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Seefat MR, Cucchi DGJ, Groen K, Donker ML, van der Hem KG, Westerman M, Gerrits AM, Beeker A, van de Donk NWCJ, Blommestein HM, Zweegman S. Treatment sequences and drug costs from diagnosis to death in multiple myeloma. Eur J Haematol 2024; 112:360-366. [PMID: 37821211 DOI: 10.1111/ejh.14119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 10/13/2023]
Abstract
Novel therapies for multiple myeloma (MM) have improved patient survival, but their high costs strain healthcare budgets. End-of-life phases of treatment are generally the most expensive, however, these high costs may be less justifiable in the context of a less pronounced clinical benefit. To manage drug expenses effectively, detailed information on end-of-life drug administration and costs are crucial. In this retrospective study, we analysed treatment sequences and drug costs from 96 MM patients in the Netherlands who died between January 2017 and July 2019. Patients received up to 16 lines of therapy (median overall survival: 56.5 months), with average lifetime costs of €209 871 (€3111/month; range: €3942-€776 185) for anti-MM drugs. About 85% of patients received anti-MM treatment in the last 3 months before death, incurring costs of €20 761 (range: €70-€50 122; 10% of total). Half of the patients received anti-MM treatment in the last 14 days, mainly fully oral regimens (66%). End-of-life treatment costs are substantial despite limited survival benefits. The use of expensive treatment options is expected to increase costs further. These data serve as a reference point for future cost studies, and further research is needed to identify factors predicting the efficacy and clinical benefit of continuing end-of-life therapy.
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Affiliation(s)
- M R Seefat
- Department of Hematology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - D G J Cucchi
- Department of Hematology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - K Groen
- Department of Hematology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - M L Donker
- Department of Hematology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - K G van der Hem
- Department of Internal Medicine, Zaandam Medical Center, Zaandam, The Netherlands
| | - M Westerman
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | - A M Gerrits
- Department of Internal Medicine, OLVG, Amsterdam, The Netherlands
| | - A Beeker
- Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - N W C J van de Donk
- Department of Hematology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - H M Blommestein
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - S Zweegman
- Department of Hematology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
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Krepuska M, Mayer B, Vitale-Cross L, Myneni VD, Boyajian MK, Németh K, Szalayova I, Cho T, McClain-Caldwell I, Gingerich AD, Han H, Westerman M, Rada B, Mezey É. Bone marrow stromal cell-derived hepcidin has antimicrobial and immunomodulatory activities. Sci Rep 2024; 14:3986. [PMID: 38368463 PMCID: PMC10874407 DOI: 10.1038/s41598-024-54227-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/09/2024] [Indexed: 02/19/2024] Open
Abstract
Bone marrow stromal cells (BMSCs) have immunomodulatory activities in numerous species and have been used in clinical trials. BMSCs also make antibacterial agents. Since hepcidin is known to have antimicrobial effects in fish, we wondered if it might also be used as an antimicrobial agent by mammalian BMSCs. In the present study, we show hepcidin expression in both mouse (mBMSC) and human BMSCs (hBMSC). We observed a hBMSC hepcidin-dependent degradation of ferroportin in HEK-293 reporter cells in vitro. In human and mouse bone marrows (BM) we detected hepcidin-positive BMSCs in close proximity to hematopoietic progenitors. The conditioned culture medium of hBMSCs significantly reduced bacterial proliferation that was partially blocked by a hepcidin-neutralizing antibody. Similarly, medium in which hepcidin-deficient (Hamp-/-) mouse BMSCs had been grown was significantly less effective in reducing bacterial counts than the medium of wild-type cells. In a zymosan-induced peritonitis mouse model we found that mBMSC-derived hepcidin reduced the number of invading polymorphonuclear (PMN) cells in the peritoneal cavity. Our results show that BMSC-derived hepcidin has antimicrobial properties in vitro and also reduces inflammation in vivo. We conclude that hepcidin should be added to the expanding arsenal of agents available to BMSCs to fight infections and inflammation.
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Affiliation(s)
- Miklós Krepuska
- National Institutes of Health, NIDCR, ASCS, Bethesda, MD, USA
- Department of Neuroradiology, University Hospital Zürich, Zürich, Switzerland
| | - Balázs Mayer
- National Institutes of Health, NIDCR, ASCS, Bethesda, MD, USA
- Stem Cell Laboratory, Department of Dermatology, Venereology and Dermato-Oncology, Semmelweis University, Budapest, Hungary
| | | | - Vamsee D Myneni
- National Institutes of Health, NIDCR, ASCS, Bethesda, MD, USA
| | | | - Krisztián Németh
- National Institutes of Health, NIDCR, ASCS, Bethesda, MD, USA
- Stem Cell Laboratory, Department of Dermatology, Venereology and Dermato-Oncology, Semmelweis University, Budapest, Hungary
| | | | - Ted Cho
- National Institutes of Health, NIDCR, ASCS, Bethesda, MD, USA
| | | | - Aaron D Gingerich
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | | | | | - Balázs Rada
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, USA.
| | - Éva Mezey
- National Institutes of Health, NIDCR, ASCS, Bethesda, MD, USA
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Westerman M, Loke S, Tan MH. <i>Corrigendum to</i>: Molecular relationships of the red-bellied dasyure (<i>Phascolosorex doriae</i>) – a rare marsupial from western New Guinea. Aust Mammal 2022. [DOI: 10.1071/am21011_co] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The mitochondrial genome of the rare endemic New Guinean dasyurid <italic>Phascolosorex doriae</italic> (<xref ref-type="bibr" rid="R11">Thomas 1886</xref>) has been used to clarify relationships within ‘phascolosoricinae’. The mitochondrial genome has the typical gene arrangement seen in other marsupials. Molecular analyses using complete mitogenomes of other dasyurids resolve the red-bellied dasyure as sister to the narrow-striped dasyure <italic>Phascolosorex dorsalis</italic> and show that these two species diverged in the early Pliocene. The invasion of emergent New Guinean rainforest habitats (in the late Miocene) by the common ancestor of <italic>Ph. doriae</italic>, <italic>Ph. dorsalis</italic> and <italic>Neophascogale lorentzii</italic> represents one of three separate such invasions by dasyurid lineages.
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Umbrello LS, Potter LC, Westerman M, Woolley PA. First record of Pseudantechinus macdonnellensis (Marsupialia: Dasyuridae) in the Kimberley region of Western Australia. Aust Mammalogy 2022. [DOI: 10.1071/am21031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Westerman M, Loke S, Tan MH. Molecular relationships of the red-bellied dasyure (Phascolosorex doriae) – a rare marsupial from western New Guinea. Aust Mammalogy 2022. [DOI: 10.1071/am21011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The mitochondrial genome of the rare endemic New Guinean dasyurid Phascolosorex doriae (Thomas 1886) has been used to clarify relationships within ‘phascolosoricinae’. The mitochondrial genome has the typical gene arrangement seen in other marsupials. Molecular analyses using complete mitogenomes of other dasyurids resolve the red-bellied dasyure as sister to the narrow-striped dasyure Phascolosorex dorsalis and show that these two species diverged in the early Pliocene. The invasion of emergent New Guinean rainforest habitats (in the late Miocene) by the common ancestor of Ph. doriae, Ph. dorsalis and Neophascogale lorentzii represents one of three separate such invasions by dasyurid lineages.
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van der Hout A, van Uden-Kraan C, Holtmaat K, Jansen F, Lissenberg-Witte B, Nieuwenhuijzen G, Hardillo J, Baatenburg de Jong R, Tiren-Verbeet N, Sommeijer D, de Heer K, Schaar C, Sedee R, Bosscha K, van den Brekel M, Petersen J, Westerman M, Honings J, Takes R, Houtenbos I, van den Broek W, de Bree R, Jansen P, Eerenstein S, Leemans C, Zijlstra J, Cuijpers P, van de Poll-Franse L, Verdonck-de Leeuw I. Reasons for not reaching or using web-based self-management applications, and the use and evaluation of Oncokompas among cancer survivors, in the context of a randomised controlled trial. Internet Interv 2021; 25:100429. [PMID: 34401388 PMCID: PMC8350584 DOI: 10.1016/j.invent.2021.100429] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/22/2021] [Accepted: 07/07/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The web-based self-management application Oncokompas was developed to support cancer survivors to monitor health-related quality of life and symptoms (Measure) and to provide tailored information (Learn) and supportive care options (Act). In a previously reported randomised controlled trial (RCT), 68% of 655 recruited survivors were eligible, and of those 45% participated in the RCT. Among participants of the RCT that were randomised to the intervention group, 52% used Oncokompas as intended. The aim of this study was to explore reasons for not participating in the RCT, and reasons for not using Oncokompas among non-users, and the use and evaluation of Oncokompas among users. METHODS Reasons for not participating were assessed with a study-specific questionnaire among 243 survivors who declined participation. Usage was investigated among 320 participants randomised to the intervention group of the RCT via system data and a study-specific questionnaire that was assessed during the 1 week follow-up (T1) assessment. RESULTS Main reasons for not participating were not interested in participation in scientific research (40%) and not interested in scientific research and Oncokompas (28%). Main reasons for not being interested in Oncokompas were wanting to leave the period of being ill behind (29%), no symptom burden (23%), or lacking internet skills (18%). Out of the 320 participants in the intervention group 167 (52%) used Oncokompas as intended. Among 72 non-users, main reasons for not using Oncokompas were no symptom burden (32%) or lack of time (26%). Among 248 survivors that activated their account, satisfaction and user-friendliness were rated with a 7 (scale 0-10). Within 3 (IQR 1-4) sessions, users selected 32 (IQR 6-37) topics. Main reasons for not using healthcare options in Act were that the information in Learn was already sufficient (44%) or no supportive care needs (32%). DISCUSSION Main reasons for not reaching or using Oncokompas were no symptom burden, no supportive care needs, or lack of time. Users selected many cancer-generic and tumour-specific topics to address, indicating added value of the wide range of available topics.
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Affiliation(s)
- A. van der Hout
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
| | - C.F. van Uden-Kraan
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
| | - K. Holtmaat
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
| | - F. Jansen
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology – Head and Neck Surgery, Amsterdam, the Netherlands
| | - B.I. Lissenberg-Witte
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam, the Netherlands
| | | | - J.A. Hardillo
- Department of Otolaryngology and Head and Neck Surgery, Erasmus MC Cancer Centre, Erasmus Medical Center, Rotterdam, the Netherlands
| | - R.J. Baatenburg de Jong
- Department of Otolaryngology and Head and Neck Surgery, Erasmus MC Cancer Centre, Erasmus Medical Center, Rotterdam, the Netherlands
| | - N.L. Tiren-Verbeet
- Department of Hematology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - D.W. Sommeijer
- Department of Internal Medicine, Flevoziekenhuis, Almere, the Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Amsterdam, the Netherlands
| | - K. de Heer
- Department of Internal Medicine, Flevoziekenhuis, Almere, the Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Hematology, Amsterdam, the Netherlands
| | - C.G. Schaar
- Department of Internal Medicine, Gelre ziekenhuis, Apeldoorn, the Netherlands
| | - R.J.E. Sedee
- Department of Otolaryngology, Head and Neck Surgery, Haaglanden MC, The Hague, the Netherlands
| | - K. Bosscha
- Department of Surgery, Jeroen Bosch Ziekenhuis, Den Bosch, the Netherlands
| | - M.W.M. van den Brekel
- Department of Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - J.F. Petersen
- Department of Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M. Westerman
- Department of Hematology, Northwest Clinics, Alkmaar, the Netherlands
| | - J. Honings
- Department of Otorhinolaryngology – Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - R.P. Takes
- Department of Otorhinolaryngology – Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - I. Houtenbos
- Department of Hematology, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | | | - R. de Bree
- Department of Head and Neck Surgical Oncology, Utrecht University Medical Center, Utrecht, the Netherlands
| | - P. Jansen
- Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - S.E.J. Eerenstein
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology – Head and Neck Surgery, Amsterdam, the Netherlands
| | - C.R. Leemans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology – Head and Neck Surgery, Amsterdam, the Netherlands
| | - J.M. Zijlstra
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Hematology, Amsterdam, the Netherlands
| | - P. Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - L.V. van de Poll-Franse
- Department of Research, Netherlands Comprehensive Cancer Organisation, Eindhoven, the Netherlands
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, the Netherlands
- CoRPS - Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - I.M. Verdonck-de Leeuw
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology – Head and Neck Surgery, Amsterdam, the Netherlands
- Corresponding author at: Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.
