antibodies in phase 2. CONCLUSIONS AND RELEVANCE The Action to Beat Coronavirus study found that the incidence of SARS-CoV-2 infection in Canada was modest until March 2021, and this incidence was lower than the levels of population immunity required to substantially reduce transmission of the virus. Ongoing vaccination efforts remain central to reducing viral transmission and mortality. Assessment of future infection-induced and vaccine-induced immunity is practicable through the use of serial online surveys and participant-collected DBS.
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Affiliation(s)
- Xuyang Tang
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Abha Sharma
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Maria Pasic
- St Joseph’s Health Centre, Unity Health Toronto, Toronto, Ontario, Canada
| | - Patrick Brown
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Karen Colwill
- Network Biology Collaborative Center, Sinai Health, Toronto, Ontario, Canada
| | - Hellen Gelband
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - H. Chaim Birnboim
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Nico Nagelkerke
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | | | - Aiyush Bansal
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Leslie Newcombe
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Justin Slater
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Peter S. Rodriguez
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Guowen Huang
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Sze Hang Fu
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Catherine Meh
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Daphne C. Wu
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Rupert Kaul
- University Health Network, Toronto, Ontario, Canada
| | | | - Ed Morawski
- Angus Reid Institute, Vancouver, British Columbia, Canada
| | - Andy Hollander
- Angus Reid Institute, Vancouver, British Columbia, Canada
| | | | - Benjamin Aloi
- Angus Reid Institute, Vancouver, British Columbia, Canada
| | - Teresa Lam
- Angus Reid Institute, Vancouver, British Columbia, Canada
| | - Kento T. Abe
- Network Biology Collaborative Center, Sinai Health, Toronto, Ontario, Canada
| | - Bhavisha Rathod
- Network Biology Collaborative Center, Sinai Health, Toronto, Ontario, Canada
| | - Mahya Fazel-Zarandi
- Network Biology Collaborative Center, Sinai Health, Toronto, Ontario, Canada
| | - Jenny Wang
- Network Biology Collaborative Center, Sinai Health, Toronto, Ontario, Canada
| | - Mariam Iskilova
- Network Biology Collaborative Center, Sinai Health, Toronto, Ontario, Canada
| | - Adrian Pasculescu
- Network Biology Collaborative Center, Sinai Health, Toronto, Ontario, Canada
| | - Lauren Caldwell
- Network Biology Collaborative Center, Sinai Health, Toronto, Ontario, Canada
| | | | | | - Nandita Vas
- St Joseph’s Health Centre, Unity Health Toronto, Toronto, Ontario, Canada
| | - Divya Raman Santhanam
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Eo Rin Cho
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Kathleen Qu
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Shreya Jha
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Vedika Jha
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Wilson Suraweera
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Varsha Malhotra
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Kathy Mastali
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Richard Wen
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Samir Sinha
- Network Biology Collaborative Center, Sinai Health, Toronto, Ontario, Canada
| | - Angus Reid
- Angus Reid Institute, Vancouver, British Columbia, Canada
| | - Anne-Claude Gingras
- Network Biology Collaborative Center, Sinai Health, Toronto, Ontario, Canada
| | | | | | - Prabhat Jha
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
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Tang X, Sharma A, Pasic M, Brown P, Colwill K, Gelband H, Birnboim HC, Nagelkerke N, Bogoch II, Bansal A, Newcombe L, Slater J, Rodriguez PS, Huang G, Fu SH, Meh C, Wu DC, Kaul R, Langlois MA, Morawski E, Hollander A, Eliopoulos D, Aloi B, Lam T, Abe KT, Rathod B, Fazel-Zarandi M, Wang J, Iskilova M, Pasculescu A, Caldwell L, Barrios-Rodiles M, Mohammed-Ali Z, Vas N, Santhanam DR, Cho ER, Qu K, Jha S, Jha V, Suraweera W, Malhotra V, Mastali K, Wen R, Sinha S, Reid A, Gingras AC, Chakraborty P, Slutsky AS, Jha P. Assessment of SARS-CoV-2 Seropositivity During the First and Second Viral Waves in 2020 and 2021 Among Canadian Adults. JAMA Netw Open 2022. [PMID: 35171263 DOI: 10.1001/jamanetworkopen.2021.46798.pmid:35171263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
IMPORTANCE The incidence of infection during SARS-CoV-2 viral waves, the factors associated with infection, and the durability of antibody responses to infection among Canadian adults remain undocumented. OBJECTIVE To assess the cumulative incidence of SARS-CoV-2 infection during the first 2 viral waves in Canada by measuring seropositivity among adults. DESIGN, SETTING, AND PARTICIPANTS The Action to Beat Coronavirus study conducted 2 rounds of an online survey about COVID-19 experience and analyzed immunoglobulin G levels based on participant-collected dried blood spots (DBS) to assess the cumulative incidence of SARS-CoV-2 infection during the first and second viral waves in Canada. A sample of 19 994 Canadian adults (aged ≥18 years) was recruited from established members of the Angus Reid Forum, a public polling organization. The study comprised 2 phases (phase 1 from May 1 to September 30, 2020, and phase 2 from December 1, 2020, to March 31, 2021) that generally corresponded to the first (April 1 to July 31, 2020) and second (October 1, 2020, to March 1, 2021) viral waves. MAIN OUTCOMES AND MEASURES SARS-CoV-2 immunoglobulin G seropositivity (using a chemiluminescence assay) by major geographic and demographic variables and correlation with COVID-19 symptom reporting. RESULTS Among 19 994 adults who completed the online questionnaire in phase 1, the mean (SD) age was 50.9 (15.4) years, and 10 522 participants (51.9%) were female; 2948 participants (14.5%) had self-identified racial and ethnic minority group status, and 1578 participants (8.2%) were self-identified Indigenous Canadians. Among participants in phase 1, 8967 had DBS testing. In phase 2, 14 621 adults completed online questionnaires, and 7102 of those had DBS testing. Of 19 994 adults who completed the online survey in phase 1, fewer had an educational level of some college or less (4747 individuals [33.1%]) compared with the general population in Canada (45.0%). Survey respondents were otherwise representative of the general population, including in prevalence of known risk factors associated with SARS-CoV-2 infection. The cumulative incidence of SARS-CoV-2 infection among unvaccinated adults increased from 1.9% in phase 1 to 6.5% in phase 2. The seropositivity pattern was demographically and geographically heterogeneous during phase 1 but more homogeneous by phase 2 (with a cumulative incidence ranging from 6.4% to 7.0% in most regions). The exception was the Atlantic region, in which cumulative incidence reached only 3.3% (odds ratio [OR] vs Ontario, 0.46; 95% CI, 0.21-1.02). A total of 47 of 188 adults (25.3%) reporting COVID-19 symptoms during phase 2 were seropositive, and the OR of seropositivity for COVID-19 symptoms was 6.15 (95% CI, 2.02-18.69). In phase 2, 94 of 444 seropositive adults (22.2%) reported having no symptoms. Of 134 seropositive adults in phase 1 who were retested in phase 2, 111 individuals (81.8%) remained seropositive. Participants who had a history of diabetes (OR, 0.58; 95% CI, 0.38-0.90) had lower odds of having detectable antibodies in phase 2. CONCLUSIONS AND RELEVANCE The Action to Beat Coronavirus study found that the incidence of SARS-CoV-2 infection in Canada was modest until March 2021, and this incidence was lower than the levels of population immunity required to substantially reduce transmission of the virus. Ongoing vaccination efforts remain central to reducing viral transmission and mortality. Assessment of future infection-induced and vaccine-induced immunity is practicable through the use of serial online surveys and participant-collected DBS.
