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Mulhern RE, Kondash AJ, Norman E, Johnson J, Levine K, McWilliams A, Napier M, Weber F, Stella L, Wood E, Lee Pow Jackson C, Colley S, Cajka J, MacDonald Gibson J, Hoponick Redmon J. Improved Decision Making for Water Lead Testing in U.S. Child Care Facilities Using Machine-Learned Bayesian Networks. Environ Sci Technol 2023; 57:17959-17970. [PMID: 36932953 PMCID: PMC10666530 DOI: 10.1021/acs.est.2c07477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
Tap water lead testing programs in the U.S. need improved methods for identifying high-risk facilities to optimize limited resources. In this study, machine-learned Bayesian network (BN) models were used to predict building-wide water lead risk in over 4,000 child care facilities in North Carolina according to maximum and 90th percentile lead levels from water lead concentrations at 22,943 taps. The performance of the BN models was compared to common alternative risk factors, or heuristics, used to inform water lead testing programs among child care facilities including building age, water source, and Head Start program status. The BN models identified a range of variables associated with building-wide water lead, with facilities that serve low-income families, rely on groundwater, and have more taps exhibiting greater risk. Models predicting the probability of a single tap exceeding each target concentration performed better than models predicting facilities with clustered high-risk taps. The BN models' Fβ-scores outperformed each of the alternative heuristics by 118-213%. This represents up to a 60% increase in the number of high-risk facilities that could be identified and up to a 49% decrease in the number of samples that would need to be collected by using BN model-informed sampling compared to using simple heuristics. Overall, this study demonstrates the value of machine-learning approaches for identifying high water lead risk that could improve lead testing programs nationwide.
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Affiliation(s)
- Riley E. Mulhern
- RTI
International, Research
Triangle Park, North Carolina 27709, United States
| | - AJ Kondash
- RTI
International, Research
Triangle Park, North Carolina 27709, United States
| | - Ed Norman
- Environmental
Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina 27609, United States
| | - Joseph Johnson
- RTI
International, Research
Triangle Park, North Carolina 27709, United States
| | - Keith Levine
- RTI
International, Research
Triangle Park, North Carolina 27709, United States
| | - Andrea McWilliams
- RTI
International, Research
Triangle Park, North Carolina 27709, United States
| | - Melanie Napier
- Environmental
Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina 27609, United States
| | - Frank Weber
- RTI
International, Research
Triangle Park, North Carolina 27709, United States
| | - Laurie Stella
- RTI
International, Research
Triangle Park, North Carolina 27709, United States
| | - Erica Wood
- RTI
International, Research
Triangle Park, North Carolina 27709, United States
| | | | - Sarah Colley
- RTI
International, Research
Triangle Park, North Carolina 27709, United States
| | - Jamie Cajka
- RTI
International, Research
Triangle Park, North Carolina 27709, United States
| | - Jacqueline MacDonald Gibson
- Department
of Civil, Construction, and Environmental Engineering, North Carolina State University, Raleigh, North Carolina 27695, United States
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2
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Napier M, Reynolds K, Scott AL. Glial-mediated dysregulation of neurodevelopment in Fragile X Syndrome. Int Rev Neurobiol 2023; 173:187-215. [PMID: 37993178 DOI: 10.1016/bs.irn.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Astrocytes are highly involved in a multitude of developmental processes that are known to be dysregulated in Fragile X Syndrome. Here, we examine these processes individually and review the roles astrocytes play in contributing to the pathology of this syndrome. As a growing area of interest in the field, new and exciting insight is continually emerging. Understanding these glial-mediated roles is imperative for elucidating the underlying molecular mechanisms at play, not only in Fragile X Syndrome, but also other ASD-related disorders. Understanding these roles will be central to the future development of effective, clinically-relevant treatments of these disorders.
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Affiliation(s)
- M Napier
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, Canada; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - K Reynolds
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada; Department of Neuroscience, Tufts University School of Medicine, Boston, United States
| | - A L Scott
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, Canada; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada.
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3
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Redmon JH, Kondash AJ, Norman E, Johnson J, Levine K, McWilliams A, Napier M, Weber F, Stella L, Wood E, Jackson CLP, Mulhern R. Lead Levels in Tap Water at Licensed North Carolina Child Care Facilities, 2020-2021. Am J Public Health 2022; 112:S695-S705. [PMID: 36179303 PMCID: PMC9528649 DOI: 10.2105/ajph.2022.307003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 09/03/2023]
Abstract
Objectives. To evaluate lead levels in tap water at licensed North Carolina child care facilities. Methods. Between July 2020 and October 2021, we enrolled 4005 facilities in a grant-funded, participatory science testing program. We identified risk factors associated with elevated first-draw lead levels using multiple logistic regression analysis. Results. By sample (n = 22 943), 3% of tap water sources exceeded the 10 parts per billion (ppb) North Carolina hazard level, whereas 25% of tap water sources exceeded 1 ppb, the American Academy of Pediatrics' reference level. By facility, at least 1 tap water source exceeded 1 ppb and 10 ppb at 56% and 12% of facilities, respectively. Well water reliance was the largest risk factor, followed by participation in Head Start programs and building age. We observed large variability between tap water sources within the same facility. Conclusions. Tap water in child care facilities is a potential lead exposure source for children. Given variability among tap water sources, it is imperative to test every source used for drinking and cooking so appropriate action can be taken to protect children's health. (Am J Public Health. 2022;112(S7):S695-S705. https://doi.org/10.2105/AJPH.2022.307003).
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Affiliation(s)
- Jennifer Hoponick Redmon
- Jennifer Hoponick Redmon, A. J. Kondash, Joseph Johnson, Keith Levine, Andrea McWilliams, Frank Weber, Laurie Stella, Erica Wood, Crystal Lee Pow Jackson, and Riley Mulhern are with RTI International, Research Triangle Park, NC. Ed Norman and Melanie Napier are with the Environmental Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - A J Kondash
- Jennifer Hoponick Redmon, A. J. Kondash, Joseph Johnson, Keith Levine, Andrea McWilliams, Frank Weber, Laurie Stella, Erica Wood, Crystal Lee Pow Jackson, and Riley Mulhern are with RTI International, Research Triangle Park, NC. Ed Norman and Melanie Napier are with the Environmental Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Ed Norman
- Jennifer Hoponick Redmon, A. J. Kondash, Joseph Johnson, Keith Levine, Andrea McWilliams, Frank Weber, Laurie Stella, Erica Wood, Crystal Lee Pow Jackson, and Riley Mulhern are with RTI International, Research Triangle Park, NC. Ed Norman and Melanie Napier are with the Environmental Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Joseph Johnson
- Jennifer Hoponick Redmon, A. J. Kondash, Joseph Johnson, Keith Levine, Andrea McWilliams, Frank Weber, Laurie Stella, Erica Wood, Crystal Lee Pow Jackson, and Riley Mulhern are with RTI International, Research Triangle Park, NC. Ed Norman and Melanie Napier are with the Environmental Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Keith Levine
- Jennifer Hoponick Redmon, A. J. Kondash, Joseph Johnson, Keith Levine, Andrea McWilliams, Frank Weber, Laurie Stella, Erica Wood, Crystal Lee Pow Jackson, and Riley Mulhern are with RTI International, Research Triangle Park, NC. Ed Norman and Melanie Napier are with the Environmental Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Andrea McWilliams
- Jennifer Hoponick Redmon, A. J. Kondash, Joseph Johnson, Keith Levine, Andrea McWilliams, Frank Weber, Laurie Stella, Erica Wood, Crystal Lee Pow Jackson, and Riley Mulhern are with RTI International, Research Triangle Park, NC. Ed Norman and Melanie Napier are with the Environmental Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Melanie Napier
- Jennifer Hoponick Redmon, A. J. Kondash, Joseph Johnson, Keith Levine, Andrea McWilliams, Frank Weber, Laurie Stella, Erica Wood, Crystal Lee Pow Jackson, and Riley Mulhern are with RTI International, Research Triangle Park, NC. Ed Norman and Melanie Napier are with the Environmental Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Frank Weber
