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Fisher KJ, Shirtcliff L, Buchanan G, Thompson AW, Woolard FX, LaMunyon DH, Marshall JL, Baranouskas MB, Voelker RB, Lusk JS, Wells CE, Mohamath R, Kinsey R, Lykins WR, Ramer-Denisoff G, Fox CB, Paddon CJ, McPhee D. Kilo-Scale GMP Synthesis of Renewable Semisynthetic Vaccine-Grade Squalene. Org Process Res Dev 2023; 27:2317-2328. [PMID: 38524776 PMCID: PMC10956619 DOI: 10.1021/acs.oprd.3c00300] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Emulsions of the triterpene squalene ((6E,10E,14E,18E)-2,6,10,15,19,23-hexamethyltetracosa-2,6,10,14,18,22-hexaene, CAS 111-02-4) have been used as adjuvants in influenza vaccines since the 1990s. Traditionally sourced from shark liver oil, the overfishing of sharks and concomitant reduction in the oceanic shark population raises sustainability issues for vaccine adjuvant grade squalene. We report a semisynthetic route to squalene meeting current pharmacopeial specifications for use in vaccines that leverages the ready availability of trans-β-farnesene ((6E)-7,11-dimethyl-3-methylene-1,6,10-dodecatriene, CAS 18794-84-8), manufactured from sustainable sugarcane via a yeast fermentation process. The scalability of the proposed route was verified by a kilo-scale GMP synthesis. We also report data demonstrating the synthesized semi-synthetic squalene's physical stability and biological activity when used in a vaccine adjuvant formulation.
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Affiliation(s)
- Karl J. Fisher
- Amyris Inc, 5885 Hollis St, Suite 100, Emeryville, CA 94608, USA
| | - Laura Shirtcliff
- Actylis Eugene, 90 North Polk St., Suite 200, Eugene OR 97402, USA
| | - Greg Buchanan
- Amyris Inc, 5885 Hollis St, Suite 100, Emeryville, CA 94608, USA
| | | | - Frank X. Woolard
- Amyris Inc, 5885 Hollis St, Suite 100, Emeryville, CA 94608, USA
| | | | | | | | | | - Jason S. Lusk
- Actylis Eugene, 90 North Polk St., Suite 200, Eugene OR 97402, USA
| | - Charles E. Wells
- Actylis Eugene, 90 North Polk St., Suite 200, Eugene OR 97402, USA
| | - Raodoh Mohamath
- Access to Advanced Health Institute (AAHI), 1616 Eastlake Avenue East, Seattle, WA 98102, USA
| | - Robert Kinsey
- Access to Advanced Health Institute (AAHI), 1616 Eastlake Avenue East, Seattle, WA 98102, USA
| | - William R. Lykins
- Access to Advanced Health Institute (AAHI), 1616 Eastlake Avenue East, Seattle, WA 98102, USA
| | - Gabi Ramer-Denisoff
- Access to Advanced Health Institute (AAHI), 1616 Eastlake Avenue East, Seattle, WA 98102, USA
| | - Christopher B. Fox
- Access to Advanced Health Institute (AAHI), 1616 Eastlake Avenue East, Seattle, WA 98102, USA
| | | | - Derek McPhee
- Amyris Inc, 5885 Hollis St, Suite 100, Emeryville, CA 94608, USA
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2
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Hege CS, Stimpson A, Sefton J, Summers J, Henke H, Dundas AA, Phan T, Kinsey R, Guderian JA, Sivananthan SJ, Mohamath R, Lykins WR, Ramer-Denisoff G, Lin S, Fox CB, Irvine DJ. Screening of Oligomeric (Meth)acrylate Vaccine Adjuvants Synthesized via Catalytic Chain Transfer Polymerization. Polymers (Basel) 2023; 15:3831. [PMID: 37765685 PMCID: PMC10538096 DOI: 10.3390/polym15183831] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/31/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
This report details the first systematic screening of free-radical-produced methacrylate oligomer reaction mixtures as alternative vaccine adjuvant components to replace the current benchmark compound squalene, which is unsustainably sourced from shark livers. Homo-/co-oligomer mixtures of methyl, butyl, lauryl, and stearyl methacrylate were successfully synthesized using catalytic chain transfer control, where the use of microwave heating was shown to promote propagation over chain transfer. Controlling the mixture material properties allowed the correct viscosity to be achieved, enabling the mixtures to be effectively used in vaccine formulations. Emulsions of selected oligomers stimulated comparable cytokine levels to squalene emulsion when incubated with human whole blood and elicited an antigen-specific cellular immune response when administered with an inactivated influenza vaccine, indicating the potential utility of the compounds as vaccine adjuvant components. Furthermore, the oligomers' molecular sizes were demonstrated to be large enough to enable greater emulsion stability than squalene, especially at high temperatures, but are predicted to be small enough to allow for rapid clearance from the body.
