1
|
Coorey CP, de Malmanche T, Chou A, Feddersen M. Complement-mediated thrombotic microangiopathy on a background of Alport syndrome: A case report. Nephrology (Carlton) 2024. [PMID: 38604610 DOI: 10.1111/nep.14305] [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: 12/05/2023] [Revised: 02/10/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
Here we present a case of complement-mediated thrombotic microangiopathy (TMA) in a patient who has a background of Stage 5 chronic kidney disease secondary to Alport syndrome. We explain our approach to the diagnosis of TMA, especially the reliance on non-renal manifestations of TMA and the role of kidney biopsy given there was a background of advanced kidney impairment at baseline.
Collapse
Affiliation(s)
- Craig Peter Coorey
- Renal Unit, Gosford Hospital, Gosford, New South Wales, Australia
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Theo de Malmanche
- Immunology, NSW Health Pathology, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Angela Chou
- Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Martin Feddersen
- Renal Unit, Gosford Hospital, Gosford, New South Wales, Australia
| |
Collapse
|
2
|
Chow KL, Patchett K, Reeves G, de Malmanche T, Gillies D, Boyle M. Morphine-specific IgE testing in the assessment of neuromuscular blocking agent allergy: a single centre experience. Br J Anaesth 2024; 132:193-195. [PMID: 37945415 DOI: 10.1016/j.bja.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/26/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023] Open
Affiliation(s)
- Ke L Chow
- Department of Immunology, NSW Health Pathology, Newcastle, NSW, Australia.
| | - Kathryn Patchett
- Department of Immunology, NSW Health Pathology, Newcastle, NSW, Australia
| | - Glenn Reeves
- Department of Immunology, NSW Health Pathology, Newcastle, NSW, Australia; Department of Immunology, John Hunter Hospital, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Theo de Malmanche
- Department of Immunology, NSW Health Pathology, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Donna Gillies
- Medical and Interventional Services, John Hunter Hospital, Newcastle, NSW, Australia
| | - Michael Boyle
- Department of Immunology, John Hunter Hospital, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| |
Collapse
|
3
|
de Carle M, Macnab B, Utainrat J, Herkes-Deane J, Attia J, de Malmanche T, Teber E, Palazzi K, Scowen C, Hure A. Does an electronic pathology ordering system change the volume and pattern of routine testing in hospital? An interrupted time series analysis. J Clin Pathol 2023:jcp-2023-208850. [PMID: 37085324 DOI: 10.1136/jcp-2023-208850] [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: 02/21/2023] [Accepted: 03/31/2023] [Indexed: 04/23/2023]
Abstract
AIMS Identifying and reducing low-value care is a vital issue in Australia, with pathology test ordering a common focus in this field. This study builds on previous research and aimed to quantify the impact of the implementation of an electronic ordering (e-ordering) system on the volume of pathology testing, compared with manual (paper based) ordering. METHODS An audit and analysis of pathology test data were conducted, using an interrupted time series design to investigate the impact of the e-ordering system on pathology ordering patterns. All medical and surgical adult inpatients at a tertiary referral hospital in Newcastle, Australia, were included over a 3-year period. RESULTS Overall, there were no statistically significant differences in the volume of orders due to the implementation of the e-ordering system. There was a slight increase in the aggregated volume (tests per admission and tests per bed day) of tests ordered across the entire study period, reflecting a secular trend. CONCLUSIONS Despite providing greater visibility and tracking of orders, we conclude that the implementation of an e-ordering system does not, in and of itself, reduce ordering volume. Efforts to identify and reduce low-value care will require intentional effort and specifically designed educational programmes or hard-wired algorithms.