- Jennifer Hoponick Redmon, A. J. Kondash, Joseph Johnson, Keith Levine, Andrea McWilliams, Frank Weber, Laurie Stella, Erica Wood, Crystal Lee Pow Jackson, and Riley Mulhern are with RTI International, Research Triangle Park, NC. Ed Norman and Melanie Napier are with the Environmental Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Laurie Stella
- Jennifer Hoponick Redmon, A. J. Kondash, Joseph Johnson, Keith Levine, Andrea McWilliams, Frank Weber, Laurie Stella, Erica Wood, Crystal Lee Pow Jackson, and Riley Mulhern are with RTI International, Research Triangle Park, NC. Ed Norman and Melanie Napier are with the Environmental Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Erica Wood
- Jennifer Hoponick Redmon, A. J. Kondash, Joseph Johnson, Keith Levine, Andrea McWilliams, Frank Weber, Laurie Stella, Erica Wood, Crystal Lee Pow Jackson, and Riley Mulhern are with RTI International, Research Triangle Park, NC. Ed Norman and Melanie Napier are with the Environmental Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Crystal Lee Pow Jackson
- Jennifer Hoponick Redmon, A. J. Kondash, Joseph Johnson, Keith Levine, Andrea McWilliams, Frank Weber, Laurie Stella, Erica Wood, Crystal Lee Pow Jackson, and Riley Mulhern are with RTI International, Research Triangle Park, NC. Ed Norman and Melanie Napier are with the Environmental Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Riley Mulhern
- Jennifer Hoponick Redmon, A. J. Kondash, Joseph Johnson, Keith Levine, Andrea McWilliams, Frank Weber, Laurie Stella, Erica Wood, Crystal Lee Pow Jackson, and Riley Mulhern are with RTI International, Research Triangle Park, NC. Ed Norman and Melanie Napier are with the Environmental Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
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4
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Heikoop D, Brick L, Chitayat D, Colaiacovo S, Dupuis L, Faghfoury H, Goobie S, Mendoza R, Napier M, Nowaczyk M, Oh R, Silver J, Prasad C, Saleh M. The phenotypic spectrum of AMER1-related osteopathia striata with cranial sclerosis: The first Canadian cohort. Am J Med Genet A 2021; 185:3793-3803. [PMID: 34414661 DOI: 10.1002/ajmg.a.62452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/28/2021] [Revised: 07/12/2021] [Accepted: 07/26/2021] [Indexed: 11/10/2022]
Abstract
Osteopathia striata with cranial sclerosis (OSCS; OMIM# 300373) is a rare X-linked disorder caused by mutations of the AMER1 gene. OSCS is traditionally considered a skeletal dysplasia, characterized by cranial sclerosis and longitudinal striations in the long bone metaphyses. However, OSCS affects many body systems and varies significantly in phenotypic severity between individuals. This case series focuses on the phenotypic presentation and development of individuals with OSCS. We provide an account of 12 patients with OSCS, ranging from 5 months to 38 years of age. These patients were diagnosed with OSCS after genetic testing confirmed pathogenic mutations in AMER1. Patient consent was obtained for photos and participation. Data were collected regarding perinatal history, dysmorphic features, and review of systems. This case series documents common facial dysmorphology, as well as rare extraskeletal features of OSCS, including two patients with intestinal malrotation and two patients with pyloric stenosis. We share four apparently nonmosaic males with OSCS (one de novo and three maternal variants). We also provide a clinical update on a patient who was previously published by Chénier et al. (2012). American Journal of Medical Genetics Part A, 158, 2946-2952. More research is needed to investigate the links between genotype and phenotype and assess the long-term comorbidities and overall quality of life of individuals with OSCS.
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Affiliation(s)
- David Heikoop
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, London Health Sciences, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Lauren Brick
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - David Chitayat
- Division of Clinical and Metabolic Genetics, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada.,The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Samantha Colaiacovo
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, London Health Sciences, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Lucie Dupuis
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Hanna Faghfoury
- Division of Clinical and Metabolic Genetics, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sharan Goobie
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, IWK Hospital, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Roberto Mendoza
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Napier
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, London Health Sciences, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Margaret Nowaczyk
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Rachel Oh
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Josh Silver
- Division of Clinical and Metabolic Genetics, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Chitra Prasad
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, London Health Sciences, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Maha Saleh
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, London Health Sciences, Schulich School of Medicine, Western University, London, Ontario, Canada
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5
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Tingley K, Lamoureux M, Pugliese M, Geraghty MT, Kronick JB, Potter BK, Coyle D, Wilson K, Kowalski M, Austin V, Brunel-Guitton C, Buhas D, Chan AKJ, Dyack S, Feigenbaum A, Giezen A, Goobie S, Greenberg CR, Ghai SJ, Inbar-Feigenberg M, Karp N, Kozenko M, Langley E, Lines M, Little J, MacKenzie J, Maranda B, Mercimek-Andrews S, Mohan C, Mhanni A, Mitchell G, Mitchell JJ, Nagy L, Napier M, Pender A, Potter M, Prasad C, Ratko S, Salvarinova R, Schulze A, Siriwardena K, Sondheimer N, Sparkes R, Stockler-Ipsiroglu S, Trakadis Y, Turner L, Van Karnebeek C, Vallance H, Vandersteen A, Walia J, Wilson A, Wilson BJ, Yu AC, Yuskiv N, Chakraborty P. Evaluation of the quality of clinical data collection for a pan-Canadian cohort of children affected by inherited metabolic diseases: lessons learned from the Canadian Inherited Metabolic Diseases Research Network. Orphanet J Rare Dis 2020; 15:89. [PMID: 32276663 PMCID: PMC7149838 DOI: 10.1186/s13023-020-01358-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/17/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The Canadian Inherited Metabolic Diseases Research Network (CIMDRN) is a pan-Canadian practice-based research network of 14 Hereditary Metabolic Disease Treatment Centres and over 50 investigators. CIMDRN aims to develop evidence to improve health outcomes for children with inherited metabolic diseases (IMD). We describe the development of our clinical data collection platform, discuss our data quality management plan, and present the findings to date from our data quality assessment, highlighting key lessons that can serve as a resource for future clinical research initiatives relating to rare diseases. METHODS At participating centres, children born from 2006 to 2015 who were diagnosed with one of 31 targeted IMD were eligible to participate in CIMDRN's clinical research stream. For all participants, we collected a minimum data set that includes information about demographics and diagnosis. For children with five prioritized IMD, we collected longitudinal data including interventions, clinical outcomes, and indicators of disease management. The data quality management plan included: design of user-friendly and intuitive clinical data collection forms; validation measures at point of data entry, designed to minimize data entry errors; regular communications with each CIMDRN site; and routine review of aggregate data. RESULTS As of June 2019, CIMDRN has enrolled 798 participants of whom 764 (96%) have complete minimum data set information. Results from our data quality assessment revealed that potential data quality issues were related to interpretation of definitions of some variables, participants who transferred care across institutions, and the organization of information within the patient charts (e.g., neuropsychological test results). Little information was missing regarding disease ascertainment and diagnosis (e.g., ascertainment method - 0% missing). DISCUSSION Using several data quality management strategies, we have established a comprehensive clinical database that provides information about care and outcomes for Canadian children affected by IMD. We describe quality issues and lessons for consideration in future clinical research initiatives for rare diseases, including accurately accommodating different clinic workflows and balancing comprehensiveness of data collection with available resources. Integrating data collection within clinical care, leveraging electronic medical records, and implementing core outcome sets will be essential for achieving sustainability.