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Affiliation(s)
- Xuyang Tang
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Abha Sharma
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Maria Pasic
- St Joseph's Health Centre, Unity Health Toronto, Toronto, Ontario, Canada
| | - Patrick Brown
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Karen Colwill
- Network Biology Collaborative Center, Sinai Health, Toronto, Ontario, Canada
| | - Hellen Gelband
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - H Chaim Birnboim
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Nico Nagelkerke
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | | | - Aiyush Bansal
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Leslie Newcombe
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Justin Slater
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Peter S Rodriguez
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Guowen Huang
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Sze Hang Fu
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Catherine Meh
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Daphne C Wu
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Rupert Kaul
- University Health Network, Toronto, Ontario, Canada
| | | | - Ed Morawski
- Angus Reid Institute, Vancouver, British Columbia, Canada
| | - Andy Hollander
- Angus Reid Institute, Vancouver, British Columbia, Canada
| | | | - Benjamin Aloi
- Angus Reid Institute, Vancouver, British Columbia, Canada
| | - Teresa Lam
- Angus Reid Institute, Vancouver, British Columbia, Canada
| | - Kento T Abe
- Network Biology Collaborative Center, Sinai Health, Toronto, Ontario, Canada
| | - Bhavisha Rathod
- Network Biology Collaborative Center, Sinai Health, Toronto, Ontario, Canada
| | - Mahya Fazel-Zarandi
- Network Biology Collaborative Center, Sinai Health, Toronto, Ontario, Canada
| | - Jenny Wang
- Network Biology Collaborative Center, Sinai Health, Toronto, Ontario, Canada
| | - Mariam Iskilova
- Network Biology Collaborative Center, Sinai Health, Toronto, Ontario, Canada
| | - Adrian Pasculescu
- Network Biology Collaborative Center, Sinai Health, Toronto, Ontario, Canada
| | - Lauren Caldwell
- Network Biology Collaborative Center, Sinai Health, Toronto, Ontario, Canada
| | | | | | - Nandita Vas
- St Joseph's Health Centre, Unity Health Toronto, Toronto, Ontario, Canada
| | - Divya Raman Santhanam
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Eo Rin Cho
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Kathleen Qu
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Shreya Jha
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Vedika Jha
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Wilson Suraweera
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Varsha Malhotra
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Kathy Mastali
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Richard Wen
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
| | - Samir Sinha
- Network Biology Collaborative Center, Sinai Health, Toronto, Ontario, Canada
| | - Angus Reid
- Angus Reid Institute, Vancouver, British Columbia, Canada
| | - Anne-Claude Gingras
- Network Biology Collaborative Center, Sinai Health, Toronto, Ontario, Canada
| | | | | | - Prabhat Jha
- Centre for Global Health Research, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
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11
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Caldwell L, Papermaster AE, Halder GE, White AB, Young A, Rogers RG. Evidence-based pelvic floor disorder care pathways optimize shared decision making between patients and surgeons. Int Urogynecol J 2022; 33:2841-2847. [PMID: 35001160 PMCID: PMC8743070 DOI: 10.1007/s00192-021-05021-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
Introduction and hypothesis Evidence-based care pathways improve care standardization and patient outcomes. We created pelvic organ prolapse (POP) and stress urinary incontinence (SUI) care pathways as decision aids for our multidisciplinary team to use when counseling patients. Methods Using a modified Delphi process, an expert team reviewed existing guidelines and literature to reach consensus on pathway definitions and components. Results Entry to the care pathways occurs via an advanced practice provider visit. Symptom and quality-of-life questionnaires as well as open-ended patient goals are used to guide patient–provider shared decision making. All treatment choices, including surgical and nonsurgical management, are presented to patients by advanced practice providers. Patients electing nonsurgical management follow-up by telehealth (preferred) or in-person visits as determined by the care pathway. Surgeon consultations are scheduled for patients desiring surgery. Surgical patients undergo urodynamics, simple cystometrics or deferred bladder testing according to the urodynamics clinical pathway. Postoperative follow-up includes telehealth visits and minimizes in-person visits for women with uncomplicated postoperative courses. Patients with resolution of symptoms are graduated from clinic and return to their referring physician. The pathways are revised following publication of new compelling evidence. Conclusions We developed POP and SUI care pathways to standardize care across a diverse provider group. Advanced practice providers use care pathways with patients as shared decision-making tools for initial evaluation of patients with prolapse and incontinence. These pathways serve as components of value-based care and encourage team members to function independently while utilizing the full scope of their training.
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Affiliation(s)
- Lauren Caldwell
- University of Texas Dell Medical School, 1301 W. 38th Street, Suite 705, Austin, TX, 78705, USA.
| | - Amy E Papermaster
- University of Texas Dell Medical School, 1301 W. 38th Street, Suite 705, Austin, TX, 78705, USA
| | | | - Amanda B White
- University of Texas Dell Medical School, 1301 W. 38th Street, Suite 705, Austin, TX, 78705, USA
| | - Amy Young
- University of Texas Dell Medical School, 1301 W. 38th Street, Suite 705, Austin, TX, 78705, USA
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12
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Abstract
Synthetic midurethral slings offer optimal cure rates for the minimally invasive treatment of stress urinary incontinence in women. Performed via a retropubic or transobturator technique, midurethral sling approaches demonstrate comparable efficacy, with unique adverse event profiles. Single incision slings were introduced to minimize the complication of groin pain with full-length transobturator slings and enhance operative recovery. The earliest therapies for stress urinary incontinence including urethral bulking, retropubic colposuspension, and autologous sling offer alternative methods of surgical management without using synthetic mesh. These methods boast satisfactory efficacy with low rates of complications, and may be ideal for appropriately selected patients.
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Affiliation(s)
- Lauren Caldwell
- Female Pelvic Medicine and Reconstructive Surgery, Department of Women's Health, University of Texas at Austin, Dell Medical School, 1301 West 38th Street, Suite 705, Austin, TX 78705, USA
| | - Amanda B White
- Female Pelvic Medicine and Reconstructive Surgery, Department of Women's Health, University of Texas at Austin, Dell Medical School, 1301 West 38th Street, Suite 705, Austin, TX 78705, USA.
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Caldwell L, Papermaster A, Halder G, White A, Young A, Rogers R. 05 An evidence-based pelvic organ prolapse care pathway optimizes shared decision making between patients and surgeons. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2021.04.029] [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: 10/21/2022]
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Halder GE, White AB, Brown HW, Caldwell L, Wright ML, Giles DL, Heisler CA, Bilagi D, Rogers RG. A telehealth intervention to increase patient preparedness for surgery: a randomized trial. Int Urogynecol J 2021; 33:85-93. [PMID: 34028575 PMCID: PMC8142611 DOI: 10.1007/s00192-021-04831-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/26/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Methods to increase surgical preparedness in urogynecology are lacking. Our objective was to evaluate the impact of a preoperative provider-initiated telehealth call on surgical preparedness. METHODS This was a multicenter randomized controlled trial. Women undergoing surgery for pelvic organ prolapse and/or stress urinary incontinence were randomized to either a telehealth call 3 (± 2) days before surgery plus usual preoperative counseling versus usual preoperative counseling alone. Our primary outcome was surgical preparedness, as measured by the Preoperative Prepardeness Questionnaire. The Modified Surgical Pain Scale, Pelvic Floor Distress Inventory-20, Patient Global Impressions of Improvement, Patient Global Impressions of Severity, Satisfaction with Decision Scale, Decision Regret Scale, and Clavien-Dindo scores were obtained at 4-8 weeks postoperatively and comparisons were made between groups. RESULTS Mean telehealth call time was 11.1 ± 4.11 min. Women who received a preoperative telehealth call (n = 63) were significantly more prepared for surgery than those who received usual preoperative counseling alone (n = 69); 82.5 vs 59.4%, p < 0.01). A preoperative telehealth call was associated with greater understanding of surgical alternatives (77.8 vs 59.4%, p = 0.03), complications (69.8 vs 47.8%, p = 0.01), hospital-based catheter care (54 vs 34.8%, p = 0.04) and patient perception that nurses and doctors had spent enough time preparing them for their upcoming surgery (84.1 vs 60.9%, p < 0.01). At 4-8 weeks, no differences in postoperative and patient reported outcomes were observed between groups (all p > 0.05). CONCLUSIONS A short preoperative telehealth call improves patient preparedness for urogynecological surgery.
