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Openshaw MR, Gervasi E, Fulgenzi CAM, Pinato DJ, Dalla Pria A, Bower M. Taxonomic reclassification of Kaposi Sarcoma identifies disease entities with distinct immunopathogenesis. J Transl Med 2023; 21:283. [PMID: 37106396 PMCID: PMC10142155 DOI: 10.1186/s12967-023-04130-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The taxonomy of Kaposi Sarcoma (KS) is based on a classification system focused on the description of clinicopathological features of KS in geographically and clinically diverse populations. The classification includes classic, endemic, epidemic/HIV associated and iatrogenic KS, and KS in men who have sex with men (MSM). We assessed the medical relevance of the current classification of KS and sought clinically useful improvements in KS taxonomy. METHODS We reviewed the demographic and clinicopathological features of 676 patients with KS, who were referred to the national centre for HIV oncology at Chelsea Westminster hospital between 2000 and 2021. RESULTS Demographic differences between the different subtypes of KS exist as tautological findings of the current classification system. However, no definitive differences in clinicopathological, virological or immunological parameters at presentation could be demonstrated between the classic, endemic or MSM KS patients. Reclassifying patients as either immunosuppressed or non-immunosuppressed, showed that the immunosuppressed group had a significantly higher proportion of adverse disease features at presentation including visceral disease and extensive oral involvement, classified together as advanced disease (chi2 P = 0.0012*) and disseminated skin involvement (chi2 P < 0.0001*). Immunosuppressed patients had lower CD4 counts, higher CD8 counts and a trend towards higher HHV8 levels compared to non-immunosuppressed patients, however overall survival and disease specific (KS) survival was similar across groups. CONCLUSION The current system of KS classification does not reflect meaningful differences in clinicopathological presentation or disease pathogenesis. Reclassification of patients based on the presence or absence of immunosuppression is a more clinically meaningful system that may influence therapeutic approaches to KS.
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Affiliation(s)
- M R Openshaw
- Institute of Cancer and Genomics Sciences, University of Birmingham, Birmingham, UK.
- UK National Centre for HIV Oncology, Chelsea Westminster Hospital, London, UK.
| | - E Gervasi
- Infectious Diseases Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - C A M Fulgenzi
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, London, UK
- Department of Medical Oncology, University Campus Bio-Medico of Rome, Rome, Italy
| | - D J Pinato
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, London, UK
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - A Dalla Pria
- UK National Centre for HIV Oncology, Chelsea Westminster Hospital, London, UK
| | - M Bower
- UK National Centre for HIV Oncology, Chelsea Westminster Hospital, London, UK
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2
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Brogden DRL, Kontovounisios C, Chong I, Tait D, Warren OJ, Bower M, Tekkis P, Mills SC. Local excision and treatment of early node-negative anal squamous cell carcinomas in a highly HIV prevalent population. Tech Coloproctol 2021; 25:1027-1036. [PMID: 34117969 PMCID: PMC8370967 DOI: 10.1007/s10151-021-02473-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/30/2021] [Indexed: 11/25/2022]
Abstract
Background Anal squamous cell carcinoma (ASCC) is an uncommon cancer associated with human immunodeficiency virus (HIV) infection. There has been increasing interest in providing organ-sparing treatment in small node-negative ASCC’s, however, there is a paucity of evidence about the use of local excision alone in people living with HIV (PLWH). The aim of this study was to evaluate the efficacy of local excision alone in this patient population. Methods We present a case series of stage 1 and stage 2 ASCC in PLWH and HIV negative patients. Data were extracted from a 20-year retrospective cohort study analysing the treatment and outcomes of patients with primary ASCC in a cohort with a high prevalence of HIV. Results Ninety-four patients were included in the analysis. Fifty-seven (61%) were PLWH. Thirty-five (37%) patients received local excision alone as treatment for ASCC, they were more likely to be younger (p = 0.037, ANOVA) and have either foci of malignancy or well-differentiated tumours on histology (p = 0.002, Fisher’s exact test). There was no statistically significant difference in 5-year disease-free survival and recurrence between treatment groups, however, patients who had local excision alone and PLWH were both more likely to recur later compared to patients who received other treatments for ASCC. (72.3 months vs 27.3 months, p = 0.06, ANOVA, and 72.3 months vs 31.8 months, p = 0.035, ANOVA, respectively). Conclusions We recommend that local excision be considered the sole treatment for stage 1 node-negative tumours that have clear margins and advantageous histology regardless of HIV status. However, PLWH who have local excision alone must have access to an expert long-term surveillance programme after treatment to identify late recurrences.
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Affiliation(s)
- D R L Brogden
- Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK.,Imperial College London, London, UK
| | - C Kontovounisios
- Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK. .,Imperial College London, London, UK.
| | - I Chong
- Royal Marsden NHS Foundation Trust, London, UK.,Institute of Cancer Research, London, UK
| | - D Tait
- Royal Marsden NHS Foundation Trust, London, UK.,Institute of Cancer Research, London, UK
| | - O J Warren
- Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK.,Imperial College London, London, UK
| | - M Bower
- Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK.,Imperial College London, London, UK
| | - P Tekkis
- Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK.,Imperial College London, London, UK.,Royal Marsden NHS Foundation Trust, London, UK
| | - S C Mills
- Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK.,Imperial College London, London, UK
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3
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Pinato DJ, Kythreotou A, Mauri FA, Suardi E, Allara E, Shiner RJ, Akarca AU, Trivedi P, Gupta N, Dalla Pria A, Marafioti T, Oliveri P, Newsom-Davis T, Bower M. Functional immune characterization of HIV-associated non-small-cell lung cancer. Ann Oncol 2019; 29:1486-1488. [PMID: 29897389 DOI: 10.1093/annonc/mdy125] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- D J Pinato
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK; National Centre for HIV Malignancies, Chelsea & Westminster Hospital, London, UK
| | - A Kythreotou
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - F A Mauri
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK; Department of Histopathology, Imperial College London, Hammersmith Hospital, London, UK
| | - E Suardi
- National Centre for HIV Malignancies, Chelsea & Westminster Hospital, London, UK
| | - E Allara
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK; NIHR Blood and Transplant Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - R J Shiner
- National Heart and Lung Division, Imperial College London, London, UK
| | - A U Akarca
- Department of Histopathology, University College London, London, UK
| | - P Trivedi
- Department of Histopathology, Imperial College London, Hammersmith Hospital, London, UK
| | - N Gupta
- Department of Histopathology, Imperial College London, Hammersmith Hospital, London, UK
| | - A Dalla Pria
- National Centre for HIV Malignancies, Chelsea & Westminster Hospital, London, UK
| | - T Marafioti
- Department of Histopathology, University College London, London, UK
| | - P Oliveri
- Department of Genetics, Evolution and Environment & Cell and Developmental Biology, University College London, London, UK
| | - T Newsom-Davis
- NIHR Blood and Transplant Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - M Bower
- National Centre for HIV Malignancies, Chelsea & Westminster Hospital, London, UK.
