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Horesh N, Emile SH, Garoufalia Z, Gefen R, Zhou P, Nagarajan A, Wexner SD. Immunotherapy in Stage III-IV Colon Cancer: A Propensity Score-Matched Analysis of the National Cancer Database. J Immunother 2024:00002371-990000000-00098. [PMID: 38638079 DOI: 10.1097/cji.0000000000000520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/12/2024] [Indexed: 04/20/2024]
Abstract
SUMMARY Immunotherapy for the systemic treatment of cancer offers new treatment possibilities for advanced malignancies. Despite promising initial results, evidence on efficacy of immunotherapy for colon cancer is lacking. Thus, we aimed to assess short-term and long-term outcomes of immunotherapy in patients with advanced colon cancer. A US National Cancer Database was searched for patients with stage III-IV colonic adenocarcinoma between 2010 and 2019. Propensity score matching was used to classify the cohort into 2 groups: patients who received immunotherapy and controls. Main outcome measures were primary outcome was overall survival (OS). A total of 23,778 patients with stage III-IV colonic adenocarcinoma were treated with immunotherapy during the study period compared to 114,753 controls. Immunotherapy treated patients were younger (median age 61 vs. 67 y; P<0.001), more often male (57.3% vs. 50.7%, P<0.001), had more private insurance (44.1% vs. 33.7%; P<0.001), had more left-sided tumors (49.5% vs. 39.1%; P<0.001) and liver metastasis (80.2% vs. 61.7%; P<0.001) than controls. Immunotherapy patients received more standard chemotherapy (49.8% vs. 41.6%; P<0.001). After propensity-score matching, mean OS was significantly shorter in the immunotherapy group compared with controls (34.7 vs. 36.2 mo; P=0.008). Cox regression analysis demonstrated that immunotherapy was associated with increased risk for mortality (HR: 1.1; 95% CI: 1.02-1.18; P=0.005). Patients who received immunotherapy had lower 90-day mortality rates compared with controls (2.3% vs. 3.6%; P=0.004), but the groups had equivalent 30-day mortality rates (0.7% vs. 0.8%; P=0.76). Immunotherapy showed no improvement in OS in patients with stage III-IV colon cancer.
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Affiliation(s)
- Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL
- Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, Affiliated With the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sameh H Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL
- Colorectal Surgery Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL
| | - Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL
- Department of General Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peige Zhou
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL
- Georgia Colon and Rectal Surgical Associates, Northside Hospital, Atlanta, GA
| | - Arun Nagarajan
- Department of Hematology/Oncology, Cleveland Clinic Florida, Weston, FL
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL
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2
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Horesh N, Emile SH, Freund MR, Garoufalia Z, Gefen R, Nagarajan A, Wexner SD. Immunotherapy in rectal cancer patients-a propensity score matched analysis of the National Cancer Database. Int J Colorectal Dis 2023; 39:8. [PMID: 38133666 DOI: 10.1007/s00384-023-04574-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Rectal cancer patients with microsatellite instability (MSI-H) are candidates for immunotherapy. However, there is little evidence on its effect on overall survival (OS). METHODS Retrospective analysis of stage II-IV rectal adenocarcinoma patients in the National Cancer Database (NCDB) between 2010 and 2019. Propensity score matching was adjusted for baseline and treatment confounders. The cohort was divided into patients who received immunotherapy and matched controls. The primary outcome was OS. RESULTS 5175/206,615 (2.5%) patients with rectal adenocarcinoma underwent immunotherapy. These patients were younger (58 vs 62 years; p < 0.001), more often male (64.4% vs 61.7%; p < 0.001), were more likely to have private insurance (50.8% vs 43.4%; p < 0.001), more metastatic disease at presentation (clinical TNM stage IV-80.8% vs 23.3%; p < 0.001), presented with larger tumors (median: 5 cm vs. 4.2 cm; p < 0.001) and less often underwent surgery (33.7% vs. 69.9%; p < 0.001), radiation therapy (21.5% vs 57.4%; p < 0.001), and standard chemotherapy (38.1% vs 61%; p < 0.001) than controls. After matching, 488 patients were in each group. OS was significantly shorter in the immunotherapy group (mean survival: 56.4 months (95% CI: -53.03-59.86)) compared to controls (mean survival: 70.5 months (95% CI: -66.15-74.92) (p = 0.004)). Cox regression analysis of factors associated with OS demonstrated that immunotherapy was associated with increased mortality (HR 2.16; 95% CI: 2.09-2.24; p < 0.001). After clinical staging stratification, immunotherapy was associated with improved OS in stage IV (HR 0.91, 95% CI: 0.88-0.95; p < 0.001) but lower survival in stage II (HR 2.38; 95% CI: 2.05-2.77; p < 0.001) and stage III (HR 2.43; 95% CI: 2.18-2.7; p < 0.001) patients. CONCLUSION Immunotherapy showed modest increase in OS in stage IV metastatic rectal cancer. OS was significantly lower in stage II-III disease treated with immunotherapy.
