1
|
Allen AM, Charlton M, Cusi K, Harrison SA, Kowdley KV, Noureddin M, Shubrook JH. Guideline-based management of metabolic dysfunction-associated steatotic liver disease in the primary care setting. Postgrad Med 2024. [PMID: 38465573 DOI: 10.1080/00325481.2024.2325332] [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: 09/14/2023] [Accepted: 02/26/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing worldwide. Primary care providers play a critical role in the screening, diagnosis, and management of MASLD and/or metabolic dysfunction-associated steatohepatitis (MASH), though they can face challenges in this setting, particularly where healthcare resources are limited and barriers to care exist. To address these challenges, several guidelines have been developed to provide evidence-based recommendations for the clinical assessment and management of patients with MASLD/MASH. AIMS To provide a unified, simple-to-understand, practical guide for MASLD screening, diagnosis, and management based on current guideline recommendations, for use by primary care providers in daily practice. METHODS Evidence-based recommendations from several international guidelines were summarized, focusing on the similarities and differences between them. RESULTS Recommendations are broadly aligned across the guidelines, but several key differences are evident. Practical guidance is provided on screening, identifying target populations for risk stratification, initial evaluation of individuals with suspected MASLD, surveillance, risk stratification and referral, as well as approaches to the management of MASLD and associated comorbidities, with specific considerations for the primary care setting. CONCLUSIONS Primary care providers are ideally placed to identify at-risk individuals, implement evidence-based interventions to prevent the development of fibrosis and cirrhosis, and effectively manage comorbidities. Equipping primary care providers with the necessary knowledge and tools to effectively manage MASLD/MASH may help to improve patient outcomes and reduce the burden of liver disease.
Collapse
Affiliation(s)
- Alina M Allen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Michael Charlton
- Transplantation institute, University of Chicago Medicine, Chicago, IL, USA
| | - Kenneth Cusi
- Division of Endocrinology, University of Florida, Gainesville, Florida, USA
| | | | - Kris V Kowdley
- Liver Institute Northwest and Elson S. Floyd College of Medicine, Washington State University, Seattle, Washington, USA
| | - Mazen Noureddin
- Houston Research Institute and Houston Liver Institute, Houston, TX, USA
| | - Jay H Shubrook
- Department of Clinical Sciences and Community Health, Touro University California, Vallejo, California, USA
| |
Collapse
|
2
|
Parthasarathy G, Mauer AS, Golla N, Daniel PV, Kim LH, Sidhu GS, Marek GW, Loeuillard E, Krishnan A, Lee HSK, Pavelko KD, Charlton M, Hirsova P, Ilyas SI, Malhi H. Macrophage RAGE activation is proinflammatory in NASH. JCI Insight 2024; 9:e169138. [PMID: 38175729 DOI: 10.1172/jci.insight.169138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
Intrahepatic macrophages in nonalcoholic steatohepatitis (NASH) are heterogenous and include proinflammatory recruited monocyte-derived macrophages. The receptor for advanced glycation endproducts (RAGE) is expressed on macrophages and can be activated by damage associated molecular patterns (DAMPs) upregulated in NASH, yet the role of macrophage-specific RAGE signaling in NASH is unclear. Therefore, we hypothesized that RAGE-expressing macrophages are proinflammatory and mediate liver inflammation in NASH. Compared with healthy controls, RAGE expression was increased in liver biopsies from patients with NASH. In a high-fat, -fructose, and -cholesterol-induced (FFC)-induced murine model of NASH, RAGE expression was increased, specifically on recruited macrophages. FFC mice that received a pharmacological inhibitor of RAGE (TTP488), and myeloid-specific RAGE KO mice (RAGE-MKO) had attenuated liver injury associated with a reduced accumulation of RAGE+ recruited macrophages. Transcriptomics analysis suggested that pathways of macrophage and T cell activation were upregulated by FFC diet, inhibited by TTP488 treatment, and reduced in RAGE-MKO mice. Correspondingly, the secretome of ligand-stimulated BM-derived macrophages from RAGE-MKO mice had an attenuated capacity to activate CD8+ T cells. Our data implicate RAGE as what we propose to be a novel and potentially targetable mediator of the proinflammatory signaling of recruited macrophages in NASH.
Collapse
Affiliation(s)
| | - Amy S Mauer
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Naresh Golla
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - P Vineeth Daniel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lily H Kim
- Department of Biochemistry, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Guneet S Sidhu
- Department of Internal Medicine, University of North Dakota, Fargo, North Dakota, USA
| | - George W Marek
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Emilien Loeuillard
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Immunology, Mayo Clinic, Rochester, Minnesota
| | - Anuradha Krishnan
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Hyun Se Kim Lee
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Michael Charlton
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Petra Hirsova
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sumera I Ilyas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Harmeet Malhi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
3
|
Hutchison AL, Tavaglione F, Romeo S, Charlton M. Endocrine aspects of metabolic dysfunction-associated steatotic liver disease (MASLD): Beyond insulin resistance. J Hepatol 2023; 79:1524-1541. [PMID: 37730124 DOI: 10.1016/j.jhep.2023.08.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/22/2023]
Abstract
While the association of metabolic dysfunction-associated steatotic liver disease (MASLD) with obesity and insulin resistance is widely appreciated, there are a host of complex interactions between the liver and other endocrine axes. While it can be difficult to definitively distinguish direct causal relationships and those attributable to increased adipocyte mass, there is substantial evidence of the direct and indirect effects of endocrine dysregulation on the severity of MASLD, with strong evidence that low levels of growth hormone, sex hormones, and thyroid hormone promote the development and progression of disease. The impact of steroid hormones, e.g. cortisol and dehydroepiandrosterone, and adipokines is much more divergent. Thoughtful assessment, based on individual risk factors and findings, and management of non-insulin endocrine axes is essential in the evaluation and management of MASLD. Multiple therapeutic options have emerged that leverage various endocrine axes to reduce the fibroinflammatory cascade in MASH.
Collapse
Affiliation(s)
| | - Federica Tavaglione
- Clinical Medicine and Hepatology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy; Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stefano Romeo
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Cardiology Department, Sahlgrenska University Hospital, Gothenburg, Sweden; Clinical Nutrition Unit, Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Michael Charlton
- Center for Liver Diseases, University of Chicago, United States.
| |
Collapse
|
4
|
Anstee QM, Lucas KJ, Francque S, Abdelmalek MF, Sanyal AJ, Ratziu V, Gadano AC, Rinella M, Charlton M, Loomba R, Mena E, Schattenberg JM, Noureddin M, Lazas D, Goh GB, Sarin SK, Yilmaz Y, Martic M, Stringer R, Kochuparampil J, Chen L, Rodriguez-Araujo G, Chng E, Naoumov NV, Brass C, Pedrosa MC. Tropifexor plus cenicriviroc combination versus monotherapy in nonalcoholic steatohepatitis: Results from the phase 2b TANDEM study. Hepatology 2023; 78:1223-1239. [PMID: 37162151 PMCID: PMC10521801 DOI: 10.1097/hep.0000000000000439] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND AND AIMS With distinct mechanisms of action, the combination of tropifexor (TXR) and cenicriviroc (CVC) may provide an effective treatment for NASH. This randomized, multicenter, double-blind, phase 2b study assessed the safety and efficacy of TXR and CVC combination, compared with respective monotherapies. APPROACH AND RESULTS Patients (N = 193) were randomized 1:1:1:1 to once-daily TXR 140 μg (TXR 140 ), CVC 150 mg (CVC), TXR 140 μg + CVC 150 mg (TXR 140 + CVC), or TXR 90 μg + CVC 150 mg (TXR 90 + CVC) for 48 weeks. The primary and secondary end points were safety and histological improvement, respectively. Rates of adverse events (AEs) were similar across treatment groups. Pruritus was the most frequently experienced AE, with highest incidence in the TXR 140 group (40.0%). In TXR and combination groups, alanine aminotransferase (ALT) decreased from baseline to 48 weeks (geometric mean change: -21%, TXR 140 ; -16%, TXR 140 + CVC; -13%, TXR 90 + CVC; and +17%, CVC). Reductions in body weight observed at week 24 (mean changes from baseline: TXR 140 , -2.5 kg; TXR 140 + CVC, -1.7 kg; TXR 90 + CVC, -1.0 kg; and CVC, -0.1 kg) were sustained to week 48. At least 1-point improvement in fibrosis stage/steatohepatitis resolution without worsening of fibrosis was observed in 32.3%/25.8%, 31.6%/15.8%, 29.7%/13.5%, and 32.5%/22.5% of patients in the TXR 140 , CVC, TXR 140 + CVC, and TXR 90 + CVC groups, respectively. CONCLUSIONS The safety profile of TXR + CVC combination was similar to respective monotherapies, with no new signals. TXR monotherapy showed sustained ALT and body weight decreases. No substantial incremental efficacy was observed with TXR + CVC combination on ALT, body weight, or in histological end points compared with monotherapy.
Collapse
Affiliation(s)
- Quentin M. Anstee
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Kathryn J. Lucas
- Diabetes and Endocrinology Consultants, Morehead City, North Carolina, USA
| | - Sven Francque
- Department of Gastroenterology Hepatology, Antwerp University Hospital, Antwerp, Belgium
- InflaMed Centre of Excellence, Laboratory for Experimental Medicine and Paediatrics, Translational Sciences in Inflammation and Immunology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | | | - Arun J. Sanyal
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - Vlad Ratziu
- Sorbonne Université, Hôpital Pitié Salpêtrière, ICAN Paris, France
| | | | - Mary Rinella
- University of Chicago, Pritzker School of Medicine, Chicago, Illinois, USA
| | | | - Rohit Loomba
- University of California at San Diego, La Jolla, California, USA
| | - Edward Mena
- California Liver Research Institute, Pasadena, California, USA
| | - Jörn M. Schattenberg
- Metabolic Liver Research Program, I. Department of Medicine, University Medical Center Mainz, Germany
| | | | - Donald Lazas
- Digestive Health Research and ObjectiveHealth, Nashville, Tennessee, USA
| | - George B.B. Goh
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Shiv K. Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Yusuf Yilmaz
- Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey
- Department of Gastroenterology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | | | | | | | - Li Chen
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | | | | | | - Clifford Brass
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | |
Collapse
|
5
|
Flamm S, Lawitz E, Borg B, Charlton M, Landis C, Reddy KR, Shiffman M, Alsina A, Chang C, Ravendhran N, Hernandez C, Hézode C, Scherbakovsky S, Mercier RC, Samuel D. Efficacy and Safety of Sofosbuvir/Velpatasvir Plus Ribavirin in Patients with Hepatitis C Virus-Related Decompensated Cirrhosis. Viruses 2023; 15:2026. [PMID: 37896803 PMCID: PMC10611233 DOI: 10.3390/v15102026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 10/29/2023] Open
Abstract
A fixed-dose combination of sofosbuvir/velpatasvir (SOF/VEL) plus weight-based ribavirin (RBV) for 12 weeks is recommended for the treatment of patients with hepatitis C virus (HCV)-associated decompensated cirrhosis. However, large global studies, while confirming the effectiveness of SOF/VEL in a broad range of patients, often exclude these patients. This Phase 2, single-arm, open-label study in adult patients with HCV-associated decompensated cirrhosis in France and the USA aimed to provide further data on the safety and efficacy of SOF/VEL plus RBV for 12 weeks in this population. Patients were treated with a fixed-dose combination of SOF 400 mg/VEL 100 mg plus weight-based RBV once daily for 12 weeks. The inclusion criteria were chronic HCV infection (≥6 months), quantifiable HCV RNA at screening, Child-Turcotte-Pugh class B or C cirrhosis, and liver imaging within 6 months of Day 1 to exclude hepatocellular carcinoma. Among 32 patients who initiated treatment, 78.1% achieved sustained virologic response 12 weeks after the end of treatment (SVR12). Failure to achieve SVR12 was due to non-virologic reasons (investigator discretion, n = 1; death, n = 6). All 25 patients in the per-protocol population achieved SVR12 and all but one achieved sustained virologic response 24 weeks after the end of treatment. Adverse events (AEs) were as expected for a patient population with advanced liver disease. All Grade 3-4 and serious AEs and deaths were deemed unrelated to treatment. In patients with HCV-associated decompensated cirrhosis, SOF/VEL plus RBV achieved high SVR12 rates and was generally well tolerated.
Collapse
Affiliation(s)
- Steven Flamm
- Department of Internal Medicine, Division of Digestive Diseases and Nutrition, Rush University Medical Center, Chicago, IL 60612, USA
| | - Eric Lawitz
- Texas Liver Institute, University of Texas Health San Antonio, San Antonio, TX 78215, USA
| | - Brian Borg
- Southern Therapy and Advanced Research LLC, Jackson, MS 39216, USA
| | | | - Charles Landis
- Division of Gastroenterology and Hepatology, University of Washington, Seattle, WA 98101, USA
| | - K. Rajender Reddy
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mitchell Shiffman
- Bon Secours Mercy Health, Liver Institute of Virginia, Richmond, VA 23226, USA
| | - Angel Alsina
- Tampa General Medical Group, Tampa, FL 33609, USA
| | - Charissa Chang
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | | | | | | | | | | | - Didier Samuel
- Centre Hépatobiliaire, Hôpital Paul-Brousse, Inserm Research Unit 1193, Université Paris-Saclay, 94800 Villejuif, France
| |
Collapse
|
6
|
Anderson EK, Baker CJ, Bertsche W, Bhatt NM, Bonomi G, Capra A, Carli I, Cesar CL, Charlton M, Christensen A, Collister R, Cridland Mathad A, Duque Quiceno D, Eriksson S, Evans A, Evetts N, Fabbri S, Fajans J, Ferwerda A, Friesen T, Fujiwara MC, Gill DR, Golino LM, Gomes Gonçalves MB, Grandemange P, Granum P, Hangst JS, Hayden ME, Hodgkinson D, Hunter ED, Isaac CA, Jimenez AJU, Johnson MA, Jones JM, Jones SA, Jonsell S, Khramov A, Madsen N, Martin L, Massacret N, Maxwell D, McKenna JTK, Menary S, Momose T, Mostamand M, Mullan PS, Nauta J, Olchanski K, Oliveira AN, Peszka J, Powell A, Rasmussen CØ, Robicheaux F, Sacramento RL, Sameed M, Sarid E, Schoonwater J, Silveira DM, Singh J, Smith G, So C, Stracka S, Stutter G, Tharp TD, Thompson KA, Thompson RI, Thorpe-Woods E, Torkzaban C, Urioni M, Woosaree P, Wurtele JS. Observation of the effect of gravity on the motion of antimatter. Nature 2023; 621:716-722. [PMID: 37758891 PMCID: PMC10533407 DOI: 10.1038/s41586-023-06527-1] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/09/2023] [Indexed: 09/29/2023]
Abstract
Einstein's general theory of relativity from 19151 remains the most successful description of gravitation. From the 1919 solar eclipse2 to the observation of gravitational waves3, the theory has passed many crucial experimental tests. However, the evolving concepts of dark matter and dark energy illustrate that there is much to be learned about the gravitating content of the universe. Singularities in the general theory of relativity and the lack of a quantum theory of gravity suggest that our picture is incomplete. It is thus prudent to explore gravity in exotic physical systems. Antimatter was unknown to Einstein in 1915. Dirac's theory4 appeared in 1928; the positron was observed5 in 1932. There has since been much speculation about gravity and antimatter. The theoretical consensus is that any laboratory mass must be attracted6 by the Earth, although some authors have considered the cosmological consequences if antimatter should be repelled by matter7-10. In the general theory of relativity, the weak equivalence principle (WEP) requires that all masses react identically to gravity, independent of their internal structure. Here we show that antihydrogen atoms, released from magnetic confinement in the ALPHA-g apparatus, behave in a way consistent with gravitational attraction to the Earth. Repulsive 'antigravity' is ruled out in this case. This experiment paves the way for precision studies of the magnitude of the gravitational acceleration between anti-atoms and the Earth to test the WEP.
