1
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Nguyen W, Dans MG, Currie I, Awalt JK, Bailey BL, Lumb C, Ngo A, Favuzza P, Palandri J, Ramesh S, Penington J, Jarman KE, Mukherjee P, Chakraborty A, Maier AG, van Dooren GG, Papenfuss T, Wittlin S, Churchyard A, Baum J, Winzeler EA, Baud D, Brand S, Jackson PF, Cowman AF, Sleebs BE. 7- N-Substituted-3-oxadiazole Quinolones with Potent Antimalarial Activity Target the Cytochrome bc1 Complex. ACS Infect Dis 2023; 9:668-691. [PMID: 36853190 PMCID: PMC10012268 DOI: 10.1021/acsinfecdis.2c00607] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The development of new antimalarials is required because of the threat of resistance to current antimalarial therapies. To discover new antimalarial chemotypes, we screened the Janssen Jumpstarter library against the P. falciparum asexual parasite and identified the 7-N-substituted-3-oxadiazole quinolone hit class. We established the structure-activity relationship and optimized the antimalarial potency. The optimized analog WJM228 (17) showed robust metabolic stability in vitro, although the aqueous solubility was limited. Forward genetic resistance studies uncovered that WJM228 targets the Qo site of cytochrome b (cyt b), an important component of the mitochondrial electron transport chain (ETC) that is essential for pyrimidine biosynthesis and an established antimalarial target. Profiling against drug-resistant parasites confirmed that WJM228 confers resistance to the Qo site but not Qi site mutations, and in a biosensor assay, it was shown to impact the ETC via inhibition of cyt b. Consistent with other cyt b targeted antimalarials, WJM228 prevented pre-erythrocytic parasite and male gamete development and reduced asexual parasitemia in a P. berghei mouse model of malaria. Correcting the limited aqueous solubility and the high susceptibility to cyt b Qo site resistant parasites found in the clinic will be major obstacles in the future development of the 3-oxadiazole quinolone antimalarial class.
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Affiliation(s)
- William Nguyen
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia.,Department of Medical Biology, The University of Melbourne, Parkville 3010, Australia
| | - Madeline G Dans
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia.,Department of Medical Biology, The University of Melbourne, Parkville 3010, Australia
| | - Iain Currie
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia.,Department of Medical Biology, The University of Melbourne, Parkville 3010, Australia
| | - Jon Kyle Awalt
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia.,Department of Medical Biology, The University of Melbourne, Parkville 3010, Australia
| | - Brodie L Bailey
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia.,Department of Medical Biology, The University of Melbourne, Parkville 3010, Australia
| | - Chris Lumb
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
| | - Anna Ngo
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
| | - Paola Favuzza
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia.,Department of Medical Biology, The University of Melbourne, Parkville 3010, Australia
| | - Josephine Palandri
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia.,Department of Medical Biology, The University of Melbourne, Parkville 3010, Australia
| | - Saishyam Ramesh
- Research School of Biology, The Australian National University, Canberra 2600, Australia
| | - Jocelyn Penington
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia.,Department of Medical Biology, The University of Melbourne, Parkville 3010, Australia
| | - Kate E Jarman
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia.,Department of Medical Biology, The University of Melbourne, Parkville 3010, Australia
| | | | | | - Alexander G Maier
- Research School of Biology, The Australian National University, Canberra 2600, Australia
| | - Giel G van Dooren
- Research School of Biology, The Australian National University, Canberra 2600, Australia
| | - Tony Papenfuss
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia.,Department of Medical Biology, The University of Melbourne, Parkville 3010, Australia
| | - Sergio Wittlin
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland.,University of Basel, 4003 Basel, Switzerland
| | - Alisje Churchyard
- Department of Life Sciences, Imperial College London, South Kensington, SW7 2AZ U.K
| | - Jake Baum
- Department of Life Sciences, Imperial College London, South Kensington, SW7 2AZ U.K.,School of Biomedical Sciences, University of New South Wales, Sydney 2031, Australia
| | - Elizabeth A Winzeler
- School of Medicine, University of California San Diego, 9500 Gilman Drive 0760, La Jolla, California 92093, United States
| | - Delphine Baud
- Medicines for Malaria Venture, Geneva 1215, Switzerland
| | - Stephen Brand
- Medicines for Malaria Venture, Geneva 1215, Switzerland
| | - Paul F Jackson
- Global Public Health, Janssen R&D LLC, La Jolla, California 92121, United States
| | - Alan F Cowman
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia.,Department of Medical Biology, The University of Melbourne, Parkville 3010, Australia
| | - Brad E Sleebs
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia.,Department of Medical Biology, The University of Melbourne, Parkville 3010, Australia
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Cmero M, Yuan K, Ong CS, Schröder J, Corcoran NM, Papenfuss T, Hovens CM, Markowetz F, Macintyre G. Author Correction: Inferring structural variant cancer cell fraction. Nat Commun 2022; 13:7568. [PMID: 36481724 PMCID: PMC9732297 DOI: 10.1038/s41467-022-32338-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Marek Cmero
