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Kratchmarov R, Djeddi S, Dunlap G, He W, Jia X, Burk CM, Ryan T, McGill A, Allegretti JR, Kataru RP, Mehrara BJ, Taylor EM, Agarwal S, Bhattacharyya N, Bergmark RW, Maxfield AZ, Lee S, Roditi R, Dwyer DF, Boyce JA, Buchheit KM, Laidlaw TM, Shreffler WG, Rao DA, Gutierrez-Arcelus M, Brennan PJ. TCF1-LEF1 co-expression identifies a multipotent progenitor cell (T H2-MPP) across human allergic diseases. Nat Immunol 2024; 25:902-915. [PMID: 38589618 DOI: 10.1038/s41590-024-01803-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 03/06/2024] [Indexed: 04/10/2024]
Abstract
Repetitive exposure to antigen in chronic infection and cancer drives T cell exhaustion, limiting adaptive immunity. In contrast, aberrant, sustained T cell responses can persist over decades in human allergic disease. To understand these divergent outcomes, we employed bioinformatic, immunophenotyping and functional approaches with human diseased tissues, identifying an abundant population of type 2 helper T (TH2) cells with co-expression of TCF7 and LEF1, and features of chronic activation. These cells, which we termed TH2-multipotent progenitors (TH2-MPP) could self-renew and differentiate into cytokine-producing effector cells, regulatory T (Treg) cells and follicular helper T (TFH) cells. Single-cell T-cell-receptor lineage tracing confirmed lineage relationships between TH2-MPP, TH2 effectors, Treg cells and TFH cells. TH2-MPP persisted despite in vivo IL-4 receptor blockade, while thymic stromal lymphopoietin (TSLP) drove selective expansion of progenitor cells and rendered them insensitive to glucocorticoid-induced apoptosis in vitro. Together, our data identify TH2-MPP as an aberrant T cell population with the potential to sustain type 2 inflammation and support the paradigm that chronic T cell responses can be coordinated over time by progenitor cells.
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Affiliation(s)
- Radomir Kratchmarov
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah Djeddi
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Garrett Dunlap
- Division of Rheumatology, Inflammation, Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wenqin He
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Xiaojiong Jia
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Caitlin M Burk
- Center for Immunology and Inflammatory Diseases and Food Allergy Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tessa Ryan
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alanna McGill
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica R Allegretti
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Raghu P Kataru
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Babak J Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Erin M Taylor
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Shailesh Agarwal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Neil Bhattacharyya
- Massachusetts Eye & Ear Institute, Harvard Medical School, Boston, MA, USA
| | - Regan W Bergmark
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Alice Z Maxfield
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stella Lee
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rachel Roditi
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel F Dwyer
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joshua A Boyce
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kathleen M Buchheit
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tanya M Laidlaw
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wayne G Shreffler
- Center for Immunology and Inflammatory Diseases and Food Allergy Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Deepak A Rao
- Division of Rheumatology, Inflammation, Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Maria Gutierrez-Arcelus
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Patrick J Brennan
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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2
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Koganesawa M, Dwyer D, Alhallak K, Nagai J, Zaleski K, Samuchiwal S, Hiroaki H, Nishida A, Hirsch TI, Brennan PJ, Puder M, Balestrieri B. Pla2g5 contributes to viral-like-induced lung inflammation through macrophage proliferation and LA/Ffar1 lung cell recruitment. Immunology 2024; 172:144-162. [PMID: 38361249 PMCID: PMC11057362 DOI: 10.1111/imm.13766] [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: 09/26/2023] [Accepted: 02/01/2024] [Indexed: 02/17/2024] Open
Abstract
Macrophages expressing group V phospholipase A2 (Pla2g5) release the free fatty acid (FFA) linoleic acid (LA), potentiating lung type 2 inflammation. Although Pla2g5 and LA increase in viral infections, their role remains obscure. We generated Pla2g5flox/flox mice, deleted Pla2g5 by using the Cx3cr1cre transgene, and activated bone marrow-derived macrophages (BM-Macs) with poly:IC, a synthetic double-stranded RNA that triggers a viral-like immune response, known Pla2g5-dependent stimuli (IL-4, LPS + IFNγ, IL-33 + IL-4 + GM-CSF) and poly:IC + LA followed by lipidomic and transcriptomic analysis. Poly:IC-activated Pla2g5flox/flox;Cx3cr1cre/+ BM-Macs had downregulation of major bioactive lipids and critical enzymes producing those bioactive lipids. In addition, AKT phosphorylation was lower in poly:IC-stimulated Pla2g5flox/flox;Cx3cr1cre/+ BM-Macs, which was not restored by adding LA to poly:IC-stimulated BM-Macs. Consistently, Pla2g5flox/flox;Cx3cr1cre/+ mice had diminished poly:IC-induced lung inflammation, including inflammatory macrophage proliferation, while challenging Pla2g5flox/flox;Cx3cr1cre/+ mice with poly:IC + LA partially restored lung inflammation and inflammatory macrophage proliferation. Finally, mice lacking FFA receptor-1 (Ffar1)-null mice had reduced poly:IC-induced lung cell recruitment and tissue macrophage proliferation, not corrected by LA. Thus, Pla2g5 contributes to poly:IC-induced lung inflammation by regulating inflammatory macrophage proliferation and LA/Ffar1-mediated lung cell recruitment and tissue macrophage proliferation.
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Affiliation(s)
- Masaya Koganesawa
- Division of Allergy and Clinical Immunology, Vinik Center for Translational Immunology Research, Brigham and Women’s Hospital, Boston, MA
| | - Daniel Dwyer
- Division of Allergy and Clinical Immunology, Vinik Center for Translational Immunology Research, Brigham and Women’s Hospital, Boston, MA
| | - Kinan Alhallak
- Division of Allergy and Clinical Immunology, Vinik Center for Translational Immunology Research, Brigham and Women’s Hospital, Boston, MA
| | - Jun Nagai
- Division of Allergy and Clinical Immunology, Vinik Center for Translational Immunology Research, Brigham and Women’s Hospital, Boston, MA
| | - Kendall Zaleski
- Division of Allergy and Clinical Immunology, Vinik Center for Translational Immunology Research, Brigham and Women’s Hospital, Boston, MA
| | - Sachin Samuchiwal
- Division of Allergy and Clinical Immunology, Vinik Center for Translational Immunology Research, Brigham and Women’s Hospital, Boston, MA
| | - Hayashi Hiroaki
- Division of Allergy and Clinical Immunology, Vinik Center for Translational Immunology Research, Brigham and Women’s Hospital, Boston, MA
| | - Airi Nishida
- Division of Allergy and Clinical Immunology, Vinik Center for Translational Immunology Research, Brigham and Women’s Hospital, Boston, MA
| | - Thomas I. Hirsch
- Department of Surgery and Vascular Biology Program Boston Children’s Hospital, Boston, MA
| | - Patrick J. Brennan
- Division of Allergy and Clinical Immunology, Vinik Center for Translational Immunology Research, Brigham and Women’s Hospital, Boston, MA
| | - Mark Puder
- Department of Surgery and Vascular Biology Program Boston Children’s Hospital, Boston, MA
| | - Barbara Balestrieri
- Division of Allergy and Clinical Immunology, Vinik Center for Translational Immunology Research, Brigham and Women’s Hospital, Boston, MA
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3
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Brennan PJ, Saunders RE, Spanou M, Serafini M, Sun L, Heger GP, Konopacka A, Beveridge RD, Gordon L, Bunally SB, Saudemont A, Benowitz AB, Martinez-Fleites C, Queisser MA, An H, Deane CM, Hann MM, Brayshaw LL, Conway SJ. Orthogonal IMiD-Degron Pairs Induce Selective Protein Degradation in Cells. bioRxiv 2024:2024.03.15.585309. [PMID: 38559242 PMCID: PMC10979945 DOI: 10.1101/2024.03.15.585309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Immunomodulatory imide drugs (IMiDs) including thalidomide, lenalidomide, and pomalidomide, can be used to induce degradation of a protein of interest that is fused to a short zinc finger (ZF) degron motif. These IMiDs, however, also induce degradation of endogenous neosubstrates, including IKZF1 and IKZF3. To improve degradation selectivity, we took a bump-and-hole approach to design and screen bumped IMiD analogs against 8380 ZF mutants. This yielded a bumped IMiD analog that induces efficient degradation of a mutant ZF degron, while not affecting other cellular proteins, including IKZF1 and IKZF3. In proof-of-concept studies, this system was applied to induce efficient degradation of TRIM28, a disease-relevant protein with no known small molecule binders. We anticipate that this system will make a valuable addition to the current arsenal of degron systems for use in target validation.
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Affiliation(s)
- Patrick J. Brennan
- Department of Chemistry, Chemistry Research Laboratory, University of Oxford; Oxford, UK
- Department of Chemistry & Biochemistry, University of California, Los Angeles; Los Angeles, USA
| | | | | | - Marta Serafini
- Department of Chemistry, Chemistry Research Laboratory, University of Oxford; Oxford, UK
| | - Liang Sun
- Chemical Biology Program, Memorial Sloan Kettering Cancer Center; New York, USA
| | | | | | - Ryan D. Beveridge
- Virus Screening Facility, Weatherall Institute of Molecular Medicine, University of Oxford; Oxford, UK
| | | | | | | | | | | | | | - Heeseon An
- Chemical Biology Program, Memorial Sloan Kettering Cancer Center; New York, USA
| | | | | | | | - Stuart J. Conway
- Department of Chemistry, Chemistry Research Laboratory, University of Oxford; Oxford, UK
- Department of Chemistry & Biochemistry, University of California, Los Angeles; Los Angeles, USA
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4
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Chen Z, Ghavimi SAA, Wu M, McNamara J, Barreiro O, Maridas D, Kratchmarov R, Siegel A, Djeddi S, Gutierrez-Arcelus M, Brennan PJ, Padera TP, von Andrian U, Mehrara B, Greene AK, Kahn CR, Orgill DP, Sinha I, Rosen V, Agarwal S. PPARγ agonist treatment reduces fibroadipose tissue in secondary lymphedema by exhausting fibroadipogenic PDGFRα+ mesenchymal cells. JCI Insight 2023; 8:e165324. [PMID: 38131378 PMCID: PMC10807713 DOI: 10.1172/jci.insight.165324] [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: 09/12/2022] [Accepted: 11/10/2023] [Indexed: 12/23/2023] Open
Abstract
Secondary lymphedema occurs in up to 20% of patients after lymphadenectomy performed for the surgical management of tumors involving the breast, prostate, uterus, and skin. Patients develop progressive edema of the affected extremity due to retention of protein-rich lymphatic fluid. Despite compression therapy, patients progress to chronic lymphedema in which noncompressible fibrosis and adipose tissue are deposited within the extremity. The presence of fibrosis led to our hypothesis that rosiglitazone, a PPARγ agonist that inhibits fibrosis, would reduce fibrosis in a mouse model of secondary lymphedema after hind limb lymphadenectomy. In vivo, rosiglitazone reduced fibrosis in the hind limb after lymphadenectomy. Our findings verified that rosiglitazone reestablished the adipogenic features of TGF-β1-treated mesenchymal cells in vitro. Despite this, rosiglitazone led to a reduction in adipose tissue deposition. Single-cell RNA-Seq data obtained from human tissues and flow cytometric and histological evaluation of mouse tissues demonstrated increased presence of PDGFRα+ cells in lymphedema; human tissue analysis verified these cells have the capacity for adipogenic and fibrogenic differentiation. Upon treatment with rosiglitazone, we noted a reduction in the overall quantity of PDGFRα+ cells and LipidTOX+ cells. Our findings provide a framework for treating secondary lymphedema as a condition of fibrosis and adipose tissue deposition, both of which, paradoxically, can be prevented with a pro-adipogenic agent.
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Affiliation(s)
- Ziyu Chen
- Department of Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, Guangdong, China
| | - Soheila Ali Akbari Ghavimi
- Department of Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Mengfan Wu
- Department of Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - David Maridas
- Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Radomir Kratchmarov
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ashley Siegel
- Department of Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah Djeddi
- Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Maria Gutierrez-Arcelus
- Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Patrick J. Brennan
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy P. Padera
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Babak Mehrara
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Arin K. Greene
- Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - C. Ronald Kahn
- Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Dennis P. Orgill
- Department of Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Indranil Sinha
- Department of Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Vicki Rosen
- Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Shailesh Agarwal
- Department of Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
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5
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Kaplan LJ, Levin S, Yelon J, Cannon JM, Mehta S, Reilly PM, Kovach SJ, Donegan DJ, Claycomb K, Savchenko-Fullerton M, Filonenko E, Maiko V, Kuzmov R, Radega Y, Pashinskiy V, Demyan YY, Plesha P, Demyan Y, Vinnytskiy D, Gaulton GN, Brennan PJ. Providing Remote Aid During a Humanitarian Crisis. Crit Care Explor 2023; 5:e0992. [PMID: 38304707 PMCID: PMC10833625 DOI: 10.1097/cce.0000000000000992] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Humanitarian crises create opportunities for both in-person and remote aid. Durable, complex, and team-based care may leverage a telemedicine approach for comprehensive support within a conflict zone. Barriers and enablers are detailed, as is the need for mission expansion due to initial program success. Adapting a telemedicine program initially designed for critical care during the severe acute respiratory syndrome coronavirus 2 pandemic offers a solution to data transfer and data analysis issues. Staffing efforts and grouped elements of patient care detail the kinds of remote aid that are achievable. A multiprofessional team-based approach (clinical, administrative, nongovernmental organization, government) can provide comprehensive consultation addressing surgical planning, critical care management, infection and infection control management, and patient transfer for complex care. Operational and network security create parallel concerns relevant to avoid geolocation and network intrusion during consultation. Deliberate approaches to address cultural differences that influence relational dynamics are also essential for mission success.
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Affiliation(s)
- Lewis J Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Scott Levin
- Department of Orthopedics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jay Yelon
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jeremy M Cannon
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Samir Mehta
- Department of Orthopedics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Patrick M Reilly
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stephen J Kovach
- Division of Plastic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Derek J Donegan
- Department of Orthopedics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kierstyn Claycomb
- Penn Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Evhen Filonenko
- Department of Orthopedics, Vinnytsia Regional Pirogov Clinical Hospital, Vinnytsia, Ukraine
| | - Vyacheslav Maiko
- Department of Orthopedics, Vinnytsia Regional Pirogov Clinical Hospital, Vinnytsia, Ukraine
| | - Roman Kuzmov
- Department of Orthopedics, Vinnytsia Regional Pirogov Clinical Hospital, Vinnytsia, Ukraine
| | - Yaroslav Radega
- Department of Orthopedics, Vinnytsia Regional Pirogov Clinical Hospital, Vinnytsia, Ukraine
| | - Viktor Pashinskiy
- Department of Orthopedics, Vinnytsia Regional Pirogov Clinical Hospital, Vinnytsia, Ukraine
| | | | - Petro Plesha
- Department of Orthopedics, Zakarpattia Oblast Children's Hospital, Mukachevo, Ukraine
| | - Yuriy Demyan
- Department of Orthopedics, Zakarpattia Oblast Children's Hospital, Mukachevo, Ukraine
| | - Dmytro Vinnytskiy
- Department of Orthopedics, Zakarpattia Oblast Children's Hospital, Mukachevo, Ukraine
| | - Glen N Gaulton
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Patrick J Brennan
- Department of Internal Medicine, Division of Infectious Disease, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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6
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Green-McKenzie J, Shofer FS, Kruse G, Momplaisir F, Brennan PJ, Kuter BJ. COVID-19 vaccine uptake before and after a vaccine mandate at a major academic hospital: Trends by race/ethnicity and level of patient contact. Vaccine 2023; 41:5441-5446. [PMID: 37517911 DOI: 10.1016/j.vaccine.2023.07.032] [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: 11/09/2022] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES To assess vaccine coverage rates before and after implementation of a COVID-19 vaccine mandate among Health care Personnel (HCP) and demographic characteristics associated with vaccine uptake Design, Setting, and Participants: Cohort study conducted among 10,889 hospital employees followed from Dec 16, 2020 - October 31, 2021, at a large academic hospital in Philadelphia. MAIN OUTCOME AND MEASURES Time to COVID-19 vaccination and vaccine series completion rates before and after implementation of a COVID-19 vaccine mandate based on age, gender, race/ethnicity, and level of patient contact/occupational group. RESULTS The vaccination series completion rate was 86.0% prior to mandate announcement, and increased to 98.7% after mandate implementation. Rates before mandate announcement were highest among Asians (96.2%), Whites (94.0%), males (89.7%), employees ≥ 65 years of age (95.2%), and employees with direct patient care (physicians, 99.0%, and nurses, 93.3%). Hospital educational initiatives (including Town Halls and discussions with Black and Hispanic employees with the lowest vaccination rates) appeared to improve uptake. The largest increase in series completion after mandate announcement occurred among Blacks, those of other/multiracial backgrounds, and Hispanics (35.6%, 22.4%, and 10.8%, respectively) as well as those with some or no direct patient contact (24.5% and 18.3%, respectively). Medical or religious exemptions were approved for 64 (<0.6%) employees and 38 (<0.4%) left their positions (8 voluntary, 30 involuntary) specifically due to the COVID-19 vaccine mandate. No clinically meaningful differences by age, gender, or race/ethnicity for those who were vaccinated under the mandate versus those who left their positions were noted. CONCLUSIONS AND RELEVANCE These results suggest that while mandates may be challenging to institutions and enforcement unpopular, they play an important role in reducing hesitancy and securing high vaccination rates among HCP, a group at high risk of COVID-19 given their employment and who can be a source of disease transmission to patients.
