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Bitektine E, Hintermayer MA, Chen A, Ko A, Rodriguez C. Medical students' perceptions on preparedness and care delivery for patients with autism or intellectual disability. Can Med Educ J 2024; 15:37-47. [PMID: 38528903 PMCID: PMC10961132 DOI: 10.36834/cmej.76338] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Introduction To provide competent care to patients with autism spectrum disorder (ASD) or intellectual developmental disorder (IDD), healthcare professionals must recognize the needs of neurodivergent populations and adapt their clinical approach. We assessed the perceived preparedness of medical students to adapt care delivery for patients with ASD/IDD, as well as their perceptions on neurodiversity education. Methods We conducted a sequential explanatory mixed-methods study on undergraduate medical students at McGill University during the academic year 2020-2021. We administered an online survey, followed by semi-structured interviews. We analyzed data using descriptive statistics and thematic analysis. We integrated findings at the interpretation level. Results We included two-hundred-ten survey responses (~29% of class), and 12 interviews. Few students felt prepared to adjust care for patients with ASD/IDD despite most indicating doing so was important. Ninety-seven percent desired more training regarding care accommodation for neurodivergent patients. Thematic analysis unveiled the perception of current insufficient education, and the value of experiential learning. Discussion/Conclusions This study highlights low perceived preparedness of medical students to accommodate care for neurodivergent patients, and a desire for more instruction. Incorporating interactive training in medical school curricula regarding modifying care delivery for neurodivergent individuals may improve the perceived preparedness of medical trainees to work with these patients and care quality.
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Affiliation(s)
- E Bitektine
- Department of Medicine and Dentistry, McGill University, Quebec, Canada
| | - M A Hintermayer
- Department of Medicine and Dentistry, McGill University, Quebec, Canada
- Montreal Neurological Institute, McGill University, Quebec, Canada
| | - A Chen
- Department of Medicine and Dentistry, McGill University, Quebec, Canada
| | - A Ko
- Department of Medicine and Dentistry, McGill University, Quebec, Canada
| | - C Rodriguez
- Department of Family Medicine, School of Medicine, Faculty of Medicine and Health Sciences, McGill University, Quebec, Canada
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Quebec, Canada
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Cruz S, Ko A, Chi DL. A Qualitative Study on Dentists' Communication Approaches in Managing Fluoride-Hesitant Caregivers. JDR Clin Trans Res 2023:23800844231203673. [PMID: 37908047 DOI: 10.1177/23800844231203673] [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] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVES Guidelines on effective provider-led communication are available but may be underused in dentistry, even if such guidelines could help dentists manage complex clinical scenarios like topical fluoride hesitancy. The purpose of this study was to investigate current chairside communication approaches used by dentists with fluoride-hesitant caregivers. METHODS A 27-item semistructured interview script was developed and pretested with 3 dentists, revised, and finalized. One-on-one interviews were conducted with a purposive sample of pediatric dentists and general dentists from April to June 2020. Interviews were digitally recorded, transcribed, and analyzed to identify dentists' communication approaches used during clinical interactions with fluoride-hesitant caregivers. Thematic analyses identified themes and subthemes, and exemplary quotes were provided to illustrate each theme. RESULTS Twenty-seven dentists participated (21 pediatric dentists and 6 general dentists). The mean age of participants was 43.0 ± 8.2 y (range, 30-73). Most participants were women (88.9%), white (51.9%), and non-Hispanic (85.2%). Participants had been practicing dentistry for a mean of 13.2 ± 10.5 y (range, 2-40). There were 4 themes: leaving topical fluoride decisions completely up to the caregiver, educating the caregiver about fluoride, insisting that the caregiver accept fluoride, and engaging the caregiver and child. CONCLUSION Most communications approaches used by interviewed dentists to manage fluoride hesitancy in clinical settings are not evidence based. Future dental education efforts should ensure that trainees are exposed to and can demonstrate competency in appropriate, evidence-based patient-provider communication strategies. KNOWLEDGE TRANSFER STATEMENT The study highlights the need for dentists to apply evidence-based communication strategies when managing difficult clinical scenarios like fluoride hesitancy, which is important in optimizing dentist-patient trust.
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Affiliation(s)
- S Cruz
- Department of Oral Health Sciences at the University of Washington, Seattle, WA, USA
| | - A Ko
- Department of Oral Health Sciences at the University of Washington, Seattle, WA, USA
| | - D L Chi
- Department of Oral Health Sciences at the University of Washington, Seattle, WA, USA
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Huot S, Ho H, Ko A, Lam S, Tactay P, MacLachlan J, Raanaas RK. Identifying barriers to healthcare delivery and access in the Circumpolar North: important insights for health professionals. Int J Circumpolar Health 2020; 78:1571385. [PMID: 30696379 PMCID: PMC6352934 DOI: 10.1080/22423982.2019.1571385] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Lack of access to healthcare services for people living in the Circumpolar North may have important consequences for their health and well-being, both in terms of the actual treatment and other possible health-related consequences intertwined with their life situation. The aim of the present study was to identify the specific challenges to healthcare service delivery and access for populations in the Circumpolar North that are addressed in contemporary literature. A scoping review of literature published between 2005 and 2016 was conducted and 43 articles were selected for inclusion into the review. The review findings address 4 main themes identified in the literature: (1) the influence of physical geography, (2) healthcare provider-related barriers, (3) the importance of culture and language and (4) the impact of systemic factors. The review of the literature enabled us to identify existing gaps in both health service access and issues discussed in the available literature, particularly for informing healthcare services in the Circumpolar North, as well as point towards opportunities for future research. The thematic findings drawn from interdisciplinary and international literature inform understandings of the impact of health system barriers on healthcare services and the opportunities for Northern residents to support their own health.
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Affiliation(s)
- S Huot
- a Department of Occupational Science and Occupational Therapy , University of British Columbia , Vancouver , Canada
| | - H Ho
- b School of Occupational Therapy , University of Western Ontario , London , Canada
| | - A Ko
- b School of Occupational Therapy , University of Western Ontario , London , Canada
| | - S Lam
- b School of Occupational Therapy , University of Western Ontario , London , Canada
| | - P Tactay
- b School of Occupational Therapy , University of Western Ontario , London , Canada
| | - J MacLachlan
- c Dalla Lana School of Public Health , University of Toronto , Toronto , Canada
| | - R K Raanaas
- d Department of Public Health Science , Norwegian University of Life Sciences , Ås , Norway
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Ko A, Park HJ, Lee ES, Park SB, Kim YK, Choi SY, Ahn S. Comparison of the diagnostic performance of the 2017 and 2018 versions of LI-RADS for hepatocellular carcinoma on gadoxetic acid enhanced MRI. Clin Radiol 2019; 75:319.e1-319.e9. [PMID: 31858990 DOI: 10.1016/j.crad.2019.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 11/13/2019] [Indexed: 12/18/2022]
Abstract
AIM To compare the diagnostic performance of the 2017 (v2017) and 2018 versions (v2018) of the Liver Imaging-Reporting and Data System (LI-RADS) for hepatocellular carcinoma (HCC) using gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-MRI) and to evaluate the effect in v2018. MATERIALS AND METHODS Treatment-naive patients at high-risk for HCC who underwent Gd-EOB-MRI were included. The LI-RADS categories were assigned according to v2017 and v2018. The diagnostic performances were compared between v2017 and v2018 according to the size and combination of imaging features. RESULTS A total of 117 patients with 137 observations were identified, including 89 HCCs; 76.2% (64/84) of observations with threshold growth were re-classified as subthreshold growth when using v2018 instead of v2017. The final categories changed in nine (14%) cases. For the combination of LR-5/LR-5V, there were no significant differences in sensitivity and specificity between the two versions (sensitivity, 64% versus 58.4%; specificity, 87.5% versus 85.4%; all p>0.05). For the combination of LR-4 and LR-5/5V, the diagnostic performance of v2018 was inferior to that of v2017 when considering only major features (accuracy, 86.1% versus 80.3%, respectively; p=0.013), particularly in observations measuring 10-20 mm, but was comparable after adding the ancillary features (accuracy, 86.9% versus 86.1%, respectively; p=1.00). CONCLUSION In LI-RADS v2018, although a considerable number of observations re-classified subthreshold growth, changes in the assigned categories were insignificant; overall diagnostic performance was comparable to that of v2017, but v2018 might emphasise the value of ancillary features in combination with major features for determining the probability of HCC.