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4
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Gill A, Sharkey R, Simmons J, Bower M, Sita-Lumsden A, Evans J, Newsom-Davis T. Acute diagnostic oncology clinic: A unique primary care-oncology service. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz263.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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El-Sharkawi D, Sharma S, Cook L, Hanley B, Johnston R, Arasaretnam A, Lazana I, Greaves P, Parkinson A, Peng Y, Kassam S, Peacock V, Kaczmarski R, Bower M, Cheung B, De Lord C, Cross M, Vroobel K, Wotherspoon A, Aldridge F, Khwaja J, Sharma B, Cwynarski K, Pettengell R, Chau I, Cunningham D, Naresh K, Iyengar S. COMPARISON OF OUTCOMES BETWEEN PATIENTS WITH MYC
REARRANGED DLBCL AND DOUBLE/ TRIPLE HIT HIGH-GRADE B CELL LYMPHOMA: A PAN-LONDON RETROSPECTIVE REVIEW. Hematol Oncol 2019. [DOI: 10.1002/hon.11_2631] [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: 11/08/2022]
Affiliation(s)
- D. El-Sharkawi
- Haematology; Royal Marsden Hospital; Sutton United Kingdom
| | - S. Sharma
- Haematology; Royal Marsden Hospital; Sutton United Kingdom
| | - L. Cook
- Haematology; Hammersmith Hospital; London United Kingdom
| | - B. Hanley
- Haematology; Hammersmith Hospital; London United Kingdom
| | - R. Johnston
- Haematology; Royal Sussex County Hospital; Brighton United Kingdom
| | - A. Arasaretnam
- Haematology; Royal Sussex County Hospital; Brighton United Kingdom
| | - I. Lazana
- Haematology; King's College Hospital; London United Kingdom
| | - P. Greaves
- Haematology; Queen's Hospital; Romford United Kingdom
| | - A. Parkinson
- Haematology; Queen's Hospital; Romford United Kingdom
| | - Y. Peng
- Haematology; St George's University Hospitals NHS Foundation Trust; London United Kingdom
| | - S. Kassam
- Haematology; King's College Hospital; London United Kingdom
| | - V. Peacock
- Haematology; King's College Hospital; London United Kingdom
| | - R. Kaczmarski
- Haematology; Hillingdon Hospital; Uxbridge United Kingdom
| | - M. Bower
- Haematology; Chelsea and Westminster Hospital; London United Kingdom
| | - B. Cheung
- Haematology; Croydon University Hospital; Croydon United Kingdom
| | - C. De Lord
- Haematology; St Helier Hospital; Carshalton United Kingdom
| | - M. Cross
- Haematology; Royal Marsden Hospital; Sutton United Kingdom
| | - K. Vroobel
- Histopathology; Royal Marsden Hospital; Sutton United Kingdom
| | - A. Wotherspoon
- Histopathology; Royal Marsden Hospital; Sutton United Kingdom
| | - F. Aldridge
- Clinical Cytogenetics; Royal Marsden Hospital; Sutton United Kingdom
| | - J. Khwaja
- Haematology; University College Hospital; London United Kingdom
| | - B. Sharma
- Radiology; Royal Marsden Hospital; Sutton United Kingdom
| | - K. Cwynarski
- Haematology; University College Hospital; London United Kingdom
| | - R. Pettengell
- Haematology; St George's University Hospitals NHS Foundation Trust; London United Kingdom
| | - I. Chau
- Department of Medicine; Royal Marsden Hospital; Sutton United Kingdom
| | - D. Cunningham
- Department of Medicine; Royal Marsden Hospital; Sutton United Kingdom
| | - K. Naresh
- Histopathology; Hammersmith Hospital; Hammersmith United Kingdom
| | - S. Iyengar
- Haematology; Royal Marsden Hospital; Sutton United Kingdom
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6
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Rinaldi S, Santoni M, Leoni G, Fiordoliva I, Marcantognini G, Meletani T, Armento G, Santini D, Newsom-Davis T, Tiberi M, Morgese F, Torniai M, Bower M, Berardi R. The prognostic and predictive role of hyponatremia in patients with advanced non-small cell lung cancer (NSCLC) with bone metastases. Support Care Cancer 2018; 27:1255-1261. [PMID: 30406916 DOI: 10.1007/s00520-018-4489-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/02/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE Hyponatremia and bone metastasis (BMs) are known as negative prognostic factors in patients affected by metastatic non-small cell lung cancer (NSCLC). Hyponatremia is associated with higher risk of osteoporosis and bone fracture, but no data are available about the relationship between hyponatremia and bone metastasis. This study aims to analyze the prognostic impact of hyponatremia in NSCLC patients with bone metastases. METHODS We retrospectively collected data about advanced NSCLC patients. Survival curves were estimated using Kaplan-Meier method, and comparisons were made using chi-square test. RESULTS Six hundred forty-seven patients were enrolled into the study. BMs were present in 264 patients (41%) at diagnosis, while hyponatremia appeared in 237 (37%) patients during the first-line treatment. Patients without BMs had a median overall survival (mOS) of 15.9 months (95% CI 14.1-17.9) versus 11.4 months (95% CI 9.4-13.4) for patients with BMs (p = 0.001). Eunatremic patients had a better outcome (mOS 16.3 months, 95% CI 14.6-18.0 vs 10.3 months, 95% I 7.6-12.8, p = 0.003). Considering the two variables, patients with BMs and hyponatremia had a mOS of 10.1 months (95% CI 4.3-15.9), patients with hyponatremia without BMs 11.9 months (95% CI 11.4-12.4), while mOS was 13.1 months (95% CI 12.0-14.2) for eunatremic patients with BMs versus 17.1 months (95% CI 15.2-19.1) in eunatremic patients without BMs (p = 0.0020). Hyponatremic patients developed metachronous BMs significantly earlier (3.73 vs 5.76 months, p = 0.0187). CONCLUSIONS Our study showed that hyponatremia is an important prognostic factor and it should be necessarily considered to enhance the management of NSCLC patients with BMs.
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Affiliation(s)
- S Rinaldi
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I - GM Lancisi - G Salesi di Ancona, Via Conca 71, 60126, Ancona, Italy
| | - M Santoni
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I - GM Lancisi - G Salesi di Ancona, Via Conca 71, 60126, Ancona, Italy
| | - G Leoni
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I - GM Lancisi - G Salesi di Ancona, Via Conca 71, 60126, Ancona, Italy
| | - I Fiordoliva
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I - GM Lancisi - G Salesi di Ancona, Via Conca 71, 60126, Ancona, Italy
| | - G Marcantognini
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I - GM Lancisi - G Salesi di Ancona, Via Conca 71, 60126, Ancona, Italy
| | - T Meletani
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I - GM Lancisi - G Salesi di Ancona, Via Conca 71, 60126, Ancona, Italy
| | - G Armento
- MedicalOncology, University Campus Bio-Medico, Via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - D Santini
- MedicalOncology, University Campus Bio-Medico, Via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - T Newsom-Davis
- Chelsea & Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - M Tiberi
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I - GM Lancisi - G Salesi di Ancona, Via Conca 71, 60126, Ancona, Italy
| | - F Morgese
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I - GM Lancisi - G Salesi di Ancona, Via Conca 71, 60126, Ancona, Italy
| | - M Torniai
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I - GM Lancisi - G Salesi di Ancona, Via Conca 71, 60126, Ancona, Italy
| | - M Bower
- Chelsea & Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - Rossana Berardi
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I - GM Lancisi - G Salesi di Ancona, Via Conca 71, 60126, Ancona, Italy.
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Pinato DJ, Bräu N, Bower M. Editorial: a step forward in refining prognostication for patients with HIV-associated hepatocellular carcinoma-Authors' reply. Aliment Pharmacol Ther 2018; 47:134-135. [PMID: 29226401 DOI: 10.1111/apt.14394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- D J Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - N Bräu
- James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA.,Divisions of Infectious Diseases & Liver Diseases, Mount Sinai School of Medicine, New York, NY, USA
| | - M Bower
- National Centre for HIV Malignancies, Chelsea& Westminster Hospital, London, UK
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8
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Kythreotou A, Mauri F, Shiner R, Suardi E, Dalla Pria A, Akarca A, Trivedi P, Gupta N, Marafioti T, Newsom-Davis T, Bower M, Pinato D. The influence of HIV status on programmed-death ligands expression in non-small cell lung cancer. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30036-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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9
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Pinato DJ, Sharma R, Citti C, Platt H, Ventura-Cots M, Allara E, Chen TY, Dalla Pria A, Jain M, Mínguez B, Kikuchi L, Kaufman West E, Merli M, Kaplan DE, Hasson H, Marks K, Nelson M, Núñez M, Aytaman A, Bower M, Bräu N. The albumin-bilirubin grade uncovers the prognostic relationship between hepatic reserve and immune dysfunction in HIV-associated hepatocellular carcinoma. Aliment Pharmacol Ther 2018; 47:95-103. [PMID: 29034998 DOI: 10.1111/apt.14356] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 08/03/2017] [Revised: 08/19/2017] [Accepted: 09/11/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a leading cause of liver-related mortality in people living with HIV, where co-infection with hepatotropic viruses accelerates the course of chronic liver disease. AIM To evaluate whether the albumin-bilirubin (ALBI) grade, a more accurate marker of liver dysfunction in HCC, might identify patients with progressive liver dysfunction in the context of HIV/hepatitis co-infection. METHODS Using uni- and multi-variable analyses, we studied the albumin-bilirubin grade as a predictor of overall survival (OS) in a large, multi-center cohort of patients with HIV-associated HCC recruited from 44 centres in 9 countries within the Liver Cancer in HIV study group. Patients who underwent liver transplantation were excluded. RESULTS A total of 387 patients, predominantly HCV co-infected (78%) with balanced representation of all Barcelona Clinic Liver Cancer (BCLC) stages (A = 33%, B = 18%, C = 37%, D = 12%) were recruited. At HCC diagnosis, 84% had been on anti-retrovirals for a median duration of 8.8 years. The albumin-bilirubin grade identified significant differences in median survival of 97 months for grade 1 (95% CI 13-180 months), 17 months for grade 2 (95% CI 11-22 months) and 6 months for grade 3 (95% CI 4-9 months, P < .001). A more advanced albumin-bilirubin grade correlated with lower CD4 counts (464/373/288 cells/mm3 for grades 1/2/3) and higher HIV viraemia (3.337/8.701/61.845 copies/mL for grades 1/2/3, P < .001). CONCLUSIONS In this large, multi-center retrospective study, the albumin-bilirubin grade highlights the interplay between liver reserve and immune dysfunction as prognostic determinants in HIV-associated HCC.