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Affiliation(s)
- Judith Green-McKenzie
- Professor & Chief, Division of Occupational Medicine, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, United States; Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine, United States.
| | - Frances S Shofer
- Director & Adjunct Professor of Epidemiology & Biostatistics, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, United States
| | - Gregory Kruse
- Associate Vice President of Strategic Operations, University of Pennsylvania Perelman School of Medicine, United States
| | - Florence Momplaisir
- Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine, United States; Assistant Professor, University of Pennsylvania, Perelman School of Medicine, Department of Medicine, Division of Infectious Diseases, United States
| | - Patrick J Brennan
- Chief Medical Officer and Senior Vice President, University of Pennsylvania Health System, United States
| | - Barbara J Kuter
- Visiting Research Scientist, Vaccine Education Center, Children's Hospital of Philadelphia, United States
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7
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Lee-Sarwar KA, Chen YC, Lasky-Su J, Kelly RS, Zeiger RS, O’Connor GT, Bacharier LB, Jia X, Beigelman A, Gold DR, Laranjo N, Bunyavanich S, Weiss ST, Litonjua AA, Brennan PJ. Early-life fecal metabolomics of food allergy. Allergy 2023; 78:512-521. [PMID: 36448508 PMCID: PMC10590492 DOI: 10.1111/all.15602] [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: 08/04/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Intestinal microenvironmental perturbations may increase food allergy risk. We hypothesize that children with clinical food allergy, those with food sensitization, and healthy children can be differentiated by intestinal metabolites in the first years of life. METHODS In this ancillary analysis of the Vitamin D Antenatal Asthma Reduction Trial (VDAART), we performed untargeted metabolomic profiling in 824 stool samples collected at ages 3-6 months, 1 year and 3 years. Subjects included 23 with clinical food allergy at age 3 and/or 6 years, 151 with food sensitization but no clinical food allergy, and 220 controls. We identified modules of correlated, functionally related metabolites and sought associations of metabolite modules and individual metabolites with food allergy/sensitization using regression models. RESULTS Several modules of functionally related intestinal metabolites were reduced among subjects with food allergy, including bile acids at ages 3-6 months and 1 year, amino acids at age 3-6 months, steroid hormones at 1 year, and sphingolipids at age 3 years. One module primarily containing diacylglycerols was increased in those with food allergy at age 3-6 months. Fecal caffeine metabolites at age 3-6 months, likely derived from breast milk, were increased in those with food allergy and/or sensitization (beta = 5.9, 95% CI 1.0-10.8, p = .02) and were inversely correlated with fecal bile acids and bilirubin metabolites, though maternal plasma caffeine levels were not associated with food allergy and/or sensitization. CONCLUSIONS Several classes of bioactive fecal metabolites are associated with food allergy and/or sensitization including bile acids, steroid hormones, sphingolipids, and caffeine metabolites.
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Affiliation(s)
- Kathleen A. Lee-Sarwar
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School; Boston, MA, USA
- Division of Allergy & Clinical Immunology, Brigham and Women’s Hospital and Harvard Medical School; Boston, MA, USA
| | - Yih-Chieh Chen
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School; Boston, MA, USA
- Division of Allergy & Clinical Immunology, Brigham and Women’s Hospital and Harvard Medical School; Boston, MA, USA
| | - Jessica Lasky-Su
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School; Boston, MA, USA
| | - Rachel S. Kelly
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School; Boston, MA, USA
| | - Robert S. Zeiger
- Department of Clinical Science Kaiser Permanente Bernard J. Tyson School of Medicine; Pasadena, CA, USA
| | - George T. O’Connor
- Pulmonary Center and Department of Medicine, Boston University School of Medicine; Boston, MA, USA
| | - Leonard B. Bacharier
- Department of Pediatric Allergy, Immunology, and Pulmonary, Vanderbilt Children’s Hospital, Vanderbilt University Medical Center; Nashville, TN, USA
| | - Xiaojiong Jia
- Division of Allergy & Clinical Immunology, Brigham and Women’s Hospital and Harvard Medical School; Boston, MA, USA
| | - Avraham Beigelman
- Schneider Children’s Medical Center of Israel, Tel Aviv University; Tel Aviv, Israel; Division of Pediatric Allergy, Immunology & Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine; St. Louis, MO, USA
| | - Diane R. Gold
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School; Boston, MA, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health; Boston, MA, USA
| | - Nancy Laranjo
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School; Boston, MA, USA
| | - Supinda Bunyavanich
- Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai; New York, NY, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai; New York, NY, USA
| | - Scott T. Weiss
- Division of Allergy & Clinical Immunology, Brigham and Women’s Hospital and Harvard Medical School; Boston, MA, USA
| | - Augusto A. Litonjua
- Division of Pediatric Pulmonary Medicine, Golisano Children’s Hospital at Strong, University of Rochester Medical Center; Rochester, NY, USA
| | - Patrick J. Brennan
- Division of Allergy & Clinical Immunology, Brigham and Women’s Hospital and Harvard Medical School; Boston, MA, USA
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8
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Foer D, Wien M, Karlson EW, Song W, Boyce JA, Brennan PJ. Patient Characteristics Associated With Reactions to Mrgprx2-Activating Drugs in an Electronic Health Record-Linked Biobank. J Allergy Clin Immunol Pract 2023; 11:492-499.e2. [PMID: 36356925 DOI: 10.1016/j.jaip.2022.11.001] [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] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/24/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Mas-related G protein-couple receptor x2 (Mrgprx2) activation underlies many common non-IgE-mediated adverse drug reactions (ADRs), yet the features of patients with reactions to Mrgprx2-activating drugs are unknown. OBJECTIVE To characterize the patient-specific comorbidities and laboratory characteristics associated with listed reactions to Mrgprx2-activating drugs, including fluoroquinolones, morphine, neuromuscular blockade agents, vancomycin, and leuprolide. METHODS We used a retrospective, observational cohort study design using electronic health record data from adults with an Mrgprx2-activating drug exposure recorded within a hospital system clinical Biobank. Odds ratios (ORs) and incidence rate ratios for clinical characteristics associated with ADRs, including immediate hypersensitivity reactions, were calculated using multivariable logistic regression. RESULTS Among 59,763 patients exposed to Mrgprx2-activating drugs, 4846 had a listed ADR. Female sex, White race, asthma (OR: 1.81, 95% confidence interval [CI]: 1.68-1.94), chronic urticaria (OR: 1.73, 95% CI: 1.46-2.05), and mastocytosis (OR: 12.79, 95% CI: 5.98-27.02) were associated with increased odds of a reaction. Overall, patients with allergic disease had 1.21 times the rate of an ADR compared with patients without allergic disease. Elevated absolute eosinophil count was inversely associated with reactions, and there was no association with elevated total IgE. Observed associations were similar in a patient subgroup with immediate-type hypersensitivity reactions. CONCLUSION Specific allergic diseases and common allergic biomarkers are differentially associated with ADRs to Mrgprx2-activating drugs. These findings from a large, "real world" drug-exposed population highlight clinical factors that may contribute to non-IgE-mediated drug allergy.
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Affiliation(s)
- Dinah Foer
- Jeff and Penny Vinik Center for Allergic Disease Research, Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass; Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
| | - Matthew Wien
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Elizabeth W Karlson
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Wenyu Song
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Joshua A Boyce
- Jeff and Penny Vinik Center for Allergic Disease Research, Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Patrick J Brennan
- Jeff and Penny Vinik Center for Allergic Disease Research, Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
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9
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Klusaritz H, Paterson E, Summers C, Al-Ramahi N, Naseer N, Jeudin H, Sydnor Y, Enoch M, Dollard N, Young KD, Khan N, Henne J, Doubeni A, Kasbekar N, Gitelman Y, Brennan PJ, Bream K, Cannuscio CC, Wender RC, Feuerstein-Simon R. Community-Based COVID-19 Vaccine Clinics in Medically Underserved Neighborhoods to Improve Access and Equity, Philadelphia, 2021-2022. Am J Public Health 2022; 112:1721-1725. [PMID: 36302220 PMCID: PMC9670232 DOI: 10.2105/ajph.2022.307030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Vaccination remains key to reducing the risk of COVID-19-related severe illness and death. Because of historic medical exclusion and barriers to access, Black communities have had lower rates of COVID-19 vaccination than White communities. We describe the efforts of an academic medical institution to implement community-based COVID-19 vaccine clinics in medically underserved neighborhoods in Philadelphia, Pennsylvania. Over a 13-month period (April 2021-April 2022), the initiative delivered 9038 vaccine doses to community members, a majority of whom (57%) identified as Black. (Am J Public Health. 2022;112(12):1721-1725. https://doi.org/10.2105/AJPH.2022.307030).
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Affiliation(s)
- Heather Klusaritz
- Heather Klusaritz, Emily Paterson, Courtney Summers, Nawar Naseer, Helena Jeudin, Yuhnis Sydnor, Maurice Enoch, Nieemah Dollard, Kevin D. Young, Neda Khan, Anna Doubeni, Yevgeniy Gitelman, Yevgeniy Gitelman, Kent Bream, Carolyn C. Cannuscio, Richard C. Wender and Rachel Feuerstein-Simon are with the Perelman School of Medicine, University of Pennsylvania, Philadelphia. Nida Al-Ramahi, Jeffrey Henne, Nishaminy Kasbekar, and P. J. Brennan are with the University of Pennsylvania Health System, Philadelphia
| | - Emily Paterson
- Heather Klusaritz, Emily Paterson, Courtney Summers, Nawar Naseer, Helena Jeudin, Yuhnis Sydnor, Maurice Enoch, Nieemah Dollard, Kevin D. Young, Neda Khan, Anna Doubeni, Yevgeniy Gitelman, Yevgeniy Gitelman, Kent Bream, Carolyn C. Cannuscio, Richard C. Wender and Rachel Feuerstein-Simon are with the Perelman School of Medicine, University of Pennsylvania, Philadelphia. Nida Al-Ramahi, Jeffrey Henne, Nishaminy Kasbekar, and P. J. Brennan are with the University of Pennsylvania Health System, Philadelphia
| | - Courtney Summers
- Heather Klusaritz, Emily Paterson, Courtney Summers, Nawar Naseer, Helena Jeudin, Yuhnis Sydnor, Maurice Enoch, Nieemah Dollard, Kevin D. Young, Neda Khan, Anna Doubeni, Yevgeniy Gitelman, Yevgeniy Gitelman, Kent Bream, Carolyn C. Cannuscio, Richard C. Wender and Rachel Feuerstein-Simon are with the Perelman School of Medicine, University of Pennsylvania, Philadelphia. Nida Al-Ramahi, Jeffrey Henne, Nishaminy Kasbekar, and P. J. Brennan are with the University of Pennsylvania Health System, Philadelphia
| | - Nida Al-Ramahi
- Heather Klusaritz, Emily Paterson, Courtney Summers, Nawar Naseer, Helena Jeudin, Yuhnis Sydnor, Maurice Enoch, Nieemah Dollard, Kevin D. Young, Neda Khan, Anna Doubeni, Yevgeniy Gitelman, Yevgeniy Gitelman, Kent Bream, Carolyn C. Cannuscio, Richard C. Wender and Rachel Feuerstein-Simon are with the Perelman School of Medicine, University of Pennsylvania, Philadelphia. Nida Al-Ramahi, Jeffrey Henne, Nishaminy Kasbekar, and P. J. Brennan are with the University of Pennsylvania Health System, Philadelphia
| | - Nawar Naseer
- Heather Klusaritz, Emily Paterson, Courtney Summers, Nawar Naseer, Helena Jeudin, Yuhnis Sydnor, Maurice Enoch, Nieemah Dollard, Kevin D. Young, Neda Khan, Anna Doubeni, Yevgeniy Gitelman, Yevgeniy Gitelman, Kent Bream, Carolyn C. Cannuscio, Richard C. Wender and Rachel Feuerstein-Simon are with the Perelman School of Medicine, University of Pennsylvania, Philadelphia. Nida Al-Ramahi, Jeffrey Henne, Nishaminy Kasbekar, and P. J. Brennan are with the University of Pennsylvania Health System, Philadelphia
| | - Helena Jeudin
- Heather Klusaritz, Emily Paterson, Courtney Summers, Nawar Naseer, Helena Jeudin, Yuhnis Sydnor, Maurice Enoch, Nieemah Dollard, Kevin D. Young, Neda Khan, Anna Doubeni, Yevgeniy Gitelman, Yevgeniy Gitelman, Kent Bream, Carolyn C. Cannuscio, Richard C. Wender and Rachel Feuerstein-Simon are with the Perelman School of Medicine, University of Pennsylvania, Philadelphia. Nida Al-Ramahi, Jeffrey Henne, Nishaminy Kasbekar, and P. J. Brennan are with the University of Pennsylvania Health System, Philadelphia
| | - Yuhnis Sydnor
- Heather Klusaritz, Emily Paterson, Courtney Summers, Nawar Naseer, Helena Jeudin, Yuhnis Sydnor, Maurice Enoch, Nieemah Dollard, Kevin D. Young, Neda Khan, Anna Doubeni, Yevgeniy Gitelman, Yevgeniy Gitelman, Kent Bream, Carolyn C. Cannuscio, Richard C. Wender and Rachel Feuerstein-Simon are with the Perelman School of Medicine, University of Pennsylvania, Philadelphia. Nida Al-Ramahi, Jeffrey Henne, Nishaminy Kasbekar, and P. J. Brennan are with the University of Pennsylvania Health System, Philadelphia
| | - Maurice Enoch
- Heather Klusaritz, Emily Paterson, Courtney Summers, Nawar Naseer, Helena Jeudin, Yuhnis Sydnor, Maurice Enoch, Nieemah Dollard, Kevin D. Young, Neda Khan, Anna Doubeni, Yevgeniy Gitelman, Yevgeniy Gitelman, Kent Bream, Carolyn C. Cannuscio, Richard C. Wender and Rachel Feuerstein-Simon are with the Perelman School of Medicine, University of Pennsylvania, Philadelphia. Nida Al-Ramahi, Jeffrey Henne, Nishaminy Kasbekar, and P. J. Brennan are with the University of Pennsylvania Health System, Philadelphia
| | - Nieemah Dollard
- Heather Klusaritz, Emily Paterson, Courtney Summers, Nawar Naseer, Helena Jeudin, Yuhnis Sydnor, Maurice Enoch, Nieemah Dollard, Kevin D. Young, Neda Khan, Anna Doubeni, Yevgeniy Gitelman, Yevgeniy Gitelman, Kent Bream, Carolyn C. Cannuscio, Richard C. Wender and Rachel Feuerstein-Simon are with the Perelman School of Medicine, University of Pennsylvania, Philadelphia. Nida Al-Ramahi, Jeffrey Henne, Nishaminy Kasbekar, and P. J. Brennan are with the University of Pennsylvania Health System, Philadelphia
| | - Kevin D Young
- Heather Klusaritz, Emily Paterson, Courtney Summers, Nawar Naseer, Helena Jeudin, Yuhnis Sydnor, Maurice Enoch, Nieemah Dollard, Kevin D. Young, Neda Khan, Anna Doubeni, Yevgeniy Gitelman, Yevgeniy Gitelman, Kent Bream, Carolyn C. Cannuscio, Richard C. Wender and Rachel Feuerstein-Simon are with the Perelman School of Medicine, University of Pennsylvania, Philadelphia. Nida Al-Ramahi, Jeffrey Henne, Nishaminy Kasbekar, and P. J. Brennan are with the University of Pennsylvania Health System, Philadelphia
| | - Neda Khan
- Heather Klusaritz, Emily Paterson, Courtney Summers, Nawar Naseer, Helena Jeudin, Yuhnis Sydnor, Maurice Enoch, Nieemah Dollard, Kevin D. Young, Neda Khan, Anna Doubeni, Yevgeniy Gitelman, Yevgeniy Gitelman, Kent Bream, Carolyn C. Cannuscio, Richard C. Wender and Rachel Feuerstein-Simon are with the Perelman School of Medicine, University of Pennsylvania, Philadelphia. Nida Al-Ramahi, Jeffrey Henne, Nishaminy Kasbekar, and P. J. Brennan are with the University of Pennsylvania Health System, Philadelphia
| | - Jeffrey Henne
- Heather Klusaritz, Emily Paterson, Courtney Summers, Nawar Naseer, Helena Jeudin, Yuhnis Sydnor, Maurice Enoch, Nieemah Dollard, Kevin D. Young, Neda Khan, Anna Doubeni, Yevgeniy Gitelman, Yevgeniy Gitelman, Kent Bream, Carolyn C. Cannuscio, Richard C. Wender and Rachel Feuerstein-Simon are with the Perelman School of Medicine, University of Pennsylvania, Philadelphia. Nida Al-Ramahi, Jeffrey Henne, Nishaminy Kasbekar, and P. J. Brennan are with the University of Pennsylvania Health System, Philadelphia
| | - Anna Doubeni
- Heather Klusaritz, Emily Paterson, Courtney Summers, Nawar Naseer, Helena Jeudin, Yuhnis Sydnor, Maurice Enoch, Nieemah Dollard, Kevin D. Young, Neda Khan, Anna Doubeni, Yevgeniy Gitelman, Yevgeniy Gitelman, Kent Bream, Carolyn C. Cannuscio, Richard C. Wender and Rachel Feuerstein-Simon are with the Perelman School of Medicine, University of Pennsylvania, Philadelphia. Nida Al-Ramahi, Jeffrey Henne, Nishaminy Kasbekar, and P. J. Brennan are with the University of Pennsylvania Health System, Philadelphia