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Affiliation(s)
- Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950, Cleveland Clinic Blvd, Weston, FL 33331, USA
- Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, Israel
| | - Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950, Cleveland Clinic Blvd, Weston, FL 33331, USA
- Colorectal Surgery Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Michael R Freund
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950, Cleveland Clinic Blvd, Weston, FL 33331, USA
- Shaare Zedek Medical Center, Department of General Surgery, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950, Cleveland Clinic Blvd, Weston, FL 33331, USA
| | - Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950, Cleveland Clinic Blvd, Weston, FL 33331, USA
- Department of General Surgery, Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Arun Nagarajan
- Department of Hematology/Oncology, Cleveland Clinic Florida, Weston, FL, USA
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950, Cleveland Clinic Blvd, Weston, FL 33331, USA.
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3
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Kamath S, Roopkumar J, Ni Y, Shen M, Bejarano P, Allende D, Nagarajan A, Nguyen T, Dergham B, Shepard D, Shapiro MA, McNamara MJ, Estfan BN, Nair KG, Khorana AA. Genomic Predictors Associated With Exceptional Response to Systemic Therapy in Advanced Pancreatic Cancer. Oncology (Williston Park) 2023; 37:488-495. [PMID: 38133563 DOI: 10.46883/2023.25921008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Exceptional response to therapy is rare in patients with advanced pancreatic cancer. This study explored potential genomic differences between typical and exceptional responses that could confer more favorable biology. METHODS We included exceptional responders and controls with advanced pancreatic cancer from Cleveland Clinic from April 2013 to August 2017. Exceptional responders were defined as patients with an overall survival of more than 18 months for metastatic disease and more than 24 months for locally advanced disease. Clinical data were obtained, and next-generation sequencing was performed. Statistical analyses comparing the 2 groups were performed using descriptive statistics, the Kaplan-Meier method, and the log-rank test. RESULTS The study comprised 4 exceptional responders and 6 controls. Both groups were well balanced in age, sex, race, and treatment regimens. Exceptional responders had significantly fewer nonsynonymous mutations than controls (2.25 vs 5.17; P = .014). A mutation count of less than 3 was associated with significantly better progression-free survival (17.2 vs 2.3 months; P = .002) and overall survival (29.4 vs 4.6 months; P = .013). Tumor mutational burden did not differ between exceptional responders and controls (4.88 vs 5.70 mut/Mb; P = .39). CONCLUSION A lower number of nonsynonymous mutations may correlate with exceptional outcomes in patients with pancreatic cancer. These findings should encourage future studies into genomic signatures of exceptional response.
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John N, Montorfano L, Nagarajan A, Simpfendorfer CH, Wexner SD, Amin P, Roy M. Liver Venous Deprivation for Rapid Liver Hypertrophy Before Major Hepatectomy: A Case Report. Am Surg 2023; 89:4944-4948. [PMID: 38050321 DOI: 10.1177/00031348221135787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Liver venous deprivation (LVD) is an emerging, minimally invasive strategy to induce rapid liver hypertrophy of the future liver remnant (FLR) before a major hepatectomy. LVD (aka "double vein embolization") entails same-session percutaneous embolization of the portal and hepatic veins of the planned liver resection. This report discusses LVD's utilization and technical challenges in managing a 49-year-old male with recurrent multifocal colorectal liver metastases (CRLM). The patient initially underwent neoadjuvant FOLFOX chemotherapy followed by a simultaneous laparoscopic sigmoid colectomy and liver surgery (microwave ablation of segment V and wedge resections of segment one and IVb), followed by completion of chemotherapy. The patient had an R0 resection with clear colon and liver surgical margins. Nine months after the initial surgery, the patient had a rise in tumor markers, and surveillance imaging demonstrated recurrence of liver metastases in segments I and V. LVD was performed by interventional radiology, which led to a 28% increase in FLR (segments II, III, and IV); initially measuring 464 cm3 before LVD and measuring 594 cm3 on post-procedure day 21. The patient underwent right hemi-hepatectomy and caudate resection on post-procedure day 29. The patient did not have any complications and was discharged on postoperative day 6. The patient remains disease-free with no evidence of recurrence at 12 months follow-up.
