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Schiffer W, Pedersen LN, Lui M, Bergom C, Mitchell JD. Advances in Screening for Radiation-Associated Cardiotoxicity in Cancer Patients. Curr Cardiol Rep 2023; 25:1589-1600. [PMID: 37796395 PMCID: PMC10682284 DOI: 10.1007/s11886-023-01971-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE OF REVIEW Radiation is foundational to the treatment of cancer and improves overall survival. Yet, it is important to recognize the potential cardiovascular effects of radiation therapy and how to best minimize or manage them. Screening-both through imaging and with biomarkers-can potentially identify cardiovascular effects early, allowing for prompt initiation of treatment to mitigate late effects. RECENT FINDINGS Cardiac echocardiography, magnetic resonance imaging (MRI), computed tomography, and measurements of troponin and natriuretic peptides serve as the initial screening tests of choice for RICD. Novel imaging applications, including positron emission tomography and specific MRI parameters, and biomarker testing, including myeloperoxidase, growth differentiation factor 15, galectin 3, micro-RNA, and metabolomics, hold promise for earlier detection and more specific characterization of RICD. Advances in imaging and novel applications of biomarkers have potential to identify subclinical RICD and may reveal opportunities for early intervention. Further research is needed to elucidate optimal imaging screening modalities, biomarkers, and surveillance strategies.
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Affiliation(s)
- Walter Schiffer
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave, CB 8086, St. Louis, MO, 63110, USA
- Cardio-Oncology Center of Excellence, Washington University School of Medicine, St. Louis, MO, USA
| | - Lauren N Pedersen
- Cardio-Oncology Center of Excellence, Washington University School of Medicine, St. Louis, MO, USA
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew Lui
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave, CB 8086, St. Louis, MO, 63110, USA
| | - Carmen Bergom
- Cardio-Oncology Center of Excellence, Washington University School of Medicine, St. Louis, MO, USA
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO, USA
| | - Joshua D Mitchell
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave, CB 8086, St. Louis, MO, 63110, USA.
- Cardio-Oncology Center of Excellence, Washington University School of Medicine, St. Louis, MO, USA.
- Alvin J. Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO, USA.
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2
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Zaghlol R, Rater M, Schiffer W, Mitchell JD. Redefining Prognosis of Transthyretin Cardiomyopathy in the Tafamadis Era. J Card Fail 2022; 28:1519-1521. [PMID: 35988721 DOI: 10.1016/j.cardfail.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/25/2022]
Affiliation(s)
- R Zaghlol
- Amyloid Center of Excellence, Cardiovascular Division, Washington University School of Medicine in St. Louis, St. Louis, MO 63122
| | - M Rater
- Amyloid Center of Excellence, Cardiovascular Division, Washington University School of Medicine in St. Louis, St. Louis, MO 63122
| | - W Schiffer
- Amyloid Center of Excellence, Cardiovascular Division, Washington University School of Medicine in St. Louis, St. Louis, MO 63122
| | - J D Mitchell
- Amyloid Center of Excellence, Cardiovascular Division, Washington University School of Medicine in St. Louis, St. Louis, MO 63122.
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3
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Pedersen LN, Schiffer W, Mitchell JD, Bergom C. Radiation-induced cardiac dysfunction: Practical implications. Kardiol Pol 2022; 80:256-265. [PMID: 35238396 DOI: 10.33963/kp.a2022.0066] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 11/23/2022]
Abstract
Radiation-induced cardiac dysfunction is a critical healthcare concern facing survivors of thoracic cancers treated with radiation therapy. Despite cardiac-sparing advances in radiation therapy delivery, many patients with thoracic cancers receiving modern radiation therapy will still have incidental radiation exposure to the heart. Therefore, it is imperative that cardiovascular healthcare providers take appropriate measures to prevent, screen, and manage radiation-induced cardiac dysfunction in patients with a history of thoracic radiation therapy. In this review, we aim to provide healthcare providers with foundational information about radiation-induced cardiac pathophysiology and a chronology of advances in radiation technology. Subsequently, we provide an up-to-date review of treatment- and host-related factors that can influence a patient's risk for radiation-induced cardiac dysfunction. Finally, we culminate our discussion by detailing current screening and management guidelines to aid healthcare providers in caring for their patients with a history of thoracic radiation therapy.
