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Gandy LA, Canning AJ, Lou H, Xia K, He P, Su G, Cairns T, Liu J, Zhang F, Linhardt RJ, Cohen G, Wang C. Molecular determinants of the interaction between HSV-1 glycoprotein D and heparan sulfate. Front Mol Biosci 2022; 9:1043713. [PMID: 36419932 PMCID: PMC9678342 DOI: 10.3389/fmolb.2022.1043713] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022] Open
Abstract
Literature has well-established the importance of 3-O-sulfation of neuronal cell surface glycan heparan sulfate (HS) to its interaction with herpes simplex virus type 1 glycoprotein D (gD). Previous investigations of gD to its viral receptors HVEM and nectin-1 also highlighted the conformational dynamics of gD's N- and C-termini, necessary for viral membrane fusion. However, little is known on the structural interactions of gD with HS. Here, we present our findings on this interface from both the glycan and the protein perspective. We used C-terminal and N-terminal gD variants to probe the role of their respective regions in gD/HS binding. The N-terminal truncation mutants (with Δ1-22) demonstrate equivalent or stronger binding to heparin than their intact glycoproteins, indicating that the first 22 amino acids are disposable for heparin binding. Characterization of the conformational differences between C-terminal truncated mutants by sedimentation velocity analytical ultracentrifugation distinguished between the "open" and "closed" conformations of the glycoprotein D, highlighting the region's modulation of receptor binding. From the glycan perspective, we investigated gD interacting with heparin, heparan sulfate, and other de-sulfated and chemically defined oligosaccharides using surface plasmon resonance and glycan microarray. The results show a strong preference of gD for 6-O-sulfate, with 2-O-sulfation becoming more important in the presence of 6-O-S. Additionally, 3-O-sulfation shifted the chain length preference of gD from longer chain to mid-chain length, reaffirming the sulfation site's importance to the gD/HS interface. Our results shed new light on the molecular details of one of seven known protein-glycan interactions with 3-O-sulfated heparan sulfate.
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Affiliation(s)
- Lauren A. Gandy
- Center for Biotechnology and Interdisciplinary Studies, Troy, NY, United States
- Chemistry and Chemical Biology Department, Rensselaer Polytechnic Institute, Troy, NY, United States
| | - Ashley J. Canning
- Center for Biotechnology and Interdisciplinary Studies, Troy, NY, United States
| | - Huan Lou
- Department of Microbiology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Ke Xia
- Center for Biotechnology and Interdisciplinary Studies, Troy, NY, United States
| | - Peng He
- Center for Biotechnology and Interdisciplinary Studies, Troy, NY, United States
| | - Guowei Su
- Glycan Therapeutics, Raleigh, NC, United States
| | - Tina Cairns
- Department of Microbiology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jian Liu
- Glycan Therapeutics, Raleigh, NC, United States
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States
| | - Fuming Zhang
- Center for Biotechnology and Interdisciplinary Studies, Troy, NY, United States
| | - Robert J. Linhardt
- Center for Biotechnology and Interdisciplinary Studies, Troy, NY, United States
- Chemistry and Chemical Biology Department, Rensselaer Polytechnic Institute, Troy, NY, United States
| | - Gary Cohen
- Department of Microbiology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Chunyu Wang
- Center for Biotechnology and Interdisciplinary Studies, Troy, NY, United States
- Chemistry and Chemical Biology Department, Rensselaer Polytechnic Institute, Troy, NY, United States
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Scale R, Cairns T, Metodiev Y. P.187 Total intravenous anaesthesia for caesarean delivery in women with coagulopathy. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103483] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Brooks BD, Closmore A, Yang J, Holland M, Cairns T, Cohen GH, Bailey-Kellogg C. Characterizing Epitope Binding Regions of Entire Antibody Panels by Combining Experimental and Computational Analysis of Antibody: Antigen Binding Competition. Molecules 2020; 25:molecules25163659. [PMID: 32796656 PMCID: PMC7464469 DOI: 10.3390/molecules25163659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/16/2022] Open
Abstract
Vaccines and immunotherapies depend on the ability of antibodies to sensitively and specifically recognize particular antigens and specific epitopes on those antigens. As such, detailed characterization of antibody-antigen binding provides important information to guide development. Due to the time and expense required, high-resolution structural characterization techniques are typically used sparingly and late in a development process. Here, we show that antibody-antigen binding can be characterized early in a process for whole panels of antibodies by combining experimental and computational analyses of competition between monoclonal antibodies for binding to an antigen. Experimental "epitope binning" of monoclonal antibodies uses high-throughput surface plasmon resonance to reveal which antibodies compete, while a new complementary computational analysis that we call "dock binning" evaluates antibody-antigen docking models to identify why and where they might compete, in terms of possible binding sites on the antigen. Experimental and computational characterization of the identified antigenic hotspots then enables the refinement of the competitors and their associated epitope binding regions on the antigen. While not performed at atomic resolution, this approach allows for the group-level identification of functionally related monoclonal antibodies (i.e., communities) and identification of their general binding regions on the antigen. By leveraging extensive epitope characterization data that can be readily generated both experimentally and computationally, researchers can gain broad insights into the basis for antibody-antigen recognition in wide-ranging vaccine and immunotherapy discovery and development programs.
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Affiliation(s)
- Benjamin D. Brooks
- Department of Biomedical Sciences, Rocky Vista University, Ivins, UT 84738, USA
- Inovan Inc., Fargo, ND 58102, USA
- Department of Microbiology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (T.C.); (G.H.C.)
- Correspondence: ; Tel.: +1-435-222-1403
| | - Adam Closmore
- Department of Pharmacy, North Dakota State University, Fargo, ND 58102, USA;
| | - Juechen Yang
- Department of Biomedical Engineering, North Dakota State University, Fargo, ND 58102, USA; (J.Y.); (M.H.)
| | - Michael Holland
- Department of Biomedical Engineering, North Dakota State University, Fargo, ND 58102, USA; (J.Y.); (M.H.)
| | - Tina Cairns
- Department of Microbiology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (T.C.); (G.H.C.)
| | - Gary H. Cohen
- Department of Microbiology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (T.C.); (G.H.C.)