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Affiliation(s)
- A Ko
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - H J Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea.
| | - E S Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - S B Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Y K Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - S-Y Choi
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - S Ahn
- Department of Mathematics, Ajou University, Suwon, Republic of Korea
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Bujak A, Weng CF, Silva MJ, Yeung M, Lo L, Ftouni S, Litchfield C, Ko A, Kuykhoven K, van Geelen C, Chandrashekar S, Dawson M, Loi S, Wong S, Dawson SJ. Prospective testing of circulating tumour DNA in metastatic breast cancer facilitates clinical trial enrollment and precision oncology. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz239.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Shin J, Kim S, Park Y, Ko A, Kong J, Nam S. EP.10A progressive infantile myopathy case with TK2-related mitochondrial DNA depletion syndrome: correlation with muscle pathology. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.140] [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: 11/30/2022]
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Barmparas G, Ley EJ, Martin MJ, Ko A, Harada M, Weigmann D, Catchpole KR, Gewertz BL. Failure to rescue the elderly: a superior quality metric for trauma centers. Eur J Trauma Emerg Surg 2017; 44:377-384. [DOI: 10.1007/s00068-017-0782-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
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Thomas M, Aix SP, Ko A, Jotte R, Ong T, Page R, Socinski M, Trunova N, Villaflor V, Spigel D. nab-paclitaxel (nab-P) + carboplatin (C) induction therapy in patients (Pts) with squamous (SCC) NSCLC: Interim quality of life (QoL) outcomes from the phase 3 ABOUND.sqm study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw383.79] [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: 11/13/2022] Open
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George B, Kelly K, Ko A, Soliman H, Trunova N, Wainberg Z, Waterhouse D, O'Dwyer P, Hochster H. Phase I study of nivolumab (nivo) + nab-paclitaxel (nab-P) in solid tumors: results from the pancreatic cancer (PC) and non-small cell lung cancer (NSCLC) cohorts. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw378.13] [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: 11/13/2022] Open
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10
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Hwang M, Park J, Ko A, Kho Y, Hwang I. The association with human biomonitoring and the sources of cadmium exposure among the general Korean adults. Toxicol Lett 2016. [DOI: 10.1016/j.toxlet.2016.06.1751] [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: 10/21/2022]
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Nikkola E, Ko A, Cantor R, Muxel R, Matikainen N, Söderlund S, Motazacker M, Kuivenhoven J, Boren J, Kronenberg F, Schneider W, Palotie A, Laakso M, Taskinen M, Pajukanta P. Investigation of multiple dyslipidemias in a large Austrian pedigree by genetic risk scores and exome sequencing. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.067] [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: 11/17/2022]
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Collisson E, Ohliger M, Yeh B, Kelly D, Pampaloni M, Ko A, Tempero M, Wang Z. P-221 PET-MR Imaging to Assess early treatment response in Pancreatic Adenocarcinoma. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.213] [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: 11/14/2022] Open
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13
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Gridelli C, Ko A, O'Brien M, Ong T, Socinski M, Postmus P. 216PD: nab-Paclitaxel + carboplatin (nab-P/C) in advanced non-small cell lung cancer (NSCLC): outcomes in elderly patients (pts) with squamous (SCC) histology. J Thorac Oncol 2016. [DOI: 10.1016/s1556-0864(16)30329-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chiorean EG, Von Hoff DD, Reni M, Arena FP, Infante JR, Bathini VG, Wood TE, Mainwaring PN, Muldoon RT, Clingan PR, Kunzmann V, Ramanathan RK, Tabernero J, Goldstein D, McGovern D, Lu B, Ko A. CA19-9 decrease at 8 weeks as a predictor of overall survival in a randomized phase III trial (MPACT) of weekly nab-paclitaxel plus gemcitabine versus gemcitabine alone in patients with metastatic pancreatic cancer. Ann Oncol 2016; 27:654-60. [PMID: 26802160 PMCID: PMC4803454 DOI: 10.1093/annonc/mdw006] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [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: 09/01/2015] [Accepted: 12/23/2015] [Indexed: 12/17/2022] Open
Abstract
Any CA19-9 decline at week 8 and radiologic response by week 8 each predicted longer OS in both treatment arms. In the nab-P + Gem arm, the higher proportion of patients with week 8 CA19-9 decrease [82% (206/252); median OS 13.2 months] than a RECIST-defined response [16% (40/252); median OS 13.7 months] suggests that CA19-9 decline is a predictor of OS applicable to a larger population. Background A phase I/II study and subsequent phase III study (MPACT) reported significant correlations between CA19-9 decreases and prolonged overall survival (OS) with nab-paclitaxel plus gemcitabine (nab-P + Gem) treatment for metastatic pancreatic cancer (MPC). CA19-9 changes at week 8 and potential associations with efficacy were investigated as part of an exploratory analysis in the MPACT trial. Patients and methods Untreated patients with MPC (N = 861) received nab-P + Gem or Gem alone. CA19-9 was evaluated at baseline and every 8 weeks. Results Patients with baseline and week-8 CA19-9 measurements were analyzed (nab-P + Gem: 252; Gem: 202). In an analysis pooling the treatments, patients with any CA19-9 decline (80%) versus those without (20%) had improved OS (median 11.1 versus 8.0 months; P = 0.005). In the nab-P + Gem arm, patients with (n = 206) versus without (n = 46) any CA19-9 decrease at week 8 had a confirmed overall response rate (ORR) of 40% versus 13%, and a median OS of 13.2 versus 8.3 months (P = 0.001), respectively. In the Gem-alone arm, patients with (n = 159) versus without (n = 43) CA19-9 decrease at week 8 had a confirmed ORR of 15% versus 5%, and a median OS of 9.4 versus 7.1 months (P = 0.404), respectively. In the nab-P + Gem and Gem-alone arms, by week 8, 16% (40/252) and 6% (13/202) of patients, respectively, had an unconfirmed radiologic response (median OS 13.7 and 14.7 months, respectively), and 79% and 84% of patients, respectively, had stable disease (SD) (median OS 11.1 and 9 months, respectively). Patients with SD and any CA19-9 decrease (158/199 and 133/170) had a median OS of 13.2 and 9.4 months, respectively. Conclusion This analysis demonstrated that, in patients with MPC, any CA19-9 decrease at week 8 can be an early marker for chemotherapy efficacy, including in those patients with SD. CA19-9 decrease identified more patients with survival benefit than radiologic response by week 8.