Collapse
Affiliation(s)
- E K Anderson
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
| | - C J Baker
- Department of Physics, Faculty of Science and Engineering, Swansea University, Swansea, UK
| | - W Bertsche
- School of Physics and Astronomy, University of Manchester, Manchester, UK.
- Cockcroft Institute, Sci-Tech Daresbury, Warrington, UK.
| | - N M Bhatt
- Department of Physics, Faculty of Science and Engineering, Swansea University, Swansea, UK
| | - G Bonomi
- University of Brescia, Brescia and INFN Pavia, Pavia, Italy
| | - A Capra
- TRIUMF, Vancouver, British Columbia, Canada
| | - I Carli
- TRIUMF, Vancouver, British Columbia, Canada
| | - C L Cesar
- Instituto de Fisica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - M Charlton
- Department of Physics, Faculty of Science and Engineering, Swansea University, Swansea, UK
| | - A Christensen
- Department of Physics, University of California at Berkeley, Berkeley, CA, USA
| | - R Collister
- TRIUMF, Vancouver, British Columbia, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Cridland Mathad
- Department of Physics, Faculty of Science and Engineering, Swansea University, Swansea, UK
| | - D Duque Quiceno
- TRIUMF, Vancouver, British Columbia, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - S Eriksson
- Department of Physics, Faculty of Science and Engineering, Swansea University, Swansea, UK
| | - A Evans
- TRIUMF, Vancouver, British Columbia, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - N Evetts
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - S Fabbri
- School of Physics and Astronomy, University of Manchester, Manchester, UK
- Accelerator and Technology Sector, CERN, Geneva, Switzerland
| | - J Fajans
- Department of Physics, University of California at Berkeley, Berkeley, CA, USA.
| | - A Ferwerda
- Department of Physics and Astronomy, York University, Toronto, Ontario, Canada
| | - T Friesen
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | | | - D R Gill
- TRIUMF, Vancouver, British Columbia, Canada
| | - L M Golino
- Department of Physics, Faculty of Science and Engineering, Swansea University, Swansea, UK
| | - M B Gomes Gonçalves
- Department of Physics, Faculty of Science and Engineering, Swansea University, Swansea, UK
| | | | - P Granum
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
| | - J S Hangst
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark.
| | - M E Hayden
- Department of Physics, Simon Fraser University, Burnaby, British Columbia, Canada
| | - D Hodgkinson
- School of Physics and Astronomy, University of Manchester, Manchester, UK
- Department of Physics, University of California at Berkeley, Berkeley, CA, USA
| | - E D Hunter
- Department of Physics, University of California at Berkeley, Berkeley, CA, USA
| | - C A Isaac
- Department of Physics, Faculty of Science and Engineering, Swansea University, Swansea, UK
| | | | - M A Johnson
- School of Physics and Astronomy, University of Manchester, Manchester, UK
- Cockcroft Institute, Sci-Tech Daresbury, Warrington, UK
| | - J M Jones
- Department of Physics, Faculty of Science and Engineering, Swansea University, Swansea, UK
| | - S A Jones
- Van Swinderen Institute for Particle Physics and Gravity, University of Groningen, Groningen, The Netherlands
| | - S Jonsell
- Department of Physics, Stockholm University, Stockholm, Sweden
| | - A Khramov
- TRIUMF, Vancouver, British Columbia, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Physics, British Columbia Institute of Technology, Burnaby, British Columbia, Canada
| | - N Madsen
- Department of Physics, Faculty of Science and Engineering, Swansea University, Swansea, UK
| | - L Martin
- TRIUMF, Vancouver, British Columbia, Canada
| | | | - D Maxwell
- Department of Physics, Faculty of Science and Engineering, Swansea University, Swansea, UK
| | - J T K McKenna
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
- School of Physics and Astronomy, University of Manchester, Manchester, UK
| | - S Menary
- Department of Physics and Astronomy, York University, Toronto, Ontario, Canada
| | - T Momose
- TRIUMF, Vancouver, British Columbia, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Chemistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - M Mostamand
- TRIUMF, Vancouver, British Columbia, Canada
- Department of Chemistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - P S Mullan
- Department of Physics, Faculty of Science and Engineering, Swansea University, Swansea, UK
- Institute for Particle Physics and Astrophysics, ETH, Zurich, Switzerland
| | - J Nauta
- Department of Physics, Faculty of Science and Engineering, Swansea University, Swansea, UK
| | | | - A N Oliveira
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
| | - J Peszka
- Department of Physics, Faculty of Science and Engineering, Swansea University, Swansea, UK
- Institute for Particle Physics and Astrophysics, ETH, Zurich, Switzerland
| | - A Powell
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | - C Ø Rasmussen
- Experimental Physics Department, CERN, Geneva, Switzerland
| | - F Robicheaux
- Department of Physics and Astronomy, Purdue University, West Lafayette, IN, USA
| | - R L Sacramento
- Instituto de Fisica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - M Sameed
- School of Physics and Astronomy, University of Manchester, Manchester, UK
- Accelerator Systems Department, CERN, Geneva, Switzerland
| | - E Sarid
- Soreq NRC, Yavne, Israel
- Department of Physics, Ben Gurion University, Beer Sheva, Israel
| | - J Schoonwater
- Department of Physics, Faculty of Science and Engineering, Swansea University, Swansea, UK
| | - D M Silveira
- Instituto de Fisica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - J Singh
- School of Physics and Astronomy, University of Manchester, Manchester, UK
| | - G Smith
- TRIUMF, Vancouver, British Columbia, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - C So
- TRIUMF, Vancouver, British Columbia, Canada
| | | | - G Stutter
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
- School of Mathematical and Physical Sciences, University of Sussex, Brighton, UK
| | - T D Tharp
- Physics Department, Marquette University, Milwaukee, WI, USA
| | - K A Thompson
- Department of Physics, Faculty of Science and Engineering, Swansea University, Swansea, UK
| | - R I Thompson
- TRIUMF, Vancouver, British Columbia, Canada
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | - E Thorpe-Woods
- Department of Physics, Faculty of Science and Engineering, Swansea University, Swansea, UK
| | - C Torkzaban
- Department of Physics, University of California at Berkeley, Berkeley, CA, USA
| | - M Urioni
- University of Brescia, Brescia and INFN Pavia, Pavia, Italy
| | - P Woosaree
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | - J S Wurtele
- Department of Physics, University of California at Berkeley, Berkeley, CA, USA
| |
Collapse
|
7
|
Terrault NA, Francoz C, Berenguer M, Charlton M, Heimbach J. Liver Transplantation 2023: Status Report, Current and Future Challenges. Clin Gastroenterol Hepatol 2023; 21:2150-2166. [PMID: 37084928 DOI: 10.1016/j.cgh.2023.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 01/03/2023] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 04/23/2023]
Abstract
Liver transplantation offers live-saving therapy for patients with complications of cirrhosis and stage T2 hepatocellular carcinoma. The demand for organs far outstrips the supply, and innovations aimed at increasing the number of usable deceased donors as well as alternative donor sources are a major focus. The etiologies of cirrhosis are shifting over time, with more need for transplantation among patients with alcohol-associated liver disease and nonalcoholic/metabolic fatty liver disease and less for viral hepatitis, although hepatitis B remains an important indication for transplant in countries with high endemicity. The rise in transplantation for alcohol-associated liver disease and nonalcoholic/metabolic fatty liver disease has brought attention to how patients are selected for transplantation and the strategies needed to prevent recurrent disease. In this review, we present a status report on the most pressing topics in liver transplantation and future challenges.
Collapse
Affiliation(s)
- Norah A Terrault
- Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California.
| | - Claire Francoz
- Liver Intensive Care and Liver Transplantation Unit, Hepatology, Hospital Beaujon, Clichy, France
| | - Marina Berenguer
- Hepatology and Liver Transplantation Unit, Hospital Universitario la Fe - IIS La Fe Valencia; CiberEHD and University of Valencia, Valencia, Spain
| | - Michael Charlton
- Transplantation Institute, University of Chicago, Chicago, Illinois
| | - Julie Heimbach
- William von Liebig Center for Transplantation, Mayo Clinic Rochester, Minnesota
| |
Collapse
|
8
|
Shelley K, Articolo A, Luthra R, Charlton M. Clinical characteristics and management of patients with nonalcoholic steatohepatitis in a real-world setting: analysis of the Ipsos NASH therapy monitor database. BMC Gastroenterol 2023; 23:160. [PMID: 37208593 DOI: 10.1186/s12876-023-02794-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/30/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Nonalcoholic steatohepatitis (NASH) is the more severe, inflammatory type of nonalcoholic fatty liver disease (NAFLD). NASH, a leading indication for liver transplantation, is growing in prevalence. The extent of liver fibrosis, ranging from fibrosis stage (FS) of none (F0) to cirrhosis (F4), is a strong predictor of health outcomes. There is little information on patient demographics and clinical characteristics by fibrosis stage and NASH treatment outside of academic medical centers. METHODS We conducted a cross-sectional observational study using Ipsos' syndicated NASH Therapy Monitor database, consisting of medical chart audits provided by sampled NASH-treating physicians in the United States in 2016 (n = 174) and 2017 (n = 164). Data was collected online. RESULTS Of 2,366 patients reported on by participating physicians and included in the analysis, 68% had FS F0-F2, 21% had bridging fibrosis (F3), and 9% had cirrhosis (F4). Common comorbidities were type 2 diabetes (56%), hyperlipidemia (44%), hypertension (46%), and obesity (42%). Patients with more advanced fibrosis scores (F3-F4) had higher comorbidity rates than patients with F0-F2. Commonly used diagnostic tests included ultrasound (80%), liver biopsy (78%), AST/ALT ratio (43%), NAFLD fibrosis score (25%), transient elastography (23%), NAFLD liver fat score (22%), and Fatty Liver Index (19%). Most commonly prescribed medications were vitamin E (53%), statins (51%), metformin (47%), angiotensin converting enzyme inhibitors (28%), and beta blockers (22%). Medications were commonly prescribed for reasons other than their known effects. CONCLUSION Physicians in this study, drawn from a spectrum of practice settings, relied on ultrasound and liver biopsy for diagnosis and vitamin E, statins, and metformin for pharmacological treatment of NASH. These findings imply poor adherence to guidelines in the diagnosis and management of NAFLD and NASH. Nonalcoholic steatohepatitis (NASH) is a liver disease caused by excess fat in the liver which can lead to liver inflammation and scarring (fibrosis), ranging from stage F0 (no scarring) to F4 (advanced scarring). The stage of liver scarring can predict the likelihood of future health problems, including liver failure and liver cancer. However, we do not fully understand how patient characteristics may vary at different stages of liver scarring. We looked at medical information from physicians treating patients diagnosed with NASH to understand how patient characteristics might differ based on the severity of their liver scarring. The majority (68%) of patients were stage F0-F2, with 30% having advanced scarring (F3-F4). In addition to NASH, many patients also had type 2 diabetes, high cholesterol, high blood pressure, and obesity. Patients with more advanced scarring (F3-F4) were more likely to have these diseases than patients with less severe disease (F0-F2). Diagnosis of NASH by participating physicians was based on tests including imaging (ultrasound, CT scan, MRI), liver biopsy, blood tests, and whether patients had other conditions that would put them at risk for NASH. The medications that the doctors prescribed most often to their patients included vitamin E and drugs to treat high cholesterol, high blood pressure, or diabetes. Medications were frequently prescribed for reasons other than their known effects. By understanding how patient characteristics vary by stages of liver scarring and how NASH is currently managed may help guide the evaluation and treatment of NASH when NASH-specific therapies become available.
Collapse
Affiliation(s)
| | - Amy Articolo
- Novo Nordisk Inc, 800 Scudders Mill Road, Plainsboro, NJ, USA
| | - Rakesh Luthra
- Novo Nordisk Inc, 800 Scudders Mill Road, Plainsboro, NJ, USA.
| | - Michael Charlton
- Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences, Chicago, IL, USA
| |
Collapse
|
9
|
Davies ER, Ryan KA, Bewley KR, Coombes NS, Salguero FJ, Carnell OT, Biddlecombe S, Charlton M, Challis A, Cross ES, Handley A, Ngabo D, Weldon TM, Hall Y, Funnell SGP. The Omicron Sub-Variant BA.4 Displays a Remarkable Lack of Clinical Signs in a Golden Syrian Hamster Model of SARS-CoV-2 Infection. Viruses 2023; 15:1133. [PMID: 37243219 PMCID: PMC10224153 DOI: 10.3390/v15051133] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
The ongoing emergence of SARS-CoV-2 virus variants remains a source of concern because it is accompanied by the potential for increased virulence as well as evasion of immunity. Here we show that, although having an almost identical spike gene sequence as another Omicron variant (BA.5.2.1), a BA.4 isolate lacked all the typical disease characteristics of other isolates seen in the Golden Syrian hamster model despite replicating almost as effectively. Animals infected with BA.4 had similar viral shedding profiles to those seen with BA.5.2.1 (up to day 6 post-infection), but they all failed to lose weight or present with any other significant clinical signs. We hypothesize that this lack of detectable signs of disease during infection with BA.4 was due to a small (nine nucleotide) deletion (∆686-694) in the viral genome (ORF1ab) responsible for the production of non-structural protein 1, which resulted in the loss of three amino acids (aa 141-143).
Collapse
Affiliation(s)
- Elizabeth R. Davies
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Kathryn A. Ryan
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Kevin R. Bewley
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Naomi S. Coombes
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Francisco J. Salguero
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Oliver T. Carnell
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Sarah Biddlecombe
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Michael Charlton
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Amy Challis
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Eleanor S. Cross
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Alastair Handley
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Didier Ngabo
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Thomas M. Weldon
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Yper Hall
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Simon G. P. Funnell
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
- Quadram Institute Bioscience, Norwich Research Park, Norwich NR4 7UQ, UK
- World Health Organization, Appia 20, 1211 Geneva, Switzerland
| |
Collapse
|
10
|
Handley A, Ryan KA, Davies ER, Bewley KR, Carnell OT, Challis A, Coombes NS, Fotheringham SA, Gooch KE, Charlton M, Harris DJ, Kennard C, Ngabo D, Weldon TM, Salguero FJ, Funnell SGP, Hall Y. SARS-CoV-2 Disease Severity in the Golden Syrian Hamster Model of Infection Is Related to the Volume of Intranasal Inoculum. Viruses 2023; 15:748. [PMID: 36992457 PMCID: PMC10051760 DOI: 10.3390/v15030748] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023] Open
Abstract
The golden Syrian hamster (Mesocricetus auratus) is now commonly used in preclinical research for the study of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the assessment of vaccines, drugs and therapeutics. Here, we show that hamsters inoculated via the intranasal route with the same infectious virus dose of prototypical SARS-CoV-2 administered in a different volume present with different clinical signs, weight loss and viral shedding, with a reduced volume resulting in reduced severity of disease similar to that obtained by a 500-fold reduction in the challenge dose. The tissue burden of the virus and the severity of pulmonary pathology were also significantly affected by different challenge inoculum volumes. These findings suggest that a direct comparison between the severity of SARS-CoV-2 variants or studies assessing the efficacy of treatments determined by hamster studies cannot be made unless both the challenge dose and inoculation volume are matched when using the intranasal route. Additionally, analysis of sub-genomic and total genomic RNA PCR data demonstrated no link between sub-genomic and live viral titres and that sub-genomic analyses do not provide any information beyond that provided by more sensitive total genomic PCR.