- grid.416153.40000 0004 0624 1200Department of Surgery, Division of Urology, Royal Melbourne Hospital and University of Melbourne, Parkville, VIC 3050 Australia ,grid.414539.e0000 0001 0459 5396The Epworth Prostate Centre, Epworth Hospital, Richmond, VIC 3121 Australia ,grid.1008.90000 0001 2179 088XDepartment of Computing and Information Systems, University of Melbourne, Parkville, VIC 3010 Australia ,grid.1042.70000 0004 0432 4889Bioinformatics Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC Australia ,grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Parkville, VIC 3052 Australia
| | - Ke Yuan
- grid.8756.c0000 0001 2193 314XSchool of Computing Science, University of Glasgow, Sir Alwyn Williams Building, Glasgow, G12 8RZ UK ,grid.5335.00000000121885934Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, CB2 0RE UK
| | - Cheng Soon Ong
- grid.1008.90000 0001 2179 088XElectrical and Electronic Engineering, University of Melbourne, Parkville, VIC 3010 Australia ,Machine Learning Research Group, Data61, Canberra, ACT 2601 Australia ,grid.1001.00000 0001 2180 7477Research School of Computer Science, Australian National University, Canberra, ACT 2601 Australia
| | - Jan Schröder
- grid.1042.70000 0004 0432 4889Bioinformatics Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC Australia
| | | | - Niall M. Corcoran
- grid.416153.40000 0004 0624 1200Department of Surgery, Division of Urology, Royal Melbourne Hospital and University of Melbourne, Parkville, VIC 3050 Australia ,grid.414539.e0000 0001 0459 5396The Epworth Prostate Centre, Epworth Hospital, Richmond, VIC 3121 Australia
| | - Tony Papenfuss
- grid.1042.70000 0004 0432 4889Bioinformatics Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC Australia
| | - Christopher M. Hovens
- grid.416153.40000 0004 0624 1200Department of Surgery, Division of Urology, Royal Melbourne Hospital and University of Melbourne, Parkville, VIC 3050 Australia ,grid.414539.e0000 0001 0459 5396The Epworth Prostate Centre, Epworth Hospital, Richmond, VIC 3121 Australia
| | - Florian Markowetz
- grid.5335.00000000121885934Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, CB2 0RE UK
| | - Geoff Macintyre
- grid.1008.90000 0001 2179 088XDepartment of Computing and Information Systems, University of Melbourne, Parkville, VIC 3010 Australia ,grid.5335.00000000121885934Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, CB2 0RE UK
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3
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Lau PKH, Feran B, Smith L, Lasocki A, Molania R, Smith K, Weppler A, Angel C, Kee D, Bhave P, Lee B, Young RJ, Iravani A, Yeang HA, Vergara IA, Kok D, Drummond K, Neeson PJ, Sheppard KE, Papenfuss T, Solomon BJ, Sandhu S, McArthur GA. Melanoma brain metastases that progress on BRAF-MEK inhibitors demonstrate resistance to ipilimumab-nivolumab that is associated with the Innate PD-1 Resistance Signature (IPRES). J Immunother Cancer 2021; 9:jitc-2021-002995. [PMID: 34625515 PMCID: PMC8504361 DOI: 10.1136/jitc-2021-002995] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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] [Accepted: 08/20/2021] [Indexed: 12/13/2022] Open
Abstract
Background Melanoma brain metastases (MBMs) are a challenging clinical problem with high morbidity and mortality. Although first-line dabrafenib–trametinib and ipilimumab–nivolumab have similar intracranial response rates (50%–55%), central nervous system (CNS) resistance to BRAF-MEK inhibitors (BRAF-MEKi) usually occurs around 6 months, and durable responses are only seen with combination immunotherapy. We sought to investigate the utility of ipilimumab–nivolumab after MBM progression on BRAF-MEKi and identify mechanisms of resistance. Methods Patients who received first-line ipilimumab–nivolumab for MBMs or second/third line ipilimumab–nivolumab for intracranial metastases with BRAFV600 mutations with prior progression on BRAF-MEKi and MRI brain staging from March 1, 2015 to June 30, 2018 were included. Modified intracranial RECIST was used to assess response. Formalin-fixed paraffin-embedded samples of BRAFV600 mutant MBMs that were naïve to systemic treatment (n=18) or excised after progression on BRAF-MEKi (n=14) underwent whole transcriptome sequencing. Comparative analyses of MBMs naïve to systemic treatment versus BRAF-MEKi progression were performed. Results Twenty-five and 30 patients who received first and second/third line ipilimumab–nivolumab, were included respectively. Median sum of MBM diameters was 13 and 20.5 mm for the first and second/third line ipilimumab–nivolumab groups, respectively. Intracranial response rate was 75.0% (12/16), and median progression-free survival (PFS) was 41.6 months for first-line ipilimumab–nivolumab. Efficacy of second/third line ipilimumab-nivolumab after BRAF-MEKi progression was poor with an intracranial response rate of 4.8% (1/21) and median PFS of 1.3 months. Given the poor activity of ipilimumab–nivolumab after BRAF-MEKi MBM progression, we performed whole transcriptome sequencing to identify mechanisms of drug resistance. We identified a set of 178 differentially expressed genes (DEGs) between naïve and MBMs with progression on BRAF-MEKi treatment (p value <0.05, false discovery rate (FDR) <0.1). No distinct pathways were identified from gene set enrichment analyses using Kyoto Encyclopedia of Genes and Genomes, Gene Ontogeny or Hallmark libraries; however, enrichment of DEG from the Innate Anti-PD1 Resistance Signature (IPRES) was identified (p value=0.007, FDR=0.03). Conclusions Second-line ipilimumab–nivolumab for MBMs after BRAF-MEKi progression has poor activity. MBMs that are resistant to BRAF-MEKi that also conferred resistance to second-line ipilimumab–nivolumab showed enrichment of the IPRES gene signature.