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10
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Shepherd L, Borges ÁH, Harvey R, Bower M, Grulich A, Silverberg M, Weber J, Ristola M, Viard JP, Bogner JR, Gargalianos-Kakolyris P, Mussini C, Mansinho K, Yust I, Paduta D, Jilich D, Smiatacz T, Radoi R, Tomazic J, Plomgaard P, Frikke-Schmidt R, Lundgren J, Mocroft A. The extent of B-cell activation and dysfunction preceding lymphoma development in HIV-positive people. HIV Med 2017; 19:90-101. [PMID: 28857427 DOI: 10.1111/hiv.12546] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Accepted: 07/05/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVES B-cell dysfunction and activation are thought to contribute to lymphoma development in HIV-positive people; however, the mechanisms are not well understood. We investigated levels of several markers of B-cell dysfunction [free light chain (FLC)-κ, FLC-λ, immunoglobulin G (IgG), IgA, IgM and IgD] prior to lymphoma diagnosis in HIV-positive people. METHODS A nested matched case-control study was carried out within the EuroSIDA cohort, including 73 HIV-positive people with lymphoma and 143 HIV-positive lymphoma-free controls. Markers of B-cell dysfunction were measured in prospectively stored serial plasma samples collected before the diagnosis of lymphoma (or selection date in controls). Marker levels ≤ 2 and > 2 years prior to diagnosis were investigated. RESULTS Two-fold higher levels of FLC-κ [odds ratio (OR) 1.84; 95% confidence interval (CI) 1.19, 2.84], FLC-λ (OR 2.15; 95% CI 1.34, 3.46), IgG (OR 3.05; 95% CI 1.41, 6.59) and IgM (OR 1.46; 95% CI 1.01, 2.11) were associated with increased risk of lymphoma > 2 years prior to diagnosis, but not ≤ 2 years prior. Despite significant associations > 2 years prior to diagnosis, the predictive accuracy of each marker was poor, with FLC-λ emerging as the strongest candidate with a c-statistic of 0.67 (95% CI 0.58, 0.76). CONCLUSIONS FLC-κ, FLC-λ and IgG levels were higher > 2 years before lymphoma diagnosis, suggesting that B-cell dysfunction occurs many years prior to lymphoma development. However, the predictive value of each marker was low and they are unlikely candidates for risk assessment for targeted intervention.
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Affiliation(s)
- L Shepherd
- Research Department of Infection and Population Health, University College London, London, UK
| | - Á H Borges
- Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - R Harvey
- Charing Cross Oncology Laboratory and Trophoblastic Disease Centre, Charing Cross Hospital Campus of Imperial College Healthcare National Health Service Trust, London, UK
| | - M Bower
- National Centre for HIV Malignancy, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - A Grulich
- Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - M Silverberg
- Kaiser Permanente Northern California, Oakland, CA, USA
| | - J Weber
- Imperial College London, London, UK
| | - M Ristola
- Division of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - J-P Viard
- AP-HP, Diagnostic & Therapeutic Center, Hotel Dieu Hospital, Paris, France
| | - J R Bogner
- Department of Internal Medicine IV, University of Munich, Munich, Germany
| | - P Gargalianos-Kakolyris
- First Department of Internal Medicine and Infectious Diseases Unit, General Hospital of Athens "G. Gennimatas", Athens, Greece
| | - C Mussini
- Clinic of Infectious and Tropical Diseases, University of Modena and Reggio Emilia, Azienda Policlinico, Modena, Italy
| | - K Mansinho
- Department of Infectious Diseases, Hospital Egas Moniz-CHLO, E.P.E., Lisboa, Portugal
| | - I Yust
- Ichilov Hospital, Tel Aviv, Israel
| | - D Paduta
- Gomel Regional Centre for Hygiene, Gomel, Belarus
| | - D Jilich
- Department of Infectious and Tropical Diseases, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - T Smiatacz
- Infectious Diseases Department, Medical University of Gdańsk, Gdańsk, Poland
| | - R Radoi
- Clinical Hospital of Infectious and Tropical Diseases 'Dr. Victor Babeş', Bucharest, Romania
| | - J Tomazic
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - P Plomgaard
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - R Frikke-Schmidt
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - J Lundgren
- Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A Mocroft
- Research Department of Infection and Population Health, University College London, London, UK
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Panchal R, Ward E, Marvin V, Newsom-Davis T, Bower M, Bendle M. 110: Drug interactions with systemic anti-cancer therapy in lung cancer patients. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30160-5] [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: 11/29/2022]
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12
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Samani A, Neville I, Merchant S, Bower M, Pria AD, Smith K, Ingram E, Newsom-Davis T. 109: Characteristics of HIV-associated lung cancer. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30159-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Newsom-Davis T, Simmons J, Bower M, Cox S, Gill A, Hennah L, Robinson A, Richmond K, Sharkey R. Acute diagnostic oncology clinic: tackling emergency presentations of cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw387.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rinaldi S, Morgese F, Torniai M, Savini A, Barbotti F, Pirani F, Leoni G, Grohè C, Newsom-Davis T, Paolucci V, Bower M, Fiordoliva I, Berardi R. Gemcitabine as single agent second line treatment in patients with advanced wild-type EGFR, negative ALK non-small cell lung cancer: a retrospective study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw332.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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15
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Abstract
We describe an audit of lymphoma care in HIV-positive patients. In the smaller units (< 500 patients) areas of potentially sub-optimal care were identified.
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Affiliation(s)
- M G Brook
- Patrick Clements Clinic, North West London Hospitals Trust, London NW10 7NS
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16
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Savini A, Berardi R, Rinaldi S, Santoni M, Newsom-Davis T, Tiberi M, Morgese F, Caramanti M, Torniai M, Fiordoliva I, Paolucci V, Bower M, Cascinu S. Advanced non-small cell lung cancer (NSCLC): the prognostic role of systemic Immune-Inflammation Index (SII). Ann Oncol 2015. [DOI: 10.1093/annonc/mdv343.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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17
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Caramanti M, Berardi R, Santoni M, Newsom-Davis T, Rinaldi S, Savini A, Tiberi M, Morgese F, Torniai M, Fiordoliva I, Paolucci V, Pistelli M, Onofri A, Bower M, Cascinu S. Hyponatremia normalization as an independent prognostic factor in patients with advanced non-small cell lung cancer treated with first-line therapy. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv343.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Rossana B, Rinaldi S, Santoni M, Newsom-Davis T, Tiberi M, Morgese F, Caramanti M, Savini A, Torniai M, Fiordoliva I, Paolucci V, Bower M, Cascinu S. 3092 Systemic immune-inflammation index (SII) in patients with advanced non-small cell lung cancer (nsclc). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31733-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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19
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Young R, Poyser C, Crack L, Dockrell D, Bowman C, Billingham L, Bower M, Westwell S, Leahy M, Woll P. 3434 A UK national phase I/II clinical trial of a MEK1/2 inhibitor combined with highly active anti-retroviral therapy for HIV-associated Kaposi's sarcoma. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31907-4] [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: 11/28/2022]
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20
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Haq IU, Dalla Pria A, Papanastasopoulos P, Stegmann K, Bradshaw D, Nelson M, Bower M. The clinical application of plasma Kaposi sarcoma herpesvirus viral load as a tumour biomarker: results from 704 patients. HIV Med 2015; 17:56-61. [PMID: 26111246 DOI: 10.1111/hiv.12273] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The aim of the study was to evaluate the role of plasma Kaposi sarcoma herpesvirus (KSHV) as a diagnostic and prognostic biomarker in people living with HIV (PLWH) and diagnosed with KSHV-associated diseases. METHODS Using quantitative nested polymerase chain reaction (PCR) targeting the open reading frame-26 gene of KSHV, plasma levels of KSHV were measured in consecutive PLWH with KSHV-associated diseases or as part of the investigation of lymphadenopathy. RESULTS Plasma KSHV assays were performed on samples from 684 PLWH and 20 HIV-seronegative people with KSHV-associated malignancies. In PLWH, plasma KSHV was detected in 39% of those with KS, 99% of those with multicentric Castleman disease (MCD), 9% of those with non-Hodgkin lymphoma (NHL), 2% of those with non-AIDS-defining malignancies and 0% of those with nonmalignant lymphadenopathy. There was no significant difference in plasma KSHV viral load among those with KS, MCD and KSHV-associated NHL. The 5-year overall survival rate from KS diagnosis of 335 PLWH was 95.2% (95% confidence interval 92.6-97.8%). Plasma KSHV viraemia did not predict overall survival in those with KS (P = 0.73), nor when those with T0 stage KS (P = 0.52) or T1 stage KS (P = 0.62) were analysed separately. CONCLUSIONS Measuring the plasma levels of KSHV as a biomarker in KSHV-associated disease has a very limited value in either diagnosis or prognostication. The only potential role of clinical value is the suggestion that an undetectable plasma KSHV excludes a diagnosis of MCD in PLWH.
