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Staffaroni AM, Clark AL, Taylor JC, Heuer HW, Sanderson-Cimino M, Wise AB, Dhanam S, Cobigo Y, Wolf A, Manoochehri M, Forsberg L, Mester C, Rankin KP, Appleby BS, Bayram E, Bozoki A, Clark D, Darby RR, Domoto-Reilly K, Fields JA, Galasko D, Geschwind D, Ghoshal N, Graff-Radford N, Grossman M, Hsiung GY, Huey ED, Jones DT, Lapid MI, Litvan I, Masdeu JC, Massimo L, Mendez MF, Miyagawa T, Pascual B, Pressman P, Ramanan VK, Ramos EM, Rascovsky K, Roberson ED, Tartaglia MC, Wong B, Miller BL, Kornak J, Kremers W, Hassenstab J, Kramer JH, Boeve BF, Rosen HJ, Boxer AL. Reliability and Validity of Smartphone Cognitive Testing for Frontotemporal Lobar Degeneration. JAMA Netw Open 2024; 7:e244266. [PMID: 38558141 PMCID: PMC10985553 DOI: 10.1001/jamanetworkopen.2024.4266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Importance Frontotemporal lobar degeneration (FTLD) is relatively rare, behavioral and motor symptoms increase travel burden, and standard neuropsychological tests are not sensitive to early-stage disease. Remote smartphone-based cognitive assessments could mitigate these barriers to trial recruitment and success, but no such tools are validated for FTLD. Objective To evaluate the reliability and validity of smartphone-based cognitive measures for remote FTLD evaluations. Design, Setting, and Participants In this cohort study conducted from January 10, 2019, to July 31, 2023, controls and participants with FTLD performed smartphone application (app)-based executive functioning tasks and an associative memory task 3 times over 2 weeks. Observational research participants were enrolled through 18 centers of a North American FTLD research consortium (ALLFTD) and were asked to complete the tests remotely using their own smartphones. Of 1163 eligible individuals (enrolled in parent studies), 360 were enrolled in the present study; 364 refused and 439 were excluded. Participants were divided into discovery (n = 258) and validation (n = 102) cohorts. Among 329 participants with data available on disease stage, 195 were asymptomatic or had preclinical FTLD (59.3%), 66 had prodromal FTLD (20.1%), and 68 had symptomatic FTLD (20.7%) with a range of clinical syndromes. Exposure Participants completed standard in-clinic measures and remotely administered ALLFTD mobile app (app) smartphone tests. Main Outcomes and Measures Internal consistency, test-retest reliability, association of smartphone tests with criterion standard clinical measures, and diagnostic accuracy. Results In the 360 participants (mean [SD] age, 54.0 [15.4] years; 209 [58.1%] women), smartphone tests showed moderate-to-excellent reliability (intraclass correlation coefficients, 0.77-0.95). Validity was supported by association of smartphones tests with disease severity (r range, 0.38-0.59), criterion-standard neuropsychological tests (r range, 0.40-0.66), and brain volume (standardized β range, 0.34-0.50). Smartphone tests accurately differentiated individuals with dementia from controls (area under the curve [AUC], 0.93 [95% CI, 0.90-0.96]) and were more sensitive to early symptoms (AUC, 0.82 [95% CI, 0.76-0.88]) than the Montreal Cognitive Assessment (AUC, 0.68 [95% CI, 0.59-0.78]) (z of comparison, -2.49 [95% CI, -0.19 to -0.02]; P = .01). Reliability and validity findings were highly similar in the discovery and validation cohorts. Preclinical participants who carried pathogenic variants performed significantly worse than noncarrier family controls on 3 app tasks (eg, 2-back β = -0.49 [95% CI, -0.72 to -0.25]; P < .001) but not a composite of traditional neuropsychological measures (β = -0.14 [95% CI, -0.42 to 0.14]; P = .32). Conclusions and Relevance The findings of this cohort study suggest that smartphones could offer a feasible, reliable, valid, and scalable solution for remote evaluations of FTLD and may improve early detection. Smartphone assessments should be considered as a complementary approach to traditional in-person trial designs. Future research should validate these results in diverse populations and evaluate the utility of these tests for longitudinal monitoring.
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Affiliation(s)
- Adam M Staffaroni
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Annie L Clark
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Jack C Taylor
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Hilary W Heuer
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Mark Sanderson-Cimino
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Amy B Wise
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Sreya Dhanam
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Yann Cobigo
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Amy Wolf
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | | | - Leah Forsberg
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Carly Mester
- Department of Quantitative Health Sciences, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Katherine P Rankin
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Brian S Appleby
- Department of Neurology, Case Western Reserve University, Cleveland, Ohio
| | - Ece Bayram
- Department of Neurosciences, University of California, San Diego, La Jolla
| | - Andrea Bozoki
- Department of Radiology, University of North Carolina, Chapel Hill
| | - David Clark
- Department of Neurology, Indiana University, Indianapolis
| | - R Ryan Darby
- Department of Neurology, Vanderbilt University, Nashville, Tennessee
| | | | - Julie A Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Douglas Galasko
- Department of Neurosciences, University of California, San Diego, La Jolla
| | - Daniel Geschwind
- Department of Neurology, Institute for Precision Health, University of California, Los Angeles
| | - Nupur Ghoshal
- Department of Neurology, Knight Alzheimer Disease Research Center, Washington University, Saint Louis, Missouri
- Department of Psychiatry, Knight Alzheimer Disease Research Center, Washington University, Saint Louis, Missouri
| | | | - Murray Grossman
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Ging-Yuek Hsiung
- Division of Neurology, University of British Columbia, Musqueam, Squamish & Tsleil-Waututh Traditional Territory, Vancouver, Canada
| | - Edward D Huey
- Department of Neurology, Columbia University, New York, New York
| | - David T Jones
- Department of Quantitative Health Sciences, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Irene Litvan
- Department of Neurosciences, University of California, San Diego, La Jolla
| | - Joseph C Masdeu
- Department of Neurology, Nantz National Alzheimer Center, Houston Methodist and Weill Cornell Medicine, Houston Methodist, Houston, Texas
| | - Lauren Massimo
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Mario F Mendez
- Department of Neurology, UCLA (University of California, Los Angeles)
| | - Toji Miyagawa
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Belen Pascual
- Department of Neurology, Nantz National Alzheimer Center, Houston Methodist and Weill Cornell Medicine, Houston Methodist, Houston, Texas
| | | | | | | | - Katya Rascovsky
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | - M Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Bonnie Wong
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Bruce L Miller
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - John Kornak
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Walter Kremers
- Department of Quantitative Health Sciences, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Jason Hassenstab
- Department of Neurology, Knight Alzheimer Disease Research Center, Washington University, Saint Louis, Missouri
- Department of Psychological & Brain Sciences, Washington University, Saint Louis, Missouri
| | - Joel H Kramer
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | | | - Howard J Rosen
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Adam L Boxer
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
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Saloner R, Staffaroni A, Dammer E, Johnson ECB, Paolillo E, Wise A, Heuer H, Forsberg L, Lago AL, Webb J, Vogel J, Santillo A, Hansson O, Kramer J, Miller B, Li J, Loureiro J, Sivasankaran R, Worringer K, Seyfried N, Yokoyama J, Seeley W, Spina S, Grinberg L, VandeVrede L, Ljubenkov P, Bayram E, Bozoki A, Brushaber D, Considine C, Day G, Dickerson B, Domoto-Reilly K, Faber K, Galasko D, Geschwind D, Ghoshal N, Graff-Radford N, Hales C, Honig L, Hsiung GY, Huey E, Kornak J, Kremers W, Lapid M, Lee S, Litvan I, McMillan C, Mendez M, Miyagawa T, Pantelyat A, Pascual B, Paulson H, Petrucelli L, Pressman P, Ramos E, Rascovsky K, Roberson E, Savica R, Snyder A, Sullivan AC, Tartaglia C, Vandebergh M, Boeve B, Rosen H, Rojas J, Boxer A, Casaletto K. Large-scale network analysis of the cerebrospinal fluid proteome identifies molecular signatures of frontotemporal lobar degeneration. Res Sq 2024:rs.3.rs-4103685. [PMID: 38585969 PMCID: PMC10996789 DOI: 10.21203/rs.3.rs-4103685/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
The pathophysiological mechanisms driving disease progression of frontotemporal lobar degeneration (FTLD) and corresponding biomarkers are not fully understood. We leveraged aptamer-based proteomics (> 4,000 proteins) to identify dysregulated communities of co-expressed cerebrospinal fluid proteins in 116 adults carrying autosomal dominant FTLD mutations (C9orf72, GRN, MAPT) compared to 39 noncarrier controls. Network analysis identified 31 protein co-expression modules. Proteomic signatures of genetic FTLD clinical severity included increased abundance of RNA splicing (particularly in C9orf72 and GRN) and extracellular matrix (particularly in MAPT) modules, as well as decreased abundance of synaptic/neuronal and autophagy modules. The generalizability of genetic FTLD proteomic signatures was tested and confirmed in independent cohorts of 1) sporadic progressive supranuclear palsy-Richardson syndrome and 2) frontotemporal dementia spectrum syndromes. Network-based proteomics hold promise for identifying replicable molecular pathways in adults living with FTLD. 'Hub' proteins driving co-expression of affected modules warrant further attention as candidate biomarkers and therapeutic targets.
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Affiliation(s)
| | | | | | | | | | - Amy Wise
- University of California, San Francisco
| | | | | | | | | | | | | | | | | | | | - Jingyao Li
- Novartis Institutes for Biomedical Research, Inc
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Suzee Lee
- University of California, San Francisco
| | | | - Corey McMillan
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Adam Boxer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
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Toller G, Cobigo Y, Callahan P, Appleby BS, Brushaber D, Domoto-Reilly K, Forsberg LK, Ghoshal N, Graff-Radford J, Graff-Radford NR, Grossman M, Heuer HW, Kornak J, Kremers W, Lapid MI, Leger G, Litvan I, Mackenzie IR, Pascual MB, Ramos EM, Rascovsky K, Rojas JC, Staffaroni AM, Tartaglia MC, Toga A, Weintraub S, Wszolek ZK, Boeve BF, Boxer AL, Rosen HJ, Rankin KP. Multisite ALLFTD study modeling progressive empathy loss from the earliest stages of behavioral variant frontotemporal dementia. Alzheimers Dement 2023; 19:2842-2852. [PMID: 36591730 PMCID: PMC10314956 DOI: 10.1002/alz.12898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/19/2022] [Accepted: 10/27/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Empathy relies on fronto-cingular and temporal networks that are selectively vulnerable in behavioral variant frontotemporal dementia (bvFTD). This study modeled when in the disease process empathy changes begin, and how they progress. METHODS Four hundred thirty-one individuals with asymptomatic genetic FTD (n = 114), genetic and sporadic bvFTD (n = 317), and 163 asymptomatic non-carrier controls were enrolled. In sub-samples, we investigated empathy measured by the informant-based Interpersonal Reactivity Index (IRI) at each disease stage and over time (n = 91), and its correspondence to underlying atrophy (n = 51). RESULTS Empathic concern (estimate = 4.38, 95% confidence interval [CI] = 2.79, 5.97; p < 0.001) and perspective taking (estimate = 5.64, 95% CI = 3.81, 7.48; p < 0.001) scores declined between the asymptomatic and very mild symptomatic stages regardless of pathogenic variant status. More rapid loss of empathy corresponded with subcortical atrophy. DISCUSSION Loss of empathy is an early and progressive symptom of bvFTD that is measurable by IRI informant ratings and can be used to monitor behavior in neuropsychiatry practice and treatment trials.
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Affiliation(s)
- Gianina Toller
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, San Francisco, CA, USA
| | - Yann Cobigo
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, San Francisco, CA, USA
| | - Patrick Callahan
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, San Francisco, CA, USA
| | | | | | | | | | | | | | | | | | - Hilary W. Heuer
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, San Francisco, CA, USA
| | - John Kornak
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, San Francisco, CA, USA
| | | | | | - Gabriel Leger
- University of California, San Diego, San Diego, CA, USA
| | - Irene Litvan
- University of California, San Diego, San Diego, CA, USA
| | - Ian R. Mackenzie
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Julio C. Rojas
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, San Francisco, CA, USA
| | - Adam M. Staffaroni
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, San Francisco, CA, USA
| | | | - Arthur Toga
- University of Southern California, Los Angeles, CA, USA
| | - Sandra Weintraub
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Adam L. Boxer
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, San Francisco, CA, USA
| | - Howard J. Rosen
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, San Francisco, CA, USA
| | - Katherine P. Rankin
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, San Francisco, CA, USA
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4
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Asken BM, Ljubenkov PA, Staffaroni AM, Casaletto KB, Vandevrede L, Cobigo Y, Rojas-Rodriguez JC, Rankin KP, Kornak J, Heuer H, Shigenaga J, Appleby BS, Bozoki AC, Domoto-Reilly K, Ghoshal N, Huey E, Litvan I, Masdeu JC, Mendez MF, Pascual B, Pressman P, Tartaglia MC, Kremers W, Forsberg LK, Boeve BF, Boxer AL, Rosen HJ, Kramer JH. Plasma inflammation for predicting phenotypic conversion and clinical progression of autosomal dominant frontotemporal lobar degeneration. J Neurol Neurosurg Psychiatry 2023; 94:541-549. [PMID: 36977552 PMCID: PMC10313977 DOI: 10.1136/jnnp-2022-330866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/28/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Measuring systemic inflammatory markers may improve clinical prognosis and help identify targetable pathways for treatment in patients with autosomal dominant forms of frontotemporal lobar degeneration (FTLD). METHODS We measured plasma concentrations of IL-6, TNFα and YKL-40 in pathogenic variant carriers (MAPT, C9orf72, GRN) and non-carrier family members enrolled in the ARTFL-LEFFTDS Longitudinal Frontotemporal Lobar Degeneration consortium. We evaluated associations between baseline plasma inflammation and rate of clinical and neuroimaging changes (linear mixed effects models with standardised (z) outcomes). We compared inflammation between asymptomatic carriers who remained clinically normal ('asymptomatic non-converters') and those who became symptomatic ('asymptomatic converters') using area under the curve analyses. Discrimination accuracy was compared with that of plasma neurofilament light chain (NfL). RESULTS We studied 394 participants (non-carriers=143, C9orf72=117, GRN=62, MAPT=72). In MAPT, higher TNFα was associated with faster functional decline (B=0.12 (0.02, 0.22), p=0.02) and temporal lobe atrophy. In C9orf72, higher TNFα was associated with faster functional decline (B=0.09 (0.03, 0.16), p=0.006) and cognitive decline (B=-0.16 (-0.22, -0.10), p<0.001), while higher IL-6 was associated with faster functional decline (B=0.12 (0.03, 0.21), p=0.01). TNFα was higher in asymptomatic converters than non-converters (β=0.29 (0.09, 0.48), p=0.004) and improved discriminability compared with plasma NfL alone (ΔR2=0.16, p=0.007; NfL: OR=1.4 (1.03, 1.9), p=0.03; TNFα: OR=7.7 (1.7, 31.7), p=0.007). CONCLUSIONS Systemic proinflammatory protein measurement, particularly TNFα, may improve clinical prognosis in autosomal dominant FTLD pathogenic variant carriers who are not yet exhibiting severe impairment. Integrating TNFα with markers of neuronal dysfunction like NfL could optimise detection of impending symptom conversion in asymptomatic pathogenic variant carriers and may help personalise therapeutic approaches.
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Affiliation(s)
- Breton M Asken
- Department of Clinical and Health Psychology, 1Florida Alzheimer's Disease Research Center, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Peter A Ljubenkov
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Adam M Staffaroni
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Kaitlin B Casaletto
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Lawren Vandevrede
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Yann Cobigo
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Julio C Rojas-Rodriguez
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Katherine P Rankin
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - John Kornak
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Hilary Heuer
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Judy Shigenaga
- Department of Medicine, Veterans Affairs Health Care System, San Francisco, California, USA
| | - Brian S Appleby
- Departments of Neurology, Psychiatry, and Pathology, Case Western Reserve, Cleveland, Ohio, USA
| | - Andrea C Bozoki
- Department of Neurology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kimiko Domoto-Reilly
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Nupur Ghoshal
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Edward Huey
- Departments of Psychiatry and Neurology, Columbia University, New York, New York, USA
| | - Irene Litvan
- Department of Neurology, University of California, San Diego, La Jolla, California, USA
| | - Joseph C Masdeu
- Department of Neurology, Nantz National Alzheimer Center, Houston Methodist, Houston, Texas, USA
| | - Mario F Mendez
- Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA
| | - Belen Pascual
- Department of Neurology, Nantz National Alzheimer Center, Houston Methodist, Houston, Texas, USA
| | - Peter Pressman
- Department of Neurology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario, Canada
- Canadian Sports Concussion Project, Toronto, Ontario, Canada
| | - Walter Kremers
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Leah K Forsberg
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brad F Boeve
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Adam L Boxer
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Howie J Rosen
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Joel H Kramer
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
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5
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Taylor JC, Heuer HW, Clark AL, Wise AB, Manoochehri M, Forsberg L, Mester C, Rao M, Brushaber D, Kramer J, Welch AE, Kornak J, Kremers W, Appleby B, Dickerson BC, Domoto‐Reilly K, Fields JA, Ghoshal N, Graff‐Radford N, Grossman M, Hall MGH, Huey ED, Irwin D, Lapid MI, Litvan I, Mackenzie IR, Masdeu JC, Mendez MF, Nevler N, Onyike CU, Pascual B, Pressman P, Rankin KP, Ratnasiri B, Rojas JC, Tartaglia MC, Wong B, Gorno‐Tempini ML, Boeve BF, Rosen HJ, Boxer AL, Staffaroni AM. Feasibility and acceptability of remote smartphone cognitive testing in frontotemporal dementia research. Alzheimers Dement (Amst) 2023; 15:e12423. [PMID: 37180971 PMCID: PMC10170087 DOI: 10.1002/dad2.12423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/27/2022] [Accepted: 03/01/2023] [Indexed: 05/16/2023]
Abstract
Introduction Remote smartphone assessments of cognition, speech/language, and motor functioning in frontotemporal dementia (FTD) could enable decentralized clinical trials and improve access to research. We studied the feasibility and acceptability of remote smartphone data collection in FTD research using the ALLFTD Mobile App (ALLFTD-mApp). Methods A diagnostically mixed sample of 214 participants with FTD or from familial FTD kindreds (asymptomatic: CDR®+NACC-FTLD = 0 [N = 101]; prodromal: 0.5 [N = 49]; symptomatic ≥1 [N = 51]; not measured [N = 13]) were asked to complete ALLFTD-mApp tests on their smartphone three times within 12 days. They completed smartphone familiarity and participation experience surveys. Results It was feasible for participants to complete the ALLFTD-mApp on their own smartphones. Participants reported high smartphone familiarity, completed ∼ 70% of tasks, and considered the time commitment acceptable (98% of respondents). Greater disease severity was associated with poorer performance across several tests. Discussion These findings suggest that the ALLFTD-mApp study protocol is feasible and acceptable for remote FTD research. HIGHLIGHTS The ALLFTD Mobile App is a smartphone-based platform for remote, self-administered data collection.The ALLFTD Mobile App consists of a comprehensive battery of surveys and tests of executive functioning, memory, speech and language, and motor abilities.Remote digital data collection using the ALLFTD Mobile App was feasible in a multicenter research consortium that studies FTD. Data was collected in healthy controls and participants with a range of diagnoses, particularly FTD spectrum disorders.Remote digital data collection was well accepted by participants with a variety of diagnoses.