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Affiliation(s)
- Peter Kar Han Lau
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Molecular Oncology Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Breon Feran
- Bioinformatics Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Lorey Smith
- Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Arian Lasocki
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ramyar Molania
- Bioinformatics Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Kortnye Smith
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alison Weppler
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Christopher Angel
- Department of Histopathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Damien Kee
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Prachi Bhave
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Belinda Lee
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Richard J Young
- Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Amir Iravani
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Hanxian Aw Yeang
- Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ismael A Vergara
- Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Melanoma Institute Australia, North Sydney, New South Wales, Australia
| | - David Kok
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Kate Drummond
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paul Joseph Neeson
- Cancer Immunology Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Karen E Sheppard
- Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tony Papenfuss
- Bioinformatics Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.,Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Benjamin J Solomon
- Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shahneen Sandhu
- Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Grant A McArthur
- Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia .,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
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4
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Barker HE, Lim R, Carmagnac A, Vandenberg C, Ratnayake G, Dall G, Milesi B, Komiti A, O'Grady E, Tram J, Stewart KP, Bedo J, Penington J, Vissers J, Grimmond S, Wakefield M, Papenfuss T, Scott C. Abstract PO037: Identifying effective combinations of targeted therapies, using novel pre-clinical models, to improve treatment options for high-grade serous endometrial cancer. Clin Cancer Res 2021. [DOI: 10.1158/1557-3265.endomet20-po037] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
High-grade serous endometrial carcinoma (HGSEC) accounts for just 10% of endometrial cancer (EC) cases but is responsible for at least 40% of all EC-related deaths. It typically arises in post-menopausal women, with 70% of patients presenting with stage III or IV disease, does not respond to hormone therapy unlike the less aggressive forms of EC, and has a lower overall survival rate of just 18-27%, which has not improved over the past two decades. The primary treatment for HGSEC is surgery, followed by a combination of standard chemotherapies (platinum and taxane) with or without localised radiotherapy. However, recurrent HGSEC is less responsive to chemotherapy than are other subtypes of EC and even initial responses to chemotherapy are poor. Therefore, there is a great unmet clinical need to find better treatment options for women with this aggressive cancer. Apart from TP53 (mutated in up to 90% of cases), the other most frequently mutated genes in HGSEC are PPP2R1A (31%), PIK3CA (22%), FBXW7 (28%), CHD4 (17%) and BRCA2 (12%). Focal amplifications of the genes MYC, ERBB2, CCNE1, FGFR3 and SOX17 are also common. The presence of ERBB2 amplification and/or HER2 over-expression in around 30% of HGSEC suggests these patients may respond to HER2-targeting drugs, such as trastuzumab. However, only modest benefit has so far been seen for single-agent HER2-targeted therapies (ie trastuzumab or lapatinib) against HGSEC, suggesting resistance mechanisms are present. Another feature of HGSEC that could be exploited therapeutically is homologous recombination deficiency (HRD), which may be targeted with PARP inhibitors (PARPi). It is not clear what proportion of HGSEC are HRD and neither HER2-targeting drugs or PARPi have been approved for the treatment of HGSEC. Due to its rarity and a lack of pre-clinical models, HGSEC has so far been understudied, resulting in a lack of effective treatment options. We currently have 33 HGSEC patients consented to the WEHI-Stafford Fox Rare Cancer Program and have developed pre-clinical models from fresh patient tumour samples received (4 patient-derived xenograft (PDX) models validated, with 3 pending). Preliminary molecular analysis of whole-genome sequencing (5 samples, one of which gave rise to a PDX model), whole-exome sequencing (4 samples), and cancer panel sequencing (3 samples, 2 of which gave rise to PDX models; one harbouring ERBB2 amplification and one harbouring an AKT mutation) data from our HGSEC cohort has been performed. This has identified potential treatment targets, including ERBB2 amplifications and mutations in HR genes. I am using the PDX models for initial in vivo therapeutic characterization studies and to develop organoid models for use in high-throughput drug assays in vitro. This will guide subsequent novel drug combination testing in our PDX models. By combining specific targeted drugs I hope to overcome de novo resistance mechanisms and prevent acquired resistance. Results from this study will guide future decisions about therapeutic strategies to improve survival of women with HGSEC.
Citation Format: Holly E. Barker, Ratana Lim, Amandine Carmagnac, Cassandra Vandenberg, Gayanie Ratnayake, Genevieve Dall, Briony Milesi, Angela Komiti, Emily O'Grady, Joshua Tram, Kym Pham Stewart, Justin Bedo, Jocelyn Penington, Joep Vissers, Sean Grimmond, Matthew Wakefield, Tony Papenfuss, Clare Scott. Identifying effective combinations of targeted therapies, using novel pre-clinical models, to improve treatment options for high-grade serous endometrial cancer [abstract]. In: Proceedings of the AACR Virtual Special Conference: Endometrial Cancer: New Biology Driving Research and Treatment; 2020 Nov 9-10. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(3_Suppl):Abstract nr PO037.
