1
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Sun Y, Revach OY, Anderson S, Kessler EA, Wolfe CH, Jenney A, Mills CE, Robitschek EJ, Davis TGR, Kim S, Fu A, Ma X, Gwee J, Tiwari P, Du PP, Sindurakar P, Tian J, Mehta A, Schneider AM, Yizhak K, Sade-Feldman M, LaSalle T, Sharova T, Xie H, Liu S, Michaud WA, Saad-Beretta R, Yates KB, Iracheta-Vellve A, Spetz JKE, Qin X, Sarosiek KA, Zhang G, Kim JW, Su MY, Cicerchia AM, Rasmussen MQ, Klempner SJ, Juric D, Pai SI, Miller DM, Giobbie-Hurder A, Chen JH, Pelka K, Frederick DT, Stinson S, Ivanova E, Aref AR, Paweletz CP, Barbie DA, Sen DR, Fisher DE, Corcoran RB, Hacohen N, Sorger PK, Flaherty KT, Boland GM, Manguso RT, Jenkins RW. Targeting TBK1 to overcome resistance to cancer immunotherapy. Nature 2023; 615:158-167. [PMID: 36634707 PMCID: PMC10171827 DOI: 10.1038/s41586-023-05704-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [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: 07/16/2021] [Accepted: 01/04/2023] [Indexed: 01/14/2023]
Abstract
Despite the success of PD-1 blockade in melanoma and other cancers, effective treatment strategies to overcome resistance to cancer immunotherapy are lacking1,2. Here we identify the innate immune kinase TANK-binding kinase 1 (TBK1)3 as a candidate immune-evasion gene in a pooled genetic screen4. Using a suite of genetic and pharmacological tools across multiple experimental model systems, we confirm a role for TBK1 as an immune-evasion gene. Targeting TBK1 enhances responses to PD-1 blockade by decreasing the cytotoxicity threshold to effector cytokines (TNF and IFNγ). TBK1 inhibition in combination with PD-1 blockade also demonstrated efficacy using patient-derived tumour models, with concordant findings in matched patient-derived organotypic tumour spheroids and matched patient-derived organoids. Tumour cells lacking TBK1 are primed to undergo RIPK- and caspase-dependent cell death in response to TNF and IFNγ in a JAK-STAT-dependent manner. Taken together, our results demonstrate that targeting TBK1 is an effective strategy to overcome resistance to cancer immunotherapy.
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Affiliation(s)
- Yi Sun
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Or-Yam Revach
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Seth Anderson
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Clara H Wolfe
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Anne Jenney
- Laboratory of Systems Pharmacology, Harvard Program in Therapeutic Sciences, Harvard Medical School, Boston, MA, USA
| | - Caitlin E Mills
- Laboratory of Systems Pharmacology, Harvard Program in Therapeutic Sciences, Harvard Medical School, Boston, MA, USA
| | | | | | - Sarah Kim
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Amina Fu
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Xiang Ma
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jia Gwee
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Payal Tiwari
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Peter P Du
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Princy Sindurakar
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jun Tian
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Arnav Mehta
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Alexis M Schneider
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Keren Yizhak
- Department of Cell Biology and Cancer Science, Rappaport Faculty of Medicine, Institute of Technology, Technion, Haifa, Israel
| | - Moshe Sade-Feldman
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Thomas LaSalle
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tatyana Sharova
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Hongyan Xie
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shuming Liu
- Laboratory of Systems Pharmacology, Harvard Program in Therapeutic Sciences, Harvard Medical School, Boston, MA, USA
| | - William A Michaud
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Rodrigo Saad-Beretta
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kathleen B Yates
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Johan K E Spetz
- Laboratory of Systems Pharmacology, Harvard Program in Therapeutic Sciences, Harvard Medical School, Boston, MA, USA
- Molecular and Integrative Physiological Sciences Program, Harvard School of Public Health, Boston, MA, USA
- John B. Little Center for Radiation Sciences, Harvard School of Public Health, Boston, MA, USA
| | - Xingping Qin
- Laboratory of Systems Pharmacology, Harvard Program in Therapeutic Sciences, Harvard Medical School, Boston, MA, USA
- Molecular and Integrative Physiological Sciences Program, Harvard School of Public Health, Boston, MA, USA
- John B. Little Center for Radiation Sciences, Harvard School of Public Health, Boston, MA, USA
| | - Kristopher A Sarosiek
- Laboratory of Systems Pharmacology, Harvard Program in Therapeutic Sciences, Harvard Medical School, Boston, MA, USA
- Molecular and Integrative Physiological Sciences Program, Harvard School of Public Health, Boston, MA, USA
- John B. Little Center for Radiation Sciences, Harvard School of Public Health, Boston, MA, USA
| | - Gao Zhang
- Molecular and Cellular Oncogenesis Program, The Wistar Institute, Philadelphia, PA, USA
- Preston Robert Tisch Brain Tumor Center, Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
- Preston Robert Tisch Brain Tumor Center, Department of Pathology, Duke University School of Medicine, Durham, NC, USA
| | - Jong Wook Kim
- Moores Cancer Center, UC San Diego, La Jolla, CA, USA
- Center for Novel Therapeutics, UC San Diego, La Jolla, CA, USA
- Department of Medicine, UC San Diego, La Jolla, CA, USA
| | - Mack Y Su
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Angelina M Cicerchia
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Martin Q Rasmussen
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Samuel J Klempner
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Dejan Juric
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sara I Pai
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
| | - David M Miller
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Anita Giobbie-Hurder
- Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jonathan H Chen
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Karin Pelka
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Dennie T Frederick
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Elena Ivanova
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Amir R Aref
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA, USA
- Xsphera Biosciences, Boston, MA, USA
| | - Cloud P Paweletz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - David A Barbie
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Debattama R Sen
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David E Fisher
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ryan B Corcoran
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nir Hacohen
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Peter K Sorger
- Laboratory of Systems Pharmacology, Harvard Program in Therapeutic Sciences, Harvard Medical School, Boston, MA, USA
| | - Keith T Flaherty
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Genevieve M Boland
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Robert T Manguso
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Russell W Jenkins
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Laboratory of Systems Pharmacology, Harvard Program in Therapeutic Sciences, Harvard Medical School, Boston, MA, USA.
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2
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Pathoulas JT, Flanagan KE, Su MY, Elmariah SB, Zhan Y, Walker CJ, Burns LJ, Manatis-Lornell A, Penzi L, Miller DD, Hordinsky MK, Senna MM. A Prospective Pilot Study of NB-UVB Treatment in Lichen Planopilaris. J Am Acad Dermatol 2022; 87:703-705. [DOI: 10.1016/j.jaad.2022.04.054] [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: 12/15/2021] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
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3
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Lo JA, Kawakubo M, Juneja VR, Su MY, Erlich TH, LaFleur MW, Kemeny LV, Rashid M, Malehmir M, Rabi SA, Raghavan R, Allouche J, Kasumova G, Frederick DT, Pauken KE, Weng QY, Pereira da Silva M, Xu Y, van der Sande AAJ, Silkworth W, Roider E, Browne EP, Lieb DJ, Wang B, Garraway LA, Wu CJ, Flaherty KT, Brinckerhoff CE, Mullins DW, Adams DJ, Hacohen N, Hoang MP, Boland GM, Freeman GJ, Sharpe AH, Manstein D, Fisher DE. Epitope spreading toward wild-type melanocyte-lineage antigens rescues suboptimal immune checkpoint blockade responses. Sci Transl Med 2021; 13:13/581/eabd8636. [PMID: 33597266 DOI: 10.1126/scitranslmed.abd8636] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/13/2021] [Indexed: 12/13/2022]
Abstract
Although immune checkpoint inhibitors (ICIs), such as anti-programmed cell death protein-1 (PD-1), can deliver durable antitumor effects, most patients with cancer fail to respond. Recent studies suggest that ICI efficacy correlates with a higher load of tumor-specific neoantigens and development of vitiligo in patients with melanoma. Here, we report that patients with low melanoma neoantigen burdens who responded to ICI had tumors with higher expression of pigmentation-related genes. Moreover, expansion of peripheral blood CD8+ T cell populations specific for melanocyte antigens was observed only in patients who responded to anti-PD-1 therapy, suggesting that ICI can promote breakdown of tolerance toward tumor-lineage self-antigens. In a mouse model of poorly immunogenic melanomas, spreading of epitope recognition toward wild-type melanocyte antigens was associated with markedly improved anti-PD-1 efficacy in two independent approaches: introduction of neoantigens by ultraviolet (UV) B radiation mutagenesis or the therapeutic combination of ablative fractional photothermolysis plus imiquimod. Complete responses against UV mutation-bearing tumors after anti-PD-1 resulted in protection from subsequent engraftment of melanomas lacking any shared neoantigens, as well as pancreatic adenocarcinomas forcibly overexpressing melanocyte-lineage antigens. Our data demonstrate that somatic mutations are sufficient to provoke strong antitumor responses after checkpoint blockade, but long-term responses are not restricted to these putative neoantigens. Epitope spreading toward T cell recognition of wild-type tumor-lineage self-antigens represents a common pathway for successful response to ICI, which can be evoked in neoantigen-deficient tumors by combination therapy with ablative fractional photothermolysis and imiquimod.