Collapse
Affiliation(s)
- Alastair Handley
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Kathryn A. Ryan
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Elizabeth R. Davies
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Kevin R. Bewley
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Oliver T. Carnell
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Amy Challis
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Naomi S. Coombes
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Susan A. Fotheringham
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Karen E. Gooch
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Michael Charlton
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Debbie J. Harris
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Chelsea Kennard
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Didier Ngabo
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Thomas M. Weldon
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Francisco J. Salguero
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| | - Simon G. P. Funnell
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
- Quadram Institute Bioscience, Norwich Research Park, Norwich NR4 7UQ, UK
- World Health Organization, Appia 20, 1211 Geneva, Switzerland
| | - Yper Hall
- UKHSA Porton, Vaccine Development and Evaluation Centre, UK Health Security Agency, Manor Farm Road, Salisbury SP4 0JG, UK
| |
Collapse
|
11
|
Morris IS, Taylor H, Fleet D, Y Lai F, Charlton M, Tang JW. Outcome of patients receiving V-V ECMO for SARS-CoV-2 severe acute respiratory failure. Pulmonology 2023; 29:240-243. [PMID: 36717294 PMCID: PMC9837222 DOI: 10.1016/j.pulmoe.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/21/2022] [Accepted: 01/05/2023] [Indexed: 01/14/2023] Open
Affiliation(s)
- I S Morris
- Glenfield Adult Intensive Care Unit, University Hospitals of Leicester NHS trust, UK; Interdepartmental Division of Critical Care Medicine, University of Toronto. Toronto, Canada; Department of Intensive Care Medicine, Nepean Hospital. New South Wales, Australia
| | - H Taylor
- Kettering General Hospital NHS Foundation Trust, UK
| | - D Fleet
- Glenfield Adult Intensive Care Unit, University Hospitals of Leicester NHS trust, UK; Adult Intensive Care Unit, Royal Derby Hospital, UK
| | - F Y Lai
- Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - M Charlton
- Glenfield Adult Intensive Care Unit, University Hospitals of Leicester NHS trust, UK
| | - J W Tang
- Clinical Microbiology, University Hospitals of Leicester NHS trust, UK; Respiratory Sciences, University of Leicester, Leicester, UK.
| |
Collapse
|
12
|
Abstract
So far without an approved therapy, non-alcoholic steatohepatitis (NASH) remains at the beginning of its therapeutic cycle, whereby many pharmacological agents are initially developed as monotherapies. Given the complex pathogenesis of NASH, the prevailing opinion is that combination therapy will be key to its treatment and that therapeutic efforts should be aimed at developing combinations rather than monotherapies. However, the development of combination therapies is associated with multiple challenges, which we attempt to describe here, and which extend beyond the perceived biological rationale of combining two different mechanisms of action. Important hurdles include predicting the added benefit of a specific combination regimen over monotherapies, given the limited data provided by early phase trials. Regulatory requirements for approving a combination span from preclinical models, through initial demonstration of the efficacy of the combination, to complex late-stage therapeutic trials. Development pathways for combination therapies are, in this paradigm, highly demanding in terms of patient and sponsor resources. In light of recent, negative, late-stage trials of monotherapies, well-designed combination development programmes could be essential to avoid additional failures that may hold back therapeutic research and access to treatment for patients. Enthusiasm for combination therapies should be maintained but realistically balanced against the complexity of demonstrating their therapeutic value.
Collapse
Affiliation(s)
- Vlad Ratziu
- Sorbonne Université, France; Institute for Cardiometabolism and Nutrition (ICAN), France; Hospital Pitié-Salpêtrière, Paris, France.
| | - Michael Charlton
- Center for Liver Diseases, USA; Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| |
Collapse
|
13
|
Cotter TG, Odenwald MA, Perez‐Gutierrez A, Jayant K, DiSabato D, Charlton M, Fung J. Preservation solutions for static cold storage in donation after circulatory death and donation after brain death liver transplantation in the United States. Liver Transpl 2022; 28:1454-1462. [PMID: 35313073 PMCID: PMC9544683 DOI: 10.1002/lt.26457] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/25/2022] [Accepted: 03/15/2022] [Indexed: 01/13/2023]
Abstract
Static cold preservation remains the cornerstone for storing donor livers following procurement; however, the choice between University of Wisconsin solution (UW) and histidine-tryptophan-ketoglutarate solution (HTK) remains controversial. Recent International Liver Transplantation Society (ILTS) guidelines have recommended avoiding HTK for donation after circulatory death (DCD) grafts based on older reports. We studied the latest US adult graft outcomes in three recent eras (2006-2010, 2011-2015, 2016-2020) comparing HTK and UW among 5956 DCD LTs: 3873 (65.0%) used UW and 1944 (32.7%) used HTK. In a total of 82,679 donation after brain death (DBD) liver transplantations (LTs), 63,511 (76.8%) used UW and 15,855 (19.2%) used HTK. The HTK group had higher 1-year and 5-year graft survival rates of 89.7% and 74.3%, respectively, compared with 85.9% and 70.8% in the UW group in the 2016-2020 era (p = 0.005). This difference remained when adjusted for important potential confounders (hazard ratio, 0.78; 95% confidence interval: 0.60, 0.99). There were no differences between groups among DCD LTs in the earlier eras or among DBD LTs in all eras (all p values > 0.05). The latest US data suggest that HTK is at least noninferior to UW for preserving DCD livers. These data support HTK use in DCD LT and contradict ILTS guidance.
Collapse
Affiliation(s)
- Thomas G. Cotter
- Division of Digestive and Liver DiseasesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Matthew A. Odenwald
- Divison of Gastroenterology and HepatologyThe University of Chicago MedicineChicagoIllinoisUSA
| | - Angelica Perez‐Gutierrez
- Department of SurgerySection of Transplant SurgeryThe University of Chicago MedicineChicagoIllinoisUSA
| | - Kumar Jayant
- Department of SurgerySection of Transplant SurgeryThe University of Chicago MedicineChicagoIllinoisUSA
| | - Diego DiSabato
- Department of SurgerySection of Transplant SurgeryThe University of Chicago MedicineChicagoIllinoisUSA
| | - Michael Charlton
- Divison of Gastroenterology and HepatologyThe University of Chicago MedicineChicagoIllinoisUSA
| | - John Fung
- Department of SurgerySection of Transplant SurgeryThe University of Chicago MedicineChicagoIllinoisUSA
| |
Collapse
|
14
|
Jamil OK, Sandikçi B, Faust N, Cotter TG, Paul S, di Sabato D, Fung J, Charlton M. Relatively Poor Long-term Outcomes Following Liver Transplantation for NASH in the United States. Transplantation 2022; 106:2006-2018. [PMID: 35765128 DOI: 10.1097/tp.0000000000004208] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nonalcoholic steatohepatitis (NASH) continues to increase in frequency as an indication for liver transplantation (LT). Data on long-term outcomes for these patients are limited. We aimed to compare long-term patient and graft survival in patients undergoing LT for NASH in the United States to other indications. METHODS We analyzed data from the Scientific Registry of Transplant Recipients of adult patients who underwent primary deceased-donor LT from January 1, 2005, to December 31, 2019. RESULTS NASH has increased as an indication for LT by 4.5-fold, from 5.2% in 2005 to 23.4% in 2019. Patient (61.2%) and graft survival (59.2%) at 10 y are significantly poorer for NASH than for all other indications other than alcohol. Patients transplanted for NASH have higher body mass index (32.2 versus 27.6) and greater frequency of diabetes (13% versus 11.6%) than any other indication (P < 0.001). Portal vein thrombosis, location in intensive care unit, dialysis, and pre-LT diabetes (P < 0.001 for all) are independently predictive of patient death and graft loss. Body mass index is not predictive. NASH patients undergoing simultaneous liver kidney have markedly worse 10-y patient and graft survival than liver-only (52.3% versus 62.1%). Graft loss was attributed to recurrence of NASH in <1% of patients. CONCLUSIONS LT for NASH is associated with relatively poor long-term patient and graft survival when compared with patients transplanted for other indications, NASH patients undergoing simultaneous liver kidney have the worst long-term outcomes.
Collapse
Affiliation(s)
- Omar K Jamil
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago, Chicago, IL
| | - Burhaneddin Sandikçi
- Department of Industrial Engineering, Istanbul Technical University, Istanbul, Turkey
| | - Nolan Faust
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, IL
| | - Thomas G Cotter
- Division of Digestive and Liver Disease, Department of Internal Medicine, UT Southwestern, Dallas, TX
| | - Sonali Paul
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago, Chicago, IL
| | - Diego di Sabato
- Section of Abdominal Organ Transplantation, Department of Surgery, The University of Chicago Medicine, Chicago, IL
| | - John Fung
- Section of Abdominal Organ Transplantation, Department of Surgery, The University of Chicago Medicine, Chicago, IL
| | - Michael Charlton
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago, Chicago, IL
| |
Collapse
|
15
|
Hermanson JB, Fei N, Miyoshi S, Miyoshi J, Hawkins M, Xie B, Sulakhe D, Hart J, Chang EB, Leone VA, Charlton M. Dietary Cholesterol‐Induced Gut Microbes Drive Nonalcoholic Fatty Liver Disease Pathogenesis in a Murine Model. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.0r748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Na Fei
- Department of MedicineUniversity of ChicagoChicagoIL
| | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Brunt EM, Clouston AD, Goodman Z, Guy C, Kleiner DE, Lackner C, Tiniakos DG, Wee A, Yeh M, Leow WQ, Chng E, Ren Y, Boon Bee GG, Powell EE, Rinella M, Sanyal AJ, Neuschwander-Tetri B, Younossi Z, Charlton M, Ratziu V, Harrison SA, Tai D, Anstee QM. Complexity of ballooned hepatocyte feature recognition: Defining a training atlas for artificial intelligence-based imaging in NAFLD. J Hepatol 2022; 76:1030-1041. [PMID: 35090960 PMCID: PMC10544770 DOI: 10.1016/j.jhep.2022.01.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/21/2021] [Accepted: 01/07/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Histologically assessed hepatocyte ballooning is a key feature discriminating non-alcoholic steatohepatitis (NASH) from steatosis (NAFL). Reliable identification underpins patient inclusion in clinical trials and serves as a key regulatory-approved surrogate endpoint for drug efficacy. High inter/intra-observer variation in ballooning measured using the NASH CRN semi-quantitative score has been reported yet no actionable solutions have been proposed. METHODS A focused evaluation of hepatocyte ballooning recognition was conducted. Digitized slides were evaluated by 9 internationally recognized expert liver pathologists on 2 separate occasions: each pathologist independently marked every ballooned hepatocyte and later provided an overall non-NASH NAFL/NASH assessment. Interobserver variation was assessed and a 'concordance atlas' of ballooned hepatocytes generated to train second harmonic generation/two-photon excitation fluorescence imaging-based artificial intelligence (AI). RESULTS The Fleiss kappa statistic for overall interobserver agreement for presence/absence of ballooning was 0.197 (95% CI 0.094-0.300), rising to 0.362 (0.258-0.465) with a ≥5-cell threshold. However, the intraclass correlation coefficient for consistency was higher (0.718 [0.511-0.900]), indicating 'moderate' agreement on ballooning burden. 133 ballooned cells were identified using a ≥5/9 majority to train AI ballooning detection (AI-pathologist pairwise concordance 19-42%, comparable to inter-pathologist pairwise concordance of between 8-75%). AI quantified change in ballooned cell burden in response to therapy in a separate slide set. CONCLUSIONS The substantial divergence in hepatocyte ballooning identified amongst expert hepatopathologists suggests that ballooning is a spectrum, too subjective for its presence or complete absence to be unequivocally determined as a trial endpoint. A concordance atlas may be used to train AI assistive technologies to reproducibly quantify ballooned hepatocytes that standardize assessment of therapeutic efficacy. This atlas serves as a reference standard for ongoing work to refine how ballooning is classified by both pathologists and AI. LAY SUMMARY For the first time, we show that, even amongst expert hepatopathologists, there is poor agreement regarding the number of ballooned hepatocytes seen on the same digitized histology images. This has important implications as the presence of ballooning is needed to establish the diagnosis of non-alcoholic steatohepatitis (NASH), and its unequivocal absence is one of the key requirements to show 'NASH resolution' to support drug efficacy in clinical trials. Artificial intelligence-based approaches may provide a more reliable way to assess the range of injury recorded as "hepatocyte ballooning".
Collapse
Affiliation(s)
- Elizabeth M Brunt
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri, USA.
| | - Andrew D Clouston
- Molecular and Cellular Pathology, University of Queensland and Envoi Specialist Pathologists, Brisbane, Australia
| | - Zachary Goodman
- Pathology Department, and Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Cynthia Guy
- Division of Pathology, Duke University Medical Center, Durham, NC, USA
| | - David E Kleiner
- Laboratory of Pathology; Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Carolin Lackner
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Dina G Tiniakos
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Dept of Pathology, Aretaieion Hospital, National and Kapodistrian University of Athens, Greece
| | - Aileen Wee
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, National University Hospital, Singapore
| | - Matthew Yeh
- Department of Pathology, University of Washington, Seattle, Washington, USA
| | - Wei Qiang Leow
- Department of Anatomical Pathology, Singapore General Hospital, Singapore & Duke-NUS Medical School, Singapore
| | | | | | - George Goh Boon Bee
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Elizabeth E Powell
- Centre for Liver Disease Research, Faculty of Medicine, University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia; Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Mary Rinella
- Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Arun J Sanyal
- Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Zobair Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
| | - Michael Charlton
- Center for Liver Diseases, and Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - Vlad Ratziu
- Department of Hepatology, Sorbonne University and Pitié-Salpêtrière Hospital, Paris, France
| | - Stephen A Harrison
- Pinnacle Clinical Research, San Antonio, USA; Hepatology, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Dean Tai
- Department of Anatomical Pathology, Singapore General Hospital, Singapore & Duke-NUS Medical School, Singapore.
| | - Quentin M Anstee
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
| |
Collapse
|
17
|
Amin NB, Darekar A, Anstee QM, Wong VWS, Tacke F, Vourvahis M, Lee DS, Charlton M, Alkhouri N, Nakajima A, Yunis C. Efficacy and safety of an orally administered DGAT2 inhibitor alone or coadministered with a liver-targeted ACC inhibitor in adults with non-alcoholic steatohepatitis (NASH): rationale and design of the phase II, dose-ranging, dose-finding, randomised, placebo-controlled MIRNA (Metabolic Interventions to Resolve NASH with fibrosis) study. BMJ Open 2022; 12:e056159. [PMID: 35354614 PMCID: PMC8968568 DOI: 10.1136/bmjopen-2021-056159] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Small molecule inhibitors of the terminal step in intrahepatic triglyceride synthesis (diacylglycerol acyltransferase 2 inhibitor (DGAT2i, PF-06865571, ervogastat)) and upstream blockade of de novo lipogenesis via acetyl-coenzyme A carboxylase inhibitor (ACCi, PF-05221304, clesacostat) showed promise in reducing hepatic steatosis in early clinical trials. This study assesses efficacy and safety of these metabolic interventions to resolve non-alcoholic steatohepatitis (NASH) with fibrosis. METHODS AND ANALYSIS This phase II, randomised, dose-ranging, dose-finding study evaluates DGAT2i 25-300 mg two times per day (BID) or 150-300 mg once a day, DGAT2i 150-300 mg BID+ACCi 5-10 mg BID coadministration or matching placebo in a planned 450 adults with biopsy-confirmed NASH and liver fibrosis stages 2-3 from approximately 220 sites in 11 countries across North America, Europe and Asia. A triage approach including double-confirmation via non-invasive markers is included prior to screening/baseline liver biopsy. On confirmation of histological diagnosis, participants enter a ≥6-week run-in period, then a 48-week double-blind, double-dummy dosing period. The primary endpoint is the proportion of participants achieving histological NASH resolution without worsening fibrosis, ≥1 stage improvement in fibrosis without worsening NASH, or both, assessed by central pathologists. Other endpoints include assessment of hepatic steatosis (imaging substudy), overall safety and tolerability, and evaluation of blood-based biomarkers and quantitative ultrasound parameters over time. ETHICS AND DISSEMINATION Metabolic Interventions to Resolve NASH with fibrosis (MIRNA) is conducted in accordance with the Declaration of Helsinki and Council for International Organisations of Medical Sciences (CIOMS) International Ethical Guidelines, International Council on Harmonisation Good Clinical Practice guidelines, applicable laws and regulations, including privacy laws. Local independent review board/ethics committees (IRB/ECs) review/approve the protocol, any amendments, informed consent and other forms. Participants provide written informed consent. Details of all IRB/ECs, as well as results, will be published in a peer-reviewed journal and publicly disclosed through ClinicalTrials.gov, EudraCT, and/or www.pfizer.com and other public registries as per applicable local laws/regulations. TRIAL REGISTRATION NUMBER NCT04321031.