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Affiliation(s)
- E G Chiorean
- Department of Medicine/Oncology, University of Washington, Fred Hutchinson Cancer Research Center, Seattle
| | - D D Von Hoff
- HonorHealth and The Translational Genomics Research Institute (TGen), Scottsdale, USA
| | - M Reni
- Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - F P Arena
- Department of Oncology, NYU Langone Arena Oncology, Lake Success
| | - J R Infante
- Sarah Cannon Research Institute, Tennessee Oncology, PLLC, Nashville
| | - V G Bathini
- Cancer Center of Excellence, University of Massachusetts Medical School, Worcester
| | - T E Wood
- UAB Comprehensive Cancer Center, Birmingham, USA
| | - P N Mainwaring
- Mater Private Centre for Haematology & Oncology, South Brisbane, Australia
| | - R T Muldoon
- Department of Oncology, Genesis Cancer Center, Hot Springs, USA
| | - P R Clingan
- Southern Medical Day Care Centre, Wollongong, Australia
| | - V Kunzmann
- Medizinische Klinik und Poliklinik II, University of Wuerzburg, Wuerzburg, Germany
| | - R K Ramanathan
- HonorHealth and The Translational Genomics Research Institute (TGen), Scottsdale, USA
| | - J Tabernero
- Medical of Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - D Goldstein
- Department of Oncology, Prince of Wales Hospital, Sydney, Australia
| | | | - B Lu
- Celgene Corporation, Summit, USA
| | - A Ko
- Celgene Corporation, Summit, USA
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McEneny J, Henry S, Fogarty M, Ko A, Ingle L, Young I, Cleland J. Inflammation and peroxidation of HDL are increased in subjects with chronic heart failure. Atherosclerosis 2015. [DOI: 10.1016/j.atherosclerosis.2015.04.380] [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: 11/17/2022]
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Fidelman N, Kerlan R, Taylor A, Kolli K, Kohi M, Hawkins R, Pampaloni M, Atreya C, Bergsland E, Kelley R, Ko A, Korn W, Van Loon K, Luan J, McWhirter R, Johanson C, Venook A. Radioembolization with 490Y glass microspheres for the treatment of unresectable metastatic liver disease from chemotherapy-refractory gastrointestinal cancers: final report of a prospective pilot study. J Vasc Interv Radiol 2015. [DOI: 10.1016/j.jvir.2014.12.511] [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: 11/30/2022] Open
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17
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Ko A, Maslowski A, Jaffe W, Visser A. Rotablation in the treatment of patients with heavily calcified coronary artery disease. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.04.131] [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: 10/23/2022]
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Hirsh V, Page R, Ko A, Renshler M, Socinski M. Analysis of Predictive Factors in a Phase 3 Trial of Nab-Paclitaxel (nab-P) Plus Carboplatin (C) as First-Line Therapy for Patients (Pts) With Advanced Non-Small Cell Lung Cancer (NSCLC). Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.08.228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hirsh V, Owen S, Ko A, Renschler M, Socinski M. Analysis of Outcomes in Diabetic Patients in a Phase 3 Trial of Nab-Paclitaxel (nab-P) Plus Carboplatin (C) in the First-Line Treatment of Advanced Non-Small Cell Lung Cancer (NSCLC). Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.08.176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Baek MH, Suk H, Jung P, Ko A, Han WS, Lee SW, Park JY, Kim D, Kim JH, Kim YM, Kim YT, Nam JH. Feasibility and Safety of Laparoscopic Surgery for Obese Korean Women with Endometrial Cancer: Long-Term Results at a Single Institution. J Minim Invasive Gynecol 2014. [DOI: 10.1016/j.jmig.2014.08.612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cortes J, Ji X, Lin F, Whiting S, Ko A, Bravo M, Fandi A, Botteman M. Mean Overall Survival (Os) and Quality-Adjusted Time Without Symptoms or Toxicity (Q-Twist) of Nanoparticle Albumin-Bound Paclitaxel (Nab-P) Vs Conventional Solvent-Based Paclitaxel (Sb-P) in Metastatic Breast Cancer. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu329.19] [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: 11/15/2022] Open
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Spigel D, Ko A, Ong T, West H, Kim E, Reynolds C. Abound.Sqm: a Phase 3 Randomized Study of Maintenance Nab-Paclitaxel (Nab-P) After Induction Therapy with Nab-P Plus Carboplatin (C) in Patients (Pts) with Squamous Cell (Scc) Non-Small Cell Lung Cancer (Nsclc). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu348.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wilke H, Clingan P, Ananda S, Kurteva G, Suuroja T, Folprecht G, Beny A, Pastorelli D, Cesas A, Toganel C, Bodoky G, Lipatov O, Limon M, Cunningham D, Cummins S, Wainberg Z, Ko A, Emig M, Chandrawansa K, Van Cutsem E. Rainbow: A Global, Phase 3, Double-Blind Study of Ramucirumab Plus Paclitaxel Versus Placebo Plus Paclitaxel in the Treatment of Gastric Cancer Following Disease Progression: Western Population Subgroup. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu193.6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Deutsch E, Ko A, Perfettini J. 56: Impact of tumor autophagy on solid tumors response to IR; role of the tumor stroma. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)34077-9] [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: 11/30/2022]
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Ko A, Kanehisa A, Martins I, Senovilla L, Chargari C, Dugue D, Mariño G, Kepp O, Michaud M, Perfettini JL, Kroemer G, Deutsch E. Autophagy inhibition radiosensitizes in vitro, yet reduces radioresponses in vivo due to deficient immunogenic signalling. Cell Death Differ 2014; 21:92-9. [PMID: 24037090 PMCID: PMC3857616 DOI: 10.1038/cdd.2013.124] [Citation(s) in RCA: 163] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 07/03/2013] [Accepted: 07/10/2013] [Indexed: 12/15/2022] Open
Abstract
Clinical oncology heavily relies on the use of radiotherapy, which often leads to merely transient responses that are followed by local or distant relapse. The molecular mechanisms explaining radioresistance are largely elusive. Here, we identified a dual role of autophagy in the response of cancer cells to ionizing radiation. On one hand, we observed that the depletion of essential autophagy-relevant gene products, such as ATG5 and Beclin 1, increased the sensitivity of human or mouse cancer cell lines to irradiation, both in vitro (where autophagy inhibition increased radiation-induced cell death and decreased clonogenic survival) and in vivo, after transplantation of the cell lines into immunodeficient mice (where autophagy inhibition potentiated the tumour growth-inhibitory effect of radiotherapy). On the other hand, when tumour proficient or deficient for autophagy were implanted in immunocompetent mice, it turned out that defective autophagy reduced the efficacy of radiotherapy. Indeed, radiotherapy elicited an anti-cancer immune response that was dependent on autophagy-induced ATP release from stressed or dying tumour cells and was characterized by dense lymphocyte infiltration of the tumour bed. Intratumoural injection of an ecto-ATPase inhibitor restored the immune infiltration of autophagy-deficient tumours post radiotherapy and improved the growth-inhibitory effect of ionizing irradiation. Altogether, our results reveal that beyond its cytoprotective function, autophagy confers immunogenic properties to tumours, hence amplifying the efficacy of radiotherapy in an immunocompetent context. This has far-reaching implications for the development of pharmacological radiosensitizers.