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Affiliation(s)
- Jennifer A Lo
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.,Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA
| | - Masayoshi Kawakubo
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Vikram R Juneja
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, MA 02115, USA.,Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Mack Y Su
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.,Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA
| | - Tal H Erlich
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.,Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA
| | - Martin W LaFleur
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, MA 02115, USA.,Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA.,Division of Medical Sciences, Harvard Medical School, Boston, MA 02115, USA
| | - Lajos V Kemeny
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.,Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA
| | - Mamunur Rashid
- Experimental Cancer Genetics, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1HH, UK
| | - Mohsen Malehmir
- Division of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - S Alireza Rabi
- Division of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Rumya Raghavan
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Harvard-MIT Health Sciences and Technology Program, Cambridge, MA 02139, USA
| | - Jennifer Allouche
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.,Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA
| | - Gyulnara Kasumova
- Division of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Dennie T Frederick
- Division of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Kristen E Pauken
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, MA 02115, USA.,Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Qing Yu Weng
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.,Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA
| | - Marcelo Pereira da Silva
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Yu Xu
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Anita A J van der Sande
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.,Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA
| | - Whitney Silkworth
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.,Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA
| | - Elisabeth Roider
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.,Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA.,Department of Dermatology and Allergology, University of Szeged, Szeged 6727, Hungary.,Department of Dermatology, Venerology, and Allergology, Kantonsspital St. Gallen, St. Gallen 9000, Switzerland.,University of Zurich, Zurich 8006, Switzerland
| | - Edward P Browne
- Department of Medicine, UNC-Chapel Hill, Chapel Hill, NC 27599, USA
| | - David J Lieb
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Belinda Wang
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Levi A Garraway
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Catherine J Wu
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Keith T Flaherty
- Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA
| | - Constance E Brinckerhoff
- Departments of Medicine and Biochemistry, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - David W Mullins
- Departments of Medical Education and Microbiology/Immunology, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - David J Adams
- Experimental Cancer Genetics, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1HH, UK
| | - Nir Hacohen
- Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA.,Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Mai P Hoang
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Genevieve M Boland
- Division of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
| | - Gordon J Freeman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA. .,Harvard Medical School, Boston, MA 02115, USA
| | - Arlene H Sharpe
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, MA 02115, USA. .,Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA.,Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Dieter Manstein
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
| | - David E Fisher
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. .,Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA
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4
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Kemény LV, Robinson KC, Hermann AL, Walker DM, Regan S, Yew YW, Lai YC, Theodosakis N, Rivera PD, Ding W, Yang L, Beyer T, Loh YHE, Lo JA, van der Sande AAJ, Sarnie W, Kotler D, Hsiao JJ, Su MY, Kato S, Kotler J, Bilbo SD, Chopra V, Salomon MP, Shen S, Hoon DSB, Asgari MM, Wakeman SE, Nestler EJ, Fisher DE. Vitamin D deficiency exacerbates UV/endorphin and opioid addiction. Sci Adv 2021; 7:7/24/eabe4577. [PMID: 34117054 PMCID: PMC8195487 DOI: 10.1126/sciadv.abe4577] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 04/26/2021] [Indexed: 06/12/2023]
Abstract
The current opioid epidemic warrants a better understanding of genetic and environmental factors that contribute to opioid addiction. Here we report an increased prevalence of vitamin D (VitD) deficiency in patients diagnosed with opioid use disorder and an inverse and dose-dependent association of VitD levels with self-reported opioid use. We used multiple pharmacologic approaches and genetic mouse models and found that deficiencies in VitD signaling amplify exogenous opioid responses that are normalized upon restoration of VitD signaling. Similarly, physiologic endogenous opioid analgesia and reward responses triggered by ultraviolet (UV) radiation are repressed by VitD signaling, suggesting that a feedback loop exists whereby VitD deficiency produces increased UV/endorphin-seeking behavior until VitD levels are restored by cutaneous VitD synthesis. This feedback may carry the evolutionary advantage of maximizing VitD synthesis. However, unlike UV exposure, exogenous opioid use is not followed by VitD synthesis (and its opioid suppressive effects), contributing to maladaptive addictive behavior.
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Affiliation(s)
- Lajos V Kemény
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kathleen C Robinson
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrea L Hermann
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Deena M Walker
- Nash Family Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Susan Regan
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Yi Chun Lai
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Nicholas Theodosakis
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Phillip D Rivera
- Program in Neuroscience, Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Lurie Center for Autism, Massachusetts General Hospital for Children, Boston, MA, USA
- Department of Biology, Hope College, Holland, MI, USA
| | - Weihua Ding
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Liuyue Yang
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tobias Beyer
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yong-Hwee E Loh
- Nash Family Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- USC Libraries Bioinformatics Services, University of Southern California, Los Angeles, CA, USA
| | - Jennifer A Lo
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anita A J van der Sande
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - William Sarnie
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David Kotler
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jennifer J Hsiao
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mack Y Su
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shinichiro Kato
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph Kotler
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Staci D Bilbo
- Program in Neuroscience, Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Lurie Center for Autism, Massachusetts General Hospital for Children, Boston, MA, USA
| | - Vanita Chopra
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, USA
| | - Matthew P Salomon
- Department of Translational Molecular Medicine, Division of Molecular Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Shiqian Shen
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Dave S B Hoon
- Department of Translational Molecular Medicine, Division of Molecular Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Maryam M Asgari
- Department of Dermatology, Massachusetts General Hospital and Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | - Sarah E Wakeman
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric J Nestler
- Nash Family Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David E Fisher
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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5
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Robinson KC, Kemény LV, Fell GL, Hermann AL, Allouche J, Ding W, Yekkirala A, Hsiao JJ, Su MY, Theodosakis N, Kozak G, Takeuchi Y, Shen S, Berenyi A, Mao J, Woolf CJ, Fisher DE. Reduced MC4R signaling alters nociceptive thresholds associated with red hair. Sci Adv 2021; 7:eabd1310. [PMID: 33811065 PMCID: PMC11057701 DOI: 10.1126/sciadv.abd1310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 02/16/2021] [Indexed: 06/12/2023]
Abstract
Humans and mice with natural red hair have elevated basal pain thresholds and an increased sensitivity to opioid analgesics. We investigated the mechanisms responsible for higher nociceptive thresholds in red-haired mice resulting from a loss of melanocortin 1 receptor (MC1R) function and found that the increased thresholds are melanocyte dependent but melanin independent. MC1R loss of function decreases melanocytic proopiomelanocortin transcription and systemic melanocyte-stimulating hormone (MSH) levels in the plasma of red-haired (Mc1re/e ) mice. Decreased peripheral α-MSH derepresses the central opioid tone mediated by the opioid receptor OPRM1, resulting in increased nociceptive thresholds. We identified MC4R as the MSH-responsive receptor that opposes OPRM1 signaling and the periaqueductal gray area in the brainstem as a central area of opioid/melanocortin antagonism. This work highlights the physiologic role of melanocytic MC1R and circulating melanocortins in the regulation of nociception and provides a mechanistic framework for altered opioid signaling and pain sensitivity in red-haired individuals.
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Affiliation(s)
- Kathleen C Robinson
- Cutaneous Biology Research Center, Department of Dermatology and MGH Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Lajos V Kemény
- Cutaneous Biology Research Center, Department of Dermatology and MGH Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Gillian L Fell
- Cutaneous Biology Research Center, Department of Dermatology and MGH Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Andrea L Hermann
- Cutaneous Biology Research Center, Department of Dermatology and MGH Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
- Doctoral School of Clinical Medicine, University of Szeged, Szeged 6720, Hungary
| | - Jennifer Allouche
- Cutaneous Biology Research Center, Department of Dermatology and MGH Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Weihua Ding
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Ajay Yekkirala
- FM Kirby Neurobiology Center, Boston Children's Hospital, and Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
| | - Jennifer J Hsiao
- Cutaneous Biology Research Center, Department of Dermatology and MGH Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Mack Y Su
- Cutaneous Biology Research Center, Department of Dermatology and MGH Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Nicholas Theodosakis
- Cutaneous Biology Research Center, Department of Dermatology and MGH Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Gabor Kozak
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, Interdisciplinary Excellence Centre, University of Szeged, Szeged H-6720, Hungary
- University Neurology Hospital and Hertie Institute for Clinical Brain Research, Tübingen, Germany
| | - Yuichi Takeuchi
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, Interdisciplinary Excellence Centre, University of Szeged, Szeged H-6720, Hungary
- Department of Neuropharmacology, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya 467-8603, Japan
- Neurocybernetics Excellence Center, University of Szeged, 10 Dom sqr, Szeged 6720, Hungary
- Department of Physiology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan
| | - Shiqian Shen
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Antal Berenyi
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, Interdisciplinary Excellence Centre, University of Szeged, Szeged H-6720, Hungary
- Neurocybernetics Excellence Center, University of Szeged, 10 Dom sqr, Szeged 6720, Hungary
- Neuroscience Institute, New York University, New York City, NY 10016, USA
- HCEMM-USZ Magnetotherapeutics Research Group, University of Szeged, 10 Dom sqr, Szeged 6720, Hungary
| | - Jianren Mao
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Clifford J Woolf
- FM Kirby Neurobiology Center, Boston Children's Hospital, and Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
| | - David E Fisher
- Cutaneous Biology Research Center, Department of Dermatology and MGH Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA.