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Affiliation(s)
| | - Monica Lamoureux
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | | | - Michael T Geraghty
- University of Ottawa, Ottawa, Ontario, Canada
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Jonathan B Kronick
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Doug Coyle
- University of Ottawa, Ottawa, Ontario, Canada
| | - Kumanan Wilson
- University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Michael Kowalski
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Valerie Austin
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Daniela Buhas
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Alicia K J Chan
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Sarah Dyack
- IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Annette Feigenbaum
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Alette Giezen
- BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sharan Goobie
- IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Cheryl R Greenberg
- Health Sciences Centre Winnipeg, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shailly Jain Ghai
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | | | - Natalya Karp
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Mariya Kozenko
- Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Erica Langley
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Matthew Lines
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | | | - Jennifer MacKenzie
- Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Bruno Maranda
- Le centre hospitalier universitaire Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Connie Mohan
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Aizeddin Mhanni
- Health Sciences Centre Winnipeg, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Grant Mitchell
- Le centre hospitalier universitaire Ste-Justine, Montreal, Quebec, Canada
| | - John J Mitchell
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Laura Nagy
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Napier
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Amy Pender
- Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Murray Potter
- Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Chitra Prasad
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Suzanne Ratko
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Ramona Salvarinova
- BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andreas Schulze
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Komudi Siriwardena
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Neal Sondheimer
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Sparkes
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | | | - Yannis Trakadis
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Lesley Turner
- Janeway Children's Hospital, Memorial University, St John's, NL, Canada
| | - Clara Van Karnebeek
- BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hilary Vallance
- BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jagdeep Walia
- Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Ashley Wilson
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Brenda J Wilson
- Janeway Children's Hospital, Memorial University, St John's, NL, Canada
| | - Andrea C Yu
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Nataliya Yuskiv
- BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pranesh Chakraborty
- University of Ottawa, Ottawa, Ontario, Canada.
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada.
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6
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Davis S, Ware MA, Zeiger J, Deardorff MA, Grand K, Grimberg A, Hsu S, Kelsey M, Majidi S, Matthew RP, Napier M, Nokoff N, Prasad C, Riggs AC, McKinnon ML, Mirzaa G. Growth hormone deficiency in megalencephaly-capillary malformation syndrome: An association with activating mutations in PIK3CA. Am J Med Genet A 2019; 182:162-168. [PMID: 31729162 DOI: 10.1002/ajmg.a.61403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 07/23/2019] [Revised: 10/02/2019] [Accepted: 10/13/2019] [Indexed: 01/21/2023]
Abstract
Megalencephaly-capillary malformation syndrome (MCAP) is a brain overgrowth disorder characterized by cortical malformations (specifically polymicrogyria), vascular anomalies, and segmental overgrowth secondary to somatic activating mutations in the PI3K-AKT-MTOR pathway (PIK3CA). Cases of growth failure and hypoglycemia have been reported in patients with MCAP, raising the suspicion for unappreciated growth hormone (GH) deficiency. Here we report an observational multicenter study of children with MCAP and GH deficiency. Eleven participants were confirmed to have GH deficiency, all with very low or undetectable circulating concentrations of insulin-like growth factor-1 and insulin-like growth factor binding protein-3. Seven underwent GH stimulation testing and all had insufficient responses with a median GH peak of 3.7 ng/ml (range 1.1-8.6). Growth patterns revealed a drastic decline in length z-scores within the first year of life but then stabilized afterward. Five were treated with GH; one discontinued due to inconsolability. The other four participants continued on GH with improvement in linear growth velocity. Other endocrinopathies were identified in 7 of the 11 participants in this cohort. This study indicates that GH deficiency is associated with MCAP and that children with MCAP and hypoglycemia and/or postnatal growth failure should be evaluated for GH deficiency and other endocrinopathies.
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Affiliation(s)
- Shanlee Davis
- Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Department of Endocrinology, Children's Hospital Colorado, Aurora, Colorado
| | - Meredith A Ware
- Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Department of Endocrinology, Children's Hospital Colorado, Aurora, Colorado.,Master of Science in Modern Human Anatomy Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jordan Zeiger
- Division of Genetic Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington
| | - Matthew A Deardorff
- Division of Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Katheryn Grand
- Division of Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Adda Grimberg
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Division of Endocrinology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stephanie Hsu
- Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Department of Endocrinology, Children's Hospital Colorado, Aurora, Colorado
| | - Megan Kelsey
- Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Department of Endocrinology, Children's Hospital Colorado, Aurora, Colorado
| | - Shideh Majidi
- Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Department of Endocrinology, Children's Hospital Colorado, Aurora, Colorado
| | - Revi P Matthew
- Department of Endocrinology, TriStar Children's Specialists, Nashville, Tennessee
| | - Melanie Napier
- Medical Genetics Program of Southwestern Ontario, London Health Sciences Centre, London, Ontario, Canada
| | - Natalie Nokoff
- Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Department of Endocrinology, Children's Hospital Colorado, Aurora, Colorado
| | - Chitra Prasad
- Department of Paediatrics, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Andrew C Riggs
- Pediatric Endocrinology and Diabetes, Peyton Manning Children's Hospital at St. Vincent, Indianapolis, Indiana
| | - Margaret L McKinnon
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada.,Provincial Medical Genetics Program, BC Women's Hospital and Health Centre, Vancouver, Canada
| | - Ghayda Mirzaa
- Division of Genetic Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington
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7
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Aref-Eshghi E, Bend EG, Colaiacovo S, Caudle M, Chakrabarti R, Napier M, Brick L, Brady L, Carere DA, Levy MA, Kerkhof J, Stuart A, Saleh M, Beaudet AL, Li C, Kozenko M, Karp N, Prasad C, Siu VM, Tarnopolsky MA, Ainsworth PJ, Lin H, Rodenhiser DI, Krantz ID, Deardorff MA, Schwartz CE, Sadikovic B. Diagnostic Utility of Genome-wide DNA Methylation Testing in Genetically Unsolved Individuals with Suspected Hereditary Conditions. Am J Hum Genet 2019; 104:685-700. [PMID: 30929737 DOI: 10.1016/j.ajhg.2019.03.008] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/05/2019] [Indexed: 12/13/2022] Open
Abstract
Conventional genetic testing of individuals with neurodevelopmental presentations and congenital anomalies (ND/CAs), i.e., the analysis of sequence and copy number variants, leaves a substantial proportion of them unexplained. Some of these cases have been shown to result from DNA methylation defects at a single locus (epi-variants), while others can exhibit syndrome-specific DNA methylation changes across multiple loci (epi-signatures). Here, we investigate the clinical diagnostic utility of genome-wide DNA methylation analysis of peripheral blood in unresolved ND/CAs. We generate a computational model enabling concurrent detection of 14 syndromes using DNA methylation data with full accuracy. We demonstrate the ability of this model in resolving 67 individuals with uncertain clinical diagnoses, some of whom had variants of unknown clinical significance (VUS) in the related genes. We show that the provisional diagnoses can be ruled out in many of the case subjects, some of whom are shown by our model to have other diseases initially not considered. By applying this model to a cohort of 965 ND/CA-affected subjects without a previous diagnostic assumption and a separate assessment of rare epi-variants in this cohort, we identify 15 case subjects with syndromic Mendelian disorders, 12 case subjects with imprinting and trinucleotide repeat expansion disorders, as well as 106 case subjects with rare epi-variants, a portion of which involved genes clinically or functionally linked to the subjects' phenotypes. This study demonstrates that genomic DNA methylation analysis can facilitate the molecular diagnosis of unresolved clinical cases and highlights the potential value of epigenomic testing in the routine clinical assessment of ND/CAs.