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Affiliation(s)
- I-U Haq
- Imperial College School of Medicine, London, UK
| | - A Dalla Pria
- Department of Oncology, National Centre for HIV Malignancies, Chelsea & Westminster Hospital, London, UK
| | - P Papanastasopoulos
- Department of Oncology, National Centre for HIV Malignancies, Chelsea & Westminster Hospital, London, UK
| | - K Stegmann
- Department of HIV Medicine, National Centre for HIV Malignancies, Chelsea & Westminster Hospital, London, UK
| | - D Bradshaw
- Department of HIV Medicine, National Centre for HIV Malignancies, Chelsea & Westminster Hospital, London, UK
| | - M Nelson
- Imperial College School of Medicine, London, UK.,Department of HIV Medicine, National Centre for HIV Malignancies, Chelsea & Westminster Hospital, London, UK
| | - M Bower
- Imperial College School of Medicine, London, UK.,Department of Oncology, National Centre for HIV Malignancies, Chelsea & Westminster Hospital, London, UK
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21
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Affiliation(s)
- E Rashidghamat
- Department of Dermatology, University Hospital Lewisham, London, SE13 6LH, U.K.
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22
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Oh JZ, Ravindran R, Chassaing B, Carvalho FA, Maddur MS, Bower M, Hakimpour P, Gill KP, Nakaya HI, Yarovinsky F, Sartor RB, Gewirtz AT, Pulendran B. TLR5-mediated sensing of gut microbiota is necessary for antibody responses to seasonal influenza vaccination. Immunity 2014; 41:478-492. [PMID: 25220212 DOI: 10.1016/j.immuni.2014.08.009] [Citation(s) in RCA: 367] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 08/06/2014] [Indexed: 11/16/2022]
Abstract
Systems biological analysis of immunity to the trivalent inactivated influenza vaccine (TIV) in humans revealed a correlation between early expression of TLR5 and the magnitude of the antibody response. Vaccination of Trl5(-/-) mice resulted in reduced antibody titers and lower frequencies of plasma cells, demonstrating a role for TLR5 in immunity to TIV. This was due to a failure to sense host microbiota. Thus, antibody responses in germ-free or antibiotic-treated mice were impaired, but restored by oral reconstitution with a flagellated, but not aflagellated, strain of E. coli. TLR5-mediated sensing of flagellin promoted plasma cell differentiation directly and by stimulating lymph node macrophages to produce plasma cell growth factors. Finally, TLR5-mediated sensing of the microbiota also impacted antibody responses to the inactivated polio vaccine, but not to adjuvanted vaccines or the live-attenuated yellow fever vaccine. These results reveal an unappreciated role for gut microbiota in promoting immunity to vaccination.
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Affiliation(s)
- Jason Z Oh
- Emory Vaccine Center, Emory University, Atlanta, GA 30329, USA; Yerkes National Primate Center, Emory University, Atlanta, GA 30329, USA
| | - Rajesh Ravindran
- Emory Vaccine Center, Emory University, Atlanta, GA 30329, USA; Yerkes National Primate Center, Emory University, Atlanta, GA 30329, USA
| | - Benoit Chassaing
- Center for Inflammation, Immunity, and Infection, Georgia State University, Atlanta, GA 30302, USA
| | - Frederic A Carvalho
- Center for Inflammation, Immunity, and Infection, Georgia State University, Atlanta, GA 30302, USA; INSERM U1107, Universite d'Auvergne, 63001 Clermont-Ferrand Cedex 1, France
| | - Mohan S Maddur
- Emory Vaccine Center, Emory University, Atlanta, GA 30329, USA; Yerkes National Primate Center, Emory University, Atlanta, GA 30329, USA
| | - Maureen Bower
- National Gnotobiotic Rodent Resource Center, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Paul Hakimpour
- Yerkes National Primate Center, Emory University, Atlanta, GA 30329, USA
| | - Kiran P Gill
- Emory Vaccine Center, Emory University, Atlanta, GA 30329, USA; Yerkes National Primate Center, Emory University, Atlanta, GA 30329, USA
| | - Helder I Nakaya
- Department of Pathology, School of Medicine, Emory University, Atlanta, GA 30329, USA; Department of Clinical and Toxicological Analyses, Institute of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo 05508-000, Brazil
| | - Felix Yarovinsky
- Department of Immunology, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - R Balfour Sartor
- National Gnotobiotic Rodent Resource Center, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Andrew T Gewirtz
- Center for Inflammation, Immunity, and Infection, Georgia State University, Atlanta, GA 30302, USA
| | - Bali Pulendran
- Emory Vaccine Center, Emory University, Atlanta, GA 30329, USA; Yerkes National Primate Center, Emory University, Atlanta, GA 30329, USA; Department of Pathology, School of Medicine, Emory University, Atlanta, GA 30329, USA.
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23
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Bendle M, Pealing J, Papanastasopoulos P, Bower M. Liposomal anthracycline chemotherapy and the risk of second malignancies in patients with Kaposi's sarcoma (KS). Cancer Chemother Pharmacol 2014; 74:611-5. [PMID: 25055936 DOI: 10.1007/s00280-014-2538-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 07/10/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE People living with HIV (PLWH) are at increased risk of cancer, both non-AIDS- and AIDS-defining malignancies (NADM and ADM). Systemic chemotherapy also predisposes to secondary cancers. The potential contribution of systemic liposomal anthracycline chemotherapy (SLAC) to the development of second cancers in PLWH is unknown. METHODS Since 1998, we have treated 495 PLWH and Kaposi's sarcoma (KS) with a stage-stratified approach including 163 who received SLAC as first-line treatment for KS. Subsequent ADM and NADM diagnosed in this population were recorded. RESULTS More patients who received SLAC had T1 stage disease (p < 0.0001) and lower CD4 cell counts (p < 0.0001) in line with the stage-stratified treatment, but there were no significant differences in age (p = 0.29), gender (p = 0.18), prior AIDS-defining illness (p = 0.45), plasma HIV viral load (p = 0.15), or HHV8 viral load (p = 0.39) between the two groups. During a median follow-up of 4.6 years (maximum 15 years) from KS diagnosis, 28 patients developed a second cancer (5 ADM and 23 NADM). The 5-year cumulative risk of second cancer is 5.8 % (95 % CI 3.0-8.6 %), and there is no significant difference in the rate between those treated with SLAC and those not (log rank p = 0.19). Most patients (n = 131) were treated with daunoxome (liposomal daunorubicin) chemotherapy, and there was no significant correlation between risk of second cancer and cumulative dose of daunoxome (p = 0.23). CONCLUSION Although the risk of second cancer after a diagnosis of KS in PLWH is high, systemic liposomal anthracycline chemotherapy does not appear to increase the risk.
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Affiliation(s)
- M Bendle
- Department of Oncology, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
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24
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Cunin L, Alfa-Wali M, Turner J, Bower M, Ion L, Allen-Mersh T. Salvage surgery for residual primary and locally recurrent anal squamous cell carcinoma after chemoradiotherapy in HIV-positive individuals. Ann Surg Oncol 2013; 21:527-32. [PMID: 24242676 DOI: 10.1245/s10434-013-3353-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND The treatment of anal cancer in human immunodeficiency virus (HIV) patients-as in the general population-is primarily with chemoradiotherapy (CRT), and abdominoperineal resection of residual or recurrent primary disease. The aim of this study was to evaluate the extent of residual primary disease and local recurrence as well as the outcome of salvage surgery after CRT for anal carcinoma in HIV-positive individuals. METHODS We retrospectively studied HIV-positive anal carcinoma patients treated between February 1989 and November 2012 in a specialist London unit. Extent of residual primary disease, local recurrence after CRT, postoperative complications, and survival after salvage surgery were evaluated. RESULTS Complete response was experienced in 44 of 53 (83%) of HIV patients treated with CRT for anal carcinoma. One patient (2.3%) developed local recurrence. Nine patients (eight residual primary disease after CRT and one local recurrence) underwent salvage surgery after CRT. There were no perioperative deaths, and perioperative CD4 counts were sustained. Complications occurred in five patients (55%). Median interval to complete perineal healing was 4 months (range 2-11 months), and median hospital stay was 29 days. Survival (median 16 months) was 25% at 2 years from salvage surgery. CONCLUSIONS Results in HIV-positive patients receiving highly active antiretroviral therapy (HAART) suggest that loss of HIV sensitivity to HAART can be avoided, but that there is increased postoperative morbidity that may be related to HIV disease. Survival was comparable to that for salvage therapy after optimal CRT in non-HIV anal carcinoma patients.