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van der Hout A, Holtmaat K, Jansen F, Lissenberg-Witte BI, van Uden-Kraan CF, Nieuwenhuijzen GAP, Hardillo JA, Baatenburg de Jong RJ, Tiren-Verbeet NL, Sommeijer DW, de Heer K, Schaar CG, Sedee RJE, Bosscha K, van den Brekel MWM, Petersen JF, Westerman M, Honings J, Takes RP, Houtenbos I, van den Broek WT, de Bree R, Jansen P, Eerenstein SEJ, Leemans CR, Zijlstra JM, Cuijpers P, van de Poll-Franse LV, Verdonck-de Leeuw IM. The eHealth self-management application 'Oncokompas' that supports cancer survivors to improve health-related quality of life and reduce symptoms: which groups benefit most? Acta Oncol 2021; 60:403-411. [PMID: 33345659 DOI: 10.1080/0284186x.2020.1851764] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Oncokompas is a web-based self-management application that supports cancer survivors to monitor their health-related quality of life (HRQOL) and symptoms, and to obtain personalised feedback and tailored options for supportive care. In a large randomised controlled trial among survivors of head and neck cancer, colorectal cancer, and breast cancer and (non-)Hodgkin lymphoma, Oncokompas proved to improve HRQOL, and to reduce several tumour-specific symptoms. Effect sizes were however small, and no effect was observed on the primary outcome patient activation. Therefore, this study aims to explore which subgroups of cancer survivors may especially benefit from Oncokompas. MATERIALS AND METHODS Cancer survivors (n = 625) were randomly assigned to the intervention group (access to Oncokompas, n = 320) or control group (6 months waiting list, n = 305). Outcome measures were HRQOL, tumour-specific symptoms, and patient activation. Potential moderators included socio-demographic (sex, age, marital status, education, employment), clinical (tumour type, stage, time since diagnosis, treatment modality, comorbidities), and personal factors (self-efficacy, personal control, health literacy, Internet use), and patient activation, mental adjustment to cancer, HRQOL, symptoms, and need for supportive care, measured at baseline. Linear mixed models were performed to investigate potential moderators. RESULTS The intervention effect on HRQOL was the largest among cancer survivors with low to moderate self-efficacy, and among those with high personal control and those with high health literacy scores. Cancer survivors with higher baseline symptom scores benefitted more on head and neck (pain in the mouth, social eating, swallowing, coughing, trismus), and colorectal cancer (weight) specific symptoms. DISCUSSION Oncokompas seems most effective in reducing symptoms in head and neck cancer and colorectal cancer survivors who report a higher burden of tumour-specific symptoms. Oncokompas seems most effective in improving HRQOL in cancer survivors with lower self-efficacy, and in cancer survivors with higher personal control, and higher health literacy.
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Affiliation(s)
- A. van der Hout
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
| | - K. Holtmaat
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
- Department of Otolaryngology – Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - F. Jansen
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
- Department of Otolaryngology – Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - B. I. Lissenberg-Witte
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C. F. van Uden-Kraan
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
| | | | - J. A. Hardillo
- Department of Otolaryngology and Head and Neck Surgery, Erasmus MC Cancer Centre, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R. J. Baatenburg de Jong
- Department of Otolaryngology and Head and Neck Surgery, Erasmus MC Cancer Centre, Erasmus Medical Center, Rotterdam, The Netherlands
| | - N. L. Tiren-Verbeet
- Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - D. W. Sommeijer
- Department of Internal Medicine, Flevoziekenhuis, The Netherlands
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - K. de Heer
- Department of Internal Medicine, Flevoziekenhuis, The Netherlands
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C. G. Schaar
- Department of Internal Medicine, Gelre Ziekenhuis, Apeldoorn, The Netherlands
| | - R. J. E. Sedee
- Department of Otolaryngology, Head and Neck Surgery, Haaglanden MC, The Hague, The Netherlands
| | - K. Bosscha
- Department of Surgery, Jeroen Bosch Ziekenhuis, Den Bosch, The Netherlands
| | - M. W. M. van den Brekel
- Department of Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J. F. Petersen
- Department of Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M. Westerman
- Department of Hematology, Northwest Clinics, Alkmaar, The Netherlands
| | - J. Honings
- Department of Otorhinolaryngology – Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R. P. Takes
- Department of Otorhinolaryngology – Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - I. Houtenbos
- Department of Hematology, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | | | - R. de Bree
- Department of Head and Neck Surgical Oncology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - P. Jansen
- Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - S. E. J. Eerenstein
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
- Department of Otolaryngology – Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C. R. Leemans
- Department of Otolaryngology – Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J. M. Zijlstra
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - P. Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - L. V. van de Poll-Franse
- CoRPS – Center of Research on Psychological and Somatic disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Research, Netherlands Comprehensive Cancer Organisation, Eindhoven, The Netherlands
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - I. M. Verdonck-de Leeuw
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
- Department of Otolaryngology – Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Gutschow P, Han H, Olbina G, Westerman K, Nemeth E, Ganz T, Copeland K, Westerman M, Ostland V. Clinical Immunoassay for Human Hepcidin Predicts Iron Deficiency in First-Time Blood Donors. J Appl Lab Med 2020; 5:943-953. [PMID: 32674118 PMCID: PMC7497288 DOI: 10.1093/jalm/jfaa038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/03/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Serum markers currently used as indicators of iron status have clinical limitations. Hepcidin, a key regulator of iron homeostasis, is reduced in iron deficiency (ID) and increased in iron overload. We describe the first CLIA-validated immunoassay with excellent accuracy and precision to quantify human serum hepcidin. Its diagnostic utility for detecting ID in first-time blood donors was demonstrated. METHODS A monoclonal competitive ELISA (C-ELISA) was developed for the quantitation of human hepcidin and validated according to CLIA guidelines. Sera from nonanemic first-time blood donors (n = 292) were analyzed for hepcidin, ferritin, transferrin, and serum iron. Logistic regression served to determine the utility of hepcidin as a predictor of ID. RESULTS The C-ELISA was specific for human hepcidin and had a low limit of quantitation (4.0 ng/mL). The hepcidin concentration measured with the monoclonal C-ELISA was strongly correlated with a previously established, extensively tested polyclonal C-ELISA (Blood 2008;112:4292-7) (r = 0.95, P < 0.001). The area under the receiver operating characteristic curve for hepcidin as a predictor of ID, defined by 3 ferritin concentration thresholds, was >0.9. For predicting ID defined by ferritin <15 ng/mL, hepcidin <10 ng/mL yielded sensitivity of 93.1% and specificity of 85.5%, whereas the same hepcidin cutoff for ferritin <30 ng/mL yielded sensitivity of 67.6% and specificity of 91.7%. CONCLUSION The clinical measurement of serum hepcidin concentrations was shown to be a potentially useful tool for diagnosing ID.
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Affiliation(s)
| | | | | | | | - Elizabeta Nemeth
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Tomas Ganz
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
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van der Hout A, Jansen F, van Uden-Kraan CF, Coupé VM, Holtmaat K, Nieuwenhuijzen GA, Hardillo JA, de Jong RJB, Tiren-Verbeet NL, Sommeijer DW, de Heer K, Schaar CG, Sedee RJE, Bosscha K, van den Brekel MWM, Petersen JF, Westerman M, Honings J, Takes RP, Houtenbos I, van den Broek WT, de Bree R, Jansen P, Eerenstein SEJ, Leemans CR, Zijlstra JM, Cuijpers P, van de Poll-Franse LV, Verdonck-de Leeuw IM. Cost-utility of an eHealth application 'Oncokompas' that supports cancer survivors in self-management: results of a randomised controlled trial. J Cancer Surviv 2020; 15:77-86. [PMID: 32656739 PMCID: PMC7822793 DOI: 10.1007/s11764-020-00912-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/26/2020] [Indexed: 11/29/2022]
Abstract
Purpose The eHealth self-management application ‘Oncokompas’ was developed to support cancer survivors in monitoring health-related quality of life (HRQOL) and symptoms, and obtaining personalized feedback and options for supportive care. The aim of this study was to assess the cost-utility of Oncokompas compared with care as usual (CAU) among cancer survivors. Methods Survivors were randomly allocated to the intervention or control group. Direct (non-)medical, indirect non-medical costs, and HRQOL were measured at 3- and 6-month follow-up, using iMTA Medical Consumption and Productivity Costs and the EuroQol-5D questionnaires. Mean cumulative costs and quality-adjusted life-years (QALYs) were compared between both groups. Results In total, 625 survivors were randomized into intervention (n = 320) or control group (n = 305). Base case analysis showed that incremental costs from a societal perspective were − €163 (95% CI, − 665 to 326), and incremental QALYs were 0.0017 (95% CI, − 0.0121 to 0.0155) in the intervention group compared with those in the control group. The probability that, compared with CAU, Oncokompas is more effective was 60%, less costly 73%, and both more effective and less costly 47%. Sensitivity analyses showed that incremental costs vary between − €40 and €69, and incremental QALYs vary between − 0.0023 and − 0.0057. Conclusion Oncokompas is likely to be equally effective on utilities, and not more expensive than CAU, and will therefore contribute to sustainable cancer survivorship care in a (cost-)effective manner. Implications for Cancer Survivors Oncokompas seems to improve HRQOL and reduces the burden of several tumour-specific symptoms, while costs from a societal perspective are similar to CAU. Electronic supplementary material The online version of this article (10.1007/s11764-020-00912-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A van der Hout
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
| | - F Jansen
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
- Department of Otolaryngology - Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C F van Uden-Kraan
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
| | - V M Coupé
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - K Holtmaat
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
- Department of Otolaryngology - Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - J A Hardillo
- Department of Otolaryngology and Head and Neck Surgery, ErasmusMC Cancer Centre, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R J Baatenburg de Jong
- Department of Otolaryngology and Head and Neck Surgery, ErasmusMC Cancer Centre, Erasmus Medical Center, Rotterdam, The Netherlands
| | - N L Tiren-Verbeet
- Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - D W Sommeijer
- Department of Internal Medicine, Flevoziekenhuis, Almere, The Netherlands
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - K de Heer
- Department of Internal Medicine, Flevoziekenhuis, Almere, The Netherlands
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C G Schaar
- Department of Internal Medicine, Gelre ziekenhuis, Apeldoorn, The Netherlands
| | - R J E Sedee
- Department of Otolaryngology, Head and Neck Surgery, Haaglanden MC, The Hague, The Netherlands
| | - K Bosscha
- Department of Surgery, Jeroen Bosch Ziekenhuis, Den Bosch, The Netherlands
| | - M W M van den Brekel
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J F Petersen
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M Westerman
- Department of Hematology, Northwest Clinics, Alkmaar, The Netherlands
| | - J Honings
- Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R P Takes
- Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - I Houtenbos
- Department of Hematology, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | | | - R de Bree
- Department of Head and Neck Surgical Oncology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - P Jansen
- Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - S E J Eerenstein
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
- Department of Otolaryngology - Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C R Leemans
- Department of Otolaryngology - Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J M Zijlstra
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - P Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - L V van de Poll-Franse
- Department of Research, Netherlands Comprehensive Cancer Organisation, Eindhoven, The Netherlands
- Division of Psychosocial Research & Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- CoRPS - Center of Research on Psychological and Somatic disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - I M Verdonck-de Leeuw
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, The Netherlands.
- Department of Otolaryngology - Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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10
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Albert C, Haase M, Albert A, Kropf S, Bellomo R, Westphal S, Westerman M, Braun-Dullaeus RC, Haase-Fielitz A. Urinary Biomarkers may Complement the Cleveland Score for Prediction of Adverse Kidney Events After Cardiac Surgery: A Pilot Study. Ann Lab Med 2020; 40:131-141. [PMID: 31650729 PMCID: PMC6822001 DOI: 10.3343/alm.2020.40.2.131] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/09/2019] [Accepted: 10/08/2019] [Indexed: 12/15/2022] Open
Abstract
Background The ability of urinary biomarkers to complement established clinical risk prediction models for postoperative adverse kidney events is unclear. We assessed the effect of urinary biomarkers linked to suspected pathogenesis of cardiac surgery-induced acute kidney injury (AKI) on the performance of the Cleveland Score, a risk assessment model for postoperative adverse kidney events. Methods This pilot study included 100 patients who underwent open-heart surgery. We determined improvements to the Cleveland Score when adding urinary biomarkers measured using clinical laboratory platforms (neutrophil gelatinase-associated lipocalin [NGAL], interleukin-6) and those in the preclinical stage (hepcidin-25, midkine, alpha-1 microglobulin), all sampled immediately post-surgery. The primary endpoint was major adverse kidney events (MAKE), and the secondary endpoint was AKI. We performed ROC curve analysis, assessed baseline model performance (odds ratios [OR], 95% CI), and carried out statistical reclassification analyses to assess model improvement. Results NGAL (OR [95% CI] per 20 concentration-units wherever applicable): (1.07 [1.01–1.14]), Interleukin-6 (1.51 [1.01–2.26]), midkine (1.01 [1.00–1.02]), 1-hepcidin-25 (1.08 [1.00–1.17]), and NGAL/hepcidin-ratio (2.91 [1.30–6.49]) were independent predictors of MAKE and AKI (1.38 [1.03–1.85], 1.08 [1.01–1.15], 1.01 [1.00–1.02], 1.09 [1.01–1.18], and 3.45 [1.54–7.72]). Category-free net reclassification improvement identified interleukin-6 as a model-improving biomarker for MAKE and NGAL for AKI. However, only NGAL/hepcidin-25 improved model performance for event- and event-free patients for MAKE and AKI. Conclusions NGAL and interleukin-6 measured immediately post cardiac surgery may complement the Cleveland Score. The combination of biomarkers with hepcidin-25 may further improve diagnostic discrimination.