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8
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Mirzaa G, Timms AE, Conti V, Boyle EA, Girisha KM, Martin B, Kircher M, Olds C, Juusola J, Collins S, Park K, Carter M, Glass I, Krägeloh-Mann I, Chitayat D, Parikh AS, Bradshaw R, Torti E, Braddock S, Burke L, Ghedia S, Stephan M, Stewart F, Prasad C, Napier M, Saitta S, Straussberg R, Gabbett M, O'Connor BC, Keegan CE, Yin LJ, Lai AHM, Martin N, McKinnon M, Addor MC, Boccuto L, Schwartz CE, Lanoel A, Conway RL, Devriendt K, Tatton-Brown K, Pierpont ME, Painter M, Worgan L, Reggin J, Hennekam R, Tsuchiya K, Pritchard CC, Aracena M, Gripp KW, Cordisco M, Van Esch H, Garavelli L, Curry C, Goriely A, Kayserilli H, Shendure J, Graham J, Guerrini R, Dobyns WB. PIK3CA-associated developmental disorders exhibit distinct classes of mutations with variable expression and tissue distribution. JCI Insight 2018; 1:87623. [PMID: 27631024 PMCID: PMC5019182 DOI: 10.1172/jci.insight.87623] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [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: 01/19/2023] Open
Abstract
Mosaicism is increasingly recognized as a cause of developmental disorders with the advent of next-generation sequencing (NGS). Mosaic mutations of PIK3CA have been associated with the widest spectrum of phenotypes associated with overgrowth and vascular malformations. We performed targeted NGS using 2 independent deep-coverage methods that utilize molecular inversion probes and amplicon sequencing in a cohort of 241 samples from 181 individuals with brain and/or body overgrowth. We identified PIK3CA mutations in 60 individuals. Several other individuals (n = 12) were identified separately to have mutations in PIK3CA by clinical targeted-panel testing (n = 6), whole-exome sequencing (n = 5), or Sanger sequencing (n = 1). Based on the clinical and molecular features, this cohort segregated into three distinct groups: (a) severe focal overgrowth due to low-level but highly activating (hotspot) mutations, (b) predominantly brain overgrowth and less severe somatic overgrowth due to less-activating mutations, and (c) intermediate phenotypes (capillary malformations with overgrowth) with intermediately activating mutations. Sixteen of 29 PIK3CA mutations were novel. We also identified constitutional PIK3CA mutations in 10 patients. Our molecular data, combined with review of the literature, show that PIK3CA-related overgrowth disorders comprise a discontinuous spectrum of disorders that correlate with the severity and distribution of mutations. The clinical and molecular spectrum of PIK3CA-related developmental disorders are correlated with types of mutations, tissue distributions, and levels of mosaicism with the clinical phenotype.
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Affiliation(s)
- Ghayda Mirzaa
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA.,Center for Integrative Brain Research and
| | - Andrew E Timms
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Valerio Conti
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Neuroscience Department, A. Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Evan August Boyle
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA
| | - Katta M Girisha
- Department of Medical Genetics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Beth Martin
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | - Martin Kircher
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | | | - Jane Juusola
- Whole Exome Sequencing Program, GeneDx, Gaithersburg, Maryland, USA
| | | | | | - Melissa Carter
- Regional Genetics Program, The Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Ian Glass
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA.,Center for Integrative Brain Research and
| | - Inge Krägeloh-Mann
- Department of Pediatrics, and Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany
| | - David Chitayat
- Mount Sinai Hospital, The Prenatal Diagnosis and Medical Genetics Division, Department of Obstetrics and Gynecology, and.,Department of Pediatrics, Division of Clinical and Metabolic Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Aditi Shah Parikh
- Center for Human Genetics, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Rachael Bradshaw
- Department of Pediatrics, Division of Medical Genetics, Saint Louis University, St. Louis, Missouri, USA
| | - Erin Torti
- Department of Pediatrics, Division of Medical Genetics, Saint Louis University, St. Louis, Missouri, USA
| | - Stephen Braddock
- Department of Pediatrics, Division of Medical Genetics, Saint Louis University, St. Louis, Missouri, USA
| | - Leah Burke
- Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Sondhya Ghedia
- Department of Clinical Genetics, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Mark Stephan
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Fiona Stewart
- Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Chitra Prasad
- Genetics, Metabolism and Pediatrics, London, Ontario, Canada
| | - Melanie Napier
- Genetics, Metabolism and Pediatrics, London, Ontario, Canada
| | - Sulagna Saitta
- Clinical Genetics, Center for Personalized Medicine, Children's Hospital Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, California, USA
| | - Rachel Straussberg
- Neurology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Gabbett
- School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Bridget C O'Connor
- Division of Genetics, Department of Pediatrics, and.,Department of Human Genetics, University of Michigan, Ann Arbor, Michigan, USA
| | - Catherine E Keegan
- Division of Genetics, Department of Pediatrics, and.,Department of Human Genetics, University of Michigan, Ann Arbor, Michigan, USA
| | - Lim Jiin Yin
- Genetics Service, Department of Pediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Angeline Hwei Meeng Lai
- Genetics Service, Department of Pediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Nicole Martin
- Department of Pediatrics, Division of Clinical and Metabolic Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Margaret McKinnon
- British Columbia Medical Genetics Provincial Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marie-Claude Addor
- Service de génétique médicale, Centre Hospitalier Universitaire Vaudois CHUV, Switzerland
| | - Luigi Boccuto
- Greenwood Genetic Center, Greenwood, South Carolina, USA
| | | | - Agustina Lanoel
- Department of Dermatology, Children Hospital Prof. Dr. J. P. Garrahan, Buenos Aires, Argentina
| | - Robert L Conway
- Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, USA
| | - Koenraad Devriendt
- Center for Human Genetics, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Katrina Tatton-Brown
- South West Thames Regional Genetics Service, St George's University NHS Foundation Trust, London, and Section of Cancer Genetics, Institute of Cancer Research, Sutton, United Kingdom
| | - Mary Ella Pierpont
- Department of Pediatrics and Ophthalmology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael Painter
- Department of Child Neurology, University of Florida, Jacksonville, Florida, USA
| | - Lisa Worgan
- Department of Genetics, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - James Reggin
- Department of Neurology, University of Washington, Seattle, Washington, USA.,Providence Child Neurology, Providence Sacred Heart Medical Center and Children's Hospital, Spokane, Washington, USA
| | - Raoul Hennekam
- Department of Pediatrics and Translational Genetics, Department of Pediatrics, Academic Medical Center, University of Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Karen Tsuchiya
- Department of Laboratories, Seattle Children's Hospital and.,Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Colin C Pritchard
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Mariana Aracena
- División de Pediatría, Pontificia Universidad Católica de Chile, Pediatra-Genetista, Unidad de Genética, Hospital Dr. Luis Calvo Mackenna, Santiago, Chile
| | - Karen W Gripp
- Department of Pediatrics, Sidney Kimmel Medical School at T. Jefferson University, Chief of Division of Medical Genetics, A.I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Maria Cordisco
- Departments of Dermatology and Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Hilde Van Esch
- Center for Human Genetics, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Livia Garavelli
- Clinical Genetics Unit, IRCCS Santa Maria Nuova Hospital, Reggio Emilia, Italy
| | - Cynthia Curry
- University of California, San Francisco, San Francisco/Genetic Medicine Central California, San Francisco, California, USA
| | - Anne Goriely
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Hulya Kayserilli
- Koç University, School of Medicine, Medical Genetics Department, Koç University Hospital, Istanbul, Turkey
| | - Jay Shendure
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA.,Howard Hughes Medical Institute, Seattle, Washington, USA
| | - John Graham
- Department of Pediatrics, Cedars-Sinai Medical Center, Harbor-UCLA Medical Center, David Geffen School of Medicine Los Angeles, California, USA
| | - Renzo Guerrini
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Neuroscience Department, A. Meyer Children's Hospital, University of Florence, Florence, Italy
| | - William B Dobyns
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA.,Center for Integrative Brain Research and.,Department of Neurology, University of Washington, Seattle, Washington, USA
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9
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Gannavarapu S, Prasad C, DiRaimo J, Napier M, Goobie S, Potter M, Chakraborty P, Karaceper M, Munoz T, Schulze A, MacKenzie J, Li L, Geraghty MT, Al-Dirbashi OY, Rupar CA. Biotinidase deficiency: Spectrum of molecular, enzymatic and clinical information from newborn screening Ontario, Canada (2007-2014). Mol Genet Metab 2015; 116:146-51. [PMID: 26361991 DOI: 10.1016/j.ymgme.2015.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/24/2015] [Accepted: 08/24/2015] [Indexed: 11/22/2022]
Abstract
Untreated profound biotinidase deficiency results in a wide range of clinical features, including optic atrophy, cutaneous abnormalities, hearing loss and developmental delay. Ontario, Canada incorporated this treatable deficiency in newborn screening over the past 8years. This study elucidates the molecular, biochemical, and clinical findings from the pilot project. Information from initial screens, serum biotinidase activity level assays, molecular testing, and family history for 246 positive newborns screens were analyzed. A mutation spectrum was created for the province of Ontario, including common mutations such as D444H, D444H/A171T, Q456H, C33fs, and R157H. Individuals with partial deficiency were separated into 3 groups: D444H homozygotes (Group 1); compound heterozygotes for D444H with another profound allele (Group 2); compound heterozygotes with two non-D444H alleles (Group 3). Biochemical phenotype-genotype associations in partial deficiency showed a significant difference in serum biotinidase activity in between any given two groups. Three children with partial deficiency discontinued biotin for varied lengths of time. Two of whom became symptomatic with abnormal gait, alopecia, skin rashes and developmental delay. A need for more congruency in diagnostic, treatment and educational practices was highlighted across the province. Heterogeneity and variation in clinical presentations and management was observed in patients with the partial deficiency.