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Affiliation(s)
- Cordula S. Hege
- Centre for Additive Manufacturing, Department of Chemical and Environmental Engineering, University of Nottingham, Nottingham NG7 2RD, UK (A.A.D.)
| | - Amy Stimpson
- Centre for Additive Manufacturing, Department of Chemical and Environmental Engineering, University of Nottingham, Nottingham NG7 2RD, UK (A.A.D.)
| | - Joseph Sefton
- Centre for Additive Manufacturing, Department of Chemical and Environmental Engineering, University of Nottingham, Nottingham NG7 2RD, UK (A.A.D.)
| | - James Summers
- School of Chemistry, University of Nottingham, Nottingham NG7 2RD, UK
| | - Helena Henke
- Centre for Additive Manufacturing, Department of Chemical and Environmental Engineering, University of Nottingham, Nottingham NG7 2RD, UK (A.A.D.)
| | - Adam A. Dundas
- Centre for Additive Manufacturing, Department of Chemical and Environmental Engineering, University of Nottingham, Nottingham NG7 2RD, UK (A.A.D.)
| | - Tony Phan
- Access to Advanced Health Institute, Formerly Infectious Disease Research Institute, Seattle, WA 98102, USA
| | - Robert Kinsey
- Access to Advanced Health Institute, Formerly Infectious Disease Research Institute, Seattle, WA 98102, USA
| | - Jeffrey A. Guderian
- Access to Advanced Health Institute, Formerly Infectious Disease Research Institute, Seattle, WA 98102, USA
| | - Sandra J. Sivananthan
- Access to Advanced Health Institute, Formerly Infectious Disease Research Institute, Seattle, WA 98102, USA
| | - Raodoh Mohamath
- Access to Advanced Health Institute, Formerly Infectious Disease Research Institute, Seattle, WA 98102, USA
| | - William R. Lykins
- Access to Advanced Health Institute, Formerly Infectious Disease Research Institute, Seattle, WA 98102, USA
| | - Gabi Ramer-Denisoff
- Access to Advanced Health Institute, Formerly Infectious Disease Research Institute, Seattle, WA 98102, USA
| | - Susan Lin
- Access to Advanced Health Institute, Formerly Infectious Disease Research Institute, Seattle, WA 98102, USA
| | - Christopher B. Fox
- Access to Advanced Health Institute, Formerly Infectious Disease Research Institute, Seattle, WA 98102, USA
- Department of Global Health, University of Washington, Seattle, WA 98104, USA
| | - Derek J. Irvine
- Centre for Additive Manufacturing, Department of Chemical and Environmental Engineering, University of Nottingham, Nottingham NG7 2RD, UK (A.A.D.)
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3
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Fox CB, Khandhar AP, Khuu L, Phan T, Kinsey R, Cordero D, Gutiérrez JM, León G. Physicochemical and immunological effects of adjuvant formulations with snake venom antigens for immunization of horses for antivenom production. Toxicon 2023; 232:107229. [PMID: 37495191 DOI: 10.1016/j.toxicon.2023.107229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 07/28/2023]
Abstract
Enhancement of antivenom immune responses in horses through adjuvant technology improves antivenom production efficiency, but substantial local reactogenicity associated with some traditional veterinary adjuvants limits their usability. To explore modern adjuvant systems suitable for generating antivenom responses in horses, we first assessed their physicochemical compatibility with Bothrops asper snake venom. Liposome and nanoparticle aluminum adjuvants exhibited changes in particle size and phospholipid content after mixing with venom, whereas squalene emulsion-based adjuvants remained stable. Next, we evaluated serum antibody response magnitude and neutralization capacity in horses immunized with adjuvant-containing Echis ocellatus, Bitis arietans, Naja nigricollis, and Dendroaspis polylepis venom preparations. Whereas all tested adjuvants elicited significant neutralization capacity against the viperid venoms, the greatest antibody responses were generated by a squalene-in-water emulsion, thus representing a promising novel alternative for antivenom production.