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Affiliation(s)
- Holly E. Barker
- 1The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia,
| | - Ratana Lim
- 1The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia,
| | - Amandine Carmagnac
- 1The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia,
| | - Cassandra Vandenberg
- 1The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia,
| | | | - Genevieve Dall
- 1The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia,
| | - Briony Milesi
- 1The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia,
| | - Angela Komiti
- 1The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia,
| | - Emily O'Grady
- 1The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia,
| | - Joshua Tram
- 1The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia,
| | | | - Justin Bedo
- 1The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia,
| | - Jocelyn Penington
- 1The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia,
| | - Joep Vissers
- 3The University of Melbourne, Melbourne, VIC, Australia
| | - Sean Grimmond
- 3The University of Melbourne, Melbourne, VIC, Australia
| | - Matthew Wakefield
- 1The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia,
| | - Tony Papenfuss
- 1The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia,
| | - Clare Scott
- 1The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia,
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5
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Dall G, Vandenberg C, Carmagnac A, Lim R, Milesi B, Komiti A, O'Grady E, Tram J, Ratnayake G, Stewart KP, Bedo J, Penington J, Vissers J, Olesen I, Grimmond S, Barker H, Papenfuss T, Scott C. Abstract PO021: Developing pre-clinical models of uterine leiomyosarcoma. Clin Cancer Res 2021. [DOI: 10.1158/1557-3265.endomet20-po021] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Uterine sarcomas make up 1-4% of uterine malignancies. Of these 60% are classified as leiomyosarcoma (uLMS). The 5-year survival rate of uLMS is 35-65.2% for tumours that have not spread beyond the uterus. However, women are often diagnosed at a late stage due to a lack of screening options by which time the tumour has often spread to adjacent and distant tissues. Current standard of care for uLMS patients is surgical de-bulking followed by adjuvant chemotherapy, but significant improvement in progression free survival and overall survival is not consistently observed. The lack of advances for the treatment and screening of uLMS is due in part to the scarcity of appropriate research resources for this rare disease. Genetic analyses have been performed but on relatively small samples and there are just 14 reported patient-derived xenograft (PDX) models of uLMS in the literature to date. Through the WEHI Stafford Fox Rare Cancer Program, as well as collaborations (facilitated by ANZGOG) throughout the country and internationally, we have access to a large biobank of uLMS tissue. We have received 8 fresh uLMS samples in the laboratory, 2 of which have established PDX lines that were validated as uLMS by our anatomical pathologist. All fresh samples received into the laboratory are snap frozen for whole-genome sequencing as well as viably frozen to enable regeneration of the tissue for future applications. One application is organoid culturing, which allows the tissue to retain its 3D growth properties and is significantly cheaper than growing tissue as a PDX. Organoid culturing also allows for higher throughput of samples in drug screening assays, enabling us to fast-track the selection of drugs for validation in our PDX models. In addition to these fresh samples we also have 23 archival uLMS samples (formalin fixed, paraffin embedded) that can be used for lower coverage genetic analysis, and protein expression by immunohistochemistry. This unique biobank of uLMS tissue is the first of its kind in Australia and with it we will endeavour to gain a comprehensive understanding of this disease. Through our PDX modelling we also have the opportunity to predict resistance to therapy and test emerging therapies in a clinically relevant context. We believe this biobank will provide a critical resource which will ultimately lead to better outcomes for uLMS patients.
Citation Format: Genevieve Dall, Cassandra Vandenberg, Amandine Carmagnac, Ratana Lim, Briony Milesi, Angela Komiti, Emily O'Grady, Joshua Tram, Gayanie Ratnayake, Kym Pham Stewart, Justin Bedo, Jocelyn Penington, Joep Vissers, Inger Olesen, Sean Grimmond, Holly Barker, Tony Papenfuss, Clare Scott. Developing pre-clinical models of uterine leiomyosarcoma [abstract]. In: Proceedings of the AACR Virtual Special Conference: Endometrial Cancer: New Biology Driving Research and Treatment; 2020 Nov 9-10. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(3_Suppl):Abstract nr PO021.
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Affiliation(s)
- Genevieve Dall
- 1Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia,
| | - Cassandra Vandenberg
- 1Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia,
| | - Amandine Carmagnac
- 1Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia,
| | - Ratana Lim
- 1Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia,
| | - Briony Milesi
- 1Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia,
| | - Angela Komiti
- 1Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia,
| | - Emily O'Grady
- 1Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia,
| | - Joshua Tram
- 1Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia,
| | | | | | - Justin Bedo
- 1Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia,
| | - Jocelyn Penington
- 1Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia,
| | - Joep Vissers
- 3University of Melbourne, Parkville, VIC, Australia
| | - Inger Olesen
- 1Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia,
| | | | - Holly Barker
- 1Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia,
| | - Tony Papenfuss
- 1Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia,
| | - Clare Scott
- 1Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia,
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Lau P, Feran B, Smith L, Lasocki A, Molania R, Smith K, Weppler A, Angel C, Kee D, Bhave P, Lee B, Yeang HA, Vergara I, Kok D, Drummond K, Neeson P, Sheppard K, Papenfuss T, Sandhu S, McArthur G. 1079MO Progression of BRAF mutant CNS metastases are associated with a transcriptional network bearing similarities with the innate PD-1 resistant signature (IPRES). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1203] [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: 11/26/2022] Open
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7
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Favuzza P, de Lera Ruiz M, Thompson JK, Triglia T, Ngo A, Steel RWJ, Vavrek M, Christensen J, Healer J, Boyce C, Guo Z, Hu M, Khan T, Murgolo N, Zhao L, Penington JS, Reaksudsan K, Jarman K, Dietrich MH, Richardson L, Guo KY, Lopaticki S, Tham WH, Rottmann M, Papenfuss T, Robbins JA, Boddey JA, Sleebs BE, Sabroux HJ, McCauley JA, Olsen DB, Cowman AF. Dual Plasmepsin-Targeting Antimalarial Agents Disrupt Multiple Stages of the Malaria Parasite Life Cycle. Cell Host Microbe 2020; 27:642-658.e12. [PMID: 32109369 PMCID: PMC7146544 DOI: 10.1016/j.chom.2020.02.005] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/22/2019] [Accepted: 02/11/2020] [Indexed: 01/07/2023]
Abstract
Artemisin combination therapy (ACT) is the main treatment option for malaria, which is caused by the intracellular parasite Plasmodium. However, increased resistance to ACT highlights the importance of finding new drugs. Recently, the aspartic proteases Plasmepsin IX and X (PMIX and PMX) were identified as promising drug targets. In this study, we describe dual inhibitors of PMIX and PMX, including WM382, that block multiple stages of the Plasmodium life cycle. We demonstrate that PMX is a master modulator of merozoite invasion and direct maturation of proteins required for invasion, parasite development, and egress. Oral administration of WM382 cured mice of P. berghei and prevented blood infection from the liver. In addition, WM382 was efficacious against P. falciparum asexual infection in humanized mice and prevented transmission to mosquitoes. Selection of resistant P. falciparum in vitro was not achievable. Together, these show that dual PMIX and PMX inhibitors are promising candidates for malaria treatment and prevention.