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Affiliation(s)
- Srinitya Gannavarapu
- Department of Pediatrics London Health Sciences Centre and Western University, London ON, Canada
| | - Chitra Prasad
- Department of Pediatrics London Health Sciences Centre and Western University, London ON, Canada.
| | - Jennifer DiRaimo
- Department of Pediatrics London Health Sciences Centre and Western University, London ON, Canada
| | - Melanie Napier
- Department of Pediatrics London Health Sciences Centre and Western University, London ON, Canada
| | - Sharan Goobie
- Department of Pediatrics London Health Sciences Centre and Western University, London ON, Canada
| | - Murray Potter
- Department of Pathology and Molecular Medicine McMaster University, Hamilton ON, Canada
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa ON, Canada
| | - Maria Karaceper
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa ON, Canada
| | - Tatiana Munoz
- Divison of Clinical and Metabolic Genetics, Department of Pediatrics, the Hospital for Sick Children and University of Toronto, ON, Canada
| | - Andreas Schulze
- Divison of Clinical and Metabolic Genetics, Department of Pediatrics, the Hospital for Sick Children and University of Toronto, ON, Canada; Genetics and Genome Biology, Peter Gilgan Centre for Research and Learning, the Hospital for Sick Children, Toronto ON, Canada
| | | | - Lihua Li
- Division of Nephrology, Department of Medicine, Western University, London ON, Canada
| | - Michael T Geraghty
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa ON, Canada; Division of Metabolics, Department Pediatrics, University of Ottawa, ON, Canada
| | - Osama Y Al-Dirbashi
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa ON, Canada; Division of Metabolics, Department Pediatrics, University of Ottawa, ON, Canada
| | - C Anthony Rupar
- Department of Pediatrics London Health Sciences Centre and Western University, London ON, Canada; Department of Pathology and Laboratory Medicine Western University, London, ON, Canada
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10
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Snowsill T, Huxley N, Hoyle M, Crathorne L, Haasova M, Briscoe S, Coelho H, Medina-Lara A, Mujica MR, Napier M, Hyde C. Model-Based Cost-Utility Analysis of Erythropoiesis-Stimulating Agents for the Treatment of Cancer-Treatment Induced Anaemia in the UK NHS. Value Health 2014; 17:A641-A642. [PMID: 27202294 DOI: 10.1016/j.jval.2014.08.2316] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - N Huxley
- University of Exeter, Exeter, UK
| | - M Hoyle
- University of Exeter, Exeter, UK
| | | | | | | | - H Coelho
- University of Exeter, Exeter, UK
| | | | | | - M Napier
- Royal Devon & Exeter NHS FT, Exeter, UK
| | - C Hyde
- University of Exeter, Exeter, UK
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11
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Crathorne L, Huxley N, Haasova M, Snowsill T, Jones-Hughes T, Hoyle M, Briscoe S, Coelho H, Long L, Medina-Lara A, Mujica-Mota R, Napier M, Hyde C. What is the Clinical Effectiveness of Erythropoiesis Stimulating Agents for the Treatment of Cancer Treatment-Induced Anaemia? Ann Oncol 2014. [DOI: 10.1093/annonc/mdu356.19] [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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12
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Huxley N, Snowsill T, Hoyle M, Crathorne L, Haasova M, Briscoe S, Coelho H, Medina-Lara A, Mujica-Mota R, Napier M, Hyde C. A Cost-Effectiveness Analysis of Erythropoiesis-Stimulating Agents for Treating Cancer-Treatment Induced Anaemia. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu341.2] [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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13
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Lee S, Blackhall F, Spicer J, Nicolson M, Chaudhuri A, Middleton G, Ahmed S, Hicks J, Crosse B, Napier M, Singer J, Ferry D, Lewanski C, Rolls S, Iles N, Ngai Y, Lillywhite R, Falzon M, Rudd R, Hackshaw A. Et: a Randomized, Multicenter, Phase III Trial of Platinum Versus Nonplatinum Chemotherapy, After Ercc1 Stratification, in Patients with Advanced/Metastatic Non-Small Cell Lung Cancer (Nsclc). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu326.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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Hoyle M, Crathorne L, Peters J, Jones-Hughes T, Cooper C, Napier M, Tappenden P, Hyde C. The clinical effectiveness and cost-effectiveness of cetuximab (mono- or combination chemotherapy), bevacizumab (combination with non-oxaliplatin chemotherapy) and panitumumab (monotherapy) for the treatment of metastatic colorectal cancer after first-line chemotherapy (review of technology appraisal No.150 and part review of technology appraisal No. 118): a systematic review and economic model. Health Technol Assess 2013; 17:1-237. [PMID: 23547747 DOI: 10.3310/hta17140] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Colorectal cancer is the third most commonly diagnosed cancer in the UK after breast and lung cancer. People with metastatic disease who are sufficiently fit are usually treated with active chemotherapy as first- or second-line therapy. Recently, targeted agents have become available including anti-epidermal growth factor receptor (EGFR) agents, for example cetuximab and panitumumab, and anti-vascular endothelial growth factor (VEGF) receptor agents, for example bevacizumab. OBJECTIVE To investigate the clinical effectiveness and cost-effectiveness of panitumumab monotherapy and cetuximab (mono- or combination chemotherapy) for Kirsten rat sarcoma (KRAS) wild-type (WT) patients, and bevacizumab in combination with non-oxaliplatin chemotherapy, for the treatment of metastatic colorectal cancer after first-line chemotherapy. DATA SOURCES The assessment comprises a systematic review of clinical effectiveness and cost-effectiveness studies, a review and critique of manufacturer submissions and a de novo cohort-based economic analysis. For the assessment of effectiveness, a literature search was conducted in a range of electronic databases, including MEDLINE, EMBASE and The Cochrane Library, from 2005 to November 2010. REVIEW METHODS Studies were included if they were randomised controlled trials (RCTs) or systematic reviews of RCTs of cetuximab, bevacizumab or panitumumab in participants with EGFR-expressing metastatic colorectal cancer with KRAS WT status that has progressed after first-line chemotherapy (for cetuximab and panitumumab) or participants with metastatic colorectal cancer that has progressed after first-line chemotherapy (bevacizumab). All steps in the review were performed by one reviewer and checked independently by a second. Synthesis was mainly narrative. An economic model was developed focusing on third-line and subsequent lines of treatment. Costs and benefits were discounted at 3.5% per annum. Probabilistic and univariate deterministic sensitivity analyses were performed. RESULTS The searches identified 7745 titles and abstracts. Two clinical trials (reported in 12 papers) were included. No data were available for bevacizumab in combination with non-oxaliplatin-based chemotherapy in previously treated patients. Neither of the included studies had KRAS status performed prospectively, but the studies did report retrospective analyses of the results for the KRAS WT subgroups. Third-line treatment with cetuximab plus best supportive care or panitumumab plus best supportive care appears to have statistically significant advantages over treatment with best supportive care alone in patients with KRAS WT status. For the economic