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Affiliation(s)
- Christopher B Fox
- Access to Advanced Health Institute (formerly Infectious Disease Research Institute), Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA.
| | - Amit P Khandhar
- Access to Advanced Health Institute (formerly Infectious Disease Research Institute), Seattle, WA, USA
| | - Lisa Khuu
- Access to Advanced Health Institute (formerly Infectious Disease Research Institute), Seattle, WA, USA
| | - Tony Phan
- Access to Advanced Health Institute (formerly Infectious Disease Research Institute), Seattle, WA, USA
| | - Robert Kinsey
- Access to Advanced Health Institute (formerly Infectious Disease Research Institute), Seattle, WA, USA
| | - Daniel Cordero
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Guillermo León
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
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Fisher KJ, Kinsey R, Mohamath R, Phan T, Liang H, Orr MT, Lykins WR, Guderian JA, Bakken J, Argilla D, Ramer-Denisoff G, Larson E, Qi Y, Sivananthan S, Smolyar K, Carter D, Paddon CJ, Fox CB. Semi-synthetic terpenoids with differential adjuvant properties as sustainable replacements for shark squalene in vaccine emulsions. NPJ Vaccines 2023; 8:14. [PMID: 36797262 PMCID: PMC9935550 DOI: 10.1038/s41541-023-00608-y] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/24/2023] [Indexed: 02/18/2023] Open
Abstract
Synthetic biology has allowed for the industrial production of supply-limited sesquiterpenoids such as the antimalarial drug artemisinin and β-farnesene. One of the only unmodified animal products used in medicine is squalene, a triterpenoid derived from shark liver oil, which when formulated into an emulsion is used as a vaccine adjuvant to enhance immune responses in licensed vaccines. However, overfishing is depleting deep-sea shark populations, leading to potential supply problems for squalene. We chemically generated over 20 squalene analogues from fermentation-derived β-farnesene and evaluated adjuvant activity of the emulsified compounds compared to shark squalene emulsion. By employing a desirability function approach that incorporated multiple immune readouts, we identified analogues with enhanced, equivalent, or decreased adjuvant activity compared to shark squalene emulsion. Availability of a library of structurally related analogues allowed elucidation of structure-function relationships. Thus, combining industrial synthetic biology with chemistry and immunology enabled generation of sustainable terpenoid-based vaccine adjuvants comparable to current shark squalene-based adjuvants while illuminating structural properties important for adjuvant activity.
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Affiliation(s)
| | - Robert Kinsey
- Access to Advanced Health Institute, formerly Infectious Disease Research Institute, Seattle, WA, USA
| | - Raodoh Mohamath
- Access to Advanced Health Institute, formerly Infectious Disease Research Institute, Seattle, WA, USA
| | - Tony Phan
- Infectious Disease Research Institute, Seattle, WA, USA
- Neoleukin, Seattle, WA, USA
| | - Hong Liang
- Infectious Disease Research Institute, Seattle, WA, USA
- Bristol-Myers Squibb, Seattle, WA, USA
| | - Mark T Orr
- Infectious Disease Research Institute, Seattle, WA, USA
- Bristol-Myers Squibb, Seattle, WA, USA
| | - William R Lykins
- Access to Advanced Health Institute, formerly Infectious Disease Research Institute, Seattle, WA, USA
| | - Jeffrey A Guderian
- Access to Advanced Health Institute, formerly Infectious Disease Research Institute, Seattle, WA, USA
| | - Julie Bakken
- Access to Advanced Health Institute, formerly Infectious Disease Research Institute, Seattle, WA, USA
| | - David Argilla
- Access to Advanced Health Institute, formerly Infectious Disease Research Institute, Seattle, WA, USA
| | - Gabi Ramer-Denisoff
- Access to Advanced Health Institute, formerly Infectious Disease Research Institute, Seattle, WA, USA
| | - Elise Larson
- Access to Advanced Health Institute, formerly Infectious Disease Research Institute, Seattle, WA, USA
| | - Yizhi Qi
- Access to Advanced Health Institute, formerly Infectious Disease Research Institute, Seattle, WA, USA
| | - Sandra Sivananthan
- Access to Advanced Health Institute, formerly Infectious Disease Research Institute, Seattle, WA, USA
| | | | - Darrick Carter
- Infectious Disease Research Institute, Seattle, WA, USA
- HDT Bio Corp., Seattle, WA, USA
- PAI Life Sciences Inc., Seattle, WA, USA
| | | | - Christopher B Fox
- Access to Advanced Health Institute, formerly Infectious Disease Research Institute, Seattle, WA, USA.