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Affiliation(s)
- Nathan John
- Department of General Surgery, Section of Hepatobiliary and Pancreatic Surgery, Digestive Disease Institute, Cleveland Clinic Florida, Weston, FL, USA
| | - Lisandro Montorfano
- Department of General Surgery, Section of Hepatobiliary and Pancreatic Surgery, Digestive Disease Institute, Cleveland Clinic Florida, Weston, FL, USA
| | - Arun Nagarajan
- Department of Hematology and Medical Oncology, Cleveland Clinic Florida, Weston, FL, USA
| | - Conrad H Simpfendorfer
- Department of General Surgery, Section of Hepatobiliary and Pancreatic Surgery, Digestive Disease Institute, Cleveland Clinic Florida, Weston, FL, USA
| | - Steven D Wexner
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Florida, Weston, FL, USA
| | - Parag Amin
- Department of Imaging, Section of Interventional Radiology, Cleveland Clinic Florida, Weston, FL, USA
| | - Mayank Roy
- Department of General Surgery, Section of Hepatobiliary and Pancreatic Surgery, Digestive Disease Institute, Cleveland Clinic Florida, Weston, FL, USA
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5
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Nagarajan A, Wexner SD. We Asked the Experts: Watch and Wait; Treatment of Rectal Cancer. World J Surg 2023; 47:1068-1070. [PMID: 36303040 DOI: 10.1007/s00268-022-06811-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Arun Nagarajan
- Maroone Cancer Center, Cleveland Clinic Florida, 2950, Cleveland Clinic Blvd., Weston, FL, 33331, USA
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
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6
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Nagarajan A, Sethuraman V, Sasikumar R. Non-enzymatic electrochemical detection of creatinine based on a glassy carbon electrode modified with a Pd/Cu 2O decorated polypyrrole (PPy) nanocomposite: an analytical approach. Anal Methods 2023; 15:1410-1421. [PMID: 36826445 DOI: 10.1039/d3ay00110e] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The major constraints of standard enzymatic biosensors are poor long-term storage stability and high cost. Hence, there is extensive research towards fabrication of reliable enzymeless biosensors based on nanomaterials. In this paper, we present the development of an enzymeless electrochemical biosensor for highly precise detection of creatinine. This involves the use of a simple yet effective alternative to the commonly utilized Pd/Cu2O/PPy nanocomposite, which was characterized by different analytical methods. The present electrochemical sensor provides a wide detection range (0.1 to 150 μM), low detection limit (0.05 μM) and high sensitivity (0.207 μA), and is capable of detecting the creatinine level in human urine samples, which are inexpensive. The results are reproducible, and the sensor is stable. The sensor demonstrates good electrocatalytic activity and selectivity towards the detection of creatinine in the presence of various other similar biological entities. When compared to other existing counterparts, the electrocatalytic behaviour of the present sensor is comparable, if not better. So, the present electrochemical sensor for creatinine might be employed as a long-term diagnostic alternative.
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Affiliation(s)
- A Nagarajan
- Department of Physical Chemistry, University of Madras, Guindy Campus, Chennai-600025, Tamil Nadu, India.
| | - V Sethuraman
- Research and Development, New Energy Storage Technology, Lithium-ion Division, Amara Raja Battery Ltd, Karakambadi-517520, Tirupati, Andhra Pradesh, India
| | - R Sasikumar
- Department of Physical Chemistry, University of Madras, Guindy Campus, Chennai-600025, Tamil Nadu, India.
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7
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Shah MA, Kennedy EB, Alarcon-Rozas AE, Alcindor T, Bartley AN, Malowany AB, Bhadkamkar NA, Deighton DC, Janjigian Y, Karippot A, Khan U, King DA, Klute K, Lacy J, Lee JJ, Mehta R, Mukherjee S, Nagarajan A, Park H, Saeed A, Semrad TJ, Shitara K, Smyth E, Uboha NV, Vincelli M, Wainberg Z, Rajdev L. Immunotherapy and Targeted Therapy for Advanced Gastroesophageal Cancer: ASCO Guideline. J Clin Oncol 2023; 41:1470-1491. [PMID: 36603169 DOI: 10.1200/jco.22.02331'||'] [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: 01/29/2024] Open
Abstract
PURPOSE To develop recommendations involving targeted therapies for patients with advanced gastroesophageal cancer. METHODS The American Society of Clinical Oncology convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice. RESULTS Eighteen randomized controlled trials met the inclusion criteria for the systematic review. RECOMMENDATIONS For human epidermal growth factor receptor 2 (HER2)-negative patients with gastric adenocarcinoma (AC) and programmed death-ligand 1 (PD-L1) combined positive score (CPS) ≥ 5, first-line therapy with nivolumab and chemotherapy (CT) is recommended. For HER2-negative patients with esophageal or gastroesophageal junction (GEJ) AC and PD-L1 CPS ≥ 5, first-line therapy with nivolumab and CT is recommended. First-line therapy with pembrolizumab and CT is recommended for HER2-negative patients with esophageal or GEJ AC and PD-L1 CPS ≥ 10. For patients with esophageal squamous cell carcinoma and PD-L1 tumor proportion score ≥ 1%, nivolumab plus CT, or nivolumab plus ipilimumab is recommended; for patients with esophageal squamous cell carcinoma and PD-L1 CPS ≥ 10, pembrolizumab plus CT is recommended. For patients with HER2-positive gastric or GEJ previously untreated, unresectable or metastatic AC, trastuzumab plus pembrolizumab is recommended, in combination with CT. For patients with advanced gastroesophageal or GEJ AC whose disease has progressed after first-line therapy, ramucirumab plus paclitaxel is recommended. For HER2-positive patients with gastric or GEJ AC who have progressed after first-line therapy, trastuzumab deruxtecan is recommended. In all cases, participation in a clinical trial is recommended as it is the panel's expectation that targeted treatment options for gastroesophageal cancer will continue to evolve.Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.