Collapse
Affiliation(s)
- Neeta B Amin
- Pfizer Global Product Development, Cambridge, Massachusetts, USA
| | | | - Quentin M Anstee
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Frank Tacke
- Charité-Universitätsmedizin Berlin, Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | | | - Douglas S Lee
- Pfizer Global Product Development, Groton, Connecticut, USA
| | - Michael Charlton
- Transplant Institute, Center for Liver Diseases, University of Chicago Biological Sciences, Chicago, Illinois, USA
| | | | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Carla Yunis
- Pfizer Global Product Development, New York, New York, USA
| |
Collapse
|
18
|
Cotter TG, Charlton M. The Authors' Reply: Geographic Variation in the Utilization of HCV-viremic Donors Into HCV-negative Recipients. Transplantation 2022; 106:e166. [PMID: 35100228 DOI: 10.1097/tp.0000000000003939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Thomas G Cotter
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael Charlton
- The Center for Liver Diseases, University of Chicago Medicine, Chicago, IL
| |
Collapse
|
19
|
Mikolajczyk AE, Zilberstein N, McConville JF, Pan A, Aronsohn AI, Te HS, Reddy G, Paul S, Pillai A, Charlton M, Farnan JM. Mandatory Hepatology Education for Internal Medicine Residents: Long-Term Effects and Implications for Workforce Needs. Hepatol Commun 2021; 5:1953-1963. [PMID: 34558840 PMCID: PMC8557317 DOI: 10.1002/hep4.1792] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/23/2021] [Accepted: 06/27/2021] [Indexed: 11/08/2022] Open
Abstract
We previously created a mandatory, inpatient, hepatology resident curriculum that immediately improved comfort, knowledge, and career interest in chronic liver disease (CLD). The durability of these effects needs to be known to use this intervention to address the hepatologist shortage. Thus, we aimed to assess this curriculum's long-term outcomes on internal medicine (IM) residents' CLD comfort, knowledge, and career interest. From 2015 to 2019 at a single institution, one IM resident was always assigned to the rotation. Similar anonymous assessments were administered to incoming postgraduate year (PGY)-1 residents and graduating PGY-3 residents, including a historic control cohort that graduated in June 2015. At residency completion, the intervention cohort (n = 61) had significantly higher comfort (1, not at all comfortable/strongly disagree; 5, very comfortable/strongly agree) with both hepatology (e.g., hepatitis C, 2.5 vs. 3.3, P < 0.001) and common IM topics (e.g., heart failure, 3.6 vs. 4.8, P < 0.001) but not specialty topics lacking curricula (e.g., inflammatory bowel disease, 2.8 vs. 2.7, P = 0.54). Compared to the historic cohort (n = 27), the intervention cohort was more comfortable in several CLD topics (e.g., cirrhosis, 3.2 vs. 3.8; P = 0.005) and answered more questions correctly (65% vs. 55%; P = 0.04), but career interest was unchanged (1.9 vs. 1.8; P = 0.45). Many residents (33%) would consider a hepatology career if training were separated from gastroenterology. Conclusion: With the completion of a mandatory hepatology curriculum, residents' CLD comfort and knowledge durably improved and exceeded that of historic counterparts. Initial career interest was not sustained, perhaps due to prerequisite gastroenterology training. These findings suggest IM educational initiatives may better address hepatology workforce needs by generating comanagers than by recruiting trainees.
Collapse
Affiliation(s)
| | | | | | - Alex Pan
- Department of MedicineUniversity of Illinois at ChicagoChicagoILUSA
| | | | - Helen S Te
- Deparment of MedicineUniversity of Chicago MedicineChicagoILUSA
| | - Gautham Reddy
- Deparment of MedicineUniversity of Chicago MedicineChicagoILUSA
| | - Sonali Paul
- Deparment of MedicineUniversity of Chicago MedicineChicagoILUSA
| | - Anjana Pillai
- Deparment of MedicineUniversity of Chicago MedicineChicagoILUSA
| | | | - Jeanne M Farnan
- Deparment of MedicineUniversity of Chicago MedicineChicagoILUSA
| |
Collapse
|
20
|
Baker CJ, Bertsche W, Capra A, Cesar CL, Charlton M, Mathad AC, Eriksson S, Evans A, Evetts N, Fabbri S, Fajans J, Friesen T, Fujiwara MC, Grandemange P, Granum P, Hangst JS, Hayden ME, Hodgkinson D, Isaac CA, Johnson MA, Jones JM, Jones SA, Jonsell S, Kurchaninov L, Madsen N, Maxwell D, McKenna JTK, Menary S, Momose T, Mullan P, Olchanski K, Olin A, Peszka J, Powell A, Pusa P, Rasmussen CØ, Robicheaux F, Sacramento RL, Sameed M, Sarid E, Silveira DM, Stutter G, So C, Tharp TD, Thompson RI, van der Werf DP, Wurtele JS. Sympathetic cooling of positrons to cryogenic temperatures for antihydrogen production. Nat Commun 2021; 12:6139. [PMID: 34686658 PMCID: PMC8536749 DOI: 10.1038/s41467-021-26086-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 09/13/2021] [Indexed: 11/25/2022] Open
Abstract
The positron, the antiparticle of the electron, predicted by Dirac in 1931 and discovered by Anderson in 1933, plays a key role in many scientific and everyday endeavours. Notably, the positron is a constituent of antihydrogen, the only long-lived neutral antimatter bound state that can currently be synthesized at low energy, presenting a prominent system for testing fundamental symmetries with high precision. Here, we report on the use of laser cooled Be+ ions to sympathetically cool a large and dense plasma of positrons to directly measured temperatures below 7 K in a Penning trap for antihydrogen synthesis. This will likely herald a significant increase in the amount of antihydrogen available for experimentation, thus facilitating further improvements in studies of fundamental symmetries.
Collapse
Affiliation(s)
- C J Baker
- Department of Physics, College of Science, Swansea University, Swansea, SA2 8PP, UK
| | - W Bertsche
- School of Physics and Astronomy, University of Manchester, Manchester, M12 9PL, UK
- Cockcroft Institute, Sci-Tech Daresbury, Warrington, WA4 4AD, UK
| | - A Capra
- TRIUMF, 4004 Wesbrook Mall, Vancouver, BC, V6T 2A3, Canada
| | - C L Cesar
- Instituto de Fisica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, 21941-972, Brazil
| | - M Charlton
- Department of Physics, College of Science, Swansea University, Swansea, SA2 8PP, UK
| | - A Cridland Mathad
- Department of Physics, College of Science, Swansea University, Swansea, SA2 8PP, UK
| | - S Eriksson
- Department of Physics, College of Science, Swansea University, Swansea, SA2 8PP, UK
| | - A Evans
- Department of Physics and Astronomy, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - N Evetts
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, V6T 1Z1, Canada
| | - S Fabbri
- School of Physics and Astronomy, University of Manchester, Manchester, M12 9PL, UK
| | - J Fajans
- Department of Physics, University of California at Berkeley, Berkeley, CA, 94720-7300, USA
| | - T Friesen
- Department of Physics and Astronomy, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - M C Fujiwara
- TRIUMF, 4004 Wesbrook Mall, Vancouver, BC, V6T 2A3, Canada
| | - P Grandemange
- TRIUMF, 4004 Wesbrook Mall, Vancouver, BC, V6T 2A3, Canada
| | - P Granum
- Department of Physics and Astronomy, Aarhus University, DK-8000, Aarhus C, Denmark
| | - J S Hangst
- Department of Physics and Astronomy, Aarhus University, DK-8000, Aarhus C, Denmark
| | - M E Hayden
- Department of Physics, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - D Hodgkinson
- School of Physics and Astronomy, University of Manchester, Manchester, M12 9PL, UK
| | - C A Isaac
- Department of Physics, College of Science, Swansea University, Swansea, SA2 8PP, UK
| | - M A Johnson
- School of Physics and Astronomy, University of Manchester, Manchester, M12 9PL, UK
| | - J M Jones
- Department of Physics, College of Science, Swansea University, Swansea, SA2 8PP, UK
| | - S A Jones
- Department of Physics and Astronomy, Aarhus University, DK-8000, Aarhus C, Denmark
| | - S Jonsell
- Department of Physics, Stockholm University, SE-10691, Stockholm, Sweden
| | - L Kurchaninov
- TRIUMF, 4004 Wesbrook Mall, Vancouver, BC, V6T 2A3, Canada
| | - N Madsen
- Department of Physics, College of Science, Swansea University, Swansea, SA2 8PP, UK.
| | - D Maxwell
- Department of Physics, College of Science, Swansea University, Swansea, SA2 8PP, UK.
| | - J T K McKenna
- Department of Physics and Astronomy, Aarhus University, DK-8000, Aarhus C, Denmark
| | - S Menary
- Department of Physics and Astronomy, York University, Toronto, ON, M3J 1P3, Canada
| | - T Momose
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, V6T 1Z1, Canada
| | - P Mullan
- Department of Physics, College of Science, Swansea University, Swansea, SA2 8PP, UK
| | - K Olchanski
- TRIUMF, 4004 Wesbrook Mall, Vancouver, BC, V6T 2A3, Canada
| | - A Olin
- TRIUMF, 4004 Wesbrook Mall, Vancouver, BC, V6T 2A3, Canada
| | - J Peszka
- Department of Physics, College of Science, Swansea University, Swansea, SA2 8PP, UK
| | - A Powell
- Department of Physics and Astronomy, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - P Pusa
- Department of Physics, University of Liverpool, Liverpool, L69 7ZE, UK
| | - C Ø Rasmussen
- Experimental Physics Department, CERN, Geneva, 1211, Switzerland
| | - F Robicheaux
- Department of Physics and Astronomy, Purdue University, West Lafayette, IN, 47907, USA
| | - R L Sacramento
- Instituto de Fisica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, 21941-972, Brazil
| | - M Sameed
- School of Physics and Astronomy, University of Manchester, Manchester, M12 9PL, UK
| | - E Sarid
- Soreq NRC, 81800, Yavne, Israel
- Department of Physics, Ben Gurion University, 8410501, Beer Sheva, Israel
| | - D M Silveira
- Instituto de Fisica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, 21941-972, Brazil
| | - G Stutter
- Department of Physics and Astronomy, Aarhus University, DK-8000, Aarhus C, Denmark
| | - C So
- Department of Physics and Astronomy, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - T D Tharp
- Physics Department, Marquette University, P.O. Box 1881, Milwaukee, WI, 53201-1881, USA
| | - R I Thompson
- Department of Physics and Astronomy, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - D P van der Werf
- Department of Physics, College of Science, Swansea University, Swansea, SA2 8PP, UK
| | - J S Wurtele
- Department of Physics, University of California at Berkeley, Berkeley, CA, 94720-7300, USA
| |
Collapse
|
21
|
Kawaguchi T, Charlton M, Kawaguchi A, Yamamura S, Nakano D, Tsutsumi T, Zafer M, Torimura T. Effects of Mediterranean Diet in Patients with Nonalcoholic Fatty Liver Disease: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis of Randomized Controlled Trials. Semin Liver Dis 2021; 41:225-234. [PMID: 34147036 DOI: 10.1055/s-0041-1723751] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We conducted a meta-analysis to investigate the effects of the Mediterranean Diet (Med-Diet) on hepatic steatosis and insulin resistance in patients with nonalcoholic fatty liver disease (NAFLD). Six randomized controlled trials were selected for the meta-analysis (sample size: 250 participants). In the meta-analysis, there was no significant difference in body mass index and waist circumference between the Med-Diet and control groups. Med-Diet significantly reduced fatty liver index (FLI) compared with the control diet (standard mean difference [SMD]: -1.06; 95% CI: -1.95 to -0.17; p = 0.02). Med-Diet significantly reduced homeostasis model assessment of insulin resistance (HOMA-IR) compared with the control diet (SMD: -0.34; 95% CI: -0.65 to -0.03; p = 0.03). Similarly, a meta-regression analysis using age showed that Med-Diet significantly reduced FLI and HOMA-IR (95% CI: -0.956 to -0.237, p = 0.001 and 95% CI: -0.713 to -0.003, p = 0.048, respectively). This meta-analysis demonstrated that Med-Diet improved hepatic steatosis and insulin resistance in patients with NAFLD. Thus, Med-Diet is a beneficial pharmaconutritional therapy in patients with NAFLD.
Collapse
Affiliation(s)
- Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Michael Charlton
- Department of Medicine, Center for Liver Diseases, University of Chicago Medicine, Chicago, Illinois
| | - Atsushi Kawaguchi
- Section of Clinical Cooperation System, Center for Comprehensive Community Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Sakura Yamamura
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Dan Nakano
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Tsubasa Tsutsumi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Maryam Zafer
- Department of Medicine, Center for Liver Diseases, University of Chicago Medicine, Chicago, Illinois
| | - Takuji Torimura
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| |
Collapse
|
22
|
Cotter TG, Minhem M, Wang J, Peeraphatdit T, Ayoub F, Pillai A, Hernandez-Alejandro R, di Sabato D, Charlton M. Living Donor Liver Transplantation in the United States: Evolution of Frequency, Outcomes, Center Volumes, and Factors Associated With Outcomes. Liver Transpl 2021; 27:1019-1031. [PMID: 33619854 PMCID: PMC9257956 DOI: 10.1002/lt.26029] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/31/2021] [Accepted: 02/17/2021] [Indexed: 12/13/2022]
Abstract
Recent modifications in organ allocation policies and increases in chronic liver diseases may have resulted in important changes in living donor liver transplantation (LDLT) in the United States. We examined the trends, outcomes, and factors associated with outcomes in adult LDLT. United Network for Organ Sharing data on 2566 adult LDLT recipients who received transplants from January 1, 2010, through December 31, 2019, were analyzed. LDLT graft and patient survival rates were compared with propensity score-matched deceased donor liver transplantation recipients by the Kaplan-Meier curve estimator. The association between preceding LDLT frequency and subsequent outcomes were assessed by Cox proportional hazards mixed effects modeling. After a stable annual frequency of LDLTs from 2010 to 2014 (~200 per year), the number of LDLTs doubled to 440 in 2019. The 1-year and 5-year graft survival rates for LDLT recipients were 88.4% and 78.1%, respectively, compared with 92.5% and 80.7% in the propensity score-matched donation after brain death recipients (P = 0.005), respectively. Older donor age and recipient diabetes mellitus and life support requirement were significantly associated with graft failure among LDLT recipients (P values <0.05). Average preceding LDLT frequencies of <3 per year, 3 to 20 per year, and >20 per year resulted in 1-year graft survival rates of 82%, 88% to 89%, and 93%, respectively (P values <0.05). There were 3 living donor deaths (0.12%). The frequency of LDLTs has doubled during the past decade, with good outcomes and acceptable donor safety profiles. However, there appear to be varying threshold transplant frequencies (volume/unit time) associated with acceptable (88%-89%) and aspirational (93%) 1-year graft survival rates. These data should be reassuring and encourage LDLT practice as efforts continue to expand the donor pool.