- Department of Global Health, University of Washington, Seattle, WA, USA.
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5
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Murphy BM, Chen JZ, Rolo M, Eldam M, Jordan L, Sivananthan SJ, Kinsey R, Guderian JA, Pedersen K, Abhyankar M, Petri WA, Fox CB, Finlay WH, Vehring R, Martin AR. Intranasal delivery of a synthetic Entamoeba histolytica vaccine containing adjuvant (LecA + GLA-3M-052 liposomes): in vitro characterization. Int J Pharm 2022; 626:122141. [PMID: 36058408 DOI: 10.1016/j.ijpharm.2022.122141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/08/2022] [Accepted: 08/21/2022] [Indexed: 11/16/2022]
Abstract
Amebiasis, a disease caused by the parasite Entamoeba histolytica, is estimated to cause millions of infections and at least 55,000 deaths globally each year. With no vaccine currently available, there is an urgent need for an accessible means of stimulating protective mucosal immunity. The objective of this study was to characterize the nasal spray of a novel amebiasis vaccine candidate from a syringe-based liquid atomization device, the Teleflex MAD Nasal™, in both adult and infant nasal airways. Human ergonomic testing was completed to determine realistic actuation parameters. Spray pattern, plume geometry, and droplet size distribution were measured to evaluate reproducibility of free plume characteristics. The Alberta Idealized Nasal Inlet (AINI) and three realistic infant nasal airways were used to determine the in vitro deposition profile in adult and infant airways, respectively. Collectively, in vitro results demonstrated the feasibility of delivering the vaccine candidate to target sites within the nasal airways. Penetration through the nasal airways that could lead to deposition in the lungs was below the limit of quantification for both adult and infant geometries, indicating a low likelihood of adverse events due to lung exposure. These results support continued investigation of intranasal delivery of the synthetic Entamoeba histolytica vaccine.
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Affiliation(s)
- Brynn M Murphy
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada
| | - John Z Chen
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada
| | | | | | - Lynn Jordan
- Proveris Scientific, Hudson, MA, United States
| | | | - Robert Kinsey
- Access to Advanced Health Institute (AAHI), Seattle, WA, United States
| | | | | | - Mayuresh Abhyankar
- Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - William A Petri
- Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Christopher B Fox
- Access to Advanced Health Institute (AAHI), Seattle, WA, United States
| | - Warren H Finlay
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Reinhard Vehring
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Andrew R Martin
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada.
