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Mashar M, Aboiye A, Sehdev M, Launer D, Sylla M, Mashar R, Posever N, Jindal J, Komarraju A, Gill R. Undergraduate radiology in low- and middle-income countries (LMICs). Clin Radiol 2022. [DOI: 10.1016/j.crad.2022.08.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mashar M, Said A, Hussain M, Eze V. Trauma in a non-trauma centre: Outcomes and incidental findings. Clin Radiol 2022. [DOI: 10.1016/j.crad.2022.08.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mashar M, Bhagwanani A, Plumb A. Acute colitis on CT: Narrowing the differentials. Clin Radiol 2022. [DOI: 10.1016/j.crad.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mashar M, Said A, Hussain M, Eze V. Reporting acute trauma in a non-trauma centre: improving scan turnover time. Clin Radiol 2022. [DOI: 10.1016/j.crad.2022.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Posever N, Sehdev M, Sylla M, Mashar R, Mashar M, Abioye A. Addressing Equity in Global Medical Education During the COVID-19 Pandemic: The Global Medical Education Collaborative. Acad Med 2021; 96:1574-1579. [PMID: 34261867 PMCID: PMC8541891 DOI: 10.1097/acm.0000000000004230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PROBLEM The COVID-19 pandemic has presented a unique set of challenges to medical education globally. Low- and middle-income countries (LMICs) have faced unique barriers in transitioning to virtual modalities, and many medical students in LMICs experienced dramatically reduced educational time. The authors created the Global Medical Education Collaborative (GMEC) to address this problem by providing free, online, case-based tutorials to medical students in LMICs during the pandemic. APPROACH The authors developed a needs assessment to gauge students' educational requirements, which informed GMEC's 2 primary goals: to provide free access to interactive online tutorials for students in LMICs and to bridge the physical distance between educators and learners via an online platform. A pilot program in Nigeria (April 26-May 26, 2020) helped inform the current strategy and logistics. Tutors and students were recruited via social media and medical education networks at the authors' home institutions. OUTCOMES Within the first 2 months (April 26-June 26, 2020), 324 students representing 12 countries and 20+ medical schools joined GMEC. Additionally, 95 physicians and trainees joined as tutors and, collectively, delivered 52 tutorials. Students responded to a needs assessment querying confidence in various clinical domains, interest in covering clinical topics, barriers to virtual learning, and the effect of the pandemic on their education. Tutors held 1-hour, interactive tutorials over Zoom covering a variety of clinical topics. According to surveys, 91% of students (71 of 78) felt more confident in the material related to the tutorial's topic after participating. NEXT STEPS GMEC will continue to engage students, tutors, and collaborators to facilitate the delivery of innovative, high-quality tutorials to students affected by COVID-19 in LMICs. To ensure that the platform is sustainable and aligned with GMEC's mission to promote equity in global medical education, the collaborative will need to be agile and responsive.
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Affiliation(s)
- Natalie Posever
- N. Posever is a fourth-year medical student, Harvard Medical School, Boston, Massachusetts
| | - Morgan Sehdev
- M. Sehdev is a fourth-year medical student, Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0002-2981-0512
| | - Mariame Sylla
- M. Sylla is a fourth-year medical student, Harvard Medical School, Boston, Massachusetts
| | - Ruchir Mashar
- R. Mashar is specialty registrar in general surgery, West Midlands Deanery, Edgbaston, Birmingham, United Kingdom
| | - Meghavi Mashar
- M. Mashar is specialty registrar in radiology, University College London Hospitals, National Health Service Foundation Trust, London, United Kingdom
| | - Abubakar Abioye
- A. Abioye is physician, Luton and Dunstable Hospital, and a candidate, Postgraduate Diploma in Medical Education, Keele University, Keele, Staffordshire, United Kingdom
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Nanapragasam A, Mashar M. Postgraduate radiology education: what has Covid-19 changed? BJR Open 2021; 3:20200064. [PMID: 34381944 PMCID: PMC8327928 DOI: 10.1259/bjro.20200064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/28/2021] [Accepted: 07/14/2021] [Indexed: 12/30/2022] Open
Abstract
Radiology training in the UK follows a standardised pathway with formative and summative assessments throughout. The Covid-19 pandemic has affected multiple existing educational methods commonly used during radiology training including small group teaching, multidisciplinary team meetings, online e-learning modules, radiology courses, exam provision and more. As such, significant adaptations have been implemented in order to maintain the standard of radiology training which come with their respective advantages and disadvantages. However, the question still remains as to the effectiveness of these methods, their acceptability and longevity. In this review, we discuss these educational adaptations and future directions for training in the ongoing pandemic.