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6
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Das S, Su MY, Kvedar JC, Smith GP. Asynchronous telemedicine for isotretinoin management: A direct care pilot. J Am Acad Dermatol 2021; 86:184-186. [PMID: 33484765 DOI: 10.1016/j.jaad.2021.01.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Shinjita Das
- Massachusetts General Hospital, Department of Dermatology, Harvard Medical School, Boston, Massachusetts.
| | - Mack Y Su
- Massachusetts General Hospital, Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Joseph C Kvedar
- Massachusetts General Hospital, Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Gideon P Smith
- Massachusetts General Hospital, Department of Dermatology, Harvard Medical School, Boston, Massachusetts
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7
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Su MY, Smith GP, Das S. Trends in teledermatology use during clinic reopening after COVID-19 closures. J Am Acad Dermatol 2020; 84:e213-e214. [PMID: 33316330 PMCID: PMC7833605 DOI: 10.1016/j.jaad.2020.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/07/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Mack Y Su
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gideon P Smith
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shinjita Das
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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8
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Gordon WJ, Henderson D, DeSharone A, Fisher HN, Judge J, Levine DM, MacLean L, Sousa D, Su MY, Boxer R. Remote Patient Monitoring Program for Hospital Discharged COVID-19 Patients. Appl Clin Inform 2020; 11:792-801. [PMID: 33241547 DOI: 10.1055/s-0040-1721039] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE We deployed a Remote Patient Monitoring (RPM) program to monitor patients with coronavirus disease 2019 (COVID-19) upon hospital discharge. We describe the patient characteristics, program characteristics, and clinical outcomes of patients in our RPM program. METHODS We enrolled COVID-19 patients being discharged home from the hospital. Enrolled patients had an app, and were provided with a pulse oximeter and thermometer. Patients self-reported symptoms, O2 saturation, and temperature daily. Abnormal symptoms or vital signs were flagged and assessed by a pool of nurses. Descriptive statistics were used to describe patient and program characteristics. A mixed-effects logistic regression model was used to determine the odds of a combined endpoint of emergency department (ED) or hospital readmission. RESULTS A total of 295 patients were referred for RPM from five participating hospitals, and 225 patients were enrolled. A majority of enrolled patients (66%) completed the monitoring period without triggering an abnormal alert. Enrollment was associated with a decreased odds of ED or hospital readmission (adjusted odds ratio: 0.54; 95% confidence interval: 0.3-0.97; p = 0.039). Referral without enrollment was not associated with a reduced odds of ED or hospital readmission. CONCLUSION RPM for COVID-19 provides a mechanism to monitor patients in their home environment and reduce hospital utilization. Our work suggests that RPM reduces readmissions for patients with COVID-19 and provides scalable remote monitoring capabilities upon hospital discharge. RPM for postdischarge patients with COVID-19 was associated with a decreased risk of readmission to the ED or hospital, and provided a scalable mechanism to monitor patients in their home environment.
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Affiliation(s)
- William J Gordon
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States.,Harvard Medical School, Boston, Massachusetts, United States
| | - Daniel Henderson
- Harvard Medical School, Boston, Massachusetts, United States.,Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Avital DeSharone
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Herrick N Fisher
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States.,Harvard Medical School, Boston, Massachusetts, United States
| | - Jessica Judge
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - David M Levine
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States.,Harvard Medical School, Boston, Massachusetts, United States
| | - Laura MacLean
- Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Diane Sousa
- Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Mack Y Su
- Harvard Medical School, Boston, Massachusetts, United States
| | - Robert Boxer
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States.,Harvard Medical School, Boston, Massachusetts, United States
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9
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Su MY, Trefrey BL, Smith GP, Das S. Online portal-based system for improving patient-generated photographs for teledermatology. Dermatol Ther 2020; 33:e14453. [PMID: 33107093 DOI: 10.1111/dth.14453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Mack Y Su
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brie L Trefrey
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gideon P Smith
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Shinjita Das
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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10
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Su MY, Lilly E, Yu J, Das S. Asynchronous teledermatology in medical education: Lessons from the COVID-19 pandemic. J Am Acad Dermatol 2020; 83:e267-e268. [PMID: 32553635 PMCID: PMC7293835 DOI: 10.1016/j.jaad.2020.06.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/06/2020] [Accepted: 06/10/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Mack Y Su
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Evelyn Lilly
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - JiaDe Yu
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shinjita Das
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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11
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Miao F, Lei TC, Su MY, Yi WJ, Jiang S, Xu SZ. [Decolorization of skin and hair-derived melanin by three ligninolytic enzymes]. Zhonghua Yi Xue Za Zhi 2017; 97:3428-3431. [PMID: 29179286 DOI: 10.3760/cma.j.issn.0376-2491.2017.43.014] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To compare the decolorization efficiency of lignin peroxidase (LiP), manganese peroxidase (MnP) and laccase on eumelanin and pheomelanin, and to investigate the effect of topical administration of LiP solution on hyperpigmented guinea pigs skin induced by 308 nm excimer light. Methods: Pheomelanin-enriched specimens were prepared from human hair and cutaneous melanoma tissue using alkaline lysis method.Synthetic eumelanin was purchased from a commercial supplier.The same amount (0.02%) of melanin was incubated with the equal enzyme activity (0.2 U/ml) of ligninolytic enzymes for 3 h respectively.The absorbance at 475 nm (A(475)) in the enzyme-catalyzed solution was measured using ELISA microplate reader.The experimental hyperpigmentation model was established in the dorsal skin of brownish guinea pigs using 308 nm excimer light radiation.LiP and heat-inactivated LiP solution were topically applied at each site.Meanwhile, 3% hydroquinone and vehicle cream were used as control.The skin color (L value) was recorded using a CR-10 Minolta chromameter.Corneocytes were collected using adhesive taping method.The amount and distribution of melanin in the corneocytes and skin tissues was visualized by Fontana-Masson staining. Results: All three ligninolytic enzymes showed various degree of eumelanin and pheomelanin decolorization activity.The decolorization activity of LiP, MnP and laccase was 40%-70%, 22%-42% and 9%-21%, respectively.The similar lightening was shown in the skin treated with LiP solution and 3% hydroquinone.The amount of melanin granules in the corneocytes was 199±11 by LiP, which was less than that in untreated control (923±12) and heat-inactive control (989±13). The amount of melanin was decreased in the whole epidermis treated with hydroquinone, the epidermis thickness was increased as well. In contrast, melanin of LiP group was decreased only in the superficial epidermis, the epidermis thickness seemed to be normal. Conclusion: LiP exerts a potent decolorization activity for hair- or skin-derived pheomelanin as well as eumelanin.It remains to be further investigated whether LiP serves as a substitute for hydroquinone in skin lightening products.
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Affiliation(s)
- F Miao
- Department of Dermatology, Wuhan University, Renmin Hospital, Wuhan 430060, China
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12
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Abstract
In a Perspective, Mack Su and David Fisher discuss the development of immunotherapies for treatment of melanoma and other cancer types.
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Affiliation(s)
- Mack Y. Su
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - David E. Fisher
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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13
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He Z, O'Neal J, Wilson WC, Mahajan N, Luo J, Wang Y, Su MY, Lu L, Skeath JB, Bhattacharya D, Tomasson MH. Deletion of Rb1 induces both hyperproliferation and cell death in murine germinal center B cells. Exp Hematol 2015; 44:161-5.e4. [PMID: 26607597 DOI: 10.1016/j.exphem.2015.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 09/21/2015] [Accepted: 11/07/2015] [Indexed: 12/18/2022]
Abstract
The retinoblastoma gene (RB1) has been implicated as a tumor suppressor in multiple myeloma (MM), yet its role remains unclear because in the majority of cases with 13q14 deletions, un-mutated RB1 remains expressed from the retained allele. To explore the role of Rb1 in MM, we examined the functional consequences of single- and double-copy Rb1 loss in germinal center B cells, the cells of origin of MM. We generated mice without Rb1 function in germinal center B cells by crossing Rb1(Flox/Flox) with C-γ-1-Cre (Cγ1) mice expressing the Cre recombinase in class-switched B cells in a p107(-/-) background to prevent p107 from compensating for Rb1 loss (Cγ1-Rb1(F/F)-p107(-/-)). All mice developed normally, but B cells with two copies of Rb1 deleted (Cγ1-Rb1(F/F)-p107(-/-)) exhibited increased proliferation and cell death compared with Cγ1-Rb1(+/+)-p107(-/-) controls ex vivo. In vivo, Cγ1-Rb1(F/F)-p107(-/-) mice had a lower percentage of splenic B220+ cells and reduced numbers of bone marrow antigen-specific secreting cells compared with control mice. Our data indicate that Rb1 loss induces both cell proliferation and death in germinal center B cells. Because no B-cell malignancies developed after 1 year of observation, our data also suggest that Rb1 loss is not sufficient to transform post-germinal center B cells and that additional, specific mutations are likely required to cooperate with Rb1 loss to induce malignant transformation.
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Affiliation(s)
- Zhiwen He
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Julie O'Neal
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - William C Wilson
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Nitin Mahajan
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Jun Luo
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Yinan Wang
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Mack Y Su
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Lan Lu
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - James B Skeath
- Department of Genetics, Washington University School of Medicine, St. Louis, MO
| | - Deepta Bhattacharya
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Michael H Tomasson
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO.