| | - Nishaminy Kasbekar
- Heather Klusaritz, Emily Paterson, Courtney Summers, Nawar Naseer, Helena Jeudin, Yuhnis Sydnor, Maurice Enoch, Nieemah Dollard, Kevin D. Young, Neda Khan, Anna Doubeni, Yevgeniy Gitelman, Yevgeniy Gitelman, Kent Bream, Carolyn C. Cannuscio, Richard C. Wender and Rachel Feuerstein-Simon are with the Perelman School of Medicine, University of Pennsylvania, Philadelphia. Nida Al-Ramahi, Jeffrey Henne, Nishaminy Kasbekar, and P. J. Brennan are with the University of Pennsylvania Health System, Philadelphia
| | - Yevgeniy Gitelman
- Heather Klusaritz, Emily Paterson, Courtney Summers, Nawar Naseer, Helena Jeudin, Yuhnis Sydnor, Maurice Enoch, Nieemah Dollard, Kevin D. Young, Neda Khan, Anna Doubeni, Yevgeniy Gitelman, Yevgeniy Gitelman, Kent Bream, Carolyn C. Cannuscio, Richard C. Wender and Rachel Feuerstein-Simon are with the Perelman School of Medicine, University of Pennsylvania, Philadelphia. Nida Al-Ramahi, Jeffrey Henne, Nishaminy Kasbekar, and P. J. Brennan are with the University of Pennsylvania Health System, Philadelphia
| | - Patrick J Brennan
- Heather Klusaritz, Emily Paterson, Courtney Summers, Nawar Naseer, Helena Jeudin, Yuhnis Sydnor, Maurice Enoch, Nieemah Dollard, Kevin D. Young, Neda Khan, Anna Doubeni, Yevgeniy Gitelman, Yevgeniy Gitelman, Kent Bream, Carolyn C. Cannuscio, Richard C. Wender and Rachel Feuerstein-Simon are with the Perelman School of Medicine, University of Pennsylvania, Philadelphia. Nida Al-Ramahi, Jeffrey Henne, Nishaminy Kasbekar, and P. J. Brennan are with the University of Pennsylvania Health System, Philadelphia
| | - Kent Bream
- Heather Klusaritz, Emily Paterson, Courtney Summers, Nawar Naseer, Helena Jeudin, Yuhnis Sydnor, Maurice Enoch, Nieemah Dollard, Kevin D. Young, Neda Khan, Anna Doubeni, Yevgeniy Gitelman, Yevgeniy Gitelman, Kent Bream, Carolyn C. Cannuscio, Richard C. Wender and Rachel Feuerstein-Simon are with the Perelman School of Medicine, University of Pennsylvania, Philadelphia. Nida Al-Ramahi, Jeffrey Henne, Nishaminy Kasbekar, and P. J. Brennan are with the University of Pennsylvania Health System, Philadelphia
| | - Carolyn C Cannuscio
- Heather Klusaritz, Emily Paterson, Courtney Summers, Nawar Naseer, Helena Jeudin, Yuhnis Sydnor, Maurice Enoch, Nieemah Dollard, Kevin D. Young, Neda Khan, Anna Doubeni, Yevgeniy Gitelman, Yevgeniy Gitelman, Kent Bream, Carolyn C. Cannuscio, Richard C. Wender and Rachel Feuerstein-Simon are with the Perelman School of Medicine, University of Pennsylvania, Philadelphia. Nida Al-Ramahi, Jeffrey Henne, Nishaminy Kasbekar, and P. J. Brennan are with the University of Pennsylvania Health System, Philadelphia
| | - Richard C Wender
- Heather Klusaritz, Emily Paterson, Courtney Summers, Nawar Naseer, Helena Jeudin, Yuhnis Sydnor, Maurice Enoch, Nieemah Dollard, Kevin D. Young, Neda Khan, Anna Doubeni, Yevgeniy Gitelman, Yevgeniy Gitelman, Kent Bream, Carolyn C. Cannuscio, Richard C. Wender and Rachel Feuerstein-Simon are with the Perelman School of Medicine, University of Pennsylvania, Philadelphia. Nida Al-Ramahi, Jeffrey Henne, Nishaminy Kasbekar, and P. J. Brennan are with the University of Pennsylvania Health System, Philadelphia
| | - Rachel Feuerstein-Simon
- Heather Klusaritz, Emily Paterson, Courtney Summers, Nawar Naseer, Helena Jeudin, Yuhnis Sydnor, Maurice Enoch, Nieemah Dollard, Kevin D. Young, Neda Khan, Anna Doubeni, Yevgeniy Gitelman, Yevgeniy Gitelman, Kent Bream, Carolyn C. Cannuscio, Richard C. Wender and Rachel Feuerstein-Simon are with the Perelman School of Medicine, University of Pennsylvania, Philadelphia. Nida Al-Ramahi, Jeffrey Henne, Nishaminy Kasbekar, and P. J. Brennan are with the University of Pennsylvania Health System, Philadelphia
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10
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Richterman A, Behrman A, Brennan PJ, O’Donnell JA, Snider CK, Chaiyachati KH. Durability of Severe Acute Respiratory Syndrome Coronavirus 2 Messenger RNA Booster Vaccine Protection Against Omicron Among Healthcare Workers With a Vaccine Mandate. Clin Infect Dis 2022; 76:e319-e326. [PMID: 35666508 PMCID: PMC9214168 DOI: 10.1093/cid/ciac454] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 04/18/2022] [Revised: 05/25/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant has spread rapidly throughout the world since being identified in South Africa in November 2021. Few studies have assessed primary series and booster vaccine effectiveness against Omicron among US healthcare workers. METHODS We conducted a test-negative case-control design to estimate BNT162b2 and mRNA1273 primary vaccination and booster effectiveness against SARS-CoV-2 infection and symptomatic coronavirus disease 2019 during an Omicron surge among employees of the University of Pennsylvania Health System. The study period was between 1 July 2021 and 5 April 2022. We defined the Delta period as 1 July to 12 December 2021 and the Omicron period as beginning 12 December 21. RESULTS Our sample included 14 520 tests (2776 [19%] positive)-7422 (506 [7%] positive) during Delta and 7098 (2270 [32%] positive) during Omicron. Benchmarked against Delta, the vaccine effectiveness of 2 vaccine doses was lower during Omicron, with no significant protection against infection. Booster doses added significant protection, although they also showed reduced effectiveness during Omicron. Compared with findings in employees who had received 2 vaccine doses, 3 doses of BNT162b2 had a relative effectiveness of 50% (95% confidence interval, 42%-56%) during Omicron, relative to 78% (63%-87%) during Delta; 3 doses of mRNA1273 had a relative effectiveness of 56% (45%-65%) during Omicron, relative to 96% (82%-99%) during Delta. Restricting the sample to symptomatic tests yielded similar results to our primary analysis. After initial waning in BNT162b2 booster protection against infection, it remained largely stable for ≥16 weeks after vaccination. CONCLUSIONS Our findings provide a strong rationale for boosters among healthcare workers in the Omicron era.
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Affiliation(s)
- Aaron Richterman
- Correspondence: Aaron Richterman, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104 ()
| | - Amy Behrman
- The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA,The University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Patrick J Brennan
- The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA,The University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Judith A O’Donnell
- The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA,The University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Christopher K Snider
- The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA,The University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Krisda H Chaiyachati
- The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA,The University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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11
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Aysola J, Clapp JT, Sullivan P, Brennan PJ, Higginbotham EJ, Kearney MD, Xu C, Thomas R, Griggs S, Abdirisak M, Hilton A, Omole T, Foster S, Mamtani M. Understanding Contributors to Racial/Ethnic Disparities in Emergency Department Throughput Times: a Sequential Mixed Methods Analysis. J Gen Intern Med 2022; 37:341-350. [PMID: 34341916 PMCID: PMC8811086 DOI: 10.1007/s11606-021-07028-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 07/08/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ensuring equitable care remains a critical issue for healthcare systems. Nationwide evidence highlights the persistence of healthcare disparities and the need for research-informed approaches for reducing them at the local level. OBJECTIVE To characterize key contributors in racial/ethnic disparities in emergency department (ED) throughput times. DESIGN We conducted a sequential mixed methods analysis to understand variations in ED care throughput times for patients eventually admitted to an emergency department at a single academic medical center from November 2017 to May 2018 (n=3152). We detailed patient progression from ED arrival to decision to admit and compared racial/ethnic differences in time intervals from electronic medical record time-stamp data. We then estimated the relationships between race/ethnicity and ED throughput times, adjusting for several patient-level variables and ED-level covariates. These quantitative analyses informed our qualitative study design, which included observations and semi-structured interviews with patients and physicians. KEY RESULTS Non-Hispanic Black as compared to non-Hispanic White patients waited significantly longer during the time interval from arrival to the physician's decision to admit, even after adjustment for several ED-level and patient demographic, clinical, and socioeconomic variables (Beta (average minutes) (SE): 16.35 (5.8); p value=.005). Qualitative findings suggest that the manner in which providers communicate, advocate, and prioritize patients may contribute to such disparities. When the race/ethnicity of provider and patient differed, providers were more likely to interrupt patients, ignore their requests, and make less eye contact. Conversely, if the race/ethnicity of provider and patient were similar, providers exhibited a greater level of advocacy, such as tracking down patient labs or consultants. Physicians with no significant ED throughput disparities articulated objective criteria such as triage scores for prioritizing patients. CONCLUSIONS Our findings suggest the importance of (1) understanding how our communication style and care may differ by race/ethnicity; and (2) taking advantage of structured processes designed to equalize care.
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Affiliation(s)
- Jaya Aysola
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA. .,Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA. .,Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA. .,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA.
| | - Justin T Clapp
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA.,Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Patricia Sullivan
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Patrick J Brennan
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Eve J Higginbotham
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA.,Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Matthew D Kearney
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Chang Xu
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA.,Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Rosemary Thomas
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Sarah Griggs
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Mohamed Abdirisak
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA.,Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Alec Hilton
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA.,Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Toluwa Omole
- Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA.,Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Sean Foster
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mira Mamtani
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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12
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Green-McKenzie J, Shofer FS, Momplaisir F, Kuter BJ, Kruse G, Bialal U, Behta M, O’Donnell J, Al-Ramahi N, Kasbekar N, Sullivan P, Okala P, Brennan PJ. Factors Associated With COVID-19 Vaccine Receipt by Health Care Personnel at a Major Academic Hospital During the First Months of Vaccine Availability. JAMA Netw Open 2021; 4:e2136582. [PMID: 34851399 PMCID: PMC8637254 DOI: 10.1001/jamanetworkopen.2021.36582] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/28/2021] [Indexed: 11/25/2022] Open
Abstract
Importance Several COVID-19 vaccines have been authorized in the US, yet preliminary evidence suggests high levels of vaccine hesitancy and wide racial, ethnic, and socioeconomic disparities in uptake. Objective To assess COVID-19 vaccine acceptance among health care personnel (HCP) during the first 4 months of availability in a large academic hospital, compare acceptance with previously measured vaccine hesitancy, and describe racial, ethnic, and socioeconomic disparities in vaccine uptake. Design, Setting, and Participants This cross-sectional study included 12 610 HCP who were offered COVID-19 vaccination at a major academic hospital in Philadelphia between December 16, 2020, and April 16, 2021. Exposures For each HCP, data were collected on occupational category, age, sex, race and ethnicity (Asian or Pacific Islander, Black or African American [Black], Hispanic, White, and multiracial), and social vulnerability index (SVI) at the zip code of residence. Main Outcomes and Measures Vaccine uptake by HCP at the employee vaccination clinic. Results The study population included 4173 men (34.8%) and 7814 women (65.2%) (623 without data). A total of 1480 were Asian or Pacific Islander (12.4%); 2563 (21.6%), Black; 452 (3.8%), Hispanic; 7086 (59.6%), White; and 192 (1.6%), multiracial; 717 had no data for race and ethnicity. The mean (SD) age was 40.9 (12.4) years, and 9573 (76.0%) received at least 1 vaccine dose during the first 4 months of vaccine availability. Adjusted for age, sex, job position, and SVI, Black (relative risk [RR], 0.69; 95% CI, 0.66-0.72) and multiracial (RR, 0.80; 95% CI, 0.73-0.89) HCP were less likely to receive vaccine compared with White HCP. When stratified by job position, Black nurses (n = 189; 62.8%), Black HCP with some patient contact (n = 466; 49.9%), and Black HCP with no patient contact (n = 636; 56.3%) all had lower vaccine uptake compared with their White and Asian or Pacific Islander counterparts. Similarly, multiracial HCP with some (n = 26; 52.0%) or no (n = 48; 58.5%) patient contact had lower vaccine uptake. In contrast, Black physicians were just as likely to receive the vaccine as physicians of other racial and ethnic groups. Conclusions and Relevance In this cross-sectional study, more than two-thirds of HCP at a large academic hospital in Philadelphia received a COVID-19 vaccine within 4 months of vaccine availability. Although racial, ethnic, and socioeconomic disparities were seen in vaccine uptake, no such disparities were found among physicians. Better understanding of factors driving these disparities may help improve uptake.
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Affiliation(s)
- Judith Green-McKenzie
- Leonard Davis Institute, Division of Occupational Medicine, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Frances S. Shofer
- Epidemiology and Biostatistics Research, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Florence Momplaisir
- Leonard Davis Institute, Department of Infectious Disease, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Barbara J. Kuter
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gregory Kruse
- University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Usama Bialal
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Maryam Behta
- University of Pennsylvania Health System, Philadelphia
| | - Judith O’Donnell
- Infection Control, Penn Presbyterian Medical Center, Division of Infectious Diseases, Clinical Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Nida Al-Ramahi
- Office of the Chief Medical Officer and Chief Quality Officer, University of Pennsylvania Health System, Philadelphia
| | | | | | - Philip Okala
- University of Pennsylvania Health System, Philadelphia
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13
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Ibrahim M, Szeto WY, Gutsche J, Weiss S, Bavaria J, Ottemiller S, Williams M, Gallagher JF, Fishman N, Cunningham R, Brady L, Brennan PJ, Acker M. Transparency, Public Reporting and a Culture of Change to Quality and Safety in Cardiac Surgery. Ann Thorac Surg 2021; 114:626-635. [PMID: 34843698 DOI: 10.1016/j.athoracsur.2021.08.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022]
Abstract
Academic medical centers have a duty to serve as hospitals of last resort for advanced cardiac surgical care and therefore manage patients at elevated risk of post-operative morbidity and mortality. They must also meet state and professional quality targets devised to protect the public. The tension between these imperatives can be managed by a multi-dimensional quality improvement program which aims to manage risk, optimize outcomes and exclude futile operations. We here share our approach to this process, its impact on our institution and discuss pertinent issues relevant to institutions in a similar situation.