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Affiliation(s)
| | | | | | - Thierry Alcindor
- McGill University Health Center Research Institute, Montreal, Canada
| | | | | | | | | | | | | | - Uqba Khan
- Weill Cornell Medicine, New York, NY
| | | | | | - Jill Lacy
- Yale School of Medicine, North Haven, CT
| | | | - Rutika Mehta
- Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | | | | | - Anwaar Saeed
- University of Kansas Medical Center, Kansas City, KS
| | - Thomas J Semrad
- Gene Upshaw Memorial Tahoe Forest Cancer Center, Truckee, CA
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8
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Shah MA, Kennedy EB, Alarcon-Rozas AE, Alcindor T, Bartley AN, Malowany AB, Bhadkamkar NA, Deighton DC, Janjigian Y, Karippot A, Khan U, King DA, Klute K, Lacy J, Lee JJ, Mehta R, Mukherjee S, Nagarajan A, Park H, Saeed A, Semrad TJ, Shitara K, Smyth E, Uboha NV, Vincelli M, Wainberg Z, Rajdev L. Immunotherapy and Targeted Therapy for Advanced Gastroesophageal Cancer: ASCO Guideline. J Clin Oncol 2023; 41:1470-1491. [PMID: 36603169 DOI: 10.1200/jco.22.02331] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To develop recommendations involving targeted therapies for patients with advanced gastroesophageal cancer. METHODS The American Society of Clinical Oncology convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice. RESULTS Eighteen randomized controlled trials met the inclusion criteria for the systematic review. RECOMMENDATIONS For human epidermal growth factor receptor 2 (HER2)-negative patients with gastric adenocarcinoma (AC) and programmed death-ligand 1 (PD-L1) combined positive score (CPS) ≥ 5, first-line therapy with nivolumab and chemotherapy (CT) is recommended. For HER2-negative patients with esophageal or gastroesophageal junction (GEJ) AC and PD-L1 CPS ≥ 5, first-line therapy with nivolumab and CT is recommended. First-line therapy with pembrolizumab and CT is recommended for HER2-negative patients with esophageal or GEJ AC and PD-L1 CPS ≥ 10. For patients with esophageal squamous cell carcinoma and PD-L1 tumor proportion score ≥ 1%, nivolumab plus CT, or nivolumab plus ipilimumab is recommended; for patients with esophageal squamous cell carcinoma and PD-L1 CPS ≥ 10, pembrolizumab plus CT is recommended. For patients with HER2-positive gastric or GEJ previously untreated, unresectable or metastatic AC, trastuzumab plus pembrolizumab is recommended, in combination with CT. For patients with advanced gastroesophageal or GEJ AC whose disease has progressed after first-line therapy, ramucirumab plus paclitaxel is recommended. For HER2-positive patients with gastric or GEJ AC who have progressed after first-line therapy, trastuzumab deruxtecan is recommended. In all cases, participation in a clinical trial is recommended as it is the panel's expectation that targeted treatment options for gastroesophageal cancer will continue to evolve.Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.
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Affiliation(s)
| | | | | | - Thierry Alcindor
- McGill University Health Center Research Institute, Montreal, Canada
| | | | | | | | | | | | | | - Uqba Khan
- Weill Cornell Medicine, New York, NY
| | | | | | - Jill Lacy
- Yale School of Medicine, North Haven, CT
| | | | - Rutika Mehta
- Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | | | | | - Anwaar Saeed
- University of Kansas Medical Center, Kansas City, KS
| | - Thomas J Semrad
- Gene Upshaw Memorial Tahoe Forest Cancer Center, Truckee, CA
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9
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Shah MA, Kennedy EB, Alarcon-Rozas AE, Alcindor T, Bartley AN, Malowany AB, Bhadkamkar NA, Deighton DC, Janjigian Y, Karippot A, Khan U, King DA, Klute K, Lacy J, Lee JJ, Mehta R, Mukherjee S, Nagarajan A, Park H, Saeed A, Semrad TJ, Shitara K, Smyth E, Uboha NV, Vincelli M, Wainberg Z, Rajdev L. Immunotherapy and Targeted Therapy for Advanced Gastroesophageal Cancer: ASCO Guideline. J Clin Oncol 2023; 41:1470-1491. [PMID: 36603169 DOI: 10.1200/jco.22.02331hn7szges] [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: 01/29/2024] Open
Abstract
PURPOSE To develop recommendations involving targeted therapies for patients with advanced gastroesophageal cancer. METHODS The American Society of Clinical Oncology convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice. RESULTS Eighteen randomized controlled trials met the inclusion criteria for the systematic review. RECOMMENDATIONS For human epidermal growth factor receptor 2 (HER2)-negative patients with gastric adenocarcinoma (AC) and programmed death-ligand 1 (PD-L1) combined positive score (CPS) ≥ 5, first-line therapy with nivolumab and chemotherapy (CT) is recommended. For HER2-negative patients with esophageal or gastroesophageal junction (GEJ) AC and PD-L1 CPS ≥ 5, first-line therapy with nivolumab and CT is recommended. First-line therapy with pembrolizumab and CT is recommended for HER2-negative patients with esophageal or GEJ AC and PD-L1 CPS ≥ 10. For patients with esophageal squamous cell carcinoma and PD-L1 tumor proportion score ≥ 1%, nivolumab plus CT, or nivolumab plus ipilimumab is recommended; for patients with esophageal squamous cell carcinoma and PD-L1 CPS ≥ 10, pembrolizumab plus CT is recommended. For patients with HER2-positive gastric or GEJ previously untreated, unresectable or metastatic AC, trastuzumab plus pembrolizumab is recommended, in combination with CT. For patients with advanced gastroesophageal or GEJ AC whose disease has progressed after first-line therapy, ramucirumab plus paclitaxel is recommended. For HER2-positive patients with gastric or GEJ AC who have progressed after first-line therapy, trastuzumab deruxtecan is recommended. In all cases, participation in a clinical trial is recommended as it is the panel's expectation that targeted treatment options for gastroesophageal cancer will continue to evolve.Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.