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14
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Chen JH, Chen WP, Chan S, Yeh DC, Su MY, McLaren CE. Correlation of endogenous hormonal levels, fibroglandular tissue volume and percent density measured using 3D MRI during one menstrual cycle. Ann Oncol 2013; 24:2329-35. [PMID: 23661294 DOI: 10.1093/annonc/mdt158] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 11/14/2022] Open
Abstract
BACKGROUND We measured breast density (BD) on MRI and correlated with endogenous hormonal levels. PATIENTS AND METHODS Twenty-four premenopausal women received four weekly breast MRI. A blood sample was collected on the same day of MRI. BD was measured using a computer-based algorithm. The generalized estimation equation method was applied to model mean fibroglandular tissue volume (FV) and mean percent density (PD) from predictor variables including estradiol, progesterone, and week during a cycle. RESULTS In week 3, a borderline significant correlation between estradiol and PD (r = 0.43, P = 0.04), estradiol and FV (r = 0.40, P = 0.05) and between progesterone and FV (r = 0.42, P = 0.04) was noted. The FV and PD measured in weeks 4 and 1 were higher than in weeks 2 and 3, adjusted for variation in endogenous estradiol and progesterone, indicating that the hormone change could not account for the changes in density. No lag effect of endogenous hormone on the change of FV or PD was noted (all P-values > 0.05). CONCLUSIONS Our results showed that BD is not strongly associated with the endogenous hormone. Their association with breast cancer risk was likely coming from different mechanisms, and they should be considered as independent risk factors.
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Affiliation(s)
- J H Chen
- Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California Irvine, Irvine, USA.
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15
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Su MY, Steiner LA, Bogardus H, Mishra T, Schulz VP, Hardison RC, Gallagher PG. Identification of biologically relevant enhancers in human erythroid cells. J Biol Chem 2013; 288:8433-8444. [PMID: 23341446 DOI: 10.1074/jbc.m112.413260] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Identification of cell type-specific enhancers is important for understanding the regulation of programs controlling cellular development and differentiation. Enhancers are typically marked by the co-transcriptional activator protein p300 or by groups of cell-expressed transcription factors. We hypothesized that a unique set of enhancers regulates gene expression in human erythroid cells, a highly specialized cell type evolved to provide adequate amounts of oxygen throughout the body. Using chromatin immunoprecipitation followed by massively parallel sequencing, genome-wide maps of candidate enhancers were constructed for p300 and four transcription factors, GATA1, NF-E2, KLF1, and SCL, using primary human erythroid cells. These data were combined with gene expression analyses, and candidate enhancers were identified. Consistent with their predicted function as candidate enhancers, there was statistically significant enrichment of p300 and combinations of co-localizing erythroid transcription factors within 1-50 kb of the transcriptional start site (TSS) of genes highly expressed in erythroid cells. Candidate enhancers were also enriched near genes with known erythroid cell function or phenotype. Candidate enhancers exhibited moderate conservation with mouse and minimal conservation with nonplacental vertebrates. Candidate enhancers were mapped to a set of erythroid-associated, biologically relevant, SNPs from the genome-wide association studies (GWAS) catalogue of NHGRI, National Institutes of Health. Fourteen candidate enhancers, representing 10 genetic loci, mapped to sites associated with biologically relevant erythroid traits. Fragments from these loci directed statistically significant expression in reporter gene assays. Identification of enhancers in human erythroid cells will allow a better understanding of erythroid cell development, differentiation, structure, and function and provide insights into inherited and acquired hematologic disease.
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Affiliation(s)
- Mack Y Su
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520
| | - Laurie A Steiner
- Department of Pediatrics, University of Rochester, Rochester, New York 14642
| | - Hannah Bogardus
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520
| | - Tejaswini Mishra
- Department of Biochemistry and Molecular Biology, Center for Comparative Genomics and Bioinformatics, Pennsylvania State University, University Park, Pennsylvania 16802
| | - Vincent P Schulz
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520
| | - Ross C Hardison
- Department of Biochemistry and Molecular Biology, Center for Comparative Genomics and Bioinformatics, Pennsylvania State University, University Park, Pennsylvania 16802
| | - Patrick G Gallagher
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520; Departments of Pathology and Genetics, Yale University School of Medicine, New Haven, Connecticut 06520.
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16
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Chu L, Su MY, Maggi LB, Lu L, Mullins C, Crosby S, Huang G, Chng WJ, Vij R, Tomasson MH. Multiple myeloma-associated chromosomal translocation activates orphan snoRNA ACA11 to suppress oxidative stress. J Clin Invest 2012; 122:2793-806. [PMID: 22751105 DOI: 10.1172/jci63051] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 05/02/2012] [Indexed: 12/20/2022] Open
Abstract
The histone methyltransferase WHSC1 (also known as MMSET) is overexpressed in multiple myeloma (MM) as a result of the t(4;14) chromosomal translocation and in a broad variety of other cancers by unclear mechanisms. Overexpression of WHSC1 did not transform wild-type or tumor-prone primary hematopoietic cells. We found that ACA11, an orphan box H/ACA class small nucleolar RNA (snoRNA) encoded within an intron of WHSC1, was highly expressed in t(4;14)-positive MM and other cancers. ACA11 localized to nucleoli and bound what we believe to be a novel small nuclear ribonucleoprotein (snRNP) complex composed of several proteins involved in postsplicing intron complexes. RNA targets of this uncharacterized snRNP included snoRNA intermediates hosted within ribosomal protein (RP) genes, and an RP gene signature was strongly associated with t(4;14) in patients with MM. Expression of ACA11 was sufficient to downregulate RP genes and other snoRNAs implicated in the control of oxidative stress. ACA11 suppressed oxidative stress, afforded resistance to chemotherapy, and increased the proliferation of MM cells, demonstrating that ACA11 is a critical target of the t(4;14) translocation in MM and suggesting an oncogenic role in other cancers as well.
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Affiliation(s)
- Liang Chu
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA
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17
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Su MY. A Programmable Implantable Microstimulator SoC With Wireless Telemetry: Application in Closed-Loop Endocardial Stimulation for Cardiac Pacemaker. IEEE Trans Biomed Circuits Syst 2011; 5:511-522. [PMID: 23852549 DOI: 10.1109/tbcas.2011.2177661] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A low-power, wireless, and implantable microstimulator system on chip with smart powering management, immediate neural signal acquisition, and wireless rechargeable system is proposed. A system controller with parity checking handles the adjustable stimulus parameters for the stimulated objective. In the current paper, the rat's intra-cardiac electrogram is employed as the stimulated model in the animal study, and it is sensed by a low-voltage and low-power monitoring analog front end. The power management unit, which includes a rectifier, battery charging and detection, and a regulator, is used for the power control of the internal circuits. The stimulation data and required clock are extracted by a phase-locked-loop-based phase shift keying demodulator from an inductive AC signal. The full chip, which consumes 48 μW only, is fabricated in a TSMC 0.35 μm 2P4M standard CMOS process to perform the monitoring and pacing functions with inductively powered communication in the in vivo study.
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18
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Chen JH, Nalcioglu O, Su MY. MR imaging features of invasive breast cancer correlated with hormonal receptors: does progesterone receptor matter? Ann Oncol 2008; 19:1024-6. [PMID: 18375524 DOI: 10.1093/annonc/mdn120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
MESH Headings
- Adult
- Breast Neoplasms/chemistry
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/chemistry
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Lobular/chemistry
- Carcinoma, Lobular/pathology
- Female
- Humans
- Magnetic Resonance Imaging
- Neoplasm Invasiveness
- Neoplasm Proteins/analysis
- Neoplasms, Hormone-Dependent/chemistry
- Neoplasms, Hormone-Dependent/pathology
- Progesterone
- Receptors, Estrogen/analysis
- Receptors, Progesterone/analysis
- Retrospective Studies
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Chung HJ, Yu MC, Lien JM, Jeng LB, Su MY. Hemosuccus pancreaticus from a traumatic gastroduodenal pseudoaneurysm: an unusual cause of upper gastrointestinal bleeding. Chang Gung Med J 2001; 24:741-5. [PMID: 11820656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Hemosuccus pancreaticus, blood entering the gastrointestinal tract through the pancreatic duct, is a rare and elusive form of gastrointestinal bleeding with diagnostic difficulties. We report a 37-year-old man who had recurrent gastrointestinal bleeding from erosion of a pseudoaneurysm of the gastroduodenal artery into the pancreatic duct. The lack of history of pancreatitis, associated symptoms, equivocal endoscopic findings, and the rarity of this entity resulted in a delay in diagnosis. Pancreatic duct stenosis detected during surgery suggested the lesion might have been caused by blunt abdominal trauma. A nearly total pancreatectomy and splenectomy were performed. The patient remained symptom-free 8 months after the operation. This obscure cause of gastrointestinal bleeding should be considered when common causes of bleeding have been ruled out, even in the absence of pancreatitis.