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Gilmore AC, Wilson H, Cairns T, Botto M, Lightstone L, Bruce IN, Cook T, Pickering M. OP0044 WHOLE KIDNEY TRANSCRIPTOMIC ANALYSIS OF FORMALIN-FIXED PARAFFIN-EMBEDDED LUPUS NEPHRITIS KIDNEY BIOPSY TISSUE USING THE NANOSTRING NCOUNTER PLATFORM. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Background:There is an ongoing effort to elucidate the molecular pathways that are key to kidney injury in lupus nephritis (LN). One approach is to study the transcriptome utilising kidney tissue obtained during diagnostic renal biopsy [1]. In clinical practice the most common tissue that is surplus to diagnostic requirements is formalin-fixed paraffin-embedded (FFPE) tissue. However, due to RNA degradation, transcriptomic analysis has been sub-optimal and challenging using standard procedures. The NanoString technology platform has the advantage that reliable detection of transcripts can be achieved even with degraded RNA. In this study we explored the utility of NanoString technology in identifying transcripts in RNA isolated from archival FFPE kidney biopsy sections in a cohort of patients with LN.Objectives:To explore the utility of the NanoString platform in elucidating a renal transcriptomic signature in formalin-fixed paraffin-embedded Lupus Nephritis kidney biopsy tissue.Methods:We utilised well defined Class III (n=11); Class IV (n=22) and Class V (n=24) LN FFPE kidney biopsies from female patients attending the Imperial College Healthcare NHS Trust. We excluded biopsies with mixed lesions or chronic lesions (i.e. significant glomerular scarring). Kidney biopsies from patients with Thin Basement Membrane (TBM; n=14) disease were used as controls. Six 10 micron thick sections were obtained from each biopsy and RNA isolated using the Qiagen RNeasy FFPE Kit. 100 micrograms of RNA was used for the detection of transcripts. We used the NanoString PanCancer immune profiling panel (770 transcript probes) and an additional 30 custom designed probes, enabling us to detect 800 transcripts, including 40 reference genes. Transcript analysis was performed according to manufacturer’s instructions using the NanoString nSolver software. When analysing differential gene expression (DGE) we used Benjamini-Hochberg adjustment to account for multiple testing. The threshold for statistical significance was an adjusted P value of 0.05 (5% false discovery rate).Results:Transcriptomic data passing NanoString nSolver quality control metrics was obtained from all sections. Notably sections included biopsies up to 16 years old (range: 1-16 years). Our transcript panel contained several Type I interferon (IFN) responsive genes, including sialic acid-binding Ig-like lectin 1 (Siglec-1). We detected a type I IFN signature using 8 IFN-responsive transcripts in 39 (68.4%) of the LN biopsies but in none of the TBM biopsies. This signature was present in Class III (n=9, 81.8%), Class IV (n=16, 72.7%) and Class V (n=14, 58.3%) LN samples. When we performed DGE analysis using TBM as the baseline we detected significantly increased expression across the classes (Class III = 202; Class IV = 357 and Class V = 237 differentially expressed transcripts, Figure 1).Conclusion:We have successfully identified transcriptomic signatures in RNA samples derived from a relatively large cohort of FFPE LN samples. Consistent with published reports we could detect a type I IFN signature in the LN kidney tissue [1]. Consistent with a recent study [1], we detected increased expression of OPN (osteopontin) and FN1 (fibronectin-1) in proliferative (Class III and IV) but not Class V LN. We are now performing clinical correlations to determine if the differentially expressed transcripts are clinically informative.References:[1]Almaani S, Prokopec SD, Zhang J, Yu L, Avila-Casado C, Wither J, Scholey JW, Alberton V, Malvar A, Parikh SV, Boutros PC, Rovin BH, Reich HN. Rethinking Lupus Nephritis Classification on a Molecular Level. J Clin Med. 2019 Sep 23;8(10).Disclosure of Interests:Alyssa C. Gilmore: None declared, Hannah Wilson: None declared, Tom Cairns: None declared, Marina Botto: None declared, Liz Lightstone Grant/research support from: Roche - ended 2018, Consultant of: GSK, Aurinia, Pfizer, Achillion, Speakers bureau: Alexion, Ian N. Bruce Grant/research support from: Genzyme Sanofi, GSK, and UCB, Consultant of: Eli Lilly, AstraZeneca, UCB, Iltoo, and Merck Serono, Speakers bureau: UCB, Terry Cook Grant/research support from: Achillion funding for natural history study on C3 glomerulopathy, Consultant of: Scientific consultant to Apellis, Alexion, Achillion, GSK, Speakers bureau: Alexion, Matthew Pickering Grant/research support from: Funding for investigation of therapeutic compounds in pre-clinical models of complement-mediated kidney disease; Achillion funding for natural history study on C3 glomerulopathy, Consultant of: Scientific Advisor for Alexion, Achillion, Apellis
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Poo SX, Tham CSW, Smith C, Lee J, Cairns T, Galliford J, Hamdulay S, Jacyna M, Levy JB, McAdoo SP, Roufosse C, Wernig F, Mason JC, Pusey CD, Tam FWK, Tomlinson JAP. IgG4-related disease in a multi-ethnic community: clinical characteristics and association with malignancy. QJM 2019; 112:763-769. [PMID: 31225617 DOI: 10.1093/qjmed/hcz149] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 01/13/2019] [Revised: 05/07/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Immunoglobulin-G4-related disease (IgG4-RD) is a recently recognized fibro-inflammatory condition that can affect multiple organs. Despite growing interest in this condition, the natural history and management of IgG4-RD remain poorly understood. AIM To describe the clinical characteristics, treatment and outcomes of IgG4-RD in a multi-ethnic UK cohort, and investigate its possible association with malignancy. DESIGN Retrospective analysis of case-note and electronic data. METHODS Cases were identified from sub-specialty cohorts and a systematic search of an NHS trust histopathology database using 'IgG4' or 'inflammatory pseudotumour' as search terms. Electronic records, imaging and histopathology reports were reviewed. RESULTS In total, 66 identified cases of IgG4-RD showed a similar multi-ethnic spread to the local population of North West London. The median age was 59 years and 71% of patients were male. Presenting symptoms relating to mass effect of a lesion were present in 48% of cases and the mean number of organs involved was 2.4. Total of 10 patients had reported malignancies with 6 of these being haematological. 83% of those treated with steroids had good initial response; however, 50% had relapsing-remitting disease. Rituximab was administered in 11 cases and all achieved an initial serological response. Despite this, seven patients subsequently relapsed after a mean duration of 11 months and four progressed despite treatment. CONCLUSIONS We report a large UK-based cohort of IgG4-RD that shows no clear ethnic predisposition and a wide range of affected organs. We discuss the use of serum IgG4 concentrations as a disease marker in IgG4-RD, the association with malignant disease and outcomes according to differing treatment regimens.
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Affiliation(s)
- S X Poo
- Department of Medicine, Imperial College Healthcare NHS Trust, London, UK
- Department of Medicine, London North West Healthcare NHS Trust, Harrow, UK
| | - C S W Tham
- Department of Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - C Smith
- Department of Medicine, Imperial College London, London, UK
| | - J Lee
- Department of Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - T Cairns
- Department of Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - J Galliford
- Department of Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - S Hamdulay
- Department of Medicine, London North West Healthcare NHS Trust, Harrow, UK
| | - M Jacyna
- Department of Medicine, London North West Healthcare NHS Trust, Harrow, UK
| | - J B Levy
- Department of Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - S P McAdoo
- Department of Medicine, Imperial College Healthcare NHS Trust, London, UK
- Department of Medicine, Imperial College London, London, UK
| | - C Roufosse
- Department of Medicine, Imperial College London, London, UK
| | - F Wernig
- Department of Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - J C Mason
- Department of Medicine, Imperial College Healthcare NHS Trust, London, UK
- Department of Medicine, Imperial College London, London, UK
| | - C D Pusey
- Department of Medicine, Imperial College Healthcare NHS Trust, London, UK
- Department of Medicine, Imperial College London, London, UK
| | - F W K Tam
- Department of Medicine, Imperial College Healthcare NHS Trust, London, UK
- Department of Medicine, Imperial College London, London, UK
| | - J A P Tomlinson
- Department of Medicine, Imperial College Healthcare NHS Trust, London, UK
- Department of Medicine, Imperial College London, London, UK
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Muentze J, Gensler D, Cairns T, Maniuc O, Oder D, Wanner C, Frantz S, Nordbeck P. 4092Magnetic resonance imaging of Fabry disease cardiomyopathy in patients receiving oral chaperone therapy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Fabry disease is a lysosomal storage disorder with multiple organ involvement. Renal and cardiac symptoms can lead to dialysis and myocardial hypertrophy with fibrosis, responsible for heart failure with preserved ejection fraction (HFpEF). Enzyme replacement therapy (ERT) is available for all patients with Fabry disease since 2001, requiring infusions every other week. Since May 2016, the chaperone migalastat represents a novel form of specific therapy as the first oral therapy available for certain Fabry patients. Through this molecule the function of the mutated enzyme α-galactosidase A can be restored. Recent trials have shown positive cardiac effects of chaperone therapy using echocardiography; however, MRI investigations further evaluating these findings are not available yet.