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Affiliation(s)
- Gabriela E Halder
- Department of Women's Health, University of Texas Austin Dell Medical School, Medical Park Tower, 1301 W. 38th St., Suite 705, Austin, TX, 78705, USA.
| | - Amanda B White
- Department of Women's Health, University of Texas Austin Dell Medical School, Medical Park Tower, 1301 W. 38th St., Suite 705, Austin, TX, 78705, USA
| | - Heidi W Brown
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Wisconsin-Maddison, Maddison, WI, USA
| | - Lauren Caldwell
- Department of Women's Health, University of Texas Austin Dell Medical School, Medical Park Tower, 1301 W. 38th St., Suite 705, Austin, TX, 78705, USA
| | - Michelle L Wright
- Department of Women's Health, University of Texas Austin Dell Medical School, Medical Park Tower, 1301 W. 38th St., Suite 705, Austin, TX, 78705, USA
| | - Dobie L Giles
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Wisconsin-Maddison, Maddison, WI, USA
| | - Christine A Heisler
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Wisconsin-Maddison, Maddison, WI, USA
| | - Daksha Bilagi
- Department of Women's Health, University of Texas Austin Dell Medical School, Medical Park Tower, 1301 W. 38th St., Suite 705, Austin, TX, 78705, USA
| | - Rebecca G Rogers
- Department of Women's Health, University of Texas Austin Dell Medical School, Medical Park Tower, 1301 W. 38th St., Suite 705, Austin, TX, 78705, USA
- Department of Obstetrics and Gynecology, Albany Medical Center, Albany, NY, USA
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Jurgilas S, Chakraborty A, Rich CJH, Caldwell L, Williams HJ, Fitch NJ, Sauer BE, Frye MD, Hutson JM, Tarbutt MR. Collisions between Ultracold Molecules and Atoms in a Magnetic Trap. Phys Rev Lett 2021; 126:153401. [PMID: 33929220 DOI: 10.1103/physrevlett.126.153401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/19/2021] [Accepted: 03/04/2021] [Indexed: 06/12/2023]
Abstract
We prepare mixtures of ultracold CaF molecules and Rb atoms in a magnetic trap and study their inelastic collisions. When the atoms are prepared in the spin-stretched state and the molecules in the spin-stretched component of the first rotationally excited state, they collide inelastically with a rate coefficient k_{2}=(6.6±1.5)×10^{-11} cm^{3}/s at temperatures near 100 μK. We attribute this to rotation-changing collisions. When the molecules are in the ground rotational state we see no inelastic loss and set an upper bound on the spin-relaxation rate coefficient of k_{2}<5.8×10^{-12} cm^{3}/s with 95% confidence. We compare these measurements to the results of a single-channel loss model based on quantum defect theory. The comparison suggests a short-range loss parameter close to unity for rotationally excited molecules, but below 0.04 for molecules in the rotational ground state.
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Affiliation(s)
- S Jurgilas
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - A Chakraborty
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - C J H Rich
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - L Caldwell
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - H J Williams
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - N J Fitch
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - B E Sauer
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - Matthew D Frye
- Joint Quantum Centre (JQC) Durham-Newcastle, Department of Chemistry, Durham University, South Road, Durham DH1 3LE, United Kingdom
| | - Jeremy M Hutson
- Joint Quantum Centre (JQC) Durham-Newcastle, Department of Chemistry, Durham University, South Road, Durham DH1 3LE, United Kingdom
| | - M R Tarbutt
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
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Caldwell L, Tarbutt MR. Enhancing Dipolar Interactions between Molecules Using State-Dependent Optical Tweezer Traps. Phys Rev Lett 2020; 125:243201. [PMID: 33412074 DOI: 10.1103/physrevlett.125.243201] [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] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/02/2020] [Indexed: 06/12/2023]
Abstract
We show how state-dependent optical potentials can be used to trap a pair of molecules in different internal states at a separation much smaller than the wavelength of the trapping light. This close spacing greatly enhances the dipole-dipole interaction and we show how it can be used to implement two-qubit gates between molecules that are 100 times faster than existing protocols and than rotational coherence times already demonstrated. We analyze complications due to hyperfine structure, tensor light shifts, photon scattering, and collisional loss, and conclude that none is a barrier to implementing the scheme.
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Affiliation(s)
- L Caldwell
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - M R Tarbutt
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
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17
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Posternak G, Tang X, Maisonneuve P, Jin T, Lavoie H, Daou S, Orlicky S, Goullet de Rugy T, Caldwell L, Chan K, Aman A, Prakesch M, Poda G, Mader P, Wong C, Maier S, Kitaygorodsky J, Larsen B, Colwill K, Yin Z, Ceccarelli DF, Batey RA, Taipale M, Kurinov I, Uehling D, Wrana J, Durocher D, Gingras AC, Al-Awar R, Therrien M, Sicheri F. Functional characterization of a PROTAC directed against BRAF mutant V600E. Nat Chem Biol 2020; 16:1170-1178. [PMID: 32778845 PMCID: PMC7862923 DOI: 10.1038/s41589-020-0609-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 07/01/2020] [Indexed: 12/22/2022]
Abstract
The RAF family kinases function in the RAS-ERK pathway to transmit signals from activated RAS to the downstream kinases MEK and ERK. This pathway regulates cell proliferation, differentiation and survival, enabling mutations in RAS and RAF to act as potent drivers of human cancers. Drugs targeting the prevalent oncogenic mutant BRAF(V600E) have shown great efficacy in the clinic, but long-term effectiveness is limited by resistance mechanisms that often exploit the dimerization-dependent process by which RAF kinases are activated. Here, we investigated a proteolysis-targeting chimera (PROTAC) approach to BRAF inhibition. The most effective PROTAC, termed P4B, displayed superior specificity and inhibitory properties relative to non-PROTAC controls in BRAF(V600E) cell lines. In addition, P4B displayed utility in cell lines harboring alternative BRAF mutations that impart resistance to conventional BRAF inhibitors. This work provides a proof of concept for a substitute to conventional chemical inhibition to therapeutically constrain oncogenic BRAF.
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Affiliation(s)
- Ganna Posternak
- Center for Molecular, Cell and Systems Biology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Drug Discovery Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - Xiaojing Tang
- Center for Molecular, Cell and Systems Biology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Pierre Maisonneuve
- Center for Molecular, Cell and Systems Biology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Ting Jin
- Institute for Research in Immunology and Cancer, Laboratory of Intracellular Signaling, Université de Montréal, Quebec, Montreal, Canada
| | - Hugo Lavoie
- Institute for Research in Immunology and Cancer, Laboratory of Intracellular Signaling, Université de Montréal, Quebec, Montreal, Canada
| | - Salima Daou
- Center for Molecular, Cell and Systems Biology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Stephen Orlicky
- Center for Molecular, Cell and Systems Biology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Theo Goullet de Rugy
- Center for Molecular, Cell and Systems Biology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Lauren Caldwell
- Center for Molecular, Cell and Systems Biology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Kin Chan
- Center for Molecular, Cell and Systems Biology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Ahmed Aman
- Drug Discovery Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Michael Prakesch
- Drug Discovery Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Gennady Poda
- Drug Discovery Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Pavel Mader
- Center for Molecular, Cell and Systems Biology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Cassandra Wong
- Center for Molecular, Cell and Systems Biology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Stefan Maier
- Center for Molecular, Cell and Systems Biology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Julia Kitaygorodsky
- Center for Molecular, Cell and Systems Biology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Brett Larsen
- Center for Molecular, Cell and Systems Biology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Karen Colwill
- Center for Molecular, Cell and Systems Biology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Zhe Yin
- Center for Molecular, Cell and Systems Biology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Department of Biochemistry, University of Toronto, Toronto, Ontario, Canada
| | - Derek F Ceccarelli
- Center for Molecular, Cell and Systems Biology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Robert A Batey
- Department of Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - Mikko Taipale
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
- Donnelly Centre for Cellular and Biomolecular Research, Toronto, Ontario, Canada
| | - Igor Kurinov
- Department of Chemistry and Chemical Biology, Cornell University, NE-CAT, Argonne, IL, USA
| | - David Uehling
- Drug Discovery Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Jeff Wrana
- Center for Molecular, Cell and Systems Biology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Durocher
- Center for Molecular, Cell and Systems Biology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Anne-Claude Gingras
- Center for Molecular, Cell and Systems Biology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Rima Al-Awar
- Drug Discovery Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Marc Therrien
- Institute for Research in Immunology and Cancer, Laboratory of Intracellular Signaling, Université de Montréal, Quebec, Montreal, Canada.