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Affiliation(s)
- Jack Carson Taylor
- Department of Neurology, Memory and Aging Center, University of California, San FranciscoWeill Institute for NeurosciencesSan FranciscoCaliforniaUSA
| | - Hilary W. Heuer
- Department of Neurology, Memory and Aging Center, University of California, San FranciscoWeill Institute for NeurosciencesSan FranciscoCaliforniaUSA
| | - Annie L. Clark
- Department of Neurology, Memory and Aging Center, University of California, San FranciscoWeill Institute for NeurosciencesSan FranciscoCaliforniaUSA
| | - Amy B. Wise
- Department of Neurology, Memory and Aging Center, University of California, San FranciscoWeill Institute for NeurosciencesSan FranciscoCaliforniaUSA
| | | | - Leah Forsberg
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
| | - Carly Mester
- Department of Quantitative Health SciencesDivision of Biomedical Statistics and InformaticsMayo ClinicRochesterMinnesotaUSA
| | - Meghana Rao
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
| | - Daniell Brushaber
- Department of Quantitative Health SciencesDivision of Biomedical Statistics and InformaticsMayo ClinicRochesterMinnesotaUSA
| | - Joel Kramer
- Department of Neurology, Memory and Aging Center, University of California, San FranciscoWeill Institute for NeurosciencesSan FranciscoCaliforniaUSA
| | - Ariane E. Welch
- Department of Neurology, Memory and Aging Center, University of California, San FranciscoWeill Institute for NeurosciencesSan FranciscoCaliforniaUSA
| | - John Kornak
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Walter Kremers
- Department of Quantitative Health SciencesDivision of Biomedical Statistics and InformaticsMayo ClinicRochesterMinnesotaUSA
| | - Brian Appleby
- Department of NeurologyCase Western Reserve UniversityClevelandOhioUSA
| | - Bradford C. Dickerson
- Department of NeurologyMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | | | - Julie A. Fields
- Department of Psychiatry and PsychologyMayo ClinicRochesterMinnesotaUSA
| | - Nupur Ghoshal
- Center for Advanced Medicine Memory Diagnostic CenterWashington UniversitySaint LouisMissouriUSA
| | | | - Murray Grossman
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Matthew GH Hall
- Department of Neurology, Memory and Aging Center, University of California, San FranciscoWeill Institute for NeurosciencesSan FranciscoCaliforniaUSA
| | - Edward D. Huey
- Department of NeurologyColumbia UniversityNew YorkNew YorkUSA
| | - David Irwin
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Maria I. Lapid
- Department of Psychiatry and PsychologyMayo ClinicRochesterMinnesotaUSA
| | - Irene Litvan
- Department of NeurosciencesUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Ian R. Mackenzie
- Department of PathologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - Mario F. Mendez
- Department of NeurologyUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Naomi Nevler
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Chiadi U. Onyike
- Department of Psychiatry and Behavioral SciencesJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Belen Pascual
- Department of NeurologyHouston MethodistHoustonTexasUSA
| | - Peter Pressman
- Department of NeurologyUniversity of ColoradoAuroraColoradoUSA
| | - Katherine P. Rankin
- Department of Neurology, Memory and Aging Center, University of California, San FranciscoWeill Institute for NeurosciencesSan FranciscoCaliforniaUSA
| | - Buddhika Ratnasiri
- Department of Neurology, Memory and Aging Center, University of California, San FranciscoWeill Institute for NeurosciencesSan FranciscoCaliforniaUSA
| | - Julio C. Rojas
- Department of Neurology, Memory and Aging Center, University of California, San FranciscoWeill Institute for NeurosciencesSan FranciscoCaliforniaUSA
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | - Bonnie Wong
- Department of NeurologyMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Maria Luisa Gorno‐Tempini
- Department of Neurology, Memory and Aging Center, University of California, San FranciscoWeill Institute for NeurosciencesSan FranciscoCaliforniaUSA
| | | | - Howard J. Rosen
- Department of Neurology, Memory and Aging Center, University of California, San FranciscoWeill Institute for NeurosciencesSan FranciscoCaliforniaUSA
| | - Adam L. Boxer
- Department of Neurology, Memory and Aging Center, University of California, San FranciscoWeill Institute for NeurosciencesSan FranciscoCaliforniaUSA
| | - Adam M. Staffaroni
- Department of Neurology, Memory and Aging Center, University of California, San FranciscoWeill Institute for NeurosciencesSan FranciscoCaliforniaUSA
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6
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Smith B, Grande J, Ryan M, Smith M, Denic A, Hermsen M, Park W, Kremers W, Stegall M. Automated scoring of total inflammation in renal allograft biopsies. Clin Transplant 2023; 37:e14837. [PMID: 36259615 DOI: 10.1111/ctr.14837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/26/2022] [Accepted: 10/13/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Computer-assisted scoring is gaining prominence in the evaluation of renal histology; however, much of the focus has been on identifying larger objects such as glomeruli. Total inflammation impacts graft outcome, and its quantification requires tools to identify objects at the cellular level or smaller. The goal of the current study was to use CD45 stained slides coupled with image analysis tools to quantify the amount of non-glomerular inflammation within the cortex. METHODS Sixty renal transplant whole slide images were used for digital image analysis. Multiple thresholding methods using pixel intensity and object size were used to identify inflammation in the cortex. Additionally, convolutional neural networks were used to separate glomeruli from other objects in the cortex. This combined measure of inflammation was then correlated with rescored Banff total inflammation classification and outcomes. RESULTS Identification of glomeruli on biopsies had high fidelity (mean pixelwise dice coefficient of .858). Continuous total inflammation scores correlated well with Banff rescoring (maximum Pearson correlation .824). A separate set of thresholds resulted in a significant correlation with alloimmune graft loss. CONCLUSIONS Automated scoring of inflammation showed a high correlation with Banff scoring. Digital image analysis provides a powerful tool for analysis of renal pathology, not only because it is reproducible and can be automated, but also because it provides much more granular data for studies.
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Affiliation(s)
- Byron Smith
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph Grande
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Maggie Ryan
- Department of Anatomic Pathology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Maxwell Smith
- Department of Anatomic Pathology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Aleksandar Denic
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Meyke Hermsen
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Walter Park
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA.,Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Walter Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA.,William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark Stegall
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA.,Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
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7
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Friedman DZP, Johnson B, Beam E, Kremers W, Vergidis P. Risk Factors and Outcomes of Invasive Aspergillosis in Kidney Transplant Recipients: A Case-Control Study of USRDS Data. Clin Infect Dis 2022; 76:1431-1439. [PMID: 36516420 DOI: 10.1093/cid/ciac927] [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] [Received: 07/12/2022] [Revised: 11/16/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022] Open
Abstract
ABSTRACT
Background
Kidney transplant recipients are at increased risk for invasive aspergillosis (IA), a disease with poor outcomes and substantial economic burden. We aimed to determine risk factors for posttransplant IA by using a national database and to assess the association of IA with mortality and allograft failure.
Methods
Using the United States Renal Data System database, we performed a retrospective case-control study of patients who underwent kidney transplant from 1998 through 2017. To evaluate risk factors for IA, we performed conditional logistic regression analysis by comparing characteristics between IA-infected patients and their matched uninfected controls. We performed Cox regression analysis to evaluate the effects of IA on mortality and death-censored allograft failure.
Results
We matched 359 patients with IA to 1,436 uninfected controls (1:4). IA was diagnosed at a median of 22.5 months (IQR, 5.4-85.2 months) after kidney transplant. Risk factors for IA were Black/African American race, duration of pretransplant hemodialysis, higher Elixhauser Comorbidity Index score, weight loss, chronic pulmonary disease, need for early posttransplant hemodialysis, and a history of cytomegalovirus infection. Receiving an allograft from a living donor was protective against IA. IA was a strong independent predictor of 1-year mortality (adjusted hazard ratio, 5.02 [95% CI, 3.58-7.04], P < .001). Additionally, IA was associated with 1-year allograft failure (adjusted hazard ratio, 3.37 [95% CI, 1.96-5.77], P < .001).
Conclusions
Our findings emphasize the importance of timely transplant to mitigate the risk of posttransplant IA. An individualized approach to disease prevention is essential to decrease mortality and allograft failure.
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Affiliation(s)
- Daniel Z P Friedman
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota , USA
- Section of Infectious Diseases and Public Health, University of Chicago , Chicago, Illinois , USA
| | - Bradley Johnson
- Division of Clinical Trials and Biostatistics, Mayo Clinic , Rochester, Minnesota , USA
- William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic , Rochester, Minnesota , USA
| | - Elena Beam
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota , USA
- William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic , Rochester, Minnesota , USA
| | - Walter Kremers
- Division of Clinical Trials and Biostatistics, Mayo Clinic , Rochester, Minnesota , USA
- William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic , Rochester, Minnesota , USA
| | - Paschalis Vergidis
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota , USA
- William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic , Rochester, Minnesota , USA
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8
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Staffaroni AM, Quintana M, Wendelberger B, Heuer HW, Russell LL, Cobigo Y, Wolf A, Goh SYM, Petrucelli L, Gendron TF, Heller C, Clark AL, Taylor JC, Wise A, Ong E, Forsberg L, Brushaber D, Rojas JC, VandeVrede L, Ljubenkov P, Kramer J, Casaletto KB, Appleby B, Bordelon Y, Botha H, Dickerson BC, Domoto-Reilly K, Fields JA, Foroud T, Gavrilova R, Geschwind D, Ghoshal N, Goldman J, Graff-Radford J, Graff-Radford N, Grossman M, Hall MGH, Hsiung GY, Huey ED, Irwin D, Jones DT, Kantarci K, Kaufer D, Knopman D, Kremers W, Lago AL, Lapid MI, Litvan I, Lucente D, Mackenzie IR, Mendez MF, Mester C, Miller BL, Onyike CU, Rademakers R, Ramanan VK, Ramos EM, Rao M, Rascovsky K, Rankin KP, Roberson ED, Savica R, Tartaglia MC, Weintraub S, Wong B, Cash DM, Bouzigues A, Swift IJ, Peakman G, Bocchetta M, Todd EG, Convery RS, Rowe JB, Borroni B, Galimberti D, Tiraboschi P, Masellis M, Finger E, van Swieten JC, Seelaar H, Jiskoot LC, Sorbi S, Butler CR, Graff C, Gerhard A, Langheinrich T, Laforce R, Sanchez-Valle R, de Mendonça A, Moreno F, Synofzik M, Vandenberghe R, Ducharme S, Le Ber I, Levin J, Danek A, Otto M, Pasquier F, Santana I, Kornak J, Boeve BF, Rosen HJ, Rohrer JD, Boxer AL. Temporal order of clinical and biomarker changes in familial frontotemporal dementia. Nat Med 2022; 28:2194-2206. [PMID: 36138153 PMCID: PMC9951811 DOI: 10.1038/s41591-022-01942-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 07/08/2022] [Indexed: 01/17/2023]
Abstract
Unlike familial Alzheimer's disease, we have been unable to accurately predict symptom onset in presymptomatic familial frontotemporal dementia (f-FTD) mutation carriers, which is a major hurdle to designing disease prevention trials. We developed multimodal models for f-FTD disease progression and estimated clinical trial sample sizes in C9orf72, GRN and MAPT mutation carriers. Models included longitudinal clinical and neuropsychological scores, regional brain volumes and plasma neurofilament light chain (NfL) in 796 carriers and 412 noncarrier controls. We found that the temporal ordering of clinical and biomarker progression differed by genotype. In prevention-trial simulations using model-based patient selection, atrophy and NfL were the best endpoints, whereas clinical measures were potential endpoints in early symptomatic trials. f-FTD prevention trials are feasible but will likely require global recruitment efforts. These disease progression models will facilitate the planning of f-FTD clinical trials, including the selection of optimal endpoints and enrollment criteria to maximize power to detect treatment effects.
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Affiliation(s)
- Adam M Staffaroni
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
| | | | | | - Hilary W Heuer
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Lucy L Russell
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square London, London, UK
| | - Yann Cobigo
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Amy Wolf
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Sheng-Yang Matt Goh
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | | | - Tania F Gendron
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Carolin Heller
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square London, London, UK
| | - Annie L Clark
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jack Carson Taylor
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Amy Wise
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Elise Ong
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Leah Forsberg
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Danielle Brushaber
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Julio C Rojas
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Lawren VandeVrede
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Peter Ljubenkov
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Joel Kramer
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Kaitlin B Casaletto
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Brian Appleby
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
| | - Yvette Bordelon
- Department of Neurology, University of California, Los Angeles, Los Angeles, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Bradford C Dickerson
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Julie A Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Tatiana Foroud
- Indiana University School of Medicine, National Centralized Repository for Alzheimer's, Indianapolis, IN, USA
| | | | - Daniel Geschwind
- Department of Neurology, University of California, Los Angeles, Los Angeles, USA
- Institute for Precision Health, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Nupur Ghoshal
- Departments of Neurology and Psychiatry, Washington University School of Medicine, Washington University, St. Louis, MO, USA
| | - Jill Goldman
- Department of Neurology, Columbia University, New York, NY, USA
| | | | | | - Murray Grossman
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Matthew G H Hall
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Ging-Yuek Hsiung
- Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edward D Huey
- Department of Neurology, Columbia University, New York, NY, USA
| | - David Irwin
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Kejal Kantarci
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Daniel Kaufer
- Department of Neurology, University of North Carolina, Chapel Hill, NC, USA
| | - David Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Walter Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Argentina Lario Lago
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Irene Litvan
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Diane Lucente
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ian R Mackenzie
- Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mario F Mendez
- Department of Neurology, University of California, Los Angeles, Los Angeles, USA
| | - Carly Mester
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Bruce L Miller
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Chiadi U Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Rosa Rademakers
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Applied and Translational Neurogenomics Group, VIB Center for Molecular Neurology, VIB, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Eliana Marisa Ramos
- Department of Neurology, University of California, Los Angeles, Los Angeles, USA
| | - Meghana Rao
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Katya Rascovsky
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Katherine P Rankin
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Erik D Roberson
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - M Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Sandra Weintraub
- Department of Neurology, Northwestern University, Chicago, IL, USA
| | - Bonnie Wong
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David M Cash
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square London, London, UK
| | - Arabella Bouzigues
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square London, London, UK
| | - Imogen J Swift
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square London, London, UK
| | - Georgia Peakman
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square London, London, UK
| | - Martina Bocchetta
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square London, London, UK
| | - Emily G Todd
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square London, London, UK
| | - Rhian S Convery
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square London, London, UK
| | - James B Rowe
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust and Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Barbara Borroni
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Daniela Galimberti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Mario Masellis
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
| | | | - Harro Seelaar
- Department of Neurology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Lize C Jiskoot
- Department of Neurology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Sandro Sorbi
- Department of Neurofarba, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Chris R Butler
- Nuffield Department of Clinical Neurosciences, Medical Sciences Division, University of Oxford, Oxford, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Caroline Graff
- Center for Alzheimer Research, Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Bioclinicum, Karolinska Institutet, Solna, Sweden
- Unit for Hereditary Dementias, Theme Aging, Karolinska University Hospital, Solna, Sweden
| | - Alexander Gerhard
- Division of Neuroscience and Experimental Psychology, Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
- Departments of Geriatric Medicine and Nuclear Medicine, Center for Translational Neuro- and Behavioral Sciences, University Medicine Essen, Essen, Germany
| | - Tobias Langheinrich
- Division of Neuroscience and Experimental Psychology, Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
- Cerebral Function Unit, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques, CHU de Québec, and Faculté de Médecine, Université Laval, Québec City, Québec, Canada
| | - Raquel Sanchez-Valle
- Alzheimer's disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic, Institut d'Investigacións Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | | | - Fermin Moreno
- Cognitive Disorders Unit, Department of Neurology, Donostia University Hospital, San Sebastian, Gipuzkoa, Spain
- Neuroscience Area, Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
- Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Neurology Service, University Hospitals Leuven, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Simon Ducharme
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, Department of Neurology & Neurosurgery, McGill University, Montreal, Québec, Canada
| | - Isabelle Le Ber
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau - ICM, Inserm U1127, CNRS UMR 7225, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France
- Centre de référence des démences rares ou précoces, IM2A, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France
- Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France
| | - Johannes Levin
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität, Munich, Germany
- Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster of Systems Neurology, Munich, Germany
| | - Adrian Danek
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität, Munich, Germany
| | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Florence Pasquier
- University of Lille, Lille, France
- Inserm, Lille, France
- CHU, CNR-MAJ, Labex Distalz, LiCEND Lille, Lille, France
| | - Isabel Santana
- Neurology Service, Faculty of Medicine, University Hospital of Coimbra (HUC), University of Coimbra, Coimbra, Portugal
- Center for Neuroscience and Cell Biology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - John Kornak
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | | | - Howard J Rosen
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square London, London, UK
| | - Adam L Boxer
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
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9
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Puranik A, Lenehan PJ, O'Horo JC, Pawlowski C, Niesen MJM, Virk A, Swift MD, Kremers W, Venkatakrishnan AJ, Gordon JE, Geyer HL, Speicher LL, Soundararajan V, Badley AD. Durability analysis of the highly effective BNT162b2 vaccine against COVID-19. PNAS Nexus 2022; 1:pgac082. [PMID: 35832867 PMCID: PMC9272171 DOI: 10.1093/pnasnexus/pgac082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/02/2022] [Indexed: 02/05/2023]
Abstract
COVID-19 vaccines are effective, but breakthrough infections have been increasingly reported. We conducted a test-negative case-control study to assess the durability of protection after full vaccination with BNT162b2 against polymerase chain reaction (PCR)-confirmed symptomatic SARS-CoV-2 infection, in a national medical practice from January 2021 through January 2022. We fit conditional logistic regression (CLR) models stratified on residential county and calendar time of testing to assess the association between time elapsed since vaccination and the odds of symptomatic infection or non-COVID-19 hospitalization (negative control), adjusted for several covariates. There were 5,985 symptomatic individuals with a positive test after full vaccination with BNT162b2 (cases) and 32,728 negative tests contributed by 27,753 symptomatic individuals after full vaccination (controls). The adjusted odds of symptomatic infection were higher 250 days after full vaccination versus at the date of full vaccination (Odds Ratio [OR]: 3.62, 95% CI: 2.52 to 5.20). The odds of infection were still lower 285 days after the first BNT162b2 dose as compared to 4 days after the first dose (OR: 0.50, 95% CI: 0.37 to 0.67), when immune protection approximates the unvaccinated status. Low rates of COVID-19 associated hospitalization or death in this cohort precluded analyses of these severe outcomes. The odds of non-COVID-19 associated hospitalization (negative control) decreased with time since vaccination, suggesting a possible underestimation of waning protection by this approach due to confounding factors. In summary, BNT162b2 strongly protected against symptomatic SARS-CoV-2 infection for at least 8 months after full vaccination, but the degree of protection waned significantly over this period.
