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Lepak AJ, Buys A, Stevens L, LeClair-Netzel M, Anderson L, Osman F, Brennan MB, Bartels CM, Safdar N. COVID-19 in Health Care Personnel: Significance of Health Care Role, Contact History, and Symptoms in Those Who Test Positive for SARS-CoV-2 Infection. Mayo Clin Proc 2021; 96:2312-2322. [PMID: 34366140 PMCID: PMC8249700 DOI: 10.1016/j.mayocp.2021.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/14/2021] [Accepted: 06/25/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify significant factors that help predict whether health care personnel (HCP) will test positive for severe acute respiratory coronavirus 2 (SARS-CoV-2). PATIENTS AND METHODS We conducted a prospective cohort study among 7015 symptomatic HCP from March 25, 2020, through November 11, 2020. We analyzed the associations between health care role, contact history, symptoms, and a positive nasopharyngeal swab SARS-CoV-2 polymerase chain reaction test results, using univariate and multivariable modelling. RESULTS Of the symptomatic HCP, 624 (8.9%) were positive over the study period. On multivariable analysis, having a health care role other than physician or advanced practice provider, contact with family or community member with known or suspected coronavirus disease 2019 (COVID-19), and seven individual symptoms (cough, anosmia, ageusia, fever, myalgia, chills, and headache) were significantly associated with higher adjusted odds ratios for testing positive for SARS-CoV-2. For each increase in symptom number, the odds of testing positive nearly doubled (odds ratio, 1.93; 95% CI, 1.82 to 2.07, P<.001). CONCLUSION Symptomatic HCP have higher adjusted odds of testing positive for SARS-CoV-2 based on three distinct factors: (1) nonphysician/advanced practice provider role, (2) contact with a family or community member with suspected or known COVID-19, and (3) specific symptoms and symptom number. Differences among health care roles, which persisted after controlling for contacts, may reflect the influence of social determinants. Contacts with COVID-19-positive patients and/or HCP were not associated with higher odds of testing positive, supporting current infection control efforts. Targeted symptom and contact questionnaires may streamline symptomatic HCP testing for COVID-19.
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Key Words
- app, advanced practice provider
- astm, american society for testing and materials (formerly)
- cdc, centers for disease control and prevention
- covid-19, coronavirus disease 2019
- hcp, health care personnel
- irb, institutional review board
- ma, medical assistant
- np, nasopharyngeal
- or, odds ratio
- pcr, polymerase chain reaction
- ppe, personal protective equipment
- rt-pcr, real-time polymerase chain reaction
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
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Affiliation(s)
- Alexander J Lepak
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Ashley Buys
- Infection Control Department, UW Health University Hospital, Madison, WI, USA
| | - Linda Stevens
- Nursing Quality and Safety, UW Health University Hospital, Madison, WI, USA
| | | | - Laura Anderson
- Infection Control, University of Wisconsin Medical Foundation, Inc, Madison, WI, USA
| | - Fauzia Osman
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Meghan B Brennan
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Christie M Bartels
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Nasia Safdar
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; William S. Middleton Memorial Veterans Affairs Medical Center, Madison, WI, USA
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Khanna S, Tande A, Rubin DT, Khoruts A, Kahn SA, Pardi DS. Fecal Microbiota Transplantation for Recurrent C difficile Infection During the COVID-19 Pandemic: Experience and Recommendations. Mayo Clin Proc 2021; 96:1418-1425. [PMID: 34088413 PMCID: PMC8169126 DOI: 10.1016/j.mayocp.2021.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/23/2021] [Accepted: 04/12/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To report experience with fecal microbiota transplantation (FMT) for recurrent Clostridioides difficile infection (rCDI) and provide recommendations for management of rCDI and donor testing during the COVID-19 pandemic. METHODS A retrospective study of patients with rCDI who underwent FMT from May 26, 2020, to September 30, 2020, with stool from well-screened donors with health and infectious screening and a newly implemented strategy for COVID-19 screening with every 2-week bookend testing with stool quarantine. Patients were followed up for development of rCDI and COVID-19. RESULTS Of the 57 patients who underwent FMT for rCDI, 29 were tested for COVID-19 via nasopharyngeal polymerase chain reaction (PCR) and 22 via serology. All results were negative, except for 1 positive serology. Donor testing every 2 weeks for COVID-19 via serology and nasopharyngeal swab PCR was negative, except for 2 donors at 1 center who were excluded. Three patients had rCDI after FMT, and 1 underwent repeat FMT. One patient developed respiratory symptoms suggestive of COVID-19 and tested negative via nasopharyngeal PCR. Eleven patients who underwent COVID-19 testing for elective procedures or hospitalizations tested negative. No SARS-CoV-2 transmission was noted. CONCLUSIONS With appropriate donor screening, FMT can be performed safely for rCDI during the COVID-19 pandemic. Development of a validated stool assay for SARS-CoV-2 will simplify this process further.