- Département de Pathologie et Biologie Cellulaire, University of Montréal, Quebec, Montreal, Canada.
| | - Frank Sicheri
- Center for Molecular, Cell and Systems Biology, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada.
- Department of Biochemistry, University of Toronto, Toronto, Ontario, Canada.
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18
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Isho B, Abe KT, Zuo M, Jamal AJ, Rathod B, Wang JH, Li Z, Chao G, Rojas OL, Bang YM, Pu A, Christie-Holmes N, Gervais C, Ceccarelli D, Samavarchi-Tehrani P, Guvenc F, Budylowski P, Li A, Paterson A, Yue FY, Marin LM, Caldwell L, Wrana JL, Colwill K, Sicheri F, Mubareka S, Gray-Owen SD, Drews SJ, Siqueira WL, Barrios-Rodiles M, Ostrowski M, Rini JM, Durocher Y, McGeer AJ, Gommerman JL, Gingras AC. Persistence of serum and saliva antibody responses to SARS-CoV-2 spike antigens in COVID-19 patients. Sci Immunol 2020. [PMID: 33033173 DOI: 10.1101/2020.08.01.20166553] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
While the antibody response to SARS-CoV-2 has been extensively studied in blood, relatively little is known about the antibody response in saliva and its relationship to systemic antibody levels. Here, we profiled by enzyme-linked immunosorbent assays (ELISAs) IgG, IgA and IgM responses to the SARS-CoV-2 spike protein (full length trimer) and its receptor-binding domain (RBD) in serum and saliva of acute and convalescent patients with laboratory-diagnosed COVID-19 ranging from 3-115 days post-symptom onset (PSO), compared to negative controls. Anti-SARS-CoV-2 antibody responses were readily detected in serum and saliva, with peak IgG levels attained by 16-30 days PSO. Longitudinal analysis revealed that anti-SARS-CoV-2 IgA and IgM antibodies rapidly decayed, while IgG antibodies remained relatively stable up to 105 days PSO in both biofluids. Lastly, IgG, IgM and to a lesser extent IgA responses to spike and RBD in the serum positively correlated with matched saliva samples. This study confirms that serum and saliva IgG antibodies to SARS-CoV-2 are maintained in the majority of COVID-19 patients for at least 3 months PSO. IgG responses in saliva may serve as a surrogate measure of systemic immunity to SARS-CoV-2 based on their correlation with serum IgG responses.
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Affiliation(s)
- Baweleta Isho
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Kento T Abe
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Michelle Zuo
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Alainna J Jamal
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Microbiology, at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Bhavisha Rathod
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Jenny H Wang
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Zhijie Li
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Gary Chao
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Olga L Rojas
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Yeo Myong Bang
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Annie Pu
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | | | - Christian Gervais
- Mammalian Cell Expression, Human Health Therapeutics Research Centre, National Research Council Canada, Montréal, QC, Canada
| | - Derek Ceccarelli
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Payman Samavarchi-Tehrani
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Furkan Guvenc
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Patrick Budylowski
- Combined Containment Level 3 Unit, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Angel Li
- Department of Microbiology, at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Aimee Paterson
- Department of Microbiology, at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Feng Yun Yue
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Lina M Marin
- College of Dentistry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Lauren Caldwell
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Jeffrey L Wrana
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Karen Colwill
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Frank Sicheri
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Samira Mubareka
- Department of Laboratory Medicine and Molecular Diagnostics, Division of Microbiology, Sunnybrook Health Sciences Centre; Biological Sciences, Sunnybrook Research Institute; and Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, ON, Canada
| | - Scott D Gray-Owen
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada.,Combined Containment Level 3 Unit, University of Toronto, Toronto, ON, Canada
| | - Steven J Drews
- Canadian Blood Services, Edmonton, AB & Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Walter L Siqueira
- College of Dentistry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Miriam Barrios-Rodiles
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Mario Ostrowski
- Department of Immunology, University of Toronto, Toronto, ON, Canada.,St. Michael's Hospital, Toronto, ON, Canada; Li Ka Shing Knowledge Institute.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - James M Rini
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada.,Department of Biochemistry, University of Toronto, Toronto, ON, Canada
| | - Yves Durocher
- Mammalian Cell Expression, Human Health Therapeutics Research Centre, National Research Council Canada, Montréal, QC, Canada
| | - Allison J McGeer
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Microbiology, at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | | | - Anne-Claude Gingras
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada. .,Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
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19
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Isho B, Abe KT, Zuo M, Jamal AJ, Rathod B, Wang JH, Li Z, Chao G, Rojas OL, Bang YM, Pu A, Christie-Holmes N, Gervais C, Ceccarelli D, Samavarchi-Tehrani P, Guvenc F, Budylowski P, Li A, Paterson A, Yue FY, Marin LM, Caldwell L, Wrana JL, Colwill K, Sicheri F, Mubareka S, Gray-Owen SD, Drews SJ, Siqueira WL, Barrios-Rodiles M, Ostrowski M, Rini JM, Durocher Y, McGeer AJ, Gommerman JL, Gingras AC. Persistence of serum and saliva antibody responses to SARS-CoV-2 spike antigens in COVID-19 patients. Sci Immunol 2020; 5:5/52/eabe5511. [PMID: 33033173 PMCID: PMC8050884 DOI: 10.1126/sciimmunol.abe5511] [Citation(s) in RCA: 534] [Impact Index Per Article: 133.5] [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: 08/28/2020] [Accepted: 10/05/2020] [Indexed: 12/13/2022]
Abstract
While the antibody response to SARS-CoV-2 has been extensively studied in blood, relatively little is known about the antibody response in saliva and its relationship to systemic antibody levels. Here, we profiled by enzyme-linked immunosorbent assays (ELISAs) IgG, IgA and IgM responses to the SARS-CoV-2 spike protein (full length trimer) and its receptor-binding domain (RBD) in serum and saliva of acute and convalescent patients with laboratory-diagnosed COVID-19 ranging from 3-115 days post-symptom onset (PSO), compared to negative controls. Anti-SARS-CoV-2 antibody responses were readily detected in serum and saliva, with peak IgG levels attained by 16-30 days PSO. Longitudinal analysis revealed that anti-SARS-CoV-2 IgA and IgM antibodies rapidly decayed, while IgG antibodies remained relatively stable up to 105 days PSO in both biofluids. Lastly, IgG, IgM and to a lesser extent IgA responses to spike and RBD in the serum positively correlated with matched saliva samples. This study confirms that serum and saliva IgG antibodies to SARS-CoV-2 are maintained in the majority of COVID-19 patients for at least 3 months PSO. IgG responses in saliva may serve as a surrogate measure of systemic immunity to SARS-CoV-2 based on their correlation with serum IgG responses.