Collapse
Affiliation(s)
- Thomas G. Cotter
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, IL, USA
| | - Mohamad Minhem
- Department of Medicine, Loyola University Medical Center at Trinity Mercy Chicago, Chicago, IL, USA
| | - Jennifer Wang
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, IL, USA
| | | | - Fares Ayoub
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, IL, USA
| | - Anjana Pillai
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, IL, USA
| | | | - Diego di Sabato
- Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Michael Charlton
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, IL, USA
| |
Collapse
|
23
|
Cotter TG, Aronsohn A, Reddy KG, Charlton M. Liver Transplantation of HCV-viremic Donors Into HCV-negative Recipients in the United States: Increasing Frequency With Profound Geographic Variation. Transplantation 2021; 105:1285-1290. [PMID: 32639400 PMCID: PMC9206877 DOI: 10.1097/tp.0000000000003382] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Direct-acting antiviral therapy made possible the novel practice of utilizing hepatitis C virus (HCV)-viremic (HCV RNA-positive) donors into HCV-negative recipients in the United States. Although initial reports of outcomes have been satisfactory, higher-quality longer-term outcomes remain to be elucidated. METHODS National data were examined from the Organ Procurement and Transplantation Network on adult patients in the United States who underwent a primary, single organ, deceased donor liver transplant from January 1, 2016 to March 31, 2020. Outcomes of HCV-negative recipients (R-) who received an allograft from donors who were HCV RNA-positive (D HCV+) donors were compared with HCV RNA-negative (D HCV-) donors. RESULTS There has been a 35-fold increase in D HCV+/R- liver transplants over the past 4 y in the United States, from 8 in 2016 to 280 in 2019. There was an almost 6-fold difference in this practice among UNOS geographic regions. Graft survival following D HCV+/R- liver transplantation was excellent, with 1-y rates being 91% and 90% and 2-y rates being 88.5% and 87% for D HCV+/R- and D HCV-/R-, respectively (P = 0.672). In multivariate analysis, adjusting for other donor and recipient attributes, D HCV+/R- was not associated with patient or graft survival. CONCLUSIONS The practice of D HCV+/R- continues to increase without discernible impact on medium-term outcomes. Notable geographic variation exists, suggesting inconsistent perceptions about the impact of D HCV+/R- transplantation on outcomes. These results strengthen the perceived safety in utilizing HCV-viremic donor organs as a donor pool expansion strategy, not only in the United States, but also worldwide.
Collapse
Affiliation(s)
- Thomas G Cotter
- Center for Liver Diseases, Section of Gastroenterology & Hepatology, Department of Medicine, The University of Chicago Medicine, Chicago, IL
| | | | | | | |
Collapse
|
24
|
Cotter TG, Wang J, Peeraphatdit T, Sandıkçı B, Ayoub F, Kim G, Te H, Jeevanandam V, Sabato D, Charlton M. Simultaneous Heart-Liver Transplantation for Congenital Heart Disease in the United States: Rapidly Increasing With Acceptable Outcomes. Hepatology 2021; 73:1464-1477. [PMID: 32559317 DOI: 10.1002/hep.31426] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/14/2020] [Accepted: 06/02/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS There are more adults than children living with congenital heart disease (CHD) in the United States, with a growing proportion requiring heart-liver transplantation (HLT). Our aim was to ascertain the frequency, outcomes, and prognostic factors in this patient population. APPROACH AND RESULTS United Network for Organ Sharing data on adult patients who underwent heart transplantation (HT) from 2009 through March 2020 were analyzed. The primary study outcome was patient survival. Cox proportional-hazards modeling assessed for mortality associations. There were 1,084 HT recipients: 817 (75.4%) CHD HTs only, 74 (6.8%) CHD HLTs, 179 (16.5%) non-CHD HLTs, and 14 (1.3%) heart-liver-kidney transplants. The number of CHD HLTs increased from a prior rate of 4/year to 21/year in 2019. Among patients with CHD, the 5-year survival rates were 74.1% and 73.6% in HTs only and HLTs, respectively (P = 0.865). There was a higher rate of allograft failure attributable to rejection in CHD HTs only compared with CHD HLTs (3.2% versus 0.4%; P = 0.014). Only 25 out of 115 HT-performing hospitals undertook CHD HLTs. Higher-volume centers (averaging one CHD HLT per year) had a 5-year patient survival rate of 83.0% compared with 61.3% in lower-volume centers (P = 0.079). Among HLT recipients, total bilirubin (hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.01-1.12) and diabetes (HR = 2.97, 95% CI = 1.21-7.31) were independently associated with increased mortality risk, whereas CHD and age were not. CONCLUSIONS The rate of HLT for adult CHD in the United States is rising dramatically. The survival outcomes between CHD HT only and CHD HLT groups are comparable; however, the HLT group had lower rates of acute rejection. Among HLT recipients, diabetes and elevated bilirubin are associated with increased posttransplant mortality risk. An average of one CHD HLT per year could be considered a minimum quality metric at transplant centers.
Collapse
Affiliation(s)
- Thomas G Cotter
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, IL
| | - Jennifer Wang
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, IL
| | | | | | - Fares Ayoub
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, IL
| | - Gene Kim
- Division of Cardiology, The University of Chicago Medicine, Chicago, IL
| | - Helen Te
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, IL
| | | | - Diego Sabato
- Department of Surgery, The University of Chicago Medicine, Chicago, IL
| | - Michael Charlton
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, IL
| |
Collapse
|
25
|
Baker CJ, Bertsche W, Capra A, Carruth C, Cesar CL, Charlton M, Christensen A, Collister R, Mathad AC, Eriksson S, Evans A, Evetts N, Fajans J, Friesen T, Fujiwara MC, Gill DR, Grandemange P, Granum P, Hangst JS, Hardy WN, Hayden ME, Hodgkinson D, Hunter E, Isaac CA, Johnson MA, Jones JM, Jones SA, Jonsell S, Khramov A, Knapp P, Kurchaninov L, Madsen N, Maxwell D, McKenna JTK, Menary S, Michan JM, Momose T, Mullan PS, Munich JJ, Olchanski K, Olin A, Peszka J, Powell A, Pusa P, Rasmussen CØ, Robicheaux F, Sacramento RL, Sameed M, Sarid E, Silveira DM, Starko DM, So C, Stutter G, Tharp TD, Thibeault A, Thompson RI, van der Werf DP, Wurtele JS. Laser cooling of antihydrogen atoms. Nature 2021; 592:35-42. [PMID: 33790445 PMCID: PMC8012212 DOI: 10.1038/s41586-021-03289-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/26/2021] [Indexed: 11/08/2022]
Abstract
The photon-the quantum excitation of the electromagnetic field-is massless but carries momentum. A photon can therefore exert a force on an object upon collision1. Slowing the translational motion of atoms and ions by application of such a force2,3, known as laser cooling, was first demonstrated 40 years ago4,5. It revolutionized atomic physics over the following decades6-8, and it is now a workhorse in many fields, including studies on quantum degenerate gases, quantum information, atomic clocks and tests of fundamental physics. However, this technique has not yet been applied to antimatter. Here we demonstrate laser cooling of antihydrogen9, the antimatter atom consisting of an antiproton and a positron. By exciting the 1S-2P transition in antihydrogen with pulsed, narrow-linewidth, Lyman-α laser radiation10,11, we Doppler-cool a sample of magnetically trapped antihydrogen. Although we apply laser cooling in only one dimension, the trap couples the longitudinal and transverse motions of the anti-atoms, leading to cooling in all three dimensions. We observe a reduction in the median transverse energy by more than an order of magnitude-with a substantial fraction of the anti-atoms attaining submicroelectronvolt transverse kinetic energies. We also report the observation of the laser-driven 1S-2S transition in samples of laser-cooled antihydrogen atoms. The observed spectral line is approximately four times narrower than that obtained without laser cooling. The demonstration of laser cooling and its immediate application has far-reaching implications for antimatter studies. A more localized, denser and colder sample of antihydrogen will drastically improve spectroscopic11-13 and gravitational14 studies of antihydrogen in ongoing experiments. Furthermore, the demonstrated ability to manipulate the motion of antimatter atoms by laser light will potentially provide ground-breaking opportunities for future experiments, such as anti-atomic fountains, anti-atom interferometry and the creation of antimatter molecules.
Collapse
Affiliation(s)
- C J Baker
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - W Bertsche
- School of Physics and Astronomy, University of Manchester, Manchester, UK
- Cockcroft Institute, Sci-Tech Daresbury, Warrington, UK
| | - A Capra
- TRIUMF, Vancouver, British Columbia, Canada
| | - C Carruth
- Department of Physics, University of California at Berkeley, Berkeley, CA, USA
| | - C L Cesar
- Instituto de Fisica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - M Charlton
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - A Christensen
- Department of Physics, University of California at Berkeley, Berkeley, CA, USA
| | | | - A Cridland Mathad
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - S Eriksson
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - A Evans
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | - N Evetts
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - J Fajans
- Department of Physics, University of California at Berkeley, Berkeley, CA, USA
| | - T Friesen
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | | | - D R Gill
- TRIUMF, Vancouver, British Columbia, Canada
| | - P Grandemange
- TRIUMF, Vancouver, British Columbia, Canada
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | - P Granum
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
| | - J S Hangst
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark.
| | - W N Hardy
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - M E Hayden
- Department of Physics, Simon Fraser University, Burnaby, British Columbia, Canada
| | - D Hodgkinson
- School of Physics and Astronomy, University of Manchester, Manchester, UK
| | - E Hunter
- Department of Physics, University of California at Berkeley, Berkeley, CA, USA
| | - C A Isaac
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - M A Johnson
- School of Physics and Astronomy, University of Manchester, Manchester, UK
- Cockcroft Institute, Sci-Tech Daresbury, Warrington, UK
| | - J M Jones
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - S A Jones
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
| | - S Jonsell
- Department of Physics, Stockholm University, Stockholm, Sweden
| | - A Khramov
- TRIUMF, Vancouver, British Columbia, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Physics, British Columbia Institute of Technology, Burnaby, British Columbia, Canada
| | - P Knapp
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | | | - N Madsen
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - D Maxwell
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - J T K McKenna
- TRIUMF, Vancouver, British Columbia, Canada
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
| | - S Menary
- Department of Physics and Astronomy, York University, Toronto, Ontario, Canada
| | - J M Michan
- TRIUMF, Vancouver, British Columbia, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - T Momose
- TRIUMF, Vancouver, British Columbia, Canada.
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.
- Department of Chemistry, University of British Columbia, Vancouver, British Columbia, Canada.
| | - P S Mullan
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - J J Munich
- Department of Physics, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - A Olin
- TRIUMF, Vancouver, British Columbia, Canada
- Department of Physics and Astronomy, University of Victoria, Victoria, British Columbia, Canada
| | - J Peszka
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - A Powell
- Department of Physics, College of Science, Swansea University, Swansea, UK
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | - P Pusa
- Department of Physics, University of Liverpool, Liverpool, UK
| | - C Ø Rasmussen
- Experimental Physics Department, CERN, Geneva, Switzerland
| | - F Robicheaux
- Department of Physics and Astronomy, Purdue University, West Lafayette, IN, USA
| | - R L Sacramento
- Instituto de Fisica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - M Sameed
- School of Physics and Astronomy, University of Manchester, Manchester, UK
| | - E Sarid
- Soreq NRC, Yavne, Israel
- Department of Physics, Ben Gurion University, Beer Sheva, Israel
| | - D M Silveira
- TRIUMF, Vancouver, British Columbia, Canada
- Instituto de Fisica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - D M Starko
- Department of Physics and Astronomy, York University, Toronto, Ontario, Canada
| | - C So
- TRIUMF, Vancouver, British Columbia, Canada
| | - G Stutter
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
| | - T D Tharp
- Physics Department, Marquette University, Milwaukee, WI, USA
| | - A Thibeault
- TRIUMF, Vancouver, British Columbia, Canada
- Faculté de Génie, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - R I Thompson
- TRIUMF, Vancouver, British Columbia, Canada
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | - D P van der Werf
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - J S Wurtele
- Department of Physics, University of California at Berkeley, Berkeley, CA, USA
| |
Collapse
|
26
|
Witkowski P, Philipson LH, Kaufman DB, Ratner LE, Abouljoud MS, Bellin MD, Buse JB, Kandeel F, Stock PG, Mulligan DC, Markmann JF, Kozlowski T, Andreoni KA, Alejandro R, Baidal DA, Hardy MA, Wickrema A, Mirmira RG, Fung J, Becker YT, Josephson MA, Bachul PJ, Pyda JS, Charlton M, Millis JM, Gaglia JL, Stratta RJ, Fridell JA, Niederhaus SV, Forbes RC, Jayant K, Robertson RP, Odorico JS, Levy MF, Harland RC, Abrams PL, Olaitan OK, Kandaswamy R, Wellen JR, Japour AJ, Desai CS, Naziruddin B, Balamurugan AN, Barth RN, Ricordi C. The demise of islet allotransplantation in the United States: A call for an urgent regulatory update. Am J Transplant 2021; 21:1365-1375. [PMID: 33251712 PMCID: PMC8016716 DOI: 10.1111/ajt.16397] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/14/2020] [Accepted: 11/02/2020] [Indexed: 02/06/2023]
Abstract
Islet allotransplantation in the United States (US) is facing an imminent demise. Despite nearly three decades of progress in the field, an archaic regulatory framework has stymied US clinical practice. Current regulations do not reflect the state-of-the-art in clinical or technical practices. In the US, islets are considered biologic drugs and "more than minimally manipulated" human cell and tissue products (HCT/Ps). In contrast, across the world, human islets are appropriately defined as "minimally manipulated tissue" and not regulated as a drug, which has led to islet allotransplantation (allo-ITx) becoming a standard-of-care procedure for selected patients with type 1 diabetes mellitus. This regulatory distinction impedes patient access to islets for transplantation in the US. As a result only 11 patients underwent allo-ITx in the US between 2016 and 2019, and all as investigational procedures in the settings of a clinical trials. Herein, we describe the current regulations pertaining to islet transplantation in the United States. We explore the progress which has been made in the field and demonstrate why the regulatory framework must be updated to both better reflect our current clinical practice and to deal with upcoming challenges. We propose specific updates to current regulations which are required for the renaissance of ethical, safe, effective, and affordable allo-ITx in the United States.