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Affiliation(s)
- Lauren N Pedersen
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, United States.
| | - Walter Schiffer
- Division of Cardiology, Department of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Joshua D Mitchell
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, United States.,Alvin J Siteman Center, Washington University in St. Louis, St. Louis, MO, United States.,Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, MO, United States
| | - Carmen Bergom
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, United States.,Alvin J Siteman Center, Washington University in St. Louis, St. Louis, MO, United States.,Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, MO, United States
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4
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Kyrouac D, Schiffer W, Lennep B, Fergestrom N, Zhang KW, Gorcsan J, Lenihan DJ, Mitchell JD. Echocardiographic and clinical predictors of cardiac amyloidosis: limitations of apical sparing. ESC Heart Fail 2021; 9:385-397. [PMID: 34877800 PMCID: PMC8788049 DOI: 10.1002/ehf2.13738] [Citation(s) in RCA: 13] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/22/2021] [Accepted: 11/11/2021] [Indexed: 01/15/2023] Open
Abstract
Aims The accuracy of an apical‐sparing strain pattern on transthoracic echocardiography (TTE) for predicting cardiac amyloidosis (CA) has varied in prior studies depending on the underlying cohort. We sought to evaluate the performance of apical sparing and other TTE strain findings to screen for CA in an unselected population and determine the frequency that patients with echocardiographic concern for CA undergo evaluation for amyloidosis in clinical practice. Methods and results As strain is routinely performed at our institution on all clinical TTEs, we identified all TTEs performed from 2016 through 2019 with reported concern for CA or apical sparing. We determined the performance characteristics for echocardiographic strain findings in discriminating CA including apical sparing, the ejection fraction to global longitudinal strain ratio (EF/GLS), and the septal apical–septal basal ratio (SA/SB); other clinical predictors of confirmed CA; and predictors of patients who underwent complete evaluation for CA. CA was confirmed by endomyocardial biopsy or diagnostic cardiac imaging. A total of 547 TTEs, representing 451 patients, reported concern for CA and had adequate strain for analysis. A total of 111 patients underwent complete evaluation for amyloidosis with 100 patients undergoing complete cardiac evaluation for CA. In those 100 patients, multivariable predictors of confirmed CA were age [odds ratio (OR) 3.37 per 5 years], a visual apical‐sparing pattern (OR 10.85), and left ventricular ejection fraction (LVEF)/GLS > 4.1 (OR 35.37). CA was less likely in those with coronary artery disease (OR 0.04), hypertension (OR 0.18), and increased systolic blood pressure (OR 0.60 per 5 mm Hg increase). SA/SB [area under the curve (AUC) 0.72, 95% confidence interval (CI) 0.60–0.84] and LVEF/GLS (AUC 0.72, 95% CI 0.60–0.84) both had improved discrimination for CA compared with the apical‐sparing ratio (AUC 0.66, 95% CI 0.54–0.79). Many patients with suggestive TTE findings did not receive an evaluation for amyloidosis. Complete evaluation was more likely with Caucasian race (OR 2.1), increased septal thickness (OR 1.4), increased body mass index (OR 1.2), and if the report specifically stated ‘amyloid’ (OR 1.9). Evaluations were less likely in patients with comorbidities. While hypertension reduced the likelihood of evaluating for CA, 34% of patients with CA had hypertension (>130/80 mm Hg) at time of diagnosis. Conclusions In a broad population of patients undergoing TTE, apical sparing on strain imaging increased the likelihood of CA diagnosis but with modest sensitivity and specificity. GLS/EF ratio may be a more reliable tool to screen for CA. The low rate of complete evaluation in patients with concerning TTE findings indicates a strong need for practice improvement and enhanced disease awareness.