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Affiliation(s)
- Baweleta Isho
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Kento T Abe
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Michelle Zuo
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Alainna J Jamal
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Microbiology, at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Bhavisha Rathod
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Jenny H Wang
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Zhijie Li
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Gary Chao
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Olga L Rojas
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Yeo Myong Bang
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Annie Pu
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | | | - Christian Gervais
- Mammalian Cell Expression, Human Health Therapeutics Research Centre, National Research Council Canada, Montréal, QC, Canada
| | - Derek Ceccarelli
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Payman Samavarchi-Tehrani
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Furkan Guvenc
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Patrick Budylowski
- Combined Containment Level 3 Unit, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Angel Li
- Department of Microbiology, at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Aimee Paterson
- Department of Microbiology, at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Feng Yun Yue
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Lina M Marin
- College of Dentistry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Lauren Caldwell
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Jeffrey L Wrana
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Karen Colwill
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Frank Sicheri
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Samira Mubareka
- Department of Laboratory Medicine and Molecular Diagnostics, Division of Microbiology, Sunnybrook Health Sciences Centre; Biological Sciences, Sunnybrook Research Institute; and Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, ON, Canada
| | - Scott D Gray-Owen
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
- Combined Containment Level 3 Unit, University of Toronto, Toronto, ON, Canada
| | - Steven J Drews
- Canadian Blood Services, Edmonton, AB & Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Walter L Siqueira
- College of Dentistry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Miriam Barrios-Rodiles
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Mario Ostrowski
- Department of Immunology, University of Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Toronto, ON, Canada; Li Ka Shing Knowledge Institute
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - James M Rini
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
- Department of Biochemistry, University of Toronto, Toronto, ON, Canada
| | - Yves Durocher
- Mammalian Cell Expression, Human Health Therapeutics Research Centre, National Research Council Canada, Montréal, QC, Canada
| | - Allison J McGeer
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Microbiology, at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | | | - Anne-Claude Gingras
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada.
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
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20
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Brienen RJW, Caldwell L, Duchesne L, Voelker S, Barichivich J, Baliva M, Ceccantini G, Di Filippo A, Helama S, Locosselli GM, Lopez L, Piovesan G, Schöngart J, Villalba R, Gloor E. Forest carbon sink neutralized by pervasive growth-lifespan trade-offs. Nat Commun 2020; 11:4241. [PMID: 32901006 PMCID: PMC7479146 DOI: 10.1038/s41467-020-17966-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 07/27/2020] [Indexed: 11/09/2022] Open
Abstract
Land vegetation is currently taking up large amounts of atmospheric CO2, possibly due to tree growth stimulation. Extant models predict that this growth stimulation will continue to cause a net carbon uptake this century. However, there are indications that increased growth rates may shorten trees' lifespan and thus recent increases in forest carbon stocks may be transient due to lagged increases in mortality. Here we show that growth-lifespan trade-offs are indeed near universal, occurring across almost all species and climates. This trade-off is directly linked to faster growth reducing tree lifespan, and not due to covariance with climate or environment. Thus, current tree growth stimulation will, inevitably, result in a lagged increase in canopy tree mortality, as is indeed widely observed, and eventually neutralise carbon gains due to growth stimulation. Results from a strongly data-based forest simulator confirm these expectations. Extant Earth system model projections of global forest carbon sink persistence are likely too optimistic, increasing the need to curb greenhouse gas emissions.
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Affiliation(s)
- R J W Brienen
- School of Geography, University of Leeds, Leeds, LS2 9JT, UK.
| | - L Caldwell
- School of Geography, University of Leeds, Leeds, LS2 9JT, UK
| | - L Duchesne
- Ministère des Forêts, de la Faune et des Parcs, Direction de la recherche forestière, 2700 Einstein Street, Quebec, QC, G1P 3W8, Canada
| | - S Voelker
- Department of Environmental and Forest Biology, SUNY-ESF, Syracuse, New York, NY, 13210, USA
| | - J Barichivich
- Laboratoire des Sciences du Climat et de l'Environnement, IPSL, CNRS/CEA/UVSQ, 91191, Gif sur Yvette, France.,Instituto de Geografía, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - M Baliva
- Department of Agriculture and Forest Sciences (DAFNE), University of Tuscia, 01100, Viterbo, Via SC de Lellis, Italy
| | - G Ceccantini
- University of São Paulo, Institute of Biosciences, Department of Botany, Rua do Matão, 277, São Paulo, SP, 05508-090, Brazil
| | - A Di Filippo
- Department of Agriculture and Forest Sciences (DAFNE), University of Tuscia, 01100, Viterbo, Via SC de Lellis, Italy
| | - S Helama
- Natural Resources Institute Finland, Ounasjoentie 6, 96200, Rovaniemi, Finland
| | - G M Locosselli
- University of São Paulo, Institute of Biosciences, Department of Botany, Rua do Matão, 277, São Paulo, SP, 05508-090, Brazil
| | - L Lopez
- Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales (IANIGLA), CONICET-Mendoza, C.C. 330, (5500), Mendoza, Argentina
| | - G Piovesan
- Department of Agriculture and Forest Sciences (DAFNE), University of Tuscia, 01100, Viterbo, Via SC de Lellis, Italy
| | - J Schöngart
- Instituto Nacional de Pesquisas Da Amazônia (INPA), Coordenação de Dinâmica Ambiental (CODAM), Av. André Araújo 2936, 69067-375, Manaus, Brazil
| | - R Villalba
- Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales (IANIGLA), CONICET-Mendoza, C.C. 330, (5500), Mendoza, Argentina
| | - E Gloor
- School of Geography, University of Leeds, Leeds, LS2 9JT, UK
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21
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Gilbert RE, Caldwell L, Misra PS, Chan K, Burns KD, Wrana JL, Yuen DA. Overexpression of the Severe Acute Respiratory Syndrome Coronavirus-2 Receptor, Angiotensin-Converting Enzyme 2, in Diabetic Kidney Disease: Implications for Kidney Injury in Novel Coronavirus Disease 2019. Can J Diabetes 2020; 45:162-166.e1. [PMID: 32917504 PMCID: PMC7368650 DOI: 10.1016/j.jcjd.2020.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 12/13/2022]
Abstract
Objectives Diabetes is associated with adverse outcomes, including death, after coronavirus disease 19 (COVID-19) infection. Beyond the lungs, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), the etiologic agent of the COVID-19 pandemic, can infect a range of other tissues, including the kidney, potentially contributing to acute kidney injury in those with severe disease. We hypothesized that the renal abundance of angiotensin-converting enzyme (ACE) 2, the cell surface receptor for SARS-CoV-2, may be modulated by diabetes and agents that block the renin-angiotensin-aldosterone system (RAAS). Methods The expression of ACE 2 was examined in 49 archival kidney biopsies from patients with diabetic kidney disease and from 12 healthy, potential living allograft donors using next-generation sequencing technology (RNA Seq). Results Mean ACE 2 messenger RNA was increased approximately 2-fold in diabetes when compared with healthy control subjects (mean ± SD, 13.2±7.9 vs 7.7±3.6 reads per million reads, respectively; p=0.001). No difference in transcript abundance was noted between recipients and nonrecipients of agents that block the RAAS (12.2±6.7 vs 16.2±10.7 reads per million reads, respectively; p=0.25). Conclusions Increased ACE 2 messenger RNA in the diabetic kidney may increase the risk and/or severity of kidney infection with SARS-CoV-2 in the setting of COVID-19 disease. Further studies are needed to ascertain whether this diabetes-related overexpression is generalizable to other tissues, most notably the lungs.
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Affiliation(s)
- Richard E Gilbert
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, Unity Health Toronto, St. Michael's Hospital, Toronto, Ontario, Canada.
| | - Lauren Caldwell
- Center for Systems Biology, Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital and Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Paraish S Misra
- Division of Nephrology, Department of Medicine, University of Toronto, Ontario, Ontario, Canada
| | - Kin Chan
- Center for Systems Biology, Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital and Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey L Wrana
- Center for Systems Biology, Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital and Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Darren A Yuen
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, Unity Health Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
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22
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Caldwell L, Williams HJ, Fitch NJ, Aldegunde J, Hutson JM, Sauer BE, Tarbutt MR. Long Rotational Coherence Times of Molecules in a Magnetic Trap. Phys Rev Lett 2020; 124:063001. [PMID: 32109098 DOI: 10.1103/physrevlett.124.063001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/17/2019] [Indexed: 06/10/2023]
Abstract
Polar molecules in superpositions of rotational states exhibit long-range dipolar interactions, but maintaining their coherence in a trapped sample is a challenge. We present calculations that show many laser-coolable molecules have convenient rotational transitions that are exceptionally insensitive to magnetic fields. We verify this experimentally for CaF where we find a transition with sensitivity below 5 Hz G^{-1} and use it to demonstrate a rotational coherence time of 6.4(8) ms in a magnetic trap. Simulations suggest it is feasible to extend this to more than 1 s using a smaller cloud in a biased magnetic trap.