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Affiliation(s)
- A Ko
- INSERM U1030, Radiothérapie moléculaire SIRIC SOCRATES, LABEX LERMIT & DHU TORINO, Institut Gustave Roussy, Villejuif, France
- Gustave Roussy Cancer Campus, Villejuif, France
- SIRIC SOCRATES, LABEX LERMIT & DHU TORINO, Université Paris Sud—Paris 11, Villejuif, France
| | - A Kanehisa
- INSERM U1030, Radiothérapie moléculaire SIRIC SOCRATES, LABEX LERMIT & DHU TORINO, Institut Gustave Roussy, Villejuif, France
- Gustave Roussy Cancer Campus, Villejuif, France
- SIRIC SOCRATES, LABEX LERMIT & DHU TORINO, Université Paris Sud—Paris 11, Villejuif, France
| | - I Martins
- Gustave Roussy Cancer Campus, Villejuif, France
- SIRIC SOCRATES, LABEX LERMIT & DHU TORINO, Université Paris Sud—Paris 11, Villejuif, France
- INSERM U848, Institut Gustave Roussy, Villejuif, France
| | - L Senovilla
- Gustave Roussy Cancer Campus, Villejuif, France
- SIRIC SOCRATES, LABEX LERMIT & DHU TORINO, Université Paris Sud—Paris 11, Villejuif, France
- INSERM U848, Institut Gustave Roussy, Villejuif, France
| | - C Chargari
- INSERM U1030, Radiothérapie moléculaire SIRIC SOCRATES, LABEX LERMIT & DHU TORINO, Institut Gustave Roussy, Villejuif, France
- Gustave Roussy Cancer Campus, Villejuif, France
- SIRIC SOCRATES, LABEX LERMIT & DHU TORINO, Université Paris Sud—Paris 11, Villejuif, France
| | - D Dugue
- INSERM U1030, Radiothérapie moléculaire SIRIC SOCRATES, LABEX LERMIT & DHU TORINO, Institut Gustave Roussy, Villejuif, France
- Gustave Roussy Cancer Campus, Villejuif, France
| | - G Mariño
- Gustave Roussy Cancer Campus, Villejuif, France
- SIRIC SOCRATES, LABEX LERMIT & DHU TORINO, Université Paris Sud—Paris 11, Villejuif, France
- INSERM U848, Institut Gustave Roussy, Villejuif, France
| | - O Kepp
- Gustave Roussy Cancer Campus, Villejuif, France
- SIRIC SOCRATES, LABEX LERMIT & DHU TORINO, Université Paris Sud—Paris 11, Villejuif, France
- INSERM U848, Institut Gustave Roussy, Villejuif, France
| | - M Michaud
- Gustave Roussy Cancer Campus, Villejuif, France
- SIRIC SOCRATES, LABEX LERMIT & DHU TORINO, Université Paris Sud—Paris 11, Villejuif, France
- INSERM U848, Institut Gustave Roussy, Villejuif, France
| | - J-L Perfettini
- Gustave Roussy Cancer Campus, Villejuif, France
- SIRIC SOCRATES, LABEX LERMIT & DHU TORINO, Université Paris Sud—Paris 11, Villejuif, France
- INSERM U848, Institut Gustave Roussy, Villejuif, France
| | - G Kroemer
- Gustave Roussy Cancer Campus, Villejuif, France
- SIRIC SOCRATES, LABEX LERMIT & DHU TORINO, Université Paris Sud—Paris 11, Villejuif, France
- INSERM U848, Institut Gustave Roussy, Villejuif, France
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France
- Equipe 11 labellisée Ligue contre le Cancer, Centre de Recherche des Cordeliers, Paris, France
- Pôle de Biologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
- Université Paris Descartes, Paris 5, Paris, France
| | - E Deutsch
- INSERM U1030, Radiothérapie moléculaire SIRIC SOCRATES, LABEX LERMIT & DHU TORINO, Institut Gustave Roussy, Villejuif, France
- Gustave Roussy Cancer Campus, Villejuif, France
- SIRIC SOCRATES, LABEX LERMIT & DHU TORINO, Université Paris Sud—Paris 11, Villejuif, France
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
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Hornung T, Ko A, Tüting T, Bieber T, Wenzel J. Efficacy of low-dose methotrexate in the treatment of dermatomyositis skin lesions. Clin Exp Dermatol 2011; 37:139-42. [DOI: 10.1111/j.1365-2230.2011.04188.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Carvalho M, Claudio S, Boaventura E, Ribeiro G, Quintana M, Nobre A, Diggle P, Reis M, Ko A. P2-506 Influence of climate on the incidence of urban leptospirosis. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976m.33] [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: 11/04/2022]
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Kraus VB, Burnett B, Coindreau J, Cottrell S, Eyre D, Gendreau M, Gardiner J, Garnero P, Hardin J, Henrotin Y, Heinegård D, Ko A, Lohmander LS, Matthews G, Menetski J, Moskowitz R, Persiani S, Poole AR, Rousseau JC, Todman M. Application of biomarkers in the development of drugs intended for the treatment of osteoarthritis. Osteoarthritis Cartilage 2011; 19:515-42. [PMID: 21396468 PMCID: PMC3568396 DOI: 10.1016/j.joca.2010.08.019] [Citation(s) in RCA: 220] [Impact Index Per Article: 16.9] [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] [Received: 06/22/2010] [Revised: 08/21/2010] [Accepted: 08/28/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Osteoarthritis (OA) is a chronic and slowly progressive disease for which biomarkers may be able to provide a more rapid indication of therapeutic responses to therapy than is currently available; this could accelerate and facilitate OA drug discovery and development programs. The goal of this document is to provide a summary and guide to the application of in vitro (biochemical and other soluble) biomarkers in the development of drugs for OA and to outline and stimulate a research agenda that will further this goal. METHODS The Biomarkers Working Group representing experts in the field of OA biomarker research from both academia and industry developed this consensus document between 2007 and 2009 at the behest of the Osteoarthritis Research Society International Federal Drug Administration initiative (OARSI FDA initiative). RESULTS This document summarizes definitions and classification systems for biomarkers, the current outcome measures used in OA clinical trials, applications and potential utility of biomarkers for development of OA therapeutics, the current state of qualification of OA-related biomarkers, pathways for biomarker qualification, critical needs to advance the use of biomarkers for drug development, recommendations regarding practices and clinical trials, and a research agenda to advance the science of OA-related biomarkers. CONCLUSIONS Although many OA-related biomarkers are currently available they exist in various states of qualification and validation. The biomarkers that are likely to have the earliest beneficial impact on clinical trials fall into two general categories, those that will allow targeting of subjects most likely to either respond and/or progress (prognostic value) within a reasonable and manageable time frame for a clinical study (for instance within 1-2 years for an OA trial), and those that provide early feedback for preclinical decision-making and for trial organizers that a drug is having the desired biochemical effect. As in vitro biomarkers are increasingly investigated in the context of specific drug treatments, advances in the field can be expected that will lead to rapid expansion of the list of available biomarkers with increasing understanding of the molecular processes that they represent.
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Affiliation(s)
- V B Kraus
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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Lönnies M, Hoffmann B, Bock E, Hertel S, Viehmann A, Jöckel K, Pannier F, Ko A, Berboth G, Rabe E. Assoziation sozioökonomischer Faktoren mit Inzidenz und Progression chronischer phlebologischer Erkrankungen. Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266451] [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]
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Oh W, Lee EW, Lee D, Yang MR, Ko A, Yoon CH, Lee HW, Bae YS, Choi CY, Song J. Hdm2 negatively regulates telomerase activity by functioning as an E3 ligase of hTERT. Oncogene 2010; 29:4101-12. [PMID: 20453884 DOI: 10.1038/onc.2010.160] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In this study, we identified posttranslational regulation of human telomerase reverse-transcriptase (hTERT) by the E3 ligase Hdm2. The telomerase activity generated by exogenous hTERT in U2OS cells was reduced on adriamycin treatment. The overexpressed levels of hTERT were also decreased under the same conditions. These processes were reversed by treatment with a proteasome inhibitor or depletion of Hdm2. Furthermore, intrinsic telomerase activity was increased in HCT116 cells with ablation of Hdm2. Immunoprecipitation analyses showed that hTERT and Hdm2 bound to each other in multiple domains. Ubiquitination analyses showed that Hdm2 could polyubiquitinate hTERT principally at the N-terminus, which was further degraded in a proteasome-dependent manner. An hTERT mutant with all five lysine residues at the N-terminus of hTERT that mutated to arginine became resistant to Hdm2-mediated ubiquitination and degradation. In U2OS cells, depletion of Hdm2 or addition of the Hdm2-resistant hTERT mutant strengthened the cellular protective effects against apoptosis. Similar results were obtained with the Hdm2-stable H1299 cell line. These observations indicate that Hdm2 is an E3 ligase of hTERT.
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Affiliation(s)
- W Oh
- Department of Biotechnology and Bioengineering, Sungkyunkwan University, Suwon, Korea
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Rabe E, Pannier F, Ko A, Berboth G, Hoffmann B, Hertel S. Incidence of Varicose Veins, Chronic Venous Insufficiency, and Progression of the Disease in the Bonn Vein Study II. J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2009.11.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ringe B, Xiao G, Sass DA, Karam J, Shang S, Maroney TP, Trebelev AE, Levison S, Fuchs AC, Petrucci R, Ko A, Gonzalez M, Reynolds JC, Meyers WC. Rescue of a living donor with liver transplantation. Am J Transplant 2008; 8:1557-61. [PMID: 18510644 DOI: 10.1111/j.1600-6143.2008.02261.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Postoperative liver failure is a rare complication after living donor liver resection. This is a case report of a 22-year-old healthy donor who was rescued with liver transplantation 11 days after right hemihepatectomy. Nine months later the patient is alive, and has fully recovered from his multiple organ failure. According to a review of the literature, there are four additional living liver donors, who received a liver transplant. Our own patient is the only survivor, so far. This case demonstrates that even in supposedly healthy living donors postoperative complications cannot be completely prevented. Although liver failure is rare in these patients, timely transplantation may need to be considered as the only life-saving treatment.
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Affiliation(s)
- B Ringe
- Department of Surgery, Division of Gastroenterology and Hepatology, Drexel University College of Medicine, Philadelphia, PA, USA.