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Affiliation(s)
| | | | | | | | | | - Abinash Virk
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55902, USA
| | - Melanie D Swift
- Division of Aerospace, Occupational and Preventive Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - Walter Kremers
- Division of Biomedical Statistics, Mayo Clinic, Rochester, MN 55902, USA
| | | | - Joel E Gordon
- Department of Family Medicine, Mayo Clinic Health System, Mankato, MN 56001, USA
| | - Holly L Geyer
- Division of Hospital Internal Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA
| | | | | | - Andrew D Badley
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55902, USA,Department of Molecular Medicine, Mayo Clinic, Rochester, MN 55902, USA
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10
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Puranik A, Lenehan PJ, O'Horo JC, Pawlowski C, Virk A, Swift MD, Kremers W, Venkatakrishnan AJ, Challener DW, Breeher L, Gordon JE, Geyer HL, Speicher LL, Soundararajan V, Badley AD. Durability analysis of the highly effective mRNA-1273 vaccine against COVID-19. PNAS Nexus 2022; 1:pgac058. [PMID: 36713311 PMCID: PMC9802296 DOI: 10.1093/pnasnexus/pgac058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 05/17/2022] [Indexed: 02/01/2023]
Abstract
COVID-19 vaccines are effective, but breakthrough infections have been increasingly reported. We conducted a test-negative case-control study to assess the durability of protection against symptomatic infection after vaccination with mRNA-1273. We fit conditional logistic regression (CLR) models stratified on residential county and calendar date of SARS-CoV-2 PCR testing to assess the association between the time elapsed since vaccination and the odds of symptomatic infection, adjusted for several covariates. There were 2,364 symptomatic individuals who had a positive SARS-CoV-2 PCR test after full vaccination with mRNA-1273 ("cases") and 12,949 symptomatic individuals who contributed 15,087 negative tests after full vaccination ("controls"). The odds of symptomatic infection were significantly higher 250 days after full vaccination compared to the date of full vaccination (Odds Ratio [OR]: 2.47, 95% confidence interval [CI]: 1.19-5.13). The odds of non-COVID-19 associated hospitalization and non-COVID-19 pneumonia (negative control outcomes) remained relatively stable over the same time interval (Day 250 ORNon-COVID Hospitalization: 0.68, 95% CI: 0.47-1.0; Day 250 ORNon-COVID Pneumonia: 1.11, 95% CI: 0.24-5.2). The odds of symptomatic infection remained significantly lower almost 300 days after the first mRNA-1273 dose as compared to 4 days after the first dose, when immune protection approximates the unvaccinated state (OR: 0.26, 95% CI: 0.17-0.39). Low rates of COVID-19 associated hospitalization or death in this cohort precluded analyses of these severe outcomes. In summary, mRNA-1273 robustly protected against symptomatic SARS-CoV-2 infection at least 8 months after full vaccination, but the degree of protection waned over this time period.
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Affiliation(s)
| | | | | | | | - Abinash Virk
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55902, USA
| | - Melanie D Swift
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - Walter Kremers
- Division of Biomedical Statistics, Mayo Clinic, Rochester, MN 55902, USA
| | | | - Doug W Challener
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55902, USA
| | - Laura Breeher
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - Joel E Gordon
- Department of Family Medicine, Mayo Clinic Health System, Mankato, MN 56001, USA
| | - Holly L Geyer
- Division of Hospital Internal Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA
| | | | | | - Andrew D Badley
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55902, USA,Department of Molecular Medicine, Mayo Clinic, Rochester, MN 55902, USA
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11
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Puranik A, Lenehan PJ, Silvert E, Niesen MJM, Corchado-Garcia J, O'Horo JC, Virk A, Swift MD, Gordon JE, Speicher LL, Geyer HL, Kremers W, Halamka J, Badley AD, Venkatakrishnan AJ, Soundararajan V. Comparative effectiveness of mRNA-1273 and BNT162b2 against symptomatic SARS-CoV-2 infection. Med 2022; 3:28-41.e8. [PMID: 34927113 PMCID: PMC8664708 DOI: 10.1016/j.medj.2021.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/19/2021] [Accepted: 11/25/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND mRNA coronavirus disease 2019 (COVID-19) vaccines are safe and effective, but increasing reports of breakthrough infections highlight the need to vigilantly monitor and compare the effectiveness of these vaccines. METHODS We retrospectively compared protection against symptomatic infection conferred by mRNA-1273 and BNT162b2 at Mayo Clinic sites from December 2020 to September 2021. We used a test-negative case-control design to estimate vaccine effectiveness (VE) and to compare the odds of symptomatic infection after full vaccination with mRNA-1273 versus BNT162b2, while adjusting for age, sex, race, ethnicity, geography, comorbidities, and calendar time of vaccination and testing. FINDINGS Both vaccines were highly effective over the study duration (VEmRNA-1273: 84.1%, 95% confidence interval [CI]: 81.6%-86.2%; VEBNT162b2: 75.6%, 95% CI: 72.2%-78.7%), but their effectiveness was reduced during July-September (VEmRNA-1273: 75.6%, 95% CI: 70.1%-80%; VEBNT162b2: 63.5%, 95% CI: 55.8%-69.9%) as compared to December-May (VEmRNA-1273: 93.7%, 95% CI: 90.4%-95.9%; VEBNT162b2: 85.7%, 95% CI: 81.4%-88.9%). Adjusted for demographic characteristics, clinical comorbidities, time of vaccination, and time of testing, the odds of experiencing a symptomatic breakthrough infection were lower after full vaccination with mRNA-1273 than with BNT162b2 (odds ratio: 0.60; 95% CI: 0.55-0.67). CONCLUSIONS Both mRNA-1273 and BNT162b2 strongly protect against symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. It is imperative to continue monitoring and comparing available vaccines over time and with respect to emerging variants to inform public and global health decisions. FUNDING This study was funded by nference.
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Affiliation(s)
| | | | | | | | | | - John C O'Horo
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55902, USA
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - Abinash Virk
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55902, USA
| | - Melanie D Swift
- Division of Aerospace, Occupational and Preventive Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - Joel E Gordon
- Department of Family Medicine, Mayo Clinic Health System, Mankato, MN 56001, USA
| | | | - Holly L Geyer
- Division of Hospital Internal Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Walter Kremers
- Division of Biomedical Statistics, Mayo Clinic, Rochester, MN 55902, USA
| | - John Halamka
- Mayo Clinic Platform, Mayo Clinic, Rochester, MN 55902, USA
| | - Andrew D Badley
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55902, USA
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN 55902, USA
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12
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Romero-Brufau S, Chopra A, Ryu AJ, Gel E, Raskar R, Kremers W, Anderson KS, Subramanian J, Krishnamurthy B, Singh A, Pasupathy K, Dong Y, O'Horo JC, Wilson WR, Mitchell O, Kingsley TC. Public health impact of delaying second dose of BNT162b2 or mRNA-1273 covid-19 vaccine: simulation agent based modeling study. BMJ 2021; 373:n1087. [PMID: 33980718 PMCID: PMC8114182 DOI: 10.1136/bmj.n1087] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To estimate population health outcomes with delayed second dose versus standard schedule of SARS-CoV-2 mRNA vaccination. DESIGN Simulation agent based modeling study. SETTING Simulated population based on real world US county. PARTICIPANTS The simulation included 100 000 agents, with a representative distribution of demographics and occupations. Networks of contacts were established to simulate potentially infectious interactions though occupation, household, and random interactions. INTERVENTIONS Simulation of standard covid-19 vaccination versus delayed second dose vaccination prioritizing the first dose. The simulation runs were replicated 10 times. Sensitivity analyses included first dose vaccine efficacy of 50%, 60%, 70%, 80%, and 90% after day 12 post-vaccination; vaccination rate of 0.1%, 0.3%, and 1% of population per day; assuming the vaccine prevents only symptoms but not asymptomatic spread (that is, non-sterilizing vaccine); and an alternative vaccination strategy that implements delayed second dose for people under 65 years of age, but not until all those above this age have been vaccinated. MAIN OUTCOME MEASURES Cumulative covid-19 mortality, cumulative SARS-CoV-2 infections, and cumulative hospital admissions due to covid-19 over 180 days. RESULTS Over all simulation replications, the median cumulative mortality per 100 000 for standard dosing versus delayed second dose was 226 v 179, 233 v 207, and 235 v 236 for 90%, 80%, and 70% first dose efficacy, respectively. The delayed second dose strategy was optimal for vaccine efficacies at or above 80% and vaccination rates at or below 0.3% of the population per day, under both sterilizing and non-sterilizing vaccine assumptions, resulting in absolute cumulative mortality reductions between 26 and 47 per 100 000. The delayed second dose strategy for people under 65 performed consistently well under all vaccination rates tested. CONCLUSIONS A delayed second dose vaccination strategy, at least for people aged under 65, could result in reduced cumulative mortality under certain conditions.
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Affiliation(s)
- Santiago Romero-Brufau
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Ayush Chopra
- MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Alex J Ryu
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Esma Gel
- School of Life Sciences, Arizona State University, Phoenix, AZ, USA
| | - Ramesh Raskar
- MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Walter Kremers
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Karen S Anderson
- School of Life Sciences, Arizona State University, Phoenix, AZ, USA
| | | | | | - Abhishek Singh
- MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Kalyan Pasupathy
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Yue Dong
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - John C O'Horo
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Oscar Mitchell
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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13
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Alnsasra H, Asleh R, Kumar N, Toya T, Lopez C, Kremers W, Edwards B, Daly R, Kushwaha S. INCIDENCE, PREDICTORS AND OUTCOMES OF STROKE FOLLOWING CARDIAC TRANSPLANTATION. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02005-2] [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: 11/30/2022]
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14
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Merzkani MA, Mullan A, Denic A, D'Costa M, Iverson R, Kremers W, Alexander MP, Textor SC, Taler SJ, Stegall MD, Augustine J, Issa N, Rule AD. Renal function outcomes and kidney biopsy features of living kidney donors with hypertension. Clin Transplant 2021; 35:e14293. [PMID: 33745214 DOI: 10.1111/ctr.14293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND The medium- to long-term outcomes of living kidney donors with hypertension compared to normotensive donors are not well understood, especially with the recent changes in hypertension guidelines. METHODS We studied a cohort of 950 living kidney donors using different definitions of hypertension based on either ≥140/90 or ≥130/80 mmHg thresholds and based on either office or ambulatory blood pressure readings. Microstructural features on kidney biopsy at the time of donation were compared using different definitions of hypertension. RESULTS After adjusting for years of follow-up, age, sex, and baseline eGFR, hypertension (by any definition) did not significantly predict an eGFR < 45 ml/min/1.73 m2 at a median follow-up of 10 years postdonation, though there was a borderline association with ambulatory blood pressure ≥ 130/80 mmHg predicting a 40% decline in eGFR (OR = 1.53, 1.00-2.36; p = .051). Proteinuria was predicted by office blood pressure ≥ 140/90 mmHg and by nondipper profile on nocturnal ambulatory blood pressure measurements. At the time of donation, larger glomeruli and arterial hyalinosis on biopsy were associated with hypertension defined by either ≥140/90 or ≥130/80 mmHg (by office or ambulatory measurements). Nocturnal nondipper status was associated with larger glomeruli size but not arteriolar hyalinosis when compared to dippers. CONCLUSIONS In programs that accept donors with controlled hypertension, various definitions of hypertension are associated with histological findings in the donated kidney, but none predict a clinically significant decline in kidney function 10 years after donation. These data support allowing healthy individuals with controlled hypertension to donate a kidney. However, donors with office hypertension (≥140/90 mmHg) and nondippers (regardless of hypertension status) are at greater long-term risk for proteinuria, and particularly for these donors, longer follow-up is warranted.
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Affiliation(s)
- Massini A Merzkani
- Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA.,William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA
| | - Aidan Mullan
- Division of Biomedical Statistics & Informatics, Mayo Clinic, Rochester, MN, USA
| | - Aleksandar Denic
- Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Matthew D'Costa
- Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA.,William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA
| | - Ryan Iverson
- Division of Biomedical Statistics & Informatics, Mayo Clinic, Rochester, MN, USA
| | - Walter Kremers
- Division of Biomedical Statistics & Informatics, Mayo Clinic, Rochester, MN, USA
| | | | - Stephen C Textor
- Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA.,William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA
| | - Sandra J Taler
- Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA.,William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA
| | - Mark D Stegall
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA
| | | | - Naim Issa
- Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA.,William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA
| | - Andrew D Rule
- Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA
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15
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Awasthi S, Wagner T, Venkatakrishnan AJ, Puranik A, Hurchik M, Agarwal V, Conrad I, Kirkup C, Arunachalam R, O'Horo J, Kremers W, Kashyap R, Morice W, Halamka J, Williams AW, Faubion WA, Badley AD, Gores GJ, Soundararajan V. Plasma IL-6 levels following corticosteroid therapy as an indicator of ICU length of stay in critically ill COVID-19 patients. Cell Death Discov 2021; 7:55. [PMID: 33723251 PMCID: PMC7958587 DOI: 10.1038/s41420-021-00429-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 09/27/2020] [Revised: 11/14/2020] [Accepted: 12/04/2020] [Indexed: 12/13/2022] Open
Abstract
Intensive care unit (ICU) admissions and mortality in severe COVID-19 patients are driven by "cytokine storms" and acute respiratory distress syndrome (ARDS). Interim clinical trial results suggest that the corticosteroid dexamethasone displays better 28-day survival in severe COVID-19 patients requiring ventilation or oxygen. In this study, 10 out of 16 patients (62.5%) that had an average plasma IL-6 value over 10 pg/mL post administration of corticosteroids also had worse outcomes (i.e., ICU stay >15 days or death), compared to 8 out of 41 patients (19.5%) who did not receive corticosteroids (p-value = 0.0024). Given this potential association between post-corticosteroid IL-6 levels and COVID-19 severity, we hypothesized that the glucocorticoid receptor (GR or NR3C1) may be coupled to IL-6 expression in specific cell types that govern cytokine release syndrome (CRS). Examining single-cell RNA-seq data from BALF of severe COVID-19 patients and nearly 2 million cells from a pan-tissue scan shows that alveolar macrophages, smooth muscle cells, and endothelial cells co-express NR3C1 and IL-6, motivating future studies on the links between the regulation of NR3C1 function and IL-6 levels.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - William Morice
- Mayo Clinic, Rochester, MN, 55905, USA
- Mayo Clinic Laboratories, Rochester, MN, 55905, USA
| | - John Halamka
- Mayo Clinic, Rochester, MN, 55905, USA
- Mayo Clinic Platform, Rochester, MN, 55905, USA
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16
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Christopoulos G, Graff-Radford J, Lopez CL, Yao X, Attia ZI, Rabinstein AA, Petersen RC, Knopman DS, Mielke MM, Kremers W, Vemuri P, Siontis KC, Friedman PA, Noseworthy PA. Artificial Intelligence-Electrocardiography to Predict Incident Atrial Fibrillation: A Population-Based Study. Circ Arrhythm Electrophysiol 2020; 13:e009355. [PMID: 33185118 DOI: 10.1161/circep.120.009355] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND An artificial intelligence (AI) algorithm applied to electrocardiography during sinus rhythm has recently been shown to detect concurrent episodic atrial fibrillation (AF). We sought to characterize the value of AI-enabled electrocardiography (AI-ECG) as a predictor of future AF and assess its performance compared with the CHARGE-AF score (Cohorts for Aging and Research in Genomic Epidemiology-AF) in a population-based sample. METHODS We calculated the probability of AF using AI-ECG, among participants in the population-based Mayo Clinic Study of Aging who had no history of AF at the time of the baseline study visit. Cox proportional hazards models were fit to assess the independent prognostic value and interaction between AI-ECG AF model output and CHARGE-AF score. C statistics were calculated for AI-ECG AF model output, CHARGE-AF score, and combined AI-ECG and CHARGE-AF score. RESULTS A total of 1936 participants with median age 75.8 (interquartile range, 70.4-81.8) years and median CHARGE-AF score 14.0 (IQR, 13.2-14.7) were included in the analysis. Participants with AI-ECG AF model output of >0.5 at the baseline visit had cumulative incidence of AF 21.5% at 2 years and 52.2% at 10 years. When included in the same model, both AI-ECG AF model output (hazard ratio, 1.76 per SD after logit transformation [95% CI, 1.51-2.04]) and CHARGE-AF score (hazard ratio, 1.90 per SD [95% CI, 1.58-2.28]) independently predicted future AF without significant interaction (P=0.54). C statistics were 0.69 (95% CI, 0.66-0.72) for AI-ECG AF model output, 0.69 (95% CI, 0.66-0.71) for CHARGE-AF, and 0.72 (95% CI, 0.69-0.75) for combined AI-ECG and CHARGE-AF score. CONCLUSIONS In the present study, both the AI-ECG AF model output and CHARGE-AF score independently predicted incident AF. The AI-ECG may offer a means to assess risk with a single test and without requiring manual or automated clinical data abstraction.
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Affiliation(s)
- Georgios Christopoulos
- Department of Cardiovascular Medicine (G.C., X.Y., Z.I.A., K.C.S., P.A.F., P.A.N.), Mayo Clinic, Rochester, MN
| | - Jonathan Graff-Radford
- Department of Neurology (J.G.-R., A.A.R., R.C.P., D.S.K., M.M.M., W.K., P.V.), Mayo Clinic, Rochester, MN
| | - Camden L Lopez
- Department of Health Sciences Research (C.L.L., X.Y., R.C.P., M.M.M., W.K.), Mayo Clinic, Rochester, MN
| | - Xiaoxi Yao
- Department of Cardiovascular Medicine (G.C., X.Y., Z.I.A., K.C.S., P.A.F., P.A.N.), Mayo Clinic, Rochester, MN
- Department of Health Sciences Research (C.L.L., X.Y., R.C.P., M.M.M., W.K.), Mayo Clinic, Rochester, MN
- Robert D. & Patricia E. Kern Center for the Science of Health Care Delivery (X.Y.), Mayo Clinic, Rochester, MN
| | - Zachi I Attia
- Department of Cardiovascular Medicine (G.C., X.Y., Z.I.A., K.C.S., P.A.F., P.A.N.), Mayo Clinic, Rochester, MN
| | - Alejandro A Rabinstein
- Department of Neurology (J.G.-R., A.A.R., R.C.P., D.S.K., M.M.M., W.K., P.V.), Mayo Clinic, Rochester, MN
| | - Ronald C Petersen
- Department of Neurology (J.G.-R., A.A.R., R.C.P., D.S.K., M.M.M., W.K., P.V.), Mayo Clinic, Rochester, MN
- Department of Health Sciences Research (C.L.L., X.Y., R.C.P., M.M.M., W.K.), Mayo Clinic, Rochester, MN
| | - David S Knopman
- Department of Neurology (J.G.-R., A.A.R., R.C.P., D.S.K., M.M.M., W.K., P.V.), Mayo Clinic, Rochester, MN
| | - Michelle M Mielke
- Department of Neurology (J.G.-R., A.A.R., R.C.P., D.S.K., M.M.M., W.K., P.V.), Mayo Clinic, Rochester, MN
- Department of Health Sciences Research (C.L.L., X.Y., R.C.P., M.M.M., W.K.), Mayo Clinic, Rochester, MN
| | - Walter Kremers
- Department of Neurology (J.G.-R., A.A.R., R.C.P., D.S.K., M.M.M., W.K., P.V.), Mayo Clinic, Rochester, MN
- Department of Health Sciences Research (C.L.L., X.Y., R.C.P., M.M.M., W.K.), Mayo Clinic, Rochester, MN
| | - Prashanthi Vemuri
- Department of Neurology (J.G.-R., A.A.R., R.C.P., D.S.K., M.M.M., W.K., P.V.), Mayo Clinic, Rochester, MN
| | - Konstantinos C Siontis
- Department of Cardiovascular Medicine (G.C., X.Y., Z.I.A., K.C.S., P.A.F., P.A.N.), Mayo Clinic, Rochester, MN
| | - Paul A Friedman
- Department of Cardiovascular Medicine (G.C., X.Y., Z.I.A., K.C.S., P.A.F., P.A.N.), Mayo Clinic, Rochester, MN
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine (G.C., X.Y., Z.I.A., K.C.S., P.A.F., P.A.N.), Mayo Clinic, Rochester, MN
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17
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Anand S, Young P, Alnsasra H, Shrivastava S, Asleh R, Murphy K, Smith B, Kremers W, Kushwaha S, Clavell A, Steidley D, Pereira N, Lemond L. Utilization of cardiac MRI for the assessment of suspected rejection with negative biopsy in heart transplant recipients. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1114] [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: 11/13/2022] Open
Abstract
Abstract
Background
Heart transplant (HTx) patients can develop graft dysfunction (GD) without biopsy evidence of cell or antibody mediated rejection. Cardiac MRI (CMR) can detect inflammatory or infiltrative causes of cardiomyopathy however CMR findings in HTx recipients with GD have not been previously described.