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Affiliation(s)
- Michael Ibrahim
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jacob Gutsche
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steve Weiss
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph Bavaria
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephanie Ottemiller
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew Williams
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jo Fante Gallagher
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neil Fishman
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Regina Cunningham
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Luann Brady
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Patrick J Brennan
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Acker
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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14
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Rosa TLSA, Marques MAM, DeBoard Z, Hutchins K, Silva CAA, Montague CR, Yuan T, Amaral JJ, Atella GC, Rosa PS, Mattos KA, VanderVen BC, Lahiri R, Sampson NS, Brennan PJ, Belisle JT, Pessolani MCV, Berrêdo-Pinho M. Corrigendum: Reductive Power Generated by Mycobacterium leprae Through Cholesterol Oxidation Contributes to Lipid and ATP Synthesis. Front Cell Infect Microbiol 2021; 11:765326. [PMID: 34650934 PMCID: PMC8506810 DOI: 10.3389/fcimb.2021.765326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/10/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thabatta L S A Rosa
- Laboratório de Microbiologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Maria Angela M Marques
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, United States
| | - Zachary DeBoard
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, United States
| | - Kelly Hutchins
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, United States
| | - Carlos Adriano A Silva
- Laboratório de Microbiologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Christine R Montague
- Department of Microbiology and Immunology, Cornell University, Ithaca, NY, United States
| | - Tianao Yuan
- Department of Chemistry, Stony Brook University, Stony Brook, NY, United States
| | - Julio J Amaral
- Laboratório de Química Biológica, Diretoria de Metrologia Aplicada às Ciências da Vida, Instituto Nacional de Metrologia, Qualidade e Tecnologia, Rio de Janeiro, Brazil
| | - Georgia C Atella
- Laboratório de Bioquímica de Lipídeos e Lipoproteínas, Instituto de Bioquímica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Patrícia S Rosa
- Divisão de Pesquisa e Ensino, Instituto Lauro de Souza Lima, Bauru, Brazil
| | - Katherine A Mattos
- Departmento de Controle de Qualidade, Instituto de Tecnologia em Imunobiológicos, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Brian C VanderVen
- Department of Microbiology and Immunology, Cornell University, Ithaca, NY, United States
| | - Ramanuj Lahiri
- Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen's Disease Programs, Baton Rouge, LA, United States
| | - Nicole S Sampson
- Department of Chemistry, Stony Brook University, Stony Brook, NY, United States
| | - Patrick J Brennan
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, United States
| | - John T Belisle
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, United States
| | - Maria Cristina V Pessolani
- Laboratório de Microbiologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Marcia Berrêdo-Pinho
- Laboratório de Microbiologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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15
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Rosa TLSA, Marques MAM, DeBoard Z, Hutchins K, Silva CAA, Montague CR, Yuan T, Amaral JJ, Atella GC, Rosa PS, Mattos KA, VanderVen BC, Lahiri R, Sampson NS, Brennan PJ, Belisle JT, Pessolani MCV, Berrêdo-Pinho M. Reductive Power Generated by Mycobacterium leprae Through Cholesterol Oxidation Contributes to Lipid and ATP Synthesis. Front Cell Infect Microbiol 2021; 11:709972. [PMID: 34395315 PMCID: PMC8355898 DOI: 10.3389/fcimb.2021.709972] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/13/2021] [Indexed: 12/21/2022] Open
Abstract
Upon infection, Mycobacterium leprae, an obligate intracellular bacillus, induces accumulation of cholesterol-enriched lipid droplets (LDs) in Schwann cells (SCs). LDs are promptly recruited to M. leprae-containing phagosomes, and inhibition of this process decreases bacterial survival, suggesting that LD recruitment constitutes a mechanism by which host-derived lipids are delivered to intracellular M. leprae. We previously demonstrated that M. leprae has preserved only the capacity to oxidize cholesterol to cholestenone, the first step of the normal cholesterol catabolic pathway. In this study we investigated the biochemical relevance of cholesterol oxidation on bacterial pathogenesis in SCs. Firstly, we showed that M. leprae increases the uptake of LDL-cholesterol by infected SCs. Moreover, fluorescence microscopy analysis revealed a close association between M. leprae and the internalized LDL-cholesterol within the host cell. By using Mycobacterium smegmatis mutant strains complemented with M. leprae genes, we demonstrated that ml1942 coding for 3β-hydroxysteroid dehydrogenase (3β-HSD), but not ml0389 originally annotated as cholesterol oxidase (ChoD), was responsible for the cholesterol oxidation activity detected in M. leprae. The 3β-HSD activity generates the electron donors NADH and NADPH that, respectively, fuel the M. leprae respiratory chain and provide reductive power for the biosynthesis of the dominant bacterial cell wall lipids phthiocerol dimycocerosate (PDIM) and phenolic glycolipid (PGL)-I. Inhibition of M. leprae 3β-HSD activity with the 17β-[N-(2,5-di-t-butylphenyl)carbamoyl]-6-azaandrost-4-en-3one (compound 1), decreased bacterial intracellular survival in SCs. In conclusion, our findings confirm the accumulation of cholesterol in infected SCs and its potential delivery to the intracellular bacterium. Furthermore, we provide strong evidence that cholesterol oxidation is an essential catabolic pathway for M. leprae pathogenicity and point to 3β-HSD as a prime drug target that may be used in combination with current multidrug regimens to shorten leprosy treatment and ameliorate nerve damage.
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Affiliation(s)
- Thabatta L S A Rosa
- Laboratório de Microbiologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Maria Angela M Marques
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, United States
| | - Zachary DeBoard
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, United States
| | - Kelly Hutchins
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, United States
| | - Carlos Adriano A Silva
- Laboratório de Microbiologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Christine R Montague
- Department of Microbiology and Immunology, Cornell University, Ithaca, NY, United States
| | - Tianao Yuan
- Department of Chemistry, Stony Brook University, Stony Brook, NY, United States
| | - Julio J Amaral
- Laboratório de Química Biológica, Diretoria de Metrologia Aplicada às Ciências da Vida, Instituto Nacional de Metrologia, Qualidade e Tecnologia, Rio de Janeiro, Brazil
| | - Georgia C Atella
- Laboratório de Bioquímica de Lipídeos e Lipoproteínas, Instituto de Bioquímica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Patrícia S Rosa
- Divisão de Pesquisa e Ensino, Instituto Lauro de Souza Lima, Bauru, Brazil
| | - Katherine A Mattos
- Departmento de Controle de Qualidade, Instituto de Tecnologia em Imunobiológicos, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Brian C VanderVen
- Department of Microbiology and Immunology, Cornell University, Ithaca, NY, United States
| | - Ramanuj Lahiri
- Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen's Disease Programs, Baton Rouge, LA, United States
| | - Nicole S Sampson
- Department of Chemistry, Stony Brook University, Stony Brook, NY, United States
| | - Patrick J Brennan
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, United States
| | - John T Belisle
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, United States
| | - Maria Cristina V Pessolani
- Laboratório de Microbiologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Marcia Berrêdo-Pinho
- Laboratório de Microbiologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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16
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Broyles AD, Banerji A, Barmettler S, Biggs CM, Blumenthal K, Brennan PJ, Breslow RG, Brockow K, Buchheit KM, Cahill KN, Cernadas J, Chiriac AM, Crestani E, Demoly P, Dewachter P, Dilley M, Farmer JR, Foer D, Fried AJ, Garon SL, Giannetti MP, Hepner DL, Hong DI, Hsu JT, Kothari PH, Kyin T, Lax T, Lee MJ, Lee-Sarwar K, Liu A, Logsdon S, Louisias M, MacGinnitie A, Maciag M, Minnicozzi S, Norton AE, Otani IM, Park M, Patil S, Phillips EJ, Picard M, Platt CD, Rachid R, Rodriguez T, Romano A, Stone CA, Torres MJ, Verdú M, Wang AL, Wickner P, Wolfson AR, Wong JT, Yee C, Zhou J, Castells M. Practical Guidance for the Evaluation and Management of Drug Hypersensitivity: Specific Drugs. J Allergy Clin Immunol Pract 2021; 8:S16-S116. [PMID: 33039007 DOI: 10.1016/j.jaip.2020.08.006] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Ana Dioun Broyles
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Sara Barmettler
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Catherine M Biggs
- Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Kimberly Blumenthal
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Patrick J Brennan
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Rebecca G Breslow
- Division of Sports Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - Kathleen M Buchheit
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Katherine N Cahill
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Josefina Cernadas
- Allergology and Immunology Service, Centro Hospitalar Universitário de S.João Hospital, Porto, Portugal
| | - Anca Mirela Chiriac
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Elena Crestani
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Pascale Dewachter
- Department of Anesthesiology and Intensive Care Medicine, Groupe Hospitalier Paris-Seine-Saint-Denis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Meredith Dilley
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Jocelyn R Farmer
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Dinah Foer
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Ari J Fried
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Sarah L Garon
- Associated Allergists and Asthma Specialists, Chicago, Ill
| | - Matthew P Giannetti
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - David L Hepner
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Mass
| | - David I Hong
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Joyce T Hsu
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Parul H Kothari
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Timothy Kyin
- Division of Asthma, Allergy & Immunology, University of Virginia, Charlottesville, Va
| | - Timothy Lax
- Division of Allergy and Inflammation, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Min Jung Lee
- Allergy and Immunology at Hoag Medical Group, Newport Beach, Calif
| | - Kathleen Lee-Sarwar
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Anne Liu
- Division of Allergy / Immunology, Stanford University School of Medicine, Palo Alto, Calif
| | - Stephanie Logsdon
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Margee Louisias
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Andrew MacGinnitie
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Michelle Maciag
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Samantha Minnicozzi
- Division of Allergy and Clinical Immunology, Respiratory Medicine, Department of Pediatrics, University of Virginia, Charlottesville, Va
| | - Allison E Norton
- Division of Allergy, Immunology and Pulmonology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn
| | - Iris M Otani
- Division of Pulmonary, Critical Care, Allergy, and Sleep, Department of Medicine, University of California, San Francisco Medical Center, San Francisco, Calif
| | - Miguel Park
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minn
| | - Sarita Patil
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Elizabeth J Phillips
- Department of Medicine & Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tenn
| | - Matthieu Picard
- Division of Allergy and Clinical Immunology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Craig D Platt
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Rima Rachid
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Tito Rodriguez
- Drug Allergy Department, Al-Rashed Allergy Center, Sulaibikhat, Al-Kuwait, Kuwait
| | - Antonino Romano
- IRCCS Oasi Maria S.S., Troina, Italy & Fondazione Mediterranea G.B. Morgagni, Catania, Italy
| | - Cosby A Stone
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Maria Jose Torres
- Allergy Unit and Research Group, Hospital Regional Universitario de Málaga, UMA-IBIMA-BIONAND, ARADyAL, Málaga, Spain
| | - Miriam Verdú
- Allergy Unit, Hospital Universitario de Ceuta, Ceuta, Spain
| | - Alberta L Wang
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Paige Wickner
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Anna R Wolfson
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Johnson T Wong
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Christina Yee
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Joseph Zhou
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Mariana Castells
- Drug hypersensitivity and Desensitization Center, Brigham and Women's Hospital, Boston, Mass
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17
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Anesi GL, Jablonski J, Harhay MO, Atkins JH, Bajaj J, Baston C, Brennan PJ, Candeloro CL, Catalano LM, Cereda MF, Chandler JM, Christie JD, Collins T, Courtright KR, Fuchs BD, Gordon E, Greenwood JC, Gudowski S, Hanish A, Hanson CW, Heuer M, Kinniry P, Kornfield ZN, Kruse GB, Lane-Fall M, Martin ND, Mikkelsen ME, Negoianu D, Pascual JL, Patel MB, Pugliese SC, Qasim ZA, Reilly JP, Salmon J, Schweickert WD, Scott MJ, Shashaty MGS, Sicoutris CP, Wang JK, Wang W, Wani AA, Anderson BJ, Gutsche JT. Characteristics, Outcomes, and Trends of Patients With COVID-19-Related Critical Illness at a Learning Health System in the United States. Ann Intern Med 2021; 174:613-621. [PMID: 33460330 PMCID: PMC7901669 DOI: 10.7326/m20-5327] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [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] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic continues to surge in the United States and globally. OBJECTIVE To describe the epidemiology of COVID-19-related critical illness, including trends in outcomes and care delivery. DESIGN Single-health system, multihospital retrospective cohort study. SETTING 5 hospitals within the University of Pennsylvania Health System. PATIENTS Adults with COVID-19-related critical illness who were admitted to an intensive care unit (ICU) with acute respiratory failure or shock during the initial surge of the pandemic. MEASUREMENTS The primary exposure for outcomes and care delivery trend analyses was longitudinal time during the pandemic. The primary outcome was all-cause 28-day in-hospital mortality. Secondary outcomes were all-cause death at any time, receipt of mechanical ventilation (MV), and readmissions. RESULTS Among 468 patients with COVID-19-related critical illness, 319 (68.2%) were treated with MV and 121 (25.9%) with vasopressors. Outcomes were notable for an all-cause 28-day in-hospital mortality rate of 29.9%, a median ICU stay of 8 days (interquartile range [IQR], 3 to 17 days), a median hospital stay of 13 days (IQR, 7 to 25 days), and an all-cause 30-day readmission rate (among nonhospice survivors) of 10.8%. Mortality decreased over time, from 43.5% (95% CI, 31.3% to 53.8%) to 19.2% (CI, 11.6% to 26.7%) between the first and last 15-day periods in the core adjusted model, whereas patient acuity and other factors did not change. LIMITATIONS Single-health system study; use of, or highly dynamic trends in, other clinical interventions were not evaluated, nor were complications. CONCLUSION Among patients with COVID-19-related critical illness admitted to ICUs of a learning health system in the United States, mortality seemed to decrease over time despite stable patient characteristics. Further studies are necessary to confirm this result and to investigate causal mechanisms. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.
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Affiliation(s)
- George L Anesi
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Juliane Jablonski
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Michael O Harhay
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Joshua H Atkins
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Jasmeet Bajaj
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Cameron Baston
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Patrick J Brennan
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Christina L Candeloro
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Lauren M Catalano
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Maurizio F Cereda
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - John M Chandler
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Jason D Christie
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Tara Collins
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Katherine R Courtright
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Barry D Fuchs
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Emily Gordon
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - John C Greenwood
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Steven Gudowski
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Asaf Hanish
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - C William Hanson
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Monica Heuer
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Paul Kinniry
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Zev Noah Kornfield
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Gregory B Kruse
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Meghan Lane-Fall
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Niels D Martin
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Mark E Mikkelsen
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Dan Negoianu
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Jose L Pascual
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Maulik B Patel
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Steven C Pugliese
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Zaffer A Qasim
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - John P Reilly
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - John Salmon
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - William D Schweickert
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Michael J Scott
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Michael G S Shashaty
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Corinna P Sicoutris
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - John K Wang
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Wei Wang
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Arshad A Wani
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Brian J Anderson
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
| | - Jacob T Gutsche
- University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
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18
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McKenna RA, Lee A, Yan C, Vu GH, Jantzen EC, Brennan PJ, Watson A, Burlingame C, Lin IC. Effective Reduction in Opioid Prescriptions for Ambulatory Lesion Excisions in Pediatric Patients. Plast Reconstr Surg Glob Open 2021; 9:e3466. [PMID: 33747693 PMCID: PMC7963496 DOI: 10.1097/gox.0000000000003466] [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] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/07/2021] [Indexed: 12/20/2022]
Abstract
Childhood opioid consumption is potentially deleterious to cognitive development and may predispose children to later addiction. Opioids are frequently prescribed for outpatient surgery but may not be necessary for adequate pain control. We aimed to reduce opioid prescriptions for outpatient pediatric skin and soft tissue lesion excisions using quality improvement (QI) methods. METHODS A multidisciplinary team identified drivers for opioid prescriptions. Interventions were provider education, improving computer order set defaults, and promoting non-narcotic pain control strategies and patient-family education. Outcomes included percentage of patients receiving opioid prescriptions and patient-satisfaction scores. Data were retrospectively collected for 3 years before the QI project and prospectively tracked over the 8-month QI period and the following 18 months. RESULTS The percentage of patients receiving an opioid prescription after outpatient skin or soft tissue excision dropped significantly from 18% before intervention to 6% at the end of the intervention period. Patient-reported satisfaction with pain control improved following the QI intervention. Satisfaction with postoperative pain control was independent of closure size or receipt of a postoperative opioid prescription. Intraoperative use of lidocaine or bupivacaine significantly decreased the incidence of postoperative opioid prescription in both bivariate and multivariate analyses. Results were maintained at 18 months after the conclusion of the QI project. CONCLUSION Raising provider awareness, educating patients on expected postoperative pain management options, and prioritizing non-narcotic medications postoperatively successfully reduced opioid prescription rates in children undergoing skin and soft tissue lesion excisions and simultaneously improved patient-satisfaction scores.