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Puopolo A, Boice JA, Fidelholtz JL, Littlejohn TW, Miranda P, Berrocal A, Ko A, Cichanowitz N, Reicin AS. A randomized placebo-controlled trial comparing the efficacy of etoricoxib 30 mg and ibuprofen 2400 mg for the treatment of patients with osteoarthritis. Osteoarthritis Cartilage 2007; 15:1348-56. [PMID: 17631392 DOI: 10.1016/j.joca.2007.05.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Accepted: 05/26/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We compared the efficacy of etoricoxib 30 mg to placebo and ibuprofen 2400 mg for the treatment of osteoarthritis (OA) of the hip and knee. DESIGN In this 12-week, randomized, double-blind, placebo- and active-comparator-controlled trial, 548 patients (median age 63 years) with OA of the hip or knee were randomized to receive placebo, etoricoxib 30 mg q.d., or ibuprofen 800 mg t.i.d. Demonstration of etoricoxib's efficacy vs placebo and comparison of its efficacy to ibuprofen were assessed using three co-primary endpoints: Western Ontario and McMaster's University Osteoarthritis Index (WOMAC) Pain Subscale (WOMAC-PS); WOMAC Physical Function Subscale (WOMAC-PFS); and Patient Global Assessment of Disease Status (PGADS). Each primary endpoint utilizes a 0-100 mm visual analog scale. To demonstrate comparable efficacy of etoricoxib vs ibuprofen, the 95% confidence intervals (CIs) for the difference in the least squares (LS) mean change over 12 weeks for all three co-primary endpoints had to fall within +/-10 mm. Safety and tolerability data were collected throughout the study. RESULTS Mean baseline values for the three co-primary endpoints ranged from 62.52 to 70.14 mm. Both etoricoxib and ibuprofen demonstrated superior (P< or =0.002) efficacy for all primary endpoints. The LS mean (mm) changes (95% CI) over 12 weeks for etoricoxib and ibuprofen, respectively, compared to placebo were given as follows: WOMAC-PS: -11.66 (-16.31, -7.01) and -7.62 (-12.30, -2.94); WOMAC-PFS: -10.15 (-14.74, -5.57) and -7.23 (-11.85, -2.61); PGADS: -11.65 (-16.81, -6.50) and -8.11 (-13.30, -2.92). The efficacy of etoricoxib 30 mg was comparable to ibuprofen 2400 mg. All treatments were similarly well tolerated. CONCLUSION Treatment with etoricoxib 30 mg q.d. provides superior efficacy vs placebo and comparable clinical efficacy vs ibuprofen 2400 mg (800 mg t.i.d.) for the treatment of OA of the hip and knee.
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Affiliation(s)
- A Puopolo
- Milford Emergency Associates, Milford, MA, USA
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Gineyts E, Mo JA, Ko A, Henriksen DB, Curtis SP, Gertz BJ, Garnero P, Delmas PD. Effects of ibuprofen on molecular markers of cartilage and synovium turnover in patients with knee osteoarthritis. Ann Rheum Dis 2004; 63:857-61. [PMID: 15194584 PMCID: PMC1755067 DOI: 10.1136/ard.2003.007302] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effect of ibuprofen on the urinary excretion of C-terminal crosslinking telopeptide of type II collagen (CTX-II) and urinary glucosyl galactosyl pyridinoline (Glc-Gal-PYD), two new molecular markers of cartilage and synovial tissue metabolism, respectively, in patients with knee osteoarthritis (OA). METHODS We studied 201 patients with knee pain and radiographic evidence of knee OA who were on treatment with non-steroidal anti-inflammatory drugs (NSAIDs) prior to study initiation. After an initial screening visit, patients were withdrawn from their pre-study NSAID and, following a flare of their OA symptoms, were randomised to ibuprofen (2400 mg/day) or placebo. Urinary CTX-II and Glc-Gal-PYD levels were measured at time of randomisation (baseline) and after 4-6 weeks of treatment. RESULTS After 4 to 6 weeks, urinary CTX-II (+17%, p = 0.023) and Glc-Gal-PYD (+10%, p = 0.020) increased significantly from baseline in the placebo group whereas marginal or no increase was observed in the ibuprofen group (CTX-II +2%, NS and Glc-Gal-PYD +4%, p = 0.045). For urinary CTX-II, the difference in the change from baseline between placebo and ibuprofen treated groups was significant (13%, p = 0.017). At baseline, urinary levels of CTX-II and Glc-Gal-PYD were higher in patients with knee swelling (n = 127) than in those without (n = 74) (p<0.02 for both markers). When patients were stratified according to presence or absence of knee swelling at baseline, the increases over 4-6 weeks of urinary CTX-II and Glc-Gal-PYD in the placebo group were restricted to patients with knee swelling (+22% from baseline, p = 0.001 and +12%, p = 0.011, for urinary CTX-II and Glc-Gal-PYD respectively). In patients with knee swelling who were treated with ibuprofen this increase was not observed and the difference from placebo was significant for urinary CTX-II (p = 0.014). CONCLUSION In patients with a flare of knee OA, specifically in patients with evidence of joint inflammation documented by knee swelling, there was a significant increase in markers reflecting cartilage and synovium metabolism that could partly be prevented by high doses of ibuprofen. These data suggest that patients with a flare of knee OA are characterised by increased cartilage and synovial tissue degradation, which may be partly prevented by high doses of NSAIDs.
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Affiliation(s)
- E Gineyts
- INSERM Research Unit 403, Hopital Edouard Herriot, Pavillon F, Place d'Arsonval, 69003 Lyon, France.
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Gottesdiener K, Schnitzer T, Fisher C, Bockow B, Markenson J, Ko A, DeTora L, Curtis S, Geissler L, Gertz BJ. Results of a randomized, dose-ranging trial of etoricoxib in patients with osteoarthritis. Rheumatology (Oxford) 2002; 41:1052-61. [PMID: 12209041 DOI: 10.1093/rheumatology/41.9.1052] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To evaluate the clinical efficacy and tolerability of etoricoxib in the treatment of osteoarthritis (OA) of the knee and define the clinically active dose range for further clinical trials. METHODS This two-part, randomized, double-blind, placebo- and active comparator-controlled trial was conducted in 617 adults with knee OA. In Part 1 (6 weeks), patients received placebo, etoricoxib 5, 10, 30, 60 or 90 mg q.d. In Part 2 (8 weeks), patients received etoricoxib 30, 60 or 90 mg q.d. or diclofenac 50 mg t.i.d., predetermined at Part 1 allocation. Efficacy and safety were evaluated. Primary efficacy end-points were the Western Ontario and McMaster's University Osteoarthritis Index (WOMAC) Pain subscale, Patient Global Assessment of Response to Therapy, and Investigator Global Assessment of Disease Status. RESULTS At 6 weeks, etoricoxib 5, 10, 30, 60 and 90 mg each demonstrated clinical efficacy superior to placebo. Maximal efficacy was seen with 60 mg. In Part 2, etoricoxib 30, 60 and 90 mg were generally similar to diclofenac. Patients receiving etoricoxib 30, 60 or 90 mg in Parts I and II had sustained effects over 14 weeks. All treatments were well tolerated. CONCLUSIONS Etoricoxib 60 mg once daily showed maximal efficacy in treating OA in this study. Etoricoxib 5-90 mg once daily was generally well tolerated in OA patients for up to 14 weeks.
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Affiliation(s)
- K Gottesdiener
- Clinical Pharmacology, Merck Research Laboratories, Rahway, NJ 07065, USA
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Choi SSL, Pang SY, Mak WP, Ko A. Pulmonary embolism presenting as disseminated intravascular coagulation. Hong Kong Med J 2002; 8:142-3. [PMID: 11937670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
We report an unusual case of disseminated intravascular coagulation. Occult pulmonary embolism is a recognised cause of disseminated intravascular coagulation. Unexplained shock should prompt the physician to search for a thrombotic cause such as pulmonary thromboembolism.