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Affiliation(s)
| | - Meghavi Mashar
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Tsakok MT, Mashar M, Pickup L, Peschl H, Kadir T, Gleeson F. The utility of a convolutional neural network (CNN) model score for cancer risk in indeterminate small solid pulmonary nodules, compared to clinical practice according to British Thoracic Society guidelines. Eur J Radiol 2021; 137:109553. [PMID: 33581913 DOI: 10.1016/j.ejrad.2021.109553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To determine how implementation of an artificial intelligence nodule algorithm, the Lung Cancer Prediction Convolutional Neural Network (LCP-CNN), at the point of incidental nodule detection would have influenced further investigation and management using a series of threshold scores at both the benign and malignant end of the spectrum. METHOD An observational retrospective study was performed in the assessment of nodules between 5-15 mm (158 benign, 32 malignant) detected on CT scans, which were performed as part of routine practice. The LCP-CNN was applied to the baseline CT scan producing a percentage score, and subsequent imaging and management determined for each threshold group. We hypothesized that the 5% low risk threshold group requires only one follow-up, the 0.56% very low risk threshold group requires no follow-up and the 80% high risk threshold group warrants expedited intervention. RESULTS The 158 benign nodules had an LCP-CNN score between 0.1 and 70.8%, median 5.5% (IQR 1.4-18.0), whilst the 32 cancer nodules had an LCP-CNN score between 10.1 and 98.7%, median 59.0% (IQR 37.1-83.9). 24/61 CT scans in the 0.56-5% group (n = 37) and 21/21 CT scans <0.56% group (n = 13) could be obviated resulting in an overall reduction of 18.6% (45/242) CT scans in the benign cohort. In the 80% group (n = 10), expedited intervention of malignant nodules could result in a 3.6-month reduction in time delay in 5 cancer patients. CONCLUSION We show the potential of artificial intelligence to reduce the need for follow-up scans and intervention in low-scoring benign nodules, whilst potentially accelerating the investigation and treatment of high-scoring cancer nodules.
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Affiliation(s)
- Maria T Tsakok
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Meghavi Mashar
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, UK
| | | | - Heiko Peschl
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | | | - Fergus Gleeson
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK.
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Mashar M, Nanapragasam A, Haslam P. Interventional radiology training: where will technology take us? BJR Open 2019; 1:20190002. [PMID: 33178937 PMCID: PMC7592432 DOI: 10.1259/bjro.20190002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 06/17/2019] [Accepted: 08/01/2019] [Indexed: 12/26/2022] Open
Abstract
Interventional radiology is a relatively young specialty, and it is undergoing a period of considerable growth. The benefits of a minimally invasive approach are clear, with smaller incisions, less pain, and faster recovery times being the principal benefits compared to surgical alternatives. Trainees need to acquire the technical skills and the clinical acumen to accurately deliver targeted treatment and safely follow up patients after the procedure. The need to maintain an efficient interventional radiology service whilst also giving sufficient time for trainee education is a challenge. In order to compensate for this, novel technologies like virtual reality (VR), augmented reality (AR), cadaveric simulation, and three-dimensional (3D) printing have been postulated as a means of supplementing training. In this article, we outline the main features of these innovative strategies and discuss the evidence base behind them. Benefits of these techniques beyond pure clinical training include the standardization of educational cases, access to training at any time, and less risk to patients. The main disadvantage is the large financial outlay required. Therefore, before widespread uptake can be recommended, further research is needed to confirm the educational benefit of these novel techniques, both in and of themselves and in comparison to existing clinical-based education.