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Affiliation(s)
- Douglas Kyrouac
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Walter Schiffer
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Brandon Lennep
- Cardiovascular Division, University of Mississippi School of Medicine, Jackson, MS, USA
| | - Nicole Fergestrom
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kathleen W Zhang
- Cardio-Oncology Center of Excellence, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
| | - John Gorcsan
- Cardio-Oncology Center of Excellence, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
| | - Daniel J Lenihan
- Cardio-Oncology Center of Excellence, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua D Mitchell
- Cardio-Oncology Center of Excellence, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
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Patel K, Schiffer W, Lenihan D, Zhang K. VASCULAR CALCIFICATION IS ASSOCIATED WITH SYMPTOMATIC HEART FAILURE AFTER IMMUNE CHECKPOINT INHIBITOR THERAPY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)04652-0] [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: 11/24/2022]
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6
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Schiffer W, Zhang K, Deych E, Alvarez-Cardona J, Lenihan D. PRE-TREATMENT AORTOILIAC CALCIFICATION IS MORE SEVERE IN PATIENTS WHO DEVELOP CARDIOVASCULAR TOXICITY AFTER IMMUNE CHECKPOINT INHIBITOR THERAPY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31426-1] [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: 11/24/2022]
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7
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Karlstaedt A, Vitrac H, Gould BD, Salazar R, Taylor D, Spivia W, Soetkamp D, Dinh A, Raedschelders K, Burks H, Schiffer W, McNavish D, Hanson B, Gottlieb RA, VanEyk J, Taegtmeyer H. Abstract 361: Deacetylation of Lc3 Drives Autophagy and Proteome Remodeling in Skeletal Muscle During Oncometabolic Stress. Circ Res 2019. [DOI: 10.1161/res.125.suppl_1.361] [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: 11/16/2022]
Abstract
Metabolic rewiring is a hallmark of cancer and muscle cells. In isocitrate dehydrogenase 1 and 2 mutant tumors, increased plasma levels of the oncometabolite D-2-hydroxyglutarate (D2-HG) are associated with systemic effects, including myopathy. Our recent
in vivo
work showed that increased D2-HG supply by IDH-mutant cells causes heart and skeletal muscle atrophy, and decreases cellular ATP and NADH. Although heart failure and cachexia in cancer are commonly associated with chemotherapy, cancer survivors have a 5-fold increased risk of heart failure independent of any cytostatic treatment. The connection between metabolic and proteomic remodeling in this context remain poorly understood. We hypothesize that D2-HG-mediated alpha-ketoglutarate dehydrogenase (AKGDH) inhibition in myocytes results in metabolomic perturbations, increases autophagy and proteomic remodeling. Here, we report that LC3, a key regulator of autophagy, is activated in the nucleus of myocytes in presence of D2-HG through deacetylation by the nuclear deacetylase Sirt1. Activation of Sirt1 is driven by increased NAD
+
levels through D2-HG-mediated AKGDH inhibition. We used LC3 mutants with arginine and glutamine replacements at lysine residues to show that deacetylation of LC3 at K49 and K51 by Sirt1 shifts LC3 distribution from the nucleus into the cytosol, where it is able to undergo lipidation at pre-autophagic membranes. Live cell imaging with GFP-tagged LC3 in L6 myocytes indicated that the cycle of acetylation-deacetylation allows LC3 to redistribute from the nucleus to the cytosol within less than 24 h. Co-immunoprecipitation of LC3 followed by proteomics analysis revealed that LC3 binds to dynein in presence of D2-HG. Furthermore, D2-HG promoted skeletal muscle atrophy and reduced grip strength in wild-type C57BL/J6 mice in vivo. Using LC-MS/MS-based proteomics and metabolomics combined with RNA-sequencing, we assessed the effect of D2-HG on a systems level in skeletal muscle. Pathway-enrichment analysis revealed that D2-HG induces upregulation of key metabolic enzymes involved in glycolysis and the pentose phosphate pathway. In short, autophagy activation supports proteome remodeling in muscle cells during IDH-mutant leukemia.