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Affiliation(s)
- L Caldwell
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - H J Williams
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - N J Fitch
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - J Aldegunde
- Departamento de Quimica Fisica, Universidad de Salamanca, E-37008 Salamanca, Spain
| | - Jeremy M Hutson
- Joint Quantum Centre (JQC) Durham-Newcastle, Department of Chemistry, Durham University, South Road, Durham DH1 3LE, United Kingdom
| | - B E Sauer
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - M R Tarbutt
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
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23
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Caldwell L, Devlin JA, Williams HJ, Fitch NJ, Hinds EA, Sauer BE, Tarbutt MR. Deep Laser Cooling and Efficient Magnetic Compression of Molecules. Phys Rev Lett 2019; 123:033202. [PMID: 31386461 DOI: 10.1103/physrevlett.123.033202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/27/2019] [Indexed: 06/10/2023]
Abstract
We introduce a scheme for deep laser cooling of molecules based on robust dark states at zero velocity. By simulating this scheme, we show it to be a widely applicable method that can reach the recoil limit or below. We demonstrate and characterize the method experimentally, reaching a temperature of 5.4(7) μK. We solve a general problem of measuring low temperatures for large clouds by rotating the phase-space distribution and then directly imaging the complete velocity distribution. Using the same phase-space rotation method, we rapidly compress the cloud. Applying the cooling method a second time, we compress both the position and velocity distributions.
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Affiliation(s)
- L Caldwell
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - J A Devlin
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - H J Williams
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - N J Fitch
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - E A Hinds
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - B E Sauer
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - M R Tarbutt
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
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24
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Williams HJ, Caldwell L, Fitch NJ, Truppe S, Rodewald J, Hinds EA, Sauer BE, Tarbutt MR. Magnetic Trapping and Coherent Control of Laser-Cooled Molecules. Phys Rev Lett 2018; 120:163201. [PMID: 29756945 DOI: 10.1103/physrevlett.120.163201] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Indexed: 06/08/2023]
Abstract
We demonstrate coherent microwave control of the rotational, hyperfine, and Zeeman states of ultracold CaF molecules, and the magnetic trapping of these molecules in a single, selectable quantum state. We trap about 5×10^{3} molecules for almost 2 s at a temperature of 70(8) μK and a density of 1.2×10^{5} cm^{-3}. We measure the state-specific loss rate due to collisions with background helium.
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Affiliation(s)
- H J Williams
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - L Caldwell
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - N J Fitch
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - S Truppe
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - J Rodewald
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - E A Hinds
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - B E Sauer
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
| | - M R Tarbutt
- Centre for Cold Matter, Blackett Laboratory, Imperial College London, Prince Consort Road, London SW7 2AZ, United Kingdom
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25
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Schwarz RE, Awasthi N, Konduri S, Caldwell L, Cafasso D, Schwarz MA. Antitumor effects of EMAP II against pancreatic cancer through inhibition of fibronectin-dependent proliferation. Cancer Biol Ther 2010; 9:632-9. [PMID: 20212356 DOI: 10.4161/cbt.9.8.11265] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is highly resistant to conventional chemotherapy. The presence of both cellular and stromal fibronectin (FN) and its interaction with integrins is necessary for PDAC progression. We tested the efficacy of endothelial monocyte-activating polypeptide II (EMAP II) to inhibit PDAC progression and its ability to interfere with FN-integrin angiogenesis signaling. In heterotopic PDAC tumors EMAP II caused a significant reduction (>65%) in tumor growth, accompanied by a >50 and 44% decrease in microvessel density and proliferative activity, respectively. EMAP II therapy caused a 62 and 56% reduction in host and tumor cell FN expression. Cultured PDAC cells expressed alphaVbeta3 and alpha5beta1 integrins. In vitro EMAP II had limited antiproliferative effects on ASPC-1, but a pronounced antiproliferative effect on endothellial cells. 3D FN matrices increased ASPC-1 cell proliferation by >50%, and this induction was significantly blocked by alpha3, alpha5, alpha6 and alphaV integrin funtional blocking antibodies, while alpha1, alpha2 and alpha4 antibodies had no effect. EMAP II also inhibited 3D FN-matrix induced ASPC-1 proliferation by >43% at 20 microM. These findings suggest that EMAP II demonstrates significant antitumor activity against PDAC cells, and that this effect may be in part mediated through targeted interference with stromal FN-integrin dependent PDAC cell proliferation.
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Affiliation(s)
- Roderich E Schwarz
- UT Southwestern Medical Center, Department of Surgery, Division of Surgical Oncology, Dallas, TX, USA.
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26
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Abstract
Lung morphogenesis requires precise coordination between branching morphogenesis and vascularization to generate distal airways capable of supporting respiration at the cell-cell interface. The specific origins and types of blood vessels that initially form in the lung, however, remain obscure. Herein, we definitively show that during the early phases of lung development [i.e., embryonic day (E) 11.5], functional vessels, replete with blood flow, are restricted to the mesenchyme, distal to the epithelium. However, by day E14.5, and in response to epithelial-derived VEGF signals, functional vessels extend from the mesenchyme to the epithelial interface. Moreover, these vessels reside adjacent to multipotent mesenchymal stromal cells that likely play a regulatory role in this process. As well as and distinct from the systemic vasculature, immunostaining for EphrinB2 and EphB4 revealed that arterial and venous identity is not distinguishable in emergent pulmonary vasculature. Collectively, this study provides evidence that lung vascularization initially originates in the mesenchyme, distal to the epithelium, and that arterial-venous specification does not exist in the early lung. At a mechanistic level, we show that basilar epithelial VEGF prompts endothelial cells to move toward the epithelium where they undergo morphogenesis during the proliferative, canalicular stage. Thus our findings challenge existing notions of vascular origin and identity during development.
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Affiliation(s)
- Margaret A Schwarz
- UT Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX 75390-9063, USA.
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Barker H, Caldwell L, Lovato J, Woods KF, Perrier ND. Is there a racial difference in presentation of primary hyperparathyroidism? Am Surg 2004; 70:504-6. [PMID: 15212403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Nearly 50,000 new cases of primary hyperparathyroidism (PHPT) are diagnosed annually in the United States. Most information about the disease focuses on the white population. We evaluated African American (AA) and white patients at our tertiary care university medical center to determine whether there was a racial difference in presentation of PHPT. A retrospective chart review of patients treated surgically for PHPT between 1997 and 2002 was performed. Demographic data, laboratory values, objective symptoms, surgical procedure, and histologic findings were recorded. The AA participants were matched to whites by age and gender. The effect of race was adjusted for the matching variables by including them in regression models. ANOVA chi2 tests were performed on the race effects. Thirty-six (14.4%) of the 286 patients treated for PHPT at Wake Forest University Baptist Medical Center during this 5-year period were AA. There was no difference in serum calcium or presence of objective symptoms, but PTH levels were significantly higher for blacks (207.5 vs 143.5 pg/mL; P = 0.02). In our study, AA patients had significantly higher parathyroid hormone levels at time of surgical intervention but did not present with a difference in symptoms or more advanced disease. Further research is recommended to characterize ethnic differences in patients with PHPT.
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Affiliation(s)
- Holly Barker
- Department of Surgery, Wake Forest University Baptist Medical Center, Winston Salem, North Carolina 27157, USA
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29
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Barker H, Caldwell L, Lovato J, Woods KF, Perrier ND. Is There a Racial Difference in Presentation of Primary Hyperparathyroidism? Am Surg 2004. [DOI: 10.1177/000313480407000608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Nearly 50,000 new cases of primary hyperparathyroidism (PHPT) are diagnosed annually in the United States. Most information about the disease focuses on the white population. We evaluated African American (AA) and white patients at our tertiary care university medical center to determine whether there was a racial difference in presentation of PHPT. A retrospective chart review of patients treated surgically for PHPT between 1997 and 2002 was performed. Demographic data, laboratory values, objective symptoms, surgical procedure, and histologic findings were recorded. The AA participants were matched to whites by age and gender. The effect of race was adjusted for the matching variables by including them in regression models. ANOVA χ2 tests were performed on the race effects. Thirty-six (14.4%) of the 286 patients treated for PHPT at Wake Forest University Baptist Medical Center during this 5-year period were AA. There was no difference in serum calcium or presence of objective symptoms, but PTH levels were significantly higher for blacks (207.5 vs 143.5 pg/mL; P = 0.02). In our study, AA patients had significantly higher parathyroid hormone levels at time of surgical intervention but did not present with a difference in symptoms or more advanced disease. Further research is recommended to characterize ethnic differences in patients with PHPT.