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Affiliation(s)
- Paola Favuzza
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; University of Melbourne, Melbourne, VIC 3010, Australia
| | | | - Jennifer K Thompson
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
| | - Tony Triglia
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
| | - Anna Ngo
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
| | - Ryan W J Steel
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; University of Melbourne, Melbourne, VIC 3010, Australia
| | - Marissa Vavrek
- Merck & Co., Inc., 770 Sumneytown Pike, West Point, PA 19486, USA
| | - Janni Christensen
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; University of Melbourne, Melbourne, VIC 3010, Australia
| | - Julie Healer
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; University of Melbourne, Melbourne, VIC 3010, Australia
| | | | - Zhuyan Guo
- Merck & Co., Inc., 770 Sumneytown Pike, West Point, PA 19486, USA
| | - Mengwei Hu
- Merck & Co., Inc., 770 Sumneytown Pike, West Point, PA 19486, USA
| | - Tanweer Khan
- Merck & Co., Inc., 770 Sumneytown Pike, West Point, PA 19486, USA
| | - Nicholas Murgolo
- Merck & Co., Inc., 770 Sumneytown Pike, West Point, PA 19486, USA
| | - Lianyun Zhao
- Merck & Co., Inc., 770 Sumneytown Pike, West Point, PA 19486, USA
| | | | - Kitsanapong Reaksudsan
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; University of Melbourne, Melbourne, VIC 3010, Australia
| | - Kate Jarman
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
| | - Melanie H Dietrich
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; University of Melbourne, Melbourne, VIC 3010, Australia
| | - Lachlan Richardson
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; University of Melbourne, Melbourne, VIC 3010, Australia
| | - Kai-Yuan Guo
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; University of Melbourne, Melbourne, VIC 3010, Australia
| | - Sash Lopaticki
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
| | - Wai-Hong Tham
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; University of Melbourne, Melbourne, VIC 3010, Australia
| | | | - Tony Papenfuss
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; University of Melbourne, Melbourne, VIC 3010, Australia
| | | | - Justin A Boddey
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; University of Melbourne, Melbourne, VIC 3010, Australia
| | - Brad E Sleebs
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; University of Melbourne, Melbourne, VIC 3010, Australia
| | - Hélène Jousset Sabroux
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; University of Melbourne, Melbourne, VIC 3010, Australia
| | - John A McCauley
- Merck & Co., Inc., 770 Sumneytown Pike, West Point, PA 19486, USA
| | - David B Olsen
- Merck & Co., Inc., 770 Sumneytown Pike, West Point, PA 19486, USA.
| | - Alan F Cowman
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; University of Melbourne, Melbourne, VIC 3010, Australia.
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8
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Cmero M, Yuan K, Ong CS, Schröder J, Corcoran NM, Papenfuss T, Hovens CM, Markowetz F, Macintyre G. Inferring structural variant cancer cell fraction. Nat Commun 2020; 11:730. [PMID: 32024845 PMCID: PMC7002525 DOI: 10.1038/s41467-020-14351-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 12/01/2017] [Accepted: 12/16/2019] [Indexed: 12/14/2022] Open
Abstract
We present SVclone, a computational method for inferring the cancer cell fraction of structural variant (SV) breakpoints from whole-genome sequencing data. SVclone accurately determines the variant allele frequencies of both SV breakends, then simultaneously estimates the cancer cell fraction and SV copy number. We assess performance using in silico mixtures of real samples, at known proportions, created from two clonal metastases from the same patient. We find that SVclone's performance is comparable to single-nucleotide variant-based methods, despite having an order of magnitude fewer data points. As part of the Pan-Cancer Analysis of Whole Genomes (PCAWG) consortium, which aggregated whole-genome sequencing data from 2658 cancers across 38 tumour types, we use SVclone to reveal a subset of liver, ovarian and pancreatic cancers with subclonally enriched copy-number neutral rearrangements that show decreased overall survival. SVclone enables improved characterisation of SV intra-tumour heterogeneity.
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Affiliation(s)
- Marek Cmero
- Department of Surgery, Division of Urology, Royal Melbourne Hospital and University of Melbourne, Parkville, VIC, 3050, Australia.
- The Epworth Prostate Centre, Epworth Hospital, Richmond, VIC, 3121, Australia.
- Department of Computing and Information Systems, University of Melbourne, Parkville, VIC, 3010, Australia.
- Bioinformatics Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.
- Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia.
| | - Ke Yuan
- School of Computing Science, University of Glasgow, Sir Alwyn Williams Building, Glasgow, G12 8RZ, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, CB2 0RE, UK
| | - Cheng Soon Ong
- Electrical and Electronic Engineering, University of Melbourne, Parkville, VIC, 3010, Australia
- Machine Learning Research Group, Data61, Canberra, ACT, 2601, Australia
- Research School of Computer Science, Australian National University, Canberra, ACT, 2601, Australia
| | - Jan Schröder
- Bioinformatics Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Niall M Corcoran
- Department of Surgery, Division of Urology, Royal Melbourne Hospital and University of Melbourne, Parkville, VIC, 3050, Australia
- The Epworth Prostate Centre, Epworth Hospital, Richmond, VIC, 3121, Australia
| | - Tony Papenfuss
- Bioinformatics Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Christopher M Hovens
- Department of Surgery, Division of Urology, Royal Melbourne Hospital and University of Melbourne, Parkville, VIC, 3050, Australia
- The Epworth Prostate Centre, Epworth Hospital, Richmond, VIC, 3121, Australia
| | - Florian Markowetz
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, CB2 0RE, UK
| | - Geoff Macintyre
- Department of Computing and Information Systems, University of Melbourne, Parkville, VIC, 3010, Australia.