Collapse
Affiliation(s)
- Madeleine de Carle
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Brooke Macnab
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Jenewa Utainrat
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Jessica Herkes-Deane
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - John Attia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Theo de Malmanche
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- John Hunter Hospital, NSW Health Pathology, New Lambton Heights, New South Wales, Australia
| | - Erdahl Teber
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Kerrin Palazzi
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Craig Scowen
- John Hunter Hospital, NSW Health Pathology, New Lambton Heights, New South Wales, Australia
| | - Alexis Hure
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| |
Collapse
|
4
|
Wijaya C, Burns C, Hall S, Farmer M, Jones D, Rowlandson M, Choi P, Formby M, de Malmanche T. Measurement of Complement Activation via Plasma-Soluble C5b-9 Comparison with Terminal Complement Complex Staining in a Series of Kidney Biopsies. Kidney Blood Press Res 2023; 48:220-230. [PMID: 36917968 PMCID: PMC10124756 DOI: 10.1159/000529734] [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: 06/10/2021] [Accepted: 02/09/2023] [Indexed: 03/16/2023] Open
Abstract
INTRODUCTION With the emergence of therapeutic complement inhibitors, there is a need to identify patients with complement-driven inflammation. C5b-9 is the terminal product of the three complement pathways and therefore a marker of total complement activation. We present a pilot study which aims to assess whether plasma soluble C5b-9 (sC5b-9) correlates with terminal complement complex (TCC) staining in kidney tissue. The secondary aim was to assess the utility of plasma sC5b-9 as part of routine workup in kidney patients undergoing kidney biopsy. METHODS Thirty-seven patients undergoing kidney biopsy had plasma sC5b-9 and TCC staining on kidney tissue performed. Additional blood markers including creatinine, haemoglobin, CRP, factor H, factor I, and midkine levels were also taken. These parameters were correlated with the histological diagnoses. Patients were divided into a diseased group (n = 31) and a control group (n = 6) consisting of transplanted kidneys with minor or no changes. Of the biopsies in the control group, 50% were performed as per protocol, and the other 50% were performed due to clinical need. RESULTS There was no correlation found between plasma sC5b-9 and TCC kidney staining. Elevated sC5b-9 levels were found in a heterogeneous group of patients but were associated with higher CRP and lower haemoglobin levels. Overall, there was more TCC kidney staining in the diseased group compared with the control group, and a trend was observed of diabetic, primary membranous nephropathy, and amyloidosis patients having more intense glomerular and peritubular/interstitial staining. CONCLUSION Plasma sC5b-9 as a marker of total complement activation does not correlate with TCC kidney staining. This discordance suggests that plasma sC5b-9 and TCC staining are distinct markers of disease. TCC staining reflects chronicity and tissue deposition of complement over time. Conversely, plasma sC5b-9 concentrations change rapidly and reflect systemic complement activation. Complement activation was present in a heterogeneous group of kidney disease, indicating the underlying role of complement in many disorders.
Collapse
Affiliation(s)
- Carolyn Wijaya
- Immunopathology, NSW Health Pathology, John Hunter Hospital, New Lambton Heights, NSW, Australia
- University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Christine Burns
- Immunopathology, NSW Health Pathology, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Sharron Hall
- Immunopathology, NSW Health Pathology, John Hunter Hospital, New Lambton Heights, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Melissa Farmer
- Anatomical Pathology, NSW Health Pathology, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Denise Jones
- Renal Department, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Matthew Rowlandson
- Renal Department, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Peter Choi
- Renal Department, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Mark Formby
- Anatomical Pathology, NSW Health Pathology, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Theo de Malmanche
- Immunopathology, NSW Health Pathology, John Hunter Hospital, New Lambton Heights, NSW, Australia
| |
Collapse
|
5
|
Turner KA, Frinack JL, Ettore MW, Tate JR, Graziani MS, Jacobs JFM, Booth RA, McCudden CR, Keren DF, Delgado JC, Zemtsovskaja G, Fullinfaw RO, Caldini A, de Malmanche T, Katakouzinos K, Burke M, Palladini G, Altinier S, Zaninotto M, Righetti G, Melki MT, Bell S, Willrich MAV. An international multi-center serum protein electrophoresis accuracy and M-protein isotyping study. Part I: factors impacting limit of quantitation of serum protein electrophoresis. Clin Chem Lab Med 2021; 58:533-546. [PMID: 31940284 DOI: 10.1515/cclm-2019-1104] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 10/25/2019] [Accepted: 12/02/2019] [Indexed: 11/15/2022]