Purpose
We sought to identify CMR characteristics of HTx patients with GD, and evaluate its additive value in its diagnosis and prognosis.
Methods
CMR has been performed routinely to evaluate GD at our institutions. There were 37 HTx recipients who presented with acute decline in left ventricular ejection fraction (LVEF) of <50% and >10% from baseline, with no biopsy evidence of rejection between 2007 and 2018. Coronary angiogram with IVUS was done to rule out allograft vasculopathy. Treatment of GD was per discretion of the treating clinician. Responders were defined as those with LVEF improvement >10% at 180 days or greater post-presentation. LV and RV indices, the presence and pattern of late gadolinium enhancement (LGE) were determined by CMR.
Results
There were 34% females and mean age at transplant was 49±13 years. Median time from HTx to GD was 1.2 years. Presenting symptoms were heart failure (n=25), cardiogenic shock (n=1) and 11 patients were asymptomatic. Mean LVEF at presentation was 37±12% and donor specific antibodies were detected in 38% patients. Most patients were treated with steroid bolus (n=29), and/or plasmapheresis (n=23). There were no major changes made in immunosuppression in 6 patients. Delayed enhancement MRI was performed with standard inversion-recovery (IR) gradient echo sequences, between 5 and 20 minutes after institutional-standard protocol administration of IV gadolinium contrast. Biventricular LGE was present in 18/37 (49%) patients with GD and was more prevalent in responders (57%, 13 of 23) than non-responders (35%, 5 of 14), although not statistically significant (p=0.21). There were two patterns of LGE noted: 1) Diffuse epicardial (10 patients out which 9 were responders) and 2) Patchy pattern with non-specific distribution (8 patients out of which 4 were responders). Myocardial edema by triple IR sequencing was seen in 6 patients, all having diffuse epicardial pattern of enhancement matching the delayed enhancement pattern. When comparing different treatment groups, among those treated for GD (n=31), 12 of 21 (57%) responders had LGE and 4 of 10 (40%) non-responders had LGE (p=0.37), a pattern similar to the broader population. Among those not treated for GD (n=6), 1 of 2 responders had LGE and 1 of 4 non-responders had LGE (p=0.5).
Conclusion
CMR identified inflammation as a potential cause of GD in approximately 50% of HTx patients. There are 2 distinct patterns of LGE observed in GD, diffuse epicardial (56%) and patchy (44%). Although the presence of LGE in itself is not associated with myocardial recovery, 90% of patients with a diffuse epicardial pattern have recovery of GD.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Anand
- Mayo Clinic Arizona, Scottsdale, United States of America
| | - P Young
- Mayo Clinic, Rochester, United States of America
| | - H Alnsasra
- Mayo Clinic, Rochester, United States of America
| | | | - R Asleh
- Mayo Clinic, Rochester, United States of America
| | - K Murphy
- Mayo Clinic Arizona, Scottsdale, United States of America
| | - B Smith
- Mayo Clinic, Rochester, United States of America
| | - W Kremers
- Mayo Clinic, Rochester, United States of America
| | - S Kushwaha
- Mayo Clinic, Rochester, United States of America
| | - A Clavell
- Mayo Clinic, Rochester, United States of America
| | - D.E Steidley
- Mayo Clinic Arizona, Scottsdale, United States of America
| | - N Pereira
- Mayo Clinic, Rochester, United States of America
| | - L.M Lemond
- Mayo Clinic Arizona, Scottsdale, United States of America
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Gentry MT, Lapid MI, Syrjanen J, Calvert K, Hughes S, Brushaber D, Kremers W, Bove J, Brannelly P, Coppola G, Dheel C, Dickerson B, Dickinson S, Faber K, Fields J, Fong J, Foroud T, Forsberg L, Gavrilova R, Gearhart D, Ghoshal N, Goldman J, Graff-Radford J, Graff-Radford N, Grossman M, Haley D, Heuer H, Hsiung GY, Huey E, Irwin D, Jones D, Jones L, Kantarci K, Karydas A, Knopman D, Kornak J, Kramer J, Kukull W, Lucente D, Lungu C, Mackenzie I, Manoochehri M, McGinnis S, Miller B, Pearlman R, Petrucelli L, Potter M, Rademakers R, Ramos EM, Rankin K, Rascovsky K, Sengdy P, Shaw L, Tatton N, Taylor J, Toga A, Trojanowski J, Weintraub S, Wong B, Wszolek Z, Boeve BF, Boxer A, Rosen H. Quality of life and caregiver burden in familial frontotemporal lobar degeneration: Analyses of symptomatic and asymptomatic individuals within the LEFFTDS cohort. Alzheimers Dement 2020; 16:1115-1124. [PMID: 32656921 PMCID: PMC7534513 DOI: 10.1002/alz.12095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects evaluates familial frontotemporal lobar degeneration (FTLD) kindreds with MAPT, GRN, or C9orf72 mutations. Objectives were to examine whether health-related quality of life (HRQoL) correlates with clinical symptoms and caregiver burden, and whether self-rated and informant-rated HRQoL would correlate with each other. METHODS Individuals were classified using the Clinical Dementia Rating (CDR® ) Scale plus National Alzheimer's Coordinating Center (NACC) FTLD. HRQoL was measured with DEMQOL and DEMQOL-proxy; caregiver burden with the Zarit Burden Interview (ZBI). For analysis, Pearson correlations and weighted kappa statistics were calculated. RESULTS The cohort of 312 individuals included symptomatic and asymptomatic individuals. CDR® plus NACC FTLD was negatively correlated with DEMQOL (r = -0.20, P = .001), as were ZBI and DEMQOL (r = -0.22, P = .0009). There was fair agreement between subject and informant DEMQOL (κ = 0.36, P <.0001). CONCLUSION Lower HRQoL was associated with higher cognitive/behavior impairment and higher caregiver burden. These findings demonstrate the negative impact of FTLD on individuals and caregivers.
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Affiliation(s)
| | | | | | | | | | | | | | - Jessica Bove
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Patrick Brannelly
- Tau Consortium, Rainwater Charitable Foundation, Fort Worth, Texas, USA
| | | | | | | | - Susan Dickinson
- Association for Frontotemporal Degeneration, Radnor, Pennsylvania, USA
| | - Kelley Faber
- National Cell Repository for Alzheimer's Disease (NCRAD), Indiana University, Indianapolis, Indiana, USA
| | | | | | - Tatiana Foroud
- National Cell Repository for Alzheimer's Disease (NCRAD), Indiana University, Indianapolis, Indiana, USA
| | | | | | | | | | | | | | | | | | | | | | - Ging-Yuek Hsiung
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Edward Huey
- Columbia University, New York, New York, USA
| | - David Irwin
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Lynne Jones
- Washington University, St. Louis, Missouri, USA
| | | | | | | | | | | | - Walter Kukull
- National Alzheimer's Coordinating Center (NACC), University of Washington, Seattle, Washington, USA
| | | | - Codrin Lungu
- National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, Maryland, USA
| | - Ian Mackenzie
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | - Madeline Potter
- National Cell Repository for Alzheimer's Disease (NCRAD), Indiana University, Indianapolis, Indiana, USA
| | | | | | | | | | - Pheth Sengdy
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Leslie Shaw
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nadine Tatton
- Association for Frontotemporal Degeneration, Radnor, Pennsylvania, USA
| | | | - Arthur Toga
- Laboratory of Neuroimaging (LONI), USC, Los Angeles, California, USA
| | | | | | - Bonnie Wong
- Harvard University/MGH, Boston, Massachusetts, USA
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Asleh R, Briasoulis A, Lerman A, Smith B, Lopez C, Pereira N, Edwards B, Stulak J, Kremers W, Clavell A, Daly R, Kushwaha S. LONG-TERM EFFECTS OF ASPIRIN ON CARDIAC ALLOGRAFT VASCULOPATHY PROGRESSION AND ADVERSE OUTCOMES AFTER HEART TRANSPLANTATION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31701-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Wey A, Salkowski N, Kremers W, Ahn YS, Snyder J. Piecewise exponential models with time‐varying effects: Estimating mortality after listing for solid organ transplant. Stat (Int Stat Inst) 2020. [DOI: 10.1002/sta4.264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Andrew Wey
- Scientific Registry of Transplant Recipients Hennepin Healthcare Research Institute Minneapolis MN USA
| | - Nicholas Salkowski
- Scientific Registry of Transplant Recipients Hennepin Healthcare Research Institute Minneapolis MN USA
| | - Walter Kremers
- Division of Biomedical Statistics and Informatics Mayo Clinic Rochester MN USA
| | - Yoon Son Ahn
- Scientific Registry of Transplant Recipients Hennepin Healthcare Research Institute Minneapolis MN USA
| | - Jon Snyder
- Scientific Registry of Transplant Recipients Hennepin Healthcare Research Institute Minneapolis MN USA
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21
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Olney NT, Ong E, Goh SYM, Bajorek L, Dever R, Staffaroni AM, Cobigo Y, Bock M, Chiang K, Ljubenkov P, Kornak J, Heuer HW, Wang P, Rascovsky K, Wolf A, Appleby B, Bove J, Bordelon Y, Brannelly P, Brushaber D, Caso C, Coppola G, Dickerson BC, Dickinson S, Domoto-Reilly K, Faber K, Ferrall J, Fields J, Fishman A, Fong J, Foroud T, Forsberg LK, Gearhart DJ, Ghazanfari B, Ghoshal N, Goldman J, Graff-Radford J, Graff-Radford NR, Grant I, Grossman M, Haley D, Hsiung G, Huey ED, Irwin DJ, Jones DT, Kantarci K, Karydas AM, Kaufer D, Kerwin D, Knopman DS, Kramer JH, Kraft R, Kremers W, Kukull W, Lapid MI, Litvan I, Mackenzie IR, Maldonado M, Manoochehri M, McGinnis SM, McKinley EC, Mendez MF, Miller BL, Onyike C, Pantelyat A, Pearlman R, Petrucelli L, Potter M, Rademakers R, Ramos EM, Rankin KP, Roberson ED, Rogalski E, Sengdy P, Shaw LM, Syrjanen J, Tartaglia MC, Tatton N, Taylor J, Toga A, Trojanowski JQ, Weintraub S, Wong B, Wszolek Z, Boxer AL, Boeve BF, Rosen HJ. Clinical and volumetric changes with increasing functional impairment in familial frontotemporal lobar degeneration. Alzheimers Dement 2020; 16:49-59. [PMID: 31784375 PMCID: PMC6988137 DOI: 10.1016/j.jalz.2019.08.196] [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] [Indexed: 11/24/2022]
Abstract
Introduction: The Advancing Research and Treatment in Frontotemporal Lobar Degeneration and Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects longitudinal studies were designed to describe the natural history of familial-frontotemporal lobar degeneration due to autosomal dominant mutations. Methods: We examined cognitive performance, behavioral ratings, and brain volumes from the first time point in 320 MAPT, GRN, and C9orf72 family members, including 102 non–mutation carriers, 103 asymptomatic carriers, 43 mildly/questionably symptomatic carriers, and 72 carriers with dementia. Results: Asymptomatic carriers showed similar scores on all clinical measures compared with noncarriers but reduced frontal and temporal volumes. Those with mild/questionable impairment showed decreased verbal recall, fluency, and Trail Making Test performance and impaired mood and self-monitoring. Dementia was associated with impairment in all measures. All MAPT carriers with dementia showed temporal atrophy, but otherwise, there was no single cognitive test or brain region that was abnormal in all subjects. Discussion: Imaging changes appear to precede clinical changes in familial-frontotemporal lobar degeneration, but specific early clinical and imaging changes vary across individuals.
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Affiliation(s)
- Nicholas T. Olney
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Elise Ong
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Sheng-Yang M. Goh
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Lynn Bajorek
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Reilly Dever
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Adam M. Staffaroni
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Yann Cobigo
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Meredith Bock
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Kevin Chiang
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Peter Ljubenkov
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - John Kornak
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Hilary W. Heuer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Ping Wang
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Katya Rascovsky
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amelia Wolf
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Brian Appleby
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
| | - Jessica Bove
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yvette Bordelon
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Patrick Brannelly
- Tau Consortium, Rainwater Charitable Foundation, Fort Worth, TX, USA
| | | | - Christine Caso
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Giovanni Coppola
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Bradford C. Dickerson
- Department of Neurology, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Susan Dickinson
- Association for Frontotemporal Degeneration, Radnor, PA, USA
| | | | - Kelly Faber
- National Centralized Repository for Alzheimer’s Disease and Related Disorders (NCRAD), Indiana University, Indianapolis, IN, USA
| | - Jessica Ferrall
- Department of Neurology, University of North Carolina, Chapel Hill, NC, USA
| | - Julie Fields
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Ann Fishman
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jamie Fong
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Tatiana Foroud
- National Centralized Repository for Alzheimer’s Disease and Related Disorders (NCRAD), Indiana University, Indianapolis, IN, USA
| | | | | | - Behnaz Ghazanfari
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nupur Ghoshal
- Department of Psychiatry, Washington University, St. Louis, MO, USA
- Department of Neurology, Washington University, St. Louis, MO, USA
| | - Jill Goldman
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, USA
- Department of Neurology, Columbia University, New York, NY, USA
| | | | | | - Ian Grant
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Murray Grossman
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dana Haley
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Gingyuek Hsiung
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edward D. Huey
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, USA
- Department of Neurology, Columbia University, New York, NY, USA
| | - David J. Irwin
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David T. Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Kejal Kantarci
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Anna M. Karydas
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel Kaufer
- Department of Neurology, University of North Carolina, Chapel Hill, NC, USA
| | - Diana Kerwin
- Department of Neurology and Neurotherapeutics, Center for Alzheimer’s and Neurodegenerative Diseases, The University of Texas, Southwestern Medical Center at Dallas, Dallas, TX, USA
- Department of Internal Medicine, The University of Texas, Southwestern Medical Center at Dallas, Dallas, TX, USA
| | | | - Joel H. Kramer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Ruth Kraft
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Walter Kremers
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Walter Kukull
- National Alzheimer Coordinating Center (NACC), University of Washington, Seattle, WA, USA
| | - Maria I. Lapid
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Irene Litvan
- Department of Neurosciences, Parkinson and Other Movement Disorders Center, University of California, San Diego, San Diego, CA, USA
| | - Ian R. Mackenzie
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Miranda Maldonado
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Masood Manoochehri
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, USA
- Department of Neurology, Columbia University, New York, NY, USA
| | - Scott M. McGinnis
- Department of Neurology, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Emily C. McKinley
- Department of Neurology, Alzheimer’s Disease Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mario F. Mendez
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Bruce L. Miller
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Chiadi Onyike
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Alex Pantelyat
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Len Petrucelli
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Madeleine Potter
- National Centralized Repository for Alzheimer’s Disease and Related Disorders (NCRAD), Indiana University, Indianapolis, IN, USA
| | | | - Eliana M. Ramos
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Katherine P. Rankin
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Erik D. Roberson
- Department of Neurology, Alzheimer’s Disease Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Emily Rogalski
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Pheth Sengdy
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leslie M. Shaw
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeremy Syrjanen
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - M. Carmela Tartaglia
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Nadine Tatton
- Association for Frontotemporal Degeneration, Radnor, PA, USA
| | - Joanne Taylor
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Arthur Toga
- Laboratory of Neuroimaging (LONI), University of Southern California, Los Angeles, CA, USA
| | - John Q. Trojanowski
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sandra Weintraub
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Bonnie Wong
- Department of Neurology, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | | | - Adam L. Boxer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Brad F. Boeve
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Howard J. Rosen
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
- Corresponding author. Tel.: 1 415 476 5567; Fax: 1 415 476 1816.,
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22
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Miyagawa T, Brushaber D, Syrjanen J, Kremers W, Fields J, Forsberg LK, Heuer HW, Knopman D, Kornak J, Boxer A, Rosen HJ, Boeve BF, Appleby B, Caso C, Bordelon Y, Coppola G, Bove J, Dever R, Brannelly P, Dheel C, Dickerson B, Dickinson S, Dominguez S, Domoto-Reilly K, Faber K, Ferrell J, Fishman A, Fong J, Foroud T, Gavrilova R, Gearhart D, Ghazanfari B, Ghoshal N, Goldman JS, Graff-Radford J, Graff-Radford N, Grant I, Grossman M, Haley D, Hsiung R, Huey E, Irwin D, Jones D, Jones L, Kantarci K, Karydas A, Kaufer D, Kerwin D, Kraft R, Kramer J, Kukull W, Litvan I, Lucente D, Lungu C, Mackenzie I, Maldonado M, Manoochehri M, McGinnis S, McKinley E, Mendez MF, Miller B, Multani N, Onyike C, Padmanabhan J, Pantelyat A, Pearlman R, Petrucelli L, Potter M, Rademakers R, Ramos EM, Rankin K, Rascovsky K, Roberson ED, Rogalski E, Sengdy P, Shaw L, Tartaglia MC, Tatton N, Taylor J, Toga A, Trojanowski JQ, Wang P, Weintraub S, Wong B, Wszolek Z. Utility of the global CDR ® plus NACC FTLD rating and development of scoring rules: Data from the ARTFL/LEFFTDS Consortium. Alzheimers Dement 2020; 16:106-117. [PMID: 31914218 PMCID: PMC7202045 DOI: 10.1002/alz.12033] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/20/2019] [Accepted: 12/03/2019] [Indexed: 11/10/2022]
Abstract
INTRODUCTION We created global rating scoring rules for the CDR® plus NACC FTLD to detect and track early frontotemporal lobar degeneration (FTLD) and to conduct clinical trials in FTLD. METHODS The CDR plus NACC FTLD rating was applied to 970 sporadic and familial participants from the baseline visit of Advancing Research and Treatment in Frontotemporal Lobar Degeneration (ARTFL)/Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects (LEFFTDS). Each of the eight domains of the CDR plus NACC FTLD was equally weighed in determining the global score. An interrater reliability study was completed for 40 participants. RESULTS The CDR plus NACC FTLD showed very good interrater reliability. It was especially useful in detecting clinical features of mild non-fluent/agrammatic variant primary progressive aphasia participants. DISCUSSION The global CDR plus NACC FTLD score could be an attractive outcome measure for clinical trials in symptomatic FTLD, and may be useful in natural history studies and clinical trials in FTLD spectrum disorders.