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Affiliation(s)
- Christian Albert
- Faculty of Medicine, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.,Diaverum Renal Services, MVZ Potsdam, Potsdam, Germany.
| | - Michael Haase
- Faculty of Medicine, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.,Diaverum Renal Services, MVZ Potsdam, Potsdam, Germany
| | - Annemarie Albert
- Diaverum Renal Services, MVZ Potsdam, Potsdam, Germany.,Department of Nephrology and Endocrinology, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Siegfried Kropf
- Institute for Biometrics and Medical Informatics, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Rinaldo Bellomo
- School of Medicine, University of Melbourne, Melbourne, Australia
| | - Sabine Westphal
- Institute of Laboratory Medicine, Hospital Dessau, Dessau, Germany
| | | | - Rüdiger Christian Braun-Dullaeus
- Department of Internal Medicine, University Clinic for Cardiology and Angiology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Anja Haase-Fielitz
- Department of Cardiology, Immanuel Diakonie Bernau, Heart Center Brandenburg, Brandenburg Medical School Theodor Fontane (MHB), Germany.,Institute of Social Medicine and Health Economics, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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11
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Verhaeghe R, George K, Westerman M, Olbina G, McCann D, Parrow N, Pincus E, Havranek T, Fleming RE. Hepcidin Status at 2 Months in Infants Fed Breast Milk Compared with Formula. Neonatology 2020; 117:474-479. [PMID: 32818935 DOI: 10.1159/000508447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/05/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The basis for the superior absorption of iron from breast milk compared with infant formulas is unclear. The hormone hepcidin downregulates dietary iron absorption. Hepcidin production increases with increased body iron status (reflected in serum ferritin levels). We hypothesized that serum hepcidin levels are suppressed relative to iron status in infants fed breast milk compared with formula. METHODS Subjects were healthy infants presenting for routine 2-month clinic visit and strictly fed either breast milk or standard infant formula. Urinary hepcidin and ferritin levels (reflective of serum levels) were analyzed and compared across the breast milk- and formula-fed groups. The relationship between urinary hepcidin and ferritin levels within each group was analyzed by linear regression. RESULTS Twenty-four subjects were enrolled in each group. The median urinary hepcidin level in the group fed breast milk was lower than in formula (130 vs. 359 ng hepcidin/mg creatinine, p < 0.05). However, the median ferritin levels were similar (2.1 vs. 1.9 ng/mL). Within each group, urinary hepcidin correlated with urinary ferritin (r = 0.5, p < 0.05 for each group); however, the slope of the regression line was lower in the group fed breast milk compared with formula (p < 0.005). CONCLUSION Despite similar urinary ferritin levels, urinary hepcidin levels are lower at 2 months in infants fed breast milk compared with infants fed formula. Hepcidin levels correlate with iron status in each group; however, this relationship is relatively dampened in infants fed breast milk. We speculate that relatively lower infant hepcidin contributes to the superior efficiency of iron absorption from breast milk.
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Affiliation(s)
- Rebecca Verhaeghe
- Pediatrics/Neonatology, Saint Louis University, St. Louis, Missouri, USA
| | - Kandie George
- Pediatrics/Neonatology, Albert Einstein University/Montefiore, Bronx, New York, USA
| | | | | | - Diane McCann
- Intrinsic LifeSciences, La Jolla, California, USA
| | - Nermi Parrow
- Pediatrics/Neonatology, Saint Louis University, St. Louis, Missouri, USA
| | - Elisa Pincus
- Pediatrics/Neonatology, Saint Louis University, St. Louis, Missouri, USA
| | - Tomas Havranek
- Pediatrics/Neonatology, Albert Einstein University/Montefiore, Bronx, New York, USA
| | - Robert E Fleming
- Pediatrics/Neonatology, Saint Louis University, St. Louis, Missouri, USA,
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12
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Heeney MM, Guo D, De Falco L, Campagna DR, Olbina G, Kao PPC, Schmitz-Abe K, Rahimov F, Gutschow P, Westerman K, Ostland V, Jackson T, Klaassen RJ, Markianos K, Finberg KE, Iolascon A, Westerman M, London WB, Fleming MD. Normalizing hepcidin predicts TMPRSS6 mutation status in patients with chronic iron deficiency. Blood 2018; 132:448-452. [PMID: 29895660 PMCID: PMC6071554 DOI: 10.1182/blood-2017-03-773028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/06/2018] [Indexed: 12/30/2022] Open
Affiliation(s)
- Matthew M Heeney
- Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
| | - Dongjing Guo
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
| | - Luigia De Falco
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University Medical School, Naples, Italy
- CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Dean R Campagna
- Department of Pathology, Boston Children's Hospital, Boston, MA
| | | | - Paige P-C Kao
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
| | | | - Fedik Rahimov
- Division of Genetics and Genomics, Department of Medicine, Boston Children's Hospital, Boston, MA
| | | | | | | | - Tracy Jackson
- Division of Pediatric Hematology-Oncology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada; and
| | - Robert J Klaassen
- Division of Pediatric Hematology-Oncology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada; and
| | | | | | - Achille Iolascon
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University Medical School, Naples, Italy
- CEINGE Biotecnologie Avanzate, Naples, Italy
| | | | - Wendy B London
- Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
| | - Mark D Fleming
- Department of Pathology, Boston Children's Hospital, Boston, MA
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13
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Panwar B, McCann D, Olbina G, Westerman M, Gutiérrez OM. Effect of calcitriol on serum hepcidin in individuals with chronic kidney disease: a randomized controlled trial. BMC Nephrol 2018; 19:35. [PMID: 29426300 PMCID: PMC5807766 DOI: 10.1186/s12882-018-0823-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 01/21/2018] [Indexed: 04/20/2023] Open
Abstract
Background Anemia is highly prevalent in chronic kidney disease (CKD). Elevated hepcidin concentrations are an important mediator of disordered iron metabolism, a key mechanism underlying anemia of CKD. Vitamin D was recently shown to reduce serum hepcidin concentrations in healthy individuals. We examined whether treatment with calcitriol reduces serum hepcidin in individuals with CKD. Methods A total of 40 participants with stage 3 or 4 CKD (eGFR 15–60 ml/min/1.73m2) were randomized to receive either oral calcitriol 0.5 mcg daily or identically-matched placebo for 6 weeks. The primary outcome variable was change in serum hepcidin concentrations. Secondary outcomes variables included the change in iron parameters, calcium, phosphorus, intact parathyroid hormone and hemoglobin concentrations. Study samples were drawn at baseline, 3 days, 1 week, 4 weeks and 6 weeks after randomization. Repeated measures analysis was used to examine differences in outcome variables over time in the two groups. Results There were no significant differences in the baseline characteristics between the placebo and calcitriol arms. Over 6 weeks of follow-up there were no significant differences in the change in serum hepcidin, iron parameters, or hemoglobin between the two groups. Serum calcium and phosphorus significantly increased and PTH significantly decreased after 6 weeks in calcitriol group whereas these analytes did not change in the placebo group. Conclusion Calcitriol did not reduce serum hepcidin concentrations among individuals with mild to moderate CKD. Future studies are needed to assess if nutritional forms of vitamin D affect hepcidin concentrations in CKD. Trial registration ClinicalTrials.gov Identifier: NCT01988116. Registered: November 4, 2013. Electronic supplementary material The online version of this article (10.1186/s12882-018-0823-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bhupesh Panwar
- Departments of Medicine, University of Alabama at Birmingham, ZRB 522, 1720 2nd AVE S, Birmingham, AL, 35294-0006, USA.
| | | | | | | | - Orlando M Gutiérrez
- Departments of Medicine, University of Alabama at Birmingham, ZRB 522, 1720 2nd AVE S, Birmingham, AL, 35294-0006, USA.,Departments of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
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14
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Umbrello LS, Woolley PA, Westerman M. Species relationships in the dasyurid marsupial genus Pseudantechinus (Marsupialia : Dasyuridae): a re-examination of the taxonomic status of Pseudantechinus roryi. AUST J ZOOL 2017. [DOI: 10.1071/zo17059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The status of Pseudantechinus roryi relative to its congeners has been determined from DNA sequences obtained from both nuclear and mitochondrial gene loci. Although all other recognised species of Pseudantechinus form reciprocally monophyletic lineages in phylogenetic analyses, individuals identified in museum collections as Ps. roryi (including type specimens) were indistinguishable from those identified as Ps. macdonnellensis. Ps. roryi is thus considered to be a synonym of Ps. macdonnellensis. Neighbour-joining network analyses failed to reveal any clear biogeographic differences between populations of Ps. macdonnellensis other than some evidence of isolation by distance.
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15
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De Leeuw RA, Westerman M, Nelson E, Ket JCF, Scheele F. Quality specifications in postgraduate medical e-learning: an integrative literature review leading to a postgraduate medical e-learning model. BMC Med Educ 2016; 16:168. [PMID: 27390843 PMCID: PMC4939034 DOI: 10.1186/s12909-016-0700-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 06/11/2016] [Indexed: 05/10/2023]
Abstract
BACKGROUND E-learning is driving major shifts in medical education. Prioritizing learning theories and quality models improves the success of e-learning programs. Although many e-learning quality standards are available, few are focused on postgraduate medical education. METHODS We conducted an integrative review of the current postgraduate medical e-learning literature to identify quality specifications. The literature was thematically organized into a working model. RESULTS Unique quality specifications (n = 72) were consolidated and re-organized into a six-domain model that we called the Postgraduate Medical E-learning Model (Postgraduate ME Model). This model was partially based on the ISO-19796 standard, and drew on cognitive load multimedia principles. The domains of the model are preparation, software design and system specifications, communication, content, assessment, and maintenance. CONCLUSION This review clarified the current state of postgraduate medical e-learning standards and specifications. It also synthesized these specifications into a single working model. To validate our findings, the next-steps include testing the Postgraduate ME Model in controlled e-learning settings.
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Affiliation(s)
- R. A. De Leeuw
- />Athena Institute for Trans-disciplinary Research, VU University Amsterdam, De Boelelaan 1118, Amsterdam, 1081 HZ The Netherlands
| | - M. Westerman
- />VUmc, School of Medical Sciences, Amsterdam, The Netherlands
| | - E. Nelson
- />Division of Pediatric Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, USA
| | - J. C. F. Ket
- />VU University Amsterdam, University Library, Amsterdam, The Netherlands
| | - F. Scheele
- />Athena Institute for Trans-disciplinary Research, VU University Amsterdam, De Boelelaan 1118, Amsterdam, 1081 HZ The Netherlands
- />VUmc, School of Medical Sciences, Amsterdam, The Netherlands
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16
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van der Vorm LN, Hendriks JCM, Laarakkers CM, Klaver S, Armitage AE, Bamberg A, Geurts-Moespot AJ, Girelli D, Herkert M, Itkonen O, Konrad RJ, Tomosugi N, Westerman M, Bansal SS, Campostrini N, Drakesmith H, Fillet M, Olbina G, Pasricha SR, Pitts KR, Sloan JH, Tagliaro F, Weykamp CW, Swinkels DW. Toward Worldwide Hepcidin Assay Harmonization: Identification of a Commutable Secondary Reference Material. Clin Chem 2016; 62:993-1001. [DOI: 10.1373/clinchem.2016.256768] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/07/2016] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Absolute plasma hepcidin concentrations measured by various procedures differ substantially, complicating interpretation of results and rendering reference intervals method dependent. We investigated the degree of equivalence achievable by harmonization and the identification of a commutable secondary reference material to accomplish this goal.