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Affiliation(s)
| | | | | | - Thierry Alcindor
- McGill University Health Center Research Institute, Montreal, Canada
| | | | | | | | | | | | | | - Uqba Khan
- Weill Cornell Medicine, New York, NY
| | | | | | - Jill Lacy
- Yale School of Medicine, North Haven, CT
| | | | - Rutika Mehta
- Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | | | | | - Anwaar Saeed
- University of Kansas Medical Center, Kansas City, KS
| | - Thomas J Semrad
- Gene Upshaw Memorial Tahoe Forest Cancer Center, Truckee, CA
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10
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Shah MA, Kennedy EB, Alarcon-Rozas AE, Alcindor T, Bartley AN, Malowany AB, Bhadkamkar NA, Deighton DC, Janjigian Y, Karippot A, Khan U, King DA, Klute K, Lacy J, Lee JJ, Mehta R, Mukherjee S, Nagarajan A, Park H, Saeed A, Semrad TJ, Shitara K, Smyth E, Uboha NV, Vincelli M, Wainberg Z, Rajdev L. Immunotherapy and Targeted Therapy for Advanced Gastroesophageal Cancer: ASCO Guideline. J Clin Oncol 2023; 41:1470-1491. [PMID: 36603169 DOI: 10.1200/jco.22.02331" and 2*3*8=6*8 and "aoka"="aoka] [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: 01/29/2024] Open
Abstract
PURPOSE To develop recommendations involving targeted therapies for patients with advanced gastroesophageal cancer. METHODS The American Society of Clinical Oncology convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice. RESULTS Eighteen randomized controlled trials met the inclusion criteria for the systematic review. RECOMMENDATIONS For human epidermal growth factor receptor 2 (HER2)-negative patients with gastric adenocarcinoma (AC) and programmed death-ligand 1 (PD-L1) combined positive score (CPS) ≥ 5, first-line therapy with nivolumab and chemotherapy (CT) is recommended. For HER2-negative patients with esophageal or gastroesophageal junction (GEJ) AC and PD-L1 CPS ≥ 5, first-line therapy with nivolumab and CT is recommended. First-line therapy with pembrolizumab and CT is recommended for HER2-negative patients with esophageal or GEJ AC and PD-L1 CPS ≥ 10. For patients with esophageal squamous cell carcinoma and PD-L1 tumor proportion score ≥ 1%, nivolumab plus CT, or nivolumab plus ipilimumab is recommended; for patients with esophageal squamous cell carcinoma and PD-L1 CPS ≥ 10, pembrolizumab plus CT is recommended. For patients with HER2-positive gastric or GEJ previously untreated, unresectable or metastatic AC, trastuzumab plus pembrolizumab is recommended, in combination with CT. For patients with advanced gastroesophageal or GEJ AC whose disease has progressed after first-line therapy, ramucirumab plus paclitaxel is recommended. For HER2-positive patients with gastric or GEJ AC who have progressed after first-line therapy, trastuzumab deruxtecan is recommended. In all cases, participation in a clinical trial is recommended as it is the panel's expectation that targeted treatment options for gastroesophageal cancer will continue to evolve.Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.
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Affiliation(s)
| | | | | | - Thierry Alcindor
- McGill University Health Center Research Institute, Montreal, Canada
| | | | | | | | | | | | | | - Uqba Khan
- Weill Cornell Medicine, New York, NY
| | | | | | - Jill Lacy
- Yale School of Medicine, North Haven, CT
| | | | - Rutika Mehta
- Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | | | | | - Anwaar Saeed
- University of Kansas Medical Center, Kansas City, KS
| | - Thomas J Semrad
- Gene Upshaw Memorial Tahoe Forest Cancer Center, Truckee, CA
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11
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Shah MA, Kennedy EB, Alarcon-Rozas AE, Alcindor T, Bartley AN, Malowany AB, Bhadkamkar NA, Deighton DC, Janjigian Y, Karippot A, Khan U, King DA, Klute K, Lacy J, Lee JJ, Mehta R, Mukherjee S, Nagarajan A, Park H, Saeed A, Semrad TJ, Shitara K, Smyth E, Uboha NV, Vincelli M, Wainberg Z, Rajdev L. Immunotherapy and Targeted Therapy for Advanced Gastroesophageal Cancer: ASCO Guideline. J Clin Oncol 2023; 41:1470-1491. [PMID: 36603169 DOI: 10.1200/jco.22.02331����%2527%2522\'\"] [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: 01/29/2024] Open
Abstract
PURPOSE To develop recommendations involving targeted therapies for patients with advanced gastroesophageal cancer. METHODS The American Society of Clinical Oncology convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice. RESULTS Eighteen randomized controlled trials met the inclusion criteria for the systematic review. RECOMMENDATIONS For human epidermal growth factor receptor 2 (HER2)-negative patients with gastric adenocarcinoma (AC) and programmed death-ligand 1 (PD-L1) combined positive score (CPS) ≥ 5, first-line therapy with nivolumab and chemotherapy (CT) is recommended. For HER2-negative patients with esophageal or gastroesophageal junction (GEJ) AC and PD-L1 CPS ≥ 5, first-line therapy with nivolumab and CT is recommended. First-line therapy with pembrolizumab and CT is recommended for HER2-negative patients with esophageal or GEJ AC and PD-L1 CPS ≥ 10. For patients with esophageal squamous cell carcinoma and PD-L1 tumor proportion score ≥ 1%, nivolumab plus CT, or nivolumab plus ipilimumab is recommended; for patients with esophageal squamous cell carcinoma and PD-L1 CPS ≥ 10, pembrolizumab plus CT is recommended. For patients with HER2-positive gastric or GEJ previously untreated, unresectable or metastatic AC, trastuzumab plus pembrolizumab is recommended, in combination with CT. For patients with advanced gastroesophageal or GEJ AC whose disease has progressed after first-line therapy, ramucirumab plus paclitaxel is recommended. For HER2-positive patients with gastric or GEJ AC who have progressed after first-line therapy, trastuzumab deruxtecan is recommended. In all cases, participation in a clinical trial is recommended as it is the panel's expectation that targeted treatment options for gastroesophageal cancer will continue to evolve.Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.