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6
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Abhyankar MM, Orr MT, Kinsey R, Sivananthan S, Nafziger AJ, Oakland DN, Young MK, Farr L, Uddin MJ, Leslie JL, Burgess SL, Liang H, De Lima I, Larson E, Guderian JA, Lin S, Kahn A, Ghosh P, Reed S, Tomai MA, Pedersen K, Petri WA, Fox CB. Optimizing a Multi-Component Intranasal Entamoeba Histolytica Vaccine Formulation Using a Design of Experiments Strategy. Front Immunol 2021; 12:683157. [PMID: 34248966 PMCID: PMC8268010 DOI: 10.3389/fimmu.2021.683157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/07/2021] [Indexed: 11/24/2022] Open
Abstract
Amebiasis is a neglected tropical disease caused by Entamoeba histolytica. Although the disease burden varies geographically, amebiasis is estimated to account for some 55,000 deaths and millions of infections globally per year. Children and travelers are among the groups with the greatest risk of infection. There are currently no licensed vaccines for prevention of amebiasis, although key immune correlates for protection have been proposed from observational studies in humans. We previously described the development of a liposomal adjuvant formulation containing two synthetic TLR ligands (GLA and 3M-052) that enhanced antigen-specific fecal IgA, serum IgG2a, a mixed IFNγ and IL-17A cytokine profile from splenocytes, and protective efficacy following intranasal administration with the LecA antigen. By applying a statistical design of experiments (DOE) and desirability function approach, we now describe the optimization of the dose of each vaccine formulation component (LecA, GLA, 3M-052, and liposome) as well as the excipient composition (acyl chain length and saturation; PEGylated lipid:phospholipid ratio; and presence of antioxidant, tonicity, or viscosity agents) to maximize desired immunogenicity characteristics while maintaining physicochemical stability. This DOE/desirability index approach led to the identification of a lead candidate composition that demonstrated immune response durability and protective efficacy in the mouse model, as well as an assessment of the impact of each active vaccine formulation component on protection. Thus, we demonstrate that both GLA and 3M-052 are required for statistically significant protective efficacy. We also show that immunogenicity and efficacy results differ in female vs male mice, and the differences appear to be at least partly associated with adjuvant formulation composition.
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Affiliation(s)
- Mayuresh M Abhyankar
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Mark T Orr
- Infectious Disease Research Institute (IDRI), Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Robert Kinsey
- Infectious Disease Research Institute (IDRI), Seattle, WA, United States
| | - Sandra Sivananthan
- Infectious Disease Research Institute (IDRI), Seattle, WA, United States
| | - Andrew J Nafziger
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - David N Oakland
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Mary K Young
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Laura Farr
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Md Jashim Uddin
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Jhansi L Leslie
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Stacey L Burgess
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Hong Liang
- Infectious Disease Research Institute (IDRI), Seattle, WA, United States
| | - Ines De Lima
- Infectious Disease Research Institute (IDRI), Seattle, WA, United States
| | - Elise Larson
- Infectious Disease Research Institute (IDRI), Seattle, WA, United States
| | - Jeffrey A Guderian
- Infectious Disease Research Institute (IDRI), Seattle, WA, United States
| | - Susan Lin
- Infectious Disease Research Institute (IDRI), Seattle, WA, United States
| | - Aaron Kahn
- Infectious Disease Research Institute (IDRI), Seattle, WA, United States
| | - Prakash Ghosh
- Infectious Disease Research Institute (IDRI), Seattle, WA, United States
| | - Sierra Reed
- Infectious Disease Research Institute (IDRI), Seattle, WA, United States
| | - Mark A Tomai
- 3M Corporate Research Materials Laboratory, 3M Center, St Paul, MN, United States
| | | | - William A Petri
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Christopher B Fox