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Affiliation(s)
- Holly Barker
- Departments of Surgery, Wake Forest University Baptist Medical Center, Winston Salem, North Carolina
| | - Lauren Caldwell
- Departments of Surgery, Wake Forest University Baptist Medical Center, Winston Salem, North Carolina
| | - James Lovato
- Departments of Public Health Sciences, Wake Forest University Baptist Medical Center, Winston Salem, North Carolina
| | - Kristy F. Woods
- Departments of Public Health Sciences, Wake Forest University Baptist Medical Center, Winston Salem, North Carolina
| | - Nancy D. Perrier
- Departments of Surgery, Wake Forest University Baptist Medical Center, Winston Salem, North Carolina
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30
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Benson L, Birkel A, Caldwell L, Stafford-Fox V, Casarico B. Advances in the treatment of hepatitis C: combination antiviral therapy with interferon alfa-2b and ribavirin. J Am Acad Nurse Pract 2000; 12:364-73. [PMID: 11930591 DOI: 10.1111/j.1745-7599.2000.tb00197.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To provide nurse practitioners with the information to manage patients with chronic hepatitis C (HCV) receiving a new combination drug therapy containing ribavirin and interferon alfa-2b. DATA SOURCES Reviews of clinical trial results including large multicenter trials, Centers for Disease Control and Prevention documents, data from the drug manufacturer. CONCLUSION This new therapy offers the potential for HCV remission or complete cure of the HCV infection. Although virologic responses are markedly improved with combination therapy, the side effects associated with combination therapy warrant regular patient monitoring, management, and medical intervention when clinically indicated. IMPLICATIONS FOR PRACTICE Combination therapy does not significantly worsen the side effects associated with mono-therapy, which are predictable, manageable, and reversible. However, proper patient education, symptom management, vigilance for serious side effects, and monitoring of hematologic parameters are critical to patient outcome.
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Affiliation(s)
- L Benson
- Schering Oncology/Biotech Kenliworth, NJ, USA
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31
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Birkel A, Caldwell L, Stafford-Fox V, Casarico B, Benson L. Combination Interferon alfa-2b/ribavirin therapy for the treatment of hepatitis C: nursing implications. Gastroenterol Nurs 2000; 23:55-62. [PMID: 11111599 DOI: 10.1097/00001610-200003000-00002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
An effective new therapeutic option consisting of Intron A (Interferon alfa-2b, recombinant; Schering Corporation, Kenilworth, NJ) Injection and Rebetol (Ribavirin, USP) Capsules is now available for the initial therapy of patients with hepatitis C and for patients who had previously responded to alpha interferon but subsequently relapsed. The combination of recombinant interferon alfa-2b/ribavirin therapy increases hepatitis C viral clearance 10-fold in hepatitis C relapse patients and almost threefold in previously untreated patients compared with alpha interferon monotherapy. There is no synergistic toxicity apparent with the two-drug combination. Ribavirin does not significantly worsen the side effects associated with interferon alfa-2b, which are predictable, manageable, and reversible. The major side effects of combination therapy include flulike symptoms, neutropenia, psychiatric disorders, and anemia; however, these side effects are well known and can be managed with dose modifications and nursing intervention. The assistance of nurses in patient education, in side effect management, in hematologic parameter monitoring, and in medication dosing and administration is crucial to maximizing patient compliance and therapy outcome.
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Affiliation(s)
- A Birkel
- Schering Oncology/Biotech, Kenilworth, NJ 07033, USA
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32
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Abstract
Interdisciplinary team collaboration is considered an essential component of most health care services. The overall goal of such collaboration in mental health services/ psychiatry is to provide a comprehensive biopsychosocial perspective organized around patient needs and stages of treatment. There is also increasing interest in using an interdisciplinary framework to monitor and evaluate patient care. Unfortunately, little information is available regarding treatment standards that address the issue of interdisciplinary team collaboration. This project was designed to formulate a set of interdisciplinary team standards of patient care. This article presents the standards and provides an overview of the interdisciplinary processes through which they were developed. An empirical evaluation of the standards within one service area--The Affective Disorders Clinic--is also included.
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Affiliation(s)
- L Beverley
- Mental Health and Psychiatric Services, Foothills Medical Centre, Calgary
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33
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Abstract
The recent directives to improve both the quality and the efficiency of mental health service delivery systems have emphasized the need for evidence based treatment efficacy data, yet recent evidence suggests that quality of life data may be confounded with psychiatric symptomatology. The objective of the current inquiry was to determine whether responses to patient satisfaction measures are equally effected by mood-congruent response bias. Thirty-seven patients from a mood disorders clinic in an urban acute care hospital were asked to rate their current mood, satisfaction with their care, and quality of life. While patient rating of mood were highly correlated with specific quality of life scales and predicted 21% of the variance in global quality ratings, the more objective satisfaction indicators were not. For the clinician, these data suggest that clinically depressed patients may view their support system and care givers in negative or biased perspective.
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Affiliation(s)
- M J Atkinson
- Department of Psychiatry University of Calgary, Alberta, Canada.
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34
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Sawutz DG, Bode DC, Briggs GM, Reid JR, Canniff P, Caldwell L, Faltynek CR, Miller D, Dunn JA, de Garavilla L, Guiles JW, Weigelt C, Michne W, Treasurywala AM, Silver PJ. In vitro characterization of a novel series of platelet-derived growth factor receptor tyrosine kinase inhibitors. Biochem Pharmacol 1996; 51:1631-8. [PMID: 8687478 DOI: 10.1016/0006-2952(96)00112-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [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: 02/01/2023]
Abstract
In this report, we describe the discovery and characterization of a novel biarylhydrazone series of platelet-derived growth factor (PDGF) receptor tyrosine kinase inhibitors typified by the prototype WIN 41662 (3-phenyl-N1-[1-(4-pytidyl)pyrimidine]hydrazone). WIN 41662 inhibited PDGF-stimulated autophosphorylation of PDGF receptors from human vascular smooth muscle cells (hVSMC) with an IC50 value of 60 nM. The inhibitor appeared to be competitive with respect to substrate (Mn(2+)-ATP), having a calculated Ki of 15 +/- 5 nM. WIN 41662 was approximately 500-fold more potent in inhibiting the PDGF receptor tyrosine kinase than the p56lck tyrosine kinase. It was inactive against other serine/threonine and tyrosine kinases tested. WIN 41662 produced concentration-dependent inhibition of PDGF-stimulated receptor autophosphorylation in intact hVSMC with an IC50 < 100 nM. Intracellular Ca2+ mobilization and cell proliferation were events that occurred in hVSMC subsequent to PDGF receptor activation. WIN 41662 inhibited PDGF-stimulated Ca2+ mobilization and cell proliferation ([3H]TdR incorporation) with IC50 values of 430 nM and 2.3 microM, respectively. These effects appeared to be specifically related to PDGF receptor tyrosine kinase inhibition since WIN 41662 was not cytotoxic (in vitro) and since WIN 72039, a close structural analog that does not inhibit PDGF receptor tyrosine kinase, also did not inhibit PDGF-stimulated receptor autophosphorylation, Ca2+ mobilization, or hVSMC proliferation. Thus, WIN 41662 is representative of a novel class of selective PDGF receptor tyrosine kinase inhibitors that inhibit PDGF-regulated secondary events in intact cells.