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Affiliation(s)
- H J Chung
- Department of Hepato-Gastroenterology, Chang Gung Memorial Hospital, Taipei, ROC
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Wang Z, Su MY, Najafi A, Nalcioglu O. Effect of vasodilator hydralazine on tumor microvascular random flow and blood volume as measured by intravoxel incoherent motion (IVIM) weighted MRI in conjunction with Gd-DTPA-Albumin enhanced MRI. Magn Reson Imaging 2001; 19:1063-72. [PMID: 11711230 DOI: 10.1016/s0730-725x(01)00431-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [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: 12/27/2022]
Abstract
We studied the effect of hydralazine on tumor blood volume fraction and microvascular random flow velocity magnitude by IVIM weighted MRI in conjunction with dynamic Gd-DTPA-Albumin enhanced MRI. Blood volume fraction maps were obtained from the dynamic Gd-DTPA-Albumin enhanced MRI measurements. The average blood volume fraction of R3230 AC adenocarcinoma decreased from 0.125 +/- 0.022 (s.d.) ml/g to 0.105 +/- 0.018 (s.d.) ml/g (p < 0.001) after the administration of hydralazine at a dose of 5 mg/kg. The microvascular random flow velocity magnitude maps were obtained from the IVIM weighted MRI signals by utilizing the Gd-DTPA-Albumin measured blood volume fractions as an input in the compartmental modeling analysis of the IVIM weighted MRI signal. The random-directional microvascular flow induced MRI signal attenuation was separated from the molecular diffusion induced signal attenuation. Flow induced attenuation was more significant after the administration of hydralazine. The mean microvascular random flow velocity magnitude increased from 0.52 +/- 0.15 (s.d.) mm/sec to 0.73 +/- 0.23 (s.d.) mm/sec (p < 0.05) in the presence of the above blood volume fraction change.
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Affiliation(s)
- Z Wang
- Center for Functional Onco-Imaging, College of Medicine, University of California, Irvine, CA 92697-5020, USA
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21
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Abstract
OBJECTIVE Because the medical management of persons with adenomatous colorectal polyps differs from that of those with hyperplastic polyps, accuracy of diagnosis is essential. This study reports our experience using a magnifying colonoscope combined with indigocarmine dye to diagnose colorectal polyps, emphasizing its ability to differentiate neoplastic from nonneoplastic lesions. METHODS The materials consisted of 175 polyps. A 0.2% indigocarmine solution was sprayed, and the colonoscope zoom apparatus performed a magnified observation after an ordinary colonoscopy identified the lesions. The pit patterns were classified into six categories: I, II, III(L), IIIs, IV, and V according to Kudo's modified classification. RESULTS The percentages of neoplastic changes in the lesions with pit pattern I, II, III(L), IIIs, IV, and V were 0, 12.2, 69.7, 80, 84.4, and 100%, respectively. The diagnostic sensitivity of neoplastic lesions was 93.8% and specificity was 64.6% when types I and II represented the pit pattern of nonneoplastic lesions and types III(L), IIIs, IV, and V represented neoplastic lesions. The overall diagnostic accuracy in differentiating neoplastic from nonneoplastic lesions was 80.1%. The diagnostic accuracy is not influenced by the size and shape of the lesions. The six neoplastic lesions that were misjudged to be nonneoplastic were histologically adenoma with only mild atypia. CONCLUSIONS The pit pattern analysis of colorectal lesions by magnifying colonoscopy is a useful and objective tool for differentiating neoplastic from nonneoplastic lesions of the large bowel. In its current state of development, however, this technique is not a substitute for histology.
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Affiliation(s)
- S Y Tung
- Department of Gastroenterology, Chang Gung Memorial Hospital, Taipei, Taiwan
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22
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Abstract
To analyze the efficacy and outcome of colonoscopic resection for colorectal neoplastic lesions, we retrospectively reviewed 338 colorectal lesions from 232 patients regarding the clinical profiles, colonoscopic findings, histological findings, complications, and outcome. Morphologically, these lesions were classified into three categories: pedunculated (n = 140), sessile (n = 176); and flat (n = 22). Histological findings of lesions included adenoma (n = 248), carcinoma in situ (n = 17), submucosal carcinoma (n = 2), hyperplastic polyp (n = 57), and inflammatory polyp (n = 14). Neoplastic lesions are generally larger than nonneoplastic lesions (chi2 test, P < 0.05). The incidence of carcinoma was 5.6% of 338 resected lesions. The rate of cancer or high-grade dysplasia in flat polyps was greater than in pedunculated and sessile polyps (13.6 vs 4.54 vs 5.71%; P < 0.05). There were no perforations or deaths after colonoscopic treatment, and only mild bleeding occured in two patients. To date, 19 patients with early colorectal cancer were treated successfully by endoscopy with no recurrence or metastasis. To reduce the incidence and mortality of colorectal cancer, colonoscopic resection is a simple and safe procedure for removing neoplastic lesions. Detailed histological examinations are essential to decide the indications of surgery.
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Affiliation(s)
- S Y Tung
- Department of Gastroenterology, Chang Gung Memorial Hospital, Taipei, Taiwan
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Su MY, Lien JM, Lee CS, Lin DY, Tsai MH. Acute jejunogastric intussusception: report of five cases. Chang Gung Med J 2001; 24:50-6. [PMID: 11299977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The purpose of this study was to investigate the clinical manifestations and diagnosis of patients with acute jejunogastric intussusception. From May 1986 to June 1999, a total of 5 men (54-76 years old) were collected. Their initial presentations included epigastralgia (4), coffee-ground vomitus (3), frank hematemesis (1), and tarry stool (1). All patients had gastric surgeries 10-30 years previously. Radiograph of the abdomen showed a soft tissue density at the left upper quadrant in one patient. Panendoscopies were done in 4 patients. An obstructed efferent loop with a distended hyperemic small bowel protruding into the remnant of stomach was found in 3 cases, gangrenous change of the bowel wall in one of them. Stump cancer was diagnosed initially in the other patient. Barium study (3/5) showed efferent loop obstruction with "coil spring sing" and a central defect in the stomach. All 5 patients underwent segmental resection and end-to-end anastomosis between the 2nd to 6th hospital day. Operative findings were type II jejunogastric intussusception with retrograde invagination of a segment of efferent loop (30-100 cm in length) into the stomach. In conclusion, acute jejunogastric intussusception is an emergent condition. Early and accurate diagnosis is important. A high susception must be kept in mind in patients having a history of gastrojejunostomy with severe abdominal pain or upper gastrointestinal bleeding.
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Affiliation(s)
- M Y Su
- Department of Hepatogastroenterology, Chang Gung Memorial Hospital, 5 Fu-Shin Street, Kweishan, Taoyuan, Taiwan, R.O.C
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Hsu SY, Chang CH, Su MY, Wang HZ, Tsai RK. Correlation between clinical activity score and thyroid autoantibodies in patients with thyroid ophthalmopathy. Kaohsiung J Med Sci 2000; 16:533-8. [PMID: 11272800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
To investigate the relation between clinical activity score (CAS) and thyroid autoantibodies of thyroid ophthalmopathy, we measured the level of TSH receptor antibody (TRAb), antithyroglobulin antibody (ATA), and antimicrosomal antibody (AMA) in 41 patients with thyroid ophthalmopathy. The results of thyroid autoantibodies level were compared with CAS. Under the multiple regression and correlation analysis among CAS and the levels of TRAb, ATA, and AMA, no correlation was shown in this study. In conclusion, there is no correlation of thyroid ophthalmopathy among CAS and the levels of TRAb, ATA, and AMA in our study. If we use these three kinds of thyroid autoantibodies to match the activity of thyroid ophthalmopathy, it seems to be inappropriate. Further search of other simplified index to reflect the activity of ophthalmopathy should be encouraged.
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Affiliation(s)
- S Y Hsu
- Department of Ophthalmology, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Rd., Kaohsiung, Taiwan
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25
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Su MY, Taylor JA, Villarreal LP, Nalcioglu O. Prediction of gene therapy-induced tumor size changes by the vascularity changes measured using dynamic contrast-enhanced MRI. Magn Reson Imaging 2000; 18:311-7. [PMID: 10745141 DOI: 10.1016/s0730-725x(00)00119-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We studied the changes of tumor size after gene therapy treatment and its relationship with the changes of vascular volume as measured by dynamic contrast-enhanced magnetic resonance imaging (MRI), to investigate whether the vascular changes is predictive of tumor regression. The study was carried out using a spontaneously regressing rat tumor model (C6 Glioma grown subcutaneously in rats). Three rats were treated with recombinant adenoviruses expressing three genes, mouse interleukin 1-alpha (IL1-alpha), mouse interferon gamma (IFN-gamma), and human transforming growth factor beta (TGF-beta), one from each kind. Two rats were treated with saline as controls. Longitudinal studies were performed to monitor the changes of tumor volume (based on T(2)-weighted images) and the vascular volume (based on dynamic contrast enhanced images). In untreated animals, tumor regression was preceded by several days with a decrease in vascular volume. When the tumor growth was perturbed by expression of mouse IL-1alpha, the increase in vascular volume was correlated with the continuing growth in size, and the decrease in vascular volume was predictive of the onset of tumor regression. As new advances in immunotherapy in cancer treatment emerge, the ability to determine the efficacy of therapy as early as possible will enable optimization of treatment regiments. The vascularity changes measured by dynamic MRI may provide a means to serve for this purpose.