METHODS
We applied technical procedures to achieve harmonization developed by the Consortium for Harmonization of Clinical Laboratory Results. Eleven plasma hepcidin measurement procedures (5 mass spectrometry based and 6 immunochemical based) quantified native individual plasma samples (n = 32) and native plasma pools (n = 8) to assess analytical performance and current and achievable equivalence. In addition, 8 types of candidate reference materials (3 concentrations each, n = 24) were assessed for their suitability, most notably in terms of commutability, to serve as secondary reference material.
RESULTS
Absolute hepcidin values and reproducibility (intrameasurement procedure CVs 2.9%–8.7%) differed substantially between measurement procedures, but all were linear and correlated well. The current equivalence (intermeasurement procedure CV 28.6%) between the methods was mainly attributable to differences in calibration and could thus be improved by harmonization with a common calibrator. Linear regression analysis and standardized residuals showed that a candidate reference material consisting of native lyophilized plasma with cryolyoprotectant was commutable for all measurement procedures. Mathematically simulated harmonization with this calibrator resulted in a maximum achievable equivalence of 7.7%.
CONCLUSIONS
The secondary reference material identified in this study has the potential to substantially improve equivalence between hepcidin measurement procedures and contributes to the establishment of a traceability chain that will ultimately allow standardization of hepcidin measurement results.
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Affiliation(s)
| | - Jan C M Hendriks
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Coby M Laarakkers
- Department of Laboratory Medicine and
- Hepcidinanalysis.com, Nijmegen, the Netherlands
| | | | - Andrew E Armitage
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK, and Blood Theme, NIHR Oxford Biomedical Research Centre, Oxford, UK
| | | | | | | | | | - Outi Itkonen
- Helsinki University Central Hospital, Laboratory Division HUSLAB, Helsinki, Finland
| | | | - Naohisa Tomosugi
- Division of Advanced Medicine, Medical Research Institute, Kanazawa Medical University, Ishikawa, Japan
| | | | | | | | - Hal Drakesmith
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK, and Blood Theme, NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Marianne Fillet
- Department of Analytical Pharmaceutical Chemistry, Institute of Pharmacy, University of Liège, Liège, Belgium
| | | | - Sant-Rayn Pasricha
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK, and Blood Theme, NIHR Oxford Biomedical Research Centre, Oxford, UK
| | | | | | - Franco Tagliaro
- Department of Diagnostics and Public Health, University of Verona, Italy
| | - Cas W Weykamp
- Department of Clinical Chemistry, Queen Beatrix Hospital, Winterswijk, the Netherlands
| | - Dorine W Swinkels
- Department of Laboratory Medicine and
- Hepcidinanalysis.com, Nijmegen, the Netherlands
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17
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Brigandi RA, Johnson B, Oei C, Westerman M, Olbina G, de Zoysa J, Roger SD, Sahay M, Cross N, McMahon L, Guptha V, Smolyarchuk EA, Singh N, Russ SF, Kumar S, Borsukov AV, Marasaev VV, Prasad G, Timokhovskaya GY, Kolmakova EV, Dobronravov VA, Zakharova EV, Abraham G, Packham D, Zateyshchikov DA, Arutyunov GP, Volgina GV, Lipatov KS, Perlin DV, Cooper B, Kumar Saha T, Zagrebelnaya OA, Mehta KS, Koziolova NA, Fassett R, Alexeeva NP, Lysenko LV. A Novel Hypoxia-Inducible Factor−Prolyl Hydroxylase Inhibitor (GSK1278863) for Anemia in CKD: A 28-Day, Phase 2A Randomized Trial. Am J Kidney Dis 2016; 67:861-71. [DOI: 10.1053/j.ajkd.2015.11.021] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 11/23/2015] [Indexed: 11/11/2022]
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Li H, Condon F, Kessler D, Nandi V, Rebosa M, Westerman M, Shaz BH, Ginzburg Y. Evidence of relative iron deficiency in platelet- and plasma-pheresis donors correlates with donation frequency. J Clin Apher 2016; 31:551-558. [PMID: 26915437 DOI: 10.1002/jca.21448] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 01/06/2016] [Accepted: 01/11/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND The loss of iron stores and resulting iron deficiency is well documented in whole blood or red blood cell donors. We hypothesized that relative iron deficiency also occurs as a result of more frequent platelet- and plasma-pheresis (apheresis) donation. MATERIALS AND METHODS To test this hypothesis, we proposed a pilot cross-sectional study to analyze erythropoiesis- and iron-related parameters in white male apheresis donors: (1) relative to controls, (2) in correlation with apheresis donation frequency, and (3) in correlation with pre-donation platelet count. RESULTS Fifty eligible apheresis donors and eight controls were enrolled in the study. Apheresis donors were found to have a lower serum ferritin and serum hepcidin and exhibited evidence of iron restricted erythropoiesis relative to controls. Furthermore, among donors, lower MCV, CHr , hepcidin concentration, and serum ferritin were observed in more frequent apheresis donors. Correlations between donation frequency and hepcidin and ferritin were noted in apheresis donors. CONCLUSIONS This pilot study demonstrates that apheresis donors are relatively iron deficient compared to controls and supports the premise that frequent apheresis donation correlates with relatively iron restricted erythropoiesis. An analysis of iron- and erythropoiesis-related parameters in a broader population of frequent apheresis donors (i.e., female and non-white donors) may demonstrate larger deficits and an even greater potential benefit of iron replacement. J. Clin. Apheresis 31:551-558, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Huihui Li
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York
| | - Frances Condon
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York
| | - Debra Kessler
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York
| | - Vijay Nandi
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York
| | - Mark Rebosa
- Blood Operations, New York Blood Center, New York, New York
| | | | - Beth H Shaz
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York
| | - Yelena Ginzburg
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York
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van Gelder M, van Oers MH, Alemayehu WG, Abrahamse-Testroote MCJ, Cornelissen JJ, Chamuleau ME, Zachée P, Hoogendoorn M, Nijland M, Petersen EJ, Beeker A, Timmers GJ, Verdonck L, Westerman M, de Weerdt O, Kater AP. Efficacy of cisplatin-based immunochemotherapy plus alloSCT in high-risk chronic lymphocytic leukemia: final results of a prospective multicenter phase 2 HOVON study. Bone Marrow Transplant 2016; 51:799-806. [DOI: 10.1038/bmt.2016.9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 12/22/2015] [Accepted: 12/31/2015] [Indexed: 12/21/2022]
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Handa P, Morgan-Stevenson V, Maliken BD, Nelson JE, Washington S, Westerman M, Yeh MM, Kowdley KV. Iron overload results in hepatic oxidative stress, immune cell activation, and hepatocellular ballooning injury, leading to nonalcoholic steatohepatitis in genetically obese mice. Am J Physiol Gastrointest Liver Physiol 2016; 310:G117-27. [PMID: 26564716 DOI: 10.1152/ajpgi.00246.2015] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/10/2015] [Indexed: 02/06/2023]
Abstract
The aim of this study was to determine the effect of iron overload in the development of nonalcoholic steatohepatitis (NASH) in a genetically obese mouse model (Lepr(db/db)). Leptin receptor-deficient mice were fed a normal or an iron-supplemented chow for 8 wk and switched to normal chow for 8 wk. All dietary iron (DI)-fed mice developed hepatic iron overload predominantly in the reticuloendothelial system. Hepatocellular ballooning injury was observed in the livers of 85% of DI mice, relative to 20% of chow-fed Lepr(db/db). Hepatic malonyldialdehyde levels and mRNA levels of antioxidant genes (Nrf2, Gpx1, and Hmox1) were significantly increased in the DI mice. Hepatic mRNA levels of mitochondrial biogenesis regulators Pgc1α, Tfam, Cox4, and Nrf1 were diminished in the DI mice. In addition, gene expression levels of cytokines (Il6, Tnfα) and several innate and adaptive immune cell markers such as Tlr4, Inos, CD11c, CD4, CD8, and Ifnγ were significantly increased in livers of the DI group. Strikingly, Nlrp3, a component of the inflammasome and Il18, a cytokine elicited by inflammasome activation, were significantly upregulated in the livers of DI mice. In addition, RAW 264.7 macrophages loaded with exogenous iron showed significantly higher levels of inflammatory markers (Inos, Tnfα, Mcp1, Tlr4). Thus dietary iron excess leads to hepatic oxidative stress, inflammasome activation, induction of inflammatory and immune mediators, hepatocellular ballooning injury, and therefore NASH in this model. Taken together, these studies indicate a multifactorial role for iron overload in the pathogenesis of NASH in the setting of obesity and metabolic syndrome.
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Affiliation(s)
- Priya Handa
- Liver Care Network and Organ Care Research, Swedish Medical Center, Seattle, Washington
| | | | | | | | | | | | - Matthew M Yeh
- Department of Pathology, University of Washington, Seattle, Washington
| | - Kris V Kowdley
- Liver Care Network and Organ Care Research, Swedish Medical Center, Seattle, Washington; Benaroya Research Institute, Seattle, Washington;
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21
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Lee S, Guillet R, Cooper EM, Westerman M, Orlando M, Kent T, Pressman E, O'Brien KO. Prevalence of anemia and associations between neonatal iron status, hepcidin, and maternal iron status among neonates born to pregnant adolescents. Pediatr Res 2016; 79:42-8. [PMID: 26383884 DOI: 10.1038/pr.2015.183] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 07/15/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Little is known about anemia and iron status in US newborns because screening for anemia is typically not undertaken until 1 y of age. This study was undertaken to characterize and identify determinants of iron status in newborns born to pregnant adolescents. METHODS Pregnant adolescents (≤ 18 y, n = 193) were followed from ≥ 12 wk gestation until delivery. Hemoglobin, ferritin, soluble transferrin receptor, serum iron, hepcidin, erythropoietin (EPO), IL-6, and C-reactive protein were assessed in maternal and cord blood. RESULTS At birth, 21% of the neonates were anemic (Hb < 13.0 g/dl) and 25% had low iron stores (ferritin < 76 µg/l). Cord serum ferritin concentrations were not significantly associated with gestational age (GA) at birth across the range of 37-42 wk. Neonates born to mothers with ferritin < 12 µg/l had significantly lower ferritin (P = 0.003) compared to their counterparts. Hepcidin and IL-6 were significantly (P < 0.05) higher in neonates born to mothers with longer durations of active labor. CONCLUSION Given the importance of the iron stores at birth on maintenance of iron homeostasis over early infancy, additional screening of iron status at birth is warranted among those born to this high risk obstetric population.
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Affiliation(s)
- Sunmin Lee
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Ronnie Guillet
- Department of Pediatrics, Neonatology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Elizabeth M Cooper
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | - Mark Orlando
- Department of Otolaryngology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Tera Kent
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Eva Pressman
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York
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Westerman M, Woolley PA. Comment on a research note reporting new populations of the northern quoll in Western Australia. Aust Mammalogy 2016. [DOI: 10.1071/am15024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The recent report by Turpin and Bamford (2015) notes a range extension for northern quolls in the Pilbara Bioregion of Western Australia. Mitochondrial DNA sequences derived from five scats show that the new individuals nest within a clade containing all other Pilbara animals. Northern quolls from the Pilbara Bioregion are genetically distinct from congeners from the Kimberley Bioregion. We note that there is no evidence for maternal gene flow between these two regions.
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Chen H, Choesang T, Li H, Sun S, Pham P, Bao W, Feola M, Westerman M, Li G, Follenzi A, Blanc L, Rivella S, Fleming RE, Ginzburg YZ. Increased hepcidin in transferrin-treated thalassemic mice correlates with increased liver BMP2 expression and decreased hepatocyte ERK activation. Haematologica 2015; 101:297-308. [PMID: 26635037 DOI: 10.3324/haematol.2015.127902] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 12/01/2015] [Indexed: 12/13/2022] Open
Abstract
Iron overload results in significant morbidity and mortality in β-thalassemic patients. Insufficient hepcidin is implicated in parenchymal iron overload in β-thalassemia and approaches to increase hepcidin have therapeutic potential. We have previously shown that exogenous apo-transferrin markedly ameliorates ineffective erythropoiesis and increases hepcidin expression in Hbb(th1/th1) (thalassemic) mice. We utilize in vivo and in vitro systems to investigate effects of exogenous apo-transferrin on Smad and ERK1/2 signaling, pathways that participate in hepcidin regulation. Our results demonstrate that apo-transferrin increases hepcidin expression in vivo despite decreased circulating and parenchymal iron concentrations and unchanged liver Bmp6 mRNA expression in thalassemic mice. Hepatocytes from apo-transferrin-treated mice demonstrate decreased ERK1/2 pathway and increased serum BMP2 concentration and hepatocyte BMP2 expression. Furthermore, hepatocyte ERK1/2 phosphorylation is enhanced by neutralizing anti-BMP2/4 antibodies and suppressed in vitro in a dose-dependent manner by BMP2, resulting in converse effects on hepcidin expression, and hepatocytes treated with MEK/ERK1/2 inhibitor U0126 in combination with BMP2 exhibit an additive increase in hepcidin expression. Lastly, bone marrow erythroferrone expression is normalized in apo-transferrin treated thalassemic mice but increased in apo-transferrin injected wild-type mice. These findings suggest that increased hepcidin expression after exogenous apo-transferrin is in part independent of erythroferrone and support a model in which apo-transferrin treatment in thalassemic mice increases BMP2 expression in the liver and other organs, decreases hepatocellular ERK1/2 activation, and increases nuclear Smad to increase hepcidin expression in hepatocytes.