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Affiliation(s)
| | | | | | | | | | | | | | - An Dinh
- McGovern Med Sch at UTHealth, Houston, TX
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8
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Karlstaedt A, Schiffer W, Taegtmeyer H. Actionable Metabolic Pathways in Heart Failure and Cancer-Lessons From Cancer Cell Metabolism. Front Cardiovasc Med 2018; 5:71. [PMID: 29971237 PMCID: PMC6018530 DOI: 10.3389/fcvm.2018.00071] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/24/2018] [Indexed: 12/21/2022] Open
Abstract
Recent advances in cancer cell metabolism provide unprecedented opportunities for a new understanding of heart metabolism and may offer new approaches for the treatment of heart failure. Key questions driving the cancer field to understand how tumor cells reprogram metabolism and to benefit tumorigenesis are also applicable to the heart. Recent experimental and conceptual advances in cancer cell metabolism provide the cardiovascular field with the unique opportunity to target metabolism. This review compares cancer cell metabolism and cardiac metabolism with an emphasis on strategies of cellular adaptation, and how to exploit metabolic changes for therapeutic benefit.
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Affiliation(s)
- Anja Karlstaedt
- Division of Cardiology, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Walter Schiffer
- Division of Cardiology, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Heinrich Taegtmeyer
- Division of Cardiology, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
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9
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Bedi SS, Aertker BM, Liao GP, Caplan HW, Bhattarai D, Mandy F, Mandy F, Fernandez LG, Zelnick P, Mitchell MB, Schiffer W, Johnson M, Denson E, Prabhakara K, Xue H, Smith P, Uray K, Olson SD, Mays RW, Cox CS. Therapeutic time window of multipotent adult progenitor therapy after traumatic brain injury. J Neuroinflammation 2018; 15:84. [PMID: 29548333 PMCID: PMC5856201 DOI: 10.1186/s12974-018-1122-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 03/08/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a major cause of death and disability. TBI results in a prolonged secondary central neuro-inflammatory response. Previously, we have demonstrated that multiple doses (2 and 24 h after TBI) of multipotent adult progenitor cells (MAPC) delivered intravenously preserve the blood-brain barrier (BBB), improve spatial learning, and decrease activated microglia/macrophages in the dentate gyrus of the hippocampus. In order to determine if there is an optimum treatment window to preserve the BBB, improve cognitive behavior, and attenuate the activated microglia/macrophages, we administered MAPC at various clinically relevant intervals. METHODS We administered two injections intravenously of MAPC treatment at hours 2 and 24 (2/24), 6 and 24 (6/24), 12 and 36 (12/36), or 36 and 72 (36/72) post cortical contusion injury (CCI) at a concentration of 10 million/kg. For BBB experiments, animals that received MAPC at 2/24, 6/24, and 12/36 were euthanized 72 h post injury. The 36/72 treated group was harvested at 96 h post injury. RESULTS Administration of MAPC resulted in a significant decrease in BBB permeability when administered at 2/24 h after TBI only. For behavior experiments, animals were harvested post behavior paradigm. There was a significant improvement in spatial learning (120 days post injury) when compared to cortical contusion injury (CCI) in groups when MAPC was administered at or before 24 h. In addition, there was a significant decrease in activated microglia/macrophages in the dentate gyrus of hippocampus of the treated group (2/24) only when compared to CCI. CONCLUSIONS Intravenous injections of MAPC at or before 24 h after CCI resulted in improvement of the BBB, improved cognitive behavior, and attenuated activated microglia/macrophages in the dentate gyrus.