- Infectious Disease Research Institute (IDRI), Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
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7
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Morgan WJ, VanDevanter DR, Pasta DJ, Foreman AJ, Wagener JS, Konstan MW, Liou T, McColley S, McMullen A, Quittner A, Regelmann W, Ren C, Rosenfeld M, Sawicki G, Schechter M, VanDevanter D, Wagener J, Woo M, Brasfield D, Lyrene R, Sindel L, Roberts D, Carroll J, Warren R, Nassri L, Anderson P, Brown M, Silverthorn A, Radford P, Gong G, Legris G, Greene G, Sudhakar R, Platzker A, Nickerson B, Hardy K, Harwood I, Shay G, Quick B, Lieberthal A, Moss R, Landon C, Fanous Y, Lieberman J, Spiritus E, Chipps B, McDonald R, Pian M, Cropp G, Lewis N, Nielson D, Shapiro B, Wagener J, Accurso F, Saavedra M, Daigle K, Hen J, Palazzo R, Dodds K, Pad-man R, Goodill J, Winnie G, Davies L, Kriseman T, Sallent J, Chiaro J, Kubiet M, Goldfinger S, Schwartzman M, Diaz C, Maupin K, Riff E, Geller D, Livingston F, Mavunda K, Birriel J, Faverio L, Rosenberg D, Schaeffer D, Sherman J, Wagner M, Light M, Schnapf B, Montgomery G, Kirchner K, Weatherly M, Caplan D, Guill M, Hudson V, Akhter J, Davison D, Boas S, McColley S, Chung Y, Latner R, Aljadeff G, Chan Y, Kraut J, Stone A, Still JL, Sharma G, Eagleton L, Hopkins P, Chatrath U, Lester L, Kim YJ, Anthony V, Eigan H, Howenstine M, James P, Gergesha E, Harris J, Plant R, Zivkovich V, Collins A, Nassif E, Ahrens R, Doornbos D, Kanarek J, Leff R, Shaw P, Demoss E, Riva M, Sullivan L, Anstead M, Kanga J, Eid N, Morton R, Hilman B, Jones K, Davis S, Harder R, Lever T, Cairns AM, Caldwell E, Zuckerman J, Mogayzel P, Rosenstein B, McQuestion J, Perry D, Rosenberg S, Gerstle R, Colin A, Wohl ME, Lapey A, Yee W, O'Sullivan B, Zwerdling R, Abdulhamid I, O'Hagan A, Schuen J, Kurlandsky L, Honicky R, Homnick D, Marks J, Pichurko B, Maxvold N, Nasr S, Simon R, Tsai W, Kissner D, McNamara J, Henry N, Marker S, Pryor M, Regelmann W, Walker L, Woodward J, Mizell L, Miller S, Rosenbluth D, Black P, McCubbin M, Cohen A, Ferkol T, Mallory G, Rejent A, Rubin B, Graff G, Konig P, Colombo J, Murphy P, Boyle W, Parker W, Patton C, Zanni R, Atlas A, Turcios N, Laraya-Cuasay L, Bisberg D, Aguila H, Allen S, James D, Perkett E, Thompson M, Budhecha S, Diaz R, Rosen J, Kaslovsky R, Percciacante R, Borowitz D, Cronin J, McMahon C, Quittell L, Giusti R, Cohen R, DeCelie-Germana J, Gorvoy J, Patel K, Kattan M, Dozor A, DiMango E, Berdella M, Anbar R, Ianuzzi D, Sexton J, Tayag-Kier C, McBride J, Ren C, Voter K, Dimaio M, Georgitis J, Majure JM, Martinez M, McIntosh C, Leigh M, Schechter M, Black H, Hughes J, Kantak A, Wilmott R, Omlor G, Stone R, McCoy K, Acton J, Doershuk C, Konstan M, Fink R, Steffan M, Vauthy P, Joseph P, Reyes S, Kramer J, Royall J, Eisenberg J, Wall M, Fiel S, Scanlin T, Phadke S, Winnie G, Weinberg J, Sexauer W, Wolf S, Holsclaw D, Klein D, Warren S, Kinsey R, Perez C, Ganeshanathan M, Shinnick J, Panitch H, Varlotta L, Robinson C, Santana JR, Passero MA, Gwinn J, Baker R, Bowman M, Flume P, Brown D, Marville R, Wallace J, Parry R, Ellenburg D, Rogers J, Mohon R, Ledbetter J, Hanissian A, Schoumacher R, Campbell P, Harris C, Slovis B, Stokes D, Hale K, Katz M, Seilheimer D, Sockrider M, Frank A, Daniel J, Cunningham J, Browning I, Bray J, Dove A, Mandujano F, Tremper L, Morse M, Willey-Courand D, Copenhaver S, Pohl J, McWilliams B, Martine-Logvinoff M, Wallace M, Klein R, Amaro R, Couch L, Brown M, Prestidge C, Inscore S, Lipton A, Chatfield B, Liou T, Marshall B, Lahiri T, Swartz D, Whittaker L, Karlson K, Ropoll I, Rubio T, Schmidt J, Thomas D, Osborn J, Froh D, Gaston B, Elliott G, Gibson R, Ramsey B, McCarthy M, Larson L, Ricker D, Robbins M, Aitken M, Emerson J, Aronoff S, Moffett K, Biller J, Splaingard M, Sullivan B, Pritchard P, Adair S, Holzwarth P, Dopico G, Meyer K, Green C, Rock M. Forced Expiratory Volume in 1 Second Variability Helps Identify Patients with Cystic Fibrosis at Risk of Greater Loss of Lung Function. J Pediatr 2016; 169:116-21.e2. [PMID: 26388208 DOI: 10.1016/j.jpeds.2015.08.042] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [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: 12/31/2014] [Revised: 07/15/2015] [Accepted: 08/20/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate several alternative measures of forced expiratory volume in 