Abstract
Background Serum protein electrophoresis (SPEP) is used to quantify the serum monoclonal component or M-protein, for diagnosis and monitoring of monoclonal gammopathies. Significant imprecision and inaccuracy pose challenges in reporting small M-proteins. Using therapeutic monoclonal antibody-spiked sera and a pooled beta-migrating M-protein, we aimed to assess SPEP limitations and variability across 16 laboratories in three continents. Methods Sera with normal, hypo- or hypergammaglobulinemia were spiked with daratumumab, Dara (cathodal migrating), or elotuzumab, Elo (central-gamma migrating), with concentrations from 0.125 to 10 g/L (n = 62) along with a beta-migrating sample (n = 9). Provided with total protein (reverse biuret, Siemens), laboratories blindly analyzed samples according to their SPEP and immunofixation (IFE) or immunosubtraction (ISUB) standard operating procedures. Sixteen laboratories reported the perpendicular drop (PD) method of gating the M-protein, while 10 used tangent skimming (TS). A mean percent recovery range of 80%-120% was set as acceptable. The inter-laboratory %CV was calculated. Results Gamma globulin background, migration pattern and concentration all affect the precision and accuracy of quantifying M-proteins by SPEP. As the background increases, imprecision increases and accuracy decreases leading to overestimation of M-protein quantitation especially evident in hypergamma samples, and more prominent with PD. Cathodal migrating M-proteins were associated with less imprecision and higher accuracy compared to central-gamma migrating M-proteins, which is attributed to the increased gamma background contribution in M-proteins migrating in the middle of the gamma fraction. There is greater imprecision and loss of accuracy at lower M-protein concentrations. Conclusions This study suggests that quantifying exceedingly low concentrations of M-proteins, although possible, may not yield adequate accuracy and precision between laboratories.
Collapse
Affiliation(s)
- Katherine A Turner
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jody L Frinack
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Michael W Ettore
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jillian R Tate
- Department of Chemical Pathology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | | | - Joannes F M Jacobs
- Department of Laboratory Medicine, Radboud University Medical Center, Laboratory Medical Immunology, Nijmegen, the Netherlands
| | - Ronald A Booth
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Christopher R McCudden
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | | | - Julio C Delgado
- ARUP Laboratories, Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Galina Zemtsovskaja
- Clinical Chemistry Laboratory, North Estonia Medical Centre, Tallinn, Estonia
| | - Robert O Fullinfaw
- Department of Chemical Pathology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Anna Caldini
- General Laboratory, Careggi University Hospital, Florence, Italy
| | - Theo de Malmanche
- NSW Health Pathology, Immunology Department, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Katina Katakouzinos
- Immunopathology Department, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia
| | - Matthew Burke
- Department of Chemical Pathology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Giovanni Palladini
- Amyloidosis Research and Treatment Center, Foundation IRCCS Policlinico San Matteo, and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Sara Altinier
- Laboratory Medicine of the University Hospital of Padova, Padova, Italy
| | - Martina Zaninotto
- Laboratory Medicine of the University Hospital of Padova, Padova, Italy
| | | | | | | | - Maria Alice Vieira Willrich
- Division of Clinical Biochemistry and Immunology, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| |
Collapse
|
6
|
Jacobs JFM, Turner KA, Graziani MS, Frinack JL, Ettore MW, Tate JR, Booth RA, McCudden CR, Keren DF, Delgado JC, Zemtsovskaja G, Fullinfaw RO, Caldini A, de Malmanche T, Katakouzinos K, Burke M, Palladini G, Altinier S, Zaninotto M, Righetti G, Melki MT, Bell S, Willrich MAV. An international multi-center serum protein electrophoresis accuracy and M-protein isotyping study. Part II: limit of detection and follow-up of patients with small M-proteins. Clin Chem Lab Med 2021; 58:547-559. [PMID: 31940285 DOI: 10.1515/cclm-2019-1105] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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: 10/25/2019] [Accepted: 12/17/2019] [Indexed: 11/15/2022]
Abstract