evaluation, five studies met the inclusion criteria. The base-case incremental cost-effectiveness ratio (ICER) for KRAS WT patients for cetuximab compared with best supportive care is £98,000 per quality-adjusted life-year (QALY), for panitumumab compared with best supportive care is £150,000 per QALY and for cetuximab plus irinotecan compared with best supportive care is £88,000 per QALY. All ICERs are sensitive to treatment duration. LIMITATIONS In the specific populations of interest, there is a lack of evidence on bevacizumab, cetuximab and cetuximab plus irinotecan used second line and on bevacizumab and cetuximab plus irinotecan used third line. For cetuximab plus irinotecan treatment for KRAS WT people, there is no direct evidence on progression-free survival, overall survival and duration of treatment. CONCLUSIONS Although cetuximab and panitumumab appear to be clinically beneficial for KRAS WT patients compared with best supportive care, they are likely to represent poor value for money when judged by cost-effectiveness criteria currently used in the UK. It would be useful to conduct a RCT for patients with KRAS WT status receiving cetuximab plus irinotecan. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- M Hoyle
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
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15
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Bond M, Hoyle M, Moxham T, Napier M, Anderson R. Sunitinib for the treatment of gastrointestinal stromal tumours: a critique of the submission from Pfizer. Health Technol Assess 2010; 13 Suppl 2:69-74. [PMID: 19804692 DOI: 10.3310/hta13suppl2/10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The submission's evidence for the clinical effectiveness and cost-effectiveness of sunitinib for the treatment of gastrointestinal stromal tumours (GISTs) is based on a randomised controlled trial (RCT) comparing sunitinib with placebo for people with unresectable and/or metastatic GIST after failure of imatinib and with Eastern Cooperative Oncology Group (ECOG) progression status 0-1, and an ongoing, non-comparative cohort study of a similar population but with ECOG progression status 0-4. The searches are appropriate and include all relevant studies and the RCT is of high quality. In the RCT sunitinib arm overall survival was 73 median weeks [95% confidence interval (CI) 61 to 83] versus 75 median weeks (95% CI 68 to 84) for the cohort study. However, time to tumour progression in the cohort study was different from that in the RCT sunitinib arm [41 (95% CI 36 to 47) versus 29 (95% CI 22 to 41) median weeks respectively]. Median progression-free survival with sunitinib was 24.6 weeks (95% CI 12.1 to 28.4) versus 6.4 weeks (95% CI 4.4 to 10.0) on placebo (hazard ratio 0.333, 95% CI 0.238 to 0.467, p < 0.001). The manufacturer used a three-state Markov model to model the cost-effectiveness of sunitinib compared with best supportive care for GIST patients; the modelling approach and sources and justification of estimates are reasonable. The base-case incremental cost-effectiveness ratio (ICER) was 27,365 pounds per quality-adjusted life-year (QALY) with the first cycle of sunitinib treatment not costed; when we included the cost of the first treatment cycle we estimated a base-case ICER of 32,636 pounds per QALY. Pfizer's sensitivity analysis produced a range of ICERs from 15,536 pounds per QALY to 59,002 pounds per QALY. Weaknesses of the manufacturer's submission include that the evidence is based on only one published RCT; that 84% of the RCT control population crossed over to the intervention group, giving rise to the use of unusual rank preserved structural failure time (RPSFT) analysis to correct for possible bias; and that a number of errors and omissions were made in the probabilistic sensitivity analysis, meaning that it is not possible to come to firm conclusions about the cost-effectiveness of sunitinib for GIST in this patient population. In conclusion, during the blinded phase of the RCT, overall survival was significantly longer in the sunitinib arm than in the placebo arm (hazard ratio 0.491, 95% CI 0.290 to 0.831, p <0.007). However, intention-to-treat analysis of the entire study showed no statistically significant difference in overall survival for those who received sunitinib (73 weeks) versus those who received placebo (65 weeks) (hazard ratio 0.876, 95% CI 0.679 to 1.129, p = 0.306).
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Affiliation(s)
- M Bond
- PenTAG, Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, UK.
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16
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Bond M, Hoyle M, Moxham T, Napier M, Anderson R. Sunitinib for the treatment of gastrointestinal stromal tumours: a critique of the submission from Pfizer. Health Technol Assess 2009. [DOI: 10.3310/hta13suppl2-10] [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: 11/22/2022] Open
Abstract
The submission’s evidence for the clinical effectiveness and cost-effectiveness of sunitinib for the treatment of gastrointestinal stromal tumours (GISTs) is based on a randomised controlled trial (RCT) comparing sunitinib with placebo for people with unresectable and/or metastatic GIST after failure of imatinib and with Eastern Cooperative Oncology Group (ECOG) progression status 0–1, and an ongoing, non-comparative cohort study of a similar population but with ECOG progression status 0–4. The searches are appropriate and include all relevant studies and the RCT is of high quality. In the RCT sunitinib arm overall survival was 73 median weeks [95% confidence interval (CI) 61 to 83] versus 75 median weeks (95% CI 68 to 84) for the cohort study. However, time to tumour progression in the cohort study was different from that in the RCT sunitinib arm [41 (95% CI 36 to 47) versus 29 (95% CI 22 to 41) median weeks respectively]. Median progression-free survival with sunitinib was 24.6 weeks (95% CI 12.1 to 28.4) versus 6.4 weeks (95% CI 4.4 to 10.0) on placebo (hazard ratio 0.333, 95% CI 0.238 to 0.467, p < 0.001). The manufacturer used a three-state Markov model to model the cost-effectiveness of sunitinib compared with best supportive care for GIST patients; the modelling approach and sources and justification of estimates are reasonable. The base-case incremental cost-effectiveness ratio (ICER) was £27,365 per quality-adjusted life-year (QALY) with the first cycle of sunitinib treatment not costed; when we included the cost of the first treatment cycle we estimated a base-case ICER of £32,636 per QALY. Pfizer’s sensitivity analysis produced a range of ICERs from £15,536 per QALY to £59,002 per QALY. Weaknesses of the manufacturer’s submission include that the evidence is based on only one published RCT; that 84% of the RCT control population crossed over to the intervention group, giving rise to the use of unusual rank preserved structural failure time (RPSFT) analysis to correct for possible bias; and that a number of errors and omissions were made in the probabilistic sensitivity analysis, meaning that it is not possible to come to firm conclusions about the cost-effectiveness of sunitinib for GIST in this patient population. In conclusion, during the blinded phase of the RCT, overall survival was significantly longer in the sunitinib arm than in the placebo arm (hazard ratio 0.491, 95% CI 0.290 to 0.831, p <0.007). However, intention-to-treat analysis of the entire study showed no statistically significant difference in overall survival for those who received sunitinib (73 weeks) versus those who received placebo (65 weeks) (hazard ratio 0.876, 95% CI 0.679 to 1.129, p = 0.306).