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Affiliation(s)
- Huiyong Chen
- Erythropoiesis Laboratory, LFKRI, New York Blood Center, NY, USA
| | - Tenzin Choesang
- Erythropoiesis Laboratory, LFKRI, New York Blood Center, NY, USA
| | - Huihui Li
- Erythropoiesis Laboratory, LFKRI, New York Blood Center, NY, USA Central South University, Changsha, PR China
| | - Shuming Sun
- Erythropoiesis Laboratory, LFKRI, New York Blood Center, NY, USA
| | - Petra Pham
- Flow Cytometry Core Laboratory, LFKRI, New York Blood Center, NY, USA
| | - Weili Bao
- Erythropoiesis Laboratory, LFKRI, New York Blood Center, NY, USA
| | - Maria Feola
- Erythropoiesis Laboratory, LFKRI, New York Blood Center, NY, USA University of Piemonte Orientale, Amedeo Avogadro, Novara, Italy
| | | | - Guiyuan Li
- Central South University, Changsha, PR China
| | - Antonia Follenzi
- University of Piemonte Orientale, Amedeo Avogadro, Novara, Italy
| | - Lionel Blanc
- The Feinstein Institute for Medical Research, Manhasset, NY, USA
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24
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Mårtensson J, Glassford NJ, Jones S, Eastwood GM, Young H, Peck L, Ostland V, Westerman M, Venge P, Bellomo R. Urinary neutrophil gelatinase-associated lipocalin to hepcidin ratio as a biomarker of acute kidney injury in intensive care unit patients. Minerva Anestesiol 2015; 81:1192-1200. [PMID: 25479470] [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: 06/04/2023]
Abstract
BACKGROUND Labile iron is important in the pathogenesis of acute kidney injury (AKI). Neutrophil gelatinase-associated lipocalin (NGAL) and hepcidin control iron metabolism and are upregulated during renal stress. However, higher levels of urinary NGAL are associated with AKI severity whereas higher urinary hepcidin levels are associated with absence of AKI. We aimed to investigate the value of combining both biomarkers to estimate the severity and progression of AKI in intensive care unit (ICU) patients. METHODS Urinary NGAL and hepcidin were quantified within 48 hours of ICU admission in patients with the systemic inflammatory response syndrome and early kidney dysfunction (oliguria for ≥ 2 hours and/or a 25 µmol/L creatinine rise from baseline). Diagnostic and prognostic characteristics were assessed by logistic regression and receiver operating characteristics (ROC) analysis. RESULTS Of 102 patients, 26 had mild AKI and 28 patients had severe AKI on admission. Sepsis (21%), cardiac surgery (17%) and liver failure (9%) were primary admission diagnoses. NGAL increased (P=0.03) whereas hepcidin decreased (P=0.01) with increasing AKI severity. The value of NGAL/hepcidin ratio to detect severe AKI was higher than when NGAL and hepcidin were used individually and persisted after adjusting for potential confounders (adjusted OR 2.40, 95% CI 1.20-4.78). The ROC areas for predicting worsening AKI were 0.50, 0.52 and 0.48 for NGAL, 1/hepcidin and the NGAL/hepcidin ratio. CONCLUSION The NGAL/hepcidin ratio is more strongly associated with severe AKI than the single biomarkers alone. NGAL and hepcidin, alone or combined as a ratio, were unable to predict progressive AKI in this selected ICU cohort.
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Affiliation(s)
- J Mårtensson
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia -
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25
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Cao C, Pressman EK, Cooper EM, Guillet R, Westerman M, O'Brien KO. Prepregnancy Body Mass Index and Gestational Weight Gain Have No Negative Impact on Maternal or Neonatal Iron Status. Reprod Sci 2015; 23:613-22. [PMID: 26423600 DOI: 10.1177/1933719115607976] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess the impact of maternal obesity and excessive gestational weight gain (GWG) on maternal and neonatal iron status and to explore the possible mediating role of inflammation on hepcidin. METHODS This analysis included 230 pregnant adolescents (13-18 years) enrolled in either a longitudinal or a cross-sectional study. Prepregnancy body mass index (ppBMI) and GWG were obtained from medical records. Maternal iron status (hemoglobin, serum iron, ferritin, transferrin receptor, total body iron, and hepcidin) and inflammation (interleukin-6 [IL-6] and leptin) were assessed at midgestation (26.2 ± 3.3 weeks) in the longitudinal cohort and at delivery (39.8 ± 1.3 weeks) in both study cohorts. Cord blood was collected in both studies and analyzed for iron indicators. RESULTS Approximately 40% of the adolescents entered pregnancy overweight or obese. Multivariate analysis identified ppBMI as a negative predictor of serum iron at midgestation (P = .009) and a positive predictor of serum hepcidin at delivery (P = .02). None of the other maternal iron status indicators were significantly associated with ppBMI or GWG. Serum IL-6 was significantly positively associated with hepcidin at delivery (P = .0001) but not at midgestation. There was a positive relationship between ppBMI and cord hemoglobin (P = .03). CONCLUSION These results suggest that adiposity-related inflammation does not override the iron-mediated signals that regulate hepcidin production during pregnancy, and in this adolescent cohort, there is no strong evidence for a detrimental effect of maternal obesity and excessive weight gain on iron status in the offspring at birth.
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Affiliation(s)
- Chang Cao
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Eva K Pressman
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
| | - Elizabeth M Cooper
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
| | - Ronnie Guillet
- Department of Pediatrics, University of Rochester, Rochester, NY, USA
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26
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de Kruif A, op den Kelder-Verstraten I, Derks M, van den Berg M, de Vries Y, Kamps L, Winkels R, de Boer M, Visser M, Kampman E, Westerman M. 1960 The perceptions of women with breast cancer during treatment with chemotherapy on changes in weight; a mixed methods approach. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30908-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schmidt PJ, Racie T, Westerman M, Fitzgerald K, Butler JS, Fleming MD. Combination therapy with a Tmprss6 RNAi-therapeutic and the oral iron chelator deferiprone additively diminishes secondary iron overload in a mouse model of β-thalassemia intermedia. Am J Hematol 2015; 90:310-3. [PMID: 25557851 PMCID: PMC4403964 DOI: 10.1002/ajh.23934] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 12/24/2014] [Indexed: 02/06/2023]
Abstract
β-thalassemias result from diminished β-globin synthesis and are associated with ineffective erythropoiesis and secondary iron overload caused by inappropriately low levels of the iron regulatory hormone hepcidin. The serine protease TMPRSS6 attenuates hepcidin production in response to iron stores. Hepcidin induction reduces iron overload and mitigates anemia in murine models of β-thalassemia intermedia. To further interrogate the efficacy of an RNAi-therapeutic downregulating Tmprss6, β-thalassemic Hbbth3/+ animals on an iron replete, an iron deficient, or an iron replete diet also containing the iron chelator deferiprone were treated with Tmprss6 siRNA. We demonstrate that the total body iron burden is markedly improved in Hbbth3/+ animals treated with siRNA and chelated with oral deferiprone, representing a significant improvement compared to either compound alone. These data indicate that siRNA suppression of Tmprss6, in conjunction with oral iron chelation therapy, may prove superior for treatment of anemia and secondary iron loading seen in β-thalassemia intermedia. Am. J. Hematol. 90:310–313, 2015. © 2015 The Authors. American Journal of Hematology Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Paul J. Schmidt
- Department of PathologyBoston Children's Hospital and Harvard Medical SchoolBoston Massachusetts
| | - Tim Racie
- Alnylam Pharmaceuticals, Inc.Cambridge Massachusetts
| | | | | | | | - Mark D. Fleming
- Department of PathologyBoston Children's Hospital and Harvard Medical SchoolBoston Massachusetts
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Prowle JR, Calzavacca P, Licari E, Ligabo EV, Echeverri JE, Bagshaw SM, Haase-Fielitz A, Haase M, Ostland V, Noiri E, Westerman M, Devarajan P, Bellomo R. Combination of biomarkers for diagnosis of acute kidney injury after cardiopulmonary bypass. Ren Fail 2015; 37:408-16. [PMID: 25585949 DOI: 10.3109/0886022x.2014.1001303] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Novel acute kidney injury (AKI) biomarkers offer promise of earlier diagnosis and risk stratification, but have yet to find widespread clinical application. We measured urinary α and π glutathione S-transferases (α-GST and π-GST), urinary l-type fatty acid-binding protein (l-FABP), urinary neutrophil gelatinase-associated lipocalin (NGAL), urinary hepcidin and serum cystatin c (CysC) before surgery, post-operatively and at 24 h after surgery in 93 high risk patient undergoing cardiopulmonary bypass (CPB) and assessed the ability of these biomarkers alone and in combination to predict RIFLE-R defined AKI in the first 5 post-operative days. Twenty-five patients developed AKI. π-GST (ROCAUC = 0.75), lower urine Hepcidin:Creatine ratio at 24 h (0.77), greater urine NGAL:Cr ratio post-op (0.73) and greater serum CysC at 24 h (0.72) best predicted AKI. Linear combinations with significant improvement in AUC were: Hepcidin:Cr 24 h + post-operative π-GST (AUC = 0.86, p = 0.01), Hepcidin:Cr 24 h + NGAL:Cr post-op (0.84, p = 0.03) and CysC 24 h + post-operative π-GST (0.83, p = 0.03), notably these significant biomarkers combinations all involved a tubular injury and a glomerular filtration biomarker. Despite statistical significance in receiver-operator characteristic (ROC) analysis, when assessed by ability to define patients to two groups at high and low risk of AKI, combinations failed to significantly improve classification of risk compared to the best single biomarkers. In an alternative approach using Classification and Regression Tree (CART) analysis a model involving NGAL:Cr measurement post-op followed by Hepcidin:Cr at 24 h was developed which identified high, intermediate and low risk groups for AKI. Regression tree analysis has the potential produce models with greater clinical utility than single combined scores.
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Lorenz L, Müller KF, Poets CF, Peter A, Olbina G, Westerman M, Franz AR. Short-Term Effects of Blood Transfusions on Hepcidin in Preterm Infants. Neonatology 2015; 108:205-10. [PMID: 26304233 DOI: 10.1159/000437132] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 06/23/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Hepcidin, a key regulatory peptide hormone in iron homeostasis, may in future serve as a non-invasive iron status parameter for monitoring iron supplementation in preterm infants. For this, coexisting influencing factors should be taken into account. OBJECTIVES To evaluate the short-term effects of red blood cell (RBC) transfusions on hepcidin concentrations in serum (HepS) and urine (HepU) of preterm infants. METHODS This was a prospective, observational study conducted between May 2009 and September 2010 at a single neonatal unit (Tübingen University Hospital, Tübingen, Germany) in very preterm infants, i.e. with a gestational age (GA) of <32 weeks, who received clinically indicated RBC transfusions. The concentration of the mature, 25 amino-acid form of hepcidin was determined in serum und urine by competitive enzyme-linked immunosorbent assay together with cellular indices before and after transfusion. RESULTS Twenty preterm infants born at a median GA of 26 + 0/7 (interquartile range: 24 + 6/7 to 27 + 3/7) weeks received 27 RBC transfusions at a median corrected age of 31 + 3/7 (29 + 6/7 to 34 + 5/7) weeks. When measured shortly after transfusion (mean time: 10 h), haematocrit values increased from a mean of 26.6% (SD 2.8) to 40.9% (SD 3.2); p < 0.0001. HepS also increased [geometric mean: 44.3 (95% confidence interval 30.8-63.8) ng/ml vs. 58.0 (35.7-94.3) ng/ml; p < 0.05] but HepU remained unaffected. CONCLUSION The data indicate that HepS concentrations increase shortly after RBC transfusion in preterm infants. Long-term observational studies are needed to understand the dynamics of hepcidin regulation in preterm infants.