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Affiliation(s)
| | | | | | - Thierry Alcindor
- McGill University Health Center Research Institute, Montreal, Canada
| | | | | | | | | | | | | | - Uqba Khan
- Weill Cornell Medicine, New York, NY
| | | | | | - Jill Lacy
- Yale School of Medicine, North Haven, CT
| | | | - Rutika Mehta
- Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | | | | | - Anwaar Saeed
- University of Kansas Medical Center, Kansas City, KS
| | - Thomas J Semrad
- Gene Upshaw Memorial Tahoe Forest Cancer Center, Truckee, CA
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12
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Shah MA, Kennedy EB, Alarcon-Rozas AE, Alcindor T, Bartley AN, Malowany AB, Bhadkamkar NA, Deighton DC, Janjigian Y, Karippot A, Khan U, King DA, Klute K, Lacy J, Lee JJ, Mehta R, Mukherjee S, Nagarajan A, Park H, Saeed A, Semrad TJ, Shitara K, Smyth E, Uboha NV, Vincelli M, Wainberg Z, Rajdev L. Immunotherapy and Targeted Therapy for Advanced Gastroesophageal Cancer: ASCO Guideline. J Clin Oncol 2023; 41:1470-1491. [PMID: 36603169 DOI: 10.1200/jco.22.02331%' and 2*3*8=6*8 and 'ialr'!='ialr%] [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: 01/29/2024] Open
Abstract
PURPOSE To develop recommendations involving targeted therapies for patients with advanced gastroesophageal cancer. METHODS The American Society of Clinical Oncology convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice. RESULTS Eighteen randomized controlled trials met the inclusion criteria for the systematic review. RECOMMENDATIONS For human epidermal growth factor receptor 2 (HER2)-negative patients with gastric adenocarcinoma (AC) and programmed death-ligand 1 (PD-L1) combined positive score (CPS) ≥ 5, first-line therapy with nivolumab and chemotherapy (CT) is recommended. For HER2-negative patients with esophageal or gastroesophageal junction (GEJ) AC and PD-L1 CPS ≥ 5, first-line therapy with nivolumab and CT is recommended. First-line therapy with pembrolizumab and CT is recommended for HER2-negative patients with esophageal or GEJ AC and PD-L1 CPS ≥ 10. For patients with esophageal squamous cell carcinoma and PD-L1 tumor proportion score ≥ 1%, nivolumab plus CT, or nivolumab plus ipilimumab is recommended; for patients with esophageal squamous cell carcinoma and PD-L1 CPS ≥ 10, pembrolizumab plus CT is recommended. For patients with HER2-positive gastric or GEJ previously untreated, unresectable or metastatic AC, trastuzumab plus pembrolizumab is recommended, in combination with CT. For patients with advanced gastroesophageal or GEJ AC whose disease has progressed after first-line therapy, ramucirumab plus paclitaxel is recommended. For HER2-positive patients with gastric or GEJ AC who have progressed after first-line therapy, trastuzumab deruxtecan is recommended. In all cases, participation in a clinical trial is recommended as it is the panel's expectation that targeted treatment options for gastroesophageal cancer will continue to evolve.Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.