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Affiliation(s)
- Supinder S Bedi
- Departments of Pediatric Surgery, University of Texas, Health Science Center at Houston, Houston, TX, USA.
| | - Benjamin M Aertker
- Departments of Pediatric Surgery, University of Texas, Health Science Center at Houston, Houston, TX, USA
| | - George P Liao
- Departments of Pediatric Surgery, University of Texas, Health Science Center at Houston, Houston, TX, USA
| | - Henry W Caplan
- Departments of Pediatric Surgery, University of Texas, Health Science Center at Houston, Houston, TX, USA
| | - Deepa Bhattarai
- Departments of Pediatric Surgery, University of Texas, Health Science Center at Houston, Houston, TX, USA
| | - Fanni Mandy
- Departments of Pediatric Surgery, University of Texas, Health Science Center at Houston, Houston, TX, USA
| | - Franciska Mandy
- Departments of Pediatric Surgery, University of Texas, Health Science Center at Houston, Houston, TX, USA
| | - Luis G Fernandez
- Departments of Pediatric Surgery, University of Texas, Health Science Center at Houston, Houston, TX, USA
| | - Pamela Zelnick
- Departments of Pediatric Surgery, University of Texas, Health Science Center at Houston, Houston, TX, USA
| | - Matthew B Mitchell
- Departments of Pediatric Surgery, University of Texas, Health Science Center at Houston, Houston, TX, USA
| | - Walter Schiffer
- Departments of Pediatric Surgery, University of Texas, Health Science Center at Houston, Houston, TX, USA
| | - Margaret Johnson
- Departments of Pediatric Surgery, University of Texas, Health Science Center at Houston, Houston, TX, USA
| | - Emma Denson
- Departments of Pediatric Surgery, University of Texas, Health Science Center at Houston, Houston, TX, USA
| | - Karthik Prabhakara
- Departments of Pediatric Surgery, University of Texas, Health Science Center at Houston, Houston, TX, USA
| | - Hasen Xue
- Departments of Pediatric Surgery, University of Texas, Health Science Center at Houston, Houston, TX, USA
| | - Philippa Smith
- Departments of Pediatric Surgery, University of Texas, Health Science Center at Houston, Houston, TX, USA
| | - Karen Uray
- Departments of Pediatric Surgery, University of Texas, Health Science Center at Houston, Houston, TX, USA
| | - Scott D Olson
- Departments of Pediatric Surgery, University of Texas, Health Science Center at Houston, Houston, TX, USA
| | | | - Charles S Cox
- Departments of Pediatric Surgery, University of Texas, Health Science Center at Houston, Houston, TX, USA.,Departments of Surgery, University of Texas, Health Science Center at Houston, Houston, TX, USA.,Michael E DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices and Athersys, Inc., Cleveland, OH, USA
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10
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Ding YS, Studenov AR, Zhang Z, Gerasimov M, Schiffer W, Dewey SL, Telang F. Novel synthesis of [11C]GVG (vigabatrin) for pharmacokinetic studies of addiction treatment. J Labelled Comp Radiopharm 2001. [DOI: 10.1002/jlcr.25804401357] [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: 11/09/2022]
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11
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Hutchinson M, Schiffer W, Joseffer S, Liu A, Schlosser R, Dikshit S, Goldberg E, Brodie JD. Task-specific deactivation patterns in functional magnetic resonance imaging. Magn Reson Imaging 1999; 17:1427-36. [PMID: 10609991 DOI: 10.1016/s0730-725x(99)00093-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [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] [Indexed: 10/18/2022]
Abstract
In general, image analysis of cognitive experiments using functional magnetic resonance imaging techniques has emphasized those regions of the brain where increases in signal intensity, with regard to the reference state, are associated with activation. Nevertheless, a number of recent papers have shown that there are areas of deactivation as well. In this study, we have used a univariate analysis and echo-planar functional magnetic resonance imaging to address the relationship of the reference state to the deactivations. We employed two dichotomous covert tasks, orthographic lexical retrieval and pure visual retrieval, to contrast with the reference state (baseline) of silent counting. Our analysis yielded extensive, task-specific landscapes of regional incremental and decremental responses. We have specifically demonstrated that the decremental responses are not due to activation in the reference state. We have also demonstrated that they are not an artifact of a specific part of the image analysis, and propose that they represent a physiological, task specific signal that should be considered an integral component of neural networks representing brain function.
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Affiliation(s)
- M Hutchinson
- Department of Neurology, New York University School of Medicine, NY 10016, USA.