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Affiliation(s)
- S S L Choi
- Department of Medicine and Geriatrics, Caritas Medical Centre, 111 Wing Hong Street, Shamshuipo, Kowloon, Hong Kong
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McMahon RL, Ali A, Chekan EG, Clary EM, Garcia-Oria MJ, Fina MC, McRae RL, Ko A, Gandsas A, Pappas TN, Eubanks WS. A canine model of gastroesophageal reflux disease (GERD). Surg Endosc 2002; 16:67-74. [PMID: 11961608 DOI: 10.1007/s004640080153] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2001] [Accepted: 05/19/2001] [Indexed: 10/28/2022]
Abstract
BACKGROUND Although a variety of antireflux procedures and medications are used to treat gastroesophageal reflux disease (GERD), reliable large-animal models of GERD that can be used to objectively compare the efficacy of these treatments are lacking. METHODS Esophageal manometry and 24-h gastroesophageal pH monitoring with event data were performed in 18 mongrel dogs with a cervical esophagopexy. We then calculated a modified DeMeester score: The Duke Canine reflux score (DCR). Thereafter, the animals underwent a 4-cm anterior distal esophageal myotomy, incision of the left diaphragmatic crus, and intrathoracic gastric cardiopexy. Postoperative 24-h pH and manometry were obtained 2 weeks later. RESULTS The postoperative 24-h pH results showed a significant increase in the mean DCR score (5.9 +/- 4.5 vs 84.9 +/- 56.1, p < 0.0002), and manometry indicated a significant decrease in mean lower esophageal sphincter (LES) pressure (7.1 +/- 2.9 vs 3.2 +/- 2.5 mmHg, p < 0.0001). CONCLUSION This technique reliably creates a canine model of GERD.
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Affiliation(s)
- R L McMahon
- Department of Surgery, Duke University Medical Center, Room 3454A Duke North, Durham, NC 27710, USA
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Patterson S, Ko A, O'Connell TX. Radiation after mastectomy in high-risk patients: is it necessary? Am Surg 2001; 67:1209-12. [PMID: 11768832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
A retrospective review of cases from 1988 through 1992 was performed examining high-risk breast cancer patients treated with modified radical mastectomy without postoperative radiation at a single institution. Locoregional recurrence, distant metastases, overall survival, and number of lymph nodes removed were examined. This was compared with recent Danish and Canadian studies. Thirty-three premenopausal node-positive breast cancer patients had a 9 per cent locoregional recurrence rate. In the Danish and Canadian studies the locoregional recurrence rates were 32 and 21 per cent. These were reduced to 9 per cent and 10 per cent respectively in the radiated arms. Our locoregional recurrence in nonradiated patients was similar to that in the radiated arms of the studies and improved when compared with recurrence in their non-radiated controls. The adequacy of the axillary lymph node dissection was examined. In the current study a median of 18 lymph nodes were recovered with only 3 per cent containing less than 12 nodes. In the Danish study a median of seven lymph nodes were removed. Similarly in the Canadian trial a median of 11 nodes were removed. With complete axillary dissection results equivalent to those of postoperative adjuvant radiation is achieved. Further randomized controlled studies with standard axillary dissections are needed before the recommendation of routine postoperative radiotherapy.
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Affiliation(s)
- S Patterson
- Department of Surgery, Kaiser Permanente Medical Center, Los Angeles, California 90027, USA
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Garcia-Oria M, Ali A, Reynolds JD, Clary E, Gandsas A, Cummings T, McMahon RL, Bruch S, Fina M, Ko A, Eubanks S. Histologic evaluation of fetal brains following maternal pneumoperitoneum. Surg Endosc 2001; 15:1294-8. [PMID: 11727136 DOI: 10.1007/s004640080040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2000] [Accepted: 11/06/2000] [Indexed: 11/27/2022]
Abstract
BACKGROUND The purpose of this study was to determine if maternal pneumoperitoneum with carbon dioxide (CO2) produces evidence of central nervous system (CNS) injury in preterm fetal guinea pigs. METHODS Thirty pregnant guinea pigs at gestational day (GD) 45 were assigned at random to one of three treatment groups: anesthesia only, CO2 pneumoperitoneum (5 mmHg), or laparotomy. Dams were killed 3 or 5 days postprocedure and fetal brains (83 total) harvested and fixed for subsequent histopathologic evaluation. For comparative purposes, histologic features of fetal guinea pig brain injury were defined from examination of fetal brains harvested from an additional dam that underwent laparotomy with 20 min of uterine arterial occlusion. RESULTS Carbon dioxide pneumoperitoneum did not increase maternal/fetal morbidity. No evidence of brain injury was found in fetuses from any of the treatment groups. CONCLUSION Carbon dioxide pneumoperitoneum at 5 mmHg for 40 min in the pregnant guinea pig does not produce evidence of fetal brain injury.
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Affiliation(s)
- M Garcia-Oria
- Department of Surgery, Duke University Medical Center, Endosurgery Research Laboratory, Durham, NC, 27710, USA
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McMahon RL, Ali A, Chekan EG, Clary EM, Garcia-Oria MJ, Fina MC, McRae RL, Ko A, Gandsas A, Pappas TN, Eubanks WS. A canine model of gastroesophageal reflux disease (GERD). Surg Endosc 2001. [PMID: 11961608 DOI: 10.1007/s00464-002-8703-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although a variety of antireflux procedures and medications are used to treat gastroesophageal reflux disease (GERD), reliable large-animal models of GERD that can be used to objectively compare the efficacy of these treatments are lacking. METHODS Esophageal manometry and 24-h gastroesophageal pH monitoring with event data were performed in 18 mongrel dogs with a cervical esophagopexy. We then calculated a modified DeMeester score: The Duke Canine reflux score (DCR). Thereafter, the animals underwent a 4-cm anterior distal esophageal myotomy, incision of the left diaphragmatic crus, and intrathoracic gastric cardiopexy. Postoperative 24-h pH and manometry were obtained 2 weeks later. RESULTS The postoperative 24-h pH results showed a significant increase in the mean DCR score (5.9 +/- 4.5 vs 84.9 +/- 56.1, p < 0.0002), and manometry indicated a significant decrease in mean lower esophageal sphincter (LES) pressure (7.1 +/- 2.9 vs 3.2 +/- 2.5 mmHg, p < 0.0001). CONCLUSION This technique reliably creates a canine model of GERD.
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Affiliation(s)
- R L McMahon
- Department of Surgery, Duke University Medical Center, Room 3454A Duke North, Durham, NC 27710, USA
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41
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Santiago M, Martinelli R, Ko A, Reis EA, Fontes RD, Nascimento EG, Pierangeli S, Espinola R, Gharavi A. Anti-beta2 glycoprotein I and anticardiolipin antibodies in leptospirosis, syphilis and Kala-azar. Clin Exp Rheumatol 2001; 19:425-30. [PMID: 11491498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
OBJECTIVE Reports have shown that anticardiolipin (aCL) antibodies present in patients with autoimmune diseases are dependent on the cofactor,beta2 glycoprotein I (beta2 GPI), as opposed to aCL antibodies seen in infectious diseases such as syphilis, HIV hepatitis C, etc. The assay for anti-beta2GPI antibodies has been reported to be more specific for antiphospholipid syndrome (APS). However, the prevalence of these antibodies in diseases such as leishmaniasis and leptospirosis remains unknown. The aim of the present study was determine the prevalence of antibodies to cardiolipin and to beta2GPI in patients with different infectious diseases, including leptospirosis, syphilis and leishmaniasis. METHODS Samples from patients with Kala-azar (visceral leishmaniasis), syphilis or leptospirosis were tested for IgG and IgM anticardiolipin and IgG anti-beta2GPI antibodies by ELISA. RESULTS In patients with Kala-azar the prevalence of IgG aCL, IgM aCL and anti-beta2GPI was 6% (2/30), 3% (1/30) and 53% (16/30), respectively. In syphilis the prevalence was 18% (14/74), 13% (10/74) and 10% (8/70), respectively. In leptospirosis the frequency of these antibodies was 23% (9/39), 10% (4/39) and 17% (6/34), respectively. There was no statistical correlation between aCL and anti-beta2GPI antibodies in these diseases. DISCUSSION This study clearly shows a significant prevalence of anti-beta2GPI antibodies in leptospirosis and leishmaniasis and syphilis. This indicates that the assay for antibeta2GPI antibodies should be thoroughly validated before it is introduced as a definitive tool for the diagnosis of APS, testing a larger number of sera from patients with a wider range of clinical conditions.