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Affiliation(s)
- Meghavi Mashar
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Philip Haslam
- The Newcastle Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
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Sabry M, Zubiak A, Hood SP, Simmonds P, Arellano-Ballestero H, Cournoyer E, Mashar M, Pockley AG, Lowdell MW. Tumor- and cytokine-primed human natural killer cells exhibit distinct phenotypic and transcriptional signatures. PLoS One 2019; 14:e0218674. [PMID: 31242243 PMCID: PMC6594622 DOI: 10.1371/journal.pone.0218674] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/06/2019] [Indexed: 11/19/2022] Open
Abstract
An emerging cellular immunotherapy for cancer is based on the cytolytic activity of natural killer (NK) cells against a wide range of tumors. Although in vitro activation, or “priming,” of NK cells by exposure to pro-inflammatory cytokines, such as interleukin (IL)-2, has been extensively studied, the biological consequences of NK cell activation in response to target cell interactions have not been thoroughly characterized. We investigated the consequences of co-incubation with K562, CTV-1, Daudi RPMI-8226, and MCF-7 tumor cell lines on the phenotype, cytokine expression profile, and transcriptome of human NK cells. We observe the downregulation of several activation receptors including CD16, CD62L, C-X-C chemokine receptor (CXCR)-4, natural killer group 2 member D (NKG2D), DNAX accessory molecule (DNAM)-1, and NKp46 following tumor-priming. Although this NK cell phenotype is typically associated with NK cell dysfunction in cancer, we reveal the upregulation of NK cell activation markers, such as CD69 and CD25; secretion of pro-inflammatory cytokines, including macrophage inflammatory proteins (MIP-1) α /β and IL-1β/6/8; and overexpression of numerous genes associated with enhanced NK cell cytotoxicity and immunomodulatory functions, such as FAS, TNFSF10, MAPK11, TNF, and IFNG. Thus, it appears that tumor-mediated ligation of receptors on NK cells may induce a primed state which may or may not lead to full triggering of the lytic or cytokine secreting machinery. Key signaling molecules exclusively affected by tumor-priming include MAP2K3, MARCKSL1, STAT5A, and TNFAIP3, which are specifically associated with NK cell cytotoxicity against tumor targets. Collectively, these findings help define the phenotypic and transcriptional signature of NK cells following their encounters with tumor cells, independent of cytokine stimulation, and provide insight into tumor-specific NK cell responses to inform the transition toward harnessing the therapeutic potential of NK cells in cancer.
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Affiliation(s)
- May Sabry
- Department of Haematology, University College London, London, United Kingdom
| | - Agnieszka Zubiak
- Department of Haematology, University College London, London, United Kingdom
| | - Simon P. Hood
- John van Geest Cancer Research Centre, Nottingham Trent University, Nottingham, United Kingdom
| | - Poppy Simmonds
- Department of Haematology, University College London, London, United Kingdom
| | | | - Eily Cournoyer
- Department of Haematology, University College London, London, United Kingdom
| | - Meghavi Mashar
- Department of Haematology, University College London, London, United Kingdom
| | - A. Graham Pockley
- John van Geest Cancer Research Centre, Nottingham Trent University, Nottingham, United Kingdom
| | - Mark W. Lowdell
- Department of Haematology, University College London, London, United Kingdom
- InmuneBio Inc., La Jolla, California, United States of America
- * E-mail:
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Mashar M, Mashar R, Hajibandeh S. Uncovered versus covered stent in management of large bowel obstruction due to colorectal malignancy: a systematic review and meta-analysis. Int J Colorectal Dis 2019; 34:773-785. [PMID: 30903271 DOI: 10.1007/s00384-019-03277-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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] [Accepted: 02/06/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE To compare outcomes of uncovered stent and covered stent in management of large bowel obstruction secondary to colorectal malignancy. METHODS We conducted a search of electronic databases identifying studies comparing outcomes of uncovered and covered stents in management of large bowel obstruction secondary to colorectal malignancy. The Cochrane risk-of-bias tool and the Newcastle-Ottawa scale were used to assess the included studies. Random or fixed effects modelling were applied as appropriate to calculate pooled outcome data. RESULTS One randomised controlled trial (RCT) and nine observational studies, enrolling 753 patients, were identified. Uncovered stent was associated with lower risks of complications (RR 0.57 95% CI 0.44-0.74, P < 0.0001), tumour overgrowth (RR 0.29 95% CI 0.09-0.93, P = 0.04), and stent migration (RR 0.29 95% CI 0.17-0.48, P < 0.00001); longer duration of patency (MD 18.47 95% CI 10.46-26.48, P < 0.00001); lower need for stent reinsertion (RR 0.38 95% CI 0.17-0.86, P = 0.02); and higher risk of tumour ingrowth (RR 4.53 95% CI 1.92-10.69, P = 0.0008). Rates of technical success (RR 1.02 95% CI 0.99-1.04, P = 0.21), clinical success (RR 1.03 95% CI 0.98-1.08, P = 0.32), perforation (RD 0.01 95% CI - 0.03-0.02, P = 0.65), bleeding (RD 0.00 95% CI - 0.03-0.03, P = 0.98), stool impaction (RR 0.56 95% CI 0.12-2.04, P = 0.38) and stent obstruction (RR 2.23 95% CI 0.94-5.34, P = 0.97) were similar. CONCLUSIONS Our results suggest that uncovered stents are superior as indicated by fewer complications, lower rates of stent migration, longer duration of patency and a reduced need for stent reinsertion. The best available evidence is mainly derived from non-randomised studies; there is a need for more RCTs.
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Affiliation(s)
- Meghavi Mashar
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Ruchir Mashar
- Department of General Surgery, Hereford County Hospital, Hereford, HR1 2BN, UK
| | - Shahab Hajibandeh
- Department of General Surgery, North Manchester General Hospital, Manchester, M8 5RB, UK
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Abstract
BACKGROUND Numbers of academic medicine trainees have been declining internationally. Many countries have taken differing approaches to improving recruitment, with some having established pathways. In the UK, the academic foundation programme (AFP) is one such pathway aimed towards those interested in an academic medical career. Variation exists amongst universities with respect to application and success rates. As a group of AFP doctors, we aimed to explore these issues. Numbers of academic medicine trainees have been declining internationally METHODS: We created and implemented a 1-day national course, comprising lectures and small group workshops, geared towards informing applicants about the AFP. It was evaluated via pre- and post-course questionnaires using a Likert scale, ranging from 1 to 5. We created and implemented a 1-day national course, comprising lectures and small group workshops, geared towards informing applicants about the AFP RESULTS: A total of 150 attendees were present from 16 different medical schools; 95% (143/150) of the attendees filled in both questionnaires. Attendees appeared unaware of the stages involved in the application process and felt underprepared. Following the course, learners reported median scores (with interquartile limits) that demonstrated increased overall knowledge, from 2 (1) to 4 (1) (p < 0.01), and increased preparedness, from 2 (1) to 3 (1) (p < 0.01). DISCUSSION Our findings indicate that recruitment remains challenging, even in countries with established pathways. In the UK, the awareness of these pathways appears to be poor and courses such as ours may remedy that. Further exploration into the most effective methods to increase recruitment is necessary. The effect of institutional disparities in research culture and impact on application success needs investigation. Perhaps medical schools should introduce students to the prospect of academic careers earlier in training. Globally, efforts still need to be concentrated largely towards establishing integrated pathways.