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Affiliation(s)
- Laila Lorenz
- Department of Neonatology, University Children's Hospital of Tx00FC;bingen, Tx00FC;bingen, Germany
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30
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Gutschow P, Schmidt PJ, Han H, Ostland V, Bartnikas TB, Pettiglio MA, Herrera C, Butler JS, Nemeth E, Ganz T, Fleming MD, Westerman M. A competitive enzyme-linked immunosorbent assay specific for murine hepcidin-1: correlation with hepatic mRNA expression in established and novel models of dysregulated iron homeostasis. Haematologica 2014; 100:167-77. [PMID: 25425686 DOI: 10.3324/haematol.2014.116723] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Mice have been essential for distinguishing the role of hepcidin in iron homeostasis. Currently, investigators monitor levels of murine hepatic hepcidin-1 mRNA as a surrogate marker for the bioactive hepcidin protein itself. Here, we describe and validate a competitive, enzyme-linked immunosorbent assay that quantifies hepcidin-1 in mouse serum and urine. The assay exhibits a biologically relevant lower limit of detection, high precision, and excellent linearity and recovery. We also demonstrate correlation between serum and urine hepcidin-1 values and validate the competitive enzyme-linked immunosorbent assay by analyzing plasma hepcidin response of mice to physiological challenges, including iron deficiency, iron overload, acute blood loss, and inflammation. Furthermore, we analyze multiple murine genetic models of iron dysregulation, including β-thalassemia intermedia (Hbb(th3/+)), hereditary hemochromatosis (Hfe(-/-), Hjv(-/-), and Tfr2(Y245X/Y245X)), hypotransferrinemia (Trf(hpx/hpx)), heterozygous transferrin receptor 1 deficiency (Tfrc(+/-)) and iron refractory iron deficiency anemia (Tmprss6(-/-) and Tmprss6(hem8/hem8)). Novel compound iron metabolism mutants were also phenotypically characterized here for the first time. We demonstrate that serum hepcidin concentrations correlate with liver hepcidin mRNA expression, transferrin saturation and non-heme liver iron. In some circumstances, serum hepcidin-1 more accurately predicts iron parameters than hepcidin mRNA, and distinguishes smaller, statistically significant differences between experimental groups.
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Affiliation(s)
| | - Paul J Schmidt
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | | | | | - Thomas B Bartnikas
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI
| | - Michael A Pettiglio
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI
| | - Carolina Herrera
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI
| | | | - Elizabeta Nemeth
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Tomas Ganz
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Mark D Fleming
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA
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31
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Guimarães JS, Cominal JG, Silva-Pinto AC, Olbina G, Ginzburg YZ, Nandi V, Westerman M, Rivella S, de Souza AM. Altered erythropoiesis and iron metabolism in carriers of thalassemia. Eur J Haematol 2014; 94:511-8. [PMID: 25307880 DOI: 10.1111/ejh.12464] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2014] [Indexed: 12/13/2022]
Abstract
The thalassemia syndromes (α- and β-thalassemia) are the most common and frequent disorders associated with ineffective erythropoiesis. Imbalance of α- or β-globin chain production results in impaired red blood cell synthesis, anemia, and more erythroid progenitors in the blood stream. While patients affected by these disorders show definitive altered parameters related to erythropoiesis, the relationship between the degree of anemia, altered erythropoiesis, and dysfunctional iron metabolism has not been investigated in both α-thalassemia carriers (ATC) and β-thalassemia carriers (BTC). Here, we demonstrate that ATC have a significantly reduced hepcidin and increased soluble transferrin receptor levels but relatively normal hematological findings. In contrast, BTC have several hematological parameters significantly different from controls, including increased soluble transferrin receptor and erythropoietin levels. These changes in both groups suggest an altered balance between erythropoiesis and iron metabolism. The index sTfR/log ferritin and (hepcidin/ferritin)/sTfR are, respectively, increased and reduced relative to controls, proportional to the severity of each thalassemia group. In conclusion, we showed in this study, for the first time in the literature, that thalassemia carriers have altered iron metabolism and erythropoiesis.
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Affiliation(s)
- Jacqueline S Guimarães
- Laboratório de Hematologia Clínica, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.,The Strauss Thalassemia Laboratory, Pediatric Hematology-Oncology, Weill Medical College of Cornell University, New York, NY, USA
| | - Juçara G Cominal
- Laboratório de Hematologia Clínica, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Ana Cristina Silva-Pinto
- Centro Regional de Hemoterapia de Ribeirão Preto, Departamento de Medicina Interna, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | | | | | | | | | - Stefano Rivella
- The Strauss Thalassemia Laboratory, Pediatric Hematology-Oncology, Weill Medical College of Cornell University, New York, NY, USA
| | - Ana Maria de Souza
- Laboratório de Hematologia Clínica, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
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Lee S, Guillet R, Cooper EM, Westerman M, Orlando M, Pressman E, O'Brien KO. Maternal inflammation at delivery affects assessment of maternal iron status. J Nutr 2014; 144:1524-32. [PMID: 25080540 DOI: 10.3945/jn.114.191445] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Pregnant adolescents (aged ≤ 18 y, n = 253) were followed from ≥ 12 wk of gestation to delivery to assess longitudinal changes in anemia and iron status and to explore associations between iron status indicators, hepcidin, and inflammatory markers. Hemoglobin, soluble transferrin receptor (sTfR), ferritin, serum iron, erythropoietin (EPO), hepcidin, C-reactive protein, interleukin-6 (IL-6), folate, and vitamin B-12 were measured, and total body iron (TBI) (milligrams per kilogram) was calculated using sTfR and ferritin values. Anemia prevalence increased from trimesters 1 and 2 (3-5%, <28 wk) to trimester 3 (25%, 33.2 ± 3.7 wk, P < 0.0001). The prevalence of iron deficiency (sTfR > 8.5 mg/L) doubled from pregnancy to delivery (7% to 14%, P = 0.04). Ferritin and hepcidin concentrations at delivery may have been elevated as a consequence of inflammation because IL-6 concentrations at delivery were 1.6-fold higher than those obtained at 26.1 ± 3.3 wk of gestation (P < 0.0001), and a positive association was found between IL-6 and both hepcidin and ferritin at delivery (P < 0.01). EPO was consistently correlated with hemoglobin (r = -0.36 and -0.43, P < 0.001), ferritin (r = -0.37 and -0.32, P < 0.0001), sTfR (r = 0.35 and 0.25, P < 0.001), TBI (r = -0.44 and -0.37, P < 0.0001), and serum iron (r = -0.22 and -0.16, P < 0.05) at mid-gestation and at delivery, respectively. EPO alone explained the largest proportion of variance in hemoglobin at 26.0 ± 3.3 wk of gestation (R(2) = 0.13, P = 0.0001, n = 113) and at delivery (R(2) = 0.19, P < 0.0001, n = 192). Pregnant adolescents are at high risk of anemia. EPO is a sensitive indicator of iron status across gestation, is not affected by systemic inflammation, and may better predict risk of anemia at term. The trial was registered at clinicaltrials.gov as NCT01019902.
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Affiliation(s)
- Sunmin Lee
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Ronnie Guillet
- University of Rochester School of Medicine and Dentistry, Rochester, NY; and
| | - Elizabeth M Cooper
- University of Rochester School of Medicine and Dentistry, Rochester, NY; and
| | | | - Mark Orlando
- University of Rochester School of Medicine and Dentistry, Rochester, NY; and
| | - Eva Pressman
- University of Rochester School of Medicine and Dentistry, Rochester, NY; and
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Mebius M, Westerman M, Smorenburg CH. Skin lesions in a patient with multiple myeloma. Neth J Med 2014; 72:330-334. [PMID: 25319859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- M Mebius
- Department of Internal Medicine, Rijnland Hospital, Leiderdorp, the Netherlands
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Cao C, Pressman EK, Cooper EM, Guillet R, Westerman M, O'Brien KO. Placental heme receptor LRP1 correlates with the heme exporter FLVCR1 and neonatal iron status. Reproduction 2014; 148:295-302. [PMID: 24947444 DOI: 10.1530/rep-14-0053] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
LDL receptor-related protein 1 (LRP1) is a transmembrane receptor highly expressed in human placenta. It was recently found to be the receptor for heme and its plasma-binding protein hemopexin (Hx) and is integral to systemic heme clearance. Little is known about systemic concentrations of Hx during pregnancy and whether maternal Hx and placental LRP1 contributes to fetal iron (Fe) homeostasis during pregnancy. We hypothesized that placental LRP1 would be upregulated in maternal/neonatal Fe insufficiency and would be related to maternal circulating Hx. Placental LRP1 expression was assessed in 57 pregnant adolescents (14-18 years) in relationship with maternal and cord blood Fe status indicators (hemoglobin (Hb), serum ferritin, transferrin receptor), the Fe regulatory hormone hepcidin and serum Hx. Hx at mid-gestation correlated positively with Hb at mid-gestation (r=0.35, P=0.02) and Hx at delivery correlated positively with cord hepcidin (r=0.37, P=0.005). Placental LRP1 protein expression was significantly higher in women who exhibited greater decreases in serum Hx from mid-gestation to term (r=0.28, P=0.04). Significant associations were also found between placental LRP1 protein with cord hepcidin (r=-0.29, P=0.03) and placental heme exporter feline leukemia virus C receptor 1 (r=0.34, P=0.03). Our data are consistent with a role for placental heme Fe utilization in supporting fetal Fe demands.