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Affiliation(s)
- Laila Cunin
- Department of Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK,
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25
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Slesser AAP, Bhangu A, Bower M, Goldin R, Tekkis PP. A systematic review of anal squamous cell carcinoma in inflammatory bowel disease. Surg Oncol 2013; 22:230-7. [PMID: 24050823 DOI: 10.1016/j.suronc.2013.08.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [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: 08/15/2013] [Accepted: 08/16/2013] [Indexed: 12/13/2022]
Abstract
AIM The aim of this systematic review was to determine the incidence, aetiology and clinical characteristics of anal squamous cell carcinomas (SCC) presenting in patients with inflammatory bowel disease. METHOD A systematic review of the literature was undertaken using Medline, Embase, Cochrane and Web of Science. RESULTS A total of 33 cases of anal SCC were described, 7 in ulcerative colitis (UC) and 26 in Crohn's disease (CD). The annual incidence of anal SCCs was 0.9/100,000 and 2.0/100,000 in patients with UC and CD respectively. The gender ratio in CD was 3M:17F with a median age of 42 years, the main presenting symptom was anal pain and 85% of CD cases had peri-anal disease. No studies described anal intra-epithelial neoplasia. The human papilloma virus was found to be positive in 2 out of 5 (40%) cases. The majority of patients (73%) with CD received radical surgery as their first line treatment. The cumulative overall and disease free survival in CD was 37 per cent at five years. CONCLUSION The findings of this review when contrasted with the data from cancer registries suggests that there is a higher incidence of anal SCC, an earlier age of presentation and poorer outcomes in patients with Crohn's disease compared to the general population implying a more aggressive neoplastic process. This review supports the hypothesis that peri-anal disease plays a contributing role in anal SCCs and as such targeted surveillance in patients with longstanding peri-anal disease should be considered.
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Affiliation(s)
- A A P Slesser
- Division of Surgery and Cancer, Chelsea and Westminster Campus, Imperial College London, UK; Department of Colorectal Surgery, The Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
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26
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Bull L, Knowles A, Ogden S, Boag F, Naresh KN, Bower M. Primary cervical lymphoma: a rare presentation to a genitourinary medicine clinic. Int J STD AIDS 2013; 24:587-9. [DOI: 10.1177/0956462413476268] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Summary Primary non-Hodgkin's lymphoma of uterine cervix is a rare diagnosis. We present the case of a 47-year-old woman who presented to our genitourinary (GU) medicine service complaining of a malodorous discharge. Speculum examination revealed a necrotic mass on the cervix. She was referred urgently to gynaecology and subsequent histology revealed a diffuse large B-cell lymphoma. She received six cycles of RCHOP chemotherapy and is now in clinical remission. This case highlights the need for GU medicine physicians to remain vigilant with regard to possible gynaecological malignancies in all of our patients, the need for medical backup within GU medicine clinics and for clear pathways of referral to other specialists to exist.
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Affiliation(s)
- L Bull
- HIV and Sexual Health Directorate
| | | | | | - F Boag
- HIV and Sexual Health Directorate
| | | | - M Bower
- Oncology Department, Chelsea and Westminster Hospital, London, UK
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27
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Tull T, Papineni P, Cook C, Mee J, Bower M, Morar N, Nelson M. Paraneoplastic pemphigus in patient infected with the human immunodeficiency virus. Clin Exp Dermatol 2013; 39:83-5. [PMID: 23758217 DOI: 10.1111/ced.12172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2013] [Indexed: 11/30/2022]
Affiliation(s)
- T Tull
- Department of HIV Medicine, Chelsea and Westminster Chelsea and Westminster Hospital, London, UK.
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28
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Bashford J, Nelson M, Bower M, Atkins M. JC -- a forgotten foe or a foe to be forgotten? HIV Med 2013; 14:326. [PMID: 23551323 DOI: 10.1111/hiv.12018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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29
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Hatzimichael E, Lo Nigro C, Lattanzio L, Syed N, Shah R, Dasoula A, Janczar K, Vivenza D, Monteverde M, Merlano M, Papoudou-Bai A, Bai M, Schmid P, Stebbing J, Bower M, Dyer MJS, Karran LE, ElguetaKarstegl C, Farrell PJ, Thompson A, Briasoulis E, Crook T. The collagen prolyl hydroxylases are novel transcriptionally silenced genes in lymphoma. Br J Cancer 2012; 107:1423-32. [PMID: 22955849 PMCID: PMC3494450 DOI: 10.1038/bjc.2012.380] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [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: 05/01/2012] [Revised: 08/02/2012] [Accepted: 08/02/2012] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Prolyl hydroxylation is a post-translational modification that affects the structure, stability and function of proteins including collagen by catalysing hydroxylation of proline to hydroxyproline through action of collagen prolyl hydroxylases3 (C-P3H) and 4 (C-P4H). Three C-P3Hs (nomenclature was amended according to approval by the HGNC symbols and names at http://www.genenames.org/ and Entrez database at http://www.ncbi.nlm.nih.gov/gene) leucineproline-enriched proteoglycan (leprecan) 1 (Lepre1), leprecan-like 1 (Leprel1), leprecan-like 2 (Leprel2) and two paralogs Cartilage-Related Protein (CRTAP) and leprecan-like 4 (Leprel4) are found in humans. The C-P4Hs are tetrameric proteins comprising a variable α subunit, encoded by the P4HA1, P4HA2 and P4HA3 genes and a constant β subunit encoded by P4HB. METHODS We used RT-PCR, qPCR, pyrosequencing, methylation-specific PCR, western blotting and immunohistochemistry to investigate expression and regulation of the C-P3H and C-P4H genes in B lymphomas and normal bone marrow. RESULTS C-P3H and C-P4H are downregulated in lymphoma. Down-regulation is associated with methylation in the CpG islands and is detected in almost all common types of B-cell lymphoma, but the CpG islands are unmethylated or methylated at lower levels in DNA isolated from normal bone marrow and lymphoblastoid cell lines. Methylation of multiple C-P3H and C-P4H genes is present in some lymphomas, particularly Burkitt's lymphoma. CONCLUSIONS Methylation of C-P3H and C-P4H is common in B lymphomas and may have utility in differentiating disease subtypes.
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Affiliation(s)
- E Hatzimichael
- Department of Hematology, University Hospital
of Ioannina, St Niarchou Avenue, Ioannina,
Greece
| | - C Lo Nigro
- Laboratory of Cancer Genetics and
Translational Oncology, S Croce General Hospital, Cuneo,
Italy
| | - L Lattanzio
- Laboratory of Cancer Genetics and
Translational Oncology, S Croce General Hospital, Cuneo,
Italy
| | - N Syed
- Imperial College London, Charing Cross
Hospital, London, UK
| | - R Shah
- Imperial College London, Charing Cross
Hospital, London, UK
| | - A Dasoula
- Department of Hematology, University Hospital
of Ioannina, St Niarchou Avenue, Ioannina,
Greece
| | - K Janczar
- Imperial College London, Charing Cross
Hospital, London, UK
| | - D Vivenza
- Laboratory of Cancer Genetics and
Translational Oncology, S Croce General Hospital, Cuneo,
Italy
| | - M Monteverde
- Laboratory of Cancer Genetics and
Translational Oncology, S Croce General Hospital, Cuneo,
Italy
| | - M Merlano
- Medical Oncology, Oncology Department, S
Croce General Hospital, Cuneo, Italy
| | - A Papoudou-Bai
- Department of Pathology, University Hospital
of Ioannina, St Niarchou Avenue, Ioannina,
Greece
| | - M Bai
- Department of Pathology, University Hospital
of Ioannina, St Niarchou Avenue, Ioannina,
Greece
| | - P Schmid
- Department of Cancer Medicine, Brighton and
Sussex Medical School, University of Sussex, Brighton, UK
| | - J Stebbing
- Imperial College London, Charing Cross
Hospital, London, UK
| | - M Bower
- Department of Oncology, Chelsea and
Westminster Hospital NHS Trust, London, UK
| | - M J S Dyer
- Department of Cancer Studies and Molecular
Medicine, University of Leicester, Leicester, UK
| | - L E Karran
- Department of Cancer Studies and Molecular
Medicine, University of Leicester, Leicester, UK
| | | | - P J Farrell
- Section of Virology, Imperial College
London, London, UK
| | - A Thompson
- Dundee Cancer Center, University of
Dundee, Dundee, UK
| | - E Briasoulis
- Department of Hematology, University Hospital
of Ioannina, St Niarchou Avenue, Ioannina,
Greece
| | - T Crook
- Dundee Cancer Center, University of
Dundee, Dundee, UK
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Abstract
Natural killer (NK)/T-cell lymphoma is a rare form of non-Hodgkin's lymphoma that is seen with increased frequency in HIV infection and in transplant recipients. This case report describes an unusual case of extranodal NK/T-cell lymphoma in a patient with advanced HIV disease in which gastric involvement was a significant feature.