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, CB2 0RE, UK.
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9
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Wong E, Whittington C, Papenfuss T, Nicol S, Warren WC, Belov K. 56. The Evolutionary Origins of Monotreme Crural Glands. Toxicon 2012. [DOI: 10.1016/j.toxicon.2012.04.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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10
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Söllmann C, Trautner H, Papenfuss T, Lange M, Roewer N. [Tension pneumothorax after acute airway displacement due to pulmonary aspergillosis]. Anaesthesist 2009; 58:602-6. [PMID: 19562397 DOI: 10.1007/s00101-009-1558-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Acute lymphoblastic leukaemia is the most common malignancy in childhood. This disease and its associated therapy may lead to specific life-threatening complications if general anaesthesia has to be carried out. The case of a 14-year-old boy suffering from aspergillosis because of immunosuppression in the course of chemotherapy is reported. Due to a cerebral round lesion an open biopsy was required. After induction of anaesthesia, severe pulmonary obstruction developed. After exchange of the endotracheal tube a coagulum-like foreign body interspersed with Aspergillus hyphae obstructing the distal aperture in a valve-like manner could be recovered. The resulting unilateral tension pneumothorax had to be relieved with a closed pleural drainage. With reference to this as yet unreported life-threatening complication of pulmonary aspergillosis, the appropriate preparation and conduction of general anaesthesia are discussed.
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Affiliation(s)
- C Söllmann
- Klinik und Poliklinik für Anästhesiologie, Universitätsklinik Würzburg, Würzburg, Deutschland.
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11
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Conroy CJ, Papenfuss T, Parker J, Hahn NE. Use of tricaine methanesulfonate (MS222) for euthanasia of reptiles. J Am Assoc Lab Anim Sci 2009; 48:28-32. [PMID: 19245747 PMCID: PMC2694699] [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] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Revised: 04/28/2008] [Accepted: 06/25/2008] [Indexed: 05/27/2023]
Abstract
Tricaine methanesulfonate (MS222) injected into the intracoelomic cavity of reptiles was evaluated as a chemical euthanasia method. Three western fence lizards, 2 desert iguanas, 4 garter snakes, and 6 geckos were euthanized by intracoelomic injection of 250 to 500 mg/kg of 0.7% to 1% sodium-bicarbonate-buffered MS222 solution followed by intracoelomic injection of 0.1 to 1.0 ml unbuffered 50% (v/v) MS222 solution. A simple 2-stage protocol for euthanasia of reptiles by using MS222 is outlined. In addition, the conditions for safe use of MS222 are discussed. MS222 offers an alternative to sodium pentobarbital for euthanasia of reptiles.
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Affiliation(s)
- CJ Conroy
- Museum of Vertebrate Zoology, University of California, San Francisco, California
| | - T Papenfuss
- Museum of Vertebrate Zoology, University of California, San Francisco, California
| | - J Parker
- Office of Laboratory Animal Care, University of California, Berkeley, California
- Laboratory Animal Resource Center, University of California, San Francisco, California
| | - NE Hahn
- Office of Laboratory Animal Care, University of California, Berkeley, California
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12
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Kranke P, Apfel CC, Papenfuss T, Rauch S, Löbmann U, Rübsam B, Greim CA, Roewer N. An increased body mass index is no risk factor for postoperative nausea and vomiting. Acta Anaesthesiol Scand 2008. [DOI: 10.1111/j.1399-6576.2001.450205.x] [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: 11/30/2022]
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13
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De Koning-Ward TF, Olivieri A, Bertuccini L, Hood A, Silvestrini F, Charvalias K, Berzosa Díaz P, Camarda G, McElwain TF, Papenfuss T, Healer J, Baldassarri L, Crabb BS, Alano P, Ranford-Cartwright LC. The role of osmiophilic bodies and Pfg377 expression in female gametocyte emergence and mosquito infectivity in the human malaria parasite Plasmodium falciparum. Mol Microbiol 2007; 67:278-90. [DOI: 10.1111/j.1365-2958.2007.06039.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Kithcart AP, Powell N, Williams J, Gatson N, Papenfuss T, Gienapp I, Shawler T, Satoskar A, Whitacre CC. Migration inhibitory factor modulates experimental autoimmune encephalomyelitis through a novel combination of suppressive mediators (131.34). The Journal of Immunology 2007. [DOI: 10.4049/jimmunol.178.supp.131.34] [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] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Abstract
Multiple sclerosis (MS), an autoimmune disease of the central nervous system (CNS), is more prevalent in women than men. Recent studies suggest that the cytokine migration inhibitory factor (MIF) plays a role in the progression of MS and experimental autoimmune encephalomyelitis (EAE). We have shown that MIF−/− mice have decreased EAE severity relative to wt controls. Here, we evaluate the role of MIF in the context of known suppressive hormones. Serum levels of corticosterone (CORT) and testosterone (TEST) were measured prior to and following EAE induction in the presence and absence of MIF. Basal levels of TEST in MIF−/− mice were notably higher than controls; basal levels of CORT were low and similar between groups. Following EAE, there was little change in CORT and TEST in wt mice; however, TEST decreased and CORT increased in MIF−/− mice following immunization. To evaluate the role of TEST, we removed the testes of male MIF−/− mice and induced EAE. We found no difference in disease severity whether MIF−/− mice were gonadectomized or not; control mice had significantly more severe EAE in the absence of TEST. These findings suggest that CORT plays a larger role than TEST in disease progression, although both hormones appear to be influenced by MIF. Further study of the mechanism of MIF could lead to improved therapies for a variety of autoimmune diseases.