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Affiliation(s)
- Sahil Khanna
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
| | - Aaron Tande
- Infectious Diseases, Mayo Clinic, Rochester, MN
| | - David T Rubin
- Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, IL
| | - Alexander Khoruts
- Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN
| | - Stacy A Kahn
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA
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Lapid MI, Meagher KM, Giunta HC, Clarke BL, Ouellette Y, Armbrust TL, Sharp RR, Wright RS. Ethical Challenges in COVID-19 Biospecimen Research: Perspectives From Institutional Review Board Members and Bioethicists. Mayo Clin Proc 2021; 96:165-173. [PMID: 33413815 PMCID: PMC7584427 DOI: 10.1016/j.mayocp.2020.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/28/2020] [Accepted: 10/20/2020] [Indexed: 02/06/2023]
Abstract
Biospecimen research is a prominent investigative strategy that aims to provide novel insights into coronavirus disease 2019 (COVID-19), inform clinical trials, and develop effective, life-saving treatments. However, COVID-19 biospecimen research raises accompanying ethical concerns and practical challenges for investigators and participants. In this special article, we discuss the ethical issues that are associated with autonomy, beneficence, and justice in COVID-19 biospecimen research and describe strategies to manage the practical challenges, with an emphasis on protecting the rights and welfare of human research participants during a pandemic response. Appropriate institutional review board oversight and bioethics guidance for COVID-19 biospecimen research must maintain their focus on protecting the rights and welfare of research participants, despite the urgent need for more knowledge about the virus and the threat it poses to communities and nations.
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Affiliation(s)
- Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
| | - Karen M Meagher
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN; Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
| | - Hannah C Giunta
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Bart L Clarke
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - Yves Ouellette
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Tamyra L Armbrust
- Office for Human Research Protection and Institutional Review Board, Mayo Clinic, Rochester, MN
| | - Richard R Sharp
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN; Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN; Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | - R Scott Wright
- Office for Human Research Protection and Institutional Review Board, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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4
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Yonker LM, Neilan AM, Bartsch Y, Patel AB, Regan J, Arya P, Gootkind E, Park G, Hardcastle M, St John A, Appleman L, Chiu ML, Fialkowski A, De la Flor D, Lima R, Bordt EA, Yockey LJ, D'Avino P, Fischinger S, Shui JE, Lerou PH, Bonventre JV, Yu XG, Ryan ET, Bassett IV, Irimia D, Edlow AG, Alter G, Li JZ, Fasano A. Pediatric Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): Clinical Presentation, Infectivity, and Immune Responses. J Pediatr 2020; 227:45-52.e5. [PMID: 32827525 PMCID: PMC7438214 DOI: 10.1016/j.jpeds.2020.08.037] [Citation(s) in RCA: 224] [Impact Index Per Article: 56.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES As schools plan for re-opening, understanding the potential role children play in the coronavirus infectious disease 2019 (COVID-19) pandemic and the factors that drive severe illness in children is critical. STUDY DESIGN Children ages 0-22 years with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection presenting to urgent care clinics or being hospitalized for confirmed/suspected SARS-CoV-2 infection or multisystem inflammatory syndrome in children (MIS-C) at Massachusetts General Hospital were offered enrollment in the Massachusetts General Hospital Pediatric COVID-19 Biorepository. Enrolled children provided nasopharyngeal, oropharyngeal, and/or blood specimens. SARS-CoV-2 viral load, ACE2 RNA levels, and serology for SARS-CoV-2 were quantified. RESULTS A total of 192 children (mean age, 10.2 ± 7.0 years) were enrolled. Forty-nine children (26%) were diagnosed with acute SARS-CoV-2 infection; an additional 18 children (9%) met the criteria for MIS-C. Only 25 children (51%) with acute SARS-CoV-2 infection presented with fever; symptoms of SARS-CoV-2 infection, if present, were nonspecific. Nasopharyngeal viral load was highest in children in the first 2 days of symptoms, significantly higher than hospitalized adults with severe disease (P = .002). Age did not impact viral load, but younger children had lower angiotensin-converting enzyme 2 expression (P = .004). Immunoglobulin M (IgM) and Immunoglobulin G (IgG) to the receptor binding domain of the SARS-CoV-2 spike protein were increased in severe MIS-C (P < .001), with dysregulated humoral responses observed. CONCLUSIONS This study reveals that children may be a potential source of contagion in the SARS-CoV-2 pandemic despite having milder disease or a lack of symptoms; immune dysregulation is implicated in severe postinfectious MIS-C.