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Affiliation(s)
| | | | | | - Thierry Alcindor
- McGill University Health Center Research Institute, Montreal, Canada
| | | | | | | | | | | | | | - Uqba Khan
- Weill Cornell Medicine, New York, NY
| | | | | | - Jill Lacy
- Yale School of Medicine, North Haven, CT
| | | | - Rutika Mehta
- Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | | | | | - Anwaar Saeed
- University of Kansas Medical Center, Kansas City, KS
| | - Thomas J Semrad
- Gene Upshaw Memorial Tahoe Forest Cancer Center, Truckee, CA
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13
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Shah MA, Kennedy EB, Alarcon-Rozas AE, Alcindor T, Bartley AN, Malowany AB, Bhadkamkar NA, Deighton DC, Janjigian Y, Karippot A, Khan U, King DA, Klute K, Lacy J, Lee JJ, Mehta R, Mukherjee S, Nagarajan A, Park H, Saeed A, Semrad TJ, Shitara K, Smyth E, Uboha NV, Vincelli M, Wainberg Z, Rajdev L. Immunotherapy and Targeted Therapy for Advanced Gastroesophageal Cancer: ASCO Guideline. J Clin Oncol 2023; 41:1470-1491. [PMID: 36603169 DOI: 10.1200/jco.22.02331'"] [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: 01/29/2024] Open
Abstract
PURPOSE To develop recommendations involving targeted therapies for patients with advanced gastroesophageal cancer. METHODS The American Society of Clinical Oncology convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice. RESULTS Eighteen randomized controlled trials met the inclusion criteria for the systematic review. RECOMMENDATIONS For human epidermal growth factor receptor 2 (HER2)-negative patients with gastric adenocarcinoma (AC) and programmed death-ligand 1 (PD-L1) combined positive score (CPS) ≥ 5, first-line therapy with nivolumab and chemotherapy (CT) is recommended. For HER2-negative patients with esophageal or gastroesophageal junction (GEJ) AC and PD-L1 CPS ≥ 5, first-line therapy with nivolumab and CT is recommended. First-line therapy with pembrolizumab and CT is recommended for HER2-negative patients with esophageal or GEJ AC and PD-L1 CPS ≥ 10. For patients with esophageal squamous cell carcinoma and PD-L1 tumor proportion score ≥ 1%, nivolumab plus CT, or nivolumab plus ipilimumab is recommended; for patients with esophageal squamous cell carcinoma and PD-L1 CPS ≥ 10, pembrolizumab plus CT is recommended. For patients with HER2-positive gastric or GEJ previously untreated, unresectable or metastatic AC, trastuzumab plus pembrolizumab is recommended, in combination with CT. For patients with advanced gastroesophageal or GEJ AC whose disease has progressed after first-line therapy, ramucirumab plus paclitaxel is recommended. For HER2-positive patients with gastric or GEJ AC who have progressed after first-line therapy, trastuzumab deruxtecan is recommended. In all cases, participation in a clinical trial is recommended as it is the panel's expectation that targeted treatment options for gastroesophageal cancer will continue to evolve.Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.
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Affiliation(s)
| | | | | | - Thierry Alcindor
- McGill University Health Center Research Institute, Montreal, Canada
| | | | | | | | | | | | | | - Uqba Khan
- Weill Cornell Medicine, New York, NY
| | | | | | - Jill Lacy
- Yale School of Medicine, North Haven, CT
| | | | - Rutika Mehta
- Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | | | | | - Anwaar Saeed
- University of Kansas Medical Center, Kansas City, KS
| | - Thomas J Semrad
- Gene Upshaw Memorial Tahoe Forest Cancer Center, Truckee, CA
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14
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Shah MA, Kennedy EB, Alarcon-Rozas AE, Alcindor T, Bartley AN, Malowany AB, Bhadkamkar NA, Deighton DC, Janjigian Y, Karippot A, Khan U, King DA, Klute K, Lacy J, Lee JJ, Mehta R, Mukherjee S, Nagarajan A, Park H, Saeed A, Semrad TJ, Shitara K, Smyth E, Uboha NV, Vincelli M, Wainberg Z, Rajdev L. Immunotherapy and Targeted Therapy for Advanced Gastroesophageal Cancer: ASCO Guideline. J Clin Oncol 2023; 41:1470-1491. [PMID: 36603169 DOI: 10.1200/jco.22.02331' and 2*3*8=6*8 and 'f6u8'='f6u8] [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: 01/29/2024] Open
Abstract
PURPOSE To develop recommendations involving targeted therapies for patients with advanced gastroesophageal cancer. METHODS The American Society of Clinical Oncology convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice. RESULTS Eighteen randomized controlled trials met the inclusion criteria for the systematic review. RECOMMENDATIONS For human epidermal growth factor receptor 2 (HER2)-negative patients with gastric adenocarcinoma (AC) and programmed death-ligand 1 (PD-L1) combined positive score (CPS) ≥ 5, first-line therapy with nivolumab and chemotherapy (CT) is recommended. For HER2-negative patients with esophageal or gastroesophageal junction (GEJ) AC and PD-L1 CPS ≥ 5, first-line therapy with nivolumab and CT is recommended. First-line therapy with pembrolizumab and CT is recommended for HER2-negative patients with esophageal or GEJ AC and PD-L1 CPS ≥ 10. For patients with esophageal squamous cell carcinoma and PD-L1 tumor proportion score ≥ 1%, nivolumab plus CT, or nivolumab plus ipilimumab is recommended; for patients with esophageal squamous cell carcinoma and PD-L1 CPS ≥ 10, pembrolizumab plus CT is recommended. For patients with HER2-positive gastric or GEJ previously untreated, unresectable or metastatic AC, trastuzumab plus pembrolizumab is recommended, in combination with CT. For patients with advanced gastroesophageal or GEJ AC whose disease has progressed after first-line therapy, ramucirumab plus paclitaxel is recommended. For HER2-positive patients with gastric or GEJ AC who have progressed after first-line therapy, trastuzumab deruxtecan is recommended. In all cases, participation in a clinical trial is recommended as it is the panel's expectation that targeted treatment options for gastroesophageal cancer will continue to evolve.Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.