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Affiliation(s)
| | | | | | | | | | | | - Hilary W. Heuer
- University of California San Francisco, San Francisco, California, USA
| | | | - John Kornak
- University of California San Francisco, San Francisco, California, USA
| | - Adam Boxer
- University of California San Francisco, San Francisco, California, USA
| | - Howard J. Rosen
- University of California San Francisco, San Francisco, California, USA
| | | | - Brian Appleby
- Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Yvette Bordelon
- University of California Los Angeles, Los Angeles, California, USA
| | - Giovanni Coppola
- University of California Los Angeles, Los Angeles, California, USA
| | - Jessica Bove
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Reilly Dever
- University of California San Francisco, San Francisco, California, USA
| | - Patrick Brannelly
- Tau Consortium, Rainwater Charitable Foundation, Fort Worth, Texas, USA
| | | | - Bradford Dickerson
- Harvard University/Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Susan Dickinson
- Association for Frontotemporal Degeneration, Radnor, Pennsylvania, USA
| | | | | | - Kelley Faber
- National Centralized Repository for Alzheimer’s Disease and Related Dementias (NCRAD), Indiana University, Indianapolis, Indiana, USA
| | - Jessica Ferrell
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ann Fishman
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Jamie Fong
- University of California San Francisco, San Francisco, California, USA
| | - Tatiana Foroud
- National Centralized Repository for Alzheimer’s Disease and Related Dementias (NCRAD), Indiana University, Indianapolis, Indiana, USA
| | | | | | | | | | | | | | | | - Ian Grant
- Northwestern University, Chicago, Illinois, USA
| | | | | | - Robin Hsiung
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Edward Huey
- Columbia University, New York, New York, USA
| | - David Irwin
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Lynne Jones
- Washington University, St. Louis, Missouri, USA
| | | | - Anna Karydas
- University of California San Francisco, San Francisco, California, USA
| | - Daniel Kaufer
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Diana Kerwin
- University of Texas Southwestern, Dallas, Texas, USA
| | | | - Joel Kramer
- University of California San Francisco, San Francisco, California, USA
| | - Walter Kukull
- National Alzheimer Coordinating Center (NACC)University of Washington, Seattle, Washington, USA
| | - Irene Litvan
- University of California San Diego, San Diego, California, USA
| | - Diane Lucente
- Harvard University/Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Codrin Lungu
- National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, Maryland, USA
| | - Ian Mackenzie
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Scott McGinnis
- Harvard University/Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Mario F. Mendez
- University of California Los Angeles, Los Angeles, California, USA
| | - Bruce Miller
- University of California San Francisco, San Francisco, California, USA
| | | | | | - Jaya Padmanabhan
- Harvard University/Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | | | - Madeline Potter
- National Centralized Repository for Alzheimer’s Disease and Related Dementias (NCRAD), Indiana University, Indianapolis, Indiana, USA
| | | | - Eliana M. Ramos
- University of California Los Angeles, Los Angeles, California, USA
| | - Kate Rankin
- University of California San Francisco, San Francisco, California, USA
| | | | | | | | - Pheth Sengdy
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Leslie Shaw
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maria C. Tartaglia
- National Centralized Repository for Alzheimer’s Disease and Related Dementias (NCRAD), Indiana University, Indianapolis, Indiana, USA
| | - Nadine Tatton
- Association for Frontotemporal Degeneration, Radnor, Pennsylvania, USA
| | - Joanne Taylor
- University of California San Francisco, San Francisco, California, USA
| | - Arthur Toga
- Laboratory of Neuroimaging (LONI), University of Southern California, Los Angeles, California, USA
| | | | - Ping Wang
- University of California San Francisco, San Francisco, California, USA
| | | | - Bonnie Wong
- Harvard University/Massachusetts General Hospital, Boston, Massachusetts, USA
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Ramos EM, Dokuru DR, Van Berlo V, Wojta K, Wang Q, Huang AY, Deverasetty S, Qin Y, van Blitterswijk M, Jackson J, Appleby B, Bordelon Y, Brannelly P, Brushaber DE, Dickerson B, Dickinson S, Domoto-Reilly K, Faber K, Fields J, Fong J, Foroud T, Forsberg LK, Gavrilova R, Ghoshal N, Goldman J, Graff-Radford J, Graff-Radford N, Grant I, Grossman M, Heuer HW, Hsiung GYR, Huey E, Irwin D, Kantarci K, Karydas A, Kaufer D, Kerwin D, Knopman D, Kornak J, Kramer JH, Kremers W, Kukull W, Litvan I, Ljubenkov P, Lungu C, Mackenzie I, Mendez MF, Miller BL, Onyike C, Pantelyat A, Pearlman R, Petrucelli L, Potter M, Rankin KP, Rascovsky K, Roberson ED, Rogalski E, Shaw L, Syrjanen J, Tartaglia MC, Tatton N, Taylor J, Toga A, Trojanowski JQ, Weintraub S, Wong B, Wszolek Z, Rademakers R, Boeve BF, Rosen HJ, Boxer AL, Coppola G. Genetic screening of a large series of North American sporadic and familial frontotemporal dementia cases. Alzheimers Dement 2020; 16:118-130. [PMID: 31914217 PMCID: PMC7199807 DOI: 10.1002/alz.12011] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 08/13/2019] [Accepted: 11/18/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The Advancing Research and Treatment for Frontotemporal Lobar Degeneration (ARTFL) and Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects (LEFFTDS) consortia are two closely connected studies, involving multiple North American centers that evaluate both sporadic and familial frontotemporal dementia (FTD) participants and study longitudinal changes. METHODS We screened the major dementia-associated genes in 302 sporadic and 390 familial (symptomatic or at-risk) participants enrolled in these studies. RESULTS Among the sporadic patients, 16 (5.3%) carried chromosome 9 open reading frame 72 (C9orf72), microtubule-associated protein tau (MAPT), and progranulin (GRN) pathogenic variants, whereas in the familial series we identified 207 carriers from 146 families. Of interest, one patient was found to carry a homozygous C9orf72 expansion, while another carried both a C9orf72 expansion and a GRN pathogenic variant. We also identified likely pathogenic variants in the TAR DNA binding protein (TARDBP), presenilin 1 (PSEN1), and valosin containing protein (VCP) genes, and a subset of variants of unknown significance in other rare FTD genes. DISCUSSION Our study reports the genetic characterization of a large FTD series and supports an unbiased sequencing screen, irrespective of clinical presentation or family history.
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Affiliation(s)
- Eliana Marisa Ramos
- Department of Psychiatry, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Deepika Reddy Dokuru
- Department of Psychiatry, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Victoria Van Berlo
- Department of Psychiatry, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Kevin Wojta
- Department of Psychiatry, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Qing Wang
- Department of Psychiatry, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Alden Y. Huang
- Department of Psychiatry, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Sandeep Deverasetty
- Department of Psychiatry, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Yue Qin
- Department of Psychiatry, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | | | | | | | - Yvette Bordelon
- University of California Los Angeles, Los Angeles, California
| | | | | | | | - Susan Dickinson
- Association for Frontotemporal Degeneration, Radnor, Pennsylvania
| | | | - Kelley Faber
- National Centralized Repository for Alzheimer’s Disease and Related Dementia (NCRAD), Indiana University, Indianapolis, Indiana
| | | | - Jamie Fong
- University of California, San Francisco, San Francisco, California
| | - Tatiana Foroud
- National Centralized Repository for Alzheimer’s Disease and Related Dementia (NCRAD), Indiana University, Indianapolis, Indiana
| | | | | | | | | | | | | | - Ian Grant
- Northwestern University, Chicago, Illinois
| | | | - Hilary W. Heuer
- University of California, San Francisco, San Francisco, California
| | | | | | - David Irwin
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Anna Karydas
- University of California, San Francisco, San Francisco, California
| | - Daniel Kaufer
- University of North Carolina, Chapel Hill, North Carolina
| | - Diana Kerwin
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - John Kornak
- University of California, San Francisco, San Francisco, California
| | - Joel H. Kramer
- University of California, San Francisco, San Francisco, California
| | | | - Walter Kukull
- National Alzheimer Coordinating Center (NACC), University of Washington, Seattle, Washington
| | - Irene Litvan
- University of California, San Diego, San Diego, California
| | - Peter Ljubenkov
- University of California, San Francisco, San Francisco, California
| | - Codrin Lungu
- National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, Maryland
| | - Ian Mackenzie
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Mario F. Mendez
- University of California Los Angeles, Los Angeles, California
| | - Bruce L. Miller
- University of California, San Francisco, San Francisco, California
| | | | | | | | | | - Madeline Potter
- National Centralized Repository for Alzheimer’s Disease and Related Dementia (NCRAD), Indiana University, Indianapolis, Indiana
| | | | | | | | | | - Leslie Shaw
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Nadine Tatton
- Association for Frontotemporal Degeneration, Radnor, Pennsylvania
| | - Joanne Taylor
- University of California, San Francisco, San Francisco, California
| | - Arthur Toga
- Laboratory of Neuroimaging (LONI), USC, Los Angeles, California
| | | | | | - Bonnie Wong
- Harvard University/MGH, Boston, Massachusetts
| | | | | | | | - Howard J. Rosen
- University of California, San Francisco, San Francisco, California
| | - Adam L. Boxer
- University of California, San Francisco, San Francisco, California
| | - Giovanni Coppola
- Department of Psychiatry, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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Miyagawa T, Brushaber D, Syrjanen J, Kremers W, Fields J, Forsberg LK, Heuer HW, Knopman D, Kornak J, Boxer A, Rosen H, Boeve B. Use of the CDR® plus NACC FTLD in mild FTLD: Data from the ARTFL/LEFFTDS consortium. Alzheimers Dement 2020; 16:79-90. [PMID: 31477517 PMCID: PMC6949373 DOI: 10.1016/j.jalz.2019.05.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Behavior/Comportment/Personality (BEHAV) and Language (LANG) domains were added to the Clinical Dementia Rating (CDR®) for improving evaluation of patients with frontotemporal lobar degeneration (FTLD) (CDR® plus NACC FTLD). METHODS We analyzed the CDR® plus NACC FTLD among participants from the baseline visit of the Advancing Research and Treatment for Frontotemporal Lobar Degeneration/Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects Consortium. RESULTS The CDR® plus NACC FTLD was able to detect early symptoms in the mildly impaired participants who were rated as CDR® sum of boxes (CDR®-SB) = 0. The CDR®-SB was not sensitive, particularly in participants with mild nonfluent/agrammatic primary progressive aphasia. Participants with familial and sporadic behavioral variant FTD exhibited similar CDR® plus NACC FTLD profiles except that language impairment was more frequent in participants with mild sporadic behavioral variant FTD. Adding the BEHAV and/or LANG domains to the CDR®-SB significantly enhanced discriminatory power in differentiating among the FTLD spectrum disorders. DISCUSSION The BEHAV and LANG domains enable the CDR® plus NACC FTLD to capture early symptomatology of FTLD.
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Boeve B, Bove J, Brannelly P, Brushaber D, Coppola G, Dever R, Dheel C, Dickerson B, Dickinson S, Faber K, Fields J, Fong J, Foroud T, Forsberg L, Gavrilova R, Gearhart D, Ghoshal N, Goldman J, Graff-Radford J, Graff-Radford N, Grossman M, Haley D, Heuer H, Hsiung GYR, Huey E, Irwin D, Jones D, Jones L, Kantarci K, Karydas A, Knopman D, Kornak J, Kraft R, Kramer J, Kremers W, Kukull W, Lapid M, Lucente D, Mackenzie I, Manoochehri M, McGinnis S, Miller B, Pearlman R, Petrucelli L, Potter M, Rademakers R, Ramos EM, Rankin K, Rascovsky K, Sengdy P, Shaw L, Syrjanen J, Tatton N, Taylor J, Toga A, Trojanowski J, Weintraub S, Wong B, Wszolek Z, Boxer A, Rosen H. The longitudinal evaluation of familial frontotemporal dementia subjects protocol: Framework and methodology. Alzheimers Dement 2020; 16:22-36. [PMID: 31636026 PMCID: PMC6949411 DOI: 10.1016/j.jalz.2019.06.4947] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION It is important to establish the natural history of familial frontotemporal lobar degeneration (f-FTLD) and provide clinical and biomarker data for planning these studies, particularly in the asymptomatic phase. METHODS The Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects protocol was designed to enroll and follow at least 300 subjects for more than at least three annual visits who are members of kindreds with a mutation in one of the three most common f-FTLD genes-microtubule-associated protein tau, progranulin, or chromosome 9 open reading frame 72. RESULTS We present the theoretical considerations of f-FTLD and the aims/objectives of this protocol. We also describe the design and methodology for evaluating and rating subjects, in which detailed clinical and neuropsychological assessments are performed, biofluid samples are collected, and magnetic resonance imaging scans are performed using a standard protocol. DISCUSSION These data and samples, which are available to interested investigators worldwide, will facilitate planning for upcoming disease-modifying therapeutic trials in f-FTLD.
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Affiliation(s)
| | - Jessica Bove
- University of Pennsylvania, Philadelphia, PA, USA
| | - Patrick Brannelly
- Tau Consortium, Rainwater Charitable Foundation, Fort Worth, TX, USA
| | | | | | | | | | | | - Susan Dickinson
- Association for Frontotemporal Degeneration, Radnor, PA, USA
| | - Kelley Faber
- National Cell Repository for Alzheimer's Disease and Related Dementias (NCRAD), Indiana University, Indianapolis, IN, USA
| | | | | | - Tatiana Foroud
- National Cell Repository for Alzheimer's Disease and Related Dementias (NCRAD), Indiana University, Indianapolis, IN, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - David Irwin
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | | | | | - Walter Kukull
- National Alzheimer Coordinating Center (NACC), University of Washington, Seattle, WA, USA
| | | | | | - Ian Mackenzie
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | - Madeline Potter
- National Cell Repository for Alzheimer's Disease and Related Dementias (NCRAD), Indiana University, Indianapolis, IN, USA
| | | | | | | | | | - Pheth Sengdy
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Les Shaw
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Nadine Tatton
- Association for Frontotemporal Degeneration, Radnor, PA, USA
| | | | - Arthur Toga
- Laboratory of Neuroimaging (LONI), USC, Los Angeles, CA, USA
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Graff-Radford J, Lesnick T, Rabinstein AA, Gunter J, Aakre J, Przybelski SA, Spychalla AJ, Huston J, Brown RD, Mielke MM, Lowe VJ, Knopman DS, Petersen RC, Jack CR, Vemuri P, Kremers W, Kantarci K. Cerebral microbleed incidence, relationship to amyloid burden: The Mayo Clinic Study of Aging. Neurology 2019; 94:e190-e199. [PMID: 31801832 DOI: 10.1212/wnl.0000000000008735] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 07/05/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the incidence of cerebral microbleeds (CMBs) and the association of amyloid PET burden with incident CMBs. METHODS A total of 651 participants, age ≥50 years (55% male), underwent 3T MRI scans with ≥2 separate T2*-weighted gradient recalled echo sequences from October 2011 to August 2017. Eighty-seven percent underwent 11C Pittsburgh compound B (PiB) PET scans. Age-specific CMB incidence rates were calculated by using the piecewise exponential model. Using structural equation models (SEMs), we assessed the effect of amyloid load and baseline CMBs on future CMBs after considering the direct and indirect age, sex, vascular risk factors, and APOE effects. RESULTS Participants' mean age (SD) was 69.8 (10.0) years at baseline MRI, and 111 participants (17%) had ≥1 baseline CMB. The mean (SD) of the time interval between scans was 2.7 (1.0) years. The overall population incidence rate for CMBs was 3.6/100 person-years and increased with age: from 1.5/100 new CMBs at age 50 to 11.6/100 person-years at age 90. Using the piecewise exponential model regression, the incidence rates increased with age and the presence of baseline CMBs. The SEMs showed that (1) increasing age at MRI or carrying an APOE4 allele was associated with more amyloid at baseline, and higher amyloid, particularly occipital amyloid load, in turn increased the risk of a new lobar CMB; and (2) the presence of CMBs at baseline increased the risk of a lobar CMB and had a larger effect size than amyloid load. CONCLUSIONS Age and APOE4 carrier status act through amyloid load to increase the risk of subsequent lobar CMBs, but the presence of baseline CMBs is the most important risk factor for future CMBs.
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Affiliation(s)
- Jonathan Graff-Radford
- From the Departments of Neurology (J.G.-R., A.A.R., R.D.B., M.M.M., D.S.K., R.C.P.), Health Sciences Research (T.L., J.G., J.A., S.A.P., M.M.M., W.K.), and Radiology (A.J.S., J.H., V.J.L., C.R.J., P.V., K.K.), Mayo Clinic, Rochester, MN.