Objective
To evaluate cardiac effects of migalastat therapy in patients with amenable α-galactosidase A mutations in the prospective monocentric HEAL-FABRY registry (NCT03362164).
Methods and results
Comprehensive clinical investigations including serial MRI were conducted at baseline before initiation of migalastat therapy and at least one year thereafter in all patients without contraindications such as pacemakers or ICDs. Out of 29 patients included in the study (mean age at start of therapy 52.8±14 years, total range 20–74 years), until then 12 patients with MRI data completed the 1-year follow-up. At 1 year, enzyme activity in leucocytes increased from 0.06 to 0.21 nmol/min/mg protein (p=0.001). Distinctive changes over time were observed not only in diastolic but also systolic parameters. The systolic myocardial mass index was reduced by 2.39% (p=0.10). In the AHA segment number 5, most important for classification of severe myocardial damage in Fabry patients, late gadolinium enhancement was reduced by 8.58% in all 5 patients with verified progressive fibrosis (p=0.14). One patient stopped migalastat therapy due to personal reasons. No significant side effects were observed.
Analysis of LGE (systolic phase)
Conclusion
These preliminary MRI data show positive effects of migalastat therapy in patients with Fabry disease and cardiac involvement. Compared to echocardiography, MRI has the potential to allow for comprehensive additional analyses regarding both cardiac morphology and function.
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Affiliation(s)
- J Muentze
- University Hospital Wuerzburg, Wuerzburg, Germany
| | - D Gensler
- University Hospital Wuerzburg, Wuerzburg, Germany
| | - T Cairns
- University Hospital Wuerzburg, Wuerzburg, Germany
| | - O Maniuc
- University Hospital Wuerzburg, Wuerzburg, Germany
| | - D Oder
- University Hospital Wuerzburg, Wuerzburg, Germany
| | - C Wanner
- University Hospital Wuerzburg, Wuerzburg, Germany
| | - S Frantz
- University Hospital Wuerzburg, Wuerzburg, Germany
| | - P Nordbeck
- University Hospital Wuerzburg, Wuerzburg, Germany
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Cairns T, de Courcy J. Artefactual ST elevation with Mindray monitors. Anaesthesia 2017; 72:789. [PMID: 28654142 DOI: 10.1111/anae.13847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- T Cairns
- Cheltenham General Hospital, Cheltenham, UK
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McAdoo S, Masoud S, Bedi R, Cairns T, Lightstone L. P06 OFATUMUMAB FOR B CELL DEPLETION THERAPY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS WHO ARE INTOLERANT OF RITUXIMAB. Kidney Int Rep 2016. [DOI: 10.1016/j.ekir.2016.09.012] [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: 11/24/2022] Open
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Mcadoo S, Tanna A, Randone O, Griffith M, Levy J, Cook T, Cairns T, Pusey C. Focal necrotizing and crescentic glomerulonephritis in patients with normal serum creatinine. Presse Med 2013. [DOI: 10.1016/j.lpm.2013.02.238] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Tanna A, Mcadoo S, Tam F, Cairns T, Griffith M, Salama A, Levy J, Pusey C. Long-term outcome in patients with both ANCA and GBM positivity. Presse Med 2013. [DOI: 10.1016/j.lpm.2013.02.041] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Willicombe M, Brookes P, Santos-Nunez E, Galliford J, Ballow A, Mclean A, Roufosse C, Cook HT, Dorling A, Warrens AN, Cairns T, Taube D. Outcome of patients with preformed donor-specific antibodies following alemtuzumab induction and tacrolimus monotherapy. Am J Transplant 2011; 11:470-7. [PMID: 21299828 DOI: 10.1111/j.1600-6143.2010.03421.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
It has been shown that low-level preformed donor-specific antibodies (DSAbs) detected by luminex beads in the setting of a negative CDC and flow cytometry crossmatch (CDC/FCXM) are associated with inferior allograft outcomes. The relevance of preformed DSAbs in patients receiving alemtuzumab induction and tacrolimus monotherapy has not been studied. Four hundred and eighty renal transplant recipients with a negative CDC/FCXM had their pretransplant sera retrospectively screened for DSAbs. 45/480 (9.4%) of patients were found to have preformed DSAbs. Females and patients receiving regrafts were more likely to have a DSAb (p = 0.008 and p < 0.0001, respectively). Patients with DSAbs had inferior allograft survival (p = 0.047), increased incidence of antibody-mediated rejection (p < 0.0001) and inferior allograft function at 6 months posttransplant (p = 0.017). Patients with HLA class I DSAb (alone or in combination with a Class II DSAb) with high mean fluorescence intensities (MFIs) were at highest risk. We conclude that patients with preformed DSAb are at high risk of adverse outcomes when receiving a minimal immunosuppressive regime incorporating alemtuzumab induction. Patients found to have a preformed DSAb despite a negative crossmatch might benefit from augmented immunosuppression.
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Affiliation(s)
- M Willicombe
- Imperial College Kidney and Transplant Institute, Hammersmith Hospital, London, UK.
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Borrows R, Chusney G, Loucaidou M, James A, Lee J, Tromp JV, Owen J, Cairns T, Griffith M, Hakim N, McLean A, Palmer A, Papalois V, Taube D. Mycophenolic acid 12-h trough level monitoring in renal transplantation: association with acute rejection and toxicity. Am J Transplant 2006; 6:121-8. [PMID: 16433766 DOI: 10.1111/j.1600-6143.2005.01151.x] [Citation(s) in RCA: 113] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Studies of renal transplantation utilizing trough plasma level monitoring of mycophenolic acid (MPA) have shown inconsistent associations with toxicity and rejection. In this study, 5600 12-h trough MPA samples from 121 renal transplant recipients immunosuppressed with mycophenolate mofetil (MMF) and tacrolimus in a steroid sparing protocol (steroids for 7 days only) were sequentially analyzed. Higher MPA levels were associated with lower hemoglobin concentrations and anemia (hemoglobin <10 g/dL). Similarly, higher MPA levels were associated with lower total white cell counts and an increased incidence of leucopenia (total white cell count <4.0 x 10(9)/L). Hypoalbuminemia and renal impairment were also associated with hemotoxicity. MMF-associated diarrhea and viral infection were associated with higher MPA levels. Conversely, biopsy-proven acute rejection within the first month post-transplantation was associated with lower MPA levels. Anti-CD25 antibody induction was also associated with reduced rejection rates. No association was seen between MPA levels and platelet count, thrombocytopenia or bacterial infection. An MPA level of 1.60 mg/L early post-transplantation best discriminated patients with and without rejection, and an MPA level of 2.75 mg/L best discriminated patients with and without toxicity later post-transplantation.