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Affiliation(s)
- Rachel A. McKenna
- From the Division of Plastic and Reconstructive Surgery, The Children’s Hospital of Philadelphia, Philadelphia, Pa
| | - Alfred Lee
- From the Division of Plastic and Reconstructive Surgery, The Children’s Hospital of Philadelphia, Philadelphia, Pa
| | - Chen Yan
- From the Division of Plastic and Reconstructive Surgery, The Children’s Hospital of Philadelphia, Philadelphia, Pa
| | - Giap H. Vu
- From the Division of Plastic and Reconstructive Surgery, The Children’s Hospital of Philadelphia, Philadelphia, Pa
| | - Ellen C. Jantzen
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pa
| | - Patrick J. Brennan
- Department of Nursing and Clinical Care Services, The Children’s Hospital of Philadelphia, Philadelphia, Pa
| | - Adam Watson
- Office of Clinical Quality Improvement, The Children’s Hospital of Philadelphia, Philadelphia, Pa
| | - Caroline Burlingame
- Office of Clinical Quality Improvement, The Children’s Hospital of Philadelphia, Philadelphia, Pa
| | - Ines C. Lin
- From the Division of Plastic and Reconstructive Surgery, The Children’s Hospital of Philadelphia, Philadelphia, Pa
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19
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Berns JS, Brennan PJ. Helping Medical Trainees Understand the Financial Health of Training Institutions. Acad Med 2020; 95:1630. [PMID: 33109968 DOI: 10.1097/acm.0000000000003664] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Jeffrey S Berns
- Associate dean for graduate medical education and designated institutional official, University of Pennsylvania Health System, Philadelphia, Pennsylvania;
| | - Patrick J Brennan
- Chief medical officer, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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20
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Broyles AD, Banerji A, Barmettler S, Biggs CM, Blumenthal K, Brennan PJ, Breslow RG, Brockow K, Buchheit KM, Cahill KN, Cernadas J, Chiriac AM, Crestani E, Demoly P, Dewachter P, Dilley M, Farmer JR, Foer D, Fried AJ, Garon SL, Giannetti MP, Hepner DL, Hong DI, Hsu JT, Kothari PH, Kyin T, Lax T, Lee MJ, Lee-Sarwar K, Liu A, Logsdon S, Louisias M, MacGinnitie A, Maciag M, Minnicozzi S, Norton AE, Otani IM, Park M, Patil S, Phillips EJ, Picard M, Platt CD, Rachid R, Rodriguez T, Romano A, Stone CA, Torres MJ, Verdú M, Wang AL, Wickner P, Wolfson AR, Wong JT, Yee C, Zhou J, Castells M. Practical Guidance for the Evaluation and Management of Drug Hypersensitivity: Specific Drugs. J Allergy Clin Immunol Pract 2020. [PMID: 33039007 DOI: 10.1016/j.jaip.2020.08.006)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ana Dioun Broyles
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Sara Barmettler
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Catherine M Biggs
- Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Kimberly Blumenthal
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Patrick J Brennan
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Rebecca G Breslow
- Division of Sports Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - Kathleen M Buchheit
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Katherine N Cahill
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Josefina Cernadas
- Allergology and Immunology Service, Centro Hospitalar Universitário de S.João Hospital, Porto, Portugal
| | - Anca Mirela Chiriac
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Elena Crestani
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Pascale Dewachter
- Department of Anesthesiology and Intensive Care Medicine, Groupe Hospitalier Paris-Seine-Saint-Denis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Meredith Dilley
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Jocelyn R Farmer
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Dinah Foer
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Ari J Fried
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Sarah L Garon
- Associated Allergists and Asthma Specialists, Chicago, Ill
| | - Matthew P Giannetti
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - David L Hepner
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Mass
| | - David I Hong
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Joyce T Hsu
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Parul H Kothari
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Timothy Kyin
- Division of Asthma, Allergy & Immunology, University of Virginia, Charlottesville, Va
| | - Timothy Lax
- Division of Allergy and Inflammation, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Min Jung Lee
- Allergy and Immunology at Hoag Medical Group, Newport Beach, Calif
| | - Kathleen Lee-Sarwar
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Anne Liu
- Division of Allergy / Immunology, Stanford University School of Medicine, Palo Alto, Calif
| | - Stephanie Logsdon
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Margee Louisias
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Andrew MacGinnitie
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Michelle Maciag
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Samantha Minnicozzi
- Division of Allergy and Clinical Immunology, Respiratory Medicine, Department of Pediatrics, University of Virginia, Charlottesville, Va
| | - Allison E Norton
- Division of Allergy, Immunology and Pulmonology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn
| | - Iris M Otani
- Division of Pulmonary, Critical Care, Allergy, and Sleep, Department of Medicine, University of California, San Francisco Medical Center, San Francisco, Calif
| | - Miguel Park
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minn
| | - Sarita Patil
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Elizabeth J Phillips
- Department of Medicine & Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tenn
| | - Matthieu Picard
- Division of Allergy and Clinical Immunology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Craig D Platt
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Rima Rachid
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Tito Rodriguez
- Drug Allergy Department, Al-Rashed Allergy Center, Sulaibikhat, Al-Kuwait, Kuwait
| | - Antonino Romano
- IRCCS Oasi Maria S.S., Troina, Italy & Fondazione Mediterranea G.B. Morgagni, Catania, Italy
| | - Cosby A Stone
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Maria Jose Torres
- Allergy Unit and Research Group, Hospital Regional Universitario de Málaga, UMA-IBIMA-BIONAND, ARADyAL, Málaga, Spain
| | - Miriam Verdú
- Allergy Unit, Hospital Universitario de Ceuta, Ceuta, Spain
| | - Alberta L Wang
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Paige Wickner
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Anna R Wolfson
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Johnson T Wong
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Christina Yee
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Joseph Zhou
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Mariana Castells
- Drug hypersensitivity and Desensitization Center, Brigham and Women's Hospital, Boston, Mass
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21
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Weissman GE, Crane-Droesch A, Chivers C, Luong T, Hanish A, Levy MZ, Lubken J, Becker M, Draugelis ME, Anesi GL, Brennan PJ, Christie JD, Hanson CW, Mikkelsen ME, Halpern SD. Locally Informed Simulation to Predict Hospital Capacity Needs During the COVID-19 Pandemic. Ann Intern Med 2020; 173:21-28. [PMID: 32259197 PMCID: PMC7153364 DOI: 10.7326/m20-1260] [Citation(s) in RCA: 157] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic challenges hospital leaders to make time-sensitive, critical decisions about clinical operations and resource allocations. OBJECTIVE To estimate the timing of surges in clinical demand and the best- and worst-case scenarios of local COVID-19-induced strain on hospital capacity, and thus inform clinical operations and staffing demands and identify when hospital capacity would be saturated. DESIGN Monte Carlo simulation instantiation of a susceptible, infected, removed (SIR) model with a 1-day cycle. SETTING 3 hospitals in an academic health system. PATIENTS All people living in the greater Philadelphia region. MEASUREMENTS The COVID-19 Hospital Impact Model (CHIME) (http://penn-chime.phl.io) SIR model was used to estimate the time from 23 March 2020 until hospital capacity would probably be exceeded, and the intensity of the surge, including for intensive care unit (ICU) beds and ventilators. RESULTS Using patients with COVID-19 alone, CHIME estimated that it would be 31 to 53 days before demand exceeds existing hospital capacity. In best- and worst-case scenarios of surges in the number of patients with COVID-19, the needed total capacity for hospital beds would reach 3131 to 12 650 across the 3 hospitals, including 338 to 1608 ICU beds and 118 to 599 ventilators. LIMITATIONS Model parameters were taken directly or derived from published data across heterogeneous populations and practice environments and from the health system's historical data. CHIME does not incorporate more transition states to model infection severity, social networks to model transmission dynamics, or geographic information to account for spatial patterns of human interaction. CONCLUSION Publicly available and designed for hospital operations leaders, this modeling tool can inform preparations for capacity strain during the early days of a pandemic. PRIMARY FUNDING SOURCE University of Pennsylvania Health System and the Palliative and Advanced Illness Research Center.
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Affiliation(s)
- Gary E Weissman
- University of Pennsylvania, Philadelphia, Pennsylvania (G.E.W., M.Z.L., G.L.A., P.J.B., J.D.C., C.W.H., M.E.M., S.D.H.)
| | - Andrew Crane-Droesch
- University of Pennsylvania and Penn Medicine Predictive Healthcare, Philadelphia, Pennsylvania (A.C., M.E.D.)
| | - Corey Chivers
- Penn Medicine Predictive Healthcare, Philadelphia, Pennsylvania (C.C., T.L., A.H., J.L., M.B.)
| | - ThaiBinh Luong
- Penn Medicine Predictive Healthcare, Philadelphia, Pennsylvania (C.C., T.L., A.H., J.L., M.B.)
| | - Asaf Hanish
- Penn Medicine Predictive Healthcare, Philadelphia, Pennsylvania (C.C., T.L., A.H., J.L., M.B.)
| | - Michael Z Levy
- University of Pennsylvania, Philadelphia, Pennsylvania (G.E.W., M.Z.L., G.L.A., P.J.B., J.D.C., C.W.H., M.E.M., S.D.H.)
| | - Jason Lubken
- Penn Medicine Predictive Healthcare, Philadelphia, Pennsylvania (C.C., T.L., A.H., J.L., M.B.)
| | - Michael Becker
- Penn Medicine Predictive Healthcare, Philadelphia, Pennsylvania (C.C., T.L., A.H., J.L., M.B.)
| | - Michael E Draugelis
- University of Pennsylvania and Penn Medicine Predictive Healthcare, Philadelphia, Pennsylvania (A.C., M.E.D.)
| | - George L Anesi
- University of Pennsylvania, Philadelphia, Pennsylvania (G.E.W., M.Z.L., G.L.A., P.J.B., J.D.C., C.W.H., M.E.M., S.D.H.)
| | - Patrick J Brennan
- University of Pennsylvania, Philadelphia, Pennsylvania (G.E.W., M.Z.L., G.L.A., P.J.B., J.D.C., C.W.H., M.E.M., S.D.H.)
| | - Jason D Christie
- University of Pennsylvania, Philadelphia, Pennsylvania (G.E.W., M.Z.L., G.L.A., P.J.B., J.D.C., C.W.H., M.E.M., S.D.H.)
| | - C William Hanson
- University of Pennsylvania, Philadelphia, Pennsylvania (G.E.W., M.Z.L., G.L.A., P.J.B., J.D.C., C.W.H., M.E.M., S.D.H.)
| | - Mark E Mikkelsen
- University of Pennsylvania, Philadelphia, Pennsylvania (G.E.W., M.Z.L., G.L.A., P.J.B., J.D.C., C.W.H., M.E.M., S.D.H.)
| | - Scott D Halpern
- University of Pennsylvania, Philadelphia, Pennsylvania (G.E.W., M.Z.L., G.L.A., P.J.B., J.D.C., C.W.H., M.E.M., S.D.H.)
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22
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Nagai J, Balestrieri B, Fanning LB, Kyin T, Cirka H, Lin J, Idzko M, Zech A, Kim EY, Brennan PJ, Boyce JA. P2Y6 signaling in alveolar macrophages prevents leukotriene-dependent type 2 allergic lung inflammation. J Clin Invest 2020; 129:5169-5186. [PMID: 31638598 DOI: 10.1172/jci129761] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/20/2019] [Indexed: 02/03/2023] Open
Abstract
Antagonists of the type 1 cysteinyl leukotriene receptor (CysLT1R) are widely used to treat asthma and allergic rhinitis, with variable response rates. Alveolar macrophages express UDP-specific P2Y6 receptors that can be blocked by off-target effects of CysLT1R antagonists. Sensitizing intranasal doses of an extract from the house dust mite Dermatophagoides farinae (Df) sharply increased the levels of UDP detected in bronchoalveolar lavage fluid of mice. Conditional deletion of P2Y6 receptors before sensitization exacerbated eosinophilic lung inflammation and type 2 cytokine production in response to subsequent Df challenge. P2Y6 receptor signaling was necessary for dectin-2-dependent production of protective IL-12p40 and Th1 chemokines by alveolar macrophages, leading to activation of NK cells to generate IFN-γ. Administration of CysLT1R antagonists during sensitization blocked UDP-elicited potentiation of IL-12p40 production by macrophages in vitro, suppressed the Df-induced production of IL-12p40 and IFN-γ in vivo, and suppressed type 2 inflammation only in P2Y6-deficient mice. Thus, P2Y6 receptor signaling drives an innate macrophage/IL-12/NK cell/IFN-γ axis that prevents inappropriate allergic type 2 immune responses on respiratory allergen exposure and counteracts the Th2 priming effect of CysLT1R signaling at sensitization. Targeting P2Y6 signaling might prove to be a potential additional treatment strategy for allergy.
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Affiliation(s)
- Jun Nagai
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Jeff and Penny Vinik Center for Allergic Disease Research, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Barbara Balestrieri
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Jeff and Penny Vinik Center for Allergic Disease Research, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Laura B Fanning
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Jeff and Penny Vinik Center for Allergic Disease Research, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Timothy Kyin
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Jeff and Penny Vinik Center for Allergic Disease Research, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Haley Cirka
- Jeff and Penny Vinik Center for Allergic Disease Research, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Junrui Lin
- Jeff and Penny Vinik Center for Allergic Disease Research, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marco Idzko
- Department of Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Andreas Zech
- Department of Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Edy Y Kim
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Division of Pulmonary Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Patrick J Brennan
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Jeff and Penny Vinik Center for Allergic Disease Research, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Joshua A Boyce
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Jeff and Penny Vinik Center for Allergic Disease Research, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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23
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Donado CA, Cao AB, Simmons DP, Croker BA, Brennan PJ, Brenner MB. A Two-Cell Model for IL-1β Release Mediated by Death-Receptor Signaling. Cell Rep 2020; 31:107466. [PMID: 32268091 PMCID: PMC7192215 DOI: 10.1016/j.celrep.2020.03.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 12/19/2019] [Accepted: 03/10/2020] [Indexed: 01/22/2023] Open
Abstract
Interleukin-1β (IL-1β) is a key orchestrator of anti-microbial immunity whose secretion is typically dependent on activation of inflammasomes. However, many pathogens have evolved strategies to evade inflammasome activation. Here we describe an alternative, two-cell model for IL-1β release where invariant natural killer T (iNKT) cells use the death receptor pathway to instruct antigen-presenting cells to secrete IL-1β. Following cognate interactions with TLR-primed bone marrow-derived dendritic cells (BMDCs), iNKT cells rapidly translocate intracellular Fas ligand to the surface to engage Fas on BMDCs. Fas ligation activates a caspase-8-dependent signaling cascade in BMDCs that drives IL-1β release largely independent of inflammasomes. The apoptotic program initiated by Fas ligation rapidly transitions into a pyroptosis-like form of cell death mediated by gasdermin D. Together, our findings support a two-cell model for IL-1β secretion that may supersede inflammasome activation when cytosolic triggers fail.
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Affiliation(s)
- Carlos A Donado
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA; Division of Medical Sciences, Harvard Medical School, Boston, MA 02115, USA
| | - Anh B Cao
- Division of Medical Sciences, Harvard Medical School, Boston, MA 02115, USA
| | - Daimon P Simmons
- Department of Pathology, Brigham and Women's and Harvard Medical School, Boston, MA 02115, USA
| | - Ben A Croker
- Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA; Division of Allergy, Immunology & Rheumatology, Department of Pediatrics, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Patrick J Brennan
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
| | - Michael B Brenner
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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Liu H, Guinipero TL, Schieffer KM, Carter C, Colace S, Leonard JR, Orr BA, Kahwash SB, Brennan PJ, Fitch JR, Kelly B, Magrini VJ, White P, Wilson RK, Mardis ER, Cottrell CE, Boué DR. De novo primary central nervous system pure erythroid leukemia/sarcoma with t(1;16)(p31;q24) NFIA/CBFA2T3 translocation. Haematologica 2020; 105:e194-e197. [PMID: 31949013 DOI: 10.3324/haematol.2019.231928] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Huifei Liu
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Terri L Guinipero
- Department of Hematology/Oncology/BMT, Division of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Kathleen M Schieffer
- The Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Chris Carter
- Indiana University Health Bloomington Hospital, Bloomington, IN
| | - Susan Colace
- Department of Hematology/Oncology/BMT, Division of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Jeffrey R Leonard
- Department of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, OH
| | - Brent A Orr
- Pathology Department, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Samir B Kahwash
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Patrick J Brennan
- The Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH
| | - James R Fitch
- The Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Benjamin Kelly
- The Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Vincent J Magrini
- The Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Peter White
- The Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Richard K Wilson
- The Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Elaine R Mardis
- The Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Catherine E Cottrell
- The Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Daniel R Boué
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
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25
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Darby CA, Fitch JR, Brennan PJ, Kelly BJ, Bir N, Magrini V, Leonard J, Cottrell CE, Gastier-Foster JM, Wilson RK, Mardis ER, White P, Langmead B, Schatz MC. Samovar: Single-Sample Mosaic Single-Nucleotide Variant Calling with Linked Reads. iScience 2019; 18:1-10. [PMID: 31271967 PMCID: PMC6609817 DOI: 10.1016/j.isci.2019.05.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 04/09/2019] [Revised: 05/06/2019] [Accepted: 05/24/2019] [Indexed: 12/25/2022] Open
Abstract
Linked-read sequencing enables greatly improves haplotype assembly over standard paired-end analysis. The detection of mosaic single-nucleotide variants benefits from haplotype assembly when the model is informed by the mapping between constituent reads and linked reads. Samovar evaluates haplotype-discordant reads identified through linked-read sequencing, thus enabling phasing and mosaic variant detection across the entire genome. Samovar trains a random forest model to score candidate sites using a dataset that considers read quality, phasing, and linked-read characteristics. Samovar calls mosaic single-nucleotide variants (SNVs) within a single sample with accuracy comparable with what previously required trios or matched tumor/normal pairs and outperforms single-sample mosaic variant callers at minor allele frequency 5%-50% with at least 30X coverage. Samovar finds somatic variants in both tumor and normal whole-genome sequencing from 13 pediatric cancer cases that can be corroborated with high recall with whole exome sequencing. Samovar is available open-source at https://github.com/cdarby/samovar under the MIT license.