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Affiliation(s)
- Chang Cao
- Division of Nutritional SciencesCornell University, 230 Savage Hall, Ithaca, New York 14853, USASchool of MedicineUniversity of Rochester, Rochester, New York, USAIntrinsic LifeSciencesLa Jolla, California, USA
| | - Eva K Pressman
- Division of Nutritional SciencesCornell University, 230 Savage Hall, Ithaca, New York 14853, USASchool of MedicineUniversity of Rochester, Rochester, New York, USAIntrinsic LifeSciencesLa Jolla, California, USA
| | - Elizabeth M Cooper
- Division of Nutritional SciencesCornell University, 230 Savage Hall, Ithaca, New York 14853, USASchool of MedicineUniversity of Rochester, Rochester, New York, USAIntrinsic LifeSciencesLa Jolla, California, USA
| | - Ronnie Guillet
- Division of Nutritional SciencesCornell University, 230 Savage Hall, Ithaca, New York 14853, USASchool of MedicineUniversity of Rochester, Rochester, New York, USAIntrinsic LifeSciencesLa Jolla, California, USA
| | - Mark Westerman
- Division of Nutritional SciencesCornell University, 230 Savage Hall, Ithaca, New York 14853, USASchool of MedicineUniversity of Rochester, Rochester, New York, USAIntrinsic LifeSciencesLa Jolla, California, USA
| | - Kimberly O O'Brien
- Division of Nutritional SciencesCornell University, 230 Savage Hall, Ithaca, New York 14853, USASchool of MedicineUniversity of Rochester, Rochester, New York, USAIntrinsic LifeSciencesLa Jolla, California, USA
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Neves FMDO, Leite TT, Meneses GC, Araujo De Souza NH, Martins AMC, Parahyba MC, Queiroz REB, Liborio A, Liu Y, Li Y, Li X, Chen L, Zulkarnaev A, Vatazin A, Nikolaj S, Stadler T, Raddatz A, Hubner W, Poppleton A, Fliser D, Klingele M, Castellano G, Intini A, Stasi A, Divella C, Pontrelli P, Gigante M, Zito A, Pertosa GB, Gesualdo L, Grandaliano G, Powell TC, Donnelly JP, Wang HE, Warnock DG, De Loor J, Hoste E, Herck I, Francois K, Decrop L, Clauwaert C, Bracke S, Vermeiren D, Demeyere K, Meyer E, Mitra P, Rahim MA, Gupta RD, Samdani TS, Rahman SA, Enam SF, Mursalin G, E-Khoda MM, Haque WMM, Iqbal S, Mansur MA, Guglielmetti G, Cena T, Musetti C, Quaglia M, Battista M, Radin E, Airoldi A, Izzo C, Stratta P, Haase-Fielitz A, Albert C, Westphal S, Hoffmann J, Mertens PR, Plass M, Westerman M, Bellomo R, Maisel A, Ronco C, Haase M, Wu PC, Wu VC, Prasad B, Wong B, St.Onge JR, Rungta R, Das P, Ray DS, Gupta S, De Gracia MDC, Osuna A, Quesada A, Manzano F, Montoro S, Jimenez MDM, Wangensteen R, Strunk AK, Schmidt J, Schmidt B, Bode-Boger S, Martens-Lobenhoffer J, Welte T, Kielstein JT, Wang AY, Bellomo R, Cass A, Myburgh J, Finfer S, Gatta D, Chadban S, Jardine M, Lo S, Barzi F, Gallagher M, Marn-Pernat A, Benedik M, Bren A, Buturovic-Ponikvar J, Gubensek J, Knap B, Premru V, Ponikvar R, Koba L, Teixeira M, Macedo E, Altunoren O, Balli M, Tasolar H, Eren N, Arpaci A, Caglayan CE, Yavuz YC, Sahin M, Gliga ML, Gliga PM, Frigy A, Bandea A, Magdas AM, Dogaru G, Mergulhao C, Pinheiro H, Vidal E, Sette L, Amorim G, Fernandes G, Valente L, Hornum M, Penninga L, Rasmussen A, Plagborg UB, Oturai P, Feldt-Rasmussen B, Hillingso JG, Klimenko A, Villevalde S, Kobalava Z, Arias Cabrales C, Rodriguez E, Bermejo S, Sierra A, Pascual J, Huang TM, Wu VC, Oh WC, Rigby M, Mafrici B, Sharman A, Harvey D, Welham S, Mahajan R, Gardner D, Devonald M, Wu VC, Lin MC, Wu PC, Wu CH, Nagaraja P, Clark A, Brisk R, Jennings V, Jones H, Hashmi M, Parker C, Mikhail A, Schraut J, Keller F, Mertens T, Duprel JB, Quercia AD, Cantaluppi V, Dellepiane S, Pacitti A, Biancone L, Chang KY, Park HS, Kim HW, Choi BS, Park CW, Yang CW, Jin DC, Quercia AD, Cantaluppi V, Dellepiane S, Medica D, Besso L, Gai M, Leonardi G, Guarena C, Biancone L, Obrencevic K, Jovanovic D, Petrovic M, Ignjatovic L, Tadic J, Mijuskovic M, Maksic D, Vavic N, Pilcevic D, Mistry HD, Bramham K, Seed PT, Lynham S, Ward MA, Poston L, Chappell LC. CLINICAL ACUTE KIDNEY INJURY 1. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lee S, Guillet R, Cooper E, Westerman M, Orlando M, Pressman E, O'Brien K. Prevalence of anemia and iron deficiency among pregnant adolescents (1024.10). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.1024.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sunmin Lee
- Division of Nutritional SciencesCornell UniversityITHACANYUnited States
| | - Ronnie Guillet
- Neonatology University of RochesterSchool of Medicine and DentistryRochesterNYUnited States
| | - Elizabeth Cooper
- Obstetrics and GynecologyUniversity of RochesterSchool of Medicine and DentistryRochesterNYUnited States
| | | | - Mark Orlando
- Audiology University of RochesterSchool of Medicine and DentistryRochesterNYUnited States
| | - Eva Pressman
- Obstetrics and GynecologyUniversity of RochesterSchool of Medicine and DentistryRochesterNYUnited States
| | - Kimberly O'Brien
- Division of Nutritional SciencesCornell UniversityITHACANYUnited States
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Fertrin KY, Lanaro C, Franco-Penteado CF, de Albuquerque DM, de Mello MRB, Pallis FR, Bezerra MAC, Hatzlhofer BLD, Olbina G, Olalla Saad ST, da Silva Araújo A, Westerman M, Costa FF. Erythropoiesis-driven regulation of hepcidin in human red cell disorders is better reflected through concentrations of soluble transferrin receptor rather than growth differentiation factor 15. Am J Hematol 2014; 89:385-90. [PMID: 24860871 DOI: 10.1002/ajh.23649] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Growth differentiation factor 15 (GDF-15) is a bone marrow-derived cytokine whose ability to suppress iron regulator hepcidin in vitro and increased concentrations found in patients with ineffective erythropoiesis (IE)suggest that hepcidin deficiency mediated by GDF-15 may be the pathophysiological explanation for nontransfusional iron overload. We aimed to compare GDF-15 production in anemic states with different types of erythropoietic dysfunction. Complete blood counts, biochemical markers of iron status, plasma hepcidin, GDF-15, and known hepcidin regulators [interleukin-6 and erythropoietin (EPO)] were measured in 87 patients with red cell disorders comprising IE and hemolytic states: thalassemia, sickle cell anemia, and cobalamin deficiency. Healthy volunteers were also evaluated for comparison. Neither overall increased EPO,nor variable GDF-15 concentrations correlated with circulating hepcidin concentrations (P = 0.265 and P = 0.872). Relative hepcidin deficiency was found in disorders presenting with concurrent elevation of GDF-15 and soluble transferrin receptor (sTfR), a biomarker of erythropoiesis, and sTfR had the strongest correlation with hepcidin (r(s) = 0.584, P < 0.0001). Our data show that high concentrations of GDF-15 in vivo are not necessarily associated with pathological hepcidin reduction, and hepcidin deficiency was only found when associated with sTfR overproduction. sTfR elevation may be a necessary common denominator of erythropoiesis-driven mechanisms to favor iron absorption in anemic states and appears a suitable target for investigative approaches to iron disorders.
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Affiliation(s)
- Kleber Yotsumoto Fertrin
- Instituto Nacional de Ciência e Tecnologia do Sangue (INCTS), Hematology and Hemotherapy Center; University of Campinas; Campinas Brazil
| | - Carolina Lanaro
- Instituto Nacional de Ciência e Tecnologia do Sangue (INCTS), Hematology and Hemotherapy Center; University of Campinas; Campinas Brazil
| | - Carla Fernanda Franco-Penteado
- Instituto Nacional de Ciência e Tecnologia do Sangue (INCTS), Hematology and Hemotherapy Center; University of Campinas; Campinas Brazil
| | - Dulcinéia Martins de Albuquerque
- Instituto Nacional de Ciência e Tecnologia do Sangue (INCTS), Hematology and Hemotherapy Center; University of Campinas; Campinas Brazil
| | - Mariana Rezende Bandeira de Mello
- Instituto Nacional de Ciência e Tecnologia do Sangue (INCTS), Hematology and Hemotherapy Center; University of Campinas; Campinas Brazil
| | - Flávia Rubia Pallis
- Instituto Nacional de Ciência e Tecnologia do Sangue (INCTS), Hematology and Hemotherapy Center; University of Campinas; Campinas Brazil
| | | | | | | | - Sara Terezinha Olalla Saad
- Instituto Nacional de Ciência e Tecnologia do Sangue (INCTS), Hematology and Hemotherapy Center; University of Campinas; Campinas Brazil
| | | | | | - Fernando Ferreira Costa
- Instituto Nacional de Ciência e Tecnologia do Sangue (INCTS), Hematology and Hemotherapy Center; University of Campinas; Campinas Brazil
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Lorenz L, Herbst J, Engel C, Peter A, Abele H, Poets CF, Westerman M, Franz AR. Gestational age-specific reference ranges of hepcidin in cord blood. Neonatology 2014; 106:133-9. [PMID: 24993575 DOI: 10.1159/000360072] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 01/28/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Iron deficiency (ID) contributes to anaemia of prematurity, and hence the reliable assessment of iron nutrition status appears to be mandatory. OBJECTIVE To establish gestational age (GA)-specific reference ranges for hepcidin concentrations in cord blood [Hep(CB)] of preterm and term infants and to identify pre- and perinatal confounding factors. METHODS This is a prospective observational study including 221 infants (GA at birth: 24-42 weeks). Hep(CB) along with complete blood counts, ferritin and parameters of inflammation and clinical data were recorded. Data are presented as medians (IQR). RESULTS The Hep(CB) of very preterm infants (GA <30 weeks, n = 40) was 26.9 ng/ml (13.5-63.1), for moderately preterm infants (GA 30-36 weeks, n = 81) it was 45.9 ng/ml (24.7-74.5) and for term infants (GA ≥37 weeks, n = 100) it was 103.9 ng/ml (61.4-149.2). The Hep(CB) of infants with ID was lower [36.9 ng/ml (18.0-58.3)] than that of iron-replete infants [86.6 ng/ml (51.9-143.8)]. The Hep(CB) of infants delivered by elective caesarean section was lower [38.3 ng/ml (15.5-73.7)] than that of infants after spontaneous vaginal delivery or secondary caesarean section [80.3 ng/ml (48.5-137.6)]. Infants with a standard deviation score for birth weight (SDSBW) <-2 had a lower Hep(CB) [23.1 ng/ml (11.7-61.5)] compared to infants with SDSBW ≥-2 [71.1 ng/ml (34.0-121.7)]. The highest Hep(CB) (437.6 ng/ml) was recorded in an infant with Enterococcus faecalis sepsis. Multiple logistic regression analysis confirmed ferritin, GA and mode of delivery as important factors associated with Hep(CB). CONCLUSION This is the first report on GA-specific reference ranges for Hep(CB) in preterm infants. Whereas iron stores, GA and mode of delivery were associated with Hep(CB), the association with inflammation and intra-uterine growth retardation was less clear.
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Affiliation(s)
- Laila Lorenz
- Department of Neonatology, University Children's Hospital of Tübingen, Tübingen, Germany
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Bacchetta J, Zaritsky JJ, Sea JL, Chun RF, Lisse TS, Zavala K, Nayak A, Wesseling-Perry K, Westerman M, Hollis BW, Salusky IB, Hewison M. Suppression of iron-regulatory hepcidin by vitamin D. J Am Soc Nephrol 2013; 25:564-72. [PMID: 24204002 DOI: 10.1681/asn.2013040355] [Citation(s) in RCA: 209] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The antibacterial protein hepcidin regulates the absorption, tissue distribution, and extracellular concentration of iron by suppressing ferroportin-mediated export of cellular iron. In CKD, elevated hepcidin and vitamin D deficiency are associated with anemia. Therefore, we explored a possible role for vitamin D in iron homeostasis. Treatment of cultured hepatocytes or monocytes with prohormone 25-hydroxyvitamin D or active 1,25-dihydroxyvitamin D decreased expression of hepcidin mRNA by 0.5-fold, contrasting the stimulatory effect of 25-hydroxyvitamin D or 1,25-dihydroxyvitamin D on related antibacterial proteins such as cathelicidin. Promoter-reporter and chromatin immunoprecipitation analyses indicated that direct transcriptional suppression of hepcidin gene (HAMP) expression mediated by 1,25-dihydroxyvitamin D binding to the vitamin D receptor caused the decrease in hepcidin mRNA levels. Suppression of HAMP expression was associated with a concomitant increase in expression of the cellular target for hepcidin, ferroportin protein, and decreased expression of the intracellular iron marker ferritin. In a pilot study with healthy volunteers, supplementation with a single oral dose of vitamin D (100,000 IU vitamin D2) increased serum levels of 25D-hydroxyvitamin D from 27±2 ng/ml before supplementation to 44±3 ng/ml after supplementation (P<0.001). This response was associated with a 34% decrease in circulating levels of hepcidin within 24 hours of vitamin D supplementation (P<0.05). These data show that vitamin D is a potent regulator of the hepcidin-ferroportin axis in humans and highlight a potential new strategy for the management of anemia in patients with low vitamin D and/or CKD.
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Wumkes ML, van der Velden AMT, van der Velden AWG, Stouthard JML, Nijziel MR, Westerman M, Beeker A, Meerveld-Eggink A, Rijkers GT, Biesma DH. Influenza vaccination coverage in patients treated with chemotherapy: current clinical practice. Neth J Med 2013; 71:472-477. [PMID: 24218421] [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: 06/02/2023]
Abstract
BACKGROUND Influenza virus vaccination is recommended for patients treated with chemotherapy. Little is known about vaccination coverage in these patients. METHODS Vaccination coverage in the Netherlands was analysed by questionnaires completed by general practitioners, within a catchment area of 1.3 million people, in the period 2010-2011. RESULTS Of 433 eligible adult patients treated with chemotherapy for breast or colorectal cancer, 144 patients gave permission for us to approach their general practitioner with a questionnaire. General practitioners were asked about vaccination coverage, awareness of recommendations and their opinion about the responsibility for vaccination. We received 114 (79%) completed questionnaires. Sixty-seven out of 114 patients (59%) were vaccinated against influenza. Forty-four (66%) of these patients also had an indication for vaccination based on age (age ≥60 years). According to 48% of the general practitioners, the responsibility for vaccination belongs to the competence of the treating medical oncologist. CONCLUSION Influenza vaccination coverage is limited to 59% of patients treated with chemotherapy. Guidelines for responsibility (general practitioner or medical oncologist) may increase the vaccination rate of cancer patients.