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Affiliation(s)
- M Bond
- PenTAG, Peninsula Medical School, Universities of Exeter and Plymouth, UK
| | - M Hoyle
- PenTAG, Peninsula Medical School, Universities of Exeter and Plymouth, UK
| | - T Moxham
- PenTAG, Peninsula Medical School, Universities of Exeter and Plymouth, UK
| | - M Napier
- Royal Devon and Exeter Foundation Trust, UK
| | - R Anderson
- PenTAG, Peninsula Medical School, Universities of Exeter and Plymouth, UK
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Klinger JR, Warburton R, Carino GP, Murray J, Murphy C, Napier M, Harrington EO. Natriuretic peptides differentially attenuate thrombin-induced barrier dysfunction in pulmonary microvascular endothelial cells. Exp Cell Res 2006; 312:401-10. [PMID: 16360149 DOI: 10.1016/j.yexcr.2005.11.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Revised: 11/04/2005] [Accepted: 11/04/2005] [Indexed: 11/26/2022]
Abstract
Previous studies have described a protective effect of atrial natriuretic peptide (ANP) against agonist-induced permeability in endothelial cells derived from various vascular beds. In the current study, we assessed the effects of the three natriuretic peptides on thrombin-induced barrier dysfunction in rat lung microvascular endothelial cells (LMVEC). Both ANP and brain natriuretic peptide (BNP) attenuated the effect of thrombin on increased endothelial monolayer permeability and significantly enhanced the rate of barrier restoration. C-type natriuretic peptide (CNP) had no effect on the degree of thrombin-induced monolayer permeability, but did enhance the restoration of the endothelial barrier, similar to ANP and BNP. In contrast, the non-guanylyl cyclase-linked natriuretic peptide receptor specific ligand, cyclic-atrial natriuretic factor (c-ANF), delayed the rate of barrier restoration following exposure to thrombin. All three natriuretic peptides promoted cGMP production in the endothelial cells; however, 8-bromo-cGMP alone did not significantly affect thrombin modulation of endothelial barrier function. ANP and BNP, but not CNP or c-ANF, blunted thrombin-induced RhoA GTPase activation. We conclude that ANP and BNP protect against thrombin-induced barrier dysfunction in the pulmonary microcirculation by a cGMP-independent mechanism, possibly by attenuation of RhoA activation.
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Affiliation(s)
- James R Klinger
- Pulmonary Vascular Research Laboratory, Providence Veterans Affairs Medical Center, Department of Medicine, Brown Medical School, Research Services, Providence, RI 02908, USA
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18
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Miller W, Riehl E, Napier M, Barber K, Dabideen H. Use of physician assistants as surgery/trauma house staff at an American College of Surgeons-verified Level II trauma center. J Trauma 1998; 44:372-6. [PMID: 9498514 DOI: 10.1097/00005373-199802000-00025] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Historically, surgical physicians staff trauma centers, which provide trauma patients with improved outcomes. Such benefits fuel the expansion of designated trauma centers. Cutbacks in residency programs of surgical specialties, however, necessitate substitutions for traditional trauma providers. METHODS A literature and record review was conducted to examine the use of physician assistants in a large community hospital's verified trauma center. Current and historical outcomes were analyzed regarding the trauma surgeon/physician assistant model. RESULTS Injury Severity Scores increased 19%, transfer time to the operating room decreased 43%, transfer time to the intensive care unit decreased 51%, and transfer time to the floor decreased 20%. The length of stay for admissions decreased 13%, and the length of stay for neurotrauma intensive care unit patients decreased 33%. CONCLUSION The Hurley Medical Center trauma surgeon/physician assistant model is a viable alternative for verified trauma centers unable to maintain a surgical residency program. Consistency and quality of care indicated by shortened length of stay is a hallmark of such a model providing the highest quality of care.
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Affiliation(s)
- W Miller
- Department of Physician Assistants, Hurley Medical Center, Flint, Michigan 48503, USA
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North CS, Hansen K, Wetzel RD, Compton W, Napier M, Spitznagel EL. Nonpsychotic thought disorder: objective clinical identification of somatization and antisocial personality in language patterns. Compr Psychiatry 1997; 38:171-8. [PMID: 9154374 DOI: 10.1016/s0010-440x(97)90071-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
This report describes a new method of using language patterns to identify somatization and antisocial personality (ASPD) disorders in clinical practice. A set of definitions describing characteristic speech patterns was developed to identify "nonpsychotic thought disorder" (NPTD). Speech patterns of subjects with somatization disorder and/or ASPD were compared with those of controls. Blind raters assessed audiotaped samples of speech obtained through open-ended interviews for instances of elements of NPTD. Women with somatization or ASPD had significantly more NPTD speech responses than controls, and women with both disorders showed the greatest amount. Antisocial men did not demonstrate more NPTD than controls, nor was somatization in men associated with NPTD. Clinical attention to speech patterns in patients may help alert clinicians to these disorders in women and serve as indicators for screening for these disorders. More study is needed to develop psychometric properties of the instruments on larger samples, and to identify speech indicators of personality disorder in men. It is likely that other personality disorders, e.g., borderline personality disorder, can be identified through speech patterns, and they deserve study with these methods.
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Affiliation(s)
- C S North
- Department of Psychiatry, Washington University, St Louis, MO 63110, USA
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20
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Martin J, Stribbling SM, Poon GK, Begent RH, Napier M, Sharma SK, Springer CJ. Antibody-directed enzyme prodrug therapy: pharmacokinetics and plasma levels of prodrug and drug in a phase I clinical trial. Cancer Chemother Pharmacol 1997; 40:189-201. [PMID: 9219501 DOI: 10.1007/s002800050646] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Antibody-directed enzyme prodrug therapy (ADEPT) was administered to ten patients in a phase I clinical trial. The aim was to measure plasma levels of the prodrug 4-[(2-chloroethyl)(2-mesyloxyethyl) amino] benzoyl-L-glutamic acid (CMDA) and the bifunctional alkylating drug (CJS11) released from it by the action of tumour-localised carboxypeptidase G2 (CPG2) enzyme. New techniques were developed to extract the prodrug and drug from plasma by solid-phase absorption and elution and to measure CPG2 activity in plasma and tissue. All extracts were analysed by high-performance liquid chromatography (HPLC) and liquid chromatography-mass spectrometry (LC-MS). CPG2 activity was found in metastatic tumour biopsies but not in normal tissue, indicating that localisation had been successful. The clearing agent SB43-gal, given at 46.5 mg/m2, achieved the aim of clearing non-tumour-localised enzyme in the circulation, indicating that conversion of prodrug to drug could take place only at the site of localised conjugate. Plasma prodrug did not always remain above its required threshold of 3 microM for the "therapeutic window" of 120 min after dosing, but the presence of residual prodrug after the first administration of each day indicated that this could be achieved during the remaining four doses over the following 8 h. Despite considerable inter-patient prodrug plasma concentration variability, the elimination half-life of the prodrug was remarkably reproducible at 18 +/- 8 min. Rapid appearance of the drug in plasma indicated that successful conversion from the prodrug had taken place, but also undesirable leakback from the site of localisation into the bloodstream. However, drug plasma levels fell rapidly by at least 50% at between 10 and 60 min with a half-life of 36 +/- 14 min. Analysis of the plasma extracts by LC/MS indicated that this technique might be used to confirm qualitatively the presence of prodrug, drug and their metabolites.
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Affiliation(s)
- J Martin
- CRC Centre for Cancer Therapeutics, Institute of Cancer Research, CRC Laboratory, Sutton, Surrey, UK
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21
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Abstract
Psychoanalytic observation has launched a long tradition in medical literature that links constipation with obsessive-compulsive traits. This association, however, has never been tested empirically. The current investigation sought to test this hypothesized association empirically using a large, randomly sampled population database. Data from the Epidemiologic Catchment Area project collected with the Diagnostic Interview Schedule were analyzed to determine the association, if any, of complaint of medically unexplained constipation (ascertained from the somatization disorder section of the interview) with a DIS diagnosis of obsessive compulsive disorder (OCD). Reported history of constipation was significantly associated with a lifetime diagnosis of OCD in women (not men), even when controlling for symptom-reporting biases using number of other positive somatoform symptoms. This association was specific to constipation and OCD and did not apply to other functional bowel symptoms including diarrhea, bloating (gas), and abdominal pain. Other psychiatric disorders commonly implicated with functional bowel complaints--major depression and panic disorder--were not significantly associated with constipation controlling for effects of other somatoform symptoms. The lack of association of constipation with OCD in men in a general population sample fails to support psychoanalytic concepts that historically have linked these two phenomena, but a special relationship of OCD with constipation was present in women.