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Affiliation(s)
- M Santiago
- Escola Bahiana de Medicina e Saúde Pública/Hospital Santa Izabel, Bahia, Brazil.
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42
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Abstract
p53 is an attractive target for cancer immunotherapy because it is overexpressed in a high proportion of many different types of tumors. However, it is also expressed in normal tissues and acts as a toleragen in vivo. Previously, detailed examination of the repertoire specific for the murine p53(261-269) epitope in conventional and p53-deficient mice demonstrated that because of expression of p53, the CD8(+) T cells that respond to this epitope express low-affinity TCRs. It has been reported that tolerance to tumor Ags can be broken by in vivo administration of anti-CTLA-4 mAb. With the goal of overriding tolerance and achieving optimal activation of p53-specific CTL, the current study has assessed the effect of anti-CTLA-4 mAb on the p53-specific repertoire. It was found that blockade of CTLA-4 engagement at the time of antigenic stimulation induced a vigorous amplification of the CTL responses to p53 as well as proportionate expansion of the memory T cell pool. This effect was dependent on the presence of CD4(+) T cell help and correlated with an enhancement of helper function. However, anti-CTLA-4 treatment did not enhance the avidity of the resultant p53-specific CTL populations and, therefore, could not reverse this important consequence of tolerance.
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MESH Headings
- Abatacept
- Adjuvants, Immunologic/administration & dosage
- Animals
- Antibodies, Monoclonal/administration & dosage
- Antigens, CD
- Antigens, Differentiation/immunology
- Antigens, Neoplasm/administration & dosage
- Antigens, Neoplasm/immunology
- CTLA-4 Antigen
- Cell Line
- Cells, Cultured
- Clone Cells
- Cytotoxicity, Immunologic/immunology
- Epitopes, T-Lymphocyte/administration & dosage
- Immunoconjugates
- Injections, Intraperitoneal
- Injections, Subcutaneous
- Lymphocyte Activation
- Lymphocyte Count
- Mice
- Mice, Inbred C57BL
- Mice, Transgenic
- Peptide Fragments/administration & dosage
- Peptide Fragments/immunology
- Protein Binding/immunology
- Rats
- Self Tolerance
- Stem Cells/immunology
- T-Lymphocytes, Cytotoxic/immunology
- T-Lymphocytes, Cytotoxic/metabolism
- Tumor Suppressor Protein p53/administration & dosage
- Tumor Suppressor Protein p53/immunology
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Affiliation(s)
- J Hernández
- Department of Immunology, The Scripps Research Institute, La Jolla, CA 92037, USA
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43
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Schwartz JI, Bugianesi KJ, Ebel DL, De Smet M, Haesen R, Larson PJ, Ko A, Verbesselt R, Hunt TL, Lins R, Lens S, Porras AG, Dieck J, Keymeulen B, Gertz BJ. The effect of rofecoxib on the pharmacodynamics and pharmcokinetics of warfarin. Clin Pharmacol Ther 2000; 68:626-36. [PMID: 11180023 DOI: 10.1067/mcp.2000.112244] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to examine the effect of 3 doses of rofecoxib (12.5, 25, and 50 mg) on the pharmacodynamics and pharmacokinetics of warfarin. METHODS Two single-dose (12.5 or 50 mg of rofecoxib with 25 mg or 30 mg of oral warfarin, respectively, on day 7 of each period) trials (N = 12 men) and 1 steady-state warfarin trial (25 mg rofecoxib; N = 15, 13 men and 2 women) were completed as two-period, randomized, balanced, crossover, double-blind designs. The prothrombin time international normalized ratio (INR) and S(-) and R(+) warfarin enantiomers were assessed during 144 hours after the single warfarin doses. In the steady-state warfarin trial, after the attainment of a stable INR (1.4-1.7), the stable warfarin dose was co-administered with rofecoxib (25 mg) and placebo over two 21-day periods. After the dose of warfarin on day 21, INR and S(-) and R(+) warfarin were assessed during 24 hours. RESULTS Compared with placebo, rofecoxib slightly increased the INR by approximately 5% (90% confidence interval on the geometric ratio, 1.03, 1.08) and 11% (1.04, 1.19) for the two single-dose warfarin trials with 12.5 and 50 mg of rofecoxib, respectively. In the steady-state warfarin study with 25 mg of rofecoxib, the INR was increased by 8% (1.02, 1.15). Rofecoxib had no significant effect (versus placebo) on the pharmacokinetics of S(-) warfarin. However, in the 3 studies, treatment with 12.5, 25, and 50 mg of rofecoxib was associated with a 27%, 38%, and 40% increase in the area under the plasma concentration-time curve of the biologically less active R(+) warfarin. CONCLUSIONS Rofecoxib increased plasma concentrations of the biologically less active R(+) warfarin, which accounted for a small increase in INR. The approximately 8% increase in INR at steady state with warfarin co-administered with 25 mg of rofecoxib is not likely to be clinically important in most patients taking warfarin. However, standard monitoring of INR values should be conducted when therapy with rofecoxib is initiated or changed, particularly in the first few days, for patients receiving warfarin.
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Affiliation(s)
- J I Schwartz
- Merck Research Laboratories, Rahway, New Jersey, USA
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44
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Abstract
Large inflammatory pseudotumors (IPT) traditionally are managed with extensive surgical resection. This approach, which often is associated with significant morbidity, has been deemed necessary because of the uncertainty of diagnosis, symptomatology, and involvement of vital structures. Also, there is a lack of other reliable therapy for this clinically aggressive yet histologically benign disease characterized by an overreactive inflammatory response. The authors treated 2 cases of abdominal IPT with nonsteroidal antiinflammatory drug (NSAID) with successful results. After a diagnosis of IPT on tumor biopsy, an NSAID trial can confirm the diagnosis and treat the disease by causing tumor shrinkage and eventual resolution. Excision remains indicated in easily resectable tumors and in nonresponders to NSAID therapy.
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Affiliation(s)
- W Su
- Department of Surgery, Kaiser Permanente Medical Center, Los Angeles, CA 90029, USA
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45
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Abstract
T cell recognition of self-major histocompatibility complex-peptide complexes dictates the composition of the T cell receptor repertoire. Research projects in our laboratory deal with the mechanisms that regulate the composition of the repertoire specific for self-antigens and the defects that can result in autoimmunity. Two different types of disease models are under investigation: juvenile (type I) diabetes and cancer. Both of these diseases are impacted by the presence of anti-self CD8 cells, yet in opposite ways. By understanding the mechanisms of peripheral tolerance and the reasons they fail in autoimmunity, we may learn how to prevent undesirable autoimmunity and how to encourage an autoimmune response when it is needed to eliminate tumor cells.
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Affiliation(s)
- L A Sherman
- Department of Immunology, The Scripps Research Institute, La Jolla, CA 92037, USA.
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46
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Abstract
The association of Paget's disease of bone and hemifacial spasm has rarely been reported. Hemifacial spasm is often associated with compression of the facial nerve by a vascular loop at the point where the nerve leaves the brainstem before traversing the cerebellopontine angle. It is believed that narrowing of the cerebellopontine angle cistern caused by Paget's disease increases the chance of vascular compression of the facial nerve. Whilst specific antipagetic therapy such as calcitonin has been used with good response in hemifacial spasm associated with Paget's disease, the usefulness of the newer bisphosphonates is not clear. A 65-year-old woman with hemifacial spasm associated with Paget's disease was treated with alendronate, and the hemifacial spasm became very infrequent 4 months after commencement of the therapy.