| | - Timothy Lesnick
- From the Departments of Neurology (J.G.-R., A.A.R., R.D.B., M.M.M., D.S.K., R.C.P.), Health Sciences Research (T.L., J.G., J.A., S.A.P., M.M.M., W.K.), and Radiology (A.J.S., J.H., V.J.L., C.R.J., P.V., K.K.), Mayo Clinic, Rochester, MN
| | - Alejandro A Rabinstein
- From the Departments of Neurology (J.G.-R., A.A.R., R.D.B., M.M.M., D.S.K., R.C.P.), Health Sciences Research (T.L., J.G., J.A., S.A.P., M.M.M., W.K.), and Radiology (A.J.S., J.H., V.J.L., C.R.J., P.V., K.K.), Mayo Clinic, Rochester, MN
| | - Jeff Gunter
- From the Departments of Neurology (J.G.-R., A.A.R., R.D.B., M.M.M., D.S.K., R.C.P.), Health Sciences Research (T.L., J.G., J.A., S.A.P., M.M.M., W.K.), and Radiology (A.J.S., J.H., V.J.L., C.R.J., P.V., K.K.), Mayo Clinic, Rochester, MN
| | - Jeremiah Aakre
- From the Departments of Neurology (J.G.-R., A.A.R., R.D.B., M.M.M., D.S.K., R.C.P.), Health Sciences Research (T.L., J.G., J.A., S.A.P., M.M.M., W.K.), and Radiology (A.J.S., J.H., V.J.L., C.R.J., P.V., K.K.), Mayo Clinic, Rochester, MN
| | - Scott A Przybelski
- From the Departments of Neurology (J.G.-R., A.A.R., R.D.B., M.M.M., D.S.K., R.C.P.), Health Sciences Research (T.L., J.G., J.A., S.A.P., M.M.M., W.K.), and Radiology (A.J.S., J.H., V.J.L., C.R.J., P.V., K.K.), Mayo Clinic, Rochester, MN
| | - Anthony J Spychalla
- From the Departments of Neurology (J.G.-R., A.A.R., R.D.B., M.M.M., D.S.K., R.C.P.), Health Sciences Research (T.L., J.G., J.A., S.A.P., M.M.M., W.K.), and Radiology (A.J.S., J.H., V.J.L., C.R.J., P.V., K.K.), Mayo Clinic, Rochester, MN
| | - John Huston
- From the Departments of Neurology (J.G.-R., A.A.R., R.D.B., M.M.M., D.S.K., R.C.P.), Health Sciences Research (T.L., J.G., J.A., S.A.P., M.M.M., W.K.), and Radiology (A.J.S., J.H., V.J.L., C.R.J., P.V., K.K.), Mayo Clinic, Rochester, MN
| | - Robert D Brown
- From the Departments of Neurology (J.G.-R., A.A.R., R.D.B., M.M.M., D.S.K., R.C.P.), Health Sciences Research (T.L., J.G., J.A., S.A.P., M.M.M., W.K.), and Radiology (A.J.S., J.H., V.J.L., C.R.J., P.V., K.K.), Mayo Clinic, Rochester, MN
| | - Michelle M Mielke
- From the Departments of Neurology (J.G.-R., A.A.R., R.D.B., M.M.M., D.S.K., R.C.P.), Health Sciences Research (T.L., J.G., J.A., S.A.P., M.M.M., W.K.), and Radiology (A.J.S., J.H., V.J.L., C.R.J., P.V., K.K.), Mayo Clinic, Rochester, MN
| | - Val J Lowe
- From the Departments of Neurology (J.G.-R., A.A.R., R.D.B., M.M.M., D.S.K., R.C.P.), Health Sciences Research (T.L., J.G., J.A., S.A.P., M.M.M., W.K.), and Radiology (A.J.S., J.H., V.J.L., C.R.J., P.V., K.K.), Mayo Clinic, Rochester, MN
| | - David S Knopman
- From the Departments of Neurology (J.G.-R., A.A.R., R.D.B., M.M.M., D.S.K., R.C.P.), Health Sciences Research (T.L., J.G., J.A., S.A.P., M.M.M., W.K.), and Radiology (A.J.S., J.H., V.J.L., C.R.J., P.V., K.K.), Mayo Clinic, Rochester, MN
| | - Ronald C Petersen
- From the Departments of Neurology (J.G.-R., A.A.R., R.D.B., M.M.M., D.S.K., R.C.P.), Health Sciences Research (T.L., J.G., J.A., S.A.P., M.M.M., W.K.), and Radiology (A.J.S., J.H., V.J.L., C.R.J., P.V., K.K.), Mayo Clinic, Rochester, MN
| | - Clifford R Jack
- From the Departments of Neurology (J.G.-R., A.A.R., R.D.B., M.M.M., D.S.K., R.C.P.), Health Sciences Research (T.L., J.G., J.A., S.A.P., M.M.M., W.K.), and Radiology (A.J.S., J.H., V.J.L., C.R.J., P.V., K.K.), Mayo Clinic, Rochester, MN
| | - Prashanthi Vemuri
- From the Departments of Neurology (J.G.-R., A.A.R., R.D.B., M.M.M., D.S.K., R.C.P.), Health Sciences Research (T.L., J.G., J.A., S.A.P., M.M.M., W.K.), and Radiology (A.J.S., J.H., V.J.L., C.R.J., P.V., K.K.), Mayo Clinic, Rochester, MN
| | - Walter Kremers
- From the Departments of Neurology (J.G.-R., A.A.R., R.D.B., M.M.M., D.S.K., R.C.P.), Health Sciences Research (T.L., J.G., J.A., S.A.P., M.M.M., W.K.), and Radiology (A.J.S., J.H., V.J.L., C.R.J., P.V., K.K.), Mayo Clinic, Rochester, MN
| | - Kejal Kantarci
- From the Departments of Neurology (J.G.-R., A.A.R., R.D.B., M.M.M., D.S.K., R.C.P.), Health Sciences Research (T.L., J.G., J.A., S.A.P., M.M.M., W.K.), and Radiology (A.J.S., J.H., V.J.L., C.R.J., P.V., K.K.), Mayo Clinic, Rochester, MN
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Kornak J, Fields J, Kremers W, Farmer S, Heuer HW, Forsberg L, Brushaber D, Rindels A, Dodge H, Weintraub S, Besser L, Appleby B, Bordelon Y, Bove J, Brannelly P, Caso C, Coppola G, Dever R, Dheel C, Dickerson B, Dickinson S, Dominguez S, Domoto-Reilly K, Faber K, Ferrall J, Fishman A, Fong J, Foroud T, Gavrilova R, Gearhart D, Ghazanfari B, Ghoshal N, Goldman J, Graff-Radford J, Graff-Radford N, Grant IM, Grossman M, Haley D, Hsiao J, Hsiung R, Huey ED, Irwin D, Jones D, Jones L, Kantarci K, Karydas A, Kaufer D, Kerwin D, Knopman D, Kraft R, Kramer J, Kukull W, Lapid M, Litvan I, Ljubenkov P, Lucente D, Lungu C, Mackenzie I, Maldonado M, Manoochehri M, McGinnis S, McKinley E, Mendez M, Miller B, Multani N, Onyike C, Padmanabhan J, Pantelyat A, Pearlman R, Petrucelli L, Potter M, Rademakers R, Ramos EM, Rankin K, Rascovsky K, Roberson ED, Rogalski-Miller E, Sengdy P, Shaw L, Staffaroni AM, Sutherland M, Syrjanen J, Tartaglia C, Tatton N, Taylor J, Toga A, Trojanowski J, Wang P, Wong B, Wszolek Z, Boeve B, Boxer A, Rosen H. Nonlinear Z-score modeling for improved detection of cognitive abnormality. Alzheimers Dement (Amst) 2019; 11:797-808. [PMID: 31872042 PMCID: PMC6911910 DOI: 10.1016/j.dadm.2019.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Conventional Z-scores are generated by subtracting the mean and dividing by the standard deviation. More recent methods linearly correct for age, sex, and education, so that these "adjusted" Z-scores better represent whether an individual's cognitive performance is abnormal. Extreme negative Z-scores for individuals relative to this normative distribution are considered indicative of cognitive deficiency. METHODS In this article, we consider nonlinear shape constrained additive models accounting for age, sex, and education (correcting for nonlinearity). Additional shape constrained additive models account for varying standard deviation of the cognitive scores with age (correcting for heterogeneity of variance). RESULTS Corrected Z-scores based on nonlinear shape constrained additive models provide improved adjustment for age, sex, and education, as indicated by higher adjusted-R2. DISCUSSION Nonlinearly corrected Z-scores with respect to age, sex, and education with age-varying residual standard deviation allow for improved detection of non-normative extreme cognitive scores.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Hiroko Dodge
- Oregon Health and Science University, Portland, OR, USA
- University of Michigan, Ann Arbor, MI, USA
| | | | - Lilah Besser
- Florida Atlantic University, Boca Raton, FL, USA
| | | | - Yvette Bordelon
- Department of Psychiatry, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Jessica Bove
- University of Pennsylvania, Philadelphia, PA, USA
| | - Patrick Brannelly
- Tau Consortium, Rainwater Charitable Foundation, Fort Worth, TX, USA
| | | | - Giovanni Coppola
- Department of Psychiatry, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | | | | | | | - Susan Dickinson
- Association for Frontotemporal Degeneration, Radnor, PA, USA
| | | | | | - Kelley Faber
- National Cell Repository for Alzheimer's Disease (NCRAD), Indiana University, Indianapolis, IN, USA
| | | | - Ann Fishman
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Tatiana Foroud
- National Cell Repository for Alzheimer's Disease (NCRAD), Indiana University, Indianapolis, IN, USA
| | | | | | | | | | | | | | | | | | | | | | - John Hsiao
- National Institute on Aging (NIA), Bethesda, MD, USA
| | - Robin Hsiung
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - David Irwin
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | - Ruth Kraft
- Mayo Clinic Rochester, Rochester, MN, USA
| | | | - Walter Kukull
- National Alzheimer Coordinating Center (NACC), University of Washington, Seattle, WA, USA
| | | | | | | | | | - Codrin Lungu
- National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, MD, USA
| | - Ian Mackenzie
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Miranda Maldonado
- Department of Psychiatry, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | | | | | - Emily McKinley
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mario Mendez
- Department of Psychiatry, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | | | | | | | | | | | | | | | - Madeline Potter
- National Cell Repository for Alzheimer's Disease (NCRAD), Indiana University, Indianapolis, IN, USA
| | | | - Eliana Marisa Ramos
- Department of Psychiatry, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | | | | | | | | | - Pheth Sengdy
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Les Shaw
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Margaret Sutherland
- National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, MD, USA
| | | | | | - Nadine Tatton
- Association for Frontotemporal Degeneration, Radnor, PA, USA
| | | | - Arthur Toga
- Laboratory of Neuroimaging (LONI), USC, Los Angeles, CA, USA
| | | | | | | | | | - Brad Boeve
- Mayo Clinic Rochester, Rochester, MN, USA
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Chen Q, Boeve BF, Schwarz CG, Reid R, Tosakulwong N, Lesnick TG, Bove J, Brannelly P, Brushaber D, Coppola G, Dheel C, Dickerson BC, Dickinson S, Faber K, Fields J, Fong J, Foroud T, Forsberg L, Gavrilova RH, Gearhart D, Ghoshal N, Goldman J, Graff-Radford J, Graff-Radford NR, Grossman M, Haley D, Heuer HW, Hsiung GYR, Huey E, Irwin DJ, Jack CR, Jones DT, Jones L, Karydas AM, Knopman DS, Kornak J, Kramer J, Kremers W, Kukull WA, Lapid M, Lucente D, Lungu C, Mackenzie IRA, Manoochehri M, McGinnis S, Miller BL, Pearlman R, Petrucelli L, Potter M, Rademakers R, Ramos EM, Rankin KP, Rascovsky K, Sengdy P, Shaw L, Syrjanen J, Tatton N, Taylor J, Toga AW, Trojanowski J, Weintraub S, Wong B, Boxer AL, Rosen H, Wszolek Z, Kantarci K. Tracking white matter degeneration in asymptomatic and symptomatic MAPT mutation carriers. Neurobiol Aging 2019; 83:54-62. [PMID: 31585367 PMCID: PMC6858933 DOI: 10.1016/j.neurobiolaging.2019.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 08/07/2019] [Accepted: 08/11/2019] [Indexed: 02/05/2023]
Abstract
Our aim was to investigate the patterns and trajectories of white matter (WM) diffusion abnormalities in microtubule-associated protein tau (MAPT) mutations carriers. We studied 22 MAPT mutation carriers (12 asymptomatic, 10 symptomatic) and 20 noncarriers from 8 families, who underwent diffusion tensor imaging (DTI) and a subset (10 asymptomatic, 6 symptomatic MAPT mutation carriers, and 10 noncarriers) were followed annually (median = 4 years). Cross-sectional and longitudinal changes in mean diffusivity (MD) and fractional anisotropy were analyzed. Asymptomatic MAPT mutation carriers had higher MD in entorhinal WM, which propagated to the limbic tracts and frontotemporal projections in the symptomatic stage compared with noncarriers. Reduced fractional anisotropy and increased MD in the entorhinal WM were associated with the proximity to estimated and actual age of symptom onset. The annualized change of entorhinal MD on serial DTI was accelerated in MAPT mutation carriers compared with noncarriers. Entorhinal WM diffusion abnormalities precede the symptom onset and track with disease progression in MAPT mutation carriers. Our cross-sectional and longitudinal data showed a potential clinical utility for DTI to track neurodegenerative disease progression for MAPT mutation carriers in clinical trials.
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Affiliation(s)
- Qin Chen
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Robert Reid
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Timothy G Lesnick
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jessica Bove
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Patrick Brannelly
- Tau Consortium, Rainwater Charitable Foundation, Fort Worth, TX, USA
| | | | - Giovanni Coppola
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Bradford C Dickerson
- Department of Neurology, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Susan Dickinson
- Association for Frontotemporal Degeneration, Radnor, PA, USA
| | - Kelley Faber
- National Cell Repository for Alzheimer's Disease (NCRAD), Indiana University, Indianapolis, IN, USA
| | - Julie Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Jamie Fong
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Tatiana Foroud
- National Cell Repository for Alzheimer's Disease (NCRAD), Indiana University, Indianapolis, IN, USA
| | - Leah Forsberg
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Debra Gearhart
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Nupur Ghoshal
- Departments of Neurology and Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Jill Goldman
- Department of Neurology, Columbia University, New York, NY, USA
| | | | | | - Murray Grossman
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dana Haley
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Hilary W Heuer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Ging-Yuek R Hsiung
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edward Huey
- Department of Neurology, Columbia University, New York, NY, USA
| | - David J Irwin
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Lynne Jones
- Department of Radiology, Washington University School of Medicine, Washington University, St. Louis, MO, USA
| | - Anna M Karydas
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | | | - John Kornak
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Joel Kramer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Walter Kremers
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Walter A Kukull
- National Alzheimer Coordinating Center (NACC), University of Washington, Seattle, WA, USA
| | - Maria Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Diane Lucente
- Department of Neurology, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Codrin Lungu
- National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, MD, USA
| | - Ian R A Mackenzie
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Scott McGinnis
- Department of Neurology, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Bruce L Miller
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Madeline Potter
- National Cell Repository for Alzheimer's Disease (NCRAD), Indiana University, Indianapolis, IN, USA
| | - Rosa Rademakers
- Department of Neurosciences, Mayo Clinic, Jacksonville, FL, USA
| | - Eliana M Ramos
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Katherine P Rankin
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Katya Rascovsky
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Pheth Sengdy
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leslie Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeremy Syrjanen
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Nadine Tatton
- Association for Frontotemporal Degeneration, Radnor, PA, USA
| | - Joanne Taylor
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Arthur W Toga
- Departments of Ophthalmology, Neurology, Psychiatry and the Behavioral Sciences, Laboratory of Neuroimaging (LONI), USC, Los Angeles, CA, USA
| | - John Trojanowski
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sandra Weintraub
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Bonnie Wong
- Department of Neurology, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Adam L Boxer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Howie Rosen
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | | | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
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Stricker N, Lundt E, Christianson T, Machulda M, Kremers W, Fields J, Mielke M, Knopman D, Petersen R. Normative Data that Does Not Exclude Participants with Mild Cognitive Impairment Results in Lower Than Expected Memory Impairment Rates, Particularly in Females. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz035.16] [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: 11/13/2022] Open
Abstract
Abstract
Objective
Mayo’s Older Adult Normative Studies (MOANS) have served as an important resource for clinicians for three decades. Data collection was completed prior to the development and widespread use of Mild Cognitive Impairment (MCI) as a construct. Therefore, a portion of individuals included in the MOANS normative studies likely had undetected cognitive impairment.
Method
The Mayo Clinic Study of Aging (MCSA) is a population-based study of cognitive aging among Olmsted County, Minnesota, residents that began in October 2004. We applied age-adjusted MOANS norms (Ivnik et al., 1992) for the Auditory Verbal Learning Test (AVLT) long delay recall to cognitively unimpaired participants age 56 or older in the MCSA (N = 3,603). We used 1-sample tests of proportions comparing observed impairment rates to impairment rates expected based on a normal distribution of performance.
Results
Results showed that a significantly lower than expected number of participants demonstrated impaired delayed recall based on MOANS norms (all p’s < .001). Using a lenient cut-off (< -1 SD), only 7.3% of participants demonstrated impaired performance (vs. 15.9% expected), and this was more pronounced for females (3.5% impaired) relative to males (11.1% impaired). Further, only 0.6% of participants demonstrated impaired performance at a cut-off of < -2 SD, and no participants aged 80-91 reached this cut-off (2.3% expected).
Conclusions
Results suggest that the sensitivity of the original MOANS norms is lowered by likely inclusion of individuals with MCI, particularly in females. Updated normative data for the AVLT that exclude individuals with MCI and adjust for sex are needed.
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Burkhart HM, Qureshi MY, Rossano JW, Cantero Peral S, O'Leary PW, Hathcock M, Kremers W, Nelson TJ. Autologous stem cell therapy for hypoplastic left heart syndrome: Safety and feasibility of intraoperative intramyocardial injections. J Thorac Cardiovasc Surg 2019; 158:1614-1623. [PMID: 31345560 DOI: 10.1016/j.jtcvs.2019.06.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/30/2019] [Accepted: 06/01/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Staged surgical palliation for hypoplastic left heart syndrome results in an increased workload on the right ventricle serving as the systemic ventricle. Concerns for cardiac dysfunction and long-term heart failure have generated interest in first-in-infant, cell-based therapies as an additional surgical treatment modality. METHODS A phase 1 clinical trial was conducted to evaluate the safety and feasibility of direct intramyocardial injection of autologous umbilical cord blood-derived mononuclear cells in 10 infants with hypoplastic left heart syndrome at the time of stage II palliation. RESULTS All 10 patients underwent successful stage II palliation and intramyocardial injection of umbilical cord blood-derived mononuclear cells. Operative mortality was 0%. There was a single adverse event related to cell delivery: An injection site epicardial bleed that required simple oversew. The cohort did not demonstrate any significant safety concerns over 6 months. Additionally, the treatment group did not demonstrate any reduction in cardiac function in the context of the study related intramyocardial injections of autologous cells. CONCLUSIONS This phase 1 clinical trial showed that delivering autologous umbilical cord blood-derived mononuclear cells directly into the right ventricular myocardium during planned stage II surgical palliation for hypoplastic left heart syndrome was safe and feasible. Secondary findings of preservation of baseline right ventricular function throughout follow-up and normalized growth rates support the design of a phase 2b follow-up trial.
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Affiliation(s)
- Harold M Burkhart
- Division of Cardiovascular and Thoracic Surgery, University of Oklahoma, Oklahoma City, Okla.
| | | | - Joseph W Rossano
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pa
| | | | | | - Matthew Hathcock
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minn
| | - Walter Kremers
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minn
| | - Timothy J Nelson
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minn; Division of General Internal Medicine, Mayo Clinic, Rochester, Minn; Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minn; Center for Regenerative Medicine, Mayo Clinic, Rochester, Minn
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31
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Asleh R, Li X, Alnsasra H, Briasoulis A, Smith B, Kremers W, Pereira N, Edwards B, Daly R, Stulak J, Clavell A, Kushwaha S. Long-Term Sirolimus for Primary Immunosuppression and Incidence of De Novo Malignancy Following Heart Transplantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.682] [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: 10/27/2022] Open
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Graff-Radford J, Botha H, Rabinstein AA, Gunter JL, Przybelski SA, Lesnick T, Huston J, Flemming KD, Preboske GM, Senjem ML, Brown RD, Mielke MM, Roberts RO, Lowe VJ, Knopman DS, Petersen RC, Kremers W, Vemuri P, Jack CR, Kantarci K. Cerebral microbleeds: Prevalence and relationship to amyloid burden. Neurology 2019; 92:e253-e262. [PMID: 30568001 PMCID: PMC6340386 DOI: 10.1212/wnl.0000000000006780] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 09/10/2018] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To describe the prevalence of cerebral microbleeds (CMBs) and determine the association between CMBs and β-amyloid burden on PET. METHODS From the population-based Mayo Clinic Study of Aging, 1,215 participants (53% male) underwent 3-tesla MRI scans with T2* gradient recalled echo sequences from October 2011 to February 2017. A total of 1,123 participants (92%) underwent 11C-Pittsburgh compound B (PiB)-PET scans. The prevalence of CMBs was derived by adjusting for nonparticipation and standardizing to the Olmsted County, MN, population. The relationship between β-amyloid burden and CMB presence and location was tested using logistic regression models. Ordinal logistic models tested the relationship between CMB frequency and β-amyloid burden. RESULTS Two hundred seventy-four participants (22.6%) had at least one CMB. CMB frequency increased with age by decade (11% aged 60-69 years, 22% 70-79 years, and 39% 80 years and older). After adjusting for age, sex, and hypertension, PiB standardized uptake value ratio (SUVR) was associated with increased odds of a CMB. The association between PiB SUVR and CMBs was location-specific; PiB SUVR was associated with lobar CMBs but not deep CMBs. Age, hypertension, and PiB SUVR were associated with increasing CMB count. CMB density was greatest in parietal and occipital regions; β-amyloid burden correlated with concentration of CMBs in all lobar regions. Among participants with multiple CMBs, greater PiB uptake occurred in the pre- and postcentral gyri superiorly, the superior parietal lobe and precuneus, the angular gyrus, inferior temporal gyrus, and temporal poles. CONCLUSIONS The prevalence of CMBs increases with age. In this population-based sample, β-amyloid load was associated with lobar but not with deep CMBs.