Collapse
Affiliation(s)
- Piotr Witkowski
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | | | - Dixon B. Kaufman
- Division of Transplantation, Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Lloyd E. Ratner
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Marwan S. Abouljoud
- Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Melena D. Bellin
- Schulze Diabetes Institute, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - John B. Buse
- Division of Endocrinology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Fouad Kandeel
- Department of Translational Research and Cellular Therapeutics, Diabetes and Metabolism Research Institute, Beckman Research Institute of City of Hope, Duarte, California, USA
| | - Peter G. Stock
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, California, USA
| | - David C. Mulligan
- Department of Surgery, Transplantation and Immunology, Yale University, New Haven, Connecticut, USA
| | - James F. Markmann
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tomasz Kozlowski
- Division of Transplantation, Department of Surgery, The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | - Kenneth A. Andreoni
- Department of Surgery, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Rodolfo Alejandro
- Diabetes Research Institute and Cell Transplant Center, University of Miami, Miami, Florida, USA
| | - David A. Baidal
- Diabetes Research Institute and Cell Transplant Center, University of Miami, Miami, Florida, USA
| | - Mark A. Hardy
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Amittha Wickrema
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, Illinois, USA
| | - Raghavendra G. Mirmira
- Department of Medicine, Translational Research Center, University of Chicago, Chicago, Illinois, USA
| | - John Fung
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - Yolanda T. Becker
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - Michelle A. Josephson
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - Piotr J. Bachul
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - Jordan S. Pyda
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Charlton
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - J. Michael Millis
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - Jason L. Gaglia
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert J. Stratta
- Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jonathan A. Fridell
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Silke V. Niederhaus
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Rachael C. Forbes
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kumar Jayant
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - R. Paul Robertson
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Jon S. Odorico
- Division of Transplantation, Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Marlon F. Levy
- Division of Transplantation, Hume-Lee Transplant Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | | | - Peter L. Abrams
- MedStar Georgetown Transplant Institute, Washington, District of Columbia, USA
| | | | - Raja Kandaswamy
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jason R. Wellen
- Department of Surgery, Washington University, St Louis, Missouri, USA
| | - Anthony J. Japour
- Anthony Japour and Associates, Medical and Scientific Consulting Inc, Miami, FL, USA
| | - Chirag S. Desai
- Department of Surgery, Section of Transplantation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bashoo Naziruddin
- Transplantation Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Appakalai N. Balamurugan
- Division of Pediatric General and Thoracic Surgery, Department of Surgery, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Rolf N. Barth
- Department of Surgery, Transplantation Institute, University of Chicago, Chicago, Illinois, USA
| | - Camillo Ricordi
- Diabetes Research Institute and Cell Transplant Center, University of Miami, Miami, Florida, USA
| | | |
Collapse
|
27
|
Cotter TG, Sandıkçı B, Paul S, Gampa A, Wang J, Te H, Pillai A, Reddy KG, di Sabato D, Little EC, Sundaram V, Fung J, Lucey MR, Charlton M. Liver transplantation for alcoholic hepatitis in the United States: Excellent outcomes with profound temporal and geographic variation in frequency. Am J Transplant 2021; 21:1039-1055. [PMID: 32531107 DOI: 10.1111/ajt.16143] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/28/2020] [Accepted: 06/06/2020] [Indexed: 01/25/2023]
Abstract
Medical-refractory severe alcoholic hepatitis (AH) has a high mortality. The national frequency, longer term outcomes and regional practices of AH liver transplantation (LT) in the United States are not well described, despite the increasing mortality from alcohol-associated liver disease. We analyzed the trends in frequency and outcomes of UNOS data on 39 455 adult patients who underwent LT from 2014 to 2019, including AH LT recipients. LTs for AH increased 5-fold, from 28 in 2014 to 138 in 2019, varying 8-fold between UNOS regions. Three transplant centers accounted for 50%-90% of AH LTs within each region. The number of transplant centers performing AH LTs increased from 14 in 2014 to 47 in 2019. AH patients were younger (mean = 39.4 years), had higher MELD scores (mean = 36.8), and were more often on dialysis (46.0%) and in ICU (38.4%), compared to other indications (all P < .05). One- and 5-year graft survivals for AH LT recipients were 91.7% and 81.9%, respectively. The frequency of AH LT is increasing rapidly, with excellent medium-term outcomes. An impact of AH recurrence on patient or graft survival is not apparent in this national analysis. There are marked geographic variations in practices, highlighting the lack of selection criteria standardization.
Collapse
Affiliation(s)
- Thomas G Cotter
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, Illinois
| | | | - Sonali Paul
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, Illinois
| | - Anuhya Gampa
- Division of Gastroenterology, NorthShore University Health System, University of Chicago, Evanston, Illinois
| | - Jennifer Wang
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, Illinois
| | - Helen Te
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, Illinois
| | - Anjana Pillai
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, Illinois
| | - Kapuluru G Reddy
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, Illinois
| | - Diego di Sabato
- Department of Surgery, Section of Abdominal Organ Transplantation, The University of Chicago Medicine, Chicago, Illinois
| | | | - Vinay Sundaram
- Division of Gastroenterology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - John Fung
- Department of Surgery, Section of Abdominal Organ Transplantation, The University of Chicago Medicine, Chicago, Illinois
| | - Michael R Lucey
- Division of Gastroenterology and Hepatology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Michael Charlton
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, Illinois
| |
Collapse
|
28
|
Weeks K, Lynch C, West M, Carnahan R, O’Rorke M, Oleson J, McDonald M, Stewart S, Charlton M. Rural Disparities in Surgery from Gynecologic Oncologists: Midwestern Ovarian. Ann Epidemiol 2020. [DOI: 10.1016/j.annepidem.2020.08.062] [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: 10/23/2022]
|
29
|
Generette GS, Bachul PJ, Golab K, Basto L, Pyda JS, Borek P, Tibudan M, Anteby R, Perea L, Charlton M, Perez-Gutierrez A, Jayant K, Lucander A, Matthews JB, Millis JM, Fung J, Witkowski P. En bloc liver and pancreas transplantation after total pancreatectomy with autologous islet transplantation. ACTA ACUST UNITED AC 2020; 3:11-17. [PMID: 33409500 PMCID: PMC7785098 DOI: 10.31373/ejtcm/130187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present a patient with intractable and debilitating pain secondary to chronic pancreatitis who was effectively treated with total pancreatectomy with islet autotransplantation (TPIAT). Islets engrafted into his liver significantly contributed to improved blood glucose control and quality of life. Subsequently, the patient developed alcohol related acute liver failure and en bloc liver and pancreas transplantation was performed to replace the failing liver with engrafted islets. Pancreas transplantation was required to resolve his life-threatening severe hypoglycemic episodes. Herein, we detail an innovative and multidisciplinary management of this complex medical problem.
Collapse
Affiliation(s)
| | - Piotr J Bachul
- The Transplantation Institute, University of Chicago, USA
| | - Karolina Golab
- The Transplantation Institute, University of Chicago, USA
| | - Lindsay Basto
- The Transplantation Institute, University of Chicago, USA
| | - Jordan S Pyda
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, USA
| | - Peter Borek
- The Transplantation Institute, University of Chicago, USA
| | - Martin Tibudan
- The Transplantation Institute, University of Chicago, USA
| | - Roi Anteby
- The Transplantation Institute, University of Chicago, USA
| | | | | | | | - Kumar Jayant
- The Transplantation Institute, University of Chicago, USA
| | - Aaron Lucander
- The Transplantation Institute, University of Chicago, USA
| | | | | | - John Fung
- The Transplantation Institute, University of Chicago, USA
| | | |
Collapse
|
30
|
Albhaisi S, Kim K, Baker J, Chidambaram N, Patel MV, Charlton M, Sanyal AJ. LPCN 1144 Resolves NAFLD in Hypogonadal Males. Hepatol Commun 2020; 4:1430-1440. [PMID: 33024914 PMCID: PMC7527694 DOI: 10.1002/hep4.1571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/11/2020] [Accepted: 06/14/2020] [Indexed: 12/14/2022] Open
Abstract
Hypogonadism affects hepatic lipid metabolism and is expected to promote nonalcoholic fatty liver disease (NAFLD). The aims of this study were to determine (1) the prevalence of NAFLD in hypogonadal males and (2) the impact of correction of hypogonadism by LPCN 1144 (Lipocine, Inc., Salt Lake City, UT), an oral testosterone prodrug, on NAFLD in this population. Data were derived from a multicenter open-label single-arm trial of LPCN 1144 for hypogonadal males, in which a subset (n = 36) had serial magnetic resonance imaging-proton density fat fraction measurements (National Clinical Trial 03868059). NAFLD prevalence, defined by magnetic resonance imaging-proton density fat fraction ≥5%, was 66%. Eighty-one percent of those with baseline liver fat (BL) ≥5% had improvement in liver fat content, and NAFLD resolved in 33% of subjects at 8 weeks (mean relative reduction: 45%) and 48% (mean relative reduction: 55%) after 16 weeks of LPCN 1144 therapy. The reduction in liver fat was greater in those with higher BL (BL ≥5%: 71%; BL ≥8%: 80%; and BL ≥10%: 75%). Normalization rate of alanine aminotransferase and gamma-glutamyltransferase greater than the upper limit of normal range were 100% and 50% of treated patients, respectively. LPCN 1144 was not associated with major adverse events. Conclusion: Treatment with LPCN 1144 (oral T prodrug) in hypogonadal males with NAFLD resolved NAFLD in approximately half of the affected patients without any safety signals. Further studies are needed to validate its use in hypogonadal males with nonalcoholic steatohepatitis.
Collapse
Affiliation(s)
- Somaya Albhaisi
- Department of Internal MedicineVirginia Commonwealth University School of MedicineRichmondVA
| | | | | | | | | | - Michael Charlton
- Center for Liver DiseasesThe University of Chicago MedicineChicagoIL
| | - Arun J. Sanyal
- Division of Gastroenterology, Hepatology and NutritionDepartment of Internal MedicineVirginia Commonwealth University School of MedicineRichmondVA
| |
Collapse
|
31
|
Mandalia R, Poimenidi E, Edwards J, Charlton M, Hanna-Jumma S, Howells P. Reducing patient harm following inadvertent endobronchial placecement of nasogastric tubes in patients with SARS-COV-2. J Cardiothorac Vasc Anesth 2020. [PMCID: PMC7598358 DOI: 10.1053/j.jvca.2020.09.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction Methods Results Discussion
Collapse
|
32
|
Charlton M. The Future of Treatment for Nonalcoholic Steatohepatitis. Gastroenterol Hepatol (N Y) 2020; 16:258-261. [PMID: 34035728 PMCID: PMC8132637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Michael Charlton
- Professor of Medicine Director, Center for Liver Diseases The University of Chicago Medicine Chicago, Illinois
| |
Collapse
|
33
|
Chalasani N, Abdelmalek MF, Garcia-Tsao G, Vuppalanchi R, Alkhouri N, Rinella M, Noureddin M, Pyko M, Shiffman M, Sanyal A, Allgood A, Shlevin H, Horton R, Zomer E, Irish W, Goodman Z, Harrison SA, Traber PG, Balart L, Borg B, Chalasani N, Charlton M, Conjeevaram H, Fuchs M, Ghalib R, Gholam P, Halegoua-De Marzio D, Harrison S, Jue C, Kemmer N, Kowdley K, Lai M, Lawitz E, Loomba R, Noureddin M, Paredes A, Rinella M, Rockey D, Rodriguez M, Rubin R, Ryan M, Sanyal A, Scanga A, Sepe T, Shiffman M, Shiffman M, Tetri B, Thuluvath P, Torres D, Vierling J, Wattacheril J, Weiland A, Zogg D. Effects of Belapectin, an Inhibitor of Galectin-3, in Patients With Nonalcoholic Steatohepatitis With Cirrhosis and Portal Hypertension. Gastroenterology 2020; 158:1334-1345.e5. [PMID: 31812510 DOI: 10.1053/j.gastro.2019.11.296] [Citation(s) in RCA: 183] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Increased levels of galectin 3 have been associated with nonalcoholic steatohepatitis (NASH) and contribute to toxin-induced liver fibrosis in mice. GR-MD-02 (belapectin) is an inhibitor of galectin 3 that reduces liver fibrosis and portal hypertension in rats and was safe and well tolerated in phase 1 studies. We performed a phase 2b, randomized trial of the safety and efficacy of GR-MD-02 in patients with NASH, cirrhosis, and portal hypertension. METHODS Patients with NASH, cirrhosis, and portal hypertension (hepatic venous pressure gradient [HVPG] ≥ 6 mm Hg) from 36 centers were randomly assigned, in a double-blind manner, to groups that received biweekly infusions of belapectin 2 mg/kg (n = 54), 8 mg/kg (n = 54), or placebo (n = 54) for 52 weeks. The primary endpoint was change in HVPG (Δ HVPG) at the end of the 52-week period compared with baseline. Secondary endpoints included changes in liver histology and development of liver-related outcomes. RESULTS We found no significant difference in ΔHVPG between the 2 mg/kg belapectin group and placebo group (-0.28 mm HG vs 0.10 mm HG, P = 1.0) or between the 8 mg/kg belapectin and placebo group (-0.25 mm HG vs 0.10 mm HG, P = 1.0). Belapectin had no significant effect on fibrosis or nonalcoholic fatty liver disease activity score, and liver-related outcomes did not differ significantly among groups. In an analysis of a subgroup of patients without esophageal varices at baseline (n = 81), 2 mg/kg belapectin was associated with a reduction in HVPG at 52 weeks compared with baseline (P = .02) and reduced development of new varices (P = .03). Belapectin (2 mg/kg) was well tolerated and produced no safety signals. CONCLUSIONS In a phase 2b study of 162 patients with NASH, cirrhosis, and portal hypertension, 1 year of biweekly infusion of belapectin was safe but not associated with significant reduction in HVPG or fibrosis compared with placebo. However, in a subgroup analysis of patients without esophageal varices, 2 mg/kg belapectin did reduce HVPG and development of varices. ClinicalTrials.gov number: NCT02462967.
Collapse
Affiliation(s)
- Naga Chalasani
- Indiana University School of Medicine, Indianapolis, Indiana.
| | | | | | - Raj Vuppalanchi
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | | | - Maxmillan Pyko
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Arun Sanyal
- Virginia Commonwealth University, Richmond, Virginia
| | | | | | - Rex Horton
- Galectin Therapeutics Alpharetta, Georgia
| | | | - William Irish
- East Carolina University, Greenville, South Carolina
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Ahmadi M, Alves BXR, Baker CJ, Bertsche W, Capra A, Carruth C, Cesar CL, Charlton M, Cohen S, Collister R, Eriksson S, Evans A, Evetts N, Fajans J, Friesen T, Fujiwara MC, Gill DR, Granum P, Hangst JS, Hardy WN, Hayden ME, Hunter ED, Isaac CA, Johnson MA, Jones JM, Jones SA, Jonsell S, Khramov A, Knapp P, Kurchaninov L, Madsen N, Maxwell D, McKenna JTK, Menary S, Michan JM, Momose T, Munich JJ, Olchanski K, Olin A, Pusa P, Rasmussen CØ, Robicheaux F, Sacramento RL, Sameed M, Sarid E, Silveira DM, So C, Starko DM, Stutter G, Tharp TD, Thompson RI, van der Werf DP, Wurtele JS. Investigation of the fine structure of antihydrogen. Nature 2020; 578:375-380. [PMID: 32076225 PMCID: PMC7162817 DOI: 10.1038/s41586-020-2006-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 12/20/2019] [Indexed: 10/29/2022]
Abstract
At the historic Shelter Island Conference on the Foundations of Quantum Mechanics in 1947, Willis Lamb reported an unexpected feature in the fine structure of atomic hydrogen: a separation of the 2S1/2 and 2P1/2 states1. The observation of this separation, now known as the Lamb shift, marked an important event in the evolution of modern physics, inspiring others to develop the theory of quantum electrodynamics2-5. Quantum electrodynamics also describes antimatter, but it has only recently become possible to synthesize and trap atomic antimatter to probe its structure. Mirroring the historical development of quantum atomic physics in the twentieth century, modern measurements on anti-atoms represent a unique approach for testing quantum electrodynamics and the foundational symmetries of the standard model. Here we report measurements of the fine structure in the n = 2 states of antihydrogen, the antimatter counterpart of the hydrogen atom. Using optical excitation of the 1S-2P Lyman-α transitions in antihydrogen6, we determine their frequencies in a magnetic field of 1 tesla to a precision of 16 parts per billion. Assuming the standard Zeeman and hyperfine interactions, we infer the zero-field fine-structure splitting (2P1/2-2P3/2) in antihydrogen. The resulting value is consistent with the predictions of quantum electrodynamics to a precision of 2 per cent. Using our previously measured value of the 1S-2S transition frequency6,7, we find that the classic Lamb shift in antihydrogen (2S1/2-2P1/2 splitting at zero field) is consistent with theory at a level of 11 per cent. Our observations represent an important step towards precision measurements of the fine structure and the Lamb shift in the antihydrogen spectrum as tests of the charge-parity-time symmetry8 and towards the determination of other fundamental quantities, such as the antiproton charge radius9,10, in this antimatter system.
Collapse
|
35
|
Pedrosa M, Seyedkazemi S, Francque S, Sanyal A, Rinella M, Charlton M, Loomba R, Ratziu V, Kochuparampil J, Fischer L, Vaidyanathan S, Anstee QM. A randomized, double-blind, multicenter, phase 2b study to evaluate the safety and efficacy of a combination of tropifexor and cenicriviroc in patients with nonalcoholic steatohepatitis and liver fibrosis: Study design of the TANDEM trial. Contemp Clin Trials 2020; 88:105889. [DOI: 10.1016/j.cct.2019.105889] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 11/08/2019] [Accepted: 11/09/2019] [Indexed: 12/12/2022]
|
36
|
Abstract
Currently, nonalcoholic steatohepatitis (NASH) is the second leading indication for liver transplantation (LT), behind alcohol-related liver disease. After transplant, both recurrent and de novo nonalcoholic fatty liver disease are common; however, recurrence rates of NASH and advanced fibrosis are low. Identification of high-risk groups and optimizing treatment of metabolic comorbidities both before and after LT is paramount to maintaining a healthy allograft, especially with the additional consequences of longterm immunosuppression. In addition, NASH LT recipients are at an increased risk of cardiovascular events and malignancy, and their condition warrants a tailored approach to management. The optimal approach to NASH LT recipients including metabolic comorbidities management, tailored immunosuppression, the role of bariatric surgery, and nutritional and pharmacotherapy of NASH are discussed in this review. Overall, aggressive management of metabolic syndrome after LT via medical and surgical modalities and a minimalist approach to immunosuppression is advised.