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Affiliation(s)
- M Y Su
- Health Sciences Research Imaging Center, Irvine Hall 164, University of California, Irvine, CA 92697, USA
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26
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Chang CH, Lai YH, Wang HZ, Su MY, Chang CW, Peng CF. Antibiotic treatment of orbital cellulitis: an analysis of pathogenic bacteria and bacterial susceptibility. J Ocul Pharmacol Ther 2000; 16:75-9. [PMID: 10673134 DOI: 10.1089/jop.2000.16.75] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The proper choice of effective antibiotics is a mainstay for the treatment of orbital cellulitis. The lack of native data regarding the microorganism causing the infection and its antibiotic sensitivity prompted us to conduct this study. We retrospectively collected 29 cases of orbital cellulitis admitted to Chung-Ho Memorial Hospital of Kaohsiung Medical College from January 1994 to September 1998. The effectiveness of antibiotics with bacterial susceptibility was analyzed. Of the 29 cases, fifteen were male and fourteen female. The patients ranged in age from 7 months to 79 years (mean, 37.6 years). Sinusitis (9 cases, 31.0%) is the most common etiology. Fourteen cases received both medical and surgical treatments. Eighteen cases had purulent discharge from the infection areas sent for culture isolation of the microorganism. The culture positive rate was 50% (9 in 18 cases). The Staphylococcus aureus (5 cases) was the most common pathogen. The bacterial susceptibility test showed drug resistance of 100% for penicillin G (seven out of seven cases; 7/7), 100% for ampicillin (10/10), and 0% for amikacin (0/3) and vancomycin (0/7). Penicillin and ampicillin are not effective for those isolated bacteria. Oxacillin and gentamicin, frequently used in first line treatment, might encounter drug resistance in some cases. Amikacin and vancomycin, without any resistance in bacterial susceptibility tests, could be used in vision-threatening, critical, and intractable cases.
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Affiliation(s)
- C H Chang
- Department of Ophthalmology, Kaohsiung Medical College, Taiwan, Republic of China.
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27
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Kang MC, Chang CH, Su MY, Lin SF, Yang CY, Tsai KB. Kimura's disease of bilateral upper eyelids: a case report. Kaohsiung J Med Sci 1999; 15:239-43. [PMID: 10330804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
We present a rare case of Kimura's disease of bilateral upper eyelids. A 41-year-old Chinese male had multiple masses over retroauricular, submandibular regions and bilateral upper eyelids since 13 years previously. Tumor recurred after each surgical excision, chemotherapy and Co 60 radiotherapy. Eosinophilia and elevation of blood immunoglobulin E (IgE) were noted in this admission. We operated on left upper eyelid to relieve the blocking of vision. A diffuse infiltration with numerous fibrotic bands was noted. Histological section showed a lymphoid hyperplasia, remarkable infiltration of eosinophils and proliferation of capillaries. Oral prednisolone 60 mg was given postoperatively. The patient had a satisfactory appearance and a relief of visual block.
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Affiliation(s)
- M C Kang
- Department of Ophthalmology, Kaohsiung Medical College, Taiwan, Republic of China
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28
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Su CY, Lin CP, Wang HZ, Su MY, Tsai RK, Wu KY, Sheu MM. Intraocular use of fluconazole in the management of ocular fungal infection. Kaohsiung J Med Sci 1999; 15:218-25. [PMID: 10330801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
In this study, we investigate the efficacy and safety of intraocular use of fluconazole in the treatment of ocular fungal infection. Ten patients with intraocular fungal infections were examined. Among these patients, eight were infected with keratomycosis with intraocular spreading, one had postoperative fungal endophthalmitis after cataract operation with an intraocular lens implant, and another suffered from endogenous fungal endophthalmitis. In addition to the conventional local application with or without systemic administration of antifungal drugs, all ten patients were treated with intraocular administration of 5-10 micrograms/ml of fluconazole. The ocular fungal infections resolved in nine patients without obvious side effect. One failed in the antifungal treatment with loss of vision. In our experience, the results revealed that fluconazole is a safe and effective antifungal agent that can be administered intraocularly. We suggest that intraocular administration of this drug could be considered as an alternative or additional choice for the treatment of severe ocular fungal infections.
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Affiliation(s)
- C Y Su
- Department of Ophthalmology, Kaohsiung Medical College, Taiwan, Republic of China
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29
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Su MY, Lin DY, Sheen IS, Chu CM, Chiu CT, Liaw YF. Indocyanine green clearance test in non-cirrhotic hepatitis patients: a comparison and analysis between conventional blood sampling method and Finger Piece Monitoring method. Changgeng Yi Xue Za Zhi 1999; 22:17-23. [PMID: 10418205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND The indocyanine green (ICG) Finger Piece Monitor system is a non-invasive method for measuring blood ICG concentrations for the evaluation of hepatic function. This study was conducted to determine its clinical usefulness in non-cirrhotic patients. METHODS Traditional liver function tests, alpha-fetoprotein, prothrombin time, and ICG clearance tests, by both blood sampling method and Finger Piece Monitoring method were performed simultaneously on 56 non-cirrhotic hepatitis patients. The plasma clearance rate (K) and 15-minute retention ratio (R15) of ICG were analyzed and compared with traditional liver function test results. RESULTS The clearance rate using the Finger Piece Monitoring method was slightly lower than that of the blood sampling method (9.16 +/- 5.00%/min vs. 11.24 +/- 3.56%/min) with good correlation (r = 0.721, p = 0.0003). The 15-minute retention ratio using the Finger Piece Monitoring method showed better correlation with blood sampling method (32.83 +/- 23.99% vs. 28.49 +/- 23.74%, r = 0.944, p = 0.0002). Analysis between traditional laboratory tests and fR15 revealed a higher fR15 value in patients with bilirubin-total-T > or = 3 mg/dl (49.71 +/- 26.22% vs. 22.23 +/- 13.48%), alpha-fetoprotein > or = 100 ng/ml (61.96 +/- 15.84% vs. 28.52 +/- 21.74%), and PT prolongation > or = 3 sec (71.46 +/- 16.80% vs. 29.03 +/- 21.06%). CONCLUSION There is a good correlation between the conventional blood sampling method and the ICG Finger Piece Monitoring system method. The ICG Finger Monitoring system provides an alternative for traditional laboratory tests for the evaluation of hepatic dysfunction in hepatitis patients.
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Affiliation(s)
- M Y Su
- Liver Research Unit, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C
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30
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Su MY, Wang Z, Carpenter PM, Lao X, Mühler A, Nalcioglu O. Characterization of N-ethyl-N-nitrosourea-induced malignant and benign breast tumors in rats by using three MR contrast agents. J Magn Reson Imaging 1999; 9:177-86. [PMID: 10077011 DOI: 10.1002/(sici)1522-2586(199902)9:2<177::aid-jmri5>3.0.co;2-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A carcinogen (N-ethyl-N-nitrosourea)-induced animal tumor model was established to grow malignant and benign breast tumors. In each tumor the pharmacokinetic characteristics were measured by using three contrast agents, gadolinium-diethylene-triamine-pentaacetic acid (Gd-DTPA; <1 kD), Gadomer-17 (35 kD), and albumin-Gd-DTPA (70-90 kD). Infiltrating ductal carcinomas (IDC) with low, medium, and high Scarf-Bloom-Richardson grades and fibroadenomas (FA) were analyzed. We found that Gd-DTPA could differentiate between FA and malignant tumors, but not between malignant tumors of low and high grades. In contrast, the intermediate size agent Gadomer-17 could differentiate between high-grade and low-grade IDC, but not between low-grade IDC and FA due to their similar enhancement patterns (despite their different origins). The largest agent, albumin-Gd-DTPA, was capable of differentiating both, but the low contrast-to-noise ratio was its major technical concern. The results in this breast tumor model suggest that macromolecular agents provide useful information for differential diagnosis among IDCs of various grades, but they do not provide superior information than Gd-DTPA for differential diagnosis between IDC and FA.
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Affiliation(s)
- M Y Su
- Health Sciences Research Imaging Center, University of California, Irvine 92697, USA
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Abstract
The impact of chemotherapy on longitudinal vascular changes taking place during the growth of an animal tumor, R3230 AC adenocarcinoma, was investigated. Two contrast agents of different molecular weights, gadolinium-diethylene-triamine-pentaacetic acid (Gd-DTPA; < 1 kD) and gadomer-17 (35 kD), were used in the dynamic imaging studies. Enhancement kinetics were analyzed by a pharmacokinetic model to derive parameters related to vascular volume and permeability on a pixel-by-pixel basis. Responders and non-responders were separated according to tumor size 10 days after the therapy. Changes in the vascular volume measured by gadomer-17 at 4 days after therapy revealed a clear distinction between the controls and the responders/non-responders. Mean vascular volume decreased by 42% in responders but was not significantly changed in the controls. The one non-responder had increased vascular volume after chemotherapy. Enhancement kinetics of gadomer-17 detected the changes earlier and with greater sensitivity than Gd-DTPA. In the control group, vascular permeability determined by gadomer-17 correlated with the longitudinal growth rates of tumors, suggesting that vascular permeability assessed by gadomer-17 could potentially serve as an indicator of aggressive tumor growth.