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Affiliation(s)
- M L Wumkes
- Department of Internal Medicine, Tergooi Hospitals Hilversum, the Netherlands
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Haase-Fielitz A, Westphal S, Bellomo R, Devarajan P, Westerman M, Mertens P, Haase M. Tubular damage biomarkers linked to inflammation or iron metabolism predict acute kidney injury. Crit Care 2013. [DOI: 10.1186/cc12352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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du Perron LJ, Westerman M, Issa A, Smorenburg CH. Unresectable pancreatic tumour? The issue is tissue. Neth J Med 2013; 71:81-83. [PMID: 23462056] [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: 06/01/2023]
Abstract
The majority of tumours in the pancreas are adenocarcinomas for which therapeutic options are limited and which are associated with an unsatisfactory prognosis. However, alternative diagnoses may result in other therapeutic approaches with often a more favourable outcome. Hence, it is crucial to obtain a histological diagnosis before a definitive therapeutic plan can be devised. In this manuscript, a small series of pancreatic tumours other than adenocarcinoma are described.
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Affiliation(s)
- L J du Perron
- Department of Internal Medicine, Medical Centre Alkmaar, The Netherlands.
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Mast AE, Schlumpf KS, Wright DJ, Johnson B, Glynn SA, Busch MP, Olbina G, Westerman M, Nemeth E, Ganz T. Hepcidin level predicts hemoglobin concentration in individuals undergoing repeated phlebotomy. Haematologica 2013; 98:1324-30. [PMID: 23445875 DOI: 10.3324/haematol.2012.070979] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Dietary iron absorption is regulated by hepcidin, an iron regulatory protein produced by the liver. Hepcidin production is regulated by iron stores, erythropoiesis and inflammation, but its physiology when repeated blood loss occurs has not been characterized. Hepcidin was assayed in plasma samples obtained from 114 first-time/reactivated (no blood donations in preceding 2 years) female donors and 34 frequent (≥3 red blood cell donations in preceding 12 months) male donors as they were phlebotomized ≥4 times over 18-24 months. Hepcidin levels were compared to ferritin and hemoglobin levels using multivariable repeated measures regression models. Hepcidin, ferritin and hemoglobin levels declined with increasing frequency of donation in the first-time/reactivated females. Hepcidin and ferritin levels correlated well with each other (Spearman's correlation of 0.74), but on average hepcidin varied more between donations for a given donor relative to ferritin. In a multivariable repeated measures regression model the predicted inter-donation decline in hemoglobin varied as a function of hepcidin and ferritin; hemoglobin was 0.51 g/dL lower for subjects with low (>45.7 ng/mL) or decreasing hepcidin and low ferritin (>26 ng/mL), and was essentially zero for other subjects including those with high (>45.7 ng/mL) or increasing hepcidin and low ferritin (>26 ng/mL) levels (P<0.001). In conclusion, hepcidin levels change rapidly in response to dietary iron needed for erythropoiesis. The dynamic regulation of hepcidin in the presence of a low levels of ferritin suggests that plasma hepcidin concentration may provide clinically useful information about an individual's iron status (and hence capacity to tolerate repeated blood donations) beyond that of ferritin alone. Clinicaltrials.gov identifier: NCT00097006.
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Affiliation(s)
- Alan E Mast
- Blood Research Institute, Blood Center of Wisconsin, Milwaukee, WI, USA.
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Khuong-Quang DA, Schwartzentruber J, Westerman M, Lepage P, Finberg KE, Majewski J, Jabado N. Iron refractory iron deficiency anemia: presentation with hyperferritinemia and response to oral iron therapy. Pediatrics 2013; 131:e620-5. [PMID: 23319530 PMCID: PMC3675830 DOI: 10.1542/peds.2012-1303] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Iron-refractory iron-deficiency anemia (IRIDA) is an autosomal recessive disorder caused by mutations in TMPRSS6. Patients have hypochromic microcytic anemia refractory to oral iron and are only partially responsive to parenteral iron administration. We report a French-Canadian kindred in which 2 siblings presented in early childhood with severe microcytic anemia, hypoferremia, and hyperferritinemia. Both children have been successfully treated solely with low-dose oral iron since diagnosis. Clinical and biological presentation did not fit any previously described genetic iron-deficiency anemia. Whole exome sequencing identified in both patients compound heterozygous mutations of TMPRSS6 leading to p.G442R and p.E522K, 2 mutations previously reported to cause classic IRIDA, and no additional mutations in known iron-regulatory genes. Thus, the phenotype associated with the unique combination of mutations uncovered in both patients expands the spectrum of disease associated with TMPRSS6 mutations to include iron deficiency anemia that is accompanied by hyperferritinemia at initial presentation and is responsive to continued oral iron therapy. Our results have implications for genetic testing in early childhood iron deficiency anemia. Importantly, they emphasize that whole exome sequencing can be used as a diagnostic tool and greatly facilitate the elucidation of the genetic basis of unusual clinical presentations, including hypomorphic mutations or compound heterozygosity leading to different phenotypes in known Mendelian diseases.
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Affiliation(s)
| | | | | | - Pierre Lepage
- McGill University and Genome Quebec Innovation Centre, Montreal, Canada
| | - Karin E. Finberg
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina
| | - Jacek Majewski
- Department of Human Genetics, and ,McGill University and Genome Quebec Innovation Centre, Montreal, Canada
| | - Nada Jabado
- Department of Human Genetics, and ,Pediatrics, McGill University, Montreal, Canada
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Woolley PA, Haslem A, Westerman M. Past and present distribution of Dasycercus: toward a better understanding of the identity of specimens in cave deposits and the conservation status of the currently recognised species D. blythi and D. cristicauda (Marsupialia : Dasyuridae). AUST J ZOOL 2013. [DOI: 10.1071/zo13034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Maps of the distribution of the two currently recognised species of Dasycercus, D. blythi and D. cristicauda have been prepared following correct identification based on tail morphology of specimens in the modern collections of all Australian museums. Localities in which the remains of Dasycercus have been found in cave deposits have also been mapped and an attempt made to determine the specific identity of some of these specimens. Following examination of larger samples of each species, differences in the premolar dentition were found to no longer be diagnostic. Most cave specimens could not be assigned to species on the basis of some dental measurements. DNA sequences could provide a means for establishing the identity of the cave specimens. Correct identification of specimens, together with knowledge of the search effort underlying the known distribution and persistence of the species in localities over their ranges, is essential for assessment of their conservation status.
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Gifford AH, Moulton LA, Dorman DB, Olbina G, Westerman M, Parker HW, Stanton BA, O'Toole GA. Iron homeostasis during cystic fibrosis pulmonary exacerbation. Clin Transl Sci 2012; 5:368-73. [PMID: 22883617 DOI: 10.1111/j.1752-8062.2012.00417.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hypoferremia is a marker of disease severity in cystic fibrosis (CF). The effect of systemic antibiotics on iron homeostasis during CF pulmonary exacerbation (CFPE) is unknown. Our central hypotheses were that, by the completion of treatment, serum iron would increase, serum concentrations of interleukin-6 (IL-6) and hepcidin-25, two mediators of hypoferremia, would decrease, and sputum iron would decrease. METHODS Blood and sputum samples were collected from 12 subjects with moderate-to-severe CF (median percentage-predicted forced expiratory volume in 1 second (FEV(1) %) = 29%; median weight = 56 kg) within 24 hours of starting and completing a course of systemic antibiotics. RESULTS After treatment, subjects showed median FEV(1) % and body weight improvements of 4.5% and 2.0 kg, respectively (p < 0.05). Median serum iron rose by 2.4 μmol/L (p < 0.05), but 75% of patients remained hypoferremic. Median serum IL-6 and hepcidin-25 levels fell by 12.1 pg/mL and 37.5 ng/mL, respectively (p < 0.05). Median serum erythropoietin (EPO) and hemoglobin levels were unaffected by treatment. We observed a trend toward lower sputum iron content after treatment. CONCLUSIONS Hypoferremia is a salient characteristic of CFPE that improves with waning inflammation. Despite antibiotic treatment, many patients remain hypoferremic and anemic because of ineffective erythropoiesis.
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Affiliation(s)
- Alex H Gifford
- Pulmonary Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
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Müller KF, Lorenz L, Poets CF, Westerman M, Franz AR. Hepcidin concentrations in serum and urine correlate with iron homeostasis in preterm infants. J Pediatr 2012; 160:949-53.e2. [PMID: 22284565 DOI: 10.1016/j.jpeds.2011.12.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 11/10/2011] [Accepted: 12/14/2011] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To evaluate whether hepcidin concentrations in serum (Hep((S))) and urine (Hep((U))) correlate with iron metabolism, erythropoiesis, and inflammation in preterm infants. STUDY DESIGN Thirty-one preterm infants (23-32 weeks gestational age) were included. The concentration of the mature, 25 amino-acid form of hepcidin was determined by enzyme-linked immunosorbent assay in serum, urine, blood counts, reticulocytes, and iron measurements. RESULTS Median (IQR) Hep((S)) was 52.4 (27.9-91.9) ng/mL. The highest values were measured in patients with systemic inflammation. Hep((S)) and Hep((U)) correlated strongly (P = .0007). Hep((S)) and Hep((U)) also correlated positively with ferritin (P = .005 and P = .0002) and with reticulocyte hemoglobin content (P = .015 and P = .015). Hep((S)) and Hep((U)) correlated negatively with soluble transferrin receptor/ferritin-ratio (P = .005 and P = .003). Infants with lower hemoglobin concentrations and higher reticulocyte counts had lower Hep((S)) (P = .0016 and P = .0089). CONCLUSION In sick preterm infants, iron status, erythropoiesis, anemia, and inflammation correlated with the mature 25 amino-acid form of hepcidin. Further evaluation of Hep((U)) for non-invasive monitoring of iron status in preterm infants appears justified.
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Green JM, Mortensen RB, Fong KL, Fan Q, Leu K, Schatz PJ, Woodburn K, Kalim S, Tamez H, Wenger J, Ankers E, Berg A, Karumanchi A, Thadhani R, Guy R, Mireille G, Christelle L, Myriam R, Yves C, Philipppe J, Yokoyama T, Shimonaka Y, Sasaki Y, Yoshida Y, Yamazaki K, Wagner M, Alam A, Busbridge M, Kurtz C, Zimmermann J, Heuschmann P, Wanner C, Ashby D, Schramm L, Bacchetta J, Zaritsky JJ, Lisse TS, Sea JL, Chun RF, Nemeth E, Ganz T, Westerman M, Salusky IB, Hewison M. Anaemia. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cao C, Bemis T, Young M, McNanley T, Cooper E, Pressman E, Westerman M, Guillet R, O'Brien K. Neonatal and maternal iron status, but not serum folate, is related to placental expression of the proton coupled folate transporter (PCFT). FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.641.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Chang Cao
- Division of Nutritional SciencesCornell UniversityIthacaNY
| | - Thomas Bemis
- Division of Nutritional SciencesCornell UniversityIthacaNY
| | - Melissa Young
- Division of Nutritional SciencesCornell UniversityIthacaNY
| | | | | | - Eva Pressman
- School of MedicineUniversity of RochesterRochesterNY
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Darwich E, To-Figueras J, Molina-López RA, Deulofeu R, Olbina G, Westerman M, Sánchez-Tápias JM, Muñoz-Santos C, Herrero C. Increased serum hepcidin levels in patients with porphyria cutanea tarda. J Eur Acad Dermatol Venereol 2012; 27:e68-74. [PMID: 22429447 DOI: 10.1111/j.1468-3083.2012.04511.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Increased iron stores- are common in porphyria cutanea tarda (PCT) patients, but the pathophysiological pathways remain unknown. Down-regulation of hepcidin, a peptide which regulates systemic iron homeostasis, has been demonstrated in different conditions associated with PCT, such as haemochromatosis, chronic hepatitis C (CHC) and excessive alcohol intake. However, serum hepcidin levels have not yet been studied in PCT patients. OBJECTIVE To measure the serum hepcidin levels in patients with PCT, CHC and control patients, and to assess the association of hepcidin with serum markers of inflammation, iron overload and oxidative stress. METHODS Hepcidin levels were measured by a competitive enzyme-linked immunosorbent assay in serum samples of patients presenting PCT (n = 30), CHC (n = 31) and healthy volunteers (n = 52). RESULTS The mean of serum hepcidin levels was significantly higher in the PCT group (129.6 ng/mL) in comparison with the mean values in the CHC (41.3 ng/mL) and control (70.8 ng/mL) groups. The serum concentration of ferritin and interleukin-6 (IL-6) was also significantly higher in the PCT group, and correlated strongly with the hepcidin levels. The PCT patients with hepatitis C virus (HCV) infection showed significantly higher hepcidin levels than the group of CHC patients without porphyria. CONCLUSION Serum hepcidin levels are increased in patients with PCT suggesting that the mechanisms regulating iron homeostasis in PCT differ from those involved in other related disorders, such as haemochromatosis, HCV infection or alcohol abuse.
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Affiliation(s)
- E Darwich
- Departments of Dermatology, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Spain.
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