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Affiliation(s)
- Meghavi Mashar
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - James Kilgour
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Sam Lipworth
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Pekalski ML, García AR, Ferreira RC, Rainbow DB, Smyth DJ, Mashar M, Brady J, Savinykh N, Dopico XC, Mahmood S, Duley S, Stevens HE, Walker NM, Cutler AJ, Waldron-Lynch F, Dunger DB, Shannon-Lowe C, Coles AJ, Jones JL, Wallace C, Todd JA, Wicker LS. Neonatal and adult recent thymic emigrants produce IL-8 and express complement receptors CR1 and CR2. JCI Insight 2017; 2:93739. [PMID: 28814669 PMCID: PMC5621870 DOI: 10.1172/jci.insight.93739] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 07/18/2017] [Indexed: 12/21/2022] Open
Abstract
The maintenance of peripheral naive T lymphocytes in humans is dependent on their homeostatic division, not continuing emigration from the thymus, which undergoes involution with age. However, postthymic maintenance of naive T cells is still poorly understood. Previously we reported that recent thymic emigrants (RTEs) are contained in CD31+CD25− naive T cells as defined by their levels of signal joint T cell receptor rearrangement excision circles (sjTRECs). Here, by differential gene expression analysis followed by protein expression and functional studies, we define that the naive T cells having divided the least since thymic emigration express complement receptors (CR1 and CR2) known to bind complement C3b- and C3d-decorated microbial products and, following activation, produce IL-8 (CXCL8), a major chemoattractant for neutrophils in bacterial defense. We also observed an IL-8–producing memory T cell subpopulation coexpressing CR1 and CR2 and with a gene expression signature resembling that of RTEs. The functions of CR1 and CR2 on T cells remain to be determined, but we note that CR2 is the receptor for Epstein-Barr virus, which is a cause of T cell lymphomas and a candidate environmental factor in autoimmune disease. Complement receptors (CR1 and CR2) and IL-8 production identify T cells that have recently left the thymus.
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Affiliation(s)
- Marcin L Pekalski
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust Centre for Human Genetics, Nuffield Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom.,JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Arcadio Rubio García
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust Centre for Human Genetics, Nuffield Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom.,JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Ricardo C Ferreira
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust Centre for Human Genetics, Nuffield Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom.,JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Daniel B Rainbow
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust Centre for Human Genetics, Nuffield Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom.,JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Deborah J Smyth
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Meghavi Mashar
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Jane Brady
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Natalia Savinykh
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Xaquin Castro Dopico
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Sumiyya Mahmood
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Simon Duley
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Helen E Stevens
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Neil M Walker
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Antony J Cutler
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust Centre for Human Genetics, Nuffield Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom.,JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Frank Waldron-Lynch
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - David B Dunger
- Department of Paediatrics, MRL Wellcome Trust-MRC Institute of Metabolic Science, NIHR Cambridge Comprehensive Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Claire Shannon-Lowe
- Institute for Immunology and Immunotherapy and Centre for Human Virology, The University of Birmingham, Birmingham, United Kingdom
| | - Alasdair J Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Joanne L Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Chris Wallace
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom.,Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom, and MRC Biostatistics Unit, Cambridge Institute of Public Health, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - John A Todd
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust Centre for Human Genetics, Nuffield Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom.,JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Linda S Wicker
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust Centre for Human Genetics, Nuffield Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom.,JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
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Ferreira RC, Simons HZ, Thompson WS, Rainbow DB, Yang X, Cutler AJ, Oliveira J, Castro Dopico X, Smyth DJ, Savinykh N, Mashar M, Vyse TJ, Dunger DB, Baxendale H, Chandra A, Wallace C, Todd JA, Wicker LS, Pekalski ML. Cells with Treg-specific FOXP3 demethylation but low CD25 are prevalent in autoimmunity. J Autoimmun 2017; 84:75-86. [PMID: 28747257 PMCID: PMC5656572 DOI: 10.1016/j.jaut.2017.07.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [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: 05/16/2017] [Revised: 07/06/2017] [Accepted: 07/13/2017] [Indexed: 01/22/2023]
Abstract
Identification of alterations in the cellular composition of the human immune system is key to understanding the autoimmune process. Recently, a subset of FOXP3+ cells with low CD25 expression was found to be increased in peripheral blood from systemic lupus erythematosus (SLE) patients, although its functional significance remains controversial. Here we find in comparisons with healthy donors that the frequency of FOXP3+ cells within CD127lowCD25low CD4+ T cells (here defined as CD25lowFOXP3+ T cells) is increased in patients affected by autoimmune disease of varying severity, from combined immunodeficiency with active autoimmunity, SLE to type 1 diabetes. We show that CD25lowFOXP3+ T cells share phenotypic features resembling conventional CD127lowCD25highFOXP3+ Tregs, including demethylation of the Treg-specific epigenetic control region in FOXP3, HELIOS expression, and lack of IL-2 production. As compared to conventional Tregs, more CD25lowFOXP3+HELIOS+ T cells are in cell cycle (33.0% vs 20.7% Ki-67+; P = 1.3 × 10−9) and express the late-stage inhibitory receptor PD-1 (67.2% vs 35.5%; P = 4.0 × 10−18), while having reduced expression of the early-stage inhibitory receptor CTLA-4, as well as other Treg markers, such as FOXP3 and CD15s. The number of CD25lowFOXP3+ T cells is correlated (P = 3.1 × 10−7) with the proportion of CD25highFOXP3+ T cells in cell cycle (Ki-67+). These findings suggest that CD25lowFOXP3+ T cells represent a subset of Tregs that are derived from CD25highFOXP3+ T cells, and are a peripheral marker of recent Treg expansion in response to an autoimmune reaction in tissues. FOXP3+ compartment within CD127lowCD25low T cells is expanded in autoimmune patients. Increased numbers of CD25lowFOXP3+ T cells are a circulating marker of autoimmunity. CD25lowFOXP3+ HELIOS+ T cells are fully demethylated at the FOXP3 TSDR. CD25lowFOXP3+ T cells could represent a terminal differentiation stage of regulatory T cells.