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Affiliation(s)
- Jonathan Graff-Radford
- From the Departments of Neurology (J.G.-R., H.B., A.A.R., K.D.F., R.D.B., M.M.M., R.O.R., D.S.K., R.C.P.), Radiology (J.L.G., J.H., G.M.P., M.L.S., V.J.L., P.V., C.R.J., K.K.), and Health Sciences Research (S.A.P., T.L., M.M.M., R.O.R., W.K.), Mayo Clinic, Rochester, MN.
| | - Hugo Botha
- From the Departments of Neurology (J.G.-R., H.B., A.A.R., K.D.F., R.D.B., M.M.M., R.O.R., D.S.K., R.C.P.), Radiology (J.L.G., J.H., G.M.P., M.L.S., V.J.L., P.V., C.R.J., K.K.), and Health Sciences Research (S.A.P., T.L., M.M.M., R.O.R., W.K.), Mayo Clinic, Rochester, MN
| | - Alejandro A Rabinstein
- From the Departments of Neurology (J.G.-R., H.B., A.A.R., K.D.F., R.D.B., M.M.M., R.O.R., D.S.K., R.C.P.), Radiology (J.L.G., J.H., G.M.P., M.L.S., V.J.L., P.V., C.R.J., K.K.), and Health Sciences Research (S.A.P., T.L., M.M.M., R.O.R., W.K.), Mayo Clinic, Rochester, MN
| | - Jeffrey L Gunter
- From the Departments of Neurology (J.G.-R., H.B., A.A.R., K.D.F., R.D.B., M.M.M., R.O.R., D.S.K., R.C.P.), Radiology (J.L.G., J.H., G.M.P., M.L.S., V.J.L., P.V., C.R.J., K.K.), and Health Sciences Research (S.A.P., T.L., M.M.M., R.O.R., W.K.), Mayo Clinic, Rochester, MN
| | - Scott A Przybelski
- From the Departments of Neurology (J.G.-R., H.B., A.A.R., K.D.F., R.D.B., M.M.M., R.O.R., D.S.K., R.C.P.), Radiology (J.L.G., J.H., G.M.P., M.L.S., V.J.L., P.V., C.R.J., K.K.), and Health Sciences Research (S.A.P., T.L., M.M.M., R.O.R., W.K.), Mayo Clinic, Rochester, MN
| | - Timothy Lesnick
- From the Departments of Neurology (J.G.-R., H.B., A.A.R., K.D.F., R.D.B., M.M.M., R.O.R., D.S.K., R.C.P.), Radiology (J.L.G., J.H., G.M.P., M.L.S., V.J.L., P.V., C.R.J., K.K.), and Health Sciences Research (S.A.P., T.L., M.M.M., R.O.R., W.K.), Mayo Clinic, Rochester, MN
| | - John Huston
- From the Departments of Neurology (J.G.-R., H.B., A.A.R., K.D.F., R.D.B., M.M.M., R.O.R., D.S.K., R.C.P.), Radiology (J.L.G., J.H., G.M.P., M.L.S., V.J.L., P.V., C.R.J., K.K.), and Health Sciences Research (S.A.P., T.L., M.M.M., R.O.R., W.K.), Mayo Clinic, Rochester, MN
| | - Kelly D Flemming
- From the Departments of Neurology (J.G.-R., H.B., A.A.R., K.D.F., R.D.B., M.M.M., R.O.R., D.S.K., R.C.P.), Radiology (J.L.G., J.H., G.M.P., M.L.S., V.J.L., P.V., C.R.J., K.K.), and Health Sciences Research (S.A.P., T.L., M.M.M., R.O.R., W.K.), Mayo Clinic, Rochester, MN
| | - Gregory M Preboske
- From the Departments of Neurology (J.G.-R., H.B., A.A.R., K.D.F., R.D.B., M.M.M., R.O.R., D.S.K., R.C.P.), Radiology (J.L.G., J.H., G.M.P., M.L.S., V.J.L., P.V., C.R.J., K.K.), and Health Sciences Research (S.A.P., T.L., M.M.M., R.O.R., W.K.), Mayo Clinic, Rochester, MN
| | - Matthew L Senjem
- From the Departments of Neurology (J.G.-R., H.B., A.A.R., K.D.F., R.D.B., M.M.M., R.O.R., D.S.K., R.C.P.), Radiology (J.L.G., J.H., G.M.P., M.L.S., V.J.L., P.V., C.R.J., K.K.), and Health Sciences Research (S.A.P., T.L., M.M.M., R.O.R., W.K.), Mayo Clinic, Rochester, MN
| | - Robert D Brown
- From the Departments of Neurology (J.G.-R., H.B., A.A.R., K.D.F., R.D.B., M.M.M., R.O.R., D.S.K., R.C.P.), Radiology (J.L.G., J.H., G.M.P., M.L.S., V.J.L., P.V., C.R.J., K.K.), and Health Sciences Research (S.A.P., T.L., M.M.M., R.O.R., W.K.), Mayo Clinic, Rochester, MN
| | - Michelle M Mielke
- From the Departments of Neurology (J.G.-R., H.B., A.A.R., K.D.F., R.D.B., M.M.M., R.O.R., D.S.K., R.C.P.), Radiology (J.L.G., J.H., G.M.P., M.L.S., V.J.L., P.V., C.R.J., K.K.), and Health Sciences Research (S.A.P., T.L., M.M.M., R.O.R., W.K.), Mayo Clinic, Rochester, MN
| | - Rosebud O Roberts
- From the Departments of Neurology (J.G.-R., H.B., A.A.R., K.D.F., R.D.B., M.M.M., R.O.R., D.S.K., R.C.P.), Radiology (J.L.G., J.H., G.M.P., M.L.S., V.J.L., P.V., C.R.J., K.K.), and Health Sciences Research (S.A.P., T.L., M.M.M., R.O.R., W.K.), Mayo Clinic, Rochester, MN
| | - Val J Lowe
- From the Departments of Neurology (J.G.-R., H.B., A.A.R., K.D.F., R.D.B., M.M.M., R.O.R., D.S.K., R.C.P.), Radiology (J.L.G., J.H., G.M.P., M.L.S., V.J.L., P.V., C.R.J., K.K.), and Health Sciences Research (S.A.P., T.L., M.M.M., R.O.R., W.K.), Mayo Clinic, Rochester, MN
| | - David S Knopman
- From the Departments of Neurology (J.G.-R., H.B., A.A.R., K.D.F., R.D.B., M.M.M., R.O.R., D.S.K., R.C.P.), Radiology (J.L.G., J.H., G.M.P., M.L.S., V.J.L., P.V., C.R.J., K.K.), and Health Sciences Research (S.A.P., T.L., M.M.M., R.O.R., W.K.), Mayo Clinic, Rochester, MN
| | - Ronald C Petersen
- From the Departments of Neurology (J.G.-R., H.B., A.A.R., K.D.F., R.D.B., M.M.M., R.O.R., D.S.K., R.C.P.), Radiology (J.L.G., J.H., G.M.P., M.L.S., V.J.L., P.V., C.R.J., K.K.), and Health Sciences Research (S.A.P., T.L., M.M.M., R.O.R., W.K.), Mayo Clinic, Rochester, MN
| | - Walter Kremers
- From the Departments of Neurology (J.G.-R., H.B., A.A.R., K.D.F., R.D.B., M.M.M., R.O.R., D.S.K., R.C.P.), Radiology (J.L.G., J.H., G.M.P., M.L.S., V.J.L., P.V., C.R.J., K.K.), and Health Sciences Research (S.A.P., T.L., M.M.M., R.O.R., W.K.), Mayo Clinic, Rochester, MN
| | - Prashanthi Vemuri
- From the Departments of Neurology (J.G.-R., H.B., A.A.R., K.D.F., R.D.B., M.M.M., R.O.R., D.S.K., R.C.P.), Radiology (J.L.G., J.H., G.M.P., M.L.S., V.J.L., P.V., C.R.J., K.K.), and Health Sciences Research (S.A.P., T.L., M.M.M., R.O.R., W.K.), Mayo Clinic, Rochester, MN
| | - Clifford R Jack
- From the Departments of Neurology (J.G.-R., H.B., A.A.R., K.D.F., R.D.B., M.M.M., R.O.R., D.S.K., R.C.P.), Radiology (J.L.G., J.H., G.M.P., M.L.S., V.J.L., P.V., C.R.J., K.K.), and Health Sciences Research (S.A.P., T.L., M.M.M., R.O.R., W.K.), Mayo Clinic, Rochester, MN
| | - Kejal Kantarci
- From the Departments of Neurology (J.G.-R., H.B., A.A.R., K.D.F., R.D.B., M.M.M., R.O.R., D.S.K., R.C.P.), Radiology (J.L.G., J.H., G.M.P., M.L.S., V.J.L., P.V., C.R.J., K.K.), and Health Sciences Research (S.A.P., T.L., M.M.M., R.O.R., W.K.), Mayo Clinic, Rochester, MN
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Smith B, Cornell LD, Smith M, Cortese C, Geiger X, Alexander MP, Ryan M, Park W, Morales Alvarez MC, Schinstock C, Kremers W, Stegall M. A method to reduce variability in scoring antibody-mediated rejection in renal allografts: implications for clinical trials - a retrospective study. Transpl Int 2018; 32:173-183. [PMID: 30179275 DOI: 10.1111/tri.13340] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/14/2018] [Accepted: 08/30/2018] [Indexed: 12/24/2022]
Abstract
Poor reproducibility in scoring antibody-mediated rejection (ABMR) using the Banff criteria might limit the use of histology in clinical trials. We evaluated the reproducibility of Banff scoring of 67 biopsies by six renal pathologists at three institutions. Agreement by any two pathologists was poor: 44.8-65.7% for glomerulitis, 44.8-67.2% for peritubular capillaritis, and 53.7-80.6% for chronic glomerulopathy (cg). All pathologists agreed on cg0 (n = 20) and cg3 (n = 9) cases, however, many disagreed on scores of cg1 or cg2. The range for the incidence of composite diagnoses by individual pathologists was: 16.4-22.4% for no ABMR; 17.9-47.8% for active ABMR; and 35.8-59.7% for chronic, active antibody-mediated rejection (cABMR). A "majority rules" approach was then tested in which the scores of three pathologists were used to reach an agreement. This increased consensus both for individual scores (ex. 67.2-77.6% for cg) and for composite diagnoses (ex. 74.6-86.6% cABMR). Modeling using these results showed that differences in individual scoring could affect the outcome assessment in a mock study of cABMR. We conclude that the Banff schema has high variability and a majority rules approach could be used to adjudicate differences between pathologists and reduce variability in scoring in clinical trials.
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Affiliation(s)
- Byron Smith
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Lynn D Cornell
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Maxwell Smith
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, USA
| | - Cherise Cortese
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
| | - Xochiquetzal Geiger
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
| | - Mariam P Alexander
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Margaret Ryan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, USA
| | - Walter Park
- The William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA
| | | | - Carrie Schinstock
- The William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA.,Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Walter Kremers
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,The William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA
| | - Mark Stegall
- The William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA.,Department of Medicine, Division of Transplantation Surgery, Mayo Clinic, Rochester, MN, USA
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Asleh R, Snipelisky D, Hathcock M, Kremers W, Liu D, Batzler A, Jenkins G, Kushwaha S, Pereira NL. Genomewide association study reveals novel genetic loci associated with change in renal function in heart transplant recipients. Clin Transplant 2018; 32:e13395. [PMID: 30160337 DOI: 10.1111/ctr.13395] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/13/2018] [Accepted: 08/23/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Renal dysfunction occurs commonly after heart transplantation (HTx) with wide inter-individual variability but whether a genetic predisposition exists in these patients is unknown. Genomewide association studies (GWAS) have not been performed to assess the association of genetic variation with change in renal function after HTx. METHODS Clinical and demographic data of patients who underwent HTx and provided blood samples and consent for genetic analysis were included. Genotyping was performed using Illumina Infinium Human CoreExome v1.0 analysis kit. A GWAS utilizing linear regression models was performed with estimated glomerular filtration rate (eGFR) at 1 year as the phenotype after adjusting for baseline eGFR prior to HTx and conversion from calcineurin inhibitor to sirolimus as primary immunosuppression therapy. RESULTS A total of 251 HTx recipients were genotyped for 314,903 single nucleotide polymorphisms (SNPs). The mean (SD) age was 50 (12.5) years; most patients were of European origin (n = 243, 96.8%) and males (n = 179, 71.3%). After adjustment for potential confounders, two variants, rs17033285 (P = 4.3 × 10-7 ) and rs4917601 (P = 6.46 × 10-7 ), in a long non-coding RNA (lncRNA) gene LINC01121 and a pseudogene BTBD7P2, were identified to have a significant association with change in GFR at 1 year after HTx. CONCLUSIONS Our first of its kind GWAS demonstrates that genetic variation affects renal function after HTx independent of other risk factors. Agnostic genetic approaches such as these may lead to identification of novel biological pathways such as the role of lncRNAs in the development of renal dysfunction post-HTx.
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Affiliation(s)
- Rabea Asleh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - David Snipelisky
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matthew Hathcock
- Department of Biomedical Statistic and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Walter Kremers
- Department of Biomedical Statistic and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Duan Liu
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Anthony Batzler
- Department of Biomedical Statistic and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Gregory Jenkins
- Department of Biomedical Statistic and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Sudhir Kushwaha
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Naveen L Pereira
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.,Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
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WONG K, Smith B, Taner T, Kushwaha S, Edwards B, Gandhi M, Kremers W, Daly R, Pereira N. Development of Rejection Risk Prediction Model by Routine Monitoring for De-novo Donor Specific Antibodies After Heart Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.365] [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: 10/17/2022] Open
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Pichler M, Vemuri P, Rabinstein AA, Aakre J, Flemming KD, Brown RD, Kumar N, Kantarci K, Kremers W, Mielke MM, Knopman DS, Jack CR, Petersen RC, Lowe V, Graff-Radford J. Prevalence and Natural History of Superficial Siderosis: A Population-Based Study. Stroke 2017; 48:3210-3214. [PMID: 29070715 DOI: 10.1161/strokeaha.117.018974] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 08/30/2017] [Accepted: 09/21/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Superficial siderosis (SS) is characterized by hemosiderin deposition in the superficial layers of the central nervous system and can be seen during postmortem examination or with iron-sensitive magnetic resonance imaging techniques. The distribution of SS may predict the probable underlying cause. This study aimed to report the prevalence and natural history of SS in a population-based study. METHODS Brain magnetic resonance imaging scans from the MCSA (Mayo Clinic Study of Aging), a population-based study of residents 50 to 89 years of age in Olmsted County, Minnesota, were reviewed. Participants with imaging consistent with SS were identified from 2011 through 2016. An inverse probability weighting approach was used to convert our observed frequencies to population prevalence of SS. Additional data abstracted included amyloid positron emission tomography, Apolipoprotein E genotype, coexisting cerebral microbleeds, and extent of SS. RESULTS A total of 1412 participants had eligible magnetic resonance imaging scans. Two participants had infratentorial SS, restricted to the posterior fossa. Thirteen participants had cortical SS involving the cerebral convexities (7 focal and 6 disseminated). Only 3 of the participants with cortical SS (23%) also had cerebral microbleeds. The population prevalence of SS was 0.21% (95% confidence interval, 0-0.45) in those 50 to 69 years old and 1.43% (confidence interval, 0.53-2.34) in those over 69 years old. Apolipoprotein E ε2 allele was more common in those with SS (57.1% versus 15.0%; P<0.001). Compared with participants without SS, those with SS were also more likely to have a positive amyloid positron emission tomographic scan (76.9% versus 29.8%; P<0.001). CONCLUSIONS SS may be encountered in the general elderly population. The association with increased amyloid burden and Apolipoprotein E ε2 genotype supports cerebral amyloid angiopathy as the most common mechanism. Longitudinal follow-up is needed to evaluate the risk of subsequent hemorrhage in cases of incidentally discovered SS.
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Affiliation(s)
- Michael Pichler
- From the Department of Neurology (M.P., A.A.R., K.D.F., R.D.B., N.K., M.M.M., D.S.K., R.C.P., J.G.-R.), Department of Radiology (P.V., K.K., C.R.J., V.L.), and Department of Health Sciences Research (J.A., W.K., M.M.M.), Mayo Clinic, Rochester, MN
| | - Prashanthi Vemuri
- From the Department of Neurology (M.P., A.A.R., K.D.F., R.D.B., N.K., M.M.M., D.S.K., R.C.P., J.G.-R.), Department of Radiology (P.V., K.K., C.R.J., V.L.), and Department of Health Sciences Research (J.A., W.K., M.M.M.), Mayo Clinic, Rochester, MN
| | - Alejandro A Rabinstein
- From the Department of Neurology (M.P., A.A.R., K.D.F., R.D.B., N.K., M.M.M., D.S.K., R.C.P., J.G.-R.), Department of Radiology (P.V., K.K., C.R.J., V.L.), and Department of Health Sciences Research (J.A., W.K., M.M.M.), Mayo Clinic, Rochester, MN
| | - Jeremiah Aakre
- From the Department of Neurology (M.P., A.A.R., K.D.F., R.D.B., N.K., M.M.M., D.S.K., R.C.P., J.G.-R.), Department of Radiology (P.V., K.K., C.R.J., V.L.), and Department of Health Sciences Research (J.A., W.K., M.M.M.), Mayo Clinic, Rochester, MN
| | - Kelly D Flemming
- From the Department of Neurology (M.P., A.A.R., K.D.F., R.D.B., N.K., M.M.M., D.S.K., R.C.P., J.G.-R.), Department of Radiology (P.V., K.K., C.R.J., V.L.), and Department of Health Sciences Research (J.A., W.K., M.M.M.), Mayo Clinic, Rochester, MN
| | - Robert D Brown
- From the Department of Neurology (M.P., A.A.R., K.D.F., R.D.B., N.K., M.M.M., D.S.K., R.C.P., J.G.-R.), Department of Radiology (P.V., K.K., C.R.J., V.L.), and Department of Health Sciences Research (J.A., W.K., M.M.M.), Mayo Clinic, Rochester, MN
| | - Neeraj Kumar
- From the Department of Neurology (M.P., A.A.R., K.D.F., R.D.B., N.K., M.M.M., D.S.K., R.C.P., J.G.-R.), Department of Radiology (P.V., K.K., C.R.J., V.L.), and Department of Health Sciences Research (J.A., W.K., M.M.M.), Mayo Clinic, Rochester, MN
| | - Kejal Kantarci
- From the Department of Neurology (M.P., A.A.R., K.D.F., R.D.B., N.K., M.M.M., D.S.K., R.C.P., J.G.-R.), Department of Radiology (P.V., K.K., C.R.J., V.L.), and Department of Health Sciences Research (J.A., W.K., M.M.M.), Mayo Clinic, Rochester, MN
| | - Walter Kremers
- From the Department of Neurology (M.P., A.A.R., K.D.F., R.D.B., N.K., M.M.M., D.S.K., R.C.P., J.G.-R.), Department of Radiology (P.V., K.K., C.R.J., V.L.), and Department of Health Sciences Research (J.A., W.K., M.M.M.), Mayo Clinic, Rochester, MN
| | - Michelle M Mielke
- From the Department of Neurology (M.P., A.A.R., K.D.F., R.D.B., N.K., M.M.M., D.S.K., R.C.P., J.G.-R.), Department of Radiology (P.V., K.K., C.R.J., V.L.), and Department of Health Sciences Research (J.A., W.K., M.M.M.), Mayo Clinic, Rochester, MN
| | - David S Knopman
- From the Department of Neurology (M.P., A.A.R., K.D.F., R.D.B., N.K., M.M.M., D.S.K., R.C.P., J.G.-R.), Department of Radiology (P.V., K.K., C.R.J., V.L.), and Department of Health Sciences Research (J.A., W.K., M.M.M.), Mayo Clinic, Rochester, MN
| | - Clifford R Jack
- From the Department of Neurology (M.P., A.A.R., K.D.F., R.D.B., N.K., M.M.M., D.S.K., R.C.P., J.G.-R.), Department of Radiology (P.V., K.K., C.R.J., V.L.), and Department of Health Sciences Research (J.A., W.K., M.M.M.), Mayo Clinic, Rochester, MN
| | - Ronald C Petersen
- From the Department of Neurology (M.P., A.A.R., K.D.F., R.D.B., N.K., M.M.M., D.S.K., R.C.P., J.G.-R.), Department of Radiology (P.V., K.K., C.R.J., V.L.), and Department of Health Sciences Research (J.A., W.K., M.M.M.), Mayo Clinic, Rochester, MN
| | - Val Lowe
- From the Department of Neurology (M.P., A.A.R., K.D.F., R.D.B., N.K., M.M.M., D.S.K., R.C.P., J.G.-R.), Department of Radiology (P.V., K.K., C.R.J., V.L.), and Department of Health Sciences Research (J.A., W.K., M.M.M.), Mayo Clinic, Rochester, MN
| | - Jonathan Graff-Radford
- From the Department of Neurology (M.P., A.A.R., K.D.F., R.D.B., N.K., M.M.M., D.S.K., R.C.P., J.G.-R.), Department of Radiology (P.V., K.K., C.R.J., V.L.), and Department of Health Sciences Research (J.A., W.K., M.M.M.), Mayo Clinic, Rochester, MN.