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Affiliation(s)
- K Manley
- Faculty of Medicine, Imperial College London, UK
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31
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Liu J, McFarland K, Bower M, Xia G, Landrian I, Bushara K, Wu S, Hunter D, Ashizawa T. Characterization of Sequence Interruptions in ATTCT Repeat Expansions in SCA10 (P05.027). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p05.027] [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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32
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Dapito DH, Mencin A, Gwak GY, Pradere JP, Jang MK, Mederacke I, Caviglia JM, Khiabanian H, Adeyemi A, Bataller R, Lefkowitch JH, Bower M, Friedman R, Sartor RB, Rabadan R, Schwabe RF. Promotion of hepatocellular carcinoma by the intestinal microbiota and TLR4. Cancer Cell 2012; 21:504-16. [PMID: 22516259 PMCID: PMC3332000 DOI: 10.1016/j.ccr.2012.02.007] [Citation(s) in RCA: 901] [Impact Index Per Article: 75.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 11/12/2011] [Accepted: 02/01/2012] [Indexed: 02/06/2023]
Abstract
Increased translocation of intestinal bacteria is a hallmark of chronic liver disease and contributes to hepatic inflammation and fibrosis. Here we tested the hypothesis that the intestinal microbiota and Toll-like receptors (TLRs) promote hepatocellular carcinoma (HCC), a long-term consequence of chronic liver injury, inflammation, and fibrosis. Hepatocarcinogenesis in chronically injured livers depended on the intestinal microbiota and TLR4 activation in non-bone-marrow-derived resident liver cells. TLR4 and the intestinal microbiota were not required for HCC initiation but for HCC promotion, mediating increased proliferation, expression of the hepatomitogen epiregulin, and prevention of apoptosis. Gut sterilization restricted to late stages of hepatocarcinogenesis reduced HCC, suggesting that the intestinal microbiota and TLR4 represent therapeutic targets for HCC prevention in advanced liver disease.
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Affiliation(s)
- Dianne H Dapito
- Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA.
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Abstract
With the increasing use of tenofovir disoproxil in the management of HIV and hepatitis B, serious adverse effects, such as renal dysfunction, will inevitably increase in frequency. We describe a case of a patient presenting with hypophosphataemia suggestive of Fanconi's syndrome, but in fact explicable by simple vitamin D deficiency. This emphasizes that while monitoring for adverse effects is recommended, physicians must consider all alternative causes for biochemical abnormalities prior to discontinuing tenofovir and delaying appropriate management.
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Affiliation(s)
| | - M Bower
- Department of Medical Oncology
| | - M Nelson
- Department of HIV Medicine, Chelsea and Westminster Hospital, London, UK
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Alfa-Wali M, Allen-Mersh T, Antoniou A, Tait D, Newsom-Davis T, Gazzard B, Nelson M, Bower M. Chemoradiotherapy for anal cancer in HIV patients causes prolonged CD4 cell count suppression. Ann Oncol 2012; 23:141-147. [PMID: 21444358 DOI: 10.1093/annonc/mdr050] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Despite the advent of highly active antiretroviral therapy, anal cancer remains a significant health problem in human immunodeficiency virus (HIV) patients. We present the clinical features and treatment outcomes of anal cancer in 60 HIV-positive patients over a 20-year period. PATIENTS AND METHODS A prospective database of all HIV-positive individuals managed in a specialist unit since 1986 includes 11 112 patients (71 687 person-years of follow-up). Sixty patients with anal cancer were identified. Their clinicopathological and treatment details were analysed. RESULTS At anal cancer diagnosis, the mean age was 44 years (range: 28-75 years) and the median CD4 cell count was 305 mm(-3) (range: 16-1252 mm(-3)). Fifty (83%) had chemoradiotherapy (CRT). Forty-six (92%) responded, of whom 10 (22%) subsequently relapsed with locoregional (70%), metastatic disease (10%) or both (20%). The overall 5-year survival is 65% (95% confidence interval 51% to 78%). The median CD4 count fell from 289 mm(-3) before CRT to 132 mm(-3) after 3 months and to 189 mm(-3) after 1 year (P<0.05). Six patients in remission of anal cancer died of acquired immunodeficiency syndrome defining illnesses. CONCLUSIONS The management of anal cancer with CRT achieves similar outcomes as the general population. CRT is associated with significant prolonged CD4 suppression that may contribute to late deaths of patients in remission.
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Affiliation(s)
- M Alfa-Wali
- Department of Surgery and Cancer, Imperial College London, London
| | - T Allen-Mersh
- Department of Surgery and Cancer, Imperial College London, London
| | - A Antoniou
- Department of Surgery and Cancer, Imperial College London, London; Department of Surgery, Institute of Cancer Research, London
| | - D Tait
- Department of Clinical Oncology, Royal Marsden Hospital
| | - T Newsom-Davis
- Departments of Oncology; HIV Medicine, Chelsea and Westminster Hospital, London, UK
| | - B Gazzard
- Departments of Oncology; HIV Medicine, Chelsea and Westminster Hospital, London, UK
| | - M Nelson
- Departments of Oncology; HIV Medicine, Chelsea and Westminster Hospital, London, UK
| | - M Bower
- Department of Surgery and Cancer, Imperial College London, London; Departments of Oncology; HIV Medicine, Chelsea and Westminster Hospital, London, UK.
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Burton CT, Westrop SJ, Eccles-James I, Boasso A, Nelson MR, Bower M, Imami N. Altered phenotype of regulatory T cells associated with lack of human immunodeficiency virus (HIV)-1-specific suppressive function. Clin Exp Immunol 2011; 166:191-200. [PMID: 21985365 DOI: 10.1111/j.1365-2249.2011.04451.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Mechanisms by which CD4+ regulatory T cells (T(regs)) mediate suppression of virus-specific responses remain poorly defined. Adenosine, mediated via CD39 and CD73, has been shown to play a role in the action of murine T(regs) . In this study we investigate the phenotype of T(regs) in the context of human immunodeficiency virus (HIV)-1 infection, and the function of these cells in response to HIV-1-Gag and cytomegalovirus (CMV) peptides. Phenotypic data demonstrate a decrease in forkhead box transcription factor 3 (FoxP3+) T(reg) numbers in the peripheral blood of HIV-1+ individuals compared to healthy controls, which is most pronounced in those with high HIV-1 RNA plasma load. Due to aberrant expression of CD27 and CD127 during HIV-1 disease, these markers are unreliable for T(reg) identification. The CD3+ CD4+ CD25(hi) CD45RO+ phenotype correlated well with FoxP3 expression in both the HIV-1+ and seronegative control cohorts. We observed expression of CD39 but not CD73 on T(regs) from HIV-1+ and healthy control cohorts. We demonstrate, through T(reg) depletion, the suppressive potential of T(regs) over anti-CMV responses in the context of HIV-1 infection; however, no recovery of the HIV-1-specific T cell response was observed indicating a preferential loss of HIV-1-specific T(reg) function. We propose that before immunotherapeutic manipulation of T(regs) is considered, the immunoregulatory profile and distribution kinetics of this population in chronic HIV-1 infection must be elucidated fully.
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Affiliation(s)
- C T Burton
- Department of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK
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Koban E, Denizci M, Aslan O, Aktoprakligil D, Aksu S, Bower M, Balcioglu BK, Ozdemir Bahadir A, Bilgin R, Erdag B, Bagis H, Arat S. High microsatellite and mitochondrial diversity in Anatolian native horse breeds shows Anatolia as a genetic conduit between Europe and Asia. Anim Genet 2011; 43:401-9. [PMID: 22497212 DOI: 10.1111/j.1365-2052.2011.02285.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The horse has been a food source, but more importantly, it has been a means for transport. Its domestication was one of the crucial steps in the history of human civilization. Despite the archaeological and molecular studies carried out on the history of horse domestication, which would contribute to conservation of the breeds, the details of the domestication of horses still remain to be resolved. We employed 21 microsatellite loci and mitochondrial control region partial sequences to analyse genetic variability within and among four Anatolian native horse breeds, Ayvacık Pony, Malakan Horse, Hınıs Horse and Canik Horse, as well as samples from indigenous horses of unknown breed ancestry. The aims of the study were twofold: first, to produce data from the prehistorically and historically important land bridge, Anatolia, in order to assess its role in horse domestication and second, to analyse the data from a conservation perspective to help the ministry improve conservation and management strategies regarding native horse breeds. Even though the microsatellite data revealed a high allelic diversity, 98% of the genetic variation partitioned within groups. Genetic structure did not correlate with a breed or geographic origin. High diversity was also detected in mtDNA control region sequence analysis. Frequencies of two haplogroups (HC and HF) revealed a cline between Asia and Europe, suggesting Anatolia as a probable connection route between the two continents. This first detailed genetic study on Anatolian horse breeds revealed high diversity among horse mtDNA haplogroups in Anatolia and suggested Anatolia's role as a conduit between the two continents. The study also provides an important basis for conservation practices in Turkey.