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Affiliation(s)
- Ricardo C Ferreira
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust Centre for Human Genetics, Nuffield Department of Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK; JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, University of Cambridge, Cambridge Biomedical Research Campus, Cambridge, UK
| | - Henry Z Simons
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, University of Cambridge, Cambridge Biomedical Research Campus, Cambridge, UK
| | - Whitney S Thompson
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, University of Cambridge, Cambridge Biomedical Research Campus, Cambridge, UK
| | - Daniel B Rainbow
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust Centre for Human Genetics, Nuffield Department of Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK; JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, University of Cambridge, Cambridge Biomedical Research Campus, Cambridge, UK
| | - Xin Yang
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, University of Cambridge, Cambridge Biomedical Research Campus, Cambridge, UK
| | - Antony J Cutler
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust Centre for Human Genetics, Nuffield Department of Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK; JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, University of Cambridge, Cambridge Biomedical Research Campus, Cambridge, UK
| | - Joao Oliveira
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, University of Cambridge, Cambridge Biomedical Research Campus, Cambridge, UK
| | - Xaquin Castro Dopico
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, University of Cambridge, Cambridge Biomedical Research Campus, Cambridge, UK
| | - Deborah J Smyth
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, University of Cambridge, Cambridge Biomedical Research Campus, Cambridge, UK
| | - Natalia Savinykh
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, University of Cambridge, Cambridge Biomedical Research Campus, Cambridge, UK
| | - Meghavi Mashar
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, University of Cambridge, Cambridge Biomedical Research Campus, Cambridge, UK
| | - Tim J Vyse
- Department of Medical and Molecular Genetics, King's College Hospital, London, UK
| | - David B Dunger
- Department of Paediatrics, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Helen Baxendale
- Department of Clinical Biochemistry and Immunology, Addenbrooke's Hospital, Cambridge, UK
| | - Anita Chandra
- Department of Clinical Biochemistry and Immunology, Addenbrooke's Hospital, Cambridge, UK
| | - Chris Wallace
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, University of Cambridge, Cambridge Biomedical Research Campus, Cambridge, UK
| | - John A Todd
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust Centre for Human Genetics, Nuffield Department of Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK; JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, University of Cambridge, Cambridge Biomedical Research Campus, Cambridge, UK
| | - Linda S Wicker
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust Centre for Human Genetics, Nuffield Department of Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK; JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, University of Cambridge, Cambridge Biomedical Research Campus, Cambridge, UK.
| | - Marcin L Pekalski
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust Centre for Human Genetics, Nuffield Department of Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK; JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Wellcome Trust/MRC Building, Cambridge Institute for Medical Research, University of Cambridge, Cambridge Biomedical Research Campus, Cambridge, UK.