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Affiliation(s)
- R Borrows
- Renal and Transplant Units, St. Mary's Hospital, Paddington, London W2 1NY, UK.
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Loucaidou M, Borrows R, Cairns T, Griffith M, Hakim N, Palmer A, Papalois V, Taube D, McLean AG. Late steroid withdrawal for renal transplant recipients on tacrolimus and MMF is safe. Transplant Proc 2005; 37:1795-6. [PMID: 15919469 DOI: 10.1016/j.transproceed.2005.02.094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 11/17/2022]
Abstract
INTRODUCTION We conducted a study to assess the safety of staged, late steroid withdrawal in kidney or kidney/pancreas transplant recipients on steroids, tacrolimus, and mycophenolate mofetil (MMF). MATERIALS AND METHODS We studied 50 patients including 33 recipients of cadaveric kidneys, eight living donor kidneys, and nine kidney-pancreas transplants. The mean time posttransplantation was 5.1 years (range 2.1 to 7.9 years). All patients were induced on prednisolone, tacrolimus, and MMF; steroids were withdrawn over 5 to 6 months. The rate of steroid reduction was altered in the face of typical steroid withdrawal symptoms (limb-girdle arthralgia/myalgia). RESULTS No rejection episodes occurred during steroid withdrawal. No patient required transplant biopsy for graft dysfunction. Six patients failed steroid withdrawal: five due to arthralgia/myalgia and one due to recurrent pulmonary sarcoidosis. The unexplained rise in serum creatinine following steroid withdrawal described in several other steroid withdrawal studies was not observed in this patient cohort. The mean serum creatinine was 137 micromol/L with deltacreatinine -6.8 micromol/y per year prior to steroid cessation versus 132 micromol/L with deltacreatinine -5.9 micromol/y in the year post-steroid cessation. There were 14 patients with posttransplant diabetes mellitus in this cohort: eight on gliclazide and six on insulin. We observed a reduction in their daily insulin/gliclazide requirements from 52 units to 41 units, and 73 mg to 65 mg, respectively. Two patients became gliclazide-independent at the time of steroid cessation. CONCLUSIONS Careful steroid withdrawal from a platform of tacrolimus and MMF is safe and not associated with a significant risk of rejection or graft dysfunction.
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Affiliation(s)
- M Loucaidou
- Renal and Transplant Unit, St Mary's Hospital, London, UK.
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14
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Loucaidou M, Stitchbury J, Lee J, Borrows R, Marshall SE, McLean AG, Cairns T, Griffith M, Hakim N, Palmer A, Papalois V, Welsh K, Taube D. Cytokine Polymorphisms Do Not Influence Acute Rejection in Renal Transplantation Under Tacrolimus-Based Immunosuppression. Transplant Proc 2005; 37:1760-1. [PMID: 15919456 DOI: 10.1016/j.transproceed.2005.03.151] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Acute rejection remains an important cause of graft loss after renal transplantation. It has been suggested that cytokine genotyping may play a predictive role in identifying individuals who are at higher risk of acute rejection with a view to individualizing their immunosuppression. The aim of this study was to investigate any possible associations between acute rejection and certain cytokine polymorphisms. METHODS We genotyped 91 cadaveric renal transplant recipients on tacrolimus-based immunosuppression and 84 of their donors. The cytokine polymorphisms studied were the following: tumor necrosis factor (TNF)-alpha-1032 T/C, TNF-alpha-865 C/A, TNF-alpha-859 G/A, interleukin (IL)1-R1-970 C/T, IL-10 haplotype [-1082, -819, -592], and IL-6-174 C/G. RESULTS We found no association between any polymorphism and the incidence of acute rejection. This was true for both the recipient and donor population. CONCLUSION Cytokine polymorphisms did not influence acute rejection in our study. We conclude that in the modern era of immunosuppression cytokine genotyping is not a significant predictor of acute rejection in renal transplantation.
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Affiliation(s)
- M Loucaidou
- Renal and Transplant Unit, St Mary's Hospital, London, United Kingdom.
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Borrows R, Loucaidou M, Van Tromp J, Singh S, Cairns T, Griffith M, Hakim N, McLean A, Palmer A, Papalois V, Taube D. Steroid Sparing in Renal Transplantation With Tacrolimus and Mycophenolate Mofetil: Three-Year Results. Transplant Proc 2005; 37:1792-4. [PMID: 15919468 DOI: 10.1016/j.transproceed.2005.03.150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 10/25/2022]
Abstract
Although renal transplantation with a 7-day steroid-sparing regimen, tacrolimus and mycophenolate, is associated with good short-term outcomes, late allograft dysfunction and failure remain concerns. In this study 101 consecutive patients underwent renal transplantation using this immunosuppressive regimen. In addition, anti-CD25 monoclonal antibody was used in 25 high-risk patients (regrafts, two-antigen human leukocyte antigen (HLA)-DR mismatch or sensitized with anti-HLA panel reactivity >30%). After a median follow-up of 39 months (range 29 to 49), overall patient survival is 98%, with two cardiac deaths. Three other graft losses occurred, one each to early venous thrombosis, polyoma viral nephropathy, and late rejection due to noncompliance. Therefore, overall graft survival is 95%. The acute rejection rate at 6 and 12 months was 19% (no rejection occurred between months 6 and 12). Late rejection was uncommon, with only two further episodes beyond 12 months. Mean creatinine at 12 months was 144 micromol/L and mean estimated glomerular filtration rate (GFR) of 55 mL/min. Graft function was stable at 3 years with a mean creatinine of 142 micromol/L and mean estimated GFR 56 mL/min. During the study, five patients developed posttransplant diabetes mellitus (two cases beyond 12 months). Tissue-invasive cytomegalovirus disease and BK viral nephropathy each occurred in three patients, with all episodes in the first 12 months. Mean weight gain is 3.3 kg and mean blood pressure is 135/81 on an average of 1.5 antihypertensive agents. This steroid-avoidance regimen is associated with excellent medium-term patient and graft outcomes and a low incidence of side effects.
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Affiliation(s)
- R Borrows
- Renal Unit, St. Mary's Hospital, Paddington, London, United Kingdom.