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Affiliation(s)
- E Koban
- TUBITAK Marmara Research Center, Genetic Engineering and Biotechnology Institute, Kocaeli, Turkey
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Merchant S, Marouf A, Hachach-Haram N, Nelson M, Bower M, Newsom-Davis T. 31 Histolopathological trends in HIV-associated lung cancer. Lung Cancer 2011. [DOI: 10.1016/s0169-5002(11)70031-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Armstrong-James D, Stebbing J, John L, Murungi A, Bower M, Gazzard B, Nelson M. A trial of caspofungin salvage treatment in PCP pneumonia. Thorax 2010; 66:537-8. [DOI: 10.1136/thx.2010.135350] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lee S, Syed N, Taylor J, Smith P, Griffin B, Baens M, Bai M, Bourantas K, Stebbing J, Naresh K, Nelson M, Tuthill M, Bower M, Hatzimichael E, Crook T. DUSP16 is an epigenetically regulated determinant of JNK signalling in Burkitt's lymphoma. Br J Cancer 2010; 103:265-74. [PMID: 20551953 PMCID: PMC2906728 DOI: 10.1038/sj.bjc.6605711] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [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] [Indexed: 12/27/2022] Open
Abstract
Background: The mitogen-activated protein kinase (MAPK) phosphatases or dual specificity phosphatases (DUSPs) are a family of proteins that catalyse the inactivation of MAPK in eukaryotic cells. Little is known of the expression, regulation or function of the DUSPs in human neoplasia. Methods: We used RT–PCR and quantitative PCR (qPCR) to examine the expression of DUSP16 mRNA. The methylation in the DUSP16 CpG island was analysed using bisulphite sequencing and methylation-specific PCR. The activation of MAPK was determined using western blotting with phospho-specific antibodies for extra-cellular signal-related kinase (ERK), p38 and c-Jun N-terminal kinase (JNK). The proliferation of cell lines was assessed using the CellTiter 96 Aqueous One assay. Results: The expression of DUSP16, which inactivates MAPK, is subject to methylation-dependent transcriptional silencing in Burkitt's Lymphoma (BL) cell lines and in primary BL. The silencing is associated with aberrant methylation in the CpG island in the 5′ regulatory sequences of the gene blocking its constitutive expression. In contrast to BL, the CpG island of DUSP16 is unmethylated in other non-Hodgkin's lymphomas (NHLs) and epithelial malignancies. In BL cell lines, neither constitutive nor inducible ERK or p38 activity varied significantly with DUSP16 status. However, activation of JNK was increased in lines with DUSP16 methylation. Furthermore, methylation in the DUSP16 CpG island blocked transcriptional induction of DUSP16, thereby abrogating a normal physiological negative feedback loop that limits JNK activity, and conferred increased cellular sensitivity to agents, such as sorbitol and anthracycline chemotherapeutic agents that activate JNK. Conclusion: DUSP16 is a new epigenetically regulated determinant of JNK activation in BL.
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Affiliation(s)
- S Lee
- Laboratory of Cancer Genetics and Epigenetics, Breakthrough Breast Cancer, Institute of Cancer Research, Fulham Road, London, UK
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Davidson I, Beardsell H, Smith B, Mandalia S, Bower M, Gazzard B, Nelson M, Stebbing J. The frequency and reasons for antiretroviral switching with specific antiretroviral associations: the SWITCH study. Antiviral Res 2010; 86:227-9. [PMID: 20211651 DOI: 10.1016/j.antiviral.2010.03.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 02/01/2010] [Accepted: 03/01/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND We investigated the reasons for switching antiretroviral regimens, an issue rarely addressed in cohort studies. METHODS An observed toxicity switch rate (OTSR) was calculated by Poisson regression using the number of days individuals received each individual antiretroviral drug. RESULTS Of 3333 individuals receiving HAART, a total of 14% of regimens were switched, the majority occurring after 6 months of therapy. Toxicity was the major reason for switching (61%) and there were no major statistically significant differences in OTSR between the protease inhibitor (OTSR 26.4, 95% CI 18.3-37) and non-nucleoside reverse transcriptase inhibitor (OTSR 22.2, 95% CI 13.6-34.4) based regimes. For individual antiretrovirals, stavudine and zidovudine had significantly higher "switch" scores than all other drugs. CONCLUSIONS There were no differences between the major HAART classes in OTSR. We suggest that newer antiretrovirals will require differentiation in terms of longer-term toxicity, as this is the major reason for switching.
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Affiliation(s)
- I Davidson
- St. Stephen's Centre, Chelsea and Westminster Hospital Trust, United Kingdom
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Rosignoli G, Lim CH, Bower M, Gotch F, Imami N. Programmed death (PD)-1 molecule and its ligand PD-L1 distribution among memory CD4 and CD8 T cell subsets in human immunodeficiency virus-1-infected individuals. Clin Exp Immunol 2009; 157:90-7. [PMID: 19659774 DOI: 10.1111/j.1365-2249.2009.03960.x] [Citation(s) in RCA: 37] [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: 01/11/2023] Open
Abstract
Human immunodeficiency virus (HIV)-1 causes T cell anergy and affects T cell maturation. Various mechanisms are responsible for impaired anti-HIV-1-specific responses: programmed death (PD)-1 molecule and its ligand PD-L1 are negative regulators of T cell activity and their expression is increased during HIV-1 infection. This study examines correlations between T cell maturation, expression of PD-1 and PD-L1, and the effects of their blockade. Peripheral blood mononuclear cells (PBMC) from 24 HIV-1(+) and 17 uninfected individuals were phenotyped for PD-1 and PD-L1 expression on CD4(+) and CD8(+) T cell subsets. The effect of PD-1 and PD-L1 blockade on proliferation and interferon (IFN)-gamma production was tested on eight HIV-1(+) patients. Naive (CCR7(+)CD45RA(+)) CD8(+) T cells were reduced in HIV-1 aviraemic (P = 0.0065) and viraemic patients (P = 0.0130); CD8 T effector memory subsets [CCR7(-)CD45RA(-)(T(EM))] were increased in HIV-1(+) aviraemic (P = 0.0122) and viraemic (P = 0.0023) individuals versus controls. PD-1 expression was increased in CD4 naive (P = 0.0496), central memory [CCR7(+)CD45RA(-) (T(CM)); P = 0.0116], T(EM) (P = 0.0037) and CD8 naive T cells (P = 0.0133) of aviraemic HIV-1(+) versus controls. PD-L1 was increased in CD4 T(EMRA) (CCR7(-)CD45RA(+), P = 0.0119), CD8 T(EM) (P = 0.0494) and CD8 T(EMRA) (P = 0.0282) of aviraemic HIV-1(+)versus controls. PD-1 blockade increased HIV-1-specific proliferative responses in one of eight patients, whereas PD-L1 blockade restored responses in four of eight patients, but did not increase IFN-gamma-production. Alteration of T cell subsets, accompanied by increased PD-1 and PD-L1 expression in HIV-1 infection contributes to anergy and impaired anti-HIV-1-specific responses which are not rescued when PD-1 is blocked, in contrast to when PD-L1 is blocked, due possibly to an ability to bind to receptors other than PD-1.
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Affiliation(s)
- G Rosignoli
- Department of Immunology, Imperial College London, Chelsea & Westminster Hospital, London, UK
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Pantanowitz L, Gaughan EM, Dezube BJ, Bower M, Aboulafia D. HIV-associated bladder cancer: diagnosis and management. Infect Agent Cancer 2009. [PMCID: PMC4261808 DOI: 10.1186/1750-9378-4-s2-p34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Bower M, Syed N, Papoudou-Bai A, Stebbing J, Naresh K, Hatzimichael E, Powles S, Crook T. Methylation reversal in high-grade B lymphoma cell lines and novel epigenetic changes conserved between immunocompetent and HIV-positive hosts. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8585 Background: Methylation-dependent transcriptional silencing is an important mechanism of tumour suppressor gene inactivation in neoplasia, including lymphoma. Methods: Pharmacological “unmasking” of transcriptionally silenced genes in B lymphoma cell lines was achieved using 5' deazacytidine ± Trichostatin A and subsequent analysis of mRNA levels on micro-array. Candidate genes thus identified, were further analysed by qPCR, methylation-specific PCR (MSP) and bisulphite sequencing in B lymphoma cell lines and by MSP in clinical samples from sporadic (immunocompetent) (18 cases) and HIV-infected patients (14 cases). Samples in both patient groups were diffuse large B cell lymphoma (DLBCL) and Burkitt's lymphoma (BL). Additionally, we analysed 8 cases of marginal zone lymphoma (MZL) from the immunocompetent group. Results: We report the identification of 13 novel genes, not previously described in the literature, which are subject to methylation-dependent transcriptional silencing in high-grade lymphoma and whose expression can be reactivated by demethylating agents. The novel genes encode proteins involved in diverse functional classes and include pro-apoptotic members of the p53 pathway (Scotin), transcriptional regulators (Baz2B) and regulators of telomerase (Smrf2). The frequency of methylation in individual genes varied from approximately 10% to 75% in specific lymphoma subtypes, but was in general similar in high grade lymphomas in immunocompetent and HIV-infected hosts. Conclusions: Using pharmacological reversal of methylation, we have identified a number of genes, not previously implicated in human neoplasia, which are subject to transcriptional silencing in high-grade B lymphomas. The similar frequencies of methylation, observed in immunocompetent and HIV positive patients implies that the genes are fundamental in suppression of lymphomagenesis. Detection of methylated DNA of one or more of these genes may have utility as biomarkers of clinical outcome in each patient group. No significant financial relationships to disclose.