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Affiliation(s)
- Charlotte A Darby
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - James R Fitch
- The Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Patrick J Brennan
- The Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Benjamin J Kelly
- The Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Natalie Bir
- The Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Vincent Magrini
- The Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jeffrey Leonard
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA; Department of Neurosurgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Catherine E Cottrell
- The Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Julie M Gastier-Foster
- The Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Richard K Wilson
- The Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Elaine R Mardis
- The Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Peter White
- The Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ben Langmead
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA.
| | - Michael C Schatz
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA; Department of Biology, Johns Hopkins University, Baltimore, MD, USA; Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA.
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26
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Reinink P, Buter J, Mishra VK, Ishikawa E, Cheng TY, Willemsen PTJ, Porwollik S, Brennan PJ, Heinz E, Mayfield JA, Dougan G, van Els CA, Cerundolo V, Napolitani G, Yamasaki S, Minnaard AJ, McClelland M, Moody DB, Van Rhijn I. Discovery of Salmonella trehalose phospholipids reveals functional convergence with mycobacteria. J Exp Med 2019; 216:757-771. [PMID: 30804000 PMCID: PMC6446866 DOI: 10.1084/jem.20181812] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/08/2018] [Accepted: 02/01/2019] [Indexed: 01/11/2023] Open
Abstract
Salmonella species are among the world's most prevalent pathogens. Because the cell wall interfaces with the host, we designed a lipidomics approach to reveal pathogen-specific cell wall compounds. Among the molecules differentially expressed between Salmonella Paratyphi and S. Typhi, we focused on lipids that are enriched in S. Typhi, because it causes typhoid fever. We discovered a previously unknown family of trehalose phospholipids, 6,6'-diphosphatidyltrehalose (diPT) and 6-phosphatidyltrehalose (PT). Cardiolipin synthase B (ClsB) is essential for PT and diPT but not for cardiolipin biosynthesis. Chemotyping outperformed clsB homology analysis in evaluating synthesis of diPT. DiPT is restricted to a subset of Gram-negative bacteria: large amounts are produced by S. Typhi, lower amounts by other pathogens, and variable amounts by Escherichia coli strains. DiPT activates Mincle, a macrophage activating receptor that also recognizes mycobacterial cord factor (6,6'-trehalose dimycolate). Thus, Gram-negative bacteria show convergent function with mycobacteria. Overall, we discovered a previously unknown immunostimulant that is selectively expressed among medically important bacterial species.
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Affiliation(s)
- Peter Reinink
- Department of Infectious Diseases and Immunology, School of Veterinary Medicine, Utrecht University, Utrecht, Netherlands.,Department of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA
| | - Jeffrey Buter
- Department of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA
| | - Vivek K Mishra
- Stratingh Institute for Chemistry, University of Groningen, Groningen, Netherlands
| | - Eri Ishikawa
- Department of Molecular Immunology, Immunology Frontier Research Center, Osaka University, Osaka, Japan.,Department of Molecular Immunology, Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
| | - Tan-Yun Cheng
- Department of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA
| | - Peter T J Willemsen
- Wageningen Bioveterinary Research, Department of Infection Biology, Lelystad, Netherlands
| | - Steffen Porwollik
- Department of Microbiology and Molecular Genetics, University of California, Irvine, Irvine, CA
| | - Patrick J Brennan
- Department of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA
| | - Eva Heinz
- Wellcome Trust Sanger Institute, Hinxton, UK
| | - Jacob A Mayfield
- Department of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA
| | | | - Cécile A van Els
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Vincenzo Cerundolo
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Giorgio Napolitani
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Sho Yamasaki
- Department of Molecular Immunology, Immunology Frontier Research Center, Osaka University, Osaka, Japan.,Department of Molecular Immunology, Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
| | - Adriaan J Minnaard
- Stratingh Institute for Chemistry, University of Groningen, Groningen, Netherlands
| | - Michael McClelland
- Department of Microbiology and Molecular Genetics, University of California, Irvine, Irvine, CA
| | - D Branch Moody
- Department of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA
| | - Ildiko Van Rhijn
- Department of Infectious Diseases and Immunology, School of Veterinary Medicine, Utrecht University, Utrecht, Netherlands .,Department of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA
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27
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Gutierrez-Arcelus M, Teslovich N, Mola AR, Polidoro RB, Nathan A, Kim H, Hannes S, Slowikowski K, Watts GFM, Korsunsky I, Brenner MB, Raychaudhuri S, Brennan PJ. Lymphocyte innateness defined by transcriptional states reflects a balance between proliferation and effector functions. Nat Commun 2019; 10:687. [PMID: 30737409 PMCID: PMC6368609 DOI: 10.1038/s41467-019-08604-4] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 01/21/2019] [Indexed: 02/06/2023] Open
Abstract
How innate T cells (ITC), including invariant natural killer T (iNKT) cells, mucosal-associated invariant T (MAIT) cells, and γδ T cells, maintain a poised effector state has been unclear. Here we address this question using low-input and single-cell RNA-seq of human lymphocyte populations. Unbiased transcriptomic analyses uncover a continuous ‘innateness gradient’, with adaptive T cells at one end, followed by MAIT, iNKT, γδ T and natural killer cells at the other end. Single-cell RNA-seq reveals four broad states of innateness, and heterogeneity within canonical innate and adaptive populations. Transcriptional and functional data show that innateness is characterized by pre-formed mRNA encoding effector functions, but impaired proliferation marked by decreased baseline expression of ribosomal genes. Together, our data shed new light on the poised state of ITC, in which innateness is defined by a transcriptionally-orchestrated trade-off between rapid cell growth and rapid effector function. Innate T cells (ITC) contain many subsets and are poised to promptly respond to antigens and pathogens, but how this poised state is maintained is still unclear. Here the authors perform single-cell RNA-seq to align the various ITC subsets along an ‘innateness gradient’ that is associated with changes in proliferation and effector functions.
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Affiliation(s)
- Maria Gutierrez-Arcelus
- Department of Medicine, Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA, 02115.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, 02142, USA.,Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.,Center for Data Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Nikola Teslovich
- Department of Medicine, Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA, 02115.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, 02142, USA.,Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Alex R Mola
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Rafael B Polidoro
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Aparna Nathan
- Department of Medicine, Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA, 02115.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, 02142, USA.,Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.,Center for Data Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Hyun Kim
- Department of Medicine, Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA, 02115.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, 02142, USA.,Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Susan Hannes
- Department of Medicine, Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA, 02115.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, 02142, USA.,Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.,Center for Data Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Kamil Slowikowski
- Department of Medicine, Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA, 02115.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, 02142, USA.,Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.,Center for Data Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Gerald F M Watts
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Ilya Korsunsky
- Department of Medicine, Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA, 02115.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, 02142, USA.,Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.,Center for Data Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Michael B Brenner
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Soumya Raychaudhuri
- Department of Medicine, Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA, 02115. .,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, 02142, USA. .,Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA. .,Center for Data Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA. .,Faculty of Medical and Human Sciences, University of Manchester, Manchester, M13 9PL, UK.
| | - Patrick J Brennan
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
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Nagai J, Balestrieri B, Fanning LB, Kyin T, Cirka H, Lin J, Brennan PJ, Boyce JA. P2Y6 Signaling Controls an Innate Alveolar Macrophage-NK Cell Axis That Dampens Type 2 Lung Immunopathology. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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29
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Flores EJ, Mull NK, Lavenberg JG, Mitchell MD, Leas BF, Williams A, Brennan PJ, Umscheid CA. Using a 10-step framework to support the implementation of an evidence-based clinical pathways programme. BMJ Qual Saf 2018; 28:476-485. [PMID: 30463885 DOI: 10.1136/bmjqs-2018-008454] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/02/2018] [Accepted: 10/21/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Integration of evidence into practice is suboptimal. Clinical pathways, defined as multidisciplinary care plans, are a method for translating evidence into local settings and have been shown to improve the value of patient care. OBJECTIVE To describe the development of a clinical pathways programme across a large academic healthcare system. METHODS We use a 10-step framework (grounded in the Knowledge-to-Action framework and ADAPTE Collaboration methodology for guideline adaptation) to support pathway development and dissemination, including facilitating clinical owner and stakeholder engagement, developing pathway prototypes based on rapid reviews of the existing literature, developing tools for dissemination and impact assessment. We use a cloud-based technology platform (Dorsata, Washington, DC) to assist with development and dissemination across our geographically distributed care settings and providers. Content is viewable through desktop and mobile applications. We measured programme adoption and penetration by examining number of pathways developed as well as mobile application use and pathway views. RESULTS From 1 February 2016 to 30 April 2018, a total of 202 pathways were disseminated. The three most common clinical domains represented were oncology (46.5%, n=94), pulmonary/critical care (8.9%, n=18) and cardiovascular medicine (7.4%, n=15). Users opting to register for a personal account totalled 1279; the three largest groups were physicians (45.1%, n=504), advanced practice providers (19.5%, n=245) and nurses (19.1%, n=240). Pathway views reached an average of 2150 monthly views during the last 3 months of the period. The majority of pathways reference at least one evidence-based source (93.6%, n=180). CONCLUSIONS A healthcare system can successfully use a framework and technology platform to support the development and dissemination of pathways across a multisite institution.
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Affiliation(s)
- Emilia J Flores
- University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA .,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nikhil K Mull
- University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julia G Lavenberg
- University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Matthew D Mitchell
- University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Brian F Leas
- University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Austin Williams
- University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Patrick J Brennan
- University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Craig A Umscheid
- University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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30
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Thomas AE, Green FR, Kelleher CH, Wilkes HC, Brennan PJ, Meade TW, Humphries SE. Variation in the Promoter Region of the β Fibrinogen Gene Is Associated with Plasma Fibrinogen Levels in Smokers and Non-Smokers. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1648177] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryWe investigated the association between fibrinogen levels and a HaeIII restriction fragment length polymorphism located at −453 bp from the start of transcription of the β fibrinogen gene. 292 healthy men aged 45 to 69 years, recruited from general practices throughout Britain, were studied. None had a history of ischaemic heart disease. 41.1% (120) were smokers and fibrinogen levels were higher in this group. The frequency of the noncutting allele (designated H2) was 0.19 and was the same in smokers and non-smokers. The H2 allele was associated with elevated levels of fibrinogen in both smokers and non-smokers and the effect of genotype was similar in both groups. After smoking, HaeIII genotype was the strongest predictor of fibrinogen levels and explained 3.1% of the variance in fibrinogen levels. These results confirm earlier studies that variation at the fibrinogen locus contributes to the between-individual differences in plasma fibrinogen level.
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Affiliation(s)
- A E Thomas
- The Arterial Disease Research Unit, Charing Cross Sunley Research Centre, Hammersmith, London
| | - F R Green
- The Arterial Disease Research Unit, Charing Cross Sunley Research Centre, Hammersmith, London
| | - C H Kelleher
- The MRC Epidemiology and Medical Care Unit, Northwick Park Hospital, Harrow, Middlesex, United Kingdom
| | - H C Wilkes
- The MRC Epidemiology and Medical Care Unit, Northwick Park Hospital, Harrow, Middlesex, United Kingdom
| | - P J Brennan
- The MRC Epidemiology and Medical Care Unit, Northwick Park Hospital, Harrow, Middlesex, United Kingdom
| | - T W Meade
- The MRC Epidemiology and Medical Care Unit, Northwick Park Hospital, Harrow, Middlesex, United Kingdom
| | - S E Humphries
- The Arterial Disease Research Unit, Charing Cross Sunley Research Centre, Hammersmith, London
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Abstract
SummaryThe effects on the haemoglobin level of low dose aspirin and of low intensity oral anticoagulation with warfarin separately and in combination have been established in men aged between 45 and 69 at high risk of ischaemic heart disease. The findings confirm that combined treatment with warfarin and aspirin (WA) leads to a clear excess of minor bleeding episodes over warfarin alone (W) or aspirin alone (A). Each separate treatment on its own (either W or A) leads to an increase in these episodes compared with those on placebo (P) treatment. However, neither combined treatment (WA) nor the separate treatments (W or A) cause a fall in haemoglobin levels over a period of up to two years.
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Affiliation(s)
- T W Meade
- The MRC Epidemiology and Medical Care Unit, Wolfson Institute of Preventive Medicine, The Medical College of St Bartholomew's Hospital, London, UK
| | - D J Howarth
- The MRC Epidemiology and Medical Care Unit, Wolfson Institute of Preventive Medicine, The Medical College of St Bartholomew's Hospital, London, UK
| | - P J Brennan
- The MRC Epidemiology and Medical Care Unit, Wolfson Institute of Preventive Medicine, The Medical College of St Bartholomew's Hospital, London, UK
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32
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Meade TW, Roderick PJ, Brennan PJ, Wilkes HC, Kelleher CC. Extra-Cranial Bleeding and Other Symptoms due to Low Dose Aspirin and Low Intensity Oral Anticoagulation. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1656307] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryData from the early stages of the thrombosis prevention trial (TPT) have been used to establish and quantify the risk of extracranial bleeding due to low dose aspirin (75 mg) and low intensity oral anticoagulation with warfarin (international normalised ratio, INR, 1.5) singly or in combination, in men aged between 45 and 69 who are at high risk of ischaemic heart disease (IHD). The design of the trial is factorial, the four treatments being combined low dose aspirin and low intensity anticoagulation (WA), low intensity anticoagulation alone (W), low dose aspirin alone (A) and double placebo treatment (P). The trial is being carried out through the Medical Research Council’s General Practice Research Framework, with participating practices throughout the United Kingdom. Results are based on the first 3,667 men entered. The risk of major gastrointestinal bleeding due to active treatment is probably about 1 in 500 man-years of treatment, there currently being no difference between the three active regimes (WA, W, A). Intermediate and minor bleeding episodes occur more frequently with WA than with W or A on their own, the excess being mainly due to minor nose bleeds and bruises. In turn, both W and A on their own cause more such minor episodes than placebo treatment, P. There is no evidence that any of the three active regimes increases the risk of peptic ulceration, nor do they increase reports of indigestion. Aspirin increases reports of constipation and reduces reports of blurred vision. Minor bleeding occurs less frequently in smokers than in non-smokers but is not influenced by age. The antithrombotic regimes used are feasible and acceptable. So far, combined treatment and treatment with warfarin alone are not associated with more frequent serious hazards than low dose aspirin on its own, a regime that is increasingly used in clinical practice. The results provide a measure of reassurance for further trials of low intensity oral anticoagulation with warfarin alone or in combination with low dose aspirin.