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Affiliation(s)
- M Y Su
- Health Sciences Research Imaging Center, College of Medicine, University of California, Irvine 92697-5020, USA
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32
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Wang Z, Su MY, Nalcioglu O. Measurement of tumor vascular volume and mean microvascular random flow velocity magnitude by dynamic Gd-DTPA-albumin enhanced and diffusion-weighted MRI. Magn Reson Med 1998; 40:397-404. [PMID: 9727942 DOI: 10.1002/mrm.1910400309] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Tumor vascular volume fraction and the magnitude of the mean microvascular random flow velocity were measured in an animal tumor model by combining dynamic Gd-DTPA-albumin enhanced MRI and diffusion-weighted MRI in conjunction with a compartmental modeling analysis. The vascular volume fraction maps were obtained from the dynamic Gd-DTPA-albumin enhanced MRI measurement. It was found that the vascular volume fraction for Walker 256 tumor was higher within the outgrowing rim and decreased towards the central region. The average value obtained from five animals was 0.062 +/- 0.009 ml/g. By using the vascular volume fraction from the Gd-DTPA-albumin enhanced MRI measurement, maps of the magnitude of the mean microvascular random flow velocity were obtained from the diffusion-weighted MRI measurements with the compartmental modeling analysis. The relative extravascular and intravascular contributions to the diffusion-weighted MRI signal were determined for three tissue groups with different Gd-DTPA-albumin enhancement characteristics, and the flow and molecular diffusion-induced attenuation factors for the intravascular compartment were also compared. The mean microvascular random flow velocity magnitude maps were obtained with an average value of 0.67 +/- 0.06 mm/s.
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Affiliation(s)
- Z Wang
- Department of Radiological Sciences, and Health Sciences Research Imaging Center, College of Medicine, University of California, Irvine 92697-5020, USA
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Su MY, Head E, Brooks WM, Wang Z, Muggenburg BA, Adam GE, Sutherland R, Cotman CW, Nalcioglu O. Magnetic resonance imaging of anatomic and vascular characteristics in a canine model of human aging. Neurobiol Aging 1998; 19:479-85. [PMID: 9880050 DOI: 10.1016/s0197-4580(98)00081-5] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.8] [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] [Indexed: 01/28/2023]
Abstract
Dogs exhibit both neuroanatomical and cognitive changes as a function of age that parallel those seen in aging humans. This study describes in vivo changes in neuroanatomical and cerebrovascular characteristics of the canine brain as a function of age in a group of dogs ranging from 4 to 15 years old. Dynamic contrast-enhanced magnetic resonance imaging (MRI) was used to measure the kinetics of contrast agents in the brain. Measures of vascular volume and blood-brain barrier (BBB) permeability were derived from a pharmacokinetic analysis. Cortical atrophy and ventricular enlargement were characteristic features of the aged canine brain. Vascular volume did not vary as a function of age and BBB permeability exhibited a nonsignificant increasing trend with age. However, BBB dysfunction was detected in one middle-aged dog that in addition to having unusually large ventricles, demonstrated an early onset of diffuse senile plaques at postmortem. These findings indicate that BBB dysfunction detected by magnetic resonance imaging may be useful for predicting and potentially diagnosing early pathological conditions.
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Affiliation(s)
- M Y Su
- Health Sciences Research Imaging Center, University of California, Irvine 92697, USA.
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Tsai RK, Liu YT, Su MY. Risk factors of non-arteritic anterior ischemic optic neuropathy (NAION): ocular or systemic. Kaohsiung J Med Sci 1998; 14:221-5. [PMID: 9589616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
We retrospectively analyzed 22 patients with non-arteritic anterior ischemic optic neuropathy (NAION) seen at Chung-Ho memorial hospital between 1994 and 1996 to investigate the risk factors of NAION. The risk factors were divided into two groups: ocular and systemic. The ocular factors include refractive state, intraocular pressure, and cup-disk ratio of fellow eye. The systemic factors include diabetes, hypertension and cardiovascular diseases. The analysis revealed: (1) only 22.6% of patients with NAION have systemic risk factors; (2) intraocular pressure is not specific to NAION; (3) most of fellow eyes (72.6%) have cup-disk ratio not more than 0.1; and (4) most patients (90.9%) are hyperopic or emmetropic, only 9% of patients are myopic in either affected or fellow eyes. The statistical comparison between ocular (including cup-disk ratio and refractive state) and systemic factors is significant. The correlation with systemic factors in our study was not so high as previous study had reported. On the contrary, crowding effect of small cup-disk ratio, which induces a vicious circle of generally circulatory compromised disk, may play an important role in NAION. Besides, hyperopic or at least emmetropic eyes are more prone to NAION than myopic eyes. This may be due to lack of flattening of the temporal excavation, therefore adding a predisposing factor to a generally circulatory compromised disk. The risk factors associated with NAION seem more strongly correlated with ocular factors than with systemic factors.
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Affiliation(s)
- R K Tsai
- Department of Ophthalmology, Kaohsiung Medical College Hospital, Taiwan, Republic of China
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Su MY, Mühler A, Lao X, Nalcioglu O. Tumor characterization with dynamic contrast-enhanced MRI using MR contrast agents of various molecular weights. Magn Reson Med 1998; 39:259-69. [PMID: 9469709 DOI: 10.1002/mrm.1910390213] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Dynamic contrast-enhanced MR imaging was used to measure the kinetics of enhancement in three different animal tumor models (Walker 256, R3230 AC, MCF7) using three different Gd complexes (Gd-DTPA, Gd-DTPA-24-cascade-polymer 30 kD, and polylysine-Gd-DTPA 50 kD). The three tumor models varied in growth rate, with the most rapid growth demonstrated by Walker 256 cells and the slowest growth occurring in the MCF7 cells. For each tumor, the kinetics of enhancement using polylysine-Gd-DTPA was analyzed using a pharmacokinetic model to estimate the vascular volume of the tumor. The rate of entry of the contrast agent into the interstitial space served as the measure of vascular permeability. The smallest molecular-weight agent, Gd-DTPA, could not provide information about vascular permeability. The intermediate and the largest agents both demonstrated that the faster-growing Walker 256 tumor had greater vascular permeability than did the slower-growing R3230 AC tumor. The degree of vascular permeability in the MCF7 tumor could not be assessed fairly due to insufficient statistics. The current study provides evidence supporting the hypothesis that more rapidly growing tumors have higher vascular permeability than do tumors that grow more slowly.
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Affiliation(s)
- M Y Su
- Department of Radiological Sciences, University of California, Irvine 92697-5020, USA
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Su MY, Wang Z, Roth GM, Lao X, Samoszuk MK, Nalcioglu O. Pharmacokinetic changes induced by vasomodulators in kidneys, livers, muscles, and implanted tumors in rats as measured by dynamic Gd-DTPA-enhanced MRI. Magn Reson Med 1996; 36:868-77. [PMID: 8946352 DOI: 10.1002/mrm.1910360609] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [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: 02/03/2023]
Abstract
The effects of three physiologically different vasomodulators, angiotensin II (a vasoconstrictor), hydralazine (a vasodilator), and histamine (a permeability modulator), on the pharmaco-kinetics of entry of small molecules (measured by Gd-DTPA concentration) into normal and abnormal tissue were studied in rats implanted with R3230 AC tumors. Sequential dynamic Gd-DTPA-enhanced MRI studies, one before and one after vasomodulator administration, were performed, and the signal intensities of various tissues analyzed. Angiotensin II (6 micrograms/kg) reduced blood flow in tumors, but increased it in muscles. Hydralazine (5 mg/kg) reduced blood flow in tumors, kidneys, and livers, and slowed Gd-DTPA clearance from tumors, livers, and muscles. Histamine (25 micrograms/kg) increased renal blood flow, hastening Gd-DTPA clearance causing reduced measurable blood flow in tumors and muscles. By simultaneously monitoring the effects in various tissues, the pharmacokinetic effect of each drug in the entire body could be obtained.
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Affiliation(s)
- M Y Su
- Department of Radiological Sciences, University of California, Irvine 92714, USA
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Chen JY, Tsai RK, Su MY. [Unusual spontaneous dural cavernous sinus fistula between right external carotid artery and left cavernous sinus--a case report]. Kaohsiung J Med Sci 1996; 12:193-6. [PMID: 8709187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
A 64 year-old female had left exophthalmos which resulted from a spontaneous dural cavernous sinus fistula between the right external carotid artery and left cavernous sinus. The left cavernous sinus was fed directly from internal maxillary branches of right external carotid artery with the sparing of right cavernous sinus and intracavernous sinus. Symptoms and signs of dural cavernous sinus fistula developed slowly in the left eye only. Although this kind of spontaneou dural cavernous sinus fistula is very rare. The possibility of arterial feeding from contralateral carotid artery should not be ignored in any patient that is suffered from dural cavernous sinus fistula while angiographic study is performed.
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Affiliation(s)
- J Y Chen
- Department of Ophthalmology, Kaohsiung Medical College, Kaohsiung City, Taiwan, Republic of China
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Abstract
Sequential albumin-Gd-DTPA and Gd-DTPA dynamic enhancement studies were performed in an animal tumor model for the comparison of regional vascularity and permeability parameters measured by these two different sizes of contrast agents. The early albumin-Gd-DTPA enhancement arises from the vascular compartment, and the averaged signal enhancement derived from the first 3 to first 6 images postinjection can be reliably used to assess vascularity. The signal intensity in the images during the period of 5-10 min post-albumin-Gd-DTPA injection shows a steady linear variation. The intercept of the linear relationship is another indicator of the vascularity and the slope represents the tumor permeability to albumin-Gd-DTPA. The Gd-DTPA enhancement study was analyzed by a two-compartmental pharmacokinetic model to calculate the regional vascularity and permeability. The permeability parameters measured from albumin-Gd-DTPA and Gd-DTPA show an excellent correlation. The vascularity parameters measured from albumin-Gd-DTPA show good linear correlation with the low vascularity groups measured by Gd-DTPA, but show saturation for the high vascularity groups. The enhancement mechanisms for both contrast agents are discussed to relate the imaging parameters to the physiological variables.