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Affiliation(s)
- C S North
- Department of Psychiatry, Washington University, St. Louis, Missouri 63110, USA
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22
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Fei DT, Lowe J, Bodary S, Bunting S, McLean JW, Napier M, Chen AB. RGD-containing peptides inhibit adhesion of 293 cells transfected with GpIIb/IIIa to fibrinogen: comparison to inhibition of platelet aggregation. Blood Coagul Fibrinolysis 1993; 4:255-62. [PMID: 8499563 DOI: 10.1097/00001721-199304000-00007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 01/31/2023]
Abstract
Cyclic RGD-containing peptides caused a dose-dependent inhibition of binding of human embryonic kidney cells transfected with recombinant GpIIb/IIIa (r293 clone B) to human fibrinogen coated on to non-tissue culture plates. The inhibitory activity, IC50, of a panel of seventeen RGD-containing peptides ranged from 0.12 to 89.2 microM. These IC50 values correlated with those determined by the inhibition of platelet aggregation (r = 0.99). Even though there was a correlation, there were differences between the platelet aggregation and the bioadhesion assay. The binding of r293 clone B to fibrinogen was not increased by ADP suggesting that GpIIb/IIIa expressed on the surface of r293 clone B cells may be in the 'activated' form. Moreover, preincubation of r293 clone B cells with a monoclonal antibody (mAb) specific for GpIIIa (4B12) resulted in a dose-dependent decrease of binding to fibrinogen while a mAb specific for GPIIb (2D2) had no effect. Neither of these mAbs inhibited platelet aggregation. The binding of r293 clone B cells to fibrinogen required Ca2+ or Mg2+. This cell-based bioadhesion method can provide a tool for screening potential GpIIb/IIIa antagonists and investigating the interaction of GpIIb/IIIa and fibrinogen not possible with platelet aggregation.
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Affiliation(s)
- D T Fei
- Department of Medicinal and Analytical Chemistry, Genentech Inc., South San Francisco, CA 94080
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23
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Abstract
A patient with extensive pulmonary involvement by disseminated adenocarcinoma is presented. Response to chemotherapy resulted in the direct rupture of necrotic tumour tissue into the pleural cavity leading to a pneumothorax. The condition failed to improve with chest drainage and suction, necessitating surgical intervention. The development of the pneumothorax proved to be a fatal complication of treatment.
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Affiliation(s)
- M D Leslie
- Department of Radiotherapy and Oncology, Charing Cross Hospital, London, UK
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24
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Lu HR, Gold HK, Wu Z, Yasuda T, Pauwels P, Rapold HJ, Napier M, Bunting S, Collen D. G4120, an Arg-Gly-Asp containing pentapeptide, enhances arterial eversion graft recanalization with recombinant tissue-type plasminogen activator in dogs. Thromb Haemost 1992; 67:686-91. [PMID: 1509410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The effects of G4120, a cyclic Arg-Gly-Asp (RGD) containing peptide which inhibits fibrinogen binding to the platelet receptor GPIIb/IIIa, on thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) were investigated in a combined arterial and venous thrombosis model in heparinized dogs. The arterial thrombus model consisted of a 3 cm everted (inside-out) carotid arterial segment inserted into a transsected femoral artery which occludes within 30 min with platelet-rich material and which is resistant to recanalization with 0.5 mg/kg rt-PA. The venous thrombus was a 125I-fibrin labeled whole blood clot produced in the contralateral femoral vein. In 5 dogs given an intravenous bolus of 0.05 mg/kg G4120 followed by a continuous infusion of 0.05 mg/kg per hour for 3 h (group I), arterial occlusion persisted throughout a 4 h observation period and was still present at 24 h in all dogs; the extent of venous clot lysis after 120 min was 27 +/- 7%. In 5 dogs given the same infusion of G4120 in combination with 0.5 mg/kg rt-PA over 60 min, recanalization of the arterial graft occurred in all dogs, within 13 +/- 2 min and persisted throughout the observation period of 4 h (p = 0.01 versus G4120 or rt-PA alone); at 24 h, however, all grafts were occluded. Venous clot lysis in this group was 75 +/- 8% (p = 0.002 versus G4120 alone and p = NS versus rt-PA alone). Pathologic analysis revealed platelet-rich or mixed thrombus with platelet-rich and erythrocyte-rich zones.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- H R Lu
- Center for Thrombosis and Vascular Research, University of Leuven, Belgium
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Abstract
TGF-alpha and EGF are structurally related factors that bind to and induce tyrosine autophosphorylation of a common receptor. Proteolytic cleavage of the transmembrane TGF-alpha precursor's external domain releases several TGF-alpha species. However, membrane-bound TGF-alpha forms remain on the surface of TGF-alpha-expressing cell lines. To evaluate the biological activity of these forms, we modified two cleavage sites in the TGF-alpha precursor coding sequence, making processing into the 50 amino acid TGF-alpha impossible. Overexpression of this cDNA in a receptor-negative cell line, partial purification, and N-terminal sequence analysis indicate the existence of two transmembrane TGF-alpha forms. These solubilized precursors induce tyrosine autophosphorylation of the EGF/TGF-alpha receptor in intact receptor-overexpressing cells, and anchorage-independent growth of NRK fibroblasts. Cell-cell contact between TGF-alpha precursor-overexpressing cells and cells expressing high numbers of receptors also resulted in receptor activation. These findings suggest a role for transmembrane TGF-alpha forms in intercellular interactions in proliferating tissues.
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Affiliation(s)
- R Brachmann
- Department of Developmental Biology, Genentech, Inc., South San Francisco, California 94080
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27
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Maegawa H, McClain DA, Freidenberg G, Olefsky JM, Napier M, Lipari T, Dull TJ, Lee J, Ullrich A. Properties of a human insulin receptor with a COOH-terminal truncation. II. Truncated receptors have normal kinase activity but are defective in signaling metabolic effects. J Biol Chem 1988; 263:8912-7. [PMID: 2837468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
We have previously shown that a mutant human insulin receptor with a COOH-terminal 43-amino acid deletion (HIR delta CT), when expressed in Rat 1 fibroblasts, binds insulin normally, autophosphorylates, and undergoes endocytosis after insulin binding in a manner comparable to the normal human insulin receptor (HIRc). In this paper we have examined the biologic activity of the truncated and normal insulin receptors. In vitro, the HIR delta CT receptors caused a 1.8-fold greater phosphorylation of a Glu4/Tyr1 polypeptide than did the HIRc receptors, but the two receptor types were nearly equivalent in their ability to phosphorylate a src-derived peptide. Furthermore, insulin preactivation of HIRc and HIR delta CT receptors in intact cells led to equivalent stimulation of tyrosine kinase activity as subsequently determined for histone in vitro. Expression of HIRc receptors in cells led to enhanced sensitivity to insulin of 2-deoxy-D-glucose uptake and glycogen synthase activation. This increased sensitivity was proportional to receptor number at low (Ro = 6400) but not at high (Ro = 1.25 X 10(6] levels of receptor expression. However, expression of HIR delta CT receptors (Ro = 2.5 X 10(5] led to little, if any, increase in insulin sensitivity of either 2-deoxy-D-glucose uptake or glycogen synthase activation. Furthermore, compared with HIRc cells, HIR delta CT cells respond poorly to an agonistic monoclonal antibody specific for the human insulin receptor. In conclusion, the HIR delta CT receptor retains intact protein kinase activity in vitro. Despite this, however, the receptor displays low activity in mediating the metabolic effects of insulin.
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Affiliation(s)
- H Maegawa
- Department of Medicine, University of California, San Diego, La Jolla 92093
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28
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Maegawa H, McClain DA, Freidenberg G, Olefsky JM, Napier M, Lipari T, Dull TJ, Lee J, Ullrich A. Properties of a human insulin receptor with a COOH-terminal truncation. II. Truncated receptors have normal kinase activity but are defective in signaling metabolic effects. J Biol Chem 1988. [DOI: 10.1016/s0021-9258(18)68394-2] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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