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Affiliation(s)
- T W Meade
- The MRC Epidemiology and Medical Care Unit and British Heart Foundation Cardiovascular Epidemiology Research Group, Wolfson Institute of Preventive Medicine, The Medical College of St Bartholomew’s Hospital, London, United Kingdom
| | - P J Roderick
- The MRC Epidemiology and Medical Care Unit and British Heart Foundation Cardiovascular Epidemiology Research Group, Wolfson Institute of Preventive Medicine, The Medical College of St Bartholomew’s Hospital, London, United Kingdom
| | - P J Brennan
- The MRC Epidemiology and Medical Care Unit and British Heart Foundation Cardiovascular Epidemiology Research Group, Wolfson Institute of Preventive Medicine, The Medical College of St Bartholomew’s Hospital, London, United Kingdom
| | - H C Wilkes
- The MRC Epidemiology and Medical Care Unit and British Heart Foundation Cardiovascular Epidemiology Research Group, Wolfson Institute of Preventive Medicine, The Medical College of St Bartholomew’s Hospital, London, United Kingdom
| | - C C Kelleher
- The MRC Epidemiology and Medical Care Unit and British Heart Foundation Cardiovascular Epidemiology Research Group, Wolfson Institute of Preventive Medicine, The Medical College of St Bartholomew’s Hospital, London, United Kingdom
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Lee-Sarwar K, Kelly RS, Lasky-Su J, Moody DB, Mola AR, Cheng TY, Comstock LE, Zeiger RS, O'Connor GT, Sandel MT, Bacharier LB, Beigelman A, Laranjo N, Gold DR, Bunyavanich S, Savage JH, Weiss ST, Brennan PJ, Litonjua AA. Intestinal microbial-derived sphingolipids are inversely associated with childhood food allergy. J Allergy Clin Immunol 2018; 142:335-338.e9. [PMID: 29729303 DOI: 10.1016/j.jaci.2018.04.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/12/2018] [Accepted: 04/18/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Kathleen Lee-Sarwar
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
| | - Rachel S Kelly
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Jessica Lasky-Su
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - D Branch Moody
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Alex R Mola
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Tan-Yun Cheng
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Laurie E Comstock
- Division of Infectious Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | | | - George T O'Connor
- Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - Megan T Sandel
- Department of Pediatrics, Boston Medical Center, Boston, Mass
| | - Leonard B Bacharier
- Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Avraham Beigelman
- Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Nancy Laranjo
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Diane R Gold
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass; the Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Supinda Bunyavanich
- Department of Pediatrics - Allergy/Immunology and Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jessica H Savage
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Patrick J Brennan
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Augusto A Litonjua
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
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Lee-Sarwar K, Kelly RS, Lasky-Su J, Moody DB, Mola AR, Cheng TY, Comstock LE, Zeiger RS, O'Connor GT, Sandel M, Bacharier LB, Beigelman A, Laranjo N, Gold DR, Savage JR, Weiss ST, Litonjua AA, Brennan PJ. Intestinal Microbial-Derived Sphingolipids Are Associated with Childhood Food Allergy. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fontes ANB, Lima LNGC, Mota RMS, Almeida RLF, Pontes MA, Gonçalves HDS, Frota CC, Vissa VD, Brennan PJ, Guimaraes RJPS, Kendall C, Kerr LRFS, Suffys PN. Genotyping of Mycobacterium leprae for better understanding of leprosy transmission in Fortaleza, Northeastern Brazil. PLoS Negl Trop Dis 2017; 11:e0006117. [PMID: 29244821 PMCID: PMC5747459 DOI: 10.1371/journal.pntd.0006117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 12/29/2017] [Accepted: 11/17/2017] [Indexed: 11/19/2022] Open
Abstract
Leprosy is endemic in large part of Brazil with 28,761 new patients in 2015, the second largest number worldwide and reaches 9/10.000 in highly endemic regions and 2.7/10.000 in the city of Fortaleza, Ceará, Northeast Brazil. For better understanding of risk factors for leprosy transmission, we conducted an epidemiologic study supplemented by 17 locus VNTR and SNP 1-4 typing of Mycobacterium leprae in skin biopsy samples from new multibacillary (MB) patients diagnosed at a reference center in 2009 and 2010. Among the 1,519 new patients detected during the study period, 998 (65.7%) were MB and we performed DNA extraction and genotyping on 160 skin biopsy samples, resulting in 159 (16%) good multilocus VNTR types. Thirty-eight of these patients also provided VNTR types from M. leprae in nasal swabs. The SNP-Type was obtained for 157 patients and 87% were of type 4. Upon consideration all VNTR markers, 156 different genotypes and three pairs with identical genotypes were observed; no epidemiologic relation could be observed between individuals in these pairs. Considerable variability in differentiating index (DI) was observed between the different markers and the four with highest DI [(AT)15, (TA)18, (AT)17 and (GAA)21] frequently demonstrated differences in copy number when comparing genotypes from both type of samples. Excluding these markers from analysis resulted in 83 genotypes, 20 of which included 96 of the patients (60.3%). These clusters were composed of two (n = 8), three (n = 6), four (n = 1), five (n = 2), six (n = 1), 19 (n = 1) and 23 (n = 23) individuals and suggests that recent transmission is contributing to the maintenance of leprosy in Fortaleza. When comparing epidemiological and clinical variables among patients within clustered or with unique M. leprae genotypes, a positive bacterial index in skin biopsies and knowledge of working with someone with the disease were significantly associated with clustering. A tendency to belong to a cluster was observed with later notification of disease (mean value of 3.4 months) and having disability grade 2. A tendency for lack of clustering was observed for patients who reported to have lived with another leprosy case but this might be due to lack of inclusion of household contacts in the study. Although clusters were spread over the city, kernel analysis revealed that some of the patients belonging to the two major clusters were spatially related to some neighborhoods that report poverty and high disease incidence in children. Finally, inclusion of genotypes from nasal swabs might be warranted. A major limitation of the study is that sample size of 160 patients from a two year period represents only 15% of the new patients and this could have weakened statistical outcomes. This is the first molecular epidemiology study of leprosy in Brazil and although the high clustering level suggests that recent transmission is the major cause of disease in Fortaleza; the existence of two large clusters needs further investigation.
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Affiliation(s)
- Amanda N. B. Fontes
- Laboratory of Molecular Biology Applied to Mycobacteria, Oswaldo Cruz Institute, Rio de Janeiro, Brazil
| | | | - Rosa M. S. Mota
- Department of Statistics and Applied Mathematics, Federal University of Ceará, Fortaleza, Brazil
| | - Rosa L. F. Almeida
- Post Graduation Program of Public Health, University of Fortaleza, Fortaleza, CE, Brazil
| | - Maria A. Pontes
- Reference Center on Dermatology Dona Libânia, State Health Office, Fortaleza, Brazil
| | | | | | - Varalakshmi D. Vissa
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States
| | - Patrick J. Brennan
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States
| | | | - Carl Kendall
- Department of Global Community Health and Behavioral Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, United States
- Department of Community Health, College of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Ligia R. F. S. Kerr
- Department of Community Health, College of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Philip N. Suffys
- Laboratory of Molecular Biology Applied to Mycobacteria, Oswaldo Cruz Institute, Rio de Janeiro, Brazil
- Department of Biomedical Sciences, Mycobacteriology Unit, Tropical Institute of Medicine, Antwerp, Belgium
- * E-mail:
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Sedrak MS, Myers JS, Small DS, Nachamkin I, Ziemba JB, Murray D, Kurtzman GW, Zhu J, Wang W, Mincarelli D, Danoski D, Wells BP, Berns JS, Brennan PJ, Hanson CW, Dine CJ, Patel MS. Effect of a Price Transparency Intervention in the Electronic Health Record on Clinician Ordering of Inpatient Laboratory Tests: The PRICE Randomized Clinical Trial. JAMA Intern Med 2017; 177:939-945. [PMID: 28430829 PMCID: PMC5543323 DOI: 10.1001/jamainternmed.2017.1144] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [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: 11/14/2022]
Abstract
IMPORTANCE Many health systems are considering increasing price transparency at the time of order entry. However, evidence of its impact on clinician ordering behavior is inconsistent and limited to single-site evaluations of shorter duration. OBJECTIVE To test the effect of displaying Medicare allowable fees for inpatient laboratory tests on clinician ordering behavior over 1 year. DESIGN, SETTING, AND PARTICIPANTS The Pragmatic Randomized Introduction of Cost data through the electronic health record (PRICE) trial was a randomized clinical trial comparing a 1-year intervention to a 1-year preintervention period, and adjusting for time trends and patient characteristics. The trial took place at 3 hospitals in Philadelphia between April 2014 and April 2016 and included 98 529 patients comprising 142 921 hospital admissions. INTERVENTIONS Inpatient laboratory test groups were randomly assigned to display Medicare allowable fees (30 in intervention) or not (30 in control) in the electronic health record. MAIN OUTCOMES AND MEASURES Primary outcome was the number of tests ordered per patient-day. Secondary outcomes were tests performed per patient-day and Medicare associated fees. RESULTS The sample included 142 921 hospital admissions representing patients who were 51.9% white (74 165), 38.9% black (55 526), and 56.9% female (81 291) with a mean (SD) age of 54.7 (19.0) years. Preintervention trends of order rates among the intervention and control groups were similar. In adjusted analyses of the intervention group compared with the control group over time, there were no significant changes in overall test ordering behavior (0.05 tests ordered per patient-day; 95% CI, -0.002 to 0.09; P = .06) or associated fees ($0.24 per patient-day; 95% CI, -$0.42 to $0.91; P = .47). Exploratory subset analyses found small but significant differences in tests ordered per patient-day based on patient intensive care unit (ICU) stay (patients with ICU stay: -0.16; 95% CI, -0.31 to -0.01; P = .04; patients without ICU stay: 0.13; 95% CI, 0.08-0.17; P < .001) and the magnitude of associated fees (top quartile of tests based on fee value: -0.01; 95% CI, -0.02 to -0.01; P = .04; bottom quartile: 0.03; 95% CI, 0.002-0.06; P = .04). Adjusted analyses of tests that were performed found a small but significant overall increase in the intervention group relative to the control group over time (0.08 tests performed per patient day, 95% CI, 0.03-0.12; P < .001). CONCLUSIONS AND RELEVANCE Displaying Medicare allowable fees for inpatient laboratory tests did not lead to a significant change in overall clinician ordering behavior or associated fees. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02355496.
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Affiliation(s)
- Mina S Sedrak
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Jennifer S Myers
- Center for Healthcare Improvement & Patient Safety, University of Pennsylvania Health System, Philadelphia3University of Pennsylvania Health System, Philadelphia4Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Dylan S Small
- The Wharton School, University of Pennsylvania, Philadelphia
| | - Irving Nachamkin
- University of Pennsylvania Health System, Philadelphia4Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Justin B Ziemba
- Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Dana Murray
- University of Pennsylvania Health System, Philadelphia
| | - Gregory W Kurtzman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia 7The Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia
| | - Jingsan Zhu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Wenli Wang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | | | - Brian P Wells
- University of Pennsylvania Health System, Philadelphia
| | - Jeffrey S Berns
- University of Pennsylvania Health System, Philadelphia4Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Patrick J Brennan
- University of Pennsylvania Health System, Philadelphia4Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - C William Hanson
- University of Pennsylvania Health System, Philadelphia4Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - C Jessica Dine
- University of Pennsylvania Health System, Philadelphia4Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Mitesh S Patel
- University of Pennsylvania Health System, Philadelphia4Perelman School of Medicine, University of Pennsylvania, Philadelphia 5The Wharton School, University of Pennsylvania, Philadelphia 7The Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia 8Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Clancy-Thompson E, Chen GZ, Tyler PM, Servos MM, Barisa M, Brennan PJ, Ploegh HL, Dougan SK. Monoclonal Invariant NKT (iNKT) Cell Mice Reveal a Role for Both Tissue of Origin and the TCR in Development of iNKT Functional Subsets. J Immunol 2017; 199:159-171. [PMID: 28576977 DOI: 10.4049/jimmunol.1700214] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/02/2017] [Indexed: 01/10/2023]
Abstract
Invariant NKT (iNKT) cell functional subsets are defined by key transcription factors and output of cytokines, such as IL-4, IFN-γ, IL-17, and IL-10. To examine how TCR specificity determines iNKT function, we used somatic cell nuclear transfer to generate three lines of mice cloned from iNKT nuclei. Each line uses the invariant Vα14Jα18 TCRα paired with unique Vβ7 or Vβ8.2 subunits. We examined tissue homing, expression of PLZF, T-bet, and RORγt, and cytokine profiles and found that, although monoclonal iNKT cells differentiated into all functional subsets, the NKT17 lineage was reduced or expanded depending on the TCR expressed. We examined iNKT thymic development in limited-dilution bone marrow chimeras and show that higher TCR avidity correlates with higher PLZF and reduced T-bet expression. iNKT functional subsets showed distinct tissue distribution patterns. Although each individual monoclonal TCR showed an inherent subset distribution preference that was evident across all tissues examined, the iNKT cytokine profile differed more by tissue of origin than by TCR specificity.
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Affiliation(s)
- Eleanor Clancy-Thompson
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215
| | - Gui Zhen Chen
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215
| | - Paul M Tyler
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215
| | - Mariah M Servos
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215
| | - Marta Barisa
- Whitehead Institute for Biomedical Research, Cambridge, MA 02242; and
| | - Patrick J Brennan
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA 02215
| | - Hidde L Ploegh
- Whitehead Institute for Biomedical Research, Cambridge, MA 02242; and
| | - Stephanie K Dougan
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215; .,Whitehead Institute for Biomedical Research, Cambridge, MA 02242; and
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Iweala O, Brennan PJ, Commins SP. Serum IgE Specific for Alpha-Gal Sugar Moiety Can Bind Glycolipid. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kohlgruber AC, Donado CA, LaMarche NM, Brenner MB, Brennan PJ. Activation strategies for invariant natural killer T cells. Immunogenetics 2016; 68:649-63. [PMID: 27457886 PMCID: PMC5745583 DOI: 10.1007/s00251-016-0944-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [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: 06/30/2016] [Accepted: 07/15/2016] [Indexed: 12/17/2022]
Abstract
Invariant natural killer T (iNKT) cells are a specialized T cell subset that plays an important role in host defense, orchestrating both innate and adaptive immune effector responses against a variety of microbes. Specific microbial lipids and mammalian self lipids displayed by the antigen-presenting molecule CD1d can activate iNKT cells through their semi-invariant αβ T cell receptors (TCRs). iNKT cells also constitutively express receptors for inflammatory cytokines typically secreted by antigen-presenting cells (APCs) after recognition of pathogen-associated molecular patterns (PAMPs), and they can be activated through these cytokine receptors either in combination with TCR signals, or in some cases even in the absence of TCR signaling. During infection, experimental evidence suggests that both TCR-driven and cytokine-driven mechanisms contribute to iNKT cell activation. While the relative contributions of these two signaling mechanisms can vary widely depending on the infectious context, both lipid antigens and PAMPs mediate reciprocal activation of iNKT cells and APCs, leading to downstream activation of multiple other immune cell types to promote pathogen clearance. In this review, we discuss the mechanisms involved in iNKT cell activation during infection, focusing on the central contributions of both lipid antigens and PAMP-induced inflammatory cytokines, and highlight in vivo examples of activation during bacterial, viral, and fungal infections.
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Affiliation(s)
- Ayano C Kohlgruber
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carlos A Donado
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nelson M LaMarche
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael B Brenner
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Patrick J Brennan
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Grzegorzewicz AE, de Sousa-d'Auria C, McNeil MR, Huc-Claustre E, Jones V, Petit C, Angala SK, Zemanová J, Wang Q, Belardinelli JM, Gao Q, Ishizaki Y, Mikušová K, Brennan PJ, Ronning DR, Chami M, Houssin C, Jackson M. Assembling of the Mycobacterium tuberculosis Cell Wall Core. J Biol Chem 2016; 291:18867-79. [PMID: 27417139 DOI: 10.1074/jbc.m116.739227] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Indexed: 12/15/2022] Open
Abstract
The unique cell wall of mycobacteria is essential to their viability and the target of many clinically used anti-tuberculosis drugs and inhibitors under development. Despite intensive efforts to identify the ligase(s) responsible for the covalent attachment of the two major heteropolysaccharides of the mycobacterial cell wall, arabinogalactan (AG) and peptidoglycan (PG), the enzyme or enzymes responsible have remained elusive. We here report on the identification of the two enzymes of Mycobacterium tuberculosis, CpsA1 (Rv3267) and CpsA2 (Rv3484), responsible for this function. CpsA1 and CpsA2 belong to the widespread LytR-Cps2A-Psr (LCP) family of enzymes that has been shown to catalyze a variety of glycopolymer transfer reactions in Gram-positive bacteria, including the attachment of wall teichoic acids to PG. Although individual cpsA1 and cpsA2 knock-outs of M. tuberculosis were readily obtained, the combined inactivation of both genes appears to be lethal. In the closely related microorganism Corynebacterium glutamicum, the ortholog of cpsA1 is the only gene involved in this function, and its conditional knockdown leads to dramatic changes in the cell wall composition and morphology of the bacteria due to extensive shedding of cell wall material in the culture medium as a result of defective attachment of AG to PG. This work marks an important step in our understanding of the biogenesis of the unique cell envelope of mycobacteria and opens new opportunities for drug development.
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Affiliation(s)
- Anna E Grzegorzewicz
- From the Mycobacteria Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado 80523-1682
| | - Célia de Sousa-d'Auria
- the Institute for Integrative Biology of the Cell (I2BC), Commissariat à l'Energie Atomique (CEA), CNRS, Université Paris Sud, F-91198 Gif-sur-Yvette, France
| | - Michael R McNeil
- From the Mycobacteria Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado 80523-1682
| | - Emilie Huc-Claustre
- From the Mycobacteria Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado 80523-1682
| | - Victoria Jones
- From the Mycobacteria Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado 80523-1682
| | - Cécile Petit
- the Department of Chemistry and Biochemistry, University of Toledo, Toledo, Ohio 43606-3390
| | - Shiva Kumar Angala
- From the Mycobacteria Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado 80523-1682
| | - Júlia Zemanová
- the Department of Biochemistry, Faculty of Natural Sciences, Comenius University in Bratislava, Mlynská dolina CH-1, 84215 Bratislava, Slovakia
| | - Qinglan Wang
- From the Mycobacteria Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado 80523-1682, the Key Laboratory of Medical Molecular Virology of MOE & MOH, Institutes of Biomedical Sciences and Institute of Medical Microbiology, School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Juan Manuel Belardinelli
- From the Mycobacteria Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado 80523-1682
| | - Qian Gao
- the Key Laboratory of Medical Molecular Virology of MOE & MOH, Institutes of Biomedical Sciences and Institute of Medical Microbiology, School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Yoshimasa Ishizaki
- From the Mycobacteria Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado 80523-1682, the Institute of Microbial Chemistry (BIKAKEN), Kamiosaki, Shinagawa-ku, Tokyo 3-14-23, Japan, and
| | - Katarína Mikušová
- the Department of Biochemistry, Faculty of Natural Sciences, Comenius University in Bratislava, Mlynská dolina CH-1, 84215 Bratislava, Slovakia
| | - Patrick J Brennan
- From the Mycobacteria Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado 80523-1682
| | - Donald R Ronning
- the Department of Chemistry and Biochemistry, University of Toledo, Toledo, Ohio 43606-3390
| | - Mohamed Chami
- the C-CINA Center for Imaging and NanoAnalytics, Biozentrum, University of Basel, Mattenstrasse 26, CH-4058 Basel, Switzerland
| | - Christine Houssin
- the Institute for Integrative Biology of the Cell (I2BC), Commissariat à l'Energie Atomique (CEA), CNRS, Université Paris Sud, F-91198 Gif-sur-Yvette, France,
| | - Mary Jackson
- From the Mycobacteria Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado 80523-1682,
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McKibben L, Horan TC, Tokars JI, Fowler G, Cardo DM, Pearson ML, Brennan PJ. Guidance on Public Reporting of Healthcare-Associated Infections: Recommendations of the Healthcare Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 2016; 26:580-7. [PMID: 16018435 DOI: 10.1086/502585] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Consumer demand for healthcare information, including data about the performance of healthcare providers, has increased steadily during the past decade. Many state and national initiatives are under way to mandate or induce healthcare organizations to publicly disclose information regarding institutional and physician performance. Mandatory public reporting of healthcare performance is intended to enable stakeholders, including consumers, to make more informed choices on healthcare issues.Public reporting of healthcare performance information has taken several forms. Healthcare performance reports (report cards and honor rolls) typically describe the outcomes of medical care in terms of mortality, selected complications, or medical errors and, to a lesser extent, economic outcomes. Increasingly, process measures (ie, measurement of adherence to recommended healthcare practices, such as hand hygiene) are being used as an indicator of how well an organization adheres to established standards of practice with the implicit assumption that good processes lead to good healthcare outcomes. National healthcare quality improvement initiatives, notably those of the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), the Centers for Medicare & Medicaid Services (CMS), and the Hospital Quality Alliance, use process measures in their public reporting initiatives.