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Affiliation(s)
- K K Fu
- Department of Medicine, The University of, Hong Kong, Hong Kong
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47
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Nugent CT, Morgan DJ, Biggs JA, Ko A, Pilip IM, Pamer EG, Sherman LA. Characterization of CD8+ T lymphocytes that persist after peripheral tolerance to a self antigen expressed in the pancreas. J Immunol 2000; 164:191-200. [PMID: 10605011 DOI: 10.4049/jimmunol.164.1.191] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
As a result of expression of the influenza hemagglutinin (HA) in the pancreatic islets, the repertoire of HA-specific CD8+ T lymphocytes in InsHA transgenic mice (D2 mice expressing the HA transgene under control of the rat insulin promoter) is comprised of cells that are less responsive to cognate Ag than are HA-specific CD8+ T lymphocytes from conventional mice. Previous studies of tolerance induction involving TCR transgenic T lymphocytes suggested that a variety of different mechanisms can reduce avidity for Ag, including altered cell surface expression of molecules involved in Ag recognition and a deficiency in signaling through the TCR complex. To determine which, if any, of these mechanisms pertain to CD8+ T lymphocytes within a conventional repertoire, HA-specific CD8+ T lymphocytes from B10.D2 mice and B10.D2 InsHA transgenic mice were compared with respect to expression of cell surface molecules, TCR gene utilization, binding of tetrameric KdHA complexes, lytic mechanisms, and diabetogenic potential. No evidence was found for reduced expression of TCR or CD8 by InsHA-derived CTL, nor was there evidence for a defect in triggering lytic activity. However, avidity differences between CD8+ clones correlated with their ability to bind KdHA tetramers. These results argue that most of the KdHA-specific T lymphocytes in InsHA mice are not intrinsically different from KdHA-specific T lymphocytes isolated from conventional animals. They simply express TCRs that are less avid in their binding to KdHA.
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MESH Headings
- Animals
- Autoantigens/biosynthesis
- CD3 Complex/physiology
- CD8 Antigens/biosynthesis
- Cell Differentiation/genetics
- Cell Differentiation/immunology
- Cell Separation
- Clone Cells
- Cytotoxicity, Immunologic/genetics
- Diabetes Mellitus, Experimental/genetics
- Diabetes Mellitus, Experimental/immunology
- Epitopes, T-Lymphocyte/immunology
- H-2 Antigens/immunology
- H-2 Antigens/metabolism
- Hemagglutinin Glycoproteins, Influenza Virus/immunology
- Hemagglutinin Glycoproteins, Influenza Virus/metabolism
- Immune Tolerance/genetics
- Islets of Langerhans/immunology
- Islets of Langerhans/metabolism
- Mice
- Mice, Transgenic
- Protein Binding/immunology
- Receptors, Antigen, T-Cell/biosynthesis
- Receptors, Antigen, T-Cell/metabolism
- Signal Transduction/genetics
- Signal Transduction/immunology
- Species Specificity
- T-Lymphocyte Subsets/cytology
- T-Lymphocyte Subsets/immunology
- T-Lymphocyte Subsets/metabolism
- T-Lymphocytes, Cytotoxic/cytology
- T-Lymphocytes, Cytotoxic/immunology
- T-Lymphocytes, Cytotoxic/metabolism
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Affiliation(s)
- C T Nugent
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT 06520, USA
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48
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Abstract
Linomide is a potent immunomodulator that either enhances or suppresses certain immunological processes. Of particular interest is this compound's capacity to inhibit a variety of organ-specific autoimmune diseases. Here, we report on the effects of linomide on several immunological reactions elicited by endotoxin (LPS), both in vivo and in vitro. In rats and mice linomide inhibited the elicitation of endotoxin-induced uveitis (EIU), an acute inflammatory eye disease that develops within 24 h following footpad injection of LPS. Linomide also inhibited the production of TNF-alpha and IL-6 by LPS-stimulated rat and mouse macrophage monolayers. On the other hand, treatment with linomide significantly increased the levels of IL-1beta (mice and less in rats), IL-6 (rats), and TNF-alpha (mice) in serum samples collected 2 h following injection with LPS. The increased production of proinflammatory cytokines in linomide-treated mice was also indicated by the enhanced lethal effect of LPS in these mice. The finding of elevated levels of these cytokines in animals with suppressed EIU is also in line with previous observations of an inverse relationship between EIU severity and levels of TNF-alpha. Data recorded here underscore the unique capacity of linomide to both enhance and suppress the immune system.
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Affiliation(s)
- M Shalev
- The National Eye Institute, NIH, Bethesda, Maryland 20892, USA
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49
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Kreuwel HT, Morgan DJ, Krahl T, Ko A, Sarvetnick N, Sherman LA. Comparing the relative role of perforin/granzyme versus Fas/Fas ligand cytotoxic pathways in CD8+ T cell-mediated insulin-dependent diabetes mellitus. J Immunol 1999; 163:4335-41. [PMID: 10510373] [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] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
CD8+ cytotoxic T cells play a critical role in initiating insulin-dependent diabetes mellitus. The relative contribution of each of the major cytotoxic pathways, perforin/granzyme and Fas/Fas ligand (FasL), in the induction of autoimmune diabetes remains controversial. To evaluate the role of each lytic pathway in beta cell lysis and induction of diabetes, we have used a transgenic mouse model in which beta cells expressing the influenza virus hemagglutinin (HA) are destroyed by HA-specific CD8+ T cells from clone-4 TCR-transgenic mice. Upon adoptive transfer of CD8+ T cells from perforin-deficient clone-4 TCR mice, there was a 30-fold increase in the number of T cells required to induce diabetes. In contrast, elimination of the Fas/FasL pathway of cytotoxicity had little consequence. When both pathways of cytolysis were eliminated, mice did not become diabetic. Using a model of spontaneous diabetes, which occurs in double transgenic neonates that express both clone-4 TCR and Ins-HA transgenes, mice deficient in either the perforin or FasL/Fas lytic pathway become diabetic soon after birth. This indicates that, in the neonate, large numbers of autoreactive CD8+ T cells can lead to destruction of islet beta cells by either pathway.
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MESH Headings
- Adoptive Transfer
- Animals
- Animals, Newborn/immunology
- CD8-Positive T-Lymphocytes/enzymology
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/metabolism
- CD8-Positive T-Lymphocytes/transplantation
- Clone Cells
- Cytotoxicity, Immunologic
- Diabetes Mellitus, Type 1/enzymology
- Diabetes Mellitus, Type 1/immunology
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 1/pathology
- Fas Ligand Protein
- Granzymes
- Immunohistochemistry
- Islets of Langerhans/chemistry
- Islets of Langerhans/immunology
- Islets of Langerhans/pathology
- Ligands
- Membrane Glycoproteins/immunology
- Membrane Glycoproteins/physiology
- Mice
- Mice, Inbred BALB C
- Mice, Knockout
- Mice, Transgenic
- Perforin
- Pore Forming Cytotoxic Proteins
- Radiation Chimera/immunology
- Receptors, Antigen, T-Cell/immunology
- Serine Endopeptidases/immunology
- Serine Endopeptidases/physiology
- Signal Transduction/immunology
- T-Lymphocytes, Cytotoxic/immunology
- T-Lymphocytes, Cytotoxic/metabolism
- fas Receptor/immunology
- fas Receptor/physiology
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Affiliation(s)
- H T Kreuwel
- Department of Immunology, The Scripps Research Institute, La Jolla, CA 92037, USA
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50
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Abstract
Malignant mesothelioma is a well-recognized long-term sequela of chronic asbestos exposure. Asbestos use in the United States began in the 1950s and was widespread until the mid-1970s. Although currently only 2.2 cases per million population per year are diagnosed, disease incidence is increasing because of the long latency of this neoplasm. A latency of 15-50 years means that a higher incidence of this neoplasm can be anticipated in the future. The authors report a patient with peritoneal mesothelioma and no known prior exposure to asbestos. The diagnosis was confirmed by exploratory laparoscopy, which entailed biopsies of the diaphragm and of the peritoneal and abdominal walls, and by cytologic evaluation of 700 ml ascitis fluid. At present, exploratory laparoscopy offers the quickest, safest, and least invasive way to confirm the clinical diagnosis of peritoneal malignant mesothelioma.
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Affiliation(s)
- J C Stamat
- Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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