Background Electrophoretic methods to detect, characterize and quantify M-proteins play an important role in the management of patients with monoclonal gammopathies (MGs). Significant uncertainty in the quantification and limit of detection (LOD) is documented when M-proteins are <10 g/L. Using spiked sera, we aimed to assess the variability in intact M-protein quantification and LOD across 16 laboratories. Methods Sera with normal, hypo- or hyper-gammaglobulinemia were spiked with daratumumab or elotuzumab, with concentrations from 0.125 to 10 g/L (n = 62) along with a beta-migrating sample (n = 9). Laboratories blindly analyzed samples according to their serum protein electrophoresis (SPEP)/isotyping standard operating procedures. LOD and intra-laboratory percent coefficient of variation (%CV) were calculated and further specified with regard to the method (gel/capillary electrophoresis [CZE]), gating strategy (perpendicular drop [PD]/tangent skimming [TS]), isotyping (immunofixation/immunosubtraction [ISUB]) and manufacturer (Helena/Sebia). Results All M-proteins ≥1 g/L were detected by SPEP. With isotyping the LOD was moderately more sensitive than with SPEP. The intensity of polyclonal background had the biggest negative impact on LOD. Independent of the method used, the intra-laboratory imprecision of M-protein quantification was small (mean CV = 5.0%). Low M-protein concentration and high polyclonal background had the strongest negative impact on intra-laboratory precision. All laboratories were able to follow trend of M-protein concentrations down to 1 g/L. Conclusions In this study, we describe a large variation in the reported LOD for both SPEP and isotyping; overall LOD is most affected by the polyclonal immunoglobulin background. Satisfactory intra-laboratory precision was demonstrated. This indicates that the quantification of small M-proteins to monitor patients over time is appropriate, when subsequent testing is performed within the same laboratory.
Collapse
Affiliation(s)
- Joannes F M Jacobs
- Laboratory Medical Immunology, Department of Laboratory Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - Katherine A Turner
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Jody L Frinack
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Michael W Ettore
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jillian R Tate
- Department of Chemical Pathology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Ronald A Booth
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Christopher R McCudden
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - David F Keren
- Department of Pathology, The University of Michigan, Ann Arbor, MI, USA
| | - Julio C Delgado
- ARUP Laboratories, Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Galina Zemtsovskaja
- Clinical Chemistry Laboratory, North Estonia Medical Centre, Tallinn, Estonia
| | - Robert O Fullinfaw
- Department of Chemical Pathology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Anna Caldini
- General Laboratory, Careggi University Hospital, Florence, Italy
| | - Theo de Malmanche
- NSW Health Pathology, Immunology Department, John Hunter Hospital, New Lambton Heights NSW, Australia
| | - Katina Katakouzinos
- Immunopathology Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Matthew Burke
- Department of Chemical Pathology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Giovanni Palladini
- Amyloidosis Research and Treatment Center, Foundation IRCCS Policlinico San Matteo, and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Sara Altinier
- Laboratory Medicine of the University Hospital of Padova, Padova, Italy
| | - Martina Zaninotto
- Laboratory Medicine of the University Hospital of Padova, Padova, Italy
| | | | | | | | - Maria Alice Vieira Willrich
- Division of Clinical Biochemistry and Immunology, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| |
Collapse
|
7
|
Enjeti AK, de Malmanche T, Chapman K, Ziolkowski A. Genomic investigation of inherited thrombotic microangiopathy-aHUS and TTP. Int J Lab Hematol 2021; 42 Suppl 1:33-40. [PMID: 32543063 DOI: 10.1111/ijlh.13201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 12/12/2022]
Abstract
Thrombotic microangiopathies (TMA) are a heterogeneous group of red cell fragmentation syndromes characterized by a tendency for thrombosis and pathognomonic red cell fragments in peripheral blood, which results in thrombosis in the microvasculature due to endothelial damage. Genomic investigations into inherited TMAs are of diagnostic, prognostic and therapeutic value. Here, we present two cases that capture the importance of performing genomic testing in rare disorders. Treatment options for these conditions, such as plasma exchange and monoclonal antibodies against complement factors, are intensive and expensive health care interventions. The results of genomic investigation into rare TMAs can better inform the clinicians and their patients of prognosis and suitable personalized treatment options.