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Affiliation(s)
- M Y Su
- Department of Radiological Sciences, University of California, Irvine 92717, USA
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Su MY, Jao JC, Nalcioglu O. Measurement of vascular volume fraction and blood-tissue permeability constants with a pharmacokinetic model: studies in rat muscle tumors with dynamic Gd-DTPA enhanced MRI. Magn Reson Med 1994; 32:714-24. [PMID: 7869893 DOI: 10.1002/mrm.1910320606] [Citation(s) in RCA: 115] [Impact Index Per Article: 3.8] [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] [Indexed: 01/27/2023]
Abstract
We propose a compartmental model to explain the signal enhancement curves following the bolus injection of Gd-DTPA. The model incorporates vascular volume fraction contribution, and the possibility of having different transport constants between the plasma and extravascular components. A Walker 256 carcinoma grown in rat muscle was used to demonstrate the capability of this model. Several different types of tissues were included in the measurements: normal, quickly enhanced, slowly enhanced, and necrotic tissues. Blood volume and blood-tissue permeability information can be derived from the dynamic contrast-enhanced MRI study employing the proposed model. In the tissue contrast enhancement curve, the initial rising slope after injection is related to the blood volume (or, vascular volume fraction), the maximum enhancement ratio is related to the uptake of tissue, and the decay rate is related to the clearance of tracer from tissue. The measured permeability constant is not the conventional permeability; instead they are contrast agents uptake and clearance rates, which are limited by the blood perfusion. These parameters can be used to characterize different enhancement patterns.
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Affiliation(s)
- M Y Su
- Department of Radiological Sciences, University of California, Irvine 92717
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Wang HZ, Chang CH, Su MY, Guo SL. Use of Gore-Tex sling in brow suspension procedure. Gaoxiong Yi Xue Ke Xue Za Zhi 1994; 10:131-7. [PMID: 8176780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A variety of materials have been employed for brow suspension surgery for ptosis. Gore-Tex (expanded polytetrafluoroethylene ePTFE) has been used as vascular prosthesis. We have used cylinder Gore-Tex in brow suspension surgery for 15 ptotic eyelids (11 patients), including 10 eyes (8 patients) of congenital ptosis, 1 eye of traumatic ptosis in a young male, and 4 eyes (2 patients) of myogenic ptosis in elderly patients. All of the eyelids had minimal or absent levator muscle function, and drooped to cover the visual axes. The surgical technique for the 10 congenital ptotic eyelids was a modified Fox's method. The remaining 5 adult eyelids were operated by a modified Crawford's method, with interlocking of the two suspension bands at the lower apex of each triangle and direct suturing of the bands to the tarsal plate. The use of Gore-Tex in brow suspension makes it easy to adjust the height and contour of the operated eyelids. Patients were followed-up from 2 to 16 months (average 9.1 months) postoperatively. The only complication was granuloma formation at the most upper knot area in 5 patients (6 eyelids), one of which also had granuloma at the ipsilateral fornix with the Gore-Tex band cutting through the conjunctiva. One eyelid drooped due to knot granuloma and infection.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- H Z Wang
- Department of Ophthalmology, Kaohsiung Medical College, Taiwan, Republic of China
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41
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Abstract
Quantification of microcirculatory flow is important for the functional assessment of biologic systems. The authors describe a method of analyzing the dependence of the magnetic resonance (MR) signal intensity on microcirculatory flow. A gel bead phantom was used to simulate the randomly oriented flow capillaries, and the MR signal intensity of the phantom was studied at different flow velocities by using velocity-sensitized and -compensated spin-echo pulse sequences. A theoretical model based on the spin-phase phenomenon is proposed to elucidate the effect of flow on signal intensity. The velocity phase of a spin depends on its path and the corresponding velocity-encoding gradients. A Monte Carlo simulation was used to generate the path of a spin on the basis of a statistical model for flow through a random capillary network. From the velocity-phase distribution of a group of spins within a voxel, the signal attenuation due to flow can be calculated. The results of the statistical model and experimental measurements agreed well. Also, T1 and T2 effects in MR flow measurements were investigated. The current study provides a theoretical framework for understanding MR measurements of microcirculatory flow.
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Affiliation(s)
- M Y Su
- Department of Radiological Sciences, University of California, Irvine 92717-5000
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Abstract
Magnetic resonance (MR) imaging of microvascular flow is an important topic in biomedicine because it permits access to the functional state of a biologic system. The internal heterogeneous magnetic field due to susceptibility differences within tissues is one of the factors that can affect signal intensity. A glass bead phantom simulating a porous medium was used to experimentally study the effect of the internal magnetic field on MR flow measurements. A physical model was developed to simulate the paths of the moving spins and the local magnetic field distribution in the medium to estimate the signal intensity with spin-phase analysis. The susceptibility variation inside the glass bead phantom was estimated by comparing the simulation results with the experimental data. Experiments were also performed with a tissue-simulating phantom, and the results indicated that the effect of the internal field inhomogeneity on in vivo microvascular flow measurements was negligible.
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Affiliation(s)
- M Y Su
- Department of Radiological Sciences, University of California, Irvine 92717
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Su MY, Chiang CD, Huang WL, Li SJ, King SL, P'eng FK. A new device of incentive spirometry. Zhonghua Yi Xue Za Zhi (Taipei) 1991; 48:274-7. [PMID: 1659922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Incentive spirometry is a feedback system to encourage patients to take a deep breath and produce a sustained maximal inspiration (SMI) for the primary purpose of opening and stabilizing atelectatic areas of the lung. However, currently available incentive devices are not reusable, expensive, and emphasize inspiratory effort only. We have designed a new device of incentive spirometer based on pursed-lip breathing technique. The device consists of a piece of paper hanging on a frame. The patient is instructed to take a deep and slow inspiration followed by holding the breath for 5 seconds. Then, using pursed-lip technique, the patient generates a flow to keep the paper attached to a bar as long as possible. The duration of paper blowing is recorded and is compared with vital capacity. In the present study 96 cases were recorded. Vital capacity was correlated well with paper blowing time (multiple regression test r = 0.87, p less than 0.0001). The advantages of our device include (1) reusibility and less cost, (2) equal emphasis of both inspiration and expiration, and (3) being especially helpful for patients with chronic obstructive lung disease (COPD). This is a preliminary result and further clinical study is needed.
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Affiliation(s)
- M Y Su
- Department of Internal Medicine, Veterans General Hospital-Taichung, Taiwan, R.O.C
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Lee HJ, Wang HZ, Lin HH, Sheu MM, Su MY, Chen CW. [Intraocular lens implantation at Kaohsiung Medical College]. Gaoxiong Yi Xue Ke Xue Za Zhi 1990; 6:12-21. [PMID: 2352308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Between March 1984 and December 1987, 993 cataractous eyes in 884 patients (462 males, 422 females) were operated on using intraocular lens implantation at the Kaohsiung Medical College Hospital. The age of the patients ranged from half year to 93 years, with an average of 61.9 years. Primary lens implantation was performed in 98.4% of the cases, secondary implantation in 1.6% of the cases. There were 6 cases were done by using the triple procedure (combined keratoplasty with cataract extraction and intraocular lens implantation). Among these 742 eyes followed-up for from one to 43 months, final vision could be corrected to 6/12 or better in 63.5% of the cases. While 64.4% of the cases of post-operation cylinder were less than 2 diopters, the final refraction showed that the spherical equivalent diopters were within 2 diopters in 61.7% of the cases. Complications in the anterior chamber lens group included pupillary changes (21.2%), pseudophakic bullous keratopathy or decompensation (13.5%), lens subluxation or dislocation (13.5%) and cystoid macular edema (5.8%). Complications in the posterior chamber lens group included pupillary changes (16.2%), posterior capsular thickening (3.2%), anterior or posterior synechiae (2.7%) and lens subluxation or dislocation (2.8%).
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Affiliation(s)
- H J Lee
- Department of Ophthalmology, Kaohsiung Medical College, Taiwan, Republic of China
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Su MY. [Evaluation of the visual evoked potentials in the diagnosis and prognosis of amblyopia in children]. Gaoxiong Yi Xue Ke Xue Za Zhi 1987; 3:222-33. [PMID: 3482285] [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: 01/06/2023]
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Wang LF, Wang HM, Lin FF, Sun XZ, Xu XF, Su MY, Lin J, Feng ZY, Fan XQ. A preliminary investigation of endemic iodine goiter on the inclined plain in front of the Tianshan Mountains in Kuitun-Usum area. Chin Med J (Engl) 1986; 99:673-8. [PMID: 3100222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Krause FR, Su MY, Klugman EH. Passive optical detection of meteorological parameters in launch vehicle environments. Appl Opt 1970; 9:1044-1055. [PMID: 20076328 DOI: 10.1364/ao.9.001044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
New optical detection systems are being developed which combine conventional passive photometry with advanced data processing and statistical analysis methods. These crossed-beam detection systems can continuously monitor meteorological parameters in rocket or aircraft environments. The outputs from several photometers are analyzed by cross correlation techniques to retrieve the transit times or transit distance of light emitting, absorbing, or scattering particles between the photometer lines of sight. These transit times and distances are then transformed into wind components and turbulence levels for preselected altitudes. A continuous near real time display of these meteorological parameters is also under development.
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