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Affiliation(s)
- M. Bower
- Chelsea and Westminster Hospital, London, United Kingdom; Department of Oncology, Imperial College, London, United Kingdom; University Hospital of Ioannina, Ioannina, Greece; Department Histopathology, Imperial College, London, United Kingdom
| | - N. Syed
- Chelsea and Westminster Hospital, London, United Kingdom; Department of Oncology, Imperial College, London, United Kingdom; University Hospital of Ioannina, Ioannina, Greece; Department Histopathology, Imperial College, London, United Kingdom
| | - A. Papoudou-Bai
- Chelsea and Westminster Hospital, London, United Kingdom; Department of Oncology, Imperial College, London, United Kingdom; University Hospital of Ioannina, Ioannina, Greece; Department Histopathology, Imperial College, London, United Kingdom
| | - J. Stebbing
- Chelsea and Westminster Hospital, London, United Kingdom; Department of Oncology, Imperial College, London, United Kingdom; University Hospital of Ioannina, Ioannina, Greece; Department Histopathology, Imperial College, London, United Kingdom
| | - K. Naresh
- Chelsea and Westminster Hospital, London, United Kingdom; Department of Oncology, Imperial College, London, United Kingdom; University Hospital of Ioannina, Ioannina, Greece; Department Histopathology, Imperial College, London, United Kingdom
| | - E. Hatzimichael
- Chelsea and Westminster Hospital, London, United Kingdom; Department of Oncology, Imperial College, London, United Kingdom; University Hospital of Ioannina, Ioannina, Greece; Department Histopathology, Imperial College, London, United Kingdom
| | - S. Powles
- Chelsea and Westminster Hospital, London, United Kingdom; Department of Oncology, Imperial College, London, United Kingdom; University Hospital of Ioannina, Ioannina, Greece; Department Histopathology, Imperial College, London, United Kingdom
| | - T. Crook
- Chelsea and Westminster Hospital, London, United Kingdom; Department of Oncology, Imperial College, London, United Kingdom; University Hospital of Ioannina, Ioannina, Greece; Department Histopathology, Imperial College, London, United Kingdom
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Stebbing J, Ngan S, Ibrahim H, Charles P, Nelson M, Kelleher P, Naresh KN, Bower M. The successful treatment of haemophagocytic syndrome in patients with human immunodeficiency virus-associated multi-centric Castleman's disease. Clin Exp Immunol 2009; 154:399-405. [PMID: 19222502 DOI: 10.1111/j.1365-2249.2008.03786.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Both virus-associated haemophagocytic syndrome (HPS) and human immunodeficiency virus-associated multi-centric Castleman's disease (HIV-MCD) induced by human herpesvirus-8 (HHV-8) are extremely rare. We therefore wished to investigate their occurrence together, and establish the degree of cytokine activation present. From a prospective cohort of individuals with HIV-MCD, we investigated the incidence and outcomes of HPS and measured 15 inflammatory cytokines and the plasma HHV-8 viral loads before and during follow-up. Of 44 patients with HIV-MCD with an incidence of 4.3/10,000 patient years, four individuals (9%) were diagnosed with HPS. All are in remission (range 6-28 months) following splenectomy, etoposide and rituximab-based therapy. Plasma HHV-8 levels were raised markedly at presentation (median 3,840,000 copies/ml). Histological samples from spleen, splenic hilar lymph nodes and bone marrow demonstrated increased phagocytosis by histiocytes and presence of HHV-8-infected plasmablasts outside the follicles. Surprisingly, many known inflammatory plasma cytokines were not elevated, although interleukin (IL)-8 and interferon-gamma were increased in all cases and IL-6 levels were raised in three of four patients. HPS in the setting of HIV-MCD is common and treatment can be successful provided the diagnosis is made appropriately. Systemic activation of cytokines was limited, suggesting that immunosuppressive therapy with steroids is not indicated in HHV-8-driven HPS.
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Affiliation(s)
- J Stebbing
- Department of Oncology, Imperial College School of Medicine, Chelsea and Westminster Hospital, London UK.
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Bower M, Collins S, Cottrill C, Cwynarski K, Montoto S, Nelson M, Nwokolo N, Powles T, Stebbing J, Wales N, Webb A. British HIV Association guidelines for HIV-associated malignancies 2008. HIV Med 2009; 9:336-88. [PMID: 18705759 DOI: 10.1111/j.1468-1293.2008.00608.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- M Bower
- Department of Oncology, Chelsea & Westminster Hospital, London, UK.
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Powles T, Stebbing J, Bazeos A, Hatzimichael E, Mandalia S, Nelson M, Gazzard B, Bower M. The role of immune suppression and HHV-8 in the increasing incidence of HIV-associated multicentric Castleman's disease. Ann Oncol 2009; 20:775-9. [PMID: 19179554 DOI: 10.1093/annonc/mdn697] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In HIV cohorts with access to highly active antiretroviral therapy (HAART), the incidence of Kaposi's sarcoma (KS) is falling; however, the incidence of multicentric Castleman's disease (MCD) in HIV has not previously been described. METHODS The incidence of HIV-associated MCD was calculated from a prospective HIV database with 56 202 patient-years of follow-up and compared with KS. Univariate and multivariate analyses were carried out to identify factors associated with MCD. Plasma human herpesvirus (HHV)-8 DNA levels were measured in HIV-seropositive individuals with newly diagnosed MCD (n = 24), KS (n = 72), HIV-associated lymphoma (n = 74) and HIV-positive controls (n = 53). RESULTS From 24 cases of HIV-associated MCD, the incidence measured 4.3/10,000 patient-years [95% confidence interval (CI) 2.7-6.4]. The incidence in the pre-HAART (1983-1996), early-HAART (1997-2001) and later HAART (2002-2007) eras were 2.3 (95% CI 0.02-4.2), 2.8 (95% CI 0.9-6.5) and 8.3 (95% CI 4.6-12.6), respectively, representing a statistically significant increase over time (P < 0.05). In contrast, from 1180 cases of KS, the incidence in this cohort decreased with time. Multivariate analysis demonstrated that a nadir CD4 count >200/mm(3), increased age, no previous HAART exposure and non-Caucasian ethnicity were all associated with an increased risk of MCD. Plasma HHV-8 DNA levels were higher in patients with newly diagnosed MCD than with KS, lymphomas or HIV-positive controls (Mann-Whitney U-test, P < 0.0001). CONCLUSIONS The incidence of HIV-associated MCD is increasing. It appears to occur more frequently in older HIV-positive individuals with well-preserved immune function.
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Affiliation(s)
- T Powles
- Department of Medical Oncology, Barts and the London Medical School, London, UK
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Stebbing J, Asghar AK, Holmes P, Bower M, Isenman HL, Nelson M. Use of ezetimibe during HIV infection. J Antimicrob Chemother 2008; 63:218-20. [DOI: 10.1093/jac/dkn440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bazeos A, Powles T, Stebbing J, Mandalia S, Bower M. The increasing incidence of HIV-associated multicentric Castlemans disease. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.7085] [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: 11/20/2022] Open
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Bower M, Stebbing J, Tuthill MH, Krell J, Campbell V, Nelson M, Gazzard B, Powles T. Recovery of cellular immunity following chemotherapy for AIDS related non Hodgkin’s lymphoma. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8582] [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: 11/20/2022] Open
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Naresh KN, Francis N, Sarwar N, Bower M. Expression of human herpesvirus 8 (HHV-8), latent nuclear antigen 1 (LANA1) in angiosarcoma in acquired immunodeficiency syndrome (AIDS) - a report of two cases. Histopathology 2008; 51:861-4. [PMID: 18042074 DOI: 10.1111/j.1365-2559.2007.02877.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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