Collapse
Affiliation(s)
- Anoop K Enjeti
- NSW Health Pathology North, John Hunter Campus, New Lambton Heights, NSW, Australia.,Calvary Mater Newcastle, Waratah, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Theo de Malmanche
- NSW Health Pathology North, John Hunter Campus, New Lambton Heights, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Kent Chapman
- NSW Health Pathology North, John Hunter Campus, New Lambton Heights, NSW, Australia
| | - Andrew Ziolkowski
- NSW Health Pathology North, John Hunter Campus, New Lambton Heights, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| |
Collapse
|
8
|
de Malmanche T. Routine complement blood tests are insensitive for alternative complement activation. Intern Med J 2019; 49:1057-1058. [DOI: 10.1111/imj.14393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Theo de Malmanche
- ImmunologyUniversity of Newcastle Newcastle New South Wales Australia
- School of Medicine and Public HealthUniversity of Newcastle Newcastle New South Wales Australia
| |
Collapse
|
9
|
Fox LC, Cohney SJ, Kausman JY, Shortt J, Hughes PD, Wood EM, Isbel NM, de Malmanche T, Durkan A, Hissaria P, Blombery P, Barbour TD. Consensus opinion on diagnosis and management of thrombotic microangiopathy in Australia and New Zealand. Intern Med J 2018; 48:624-636. [DOI: 10.1111/imj.13804] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/13/2018] [Accepted: 02/13/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Lucy C. Fox
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Solomon J. Cohney
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
| | - Joshua Y. Kausman
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
- Department of Nephrology and Murdoch Children's Research Institute; Royal Children's Hospital; Melbourne Victoria Australia
| | - Jake Shortt
- Monash Haematology; Monash Health; Melbourne Victoria Australia
- School of Clinical Sciences, Monash Health; Monash University; Melbourne Victoria Australia
| | - Peter D. Hughes
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
- Department of Nephrology; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Erica M. Wood
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
- Monash Haematology; Monash Health; Melbourne Victoria Australia
| | - Nicole M. Isbel
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - Theo de Malmanche
- New South Wales Health Pathology; Newcastle New South Wales Australia
| | - Anne Durkan
- Department of Nephrology; The Children's Hospital at Westmead; Sydney New South Wales Australia
| | - Pravin Hissaria
- Department of Immunology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Piers Blombery
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
- Department of Pathology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Thomas D. Barbour
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
- Department of Nephrology; Royal Melbourne Hospital; Melbourne Victoria Australia
| |
Collapse
|
10
|
Fox LC, Cohney SJ, Kausman JY, Shortt J, Hughes PD, Wood EM, Isbel NM, de Malmanche T, Durkan A, Hissaria P, Blombery P, Barbour TD. Consensus opinion on diagnosis and management of thrombotic microangiopathy in Australia and New Zealand. Nephrology (Carlton) 2018; 23:507-517. [DOI: 10.1111/nep.13234] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Lucy C Fox
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Solomon J Cohney
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
| | - Joshua Y Kausman
- Department of Nephrology and Murdoch Children's Research Institute; Royal Children's Hospital; Melbourne Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
| | - Jake Shortt
- Monash Haematology, Monash Health, Monash University; Melbourne Victoria Australia
- School of Clinical Sciences; Monash Health, Monash University; Melbourne Victoria Australia
| | - Peter D Hughes
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
- Department of Nephrology; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Erica M Wood
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
- Monash Haematology, Monash Health, Monash University; Melbourne Victoria Australia
| | - Nicole M Isbel
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - Theo de Malmanche
- New South Wales Health Pathology, Immunology; Newcastle New South Wales Australia
| | - Anne Durkan
- Department of Nephrology; The Children's Hospital at Westmead; Sydney New South Wales Australia
| | - Pravin Hissaria
- Department of Immunology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Piers Blombery
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
- Department of Pathology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Thomas D Barbour
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
- Department of Nephrology; Royal Melbourne Hospital; Melbourne Victoria Australia
| |
Collapse
|
11
|
Reeders J, Thant A, de Malmanche T, Pasupathy A. Primary thyroid T-cell lymphoma arising in a middle-aged Caucasian male. Pathology 2017; 49:647-649. [PMID: 28826830 DOI: 10.1016/j.pathol.2017.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/08/2017] [Accepted: 04/13/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Jocelyn Reeders
- Department of Anatomical Pathology, NSW Health Pathology, John Hunter Hospital, Newcastle, NSW, Australia.