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D. Yang, Yip K, Adlam J, Laidley H, Mashar M, Ye W. Survival outcomes after whole-brain radiotherapy for metastatic melanoma. Clin Oncol (R Coll Radiol) 2017. [DOI: 10.1016/j.clon.2017.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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Ferreira RC, Simons HZ, Thompson WS, Cutler AJ, Dopico XC, Smyth DJ, Mashar M, Schuilenburg H, Walker NM, Dunger DB, Wallace C, Todd JA, Wicker LS, Pekalski ML. IL-21 production by CD4+ effector T cells and frequency of circulating follicular helper T cells are increased in type 1 diabetes patients. Diabetologia 2015; 58:781-90. [PMID: 25652388 PMCID: PMC4351433 DOI: 10.1007/s00125-015-3509-8] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/09/2015] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS Type 1 diabetes results from the autoimmune destruction of insulin-secreting pancreatic beta cells by T cells. Despite the established role of T cells in the pathogenesis of the disease, to date, with the exception of the identification of islet-specific T effector (Teff) cells, studies have mostly failed to identify reproducible alterations in the frequency or function of T cell subsets in peripheral blood from patients with type 1 diabetes. METHODS We assessed the production of the proinflammatory cytokines IL-21, IFN-γ and IL-17 in peripheral blood mononuclear cells from 69 patients with type 1 diabetes and 61 healthy donors. In an additional cohort of 30 patients with type 1 diabetes and 32 healthy donors, we assessed the frequency of circulating T follicular helper (Tfh) cells in whole blood. IL-21 and IL-17 production was also measured in peripheral blood mononuclear cells (PBMCs) from a subset of 46 of the 62 donors immunophenotyped for Tfh. RESULTS We found a 21.9% (95% CI 5.8, 40.2; p = 3.9 × 10(-3)) higher frequency of IL-21(+) CD45RA(-) memory CD4(+) Teffs in patients with type 1 diabetes (geometric mean 5.92% [95% CI 5.44, 6.44]) compared with healthy donors (geometric mean 4.88% [95% CI 4.33, 5.50]). Consistent with this finding, we found a 14.9% increase in circulating Tfh cells in the patients (95% CI 2.9, 26.9; p = 0.016). CONCLUSIONS/INTERPRETATION These results indicate that increased IL-21 production is likely to be an aetiological factor in the pathogenesis of type 1 diabetes that could be considered as a potential therapeutic target.
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Affiliation(s)
- Ricardo C. Ferreira
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, WT/MRC Building, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0XY UK
| | - Henry Z. Simons
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, WT/MRC Building, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0XY UK
| | - Whitney S. Thompson
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, WT/MRC Building, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0XY UK
| | - Antony J. Cutler
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, WT/MRC Building, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0XY UK
| | - Xaquin Castro Dopico
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, WT/MRC Building, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0XY UK
| | - Deborah J. Smyth
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, WT/MRC Building, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0XY UK
| | - Meghavi Mashar
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, WT/MRC Building, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0XY UK
| | - Helen Schuilenburg
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, WT/MRC Building, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0XY UK
| | - Neil M. Walker
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, WT/MRC Building, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0XY UK
| | - David B. Dunger
- Department of Paediatrics, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Chris Wallace
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, WT/MRC Building, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0XY UK
| | - John A. Todd
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, WT/MRC Building, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0XY UK
| | - Linda S. Wicker
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, WT/MRC Building, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0XY UK
| | - Marcin L. Pekalski
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, WT/MRC Building, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0XY UK
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Abstract
The Brugada syndrome is a rare but well-defined cause of sudden cardiac death. The key underlying abnormality is a decrease in net depolarising current due to a genetic defect, though recent evidence also implicates structural abnormalities in some patients. Diagnosis requires a Brugada-type ECG as well as typical clinical features: such clinical considerations are currently key in guiding risk stratification and hence management. Whilst pharmacological therapies are under investigation, the only intervention with a robust evidence base remains insertion of an implantable cardioverter defibrillator. Further research will be required to allow more effective risk stratification and hence more rational therapy.
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Affiliation(s)
| | | | - Richard Pinder
- School of Public Health, Imperial College London, London, UK
| | - Ian Sabir
- Downing College, Cambridge, UK; Physiological Laboratory, Rayne Institute, University of Cambridge, St. Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
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