Collapse
Affiliation(s)
- Thomas G Cotter
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, IL
| | - Michael Charlton
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, IL
| |
Collapse
|
37
|
Ebong IA, Sayer G, Kim G, Jeevanandam V, Baker T, Becker Y, Fung J, Charlton M, Te H, Josephson M, Uriel N. Simultaneous heart, liver and kidney transplantation: A viable option for heart failure patients with multiorgan failure. J Heart Lung Transplant 2019; 38:997-999. [PMID: 31495411 DOI: 10.1016/j.healun.2019.06.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/04/2019] [Accepted: 06/16/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Imo A Ebong
- Division of Advanced Heart Failure, Cardiac Transplantation and Mechanical Circulatory Support, University of Chicago Medical Center, Chicago, Illinois
| | - Gabriel Sayer
- Division of Advanced Heart Failure, Cardiac Transplantation and Mechanical Circulatory Support, University of Chicago Medical Center, Chicago, Illinois
| | - Gene Kim
- Division of Advanced Heart Failure, Cardiac Transplantation and Mechanical Circulatory Support, University of Chicago Medical Center, Chicago, Illinois
| | - Valluvan Jeevanandam
- Section of Cardiac Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Talia Baker
- Section of Transplant Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Yolanda Becker
- Section of Transplant Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - John Fung
- Section of Transplant Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Michael Charlton
- Section of Gastroenterology, Hepatology & Nutrition, University of Chicago Medical Center, Chicago, Illinois
| | - Helen Te
- Section of Gastroenterology, Hepatology & Nutrition, University of Chicago Medical Center, Chicago, Illinois
| | - Michelle Josephson
- Section of Nephrology, University of Chicago Medical Center, Chicago, Illinois
| | - Nir Uriel
- Division of Advanced Heart Failure, Cardiac Transplantation and Mechanical Circulatory Support, University of Chicago Medical Center, Chicago, Illinois
| |
Collapse
|
38
|
Cotter TG, Paul S, Sandıkçı B, Couri T, Bodzin AS, Little EC, Sundaram V, Charlton M. Increasing Utilization and Excellent Initial Outcomes Following Liver Transplant of Hepatitis C Virus (HCV)-Viremic Donors Into HCV-Negative Recipients: Outcomes Following Liver Transplant of HCV-Viremic Donors. Hepatology 2019; 69:2381-2395. [PMID: 30706517 DOI: 10.1002/hep.30540] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 01/23/2019] [Indexed: 12/11/2022]
Abstract
Direct-acting antiviral (DAA) therapy has altered the frequency and outcome of liver transplantation (LT) for hepatitis C virus (HCV). The high efficacy and tolerability of DAA therapy has also created a rationale for utilizing HCV-viremic (HCV-RNA-positive) donors, including into HCV-negative recipients. We examined trends in frequency of organ utilization and graft survival in recipients of HCV-viremic donors (HCV-RNA positive as measured by nucleic acid testing [NAT]). Data were collected from the Scientific Registry of Transplant Recipients (SRTR) on adult patients who underwent a primary, single-organ, deceased donor LT from January 1, 2008 to January 31, 2018. Outcomes of HCV-negative transplant recipients (R- ) who received an allograft from donors who were HCV-RNA positive (DNAT+ ) were compared to outcomes for R- patients who received organs from donors who were HCV-RNA negative (DNAT- ). There were 11,270 DNAT- /R- ; 4,748 DNAT- /R+ ; 87 DNAT+ /R- ; and 753 DNAT+ /R+ patients, with 2-year graft survival similar across all groups: DNAT- /R- 88%; DNAT- /R+ 88%; DNAT+ /R- 86%; and DNAT+ /R+ 90%. Additionally, there were 2,635 LTs using HCV antibody-positive donors (DAb+ ): 2,378 DAb+ /R+ and 257 DAb+ /R- . The annual number of DAb+ /R- transplants increased from seven in 2008 to 107 in 2017. In the post-DAA era, graft survival improved for all recipients, with 3-year survival of DAb+ /R- patients and DAb+ /R+ patients increasing to 88% from 79% and to 85% from 78%, respectively. Conclusion: The post-DAA era has seen increased utilization of HCV-viremic donor livers, including HCV-viremic livers into HCV-negative recipients. Early graft outcomes are similar to those of HCV-negative recipients. These results support utilization of HCV-viremic organs in selected recipients both with and without HCV infection.
Collapse
Affiliation(s)
- Thomas G Cotter
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, IL
| | - Sonali Paul
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, IL
| | | | - Thomas Couri
- Department of Medicine, The University of Chicago Medicine, Chicago, IL
| | - Adam S Bodzin
- Department of Surgery, Section of Abdominal Organ Transplantation, The University of Chicago Medicine, Chicago, IL
| | | | - Vinay Sundaram
- Division of Gastroenterology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michael Charlton
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, IL
| |
Collapse
|
39
|
Cotter TG, Paul S, Sandıkçı B, Couri T, Bodzin AS, Little EC, Sundaram V, Charlton M. Improved Graft Survival After Liver Transplantation for Recipients With Hepatitis C Virus in the Direct-Acting Antiviral Era. Liver Transpl 2019; 25:598-609. [PMID: 30716208 DOI: 10.1002/lt.25424] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/27/2019] [Indexed: 12/12/2022]
Abstract
Highly effective direct-acting antiviral (DAA) therapy has transformed outcomes of liver transplantation in hepatitis C virus (HCV) patients. We examined longer-term outcomes in HCV-positive recipients in the DAA era and analyzed the Scientific Registry of Transplant Recipients for primary adult, single-organ, nonfulminant liver transplant recipients in the United States from January 1, 2008 to June 30, 2018. Graft loss was compared among HCV-positive liver transplant recipients who received either an HCV-negative or HCV-positive donor (donor [D]-/recipient [R]+; D+/R+) and HCV-negative liver transplant recipients who received a HCV-negative donor (D-/R-). The groups were further divided between the pre-DAA and DAA eras. There were 52,526 patients included: 31,193 were D-/R- patients; 18,746 were D-/R+ patients; and 2587 were D+/R+ patients. The number of D-/R+ transplants decreased from 2010 in 2008 to 1334 in 2017, with this decline particularly noticeable since 2015. D-/R+ patients in the DAA era (n = 7107) were older, had higher rates of hepatocellular carcinoma, and lower Model for End-Stage Liver Disease scores than those in the pre-DAA era. Graft survival improved for all recipients in the DAA era but improved most dramatically in HCV-positive recipients: D-/R+ 1-year survival was 92.4% versus 88.7% and 3-year survival was 83.7% versus 77.7% (DAA versus pre-DAA era, respectively) compared with D-/R- 1-year survival of 92.7% versus 91.0% and 3-year survival of 85.7% versus 84.0% (DAA versus pre-DAA era, respectively). The magnitude of improvement in 3-year graft survival was almost 4-fold greater for D-/R+ patients. The 3-year survival for D+/R+ patients was similar to HCV-negative patients. In conclusion, the number of liver transplants for HCV has decreased by more than one-third over the past decade. Graft survival among HCV-positive recipients has increased disproportionately in the DAA era with HCV-positive recipients now achieving similar outcomes to non-HCV recipients.
Collapse
Affiliation(s)
- Thomas G Cotter
- Center for Liver Diseases, University of Chicago Medicine, Chicago, IL
| | - Sonali Paul
- Center for Liver Diseases, University of Chicago Medicine, Chicago, IL
| | | | - Thomas Couri
- Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - Adam S Bodzin
- Section of Abdominal Organ Transplantation, Department of Surgery, University of Chicago Medicine, Chicago, IL
| | | | - Vinay Sundaram
- Division of Gastroenterology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michael Charlton
- Center for Liver Diseases, University of Chicago Medicine, Chicago, IL
| |
Collapse
|
40
|
Loomba R, Kayali Z, Noureddin M, Ruane P, Lawitz EJ, Bennett M, Wang L, Harting E, Tarrant JM, McColgan BJ, Chung C, Ray AS, Subramanian GM, Myers RP, Middleton MS, Lai M, Charlton M, Harrison SA. GS-0976 Reduces Hepatic Steatosis and Fibrosis Markers in Patients With Nonalcoholic Fatty Liver Disease. Gastroenterology 2018; 155:1463-1473.e6. [PMID: 30059671 PMCID: PMC6318218 DOI: 10.1053/j.gastro.2018.07.027] [Citation(s) in RCA: 216] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/18/2018] [Accepted: 07/21/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS De novo lipogenesis is increased in livers of patients with nonalcoholic steatohepatitis (NASH). Acetyl-coenzyme carboxylase catalyzes the rate-limiting step in this process. We evaluated the safety and efficacy of GS-0976, an inhibitor of acetyl-coenzyme A carboxylase in liver, in a phase 2 randomized placebo-controlled trial of patients with NASH. METHODS We analyzed data from 126 patients with hepatic steatosis of at least 8%, based on the magnetic resonance imaging-estimated proton density fat fraction (MRI-PDFF), and liver stiffness of at least 2.5 kPa, based on magnetic resonance elastography measurement or historical biopsy result consistent with NASH and F1-F3 fibrosis. Patients were randomly assigned (2:2:1) to groups given GS-0976 20 mg, GS-0976 5 mg, or placebo daily for 12 weeks, from August 8, 2016 through July 18, 2017. Measures of hepatic steatosis, stiffness, serum markers of fibrosis, and plasma metabolomics were evaluated. The primary aims were to confirm previous findings and evaluate the relation between dose and efficacy. RESULTS A relative decrease of at least 30% from baseline in MRI-PDFF (PDFF response) occurred in 48% of patients given GS-0976 20 mg (P = .004 vs placebo), 23% given GS-0976 5 mg (P = .43 vs placebo), and 15% given placebo. Median relative decreases in MRI-PDFF were greater in patients given GS-0976 20 mg (decrease of 29%) than those given placebo (decrease of 8%; P = .002). Changes in magnetic resonance elastography-measured stiffness did not differ among groups, but a dose-dependent decrease in the fibrosis marker tissue inhibitor of metalloproteinase 1 was observed in patients given GS-0976 20 mg. Plasma levels of acylcarnitine species also decreased in patients with a PDFF response given GS-0976 20 mg. GS-0976 was safe, but median relative increases of 11% and 13% in serum levels of triglycerides were observed in patients given GS-0976. CONCLUSIONS In a randomized placebo-controlled trial of patients with NASH, we found 12-week administration of GS-0976 20 mg decreased hepatic steatosis, selected markers of fibrosis, and liver biochemistry. ClinicalTrials.gov ID NCT02856555.
Collapse
Affiliation(s)
- Rohit Loomba
- University of California at San Diego, La Jolla, California.
| | - Zeid Kayali
- Inland Empire Liver Foundation, Rialto, California
| | | | - Peter Ruane
- Ruane Medical and Liver Health Institute, Los Angeles, California
| | - Eric J. Lawitz
- Texas Liver Institute, University of Texas Health San Antonio, San Antonio, Texas
| | - Michael Bennett
- Atlanta Gastroenterology Associates, Atlanta, Georgia; (6)Medical Research Associates Group, San Diego, California
| | - Lulu Wang
- Gilead Sciences, Inc, Foster City, California
| | | | | | | | | | | | | | | | | | - Michelle Lai
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | | |
Collapse
|
41
|
Younossi ZM, Stepanova M, Lawitz E, Charlton M, Loomba R, Myers RP, Subramanian M, McHutchison JG, Goodman Z. Improvement of hepatic fibrosis and patient-reported outcomes in non-alcoholic steatohepatitis treated with selonsertib. Liver Int 2018; 38:1849-1859. [PMID: 29377462 DOI: 10.1111/liv.13706] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/20/2018] [Indexed: 02/13/2023]
Abstract
BACKGROUND Patient-reported outcomes (PROs) represent patients' perspective about their well-being. AIM To assess PRO changes in patients with non-alcoholic steatohepatitis (NASH) after treatment with selonsertib (SEL) and to associate them with different biomarkers. METHODS Patients with NASH and stage 2-3 fibrosis received SEL 6 mg or 18 mg orally QD alone or in combination with simtuzumab (SIM, 125 mg SC weekly) or SIM alone for 24 weeks. Biopsies were obtained at baseline and at treatment week 24. PROs were assessed using SF-36, CLDQ and WPAI:SHP. RESULTS Seventy-two patients with NASH were included (54 ± 10 years, 31% male, 65% stage 3, 71% diabetes). Baseline physical health-related PRO scores were significantly lower than population norms (P < .05). During treatment, there were no consistent differences in treatment-emergent PRO changes between different regimens (P > .05). However, NASH subjects who experienced ≥2 decrease in NAFLD Activity Score or ≥1-stage reduction in fibrosis showed significant improvements in their PROs (up to +15.5% of a PRO range size, P < .05). Additionally, improvements in PROs (up to +21.5%, P < .05) were noted in patients with at least 50% relative reduction in collagen, while NASH subjects with >17% increase in their collagen experienced PRO worsening (up to -13.9%, P < .05). Baseline serum CK-18, IL-6 and CRP significantly correlated with PROs (rho from -0.24 to -0.38, P < .05). CONCLUSIONS A decrease in hepatic collagen is the most prominently associated with improvement of PROs in NASH patients with F2-F3 treated with SEL. Furthermore, serum cytokines are associated with baseline PROs and with treatment-emergent changes in PROs in patients with NASH.
Collapse
Affiliation(s)
- Zobair M Younossi
- Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Maria Stepanova
- Center for Outcomes Research in Liver Diseases, Washington, DC, USA
| | | | | | - Rohit Loomba
- University of California San Diego, La Jolla, CA, USA
| | | | | | | | - Zachary Goodman
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| |
Collapse
|
42
|
Ahmadi M, Alves BXR, Baker CJ, Bertsche W, Capra A, Carruth C, Cesar CL, Charlton M, Cohen S, Collister R, Eriksson S, Evans A, Evetts N, Fajans J, Friesen T, Fujiwara MC, Gill DR, Hangst JS, Hardy WN, Hayden ME, Hunter ED, Isaac CA, Johnson MA, Jones JM, Jones SA, Jonsell S, Khramov A, Knapp P, Kurchaninov L, Madsen N, Maxwell D, McKenna JTK, Menary S, Michan JM, Momose T, Munich JJ, Olchanski K, Olin A, Pusa P, Rasmussen CØ, Robicheaux F, Sacramento RL, Sameed M, Sarid E, Silveira DM, Starko DM, Stutter G, So C, Tharp TD, Thompson RI, van der Werf DP, Wurtele JS. Observation of the 1S-2P Lyman-α transition in antihydrogen. Nature 2018; 561:211-215. [PMID: 30135588 PMCID: PMC6786973 DOI: 10.1038/s41586-018-0435-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 07/05/2018] [Indexed: 11/09/2022]
Abstract
In 1906, Theodore Lyman discovered his eponymous series of transitions in the extreme-ultraviolet region of the atomic hydrogen spectrum1,2. The patterns in the hydrogen spectrum helped to establish the emerging theory of quantum mechanics, which we now know governs the world at the atomic scale. Since then, studies involving the Lyman-α line-the 1S-2P transition at a wavelength of 121.6 nanometres-have played an important part in physics and astronomy, as one of the most fundamental atomic transitions in the Universe. For example, this transition has long been used by astronomers studying the intergalactic medium and testing cosmological models via the so-called 'Lyman-α forest'3 of absorption lines at different redshifts. Here we report the observation of the Lyman-α transition in the antihydrogen atom, the antimatter counterpart of hydrogen. Using narrow-line-width, nanosecond-pulsed laser radiation, the 1S-2P transition was excited in magnetically trapped antihydrogen. The transition frequency at a field of 1.033 tesla was determined to be 2,466,051.7 ± 0.12 gigahertz (1σ uncertainty) and agrees with the prediction for hydrogen to a precision of 5 × 10-8. Comparisons of the properties of antihydrogen with those of its well-studied matter equivalent allow precision tests of fundamental symmetries between matter and antimatter. Alongside the ground-state hyperfine4,5 and 1S-2S transitions6,7 recently observed in antihydrogen, the Lyman-α transition will permit laser cooling of antihydrogen8,9, thus providing a cold and dense sample of anti-atoms for precision spectroscopy and gravity measurements10. In addition to the observation of this fundamental transition, this work represents both a decisive technological step towards laser cooling of antihydrogen, and the extension of antimatter spectroscopy to quantum states possessing orbital angular momentum.