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Borrows R, Chusney G, Loucaidou M, Singh S, James A, Stichbury J, Van Tromp J, Cairns T, Griffith M, Hakim N, McLean A, Palmer A, Papalois V, Taube D. Tacrolimus Monitoring in Renal Transplantation: A Comparison Between High-Performance Liquid Chromatography and Immunoassay. Transplant Proc 2005; 37:1733-5. [PMID: 15919448 DOI: 10.1016/j.transproceed.2005.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 11/21/2022]
Abstract
It is recommended that specific methods of tacrolimus monitoring rather than immunoassays, which overestimate tacrolimus levels, should be used in transplant recipients. Direct comparison of these techniques, however, has not been conducted in renal transplantation. In this study, 40 renal transplant recipients with tacrolimus monitoring by microparticle enzyme immunoassay (MEIA; target trough level 10 to 15 ng/mL) were compared with 40 patients monitored by high-performance liquid chromatography with tandem mass spectrometry (HPLC-MS; target trough level 8 to 13 ng/mL). All patients received anti CD25 antibody induction and mycophenolate mofetil in a steroid-sparing protocol. No differences were seen between MEIA and HPLC-MS groups in patient demographics. All patients were followed for 6 months. Patient survival was 100% in both groups; graft survival was 100% in the MEIA group and 97.5% in the HPLC-MS group. The groups did not differ in the number of dose changes required in the first 6 months or in the number of patients displaying tacrolimus levels within target range at 3 and 6 months. Delayed graft function occurred in 14 patients in the MEIA group and 12 patients in the HPLC-MS group (P = NS). Biopsy-proven acute rejection occurred in four patients in the MEIA group and one patient in the HPLC-MS group (P < .2). No differences were seen for the following parameters at 3 or 6 months: biopsy-proven tacrolimus nephrotoxicity, serum creatinine or estimated creatinine clearance, systolic or diastolic blood pressure, cholesterol, cytomegalovirus disease, posttransplant diabetes, or tremor. This study suggests that renal transplantation with HPLC-MS monitoring of tacrolimus is safe and effective.
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Affiliation(s)
- R Borrows
- Renal and Transplant Units, St. Mary's Hospital, Paddington, London, United Kingdom.
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Cairns T, Larchar A, McKusick B. Additions and Corrections - The Reaction of Ethyl Isocyanide with Methanol, Ethanol, and Ethyl Mercaptan at High Pressure. J Org Chem 2002. [DOI: 10.1021/jo50012a021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
There is a high incidence of end-stage renal failure (ESRF) of undetermined cause in the Indo-Asian population of the UK. We studied patients presenting from the district of Brent and Harrow, which has a large Indo-Asian community, and whose renal services are largely provided by our centre. The diagnosis and ethnicity of patients starting renal replacement therapy and/or undergoing renal biopsy were collated. The incidences of ESRF, rates of renal biopsy and underlying diagnoses were calculated for Indo-Asians and Caucasians. Requirement for renal replacement therapy in Indo-Asians presenting to our centre from Brent and Harrow was 221/10(6)/year; no underlying diagnosis was identified in 77/10(6)/year. Renal biopsy rate in these patients was 456/10(6)/year, and the diagnostic categories significantly over-represented compared to Caucasians were: hypertension and ischaemia, focal segmental glomerulosclerosis (FSGS), idiopathic interstitial nephritis (IIN), diabetic nephropathy, minor glomerular abnormality, lupus nephritis and non-specific advanced chronic renal disease (p<0.001). The first three of these had a combined incidence of 135/10(6)/year in Indo-Asians and 31/10(6)/year in Caucasians. ESRF of undetermined cause is common in UK Indo-Asians, as is requirement for renal biopsy. Hypertension with ischaemia, FSGS and IIN are over-represented in the Indo-Asian population, and should be targeted for early diagnosis and treatment in this group.
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Affiliation(s)
- S Ball
- Renal Unit, Mint Wing, St Mary's Hospital, Praed Street, London W2 1NY, UK
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Fluck S, Preston R, McKane W, Harris A, Morgan R, Gedroyc W, Cairns T, Palmer A, Taube D. Intra-arterial stenting for recurrent transplant renal artery stenosis. Transplant Proc 2001; 33:1245-6. [PMID: 11267278 DOI: 10.1016/s0041-1345(00)02406-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S Fluck
- Renal & Transplant Units, St Mary's Hospital, London, UK
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McKane W, Kanganas C, Preston R, Cairns T, Hakim N, Palmer A, Taube D. Treatment of calcineurin inhibitor toxicity by dose reduction plus introduction of mycophenolate mofetil. Transplant Proc 2001; 33:1224-5. [PMID: 11267268 DOI: 10.1016/s0041-1345(00)02396-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- W McKane
- Renal and Transplant Unit, St Mary's Hospital, London, United Kingdom
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McKane W, Lee J, Preston R, van Dam M, Cairns T, Taube D. IgG2 anti-Galalpha1-3Gal does not induce porcine aortic endothelial cell accommodation in vitro. Transplantation 2000; 70:1085-93. [PMID: 11045647 DOI: 10.1097/00007890-200010150-00016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Xenografts that have been protected from hyperacute rejection (HAR) are termed accommodated if they are not then rejected despite the presence of xenoantibody. It has been proposed that IgG may confer resistance to complement dependent cytotoxicity (CDC), a conventional in vitro marker of accommodation. We hypothesized that noncytotoxic IgG2 anti-Galalpha1-3Gal was responsible for this effect. METHODS AND RESULTS We purified IgG anti-Galalpha1-3Gal from pooled human normal immunoglobulin and three sera, by elution from protein G and Galalpha1-3Gal-R immunoadsorbents. The eluates were IgM free and > or =95% IgG2. They bound to Galalpha1-3Gal, porcine aortic endothelial cells (PAEC) and lymphocytes. It was not possible to block IgM binding to PAEC or lymphocytes using IgG anti-Galalpha1-3Gal (200 microg/ml). The eluates were noncytotoxic in micro-CDC assays. To investigate accommodation, PAEC were cultured with subsaturating doses of the four IgG eluates for up to 144 hr. Resistance of nontrypsinized PAEC to CDC by human serum was measured in a cell viability assay. PAEC were not rendered resistant to CDC in any of the experiments. To investigate the possibility that accommodation might be induced by non-Galalpha1-3Gal IgG, the experiments were repeated using HNIg, again with no protection demonstrated. CONCLUSIONS Using primary PAEC monolayers, we were unable to induce resistance to CDC with human normal immunoglobulin and its IgG2 anti-Gabeta1-3Gal subset. This contradicts previous experiments using trypsinized, immortalized cells. Although resistance to CDC is not an ideal marker of accommodation, the detrimental effects of IgG make it unlikely that it will become a useful clinical means of inducing accommodation.
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Affiliation(s)
- W McKane
- The Brent Laboratory, St Mary's Hospital, London, UK
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22
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Cairns T. Comment on "Ontogeny of antipig xenoantibody and hyperacute rejection". Transplantation 2000; 70:568-9. [PMID: 10972210 DOI: 10.1097/00007890-200008270-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- T Cairns
- The Brent Laboratory, St. Mary's Hospital, London, England
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Papalois VE, Lee J, McKane W, Browning N, Palmer A, Hakim N, Cairns T, Taube D. Pig-to-rabbit islet transplantation as an immunologic model of pig-to-human islet xenografts. Transplant Proc 2000; 32:1070. [PMID: 10936362 DOI: 10.1016/s0041-1345(00)01128-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- V E Papalois
- Brent Laboratory, St Mary's Hospital, London, United Kingdom
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Sepp A, Farrar CA, Dorling T, Cairns T, George AJ, Lechler RI. Inhibition of expression of the Galalpha1-3Gal epitope on porcine cells using an intracellular single-chain antibody directed against alpha1,3galactosyltransferase. J Immunol Methods 1999; 231:191-205. [PMID: 10648938 DOI: 10.1016/s0022-1759(99)00134-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 11/17/2022]
Abstract
The carbohydrate epitope Galalpha1-3Gal has been shown to be the major target of natural antibodies responsible for hyperacute rejection of porcine tissues transplanted into primates. We have sought to produce a phenotypic knockout of the alpha1, 3Galactosyltransferase enzyme that is responsible for generating this epitope, using an intracellular antibody approach. We have isolated high affinity anti-alpha1,3Galactosyltransferase single-chain antibodies from a semi-synthetic phage display library. Expression of a KDEL-tagged anti-alpha1,3Galactosyltransferase single-chain antibody in a porcine endothelial cell line resulted in the decreased expression of the Galalpha1-3Gal epitope and increased resistance to lysis by human serum.