(Supported by NIH grant AI 064320 and National MS Society grant RG3272)
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Affiliation(s)
- Aaron P Kithcart
- 1Dept of Molecular Virology, Immunology, and Medical Genetics, The Ohio State University, 760 Biomedical Research Tower, 460 W 12th, Columbus, OH, 43210,
| | - N Powell
- 2College of Dentistry, The Ohio State University, 2159 Postle, 305 W 12th, Columbus, OH, 43210,
| | - J Williams
- 1Dept of Molecular Virology, Immunology, and Medical Genetics, The Ohio State University, 760 Biomedical Research Tower, 460 W 12th, Columbus, OH, 43210,
| | - N Gatson
- 1Dept of Molecular Virology, Immunology, and Medical Genetics, The Ohio State University, 760 Biomedical Research Tower, 460 W 12th, Columbus, OH, 43210,
| | - T Papenfuss
- 1Dept of Molecular Virology, Immunology, and Medical Genetics, The Ohio State University, 760 Biomedical Research Tower, 460 W 12th, Columbus, OH, 43210,
| | - I Gienapp
- 1Dept of Molecular Virology, Immunology, and Medical Genetics, The Ohio State University, 760 Biomedical Research Tower, 460 W 12th, Columbus, OH, 43210,
| | - T Shawler
- 1Dept of Molecular Virology, Immunology, and Medical Genetics, The Ohio State University, 760 Biomedical Research Tower, 460 W 12th, Columbus, OH, 43210,
| | - A Satoskar
- 3Dept of Microbiology, The Ohio State University, 917 Bioscience, 484 W 12th, Columbus, OH, 43210
| | - C C Whitacre
- 1Dept of Molecular Virology, Immunology, and Medical Genetics, The Ohio State University, 760 Biomedical Research Tower, 460 W 12th, Columbus, OH, 43210,
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Schwemmer U, Papenfuss T, Greim C, Brederlau J, Roewer N. Ultrasound-guided interscalene brachial plexus anaesthesia: differences in success between patients of normal and excessive weight. Ultraschall Med 2006; 27:245-50. [PMID: 16596517 DOI: 10.1055/s-2006-926591] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
UNLABELLED Interscalene plexus blocks are an important part of the peri-operative treatment in shoulder surgery. The nerve stimulation technique uses external landmarks for the definition of the injection site. Patient obesity is, therefore, one causative factor for a reduced success rate of the blockade. AIM This study investigated whether there are differences in visibility of the target nerves and in the success rate of the block between patients of normal weight (nw) and obese patients (ow), when portable sonography is used for guidance of the interscalene nerve blockade (ISB). METHODS We investigated 70 patients routinely scheduled for shoulder surgery (ASA status I-III). The patients were allocated to group nw (body mass index BMI< 25) or ow (BMI > 25). The interscalene part of the brachial plexus was examined using high-frequency portable ultrasound. The blockade was performed under continuous sonographic monitoring. The quality of the ISB was tested post-operatively, and the time required for the procedure was documented. RESULTS Identification of nerve structures in the obese patients did require slightly more time than in patients of normal weight, statistically (ow: 5 +/- 1 min versus nw: 4 +/- 2 min, p = 0.02). While in 33 patients (94 %) of group nw the plexus blockade was complete, in group ow 27 (77 %) of the blocks were sufficient. The difference in success, however, was not significant (p = 0.08). Visualisation of nerves was difficult in 3 patients in ow-group. CONCLUSION Portable ultrasound provides efficient depiction of the interscalene plexus structures in obese patients and, when used for guidance of regional blockade, renders similar results as in patients of normal weight.
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Affiliation(s)
- U Schwemmer
- Zentrum Operative Medizin, Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg.
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16
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Abstract
Surgical procedures in the region of the shoulder joint are among the most painful interventions in orthopedic practice. For this reason, in addition to intravenous pain therapy with opioids, blockade of the brachial plexus has become established as an effective method to provide analgesia.High-resolution ultrasound offers the possibility of performing nerve blockades under visual monitoring. Studies on interscalene blockade performed under sonographic control provide evidence for both the high efficacy and safety of the procedure. Clinically manifest signs of nerve damage have not appeared with use of this method. Smaller operations can usually be adequately managed with perioperative single-shot blockade. More extensive operations for which severe pain lasting for several days can be expected and surgical interventions involving preexistent shoulder stiffness necessitate catheterization for uninterrupted pain therapy. Successful rehabilitation after shoulder surgery requires diligent perioperative pain blockade, which can primarily be provided by interscalene plexus blockade.
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Affiliation(s)
- U Schwemmer
- Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg.