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Flemming KD, Graff-Radford J, Aakre J, Kantarci K, Lanzino G, Brown RD, Mielke MM, Roberts RO, Kremers W, Knopman DS, Petersen RC, Jack CR. Population-Based Prevalence of Cerebral Cavernous Malformations in Older Adults: Mayo Clinic Study of Aging. JAMA Neurol 2017; 74:801-805. [PMID: 28492932 DOI: 10.1001/jamaneurol.2017.0439] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The prevalence of cerebral cavernous malformation (CCM) is unknown. Case ascertainment in most previous studies was based on autopsy data or clinical convenience samples, often without detailed clinical or radiologic information. Objective To determine the prevalence of CCM in a population-based sample of older adults. Design, Setting, and Participants This prospective imaging study included 4721 participants aged 50 to 89 years who were enrolled between January 1, 2004, and December 15, 2015, in the Mayo Clinic Study of Aging, a longitudinal, population-based study of residents of Olmsted County, Minnesota. An age- and sex-stratified sampling strategy was used to randomly select participants from Olmsted County using the medical records linkage system of the Rochester Epidemiology Project. Participants were invited to undergo brain magnetic resonance imaging (MRI). Of the 4721 participants, 2715 had an evaluable MRI. All images were reviewed by a board-certified neuroradiologist, and MRI reports were searched for the terms cavernous malformation, cavernous angioma, and cavernoma. Two vascular neurologists reviewed MRIs, and potential CCMs were classified using Zabramski classification. Medical records of the identified individuals with CCM were reviewed along with their demographic information, medical history, and any symptoms referable to the identified CCM lesion. Main Outcomes and Measures Prevalence of CCM and clinical and radiologic characteristics of study participants with CCM. Results Of the 2715 participants who underwent MRI scans, 12 (0.44%) had CCM. With the use of inverse probability weights to adjust for participation bias, the overall prevalence was 0.46% (95% CI, 0.05-0.86). The age-adjusted prevalence was found to be 0.61% (95% CI, 0-1.47) for the 50- to 59-year age group, 0.17% (95% CI, 0-0.50) for the 60- to 69-year age group, 0.45% (95% CI, 0.09-0.81) for the 70- to 79-year age group, and 0.58% (95% CI, 0-1.29) for the 80- to 89-year age group. The sex-adjusted prevalence was 0.41% (95% CI, 0-1.00) for women and 0.51% (95% CI, 0-1.07) for men. Observed frequencies were similar in men and women, with a slight male predominance. Of the 12 participants with CCM, 9 (75%) had a single Zabramski type 2 lesion in a supratentorial location. Only 1 participant (0.037%) was symptomatic from the CCM during the study period. Conclusions and Relevance The findings and data from this study are important for determining the potential number of patients available for cohort studies and anticipated clinical trials in older patients with CCM.
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Affiliation(s)
| | | | - Jeremiah Aakre
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - Robert D Brown
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, Minnesota2Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Rosebud O Roberts
- Department of Neurology, Mayo Clinic, Rochester, Minnesota2Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Walter Kremers
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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Dupoiron D, Stachowiak A, Loewenstein O, Ellery A, Kremers W, Bosse B, Hopp M. A phase III randomized controlled study on the efficacy and improved bowel function of prolonged-release (PR) oxycodone-naloxone (up to 160/80 mg daily) vs oxycodone PR. Eur J Pain 2017. [PMID: 28641363 PMCID: PMC5600007 DOI: 10.1002/ejp.1054] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Oxycodone/naloxone (OXN PR) is a prolonged-release formulation containing oxycodone and naloxone in a 2:1 ratio. This study aimed to evaluate the tolerability and efficacy of doses up to OXN160/80 mg PR compared with oxycodone prolonged-release formulation (OxyPR) in a randomised controlled trial. METHODS Two hundred and forty-three patients were randomised to treatment with OXN PR (n = 123) or OxyPR (n = 120) during the 5-week double-blind study. Measured were: opioid-induced constipation [bowel function index score (BFI)]; analgesic efficacy (NRS 0-10); daily laxative rescue medication use; rescue medication use, and the number of complete spontaneous bowel movements (CSBMs) per week. A subanalysis was conducted in cancer patients. RESULTS Greater reductions in mean BFI scores were reported for the OXN PR group compared with OxyPR from Week 1 onwards; at Week 5 the mean change from baseline was -32.5 versus -14.2. Average 24-h pain scores were low and remained stable in the range 3-4 in both treatment groups. Analgesic rescue medication use was similar between the groups. Patients receiving OXN PR used significantly lower mean daily doses of laxative rescue medication than those receiving OxyPR (P = 0.006). The number of CSBM in the OXN PR group approximately doubled compared with a 25% decrease in the OxyPR group. Comparable results to the total study population were reported in the cancer patient subgroup. CONCLUSIONS OXN PR in daily doses of up to 160/80 mg significantly improves bowel function compared with equivalent doses of OxyPR while still providing comparable analgesic efficacy. SIGNIFICANCE Effective analgesia can be achieved using oxycodone/naloxone PR up to 160/80 mg daily without compromising bowel function. A similar outcome was reported in cancer and non-cancer patients.
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Affiliation(s)
- D Dupoiron
- Département d'Anesthésie - Douleur, Institut de Cancérologie de l'Ouest - Paul Papin, Angers, France
| | - A Stachowiak
- Pallmed sp. z o.o., NZOZ Dom Sue Ryder, Bydgoszcz, Poland
| | - O Loewenstein
- Gemeinschaftspraxis Löwenstein - Dr. Hesselbarth, Schmerz- und Palliativzentrum DGS Mainz, Mainz, Germany
| | - A Ellery
- NHS Kernow Clinical Commissioning Group, Saint Austell, UK
| | - W Kremers
- Mundipharma Research GmbH & Co. KG, Limburg, Germany
| | - B Bosse
- Mundipharma Research GmbH & Co. KG, Limburg, Germany
| | - M Hopp
- Mundipharma Research GmbH & Co. KG, Limburg, Germany
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Dupoiron D, Stachowiak A, Loewenstein O, Ellery A, Kremers W, Bosse B, Hopp M. Long-term efficacy and safety of oxycodone-naloxone prolonged-release formulation (up to 180/90 mg daily) - results of the open-label extension phase of a phase III multicenter, multiple-dose, randomized, controlled study. Eur J Pain 2017; 21:1485-1494. [PMID: 28474460 PMCID: PMC5655918 DOI: 10.1002/ejp.1050] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2017] [Indexed: 12/12/2022]
Abstract
Background The inclusion of naloxone with oxycodone in a fixed combination prolonged‐release formulation (OXN PR) improves bowel function compared with oxycodone (Oxy) alone without compromising analgesic efficacy. In a recent 5‐week, randomized, double‐blind comparative trial of OXN PR and OxyPR, it could be shown that the beneficial properties of OXN PR extend to doses up to 160/80 mg. Methods Bowel function, pain, quality of life (QoL) and safety of OXN PR up to 180/90 mg daily were evaluated in a 24‐week open‐label extension phase of the 5‐week randomized comparative study in patients with non‐malignant or malignant pain requiring opioids and suffering from opioid‐induced constipation. Results During treatment with a mean (SD) daily dose OXN PR of 130.7 (26.56) mg (median, maximum: 120 and 180 mg), the Bowel Function Index (BFI) decreased from 45.3 (26.37) to 26.7 (21.37) with the largest decrease seen in the first week. The average pain over the last 24 h remained stable (median Pain Intensity Scale score 4.0) and QoL was maintained throughout the study. Adverse events were consistent with the known effects of OXN PR and no new safety concerns emerged. Equivalent efficacy and safety benefits were observed in cancer patients. Conclusions The OXN PR in doses up to 180/90 mg provides effective analgesia with maintenance of bowel function during long‐term treatment. The beneficial effects of such dose levels of OXN PR contribute to stable patient‐reported QoL and health status despite serious underlying pain conditions, such as cancer. Significance In patients with pain requiring continuous opioid therapy at doses above 80 mg of oxycodone, stable and effective long‐term analgesia can be achieved using OXN PR up to 180/90 mg daily without compromising bowel function and may be preferential to supplemental oxycodone.
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Affiliation(s)
- D Dupoiron
- Département d'Anesthésie - Douleur, Institut de Cancérologie de l'Ouest - Paul Papin, Angers, France
| | - A Stachowiak
- Pallmed sp. z o.o., NZOZ Dom Sue Ryder, Bydgoszcz, Poland
| | - O Loewenstein
- Gemeinschaftspraxis Löwenstein - Dr. Hesselbarth, Schmerz- und Palliativzentrum DGS Mainz, Mainz, Germany
| | - A Ellery
- NHS Kernow Clinical Commissioning Group, Saint Austell, UK
| | - W Kremers
- Mundipharma Research GmbH & Co. KG, Limburg, Germany
| | - B Bosse
- Mundipharma Research GmbH & Co. KG, Limburg, Germany
| | - M Hopp
- Mundipharma Research GmbH & Co. KG, Limburg, Germany
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Pereira N, Valero MJ, Wong M, Kushwaha S, Smith B, Kremers W, Gandhi M, Richard D. De Novo Donor Specific Antibodies (dnDSA) Is Associated with Cardiac Allograft Hypertrophy After Heart Transplantation (HT). J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.603] [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: 10/19/2022] Open
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Lapid MI, Kuntz KM, Mason SS, Aakre JA, Lundt ES, Kremers W, Allen LA, Drubach DA, Boeve BF. Efficacy, Safety, and Tolerability of Armodafinil Therapy for Hypersomnia Associated with Dementia with Lewy Bodies: A Pilot Study. Dement Geriatr Cogn Disord 2017; 43:269-280. [PMID: 28448998 PMCID: PMC5503747 DOI: 10.1159/000471507] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND/AIMS Hypersomnia is common in dementia with Lewy bodies (DLB). We assessed the efficacy, safety, and tolerability of armodafinil for hypersomnia associated with DLB. METHODS We performed a 12-week pilot trial of armodafinil therapy (125-250 mg orally daily) in DLB outpatients with hypersomnia. The patients underwent neurologic examinations, a neuropsychological battery, laboratory testing, electrocardiography, and polysomnography. Efficacy was assessed at 2, 4, 8, and 12 weeks. Safety assessment included laboratory examinations, QTc interval, and heart rate. Tolerability was assessed by analysis of adverse events. Data were analyzed using the last-observation-carried-forward method. RESULTS Of 20 participants, 17 completed the protocol. The median age was 72 years, most of the participants were men (80%), and most had spouses as caregivers. The Epworth Sleepiness Scale (p < 0.001), Maintenance of Wakefulness Test (p = 0.003), and Clinical Global Impression of Change (p < 0.001) scores improved at week 12. The Neuropsychiatric Inventory total score (p = 0.003), visual hallucinations (p = 0.003), and agitation (p = 0.02) improved at week 4. Caregiver overall quality of life improved at week 12 (p = 0.004). No adverse events occurred. CONCLUSION These pilot data suggest improvements in hypersomnia and wakefulness and reasonable safety and tolerability of armodafinil therapy in hypersomnolent patients with DLB. Our findings inform the use of pharmacologic strategies for managing hypersomnolence in these patients.
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Affiliation(s)
- Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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Graff-Radford J, Boeve BF, Aakre JA, Savica R, Ferman TJ, Dickson DW, Kremers W, Jones DT, Kantarci K, Knopman DS, Petersen RC. P2‐201: Pathologic Predictors of Disease Duration in Lewy Body Disease. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.1369] [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: 10/20/2022]
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Bryan A, Sanders T, Kremers HM, Kremers W, Levy B, Dahm D, Stuart M, Krych A. Delayed Reconstruction for Symptomatic Anterior Cruciate Ligament Tears. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000487637.95878.43] [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: 11/21/2022]
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44
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Beam E, Lesnick T, Kremers W, Kennedy CC, Razonable RR. Cytomegalovirus disease is associated with higher all-cause mortality after lung transplantation despite extended antiviral prophylaxis. Clin Transplant 2016; 30:270-8. [PMID: 26701733 DOI: 10.1111/ctr.12686] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND The duration of anticytomegalovirus (CMV) prophylaxis after lung transplantation (LT) varies among transplant centers. METHODS A retrospective review of CMV donor-seropositive/recipient-seronegative (D+/R-) and CMV recipient-seropositive (R+) LT patients between January 2005 and September 2012 was performed. Starting January 2007, valganciclovir prophylaxis was given for at least 12 months (often lifelong) for CMV D+/R- and extended from three to six months for R+ LT patients. Risks of CMV infection and CMV disease, and mortality after LT, were assessed. RESULTS A total of 88 LT patients were studied, including 32 CMV D+/R-, and 56 R+ patients. During the follow-up period, 11 (12.5%) patients had asymptomatic CMV infection, and nine (10.3%) developed CMV disease. CMV disease (HR, 4.189; 95% CI: 1.672-10.495; p = 0.002) and CMV infection and disease (HR, 3.775; 95% CI: 1.729-8.240; p = 0.001) were significant risk factors for mortality. Overall, no significant difference was observed in rates of CMV infection or disease among LT recipients who received shorter vs. extended CMV prophylaxis. CONCLUSIONS Despite extended prophylaxis, LT patients remain at risk of CMV infection and disease. CMV remains associated with increased mortality after transplantation.
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Affiliation(s)
- E Beam
- Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - T Lesnick
- Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - W Kremers
- Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA.,The William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - C C Kennedy
- The William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic College of Medicine, Rochester, MN, USA.,Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - R R Razonable
- Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA.,Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
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Hasin T, Kushwaha SS, Lesnick TG, Kremers W, Boilson BA, Schirger JA, Clavell AL, Rodeheffer RJ, Frantz RP, Edwards BS, Pereira NL, Stulak JM, Joyce L, Daly R, Park SJ, Jaffe AS. Early trends in N-terminal pro-brain natriuretic peptide values after left ventricular assist device implantation for chronic heart failure. Am J Cardiol 2014; 114:1257-63. [PMID: 25194171 DOI: 10.1016/j.amjcard.2014.07.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 07/16/2014] [Accepted: 07/16/2014] [Indexed: 10/25/2022]
Abstract
Left ventricular assist devices (LVADs) acutely decrease left ventricular wall stress. Thus, early postoperative levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) should decrease. This study investigated postoperative changes in NT-proBNP levels, the parameters related to changes, and the possible association with complications by performing a retrospective analysis of changes in daily NT-proBNP (pg/ml) levels from admission to discharge both before and after LVAD implantation in a tertiary referral center. For 72 patients implanted with HeartMate II LVADs, baseline NT-proBNP levels were elevated at 3,943 ng/ml (interquartile range 1,956 to 12,964). Preoperative stabilization led to marked decreases in NT-proBNP. Levels peaked 3 days after surgery and subsequently decreased. Patients with complicated postoperative courses had higher early postoperative elevations. By discharge, NT-proBNP decreased markedly but was still 2.83 (1.60 to 5.76) times the age-based upper limit of normal. The 26% reduction in NT-proBNP between admission and discharge was due mostly to the preoperative reductions and not those induced by the LVAD itself. The decrease was not associated with decreases in LV volume. In conclusion, preoperative treatment reduces NT-proBNP values. The magnitude of early postoperative changes is related to the clinical course. Levels at discharge remain markedly elevated and similar to values after preoperative stabilization despite presumptive acute LV unloading.
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Ramanan P, Cummins N, Wilhelm M, Heimbach J, Dierkhising R, Kremers W, Rosen C, Gores G, Razonable R. Intra-Abdominal Infections in Patients Undergoing Liver Transplantation (LT) for Hilar Cholangiocarcinoma (CCA). Transplantation 2014. [DOI: 10.1097/00007890-201407151-02377] [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: 11/25/2022]
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Ramanan P, Cummins N, Wilhelm M, Heimbach J, Dierkhising R, Kremers W, Rosen C, Gores G, Razonable R. Bloodstream Infections (BSI) in Patients Undergoing Liver Transplantation (LT) for Hilar Cholangiocarcinoma (CCA). Transplantation 2014. [DOI: 10.1097/00007890-201407151-02373] [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: 11/25/2022]
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48
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Rosenbaum A, Zhuang K, Kremers W, Allison T, Daly R, Schirger J, Kushwaha S, Edwards B. The Positive Impact of Early Cardiac Rehabilitation on Long Term Survival in Cardiac Transplant Recipients. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.737] [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: 10/25/2022] Open
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Liang J, Geske J, Boilson B, Kremers W, Weinshilboum R, Pereira N. Thiopurine S-methyltranferase heterozygote heart transplant recipients treated with azathioprine are at an increased risk for rejection. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.881] [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: 11/14/2022] Open
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50
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Singal AK, Kamath PS, Francisco Ziller N, DiCecco S, Shoreibah M, Kremers W, Charlton MR, Heimbach JK, Watt KD, Shah VH. Nutritional status of patients with alcoholic cirrhosis undergoing liver transplantation: time trends and impact on survival. Transpl Int 2013; 26:788-94. [PMID: 23751180 DOI: 10.1111/tri.12123] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 11/12/2012] [Accepted: 04/29/2013] [Indexed: 01/11/2023]
Abstract
Alcoholic cirrhotics evaluated for liver transplantation are frequently malnourished or obese. We analyzed alcoholic cirrhotics undergoing transplantation to examine time trends of nutrition/weight, transplant outcome, and effects of concomitant hepatitis C virus (HCV) and/or hepatocellular carcinoma (HCC). Nutrition and transplant outcomes were reviewed for alcoholic cirrhosis with/without HCV/HCC. Malnutrition was defined by subjective global assessment. Body mass index (BMI) classified obesity. A total of 261 patients receiving transplants were separated (1988-2000, 2001-2006, and 2007-2011) to generate similar size cohorts. Mean BMI for the whole cohort was 28 ± 6 with 68% classified as overweight/obese. Mean BMI did not vary among cohorts and was not affected by HCV/HCC. While prevalence of malnutrition did not vary among cohorts, it was lower in patients with HCV/HCC (P < 0.01). One-year graft/patient survival was 90% and not impacted by time period, HCV/HCC, or malnutrition after adjusting for demographics and model end-stage liver disease (MELD). Alcoholic cirrhotics undergoing transplantation are malnourished yet frequently overweight/obese. Among patients selected for transplantation, 1-year post-transplant graft/patient survival is excellent, have not changed over time, and do not vary by nutrition/BMI. Our findings support feasibility of liver transplantation for alcoholic cirrhotics with obesity and malnutrition.
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Affiliation(s)
- Ashwani K Singal
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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