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Affiliation(s)
- A Sepp
- Department of Immunology, Division of Medicine, Imperial College School of Medicine, Hammersmith Campus, Du Cane Road, London, UK
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25
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Fluck S, McKane W, Cairns T, Fairchild V, Lawrence A, Lee J, Murray D, Polpitiye M, Palmer A, Taube D. Chloramine-induced haemolysis presenting as erythropoietin resistance. Nephrol Dial Transplant 1999; 14:1687-91. [PMID: 10435877 DOI: 10.1093/ndt/14.7.1687] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [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: 11/14/2022] Open
Abstract
BACKGROUND In December 1996 we identified an outbreak of erythropoietin (rHuEpo) resistance requiring a substantial increase in rHuEpo dosage in one of our four haemodialysis (HD) units. The dialysate chloramine levels in this unit had risen from <0.1 p.p.m. in 1996 to 0.25-0.3 p.p.m. in 1997. In the other three HD units levels remained <0.1 p.p.m. Other parameters of water quality were within accepted standards. METHODS Monthly records of haemoglobin level and rHuEpo dose were available for 148 patients between January 1996 and May 1998. Seventy-two patients, with no recognized cause of rHuEpo resistance, were analysed in detail (August 1997 to April 1998). A subgroup of 15 patients was examined for evidence of haemolysis during HD (methaemoglobin and haptoglobin levels, reticulocyte counts and Heinz bodies). Larger carbon columns were installed in December 1997 to effect chloramine removal. RESULTS There was an increase in mean methaemoglobinaemia of 23% (P<0.01) and a 21% fall in mean haptoglobin (P<0.01) across HD, although no patient had a reticulocytosis and only one patient with G6PD deficiency had Heinz bodies. Following installation of larger carbon columns there was an 18.6% rise (P<0.001) in mean haemoglobin level and a subsequent 25.0% reduction (P<0.001) in mean rHuEpo dose. Intradialytic changes in methaemoglobin and haptoglobin were abolished. The dialysate chloramine levels fell to < 0.1 p.p.m. Water company records subsequently revealed a sustained twofold increase in mains water chloramine from November 1996. CONCLUSIONS This is the first report linking chloramine exposure and rHuEpo resistance, with only subtle signs of haemolysis. Unheralded changes in mains water constituents can directly affect dialysate water quality and clinical outcomes.
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Affiliation(s)
- S Fluck
- The Brent Laboratory, St. Mary's Hospital, London, UK
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Papalois VE, Goldberg LC, Lee J, Preston RC, Hakim NS, Cairns T, Taube DH. Donor selection for xenotransplantation: detection of Galalpha1-3Gal on different porcine organs. Int Surg 1999; 84:258-61. [PMID: 10533788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
The expression of the major porcine xenoantigens (Galalpha1-3Gal) in different tissues varies between species. The selection of suitable donors and the interpretation of studies which attempt to prevent hyperacute rejection are dependent on donor expression of Galalpha1-3Gal. Screening of large number of animals to find potential Galalpha1-3Gal negative donors requires a robust, tissue-based and practical method of assessing Galalpha1-3Gal expression. In this study, we have assessed the expression of Galalpha1-3Gal in a variety of pig organs using anti Galalpha1-3Gal antibody. Biopsies of heart, kidney, ear and tail were obtained from 20 outbred pigs. Biopsies were fixed in formalin and stained with a human anti Galalpha1-3Gal antibody obtained from pooled human AB serum passed down a Galalpha1-3Gal immunoadsorbent column. Tissue from all 4 organs from all 20 pigs expressed Galalpha13Gal. This study shows that detection of Galalpha1-3Gal on an ear or tail biopsy is a simple but very reliable method for assessing Galalpha1-3Gal expression on the heart and kidney and facilitates donor selection for xenotransplantation.
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Affiliation(s)
- V E Papalois
- Brent Laboratory, Transplant Unit, St Mary's Hospital, London, UK
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Lee J, Cairns T, McKane W, Rashid M, George AJ, Taube D. Demonstration of IgM antibodies of high affinity within the anti-Galalpha1-3Gal antibody repertoire. Transplantation 1998; 66:1117-9. [PMID: 9808504 DOI: 10.1097/00007890-199810270-00028] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Human anti-Galalpha1-3Gal IgG and IgM xenoantibodies can distinguish between very similar epitopes with a high degree of selectivity. METHODS Anti-Galalpha1-3Gal antibodies were affinity isolated using two separate Galalpha1-3Gal-based immunoadsorbents, Galalpha1-3Gal itself and Galalpha1-3Galbeta1-4Glc. IgG and IgM were separated using a protein G column. Antibody purity was achieved by serial adsorption/elutions from the columns. By this means, different antibody fractions were prepared that contained either IgG or IgM, reactive with either Galalpha1-3Gal, Galalpha1-3Galbeta1-4Glc, or both. The dissociation equilibrium constants (Kd) of these antibodies were then measured using an IAsys biosensor. RESULTS AND CONCLUSIONS Sera from two individuals were used and Kd values for one IgG (fraction 1A) and two IgM (fractions 1B and 2A) fractions were obtained. The Kd for the IgG was 4.85 x 10(-7) M (fraction 1A). For IgM, the Kd values were higher at 7.8x10(-10) M (fraction 1B) and 1.07x10(-10) M (fraction 2A). Natural anti-pig antibodies include high affinity IgM that continue to be produced without class switch. The B cell mechanism behind this is not known. It may be possible to exploit this mechanism in future xenotransplantation strategies.