| | - Aung Thant
- Haematology Unit, Tamworth Hospital, Tamworth, NSW, Australia
| | - Theo de Malmanche
- Department of Immunology, NSW Health Pathology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Asokan Pasupathy
- NSW Health Pathology, Tamworth Hospital, Tamworth, NSW, Australia
| |
Collapse
|
12
|
|
13
|
|
14
|
Hiles SA, Baker AL, de Malmanche T, McEvoy M, Boyle M, Attia J. Unhealthy lifestyle may increase later depression via inflammation in older women but not men. J Psychiatr Res 2015; 63:65-74. [PMID: 25795094 DOI: 10.1016/j.jpsychires.2015.02.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 02/15/2015] [Accepted: 02/16/2015] [Indexed: 12/30/2022]
Abstract
Depression and inflammatory markers have a reliable cross-sectional association although less is known about the prospective relationship. The current study investigated whether pro-inflammatory markers are prospectively associated with depression, and whether indicators of unhealthy lifestyle, physical health and psychosocial functioning may drive this association. Participants were drawn from the Hunter Community Study, a community-dwelling cohort of individuals aged 55-85 years (N = 1410). Participants completed baseline physiological assessment, health-related questionnaires, and blood sampling for the analysis of inflammatory markers, C-reactive protein (CRP) and interleukin (IL)-6. Participants completed the same depressive symptom questionnaire again after 3.5-5.5 years. Depression outcomes at follow-up were analysed dichotomously using established scale cut-off scores and continuously as a "residual score", representing the variation in follow-up depressive symptoms not explained by baseline symptoms and age. Analyses were conducted on males and females separately. At baseline, indicators of unhealthy lifestyle, physical health and psychosocial functioning were associated with depressive symptoms and inflammatory markers. For males, there were no relationships between inflammatory markers and follow-up depression outcomes. In females, IL-6 was significantly associated with depression outcomes in univariate, but not multivariate analyses. However, IL-6 significantly mediated the association between the predictors of waist-to-hip ratio, smoking and psychological coping at baseline, and follow-up depression outcomes. The results support the inflammatory hypothesis of depression, although females may be more vulnerable to effects. The findings raise the possibility that unhealthy lifestyle and psychosocial stress may drive inflammation and subsequent depressive symptoms.
Collapse
Affiliation(s)
- Sarah A Hiles
- Priority Research Centre for Translational Neuroscience and Mental Health, Faculty of Health, University of Newcastle, New South Wales, Australia.
| | - Amanda L Baker
- Priority Research Centre for Translational Neuroscience and Mental Health, Faculty of Health, University of Newcastle, New South Wales, Australia
| | - Theo de Malmanche
- Immunology, Hunter Area Pathology Service, John Hunter Hospital, New South Wales, Australia
| | - Mark McEvoy
- Centre for Clinical Epidemiology and Biostatistics, Faculty of Health, University of Newcastle, New South Wales, Australia; Hunter Medical Research Institute, John Hunter Hospital, New South Wales, Australia
| | - Michael Boyle
- Immunology and Infectious Diseases Unit, Medical and Interventional Service, John Hunter Hospital, New South Wales, Australia
| | - John Attia
- Centre for Clinical Epidemiology and Biostatistics, Faculty of Health, University of Newcastle, New South Wales, Australia; Hunter Medical Research Institute, John Hunter Hospital, New South Wales, Australia
| |
Collapse
|
15
|
Sarwar G, de Malmanche T, Rassam L, Grainge C, Williams A, Arnold D. Chronic granulomatous disease presenting as refractory pneumonia in late adulthood. Respirol Case Rep 2015; 3:54-6. [PMID: 26090111 PMCID: PMC4469140 DOI: 10.1002/rcr2.99] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 01/11/2015] [Revised: 02/01/2015] [Accepted: 02/09/2015] [Indexed: 11/08/2022] Open
Abstract
We present a case of refractory pneumonia in an adult patient with underlying chronic granulomatous disease (CGD). Her lobectomy tissue grew B urkholderia cepacia and histopathology revealed diffuse severe pneumonic consolidation with suppurative/necrotizing granulomata. An initial attempt to find an underlying immune deficiency was unsuccessful. Following recurrent invasive infections, repeat immunological assessment revealed reduced neutrophil function, demonstrating skewed carrier status (lyonization) for X-linked CGD (only 3% normal cells). A pathogenic mutation in the CYBB gene was found on sequencing. CYBB gene encodes the gp91phox, a catalytic subunit of nicotinamide adenine dinucleotide phosphate-oxidase that produces reactive oxygen species in phagocytes. Lyonization increases with age, explaining the delayed clinical CGD. CGD is a rare neutrophil disorder that usually presents in early life with recurrent infections due to bacteria and fungi primarily involving lungs and skin. It is secondary to a defective NADPH oxidase system needed to kill intracellular organisms and activate the formation of neutrophil extracellular traps.