1 second percent predicted (FEV1 %pred) variability as potential predictors of future FEV1 %pred decline in patients with cystic fibrosis. STUDY DESIGN We included 13,827 patients age ≥6 years from the Epidemiologic Study of Cystic Fibrosis 1994-2002 with ≥4 FEV1 %pred measurements spanning ≥366 days in both a 2-year baseline period and a 2-year follow-up period. We predicted change from best baseline FEV1 %pred to best follow-up FEV1 %pred and change from baseline to best in the second follow-up year by using multivariable regression stratified by 4 lung-disease stages. We assessed 5 measures of variability (some as deviations from the best and some as deviations from the trend line) both alone and after controlling for demographic and clinical factors and for the slope and level of FEV1 %pred. RESULTS All 5 measures of FEV1 %pred variability were predictive, but the strongest predictor was median deviation from the best FEV1 %pred in the baseline period. The contribution to explanatory power (R(2)) was substantial and exceeded the total contribution of all other factors excluding the FEV1 %pred rate of decline. Adding the other variability measures provided minimal additional value. CONCLUSIONS Median deviation from the best FEV1 %pred is a simple metric that markedly improves prediction of FEV1 %pred decline even after the inclusion of demographic and clinical characteristics and the FEV1 %pred rate of decline. The routine calculation of this variability measure could allow clinicians to better identify patients at risk and therefore in need of increased intervention.
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Affiliation(s)
- Wayne J Morgan
- Department of Pediatrics, University of Arizona, Tucson, AZ.
| | - Donald R VanDevanter
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
| | | | | | - Jeffrey S Wagener
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Michael W Konstan
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
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Whitton B, Kinsey R, Waretini N, Toppin W, Connelly M, Byron K, Onus-Williams T, Steele A. P01.02 A regional sexual and reproductive health campaign providing clinical education and health promotion activities in 2015 for aboriginal health services and communities in the western district of victoria. Sex Transm Infect 2015. [DOI: 10.1136/sextrans-2015-052270.213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kinsey R, Van Gerpen R. The diagnosis of breast abnormalities: nursing implications. Nebr Nurse 1997; 30:10-3. [PMID: 9400218] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- R Kinsey
- Regional West Medical Center, Scottsbluff, USA
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Kinsey R, Doty T. Cancer resources in the United States. Oncol Nurs Forum 1995; 22:1421-32. [PMID: 8539183] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- R Kinsey
- Oncology Nursing Society Education Committee
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Woodard ED, Friedlander B, Lesher RJ, Font W, Kinsey R, Hearne FT. Outbreak of hypersensitivity pneumonitis in an industrial setting. JAMA 1988; 259:1965-9. [PMID: 3346977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Symptoms consistent with hypersensitivity pneumonitis developed in several workers in two multistory buildings in an industrial complex. A health questionnaire survey was conducted to determine the extent of the problem. Eighty-seven percent of the population of 1050 employees completed the health questionnaire. Serological testing identified 152 positive precipitin reactors to the fungus Aureobasidium pullulans; 115 reactors were symptomatic. The clinical and laboratory features at the time of the acute illness and during four years of follow-up are described. The agent, A pullulans, was identified as a contaminant of the heating-cooling ventilation units containing open waterspray chambers. Control was accomplished by replacement of the ventilation systems. A secondary source of antigen was found to be corrugated cardboard. Some sensitized employees required removal from work exposure to corrugated cardboard to prevent recurrent symptoms.
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Affiliation(s)
- E D Woodard
- Medical Department, Eastman Kodak Company, Rochester, NY
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