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Affiliation(s)
- J Lee
- The Brent Laboratory, St. Mary's Hospital, London, England, United Kingdom
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McKane W, Lee J, Preston R, Hacking A, Simpson P, Lynds S, Goldberg L, Cairns T, Taube D. Polymorphism in the human anti-pig natural antibody repertoire: implications for antigen-specific immunoadsorption. Transplantation 1998; 66:626-33. [PMID: 9753344 DOI: 10.1097/00007890-199809150-00014] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [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: 10/26/2022]
Abstract
BACKGROUND Anti-Galalpha1-3Gal antibodies cause hyperacute rejection (HAR) in pig-to-primate xenotransplantation. Long-term graft survival has not been achieved despite abrogation of HAR using transgenic pigs. IgG and IgM anti-Galalpha1-3Gal also play a role in the events following abrogation of HAR. Characterizing these antibodies and developing a system for their removal is therefore crucial to future success in xenotransplantation. METHODS AND RESULTS We have developed a neoglycoprotein enzyme-linked immunosorbent assay to probe the precise antigenic requirements for the binding of anti-Galalpha1-3Gal and have analyzed 77 normal sera. Sixty-six percent of individuals have IgG that recognizes the Galalpha1-3Gal di-, tri-, and pentasaccharides (D, T, and P, respectively), termed DTP phenotype. The frequency of other phenotypes was - -P, 13%; -TP, 12%; D-P, 8%; and DT-, 1%. The IgG subclasses found were IgG2 (95%), IgG3 (34%), IgG1 (31%), and IgG4 (17%). IgM in 91% of individuals recognized all three antigens. Further antibody heterogeneity was demonstrated when immunoadsorbents derived from Galalpha1-3Galbeta1-4GlcNAcbeta1-3Galbeta1-4Glc (PENTA) were tested. Galalpha1-3Galbeta1-4Glc (TRI 6) or PENTA agarose were effective for IgG removal in all individuals. For IgM removal, two deoxy derivatives were completely successful in 73% of individuals. Combining the Galalpha1-3Gal (DI) and TRI 6 agarose produced an adsorbent that completely removed anti-Galalpha1-3Gal IgG and IgM in all individuals tested. CONCLUSIONS Although the polymorphism in the anti-Galalpha1-3Gal repertoire, which we have demonstrated, represents a major obstacle to the development of an effective immunoadsorbent, the combination of DI and TRI 6 agarose appears sufficient for pig-to-human xenotransplantation.
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Affiliation(s)
- W McKane
- The Brent Laboratory, St. Mary's Hospital, London, United Kingdom
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Papalois VE, Berwanger C, Romagnoli J, Lee J, Cleanthis T, Robinson J, Cairns T, Stansby G, Taube D, Hakim NS. Effect of cryopreservation on Gal alpha 1-3Gal expression on adult porcine pancreatic islets. Transplant Proc 1998; 30:2474. [PMID: 9723544 DOI: 10.1016/s0041-1345(98)00693-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- V E Papalois
- Brent Laboratory, St. Mary's Hospital, London, United Kingdom
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Preston R, Ball S, Cairns T, Contis J, Hakim N, Palmer A, Papalois V, Taube D. FK 506 as primary immunosuppressive therapy in renal transplantation. Transplant Proc 1998; 30:1214-5. [PMID: 9636493 DOI: 10.1016/s0041-1345(98)00215-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- R Preston
- Renal Unit, St Mary's Hospital, Paddington, London, England
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Papalois VE, el-Atrozy T, Romagnoli J, Nicolaides A, Palmer A, Cairns T, Taube D, Hakim NS. Evaluation of arterial flow of pancreatic grafts with duplex-Doppler ultrasonography. Transplant Proc 1998; 30:255. [PMID: 9532020 DOI: 10.1016/s0041-1345(97)01249-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Papalois VE, Romagnoli J, Lee J, Cairns T, Hakim NS, Taube D. Collagenase digestion of the pig pancreas modifies the expression of Gal alpha 1-3Gal, Pk, and Thomsen-Friedenreich antigens on adult porcine islets. Transplant Proc 1998; 30:656. [PMID: 9532220 DOI: 10.1016/s0041-1345(97)01449-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- V E Papalois
- Brent Laboratory, St. Mary's Hospital, London, United Kingdom
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Cairns T, Gustavsson M, Goldberg L, Steen L, Strokan V, Samuelsson B, Taube D. Identification of Forssman as a major guinea pig xenoantigen. Transplant Proc 1996; 28:575. [PMID: 8623280] [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)
- T Cairns
- Renal and Transplant Unit, St. Mary's Hospital, London, UK
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Jurd KM, Lee J, Cairns T, Hunt BJ. Effect of Gal alpha 1,3 Gal-beta 1,4 GlcNAc and complement depletion on haemostatic activation in an in vitro model of the pig-to-human xenograft reaction. Transplant Proc 1996; 28:637-8. [PMID: 8623318] [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)
- K M Jurd
- Department of Haematology, St Thomas' Hospital, London, UK
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Cairns T, Lee J, Goldberg LC, Hakim N, Cook T, Rydberg L, Samuelsson B, Taube D. Thomsen-Friedenreich and PK antigens in pig-to-human xenotransplantation. Transplant Proc 1996; 28:795-6. [PMID: 8623404] [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)
- T Cairns
- Renal and Transplant Unit, St. Mary's Hospital, London, England
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36
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Goldberg LC, Lee J, Cairns T, Weymouth-Wilson A, Simpson P, Lawson C, Hacking A, Nilsson R, Hakim N, Taube D. Polymorphism within the human anti-pig repertoire. Transplant Proc 1996; 28:549-50. [PMID: 8623261] [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)
- L C Goldberg
- Renal and Transplant Unit, St. Mary's Hospital, London, England
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Cairns T, Lee J, Goldberg L, Cook T, Simpson P, Spackman D, Palmer A, Taube D. Inhibition of the pig to human xenograft reaction, using soluble Gal alpha 1-3Gal and Gal alpha 1-3Gal beta 1-4GlcNAc. Transplantation 1995; 60:1202-7. [PMID: 8525510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Natural anti-carbohydrate antibodies are central to hyperacute rejection in ABO-incompatible allotransplantation and in discordant xenotransplantation. ABO-incompatible rejection has been inhibited successfully using intravenous soluble carbohydrates as antibody inhibitors. The approach has been less successful previously in pig to primate xenotransplantation, where the necessary concentrations of a partial inhibitor (Gal alpha 1-6Glc) proved highly toxic. In this study, we have identified more effective inhibitors of the dominant human anti-pig antibodies that bind to the pentasaccharide Gal alpha 1-3Gal beta 1-4GlcNAc beta 1-3Gal beta 1-4Glc beta 1-. The inhibitors are the terminal disaccharide (Gal alpha 1-3Gal) and terminal trisaccharide (Gal alpha 1-3Gal beta 1-4GlcNAc) of the target pentasaccharide. Twelve sera (3 from each ABO blood group) were tested in 3 different assays: lymphocytotoxic, lymphocyte flow cytometry, and solid-phase antigen ELISA. Fifty percent to 75% inhibition of human IgG and IgM was achieved using the disaccharide and trisaccharide inhibitors in the range of 10-50 mM. Disaccharide (70 mM) was used to inhibit hyperacute thrombosis in pig kidneys perfused for 40 min with heparinized human AB whole blood. The disaccharide completely inhibited red cell occlusion of glomerular but not of intertubular capillaries, although there was residual platelet thrombus in glomeruli. Disaccharide and trisaccharide can, therefore, be used in concentrations shown for other carbohydrate inhibitors to be nontoxic, for inhibition of hyperacute pig-to-human xenograft rejection. The inhibition is incomplete, however, and other antigen specificities and other rejection mechanisms are likely to be involved.