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Key Words
- ace2, angiotensin-converting enzyme
- covid-19, coronavirus disease-19
- ipo8, importin-8
- irb, institutional review board
- mgh, massachusetts general hospital
- mis-c, multisystem inflammatory syndrome in children
- nt-probnb, n-terminal pro b-type natriuretic peptide
- rbd, receptor binding domain
- rsv, respiratory syncytial virus
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
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Affiliation(s)
- Lael M Yonker
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA; Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Anne M Neilan
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Yannic Bartsch
- Harvard Medical School, Boston, MA; Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard, Harvard Medical School, Cambridge, MA
| | - Ankit B Patel
- Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Department of Medicine, Renal Division, Boston, MA
| | - James Regan
- Department of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
| | - Puneeta Arya
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | | | - Grace Park
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Margot Hardcastle
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Anita St John
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Lori Appleman
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Michelle L Chiu
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | | | - Denis De la Flor
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA; Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Rosiane Lima
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA; Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Evan A Bordt
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Laura J Yockey
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA; Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA
| | - Paolo D'Avino
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA
| | - Stephanie Fischinger
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard, Harvard Medical School, Cambridge, MA
| | - Jessica E Shui
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Paul H Lerou
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Joseph V Bonventre
- Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Department of Medicine, Renal Division, Boston, MA
| | - Xu G Yu
- Harvard Medical School, Boston, MA; Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard, Harvard Medical School, Cambridge, MA; Department of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
| | - Edward T Ryan
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Internal Medicine, Massachusetts General Hospital, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA
| | - Ingrid V Bassett
- Harvard Medical School, Boston, MA; Department of Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Daniel Irimia
- Harvard Medical School, Boston, MA; Center for Engineering in Medicine, Department of Surgery, Boston, MA
| | - Andrea G Edlow
- Harvard Medical School, Boston, MA; Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA; Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Massachusetts General Hospital Boston, Boston, MA
| | - Galit Alter
- Harvard Medical School, Boston, MA; Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard, Harvard Medical School, Cambridge, MA
| | - Jonathan Z Li
- Harvard Medical School, Boston, MA; Department of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
| | - Alessio Fasano
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA; Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
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5
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Joyner MJ, Bruno KA, Klassen SA, Kunze KL, Johnson PW, Lesser ER, Wiggins CC, Senefeld JW, Klompas AM, Hodge DO, Shepherd JRA, Rea RF, Whelan ER, Clayburn AJ, Spiegel MR, Baker SE, Larson KF, Ripoll JG, Andersen KJ, Buras MR, Vogt MNP, Herasevich V, Dennis JJ, Regimbal RJ, Bauer PR, Blair JE, van Buskirk CM, Winters JL, Stubbs JR, van Helmond N, Butterfield BP, Sexton MA, Diaz Soto JC, Paneth NS, Verdun NC, Marks P, Casadevall A, Fairweather D, Carter RE, Wright RS. Safety Update: COVID-19 Convalescent Plasma in 20,000 Hospitalized Patients. Mayo Clin Proc 2020; 95:1888-1897. [PMID: 32861333 PMCID: PMC7368917 DOI: 10.1016/j.mayocp.2020.06.028] [Citation(s) in RCA: 293] [Impact Index Per Article: 73.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To provide an update on key safety metrics after transfusion of convalescent plasma in hospitalized coronavirus 2019 (COVID-19) patients, having previously demonstrated safety in 5000 hospitalized patients. PATIENTS AND METHODS From April 3 to June 2, 2020, the US Food and Drug Administration Expanded Access Program for COVID-19 convalescent plasma transfused a convenience sample of 20,000 hospitalized patients with COVID-19 convalescent plasma. RESULTS The incidence of all serious adverse events was low; these included transfusion reactions (n=78; <1%), thromboembolic or thrombotic events (n=113; <1%), and cardiac events (n=677, ~3%). Notably, the vast majority of the thromboembolic or thrombotic events (n=75) and cardiac events (n=597) were judged to be unrelated to the plasma transfusion per se. The 7-day mortality rate was 13.0% (12.5%, 13.4%), and was higher among more critically ill patients relative to less ill counterparts, including patients admitted to the intensive care unit versus those not admitted (15.6 vs 9.3%), mechanically ventilated versus not ventilated (18.3% vs 9.9%), and with septic shock or multiple organ dysfunction/failure versus those without dysfunction/failure (21.7% vs 11.5%). CONCLUSION These updated data provide robust evidence that transfusion of convalescent plasma is safe in hospitalized patients with COVID-19, and support the notion that earlier administration of plasma within the clinical course of COVID-19 is more likely to reduce mortality.