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12
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Schlösser R, Bartlett E, Brodie J, Simkowitz P, Dewey S, Lindenmayer JP, Rusinek H, Wolkin A, Schiffer W, Cancro R. Regional brain metabolic effects of an acute haloperidol challenge in neuroleptic-responsive and non-responsive schizophrenics. Neuroimage 1998. [DOI: 10.1016/s1053-8119(18)31068-1] [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: 11/24/2022] Open
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13
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Bartlett EJ, Brodie JD, Simkowitz P, Schlösser R, Dewey SL, Lindenmayer JP, Rusinek H, Wolkin A, Cancro R, Schiffer W. Effect of a haloperidol challenge on regional brain metabolism in neuroleptic-responsive and nonresponsive schizophrenic patients. Am J Psychiatry 1998; 155:337-43. [PMID: 9501742 DOI: 10.1176/ajp.155.3.337] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.7] [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: 02/06/2023]
Abstract
OBJECTIVE The CNS metabolic response to a neuroleptic challenge in treatment-responsive and nonresponsive schizophrenic patients was measured in order to examine the relation between treatment outcome and the capacity to alter neurochemical function in response to acute receptor blockade. METHOD Positron emission tomography (PET) and [18F]fluorodeoxyglucose (FDG) were used to measure regional cerebral metabolism in seven schizophrenic patients judged to have been responsive to drug treatment previously and seven nonresponsive schizophrenic patients after a drug-free period of at least 3 weeks (baseline) and again 12 hours after administration of 5.0 mg of haloperidol. RESULTS The haloperidol challenge caused widespread decreases in absolute metabolism in the nonresponsive patients but not the responsive patients. These group differences reflect the findings on the second (challenge) scans, since metabolic values at baseline were not statistically different in the two groups. The pattern of decreased metabolic activity in the nonresponders after the haloperidol challenge is similar to that previously observed in normal subjects. CONCLUSIONS The metabolic response to drug challenge separates treatment responders from nonresponders and normal subjects. The results suggest that subtyping of schizophrenia (and other psychiatric disorders) can be achieved by measuring the physiologic response to a pharmacologic challenge in vivo with chemical brain-imaging techniques.
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Affiliation(s)
- E J Bartlett
- Department of Psychiatry, New York University Medical Center, NY 10016, USA
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14
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Meyer VU, Marten W, Schiffer W, Raff WK. [The effect of increased extracellular calcium concentration on the hypoxic and pharmacologic hyperemia of skeletal muscle]. Arzneimittelforschung 1975; 25:749-53. [PMID: 1242316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The influence of an increased Ca concentration on reactive hyperemia, work induced vasodilation and pharmacologically induced dilation (adenosine, nifedipine, verapamil) was studied in the blood perfused gastrocnemius of dogs. Reactive hyperemia, work induced vasodilation and increased blood flow by administration of adenosine could not be influenced by increased extracellular Ca concentrations. A Ca antagonism was demonstrated for nifedipine and verapamil, especially with regard to a diminution of the drug eff.
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Abstract
On 11 isolated dog hearts, perfused with arterial blood of a donor dog, the degree of hypoxic dilatation and the maximum coronary blood flow achieved by adenosine were compared. The maximum coronary blood flow under adenosine infusion amounted to 455ml/minx100g, that means an increase of about 600% of the normal flow. If coronary venous pO2 was below 5mm Hg coronary blood flow was increased to 420ml/minx100g, which is 93% of the pharmacologically achieved maximum increase of the coronary blood flow. The difference between the maximum hypoxic and the maximum pharmacological dilatation is due to the method; it is caused by an increase of the extravascular component of coronary resistance under the influence of catecholamines in the case of hypoxic dilatation. It is pointed out that in order to achieve a maximum hypoxic dilatation oxygen pressure has to be below the critical value. It can be concluded that the intravascular component of coronary resistance is as low under hypoxic as under pharmacological dilatation.
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16
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Schiffer W. [The treatment of unspecific coughs during a spá cure in a health resort for rheumatics]. Dtsch Med J 1966; 17:599-600. [PMID: 5297032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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