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18
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Apfel CC, Kranke P, Katz MH, Goepfert C, Papenfuss T, Rauch S, Heineck R, Greim CA, Roewer N. Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design. Br J Anaesth 2002; 88:659-68. [PMID: 12067003 DOI: 10.1093/bja/88.5.659] [Citation(s) in RCA: 362] [Impact Index Per Article: 16.5] [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: 11/13/2022] Open
Abstract
BACKGROUND Despite intensive research, the main causes of postoperative nausea and vomiting (PONV) remain unclear. We sought to quantify the relative importance of operative, anaesthetic and patient-specific risk factors to the development of PONV. METHODS We conducted a randomized controlled trial of 1180 children and adults at high risk for PONV scheduled for elective surgery. Using a five-way factorial design, we randomly assigned subjects by gender who were undergoing specific operative procedures, to receive various combinations of anaesthetics, opioids, and prophylactic antiemetics. RESULTS Of the 1180 patients, 355 (30.1% 95% CI (27.5-32.7%)) had at least one episode of postoperative vomiting (PV) within 24 h post-anaesthesia. In the early postoperative period (0-2 h), the leading risk factor for vomiting was the use of volatile anaesthetics, with similar odds ratios (OR (95% CI)) being found for isoflurane (19.8 (7.7-51.2)), enflurane (16.1 (6.2-41.8)) and sevoflurane (14.5 (5.6-37.4)). A dose-response relationship was present for the use of volatile anaesthetics. In contrast, no dose response existed for propofol anaesthesia. In the delayed postoperative period (2-24 h), the main predictors were being a child (5.7 (3.0-10.9)), PONV in the early period (3.4 (2.4-4.7)) and the use of postoperative opioids (2.5 (1.7-3.7)). The influence of the antiemetics was considerably smaller and did not interact with anaesthetic or surgical variables. CONCLUSION Volatile anaesthetics were the leading cause of early postoperative vomiting. The pro-emetic effect was larger than other risk factors. In patients at high risk for PONV, it would therefore make better sense to avoid inhalational anaesthesia rather than simply to add an antiemetic, which may still be needed to prevent or treat delayed vomiting.
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Affiliation(s)
- C C Apfel
- Department of Anaesthesiology, Julius-Maximilians-University of Wuerzburg, Germany
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Kranke P, Apfel CC, Papenfuss T, Rauch S, Lobmann U, Rubsam B, Greim CA, Roewer N. An increased body mass index is no risk factor for postoperative nausea and vomiting. A systematic review and results of original data Note. Acta Anaesthesiol Scand 2001. [DOI: 10.1034/j.1399-6576.2001.450205.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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20
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Kranke P, Apefel CC, Papenfuss T, Rauch S, Löbmann U, Rübsam B, Greim CA, Roewer N. An increased body mass index is no risk factor for postoperative nausea and vomiting. A systematic review and results of original data. Acta Anaesthesiol Scand 2001; 45:160-6. [PMID: 11167160] [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: 02/18/2023]
Abstract
BACKGROUND An increased Body Mass Index (BMI) is almost always mentioned as a fundamental risk factor for postoperative nausea (PN), vomiting (PV) or both (PONV). However, multivariate analyses were unable to detect any correlation. Therefore, we asked whether an increased BMI is really a risk factor for PONV. METHODS For the systematic review, a search of electronic databases and a detailed manual search of reviews were carried out. For the analysis of the original data, 587 adult patients from a randomised controlled antiemetic trial (RCT) who underwent general anaesthesia were allocated to four weight groups: Underweight (BMI < 20), Normal Weight (BMI 20-25), Overweight (BMI 25-30) and Obesity (BMI > or = 30). RESULTS Four publications with original data were found. Two described a positive relationship, although not clearly supported by the data. Despite this, most narrative reviews claimed a positive correlation between obesity and PONV by quoting again narrative reviews or misquoting originals. In the RCT, the calculated underlying risk profile for PONV was comparable between all groups. Incidences (95% confidence intervals) of PONV were 45.8% (34.0; 57.6), 41.7 (36.5; 46.9), 47.8 (38.4; 57.1) and 44.1 (31.0; 57.1), for the groups Underweight, Normal Weight, Overweight and Obesity, respectively (P=0.69). The incidences of PN and PV also did not differ with P=0.76 and P=0.36, respectively. CONCLUSION Systematic search of the literature provides no evidence for a positive relationship. Furthermore, our data confirm that an increased BMI is not a risk factor for PONV. This negative finding is important as focussing on the relevant risk factors is needed to allow for an objective risk assessment of PONV.
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Affiliation(s)
- P Kranke
- Department of Anaesthesiology, University of Wuerzburg, Germany
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Hildebrandt F, Singh-Sawhney I, Schnieders B, Papenfuss T, Brandis M. Refined genetic mapping of a gene for familial juvenile nephronophthisis (NPH1) and physical mapping of linked markers. APN Study Group. Genomics 1995; 25:360-4. [PMID: 7789968 DOI: 10.1016/0888-7543(95)80034-j] [Citation(s) in RCA: 15] [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: 01/27/2023]
Abstract
We have recently assigned a gene for familial juvenile nephronophthisis (NPH1) to chromosome 2q between microsatellite markers at loci D2S135 and D2S110. Here we have extended and refined our previous linkage analysis by studying five additional NPH families and by testing five additional markers. By haplotype analysis in a large family yielding proof of linkage, D2S135 and D2S283 were defined with certainty as flanking the NPH1 critical region within a 14-cM interval. These data now allow cytogenetic assignment of the NPH1 critical region to 2q11.1-q21.1. Furthermore, haplotype analysis in 12 small families helped to define as flanking markers D2S293 and D2S363, which span an 8-cM interval. Multipoint linkage analysis by the location score method resulted in a maximum multipoint lod score of 10.30. The Zmax-1 support interval spans 6.9 cM and is flanked by marker loci D2S293 and D2S363. Since IL1A maps to this region and has been cytogenetically mapped to 2q13 in the literature, NPH1 can be assigned more closely to 2q13 or adjacent bands. Contigs of CEPH mega-YAC clones in the region were established by screening the clones with microsatellite markers, adding marker IL1A to the physical map as a novel assignment. We conclude that the NPH1 gene most probably localizes to an interval of 6.9 cM between marker loci D2S293 and D2S363 in the vicinity of 2q13. This contig mapping provides the basis for cloning of this interval and for isolation of the NPH1 gene.
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Affiliation(s)
- F Hildebrandt
- University Children's Hospital, Freiburg University, Germany
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