Collapse
Affiliation(s)
- M Ahmadi
- Department of Physics, University of Liverpool, Liverpool, UK
| | - B X R Alves
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
| | - C J Baker
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - W Bertsche
- School of Physics and Astronomy, University of Manchester, Manchester, UK
- Cockcroft Institute, Sci-Tech Daresbury, Warrington, UK
| | - A Capra
- TRIUMF, Vancouver, British Columbia, Canada
| | - C Carruth
- Department of Physics, University of California at Berkeley, Berkeley, CA, USA
| | - C L Cesar
- Instituto de Fisica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - M Charlton
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - S Cohen
- Department of Physics, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - S Eriksson
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - A Evans
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | - N Evetts
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - J Fajans
- Department of Physics, University of California at Berkeley, Berkeley, CA, USA
| | - T Friesen
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | | | - D R Gill
- TRIUMF, Vancouver, British Columbia, Canada
| | - J S Hangst
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark.
| | - W N Hardy
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - M E Hayden
- Department of Physics, Simon Fraser University, Burnaby, British Columbia, Canada
| | - E D Hunter
- Department of Physics, University of California at Berkeley, Berkeley, CA, USA
| | - C A Isaac
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - M A Johnson
- School of Physics and Astronomy, University of Manchester, Manchester, UK
- Cockcroft Institute, Sci-Tech Daresbury, Warrington, UK
| | - J M Jones
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - S A Jones
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - S Jonsell
- Department of Physics, Stockholm University, Stockholm, Sweden
| | - A Khramov
- TRIUMF, Vancouver, British Columbia, Canada
| | - P Knapp
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | | | - N Madsen
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - D Maxwell
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | | | - S Menary
- Department of Physics and Astronomy, York University, Toronto, Ontario, Canada
| | - J M Michan
- TRIUMF, Vancouver, British Columbia, Canada
- École Polytechnique Fédérale de Lausanne (EPFL), Swiss Plasma Center (SPC), Lausanne, Switzerland
| | - T Momose
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.
- Department of Chemistry, University of British Columbia, Vancouver, British Columbia, Canada.
| | - J J Munich
- Department of Physics, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - A Olin
- TRIUMF, Vancouver, British Columbia, Canada
- Department of Physics and Astronomy, University of Victoria, Victoria, British Columbia, Canada
| | - P Pusa
- Department of Physics, University of Liverpool, Liverpool, UK
| | - C Ø Rasmussen
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
| | - F Robicheaux
- Department of Physics and Astronomy, Purdue University, West Lafayette, IN, USA
| | - R L Sacramento
- Instituto de Fisica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - M Sameed
- School of Physics and Astronomy, University of Manchester, Manchester, UK
| | | | - D M Silveira
- Instituto de Fisica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - D M Starko
- Department of Physics and Astronomy, York University, Toronto, Ontario, Canada
| | - G Stutter
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
| | - C So
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | - T D Tharp
- Physics Department, Marquette University, Milwaukee, WI, USA
| | - R I Thompson
- TRIUMF, Vancouver, British Columbia, Canada
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | - D P van der Werf
- Department of Physics, College of Science, Swansea University, Swansea, UK
- IRFU, CEA/Saclay, Gif-sur-Yvette Cedex, France
| | - J S Wurtele
- Department of Physics, University of California at Berkeley, Berkeley, CA, USA
| |
Collapse
|
43
|
Moffatt S, Venturini S, Williams C, Charlton M, Thompson J. An audit of post-operative pain and related outcomes following oesophagectomy at the leicester royal infirmary. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.568] [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: 11/25/2022]
|
44
|
El-Sherif O, Jiang ZG, Tapper EB, Huang KC, Zhong A, Osinusi A, Charlton M, Manns M, Afdhal NH, Mukamal K, McHutchison J, Brainard DM, Terrault N, Curry MP. Baseline Factors Associated With Improvements in Decompensated Cirrhosis After Direct-Acting Antiviral Therapy for Hepatitis C Virus Infection. Gastroenterology 2018. [PMID: 29535028 DOI: 10.1053/j.gastro.2018.03.022] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Treatment with direct-acting antiviral (DAA) agents can reduce Model for End-Stage Liver Disease and Child-Pugh-Turcotte (CPT) scores in patients with decompensated cirrhosis caused by hepatitis C virus. However, many of these patients still die or require liver transplantation. We collected data on baseline features of patients and aimed to develop a scoring system to predict response to DAA therapy. METHODS We performed a retrospective analysis of data from 4 trials on the effects of sofosbuvir-based therapy in patients with hepatitis C virus-associated decompensated cirrhosis (502 of CPT class B and 120 of CPT class C). In these trials, patients were given 12 or 24 weeks of treatment with ledipasvir, sofosbuvir, and ribavirin or velpatasvir, sofosbuvir, and/or ribavirin, or 48 weeks of treatment with sofosbuvir and ribavirin. We collected demographic, clinical, treatment response, and laboratory data from patients and tested their associations with patient outcomes at 36 weeks. The primary outcome was factors associated with reduction of CPT score to class A. RESULTS The presence of ascites or encephalopathy, serum level of albumin <3.5 g/dL or alanine aminotransferase <60 U/L, and body mass index >25 kg/m2 were associated with an increased risk of not achieving a reduction in CPT to class A, independent of sustained viral response to therapy. Serum level of albumin <2.8 g/dL and abnormal level of bilirubin were associated with an increased risk of liver transplantation or death. We developed a scoring system based on 5 baseline factors (body mass index, encephalopathy, ascites, and serum levels of alanine aminotransferase and albumin) associated significantly with patient outcomes, which we called the "BE3A score." For patients with scores of 4-5, the hazard ratio for reduction of CPT score to class A was 52.3 (95% confidence interval, 15.2-179.7). CONCLUSIONS We identified 5 baseline factors (body mass index, encephalopathy, ascites, and serum levels of alanine aminotransferase and albumin) associated with a reduction of CPT score to class A in patients with hepatitis C virus-associated decompensated cirrhosis receiving DAA therapy. We developed a predictive score using these factors, called the BE3A score, which can be used as a shared decision-making tool, quantifying the potential benefits of DAA therapy for patients with decompensated cirrhosis.
Collapse
Affiliation(s)
| | - Z Gordon Jiang
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - K C Huang
- Gilead Sciences, Foster City, California
| | - Alex Zhong
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | - Michael Manns
- University of California San Francisco, San Francisco, California
| | - Nezam H Afdhal
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Michael P Curry
- Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| |
Collapse
|
45
|
Ahmadi M, Alves BXR, Baker CJ, Bertsche W, Capra A, Carruth C, Cesar CL, Charlton M, Cohen S, Collister R, Eriksson S, Evans A, Evetts N, Fajans J, Friesen T, Fujiwara MC, Gill DR, Hangst JS, Hardy WN, Hayden ME, Isaac CA, Johnson MA, Jones JM, Jones SA, Jonsell S, Khramov A, Knapp P, Kurchaninov L, Madsen N, Maxwell D, McKenna JTK, Menary S, Momose T, Munich JJ, Olchanski K, Olin A, Pusa P, Rasmussen CØ, Robicheaux F, Sacramento RL, Sameed M, Sarid E, Silveira DM, Stutter G, So C, Tharp TD, Thompson RI, van der Werf DP, Wurtele JS. Characterization of the 1S-2S transition in antihydrogen. Nature 2018; 557:71-75. [PMID: 29618820 PMCID: PMC6784861 DOI: 10.1038/s41586-018-0017-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 12/11/2017] [Accepted: 03/06/2018] [Indexed: 11/09/2022]
Abstract
In 1928, Dirac published an equation 1 that combined quantum mechanics and special relativity. Negative-energy solutions to this equation, rather than being unphysical as initially thought, represented a class of hitherto unobserved and unimagined particles-antimatter. The existence of particles of antimatter was confirmed with the discovery of the positron 2 (or anti-electron) by Anderson in 1932, but it is still unknown why matter, rather than antimatter, survived after the Big Bang. As a result, experimental studies of antimatter3-7, including tests of fundamental symmetries such as charge-parity and charge-parity-time, and searches for evidence of primordial antimatter, such as antihelium nuclei, have high priority in contemporary physics research. The fundamental role of the hydrogen atom in the evolution of the Universe and in the historical development of our understanding of quantum physics makes its antimatter counterpart-the antihydrogen atom-of particular interest. Current standard-model physics requires that hydrogen and antihydrogen have the same energy levels and spectral lines. The laser-driven 1S-2S transition was recently observed 8 in antihydrogen. Here we characterize one of the hyperfine components of this transition using magnetically trapped atoms of antihydrogen and compare it to model calculations for hydrogen in our apparatus. We find that the shape of the spectral line agrees very well with that expected for hydrogen and that the resonance frequency agrees with that in hydrogen to about 5 kilohertz out of 2.5 × 1015 hertz. This is consistent with charge-parity-time invariance at a relative precision of 2 × 10-12-two orders of magnitude more precise than the previous determination 8 -corresponding to an absolute energy sensitivity of 2 × 10-20 GeV.
Collapse
Affiliation(s)
- M Ahmadi
- Department of Physics, University of Liverpool, Liverpool, UK
| | - B X R Alves
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
| | - C J Baker
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - W Bertsche
- School of Physics and Astronomy, University of Manchester, Manchester, UK
- Cockcroft Institute, Sci-Tech Daresbury, Warrington, UK
| | - A Capra
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia, Canada
| | - C Carruth
- Department of Physics, University of California at Berkeley, Berkeley, CA, USA
| | - C L Cesar
- Instituto de Fisica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - M Charlton
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - S Cohen
- Department of Physics, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - R Collister
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia, Canada
| | - S Eriksson
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - A Evans
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | - N Evetts
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - J Fajans
- Department of Physics, University of California at Berkeley, Berkeley, CA, USA
| | - T Friesen
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
| | - M C Fujiwara
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia, Canada
| | - D R Gill
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia, Canada
| | - J S Hangst
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark.
| | - W N Hardy
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - M E Hayden
- Department of Physics, Simon Fraser University, Burnaby, British Columbia, Canada
| | - C A Isaac
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - M A Johnson
- School of Physics and Astronomy, University of Manchester, Manchester, UK
- Cockcroft Institute, Sci-Tech Daresbury, Warrington, UK
| | - J M Jones
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - S A Jones
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - S Jonsell
- Department of Physics, Stockholm University, Stockholm, Sweden
| | - A Khramov
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia, Canada
| | - P Knapp
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - L Kurchaninov
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia, Canada
| | - N Madsen
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - D Maxwell
- Department of Physics, College of Science, Swansea University, Swansea, UK
| | - J T K McKenna
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia, Canada
| | - S Menary
- Department of Physics and Astronomy, York University, Toronto, Ontario, Canada
| | - T Momose
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - J J Munich
- Department of Physics, Simon Fraser University, Burnaby, British Columbia, Canada
| | - K Olchanski
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia, Canada
| | - A Olin
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia, Canada
- Department of Physics and Astronomy, University of Victoria, Victoria, British Columbia, Canada
| | - P Pusa
- Department of Physics, University of Liverpool, Liverpool, UK
| | - C Ø Rasmussen
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
| | - F Robicheaux
- Department of Physics and Astronomy, Purdue University, West Lafayette, IN, USA
| | - R L Sacramento
- Instituto de Fisica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - M Sameed
- Department of Physics, College of Science, Swansea University, Swansea, UK
- School of Physics and Astronomy, University of Manchester, Manchester, UK
| | | | - D M Silveira
- Instituto de Fisica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - G Stutter
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
| | - C So
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | - T D Tharp
- Physics Department, Marquette University, Milwaukee, WI, USA
| | - R I Thompson
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | - D P van der Werf
- Department of Physics, College of Science, Swansea University, Swansea, UK
- IRFU, CEA/Saclay, Gif-sur-Yvette Cedex, France
| | - J S Wurtele
- Department of Physics, University of California at Berkeley, Berkeley, CA, USA
| |
Collapse
|
46
|
Rook W, Charlton M, Thompson J. Microvascular function in healthy volunteers; a comparison of manually and automatically derived measurements. Br J Anaesth 2018. [DOI: 10.1016/j.bja.2017.11.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
47
|
Brown S, Charlton M, Simoes C, Thompson J. Monitoring of neuromuscular blockade during general anaesthesia. Br J Anaesth 2018. [DOI: 10.1016/j.bja.2017.11.046] [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: 10/17/2022] Open
|
48
|
Charlton M. Risk of Hepatocellular Carcinoma in Patients With Nonalcoholic Steatohepatitis. Gastroenterol Hepatol (N Y) 2018; 14:247-249. [PMID: 29942224 PMCID: PMC6009190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Michael Charlton
- Professor of Medicine Director, Center for Liver Diseases The University of Chicago Medicine Chicago, Illinois
| |
Collapse
|
49
|
Affiliation(s)
- Michael Charlton
- Center for Liver Diseases, University of Chicago, Chicago, IL 60637, USA.
| |
Collapse
|
50
|
Bourliere M, Charlton M, Manns M, Prieto M, Fernandez I, Londoño M, Kwok R, Smith C, Ngo H, Lee S, Zhang J, Arterburn S, Copans A, Rosarro L, Curry M, Flamm S. A168 USE OF LEDIPASVIR/SOFOSBUVIR (LDV/SOF) WITH OR WITHOUT RIBAVIRIN (RBV) IN GENOTYPE 1 (GT 1) HCV-INFECTED PATIENTS POST LIVER TRANSPLANT (LT): EVALUATION OF SEVERAL REAL-WORLD DATASETS (RWD). J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - M Charlton
- Intermountain Medical Center, Murray, UT
| | - M Manns
- Hannover Medical School, Hannover, Germany
| | - M Prieto
- Unidad de Hepatología, Servicio de Medicina Digestiva, Hospital Universitari i Politècnic La Fe, Spain, Valencia, Spain
| | - I Fernandez
- Service of Gastroenterology Hospital Universitario, Madrid, Spain
| | - M Londoño
- Hospital Clinic Barcelona, Barcelona, Spain
| | - R Kwok
- Walter Reed National Military Medical Center, Bethesda, MD
| | - C Smith
- Medstar Georgetown University Hospital, Washington
| | - H Ngo
- Gilead Sciences Canada, Inc., Mississauga, ON, Canada
| | - S Lee
- Gilead Sciences, Inc., Foster City, CA
| | - J Zhang
- Gilead Sciences, Inc., Foster City, CA
| | | | - A Copans
- Gilead Sciences, Inc., Foster City, CA
| | - L Rosarro
- Gilead Sciences, Inc., Foster City, CA
| | - M Curry
- Beth Israel Deaconess Medical Center, Boston, MA
| | - S Flamm
- Northwestern University Feinberg School of Medicine, Chicago, IL
| |
Collapse
|