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Affiliation(s)
- D G Sawutz
- Department of Biochemistry, Sterling Winthrop Pharmaceuticals Research Division, Collegeville, PA 19426, USA
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35
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Brady MT, Crim L, Caldwell L, Koranyi K. Family-centered care: a paradigm for care of the HIV-affected family. Pediatr AIDS HIV Infect 1996; 7:168-75. [PMID: 11361584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- M T Brady
- Department of Pediatrics, College of Medicine, Ohio State University, USA
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36
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Abstract
Radioligand receptor binding has been used extensively to identify and characterize a host of receptors and enzymes targeting virtually every therapeutic area. Many drug discovery programs have been based on the utilization of radioligand receptor binding technology to identify lead compounds which interact with receptors likely to be important in neuronal, immunological, gastrointestinal, and cardiovascular function/dysfunction. There are several obvious advantages to using in vitro receptor binding as a first level screen when compared to in vivo pharmacometric screens. Scientifically, the structure activity data generated in binding assays is a direct reflection of the ligand/receptor interaction minus the complications which result from secondary events, bioavailability, and pharmacodynamic issues. Technically, the binding studies require only a small amount of test compound (< or = 1 mg), while whole animal studies routinely need gram quantities. Similarly, only a small amount of tissue is required, compared with the cost of purchase and maintenance of live animals for in vivo screening. Supply and labor costs are drastically reduced due to the limited volume and test tube based technology of receptor binding. For these reasons receptor binding assays have been utilized with considerable success to discover site specific lead compounds in virtually every therapeutic area.
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Affiliation(s)
- P M Sweetnam
- NovaScreen, Division of Scios Nova Inc., Baltimore, Maryland 21224
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37
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Conners CK, Reader M, Reiss A, Caldwell J, Caldwell L, Adesman A, Mayer L, Berg M, Clymer R, Erwin R. The effects of piracetam upon visual event-related potentials in dyslexic children. Psychophysiology 1987; 24:513-21. [PMID: 3685231 DOI: 10.1111/j.1469-8986.1987.tb00328.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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38
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Itoh T, Higuchi T, Gardner CR, Caldwell L. Effect of particle size and food on gastric residence time of non-disintegrating solids in beagle dogs. J Pharm Pharmacol 1986; 38:801-6. [PMID: 2879009 DOI: 10.1111/j.2042-7158.1986.tb04498.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The gastric residence times of various sizes of radio-opaque particles and tablets were measured in beagle dogs by X-ray, both in the fasted state and after a single meal. During the course of the studies, changes in intragastric pH were also monitored with a radiotelemetric pH sensor, the Heidelberg capsule. The gastric residence time increased with increasing particle size and with particles greater than or equal to 5 mm in diameter approached a plateau value both in the fasted state and after feeding. This value was about 7.5 h after feeding and about 1.5 h in the fasted state, and probably corresponded to the occurrence of the interdigestive migratory myoelectric complex (IMMC wave). The pH in the stomach was variable in the fasted state, but an abrupt pH increase (up to pH 6-7) was observed during the emptying of larger tablets. In some instances this high pH in the stomach was maintained until the next IMMC wave occurred. The gastric emptying of larger tablets administered with food was also associated with an abrupt pH increase.
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Abstract
The disposition of Witepsol H 15 suppositories radiolabelled with [99mTc] technetium hydroxymethyldiphosphonate was studied after rectal administration in volunteers. The migration of the radiolabel was monitored continuously by external scintigraphy. The resulting scintiphotos were superimposed on lower GI radiographs to determine the extent of spreading of the dosage form in the rectum. The dosage form migrated approximately 5-7 cm into the rectum in nearly all of the studies and was, in general, confined to the lower and middle regions of the rectum. Since the venous supply to the lower rectum leads primarily to the inferior vena cava, the data presented here indicate that the metabolism of drugs sensitive to the 'first-pass' effect may be partially avoided by their rectal administration.
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40
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Sloan KB, Selk S, Haslam J, Caldwell L, Shaffer R. Acyloxyamines as prodrugs of anti-inflammatory carboxylic acids for improved delivery through skin. J Pharm Sci 1984; 73:1734-7. [PMID: 6527246 DOI: 10.1002/jps.2600731219] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
An N,N-dialkylhydroxylamine derivative of indomethacin has been synthesized. It has been shown to improve the delivery of indomethacin through mouse skin (compared to indomethacin itself) by a factor of two, to be more effective than indomethacin in inhibiting thermal inflammation (two to three times) in animal models, but to be only as effective as indomethacin in inhibiting UV-B radiation erythema in human volunteers.
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41
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Caldwell L, Nishihata T, Fix J, Selk S, Cargill R, Gardner CR, Higuchi T. Absorption-promoting adjuvants: animal studies on their effects on rectal drug absorption. Methods Find Exp Clin Pharmacol 1984; 6:503-7. [PMID: 6392793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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42
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Sithigorngul P, Burton P, Nishihata T, Caldwell L. Effects of sodium salicylate on epithelial cells of the rectal mucosa of the rat: a light and electron microscopic study. Life Sci 1983; 33:1025-32. [PMID: 6888160 DOI: 10.1016/0024-3205(83)90656-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Using a ligation method, rat rectal epithelium was exposed to 2% sodium salicylate, and light and electron microscopic methods were used to assay for: 1) permeability of the epithelium to a marker dye, trypan blue, and 2) damage expressed in terms of disruption of the epithelial surface. Rectal mucosa was exposed to salicylate at pH 4.8, 7.0, and 9.0, and the effects of pretreatment with phlorizin were also studied. Results indicated that 2% sodium salicylate does very little damage to rectal epithelial cells at pH 7.0 while enhancing their permeability to trypan blue, an effect that is reversed upon washing out the sodium salicylate. The major cellular change induced by salicylate was a reduction in the length or distribution of glycocalyx filaments on microvilli of epithelial cells. It was also noted that pretreatment with phlorizin counteracted some of the effects of salicylate treatment.
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Abstract
Sodium salicylate and 5-methoxysalicylate both increased the rectal absorption of insulin in dogs when co-administered with insulin in various formulations. Microenema formulations containing 4% gelatin showed the highest insulin bioavailability of the formulations studied whereas microenemas (without gelatin) and suppository formulations were not as effective in enhancing the rectal absorption of insulin.
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Windheuser JJ, Haslam JL, Caldwell L, Shaffer RD. The use of N,N-diethyl-m-toluamide to enhance dermal and transdermal delivery of drugs. J Pharm Sci 1982; 71:1211-3. [PMID: 7175710 DOI: 10.1002/jps.2600711107] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A dermal penetration enhancer has been found which improves the dermal delivery of a wide variety of drugs and at the same time has a history of low toxicity for human dermal application. N,N-Diethyl-m-toluamide (I) has been shown to improve the delivery of many drugs through hairless mouse skin in an in vitro diffusion cell model. A topically applied steroid, hydrocortisone, has been used to demonstrate the in vivo effectiveness of I on human skin. The degree of pallor produced on human skin by the corticosteroids was used as a measure of the relative delivery of hydrocortisone from formulations with and without I.
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Yoshioka S, Caldwell L, Higuchi T. Enhanced rectal bioavailability of polypeptides using sodium 5-methoxysalicylate as an absorption promoter. J Pharm Sci 1982; 71:593-4. [PMID: 7097511 DOI: 10.1002/jps.2600710529] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The absorption-promoting effect of sodium 5-methoxysalicylate was studied in the rat with respect to rectal delivery of pentagastrin and gastrin. Rectal bioavailability was quantitated by direct comparison of pharmacological effect with intravenous dose response. Coadministration of the absorption adjuvant greatly enhanced the rectal bioavailability of the model polypeptides. Sodium 5-methoxysalicylate, therefore, is representative of a new type of absorption promoter which appears to facilitate rectal absorption of polypeptide drug entities.
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Nishihata T, Rytting JH, Higuchi T, Caldwell L. Enhanced rectal absortion of insulin and heparin in rats in the presence of non-surfactant adjuvants. J Pharm Pharmacol 1981; 33:334-5. [PMID: 6116789 DOI: 10.1111/j.2042-7158.1981.tb13796.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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