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Affiliation(s)
- Linda McKibben
- Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Center for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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Rownaghi AA, Kant A, Li X, Thakkar H, Hajari A, He Y, Brennan PJ, Hosseini H, Koros WJ, Rezaei F. Aminosilane-Grafted Zirconia-Titiania-Silica Nanoparticles/Torlon Hollow Fiber Composites for CO2 Capture. ChemSusChem 2016; 9:1166-1177. [PMID: 27076214 DOI: 10.1002/cssc.201600082] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/20/2016] [Indexed: 06/05/2023]
Abstract
In this work, the development of novel binary and ternary oxide/Torlon hollow fiber composites comprising zirconia, titania, and silica as amine supports was demonstrated. The resulting binary (Zr-Si/PAI-HF, Ti-Si/PAI-HF) and ternary (Zr-Ti-Si/PAI-HF) composites were then functionalized with monoamine-, diamine-, and triamine-substituted trialkoxysilanes and were evaluated in CO2 capture. Although the introduction of both Zr and Ti improved the CO2 adsorption capacity relative to that with Si/PAI-HF sorbents, zirconia was found to have a more favorable effect on the CO2 adsorption performance than titania, as previously demonstrated for amine sorbents in the powder form. The Zr-Ti-Si/PAI-HF sample with an oxide content of 20 wt % was found to exhibit a relatively high CO2 capacity, that is, 1.90 mmol g(-1) at atmospheric pressure under dry conditions, owing to more favorable synergy between the metal oxides and CO2 . The ternary fiber sorbent showed improved sorption kinetics and long-term stability in cyclic adsorption/desorption runs.
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Affiliation(s)
- Ali A Rownaghi
- Department of Chemical & Biochemical Engineering, Missouri University of Science and Technology, 110 N State St., Rolla, MO, 65409, USA
- School of Chemical & Biomolecular Engineering, Georgia Institute of Technology, 311 Ferst Dr. NW, Atlanta, GA, 30332, USA
| | - Amit Kant
- Department of Chemical & Biochemical Engineering, Missouri University of Science and Technology, 110 N State St., Rolla, MO, 65409, USA
| | - Xin Li
- Department of Chemical & Biochemical Engineering, Missouri University of Science and Technology, 110 N State St., Rolla, MO, 65409, USA
| | - Harshul Thakkar
- Department of Chemical & Biochemical Engineering, Missouri University of Science and Technology, 110 N State St., Rolla, MO, 65409, USA
| | - Amit Hajari
- Department of Chemical & Biochemical Engineering, Missouri University of Science and Technology, 110 N State St., Rolla, MO, 65409, USA
| | - Yingxin He
- Department of Chemical & Biochemical Engineering, Missouri University of Science and Technology, 110 N State St., Rolla, MO, 65409, USA
| | - Patrick J Brennan
- Department of Chemical & Biochemical Engineering, Missouri University of Science and Technology, 110 N State St., Rolla, MO, 65409, USA
| | - Hooman Hosseini
- Department of Chemical & Biochemical Engineering, Missouri University of Science and Technology, 110 N State St., Rolla, MO, 65409, USA
| | - William J Koros
- School of Chemical & Biomolecular Engineering, Georgia Institute of Technology, 311 Ferst Dr. NW, Atlanta, GA, 30332, USA
| | - Fateme Rezaei
- Department of Chemical & Biochemical Engineering, Missouri University of Science and Technology, 110 N State St., Rolla, MO, 65409, USA.
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Jayakumar KL, Lavenberg JA, Mitchell MD, Doshi JA, Leas B, Goldmann DR, Williams K, Brennan PJ, Umscheid CA. Evidence synthesis activities of a hospital evidence-based practice center and impact on hospital decision making. J Hosp Med 2016; 11:185-92. [PMID: 26505618 DOI: 10.1002/jhm.2498] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 07/26/2015] [Revised: 09/18/2015] [Accepted: 09/26/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND Hospital evidence-based practice centers (EPCs) synthesize and disseminate evidence locally, but their impact on institutional decision making is unclear. OBJECTIVE To assess the evidence synthesis activities and impact of a hospital EPC serving a large academic healthcare system. DESIGN, SETTING, AND PARTICIPANTS Descriptive analysis of the EPC's database of rapid systematic reviews since EPC inception (July 2006-June 2014), and survey of report requestors from the EPC's last 4 fiscal years. MEASUREMENTS Descriptive analyses examined requestor and report characteristics; questionnaire examined report usability, impact, and requestor satisfaction (higher scores on 5-point Likert scales reflected greater agreement). RESULTS The EPC completed 249 evidence reviews since inception. The most common requestors were clinical departments (29%, n = 72), chief medical officers (19%, n = 47), and purchasing committees (14%, n = 35). The most common technologies reviewed were drugs (24%, n = 60), devices (19%, n = 48), and care processes (12%, n = 31). Mean report completion time was 70 days. Thirty reports (12%) informed computerized decision support interventions. More than half of reports (56%, n = 139) were completed in the last 4 fiscal years for 65 requestors. Of the 64 eligible participants, 46 responded (72%). Requestors were satisfied with the report (mean = 4.4), and agreed it was delivered promptly (mean = 4.4), answered the questions posed (mean = 4.3), and informed their final decision (mean = 4.1). CONCLUSIONS This is the first examination of evidence synthesis activities by a hospital EPC in the United States. Our findings suggest hospital EPCs can efficiently synthesize and disseminate evidence addressing a range of clinical topics for diverse stakeholders, and can influence local decision making.
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Affiliation(s)
- Kishore L Jayakumar
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Julia A Lavenberg
- Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Matthew D Mitchell
- Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jalpa A Doshi
- Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian Leas
- Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - David R Goldmann
- Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kendal Williams
- Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Patrick J Brennan
- Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Craig A Umscheid
- Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
- Institute for Biomedical Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania
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Brennan PJ. 50 Years On: The United States-Japan Cooperative Medical Science Program 1965 -2015; Part II, the Leprosy Joint Panel. Nihon Hansenbyo Gakkai Zasshi 2015; 84:79-86. [PMID: 26630800 DOI: 10.5025/hansen.84.79] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Rownaghi AA, Rezaei F, Labreche Y, Brennan PJ, Johnson JR, Li FS, Koros WJ. In situ Formation of a Monodispersed Spherical Mesoporous Nanosilica-Torlon Hollow-Fiber Composite for Carbon Dioxide Capture. ChemSusChem 2015; 8:3439-3450. [PMID: 26355795 DOI: 10.1002/cssc.201500906] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Indexed: 06/05/2023]
Abstract
We describe a new template-free method for the in situ formation of a monodispersed spherical mesoporous nanosilica-Torlon hollow-fiber composite. A thin layer of Torlon hollow fiber that comprises silica nanoparticles was created by the in situ extrusion of a tetraethyl orthosilicate/N-methyl-2-pyrrolidone solution in a sheath layer and a Torlon polymer dope in a core support layer. This new method can be integrated easily into current hollow-fiber composite fabrication processes. The hollow-fiber composites were then functionalized with 3-aminopropyltrimethoxy silane (APS) and evaluated for their CO2 -capture performance. The resulting APS-functionalized mesoporous silica nanoparticles/Torlon hollow fibers exhibited a high CO2 equilibrium capacity of 1.5 and 1.9 mmol g(-1) at 35 and 60 °C, respectively, which is significantly higher than values for fiber sorbents without nanoparticles reported previously.
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Affiliation(s)
- Ali A Rownaghi
- Department of Chemical and Biochemical Engineering, Missouri University of Science and Technology, 110 N State, St. Rolla, MO, 65409, USA.
| | - Fateme Rezaei
- Department of Chemical and Biochemical Engineering, Missouri University of Science and Technology, 110 N State, St. Rolla, MO, 65409, USA
| | - Ying Labreche
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, 311 Ferst Dr. NW, Atlanta, GA, 30332, USA
| | - Patrick J Brennan
- Department of Chemical and Biochemical Engineering, Missouri University of Science and Technology, 110 N State, St. Rolla, MO, 65409, USA
| | - Justin R Johnson
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, 311 Ferst Dr. NW, Atlanta, GA, 30332, USA
| | - Fuyue Stephanie Li
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, 311 Ferst Dr. NW, Atlanta, GA, 30332, USA
| | - William J Koros
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, 311 Ferst Dr. NW, Atlanta, GA, 30332, USA.
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Larrouy-Maumus G, Gilleron M, Skovierová H, Zuberogoitia S, Brennan PJ, Puzo G, Jackson M, Nigou J. A glycomic approach reveals a new mycobacterial polysaccharide. Glycobiology 2015; 25:1163-71. [PMID: 26261090 DOI: 10.1093/glycob/cwv061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 08/05/2015] [Indexed: 12/26/2022] Open
Abstract
Mycobacterium tuberculosis lipoarabinomannan (LAM) and biosynthetically related lipoglycans and glycans play an important role in host-pathogen interactions. Therefore, the elucidation of the complete biosynthetic pathways of these important molecules is expected to afford novel therapeutic targets. The characterization of biosynthetic enzymes and transporters involved in the formation and localization of these complex macromolecules in the bacterial cell envelope largely relies on genetic manipulation of mycobacteria and subsequent analyses of lipoglycan structural alterations. However, lipoglycans are present in relatively low amounts. Their purification to homogeneity remains tedious and time-consuming. To overcome these issues and to reduce the biomass and time required for lipoglycan purification, we report here the development of a methodology to efficiently purify lipoglycans by sodium deoxycholate-polyacrylamide gel electrophoresis. This faster purification method can be applied on a small amount of mycobacterial cells biomass (10-50 mg), resulting in tens of micrograms of purified lipoglycans. This amount of purified products was found to be sufficient to undertake structural analyses of lipoglycans and glycans carbohydrate domains by a combination of highly sensitive analytical procedures, involving cryoprobe NMR analysis of intact macromolecules and chemical degradations monitored by gas chromatography and capillary electrophoresis. This glycomic approach was successfully applied to the purification and structural characterization of a newly identified polysaccharide, structurally related to LAM, in the model fast-growing species Mycobacterium smegmatis.
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Affiliation(s)
- Gérald Larrouy-Maumus
- CNRS, Institut de Pharmacologie et de Biologie Structurale (IPBS), UMR 5089 CNRS/Université Paul Sabatier, 205 route de Narbonne, BP 64182, F-31077 Toulouse Cedex 4, France Université de Toulouse, Université Paul Sabatier, IPBS, F-31077 Toulouse, France
| | - Martine Gilleron
- CNRS, Institut de Pharmacologie et de Biologie Structurale (IPBS), UMR 5089 CNRS/Université Paul Sabatier, 205 route de Narbonne, BP 64182, F-31077 Toulouse Cedex 4, France Université de Toulouse, Université Paul Sabatier, IPBS, F-31077 Toulouse, France
| | - Henrieta Skovierová
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO 80523-1682, USA
| | - Sophie Zuberogoitia
- CNRS, Institut de Pharmacologie et de Biologie Structurale (IPBS), UMR 5089 CNRS/Université Paul Sabatier, 205 route de Narbonne, BP 64182, F-31077 Toulouse Cedex 4, France Université de Toulouse, Université Paul Sabatier, IPBS, F-31077 Toulouse, France
| | - Patrick J Brennan
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO 80523-1682, USA
| | - Germain Puzo
- CNRS, Institut de Pharmacologie et de Biologie Structurale (IPBS), UMR 5089 CNRS/Université Paul Sabatier, 205 route de Narbonne, BP 64182, F-31077 Toulouse Cedex 4, France Université de Toulouse, Université Paul Sabatier, IPBS, F-31077 Toulouse, France
| | - Mary Jackson
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO 80523-1682, USA
| | - Jérôme Nigou
- CNRS, Institut de Pharmacologie et de Biologie Structurale (IPBS), UMR 5089 CNRS/Université Paul Sabatier, 205 route de Narbonne, BP 64182, F-31077 Toulouse Cedex 4, France Université de Toulouse, Université Paul Sabatier, IPBS, F-31077 Toulouse, France
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Affiliation(s)
- Craig A Umscheid
- Center for Evidence-based Practice, University of Pennsylvania, Philadelphia 2Department of Medicine, University of Pennsylvania, Philadelphia3Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of
| | - Patrick J Brennan
- Department of Medicine, University of Pennsylvania, Philadelphia3Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia4University of Pennsylvania Health System, Philadelp
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Grzegorzewicz AE, Eynard N, Quémard A, North EJ, Margolis A, Lindenberger JJ, Jones V, Korduláková J, Brennan PJ, Lee RE, Ronning DR, McNeil MR, Jackson M. Covalent modification of the Mycobacterium tuberculosis FAS-II dehydratase by Isoxyl and Thiacetazone. ACS Infect Dis 2015; 1:91-97. [PMID: 25897434 PMCID: PMC4401429 DOI: 10.1021/id500032q] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [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: 11/30/2022]
Abstract
Isoxyl and Thiacetazone are two antitubercular prodrugs formerly used in the clinical treatment of tuberculosis. Although both prodrugs have recently been shown to kill Mycobacterium tuberculosis through the inhibition of the dehydration step of the type II fatty acid synthase pathway, their detailed mechanism of inhibition, the precise number of enzymes involved in their activation and the nature of their activated forms remained unknown. We here demonstrate that both Isoxyl and Thiacetazone specifically and covalently react with a cysteine residue (Cys61) of the HadA subunit of the dehydratase thereby inhibiting HadAB activity. Our results unveil for the first time the nature of the active forms of Isoxyl and Thiacetazone and explain the basis for the structure-activity relationship of and resistance to these thiourea prodrugs. Our results further indicate that the flavin-containing monooxygenase EthA is most likely the only enzyme required for the activation of ISO and TAC in mycobacteria.
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Affiliation(s)
- Anna E. Grzegorzewicz
- Mycobacteria Research
Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado 80523-1682, United States
| | - Nathalie Eynard
- CNRS; IPBS (Institut
de Pharmacologie et de Biologie Structurale), UMR5089, Département
Tuberculose et Biologie des Infections, 205 route de Narbonne, F-31077 Toulouse, France
- Université de Toulouse, UPS, IPBS, F-31077 Toulouse, France
| | - Annaïk Quémard
- CNRS; IPBS (Institut
de Pharmacologie et de Biologie Structurale), UMR5089, Département
Tuberculose et Biologie des Infections, 205 route de Narbonne, F-31077 Toulouse, France
- Université de Toulouse, UPS, IPBS, F-31077 Toulouse, France
| | - E. Jeffrey North
- Department of Chemical Biology and Therapeutics, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105, United States
| | - Alyssa Margolis
- Mycobacteria Research
Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado 80523-1682, United States
| | - Jared J. Lindenberger
- Department of Chemistry and Biochemistry, University of Toledo, Toledo, Ohio 43606-3390, United States
| | - Victoria Jones
- Mycobacteria Research
Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado 80523-1682, United States
| | - Jana Korduláková
- Department of Biochemistry, Faculty of
Natural Sciences, Comenius University, Mlynska dolina CH-1, 84215 Bratislava, Slovak Republic
| | - Patrick J. Brennan
- Mycobacteria Research
Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado 80523-1682, United States
| | | | - Donald R. Ronning
- Department of Chemistry and Biochemistry, University of Toledo, Toledo, Ohio 43606-3390, United States
| | - Michael R. McNeil
- Mycobacteria Research
Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado 80523-1682, United States
| | - Mary Jackson
- Mycobacteria Research
Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado 80523-1682, United States
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