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Affiliation(s)
- Michael J Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN. https://twitter.com/DrMJoyner
| | - Katelyn A Bruno
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | - Stephen A Klassen
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Katie L Kunze
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ
| | - Patrick W Johnson
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
| | | | - Chad C Wiggins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Jonathon W Senefeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Allan M Klompas
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
| | - John R A Shepherd
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Robert F Rea
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Emily R Whelan
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | - Andrew J Clayburn
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Matthew R Spiegel
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
| | - Sarah E Baker
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Kathryn F Larson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Juan G Ripoll
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Kylie J Andersen
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Matthew R Buras
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ
| | - Matthew N P Vogt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Vitaly Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Joshua J Dennis
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Riley J Regimbal
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Philippe R Bauer
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, MN
| | - Janis E Blair
- Department of Internal Medicine, Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ
| | | | - Jeffrey L Winters
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - James R Stubbs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Noud van Helmond
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ
| | - Brian P Butterfield
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Matthew A Sexton
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Juan C Diaz Soto
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Nigel S Paneth
- Departments of Epidemiology and Biostatistics and Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing
| | - Nicole C Verdun
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD
| | - Peter Marks
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Rickey E Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
| | - R Scott Wright
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Human Research Protection Program, Mayo Clinic, Rochester, MN
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6
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Lewis R, Li YD, Hoffman L, Hashizume R, Gravohac G, Rice G, Wadhwani NR, Jie C, Pundy T, Mania-Farnell B, Mayanil CS, Soares MB, Lei T, James CD, Foreman NK, Tomita T, Xi G. Global Reduction of H3K4me3 Improves Chemotherapeutic Efficacy for Pediatric Ependymomas. Neoplasia 2019; 21:505-515. [PMID: 31005631 PMCID: PMC6477190 DOI: 10.1016/j.neo.2019.03.012] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/24/2019] [Accepted: 03/26/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Ependymomas (EPNs) are the third most common brain tumor in children. These tumors are resistant to available chemotherapeutic treatments, therefore new effective targeted therapeutics must be identified. Increasing evidence shows epigenetic alterations including histone posttranslational modifications (PTMs), are associated with malignancy, chemotherapeutic resistance and prognosis for pediatric EPNs. In this study we examined histone PTMs in EPNs and identified potential targets to improve chemotherapeutic efficacy. METHODS Global histone H3 lysine 4 trimethylation (H3K4me3) levels were detected in pediatric EPN tumor samples with immunohistochemistry and immunoblots. Candidate genes conferring therapeutic resistance were profiled in pediatric EPN tumor samples with micro-array. Promoter H3K4me3 was examined for two candidate genes, CCND1 and ERBB2, with chromatin-immunoprecipitation coupled with real-time PCR (ChIP-PCR). These methods and MTS assay were used to verify a relationship between H3K4me3 levels and CCND1 and ERBB2, and to investigate cell viability in response to chemotherapeutic drugs in primary cultured pediatric EPN cells. RESULTS H3K4me3 levels positively correlate with WHO grade malignancy in pediatric EPNs and are associated with progression free survival in patients with posterior fossa group A EPNs (PF-EPN-A). Reduction of H3K4me3 by silencing its methyltransferase SETD1A, in primary cultured EPN cells increased cell response to chemotherapy. CONCLUSIONS Our results support the development of a novel treatment that targets H3K4me3 to increase chemotherapeutic efficacy in pediatric PF-EPN-A tumors.