Collapse
Affiliation(s)
- Ghulam Sarwar
- Department of Medicine, John Hunter Hospital New Lambton, New South Wales, Australia ; School of Medicine and Public Health, The University of Newcastle Newcastle, New South Wales, Australia
| | - Theo de Malmanche
- School of Medicine and Public Health, The University of Newcastle Newcastle, New South Wales, Australia ; Immunology, Hunter Area Pathology Service New Lambton, New South Wales, Australia
| | - Loui Rassam
- School of Medicine and Public Health, The University of Newcastle Newcastle, New South Wales, Australia ; Pathology, Hunter Area Pathology Service New Lambton, New South Wales, Australia
| | - Christopher Grainge
- School of Medicine and Public Health, The University of Newcastle Newcastle, New South Wales, Australia ; Department of Respiratory Medicine, John Hunter Hospital New Lambton, New South Wales, Australia
| | - Andrew Williams
- Immunology Laboratory, The Children's Hospital at Westmead Sydney, New South Wales, Australia ; Central Clinical School, University of Sydney Sydney, New South Wales, Australia
| | - David Arnold
- School of Medicine and Public Health, The University of Newcastle Newcastle, New South Wales, Australia ; Department of Respiratory Medicine, John Hunter Hospital New Lambton, New South Wales, Australia
| |
Collapse
|
16
|
Hiles SA, Baker AL, de Malmanche T, Attia J. A meta-analysis of differences in IL-6 and IL-10 between people with and without depression: exploring the causes of heterogeneity. Brain Behav Immun 2012; 26:1180-8. [PMID: 22687336 DOI: 10.1016/j.bbi.2012.06.001] [Citation(s) in RCA: 200] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 05/22/2012] [Accepted: 06/01/2012] [Indexed: 12/13/2022] Open
Abstract
Epidemiological evidence for the inflammatory hypothesis of depression is largely cross-sectional; people with depression have elevated levels of circulating pro-inflammatory markers compared to people without depression. The limitation of cross sectional research is the potential for extraneous factors to influence observed effects. The purpose of this meta-analysis of cross-sectional studies of interleukin(IL)-6 and IL-10 in people with and without depression is to provide a targeted analysis of potential moderator factors relating to the diagnosis of depression and to physical and psychiatric comorbidity. Electronic searches of Embase and Medline databases were conducted using subject headings "interleukin-6" or "interleukin-10" and those relating to depression. Studies were included if they measured circulating marker levels in serum or plasma in a group of people with and without depressive symptoms (99 studies for IL-6, 19 studies for IL-10). IL-6 was elevated in depressed compared to non-depressed groups (d = 0.46, 99% CI 0.34 to 0.58, I(2) = 85.9%). This effect was larger in subgroups where depressive disorders were diagnosed compared to those with only depressive symptoms via standardized inventory, and subgroups where participants were recruited from inpatient or outpatient settings compared to the general community. The effect was also larger in those who were not selected for a particular comorbidity compared to those selected for cardiovascular disease. IL-10 effect size was not significant (d = -0.31, 99% CI -0.95 to 0.32, I(2) = 94.1%) which was not accounted for in subgroup analyses or meta-regression, indicating there is not a global elevation in cytokines. These data highlight that comorbidity and behavioral aspects of depression need to be measured and controlled in future prospective and experimental research testing the inflammatory hypothesis of depression.
Collapse
Affiliation(s)
- Sarah A Hiles
- Priority Research Centre for Translational Neuroscience and Mental Health, Faculty of Health, University of Newcastle, Callaghan, New South Wales 2308, Australia.
| | | | | | | |
Collapse
|