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Affiliation(s)
- T Cairns
- Renal Unit, St. Mary's Hospital, London, United Kingdom
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Affiliation(s)
- T Cairns
- U.S. Food and Drug Administration, USA
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Goldberg L, Lee J, Cairns T, Cook T, Lin CK, Palmer A, Simpson P, Taube D. Inhibition of the human antipig xenograft reaction with soluble oligosaccharides. Transplant Proc 1995; 27:249-50. [PMID: 7878988] [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: 01/27/2023]
Affiliation(s)
- L Goldberg
- Renal Unit, St Mary's Hospital, London, England
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Samuelsson BE, Rydberg L, Breimer ME, Bäcker A, Gustavsson M, Holgersson J, Karlsson E, Uyterwaal AC, Cairns T, Welsh K. Natural antibodies and human xenotransplantation. Immunol Rev 1994; 141:151-68. [PMID: 7532617 DOI: 10.1111/j.1600-065x.1994.tb00876.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- B E Samuelsson
- Department of Clinical Chemistry and Transfusion Medicine, Sahlgren's Hospital, Göteborg, Sweden
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41
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Cairns T, Karlsson E, Holgersson J, Taube D, Welsh K, Samuelsson G. Confirmation of a major target epitope of human natural IgG and IgM anti-pig antibodies: terminal galactose alpha -1,3-galactose. Transplant Proc 1994; 26:1384. [PMID: 7518131] [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: 01/25/2023]
Affiliation(s)
- T Cairns
- Department of Clinical Transplant Immunology, Churchill Hospital, Oxford, England
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42
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Jurd KM, Cairns T, Hunt BJ. Activation of haemostasis in an in vitro model of the pig-to-human xenograft reaction. Transplant Proc 1994; 26:1159-60. [PMID: 8029868] [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: 01/28/2023]
Affiliation(s)
- K M Jurd
- Haemophilia Centre, St. Thomas Hospital, London, UK
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Cairns T, Hammelmann W, Gray D, Welsh K, Larson G. Enzymatic removal from various tissues of the galactose alpha 1,3-galactose target antigens of human antispecies antibodies. Transplant Proc 1994; 26:1279-80. [PMID: 7518125] [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: 01/25/2023]
Affiliation(s)
- T Cairns
- Department of Clinical Transplant Immunology, Churchill Hospital, Oxford, United Kingdom
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Hamelmann W, Ozasa T, Cairns T, Welsh K, Gray DW. Xenotransplantation of islets across a strong species barrier (rabbit to cynomolgus monkey). Transplant Proc 1994; 26:1097. [PMID: 8029844] [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: 01/28/2023]
Affiliation(s)
- W Hamelmann
- Nuffield Department of Surgery, Churchill John Radcliffe Hospital, Oxford, United Kingdom
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Abstract
The ion trap has been demonstrated to be able to detect and quantify 245 target pesticides extracted via the Luke method while providing concurrent confirmation of presence via full scan data at the sub-ppm level. The precision and accuracy of the analytical approach was determined to be no greater than 15% relative standard deviation. A comparison study of over 100 incurred residues analyzed by the ion trap and gas chromatography with an array of element-selective detectors has indicated that sample clean-up will probably be necessary before quantification is acceptable for all target compounds. The data obtained using a combination of gas chromatography and mass spectrometry and presented for 250 target pesticides constitutes the basic information required to duplicate and extend the methodology.
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Affiliation(s)
- T Cairns
- Department of Health & Human Services, Food & Drug Administration, Los Angeles District Laboratory, California 90015
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Karlsson E, Cairns T, Holgersson J, Welsh K, Samuelsson B. S12.8 Pig to human xenotransplantation. confirmation of the major target epitope of pre-formed human natural IgG and IgM anti-pig-terminal galactose? 1,3 galactose. Glycoconj J 1993. [DOI: 10.1007/bf01210042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rydberg L, Cairns T, Karlsson E, M�ller E, Satake M, Groth CG, Samuelsson BE. S12.6 Xenotransplantation of pig islet cells to man: specificities of human IgM and IgG anticarbohydrate antibodies. Glycoconj J 1993. [DOI: 10.1007/bf01210040] [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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Cairns T, Siegmund EG, Rader B. Analysis of testosterone esters by tandem mass spectrometry. J AOAC Int 1993; 76:306-12. [PMID: 8471857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The electron ionization (EI) and chemical ionization (CI) mass spectra of 12 representative testosterone esters were examined to explore the various analytical options available for identification and confirmation of the esters. Using EI, a number of fragment ions indicated the identification of the testosterone moiety, but structural confirmation of the individual esters often required the observance of the molecular ion at very low relative abundance ratios. The acceptable analytical method involved CI/tandem mass spectrometry based on the production of the 2 generic product ions derived from the protonated molecule ion.
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Affiliation(s)
- T Cairns
- U.S. Food and Drug Administration, Los Angeles District Laboratory, CA 90015
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Palmer A, Cairns T, Dische F, Gluck G, Gjorstrup P, Parsons V, Welsh K, Taube D. Treatment of rapidly progressive glomerulonephritis by extracorporeal immunoadsorption, prednisolone and cyclophosphamide. Nephrol Dial Transplant 1991; 6:536-42. [PMID: 1956551 DOI: 10.1093/ndt/6.8.536] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.4] [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: 12/29/2022] Open
Abstract
Ten patients with rapidly progressive glomerulonephritis and acute renal failure were treated with extracorporeal immunoadsorption, prednisolone, and cyclophosphamide. Three patients had systemic lupus erythematosus, five had microscopic polyarteritis and two had Wegener's granulomatosis. All ten patients were dialysis-dependent prior to immunoadsorption. Nine of ten patients rapidly regained renal function and seven continue to have independent renal function between 9 and 30 months after immunoadsorption. Three patients at presentation were not dialysis dependent. Despite treatment with methylprednisolone, cyclophosphamide, and oral prednisolone, renal function continued to deteriorate and they required dialysis. Immunoadsorption was then started without alteration in baseline immunosuppression. Within a mean of 4.6 days, range 3-7 days, renal function improved and the patients no longer required dialysis. Antineutrophil cytoplasmic antibodies and double-stranded DNA antibodies were rapidly removed by immunoadsorption. Only one patient with systemic lupus erythematosus and two with microscopic polyarteritis had significant resynthesis of antibody at 1 month post-immunoadsorption. Renal biopsy before and after immunoadsorption and immunosuppressive therapy showed resolution of glomerular crescents and no evidence of active disease. Immunoadsorption coupled with prednisolone and cyclophosphamide may be of value in the treatment of rapidly progressive glomerulonephritis.
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Affiliation(s)
- A Palmer
- Renal Unit, Dulwich, College Hospital, London, UK
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Abstract
With the recent proliferation of mass spectrometric methods available for the identification and confirmation of various compounds in different environmental matrices, it is timely to address the criteria desirable in a regulatory sample case. The emphasis of this review is on the experimental process of confirmation at concentration levels in the range of low parts per million (ppm) to parts per trillion (ppt). At such levels, various data manipulations or alternate choices of approaching the analytical problem of confirmation must be employed to ensure an acceptable result. The problems experienced when dealing with nanogram levels in analysis are much more complex than when recording a mass spectrum of an ample supply of a reference standard. This review reflects an interpretation of the developing status of confirmation since there does not yet exist "accepted criteria".
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Affiliation(s)
- T Cairns
- Department of Health and Human Services, Food and Drug Administration Los Angeles, California
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