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Key Words
- epn, ependymoma
- ptm, posttranslational modification
- cns, central nervous system
- emem, eagle's minimum essential medium
- cimp+, cpg island methylator positive
- tss, transcription start site
- pfs, progression free survival
- vcr, vincristine
- cpl, carboplatin
- irb, institutional review board
- mts, 3-(4, 5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2h-tetrazolium
- ffpe, formalin-fixed paraffin-embedded
- chip-pcr, chromatin-immunoprecipitation coupled with real-time pcr
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Affiliation(s)
- Rebecca Lewis
- Falk Brain Tumor Center and Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Yuping D Li
- Falk Brain Tumor Center and Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lindsey Hoffman
- Department of Pediatrics, University of Colorado Denver, Aurora, CO, USA,Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, CO, USA
| | - Rintaro Hashizume
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gordan Gravohac
- Falk Brain Tumor Center and Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gavin Rice
- Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nitin R Wadhwani
- Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chunfa Jie
- Department of Biochemistry, Des Moines University, Des Moines, Iowa, USA
| | - Tatiana Pundy
- Falk Brain Tumor Center and Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Chandra S Mayanil
- Falk Brain Tumor Center and Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Department of Development Biology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Marcelo B Soares
- Cancer Biology and Epigenomics Program, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ting Lei
- Department of Neurological Surgery of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Charles D James
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nicolas K Foreman
- Department of Pediatrics, University of Colorado Denver, Aurora, CO, USA,Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, CO, USA
| | - Tadanori Tomita
- Falk Brain Tumor Center and Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Guifa Xi
- Falk Brain Tumor Center and Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Development Biology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Hegge SR, Hickey BW, Mcgrath SM, Stewart VA. Using Hematology Data from Malaria Vaccine Research Trials in Humans and Rhesus Macaques ( Macaca mulatta) To Guide Volume Limits for Blood Withdrawal. Comp Med 2016; 66:474-479. [PMID: 28304251 PMCID: PMC5157963] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/21/2016] [Accepted: 06/12/2016] [Indexed: 06/06/2023]
Abstract
Guidelines on safe volume limits for blood collection from research participants in both humans and laboratory animals vary widely between institutions. The main adverse event that may be encountered in large blood volume withdrawal is iron-deficiency anemia. Monitoring various parameters in a standard blood panel may help to prevent this outcome. To this end, we analyzed the Hgb and MCV values from 43 humans and 46 macaques in malaria vaccine research trials. Although the percentage of blood volume removed was greater for macaques than humans, macaques demonstrated an overall increase of MCV over time, indicating the ability to respond appropriately to frequent volume withdrawals. In contrast, humans showed a consistent declining trend in MCV. These declines in human MCV and Hgb were significant from the beginning to end of the study despite withdrawals that were smaller than recommended volume limits. Limiting the volume withdrawn to no more than 12.5% seemed to be sufficient for macaques, and at 14% or more individual animals tended to fail to respond appropriately to large-volume blood loss, as demonstrated by a decrease in MCV. The overall positive erythropoietic response seen in macaques was likely due to the controlled, iron-fortified diet they received. The lack of erythropoietic response in the human subjects may warrant iron supplementation or reconsideration of current blood volume withdrawal guidelines.
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Affiliation(s)
- Sara R Hegge
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland;,
| | - Bradley W Hickey
- Clinical Trials Center, Naval Medical Research Center, Silver Spring, Maryland
| | | | - V Ann Stewart
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Rocca WA, Yawn BP, St Sauver JL, Grossardt BR, Melton LJ. History of the Rochester Epidemiology Project: half a century of medical records linkage in a US population. Mayo Clin Proc 2012; 87:1202-13. [PMID: 23199802 PMCID: PMC3541925 DOI: 10.1016/j.mayocp.2012.08.012] [Citation(s) in RCA: 661] [Impact Index Per Article: 55.1] [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: 06/28/2012] [Revised: 08/10/2012] [Accepted: 08/15/2012] [Indexed: 11/30/2022]
Abstract
The Rochester Epidemiology Project (REP) has maintained a comprehensive medical records linkage system for nearly half a century for almost all persons residing in Olmsted County, Minnesota. Herein, we provide a brief history of the REP before and after 1966, the year in which the REP was officially established. The key protagonists before 1966 were Henry Plummer, Mabel Root, and Joseph Berkson, who developed a medical records linkage system at Mayo Clinic. In 1966, Leonard Kurland established collaborative agreements with other local health care providers (hospitals, physician groups, and clinics [primarily Olmsted Medical Center]) to develop a medical records linkage system that covered the entire population of Olmsted County, and he obtained funding from the National Institutes of Health to support the new system. In 1997, L. Joseph Melton III addressed emerging concerns about the confidentiality of medical record information by introducing a broad patient research authorization as per Minnesota state law. We describe how the key protagonists of the REP have responded to challenges posed by evolving medical knowledge, information technology, and public expectation and policy. In addition, we provide a general description of the system; discuss issues of data quality, reliability, and validity; describe the research team structure; provide information about funding; and compare the REP with other medical information systems. The REP can serve as a model for the development of similar research infrastructures in the United States and worldwide.
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Affiliation(s)
- Walter A Rocca
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA.
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