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Affiliation(s)
| | | | | | - Thierry Alcindor
- McGill University Health Center Research Institute, Montreal, Canada
| | | | | | | | | | | | | | - Uqba Khan
- Weill Cornell Medicine, New York, NY
| | | | | | - Jill Lacy
- Yale School of Medicine, North Haven, CT
| | | | - Rutika Mehta
- Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | | | | | - Anwaar Saeed
- University of Kansas Medical Center, Kansas City, KS
| | - Thomas J Semrad
- Gene Upshaw Memorial Tahoe Forest Cancer Center, Truckee, CA
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15
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Nagarajan A, Sethuraman V, Sridhar T, Sasikumar R. Development of Au@NiO Decorated Polypyrrole Composite for Non-Enzymatic Electrochemical Sensing of Cholesterol. J IND ENG CHEM 2023. [DOI: 10.1016/j.jiec.2022.12.054] [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: 01/06/2023]
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16
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Bou Zerdan M, Hebbo E, Hijazi A, El Gemayel M, Nasr J, Nasr D, Yaghi M, Bouferraa Y, Nagarajan A. The Gut Microbiome and Alzheimer's Disease: A Growing Relationship. Curr Alzheimer Res 2022; 19:CAR-EPUB-128458. [PMID: 36578263 DOI: 10.2174/1567205020666221227090125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/03/2022] [Accepted: 10/19/2022] [Indexed: 12/30/2022]
Abstract
Evidence that the gut microbiota plays a key role in the pathogenesis of Alzheimer's disease is already un-ravelling. The microbiota-gut-brain axis is a bidirectional communication system that is not fully understood but includes neural, immune, endocrine, and metabolic pathways. The progression of Alzheimer's disease is supported by mechanisms related to the imbalance in the gut microbiota and the development of amyloid plaques in the brain, which are at the origin of Alzheimer's disease. Alterations in the composition of the gut microbiome led to dysregulation in the pathways governing this system. This leads to neurodegeneration through neuroinflammation and neurotransmitter dysregulation. Neurodegeneration and disruption of the blood-brain barrier are frontiers at the origin of Alzheimer's disease. Furthermore, bacteria populating the gut microbiota can secrete large amounts of amyloid proteins and lipopolysaccharides, which modulate signaling pathways and alter the production of proinflammatory cytokines associated with the pathogenesis of Alz-heimer's disease. Importantly, through molecular mimicry, bacterial amyloids may elicit cross-seeding of misfolding and induce microglial priming at different levels of the brain-gut-microbiota axis. The potential mechanisms of amyloid spreading include neuron-to-neuron or distal neuron spreading, direct blood-brain barrier crossing, or via other cells such as astrocytes, fibroblasts, microglia, and immune system cells. Gut microbiota metabolites, including short-chain fatty acids, pro-inflammatory factors, and neurotransmitters may also affect AD pathogenesis and associated cognitive decline. The purpose of this review is to summarize and discuss the current findings that may elucidate the role of gut microbiota in the development of Alzheimer's disease. Understanding the underlying mechanisms may provide new insights into novel therapeutic strategies for Alzheimer's disease, such as probiotics and targeted oligosaccharides.
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Affiliation(s)
- Maroun Bou Zerdan
- Department of Internal Medicine, SUNY Upstate Medical University, New York, USA
- Department of Hematology and Oncology, Cleveland Clinic Florida, Weston, Florida, USA
| | - Elsa Hebbo
- Faculty of Medicine, American University of Beirut, Beirut 2020, Lebanon
| | - Ali Hijazi
- Faculty of Medicine, American University of Beirut, Beirut 2020, Lebanon
| | - Maria El Gemayel
- Department of Gastroenterology and Hepatology, Hotel-Dieu de France Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Janane Nasr
- Saint George Hospital, Faculty of Medicine, University of Balamand, Beirut 1100, Lebanon
| | - Dayana Nasr
- Department of Internal Medicine, SUNY Upstate Medical University, New York, USA
| | - Marita Yaghi
- Department of Hematology and Oncology, Cleveland Clinic Florida, Weston, Florida, USA
| | - Youssef Bouferraa
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Arun Nagarajan
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, 44195, USA
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17
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Jabbal IS, Nagarajan A, Rivera C, Yaghi M, Liang H, Nahleh Z, Bejarano P, Berho M, Wexner S. Medullary carcinoma of the colon: A comprehensive analysis of the National Cancer Database. Surg Oncol 2022; 45:101856. [PMID: 36446307 DOI: 10.1016/j.suronc.2022.101856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/07/2022] [Accepted: 09/26/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Medullary carcinomas (MC) of the colon are uncommon tumors. In this study, we analyzed demographic and disease characteristics as well as survival outcomes of MC versus undifferentiated (UDA) and poorly differentiated (PDA) adenocarcinomas (AC) of the colon. MATERIALS AND METHODS The National Cancer Database (2004-2018) was utilized to identify patients with colon cancer. Patient demographics (including age, gender, race), disease characteristics (including grade, TNM stage, carcinoembryonic levels, perineural and lymphovascular invasion, lymph node status, microsatellite stability, KRAS mutation, and primary tumor site), and facility type and location were evaluated. Chi-square tests were used to compare descriptive data. Cox Regression and Kaplan Meier analyses were used to analyze survival characteristics. RESULTS 1,041,753 patients with colon cancer were identified of whom 2709 patients had MC and 897,902 had AC (136,597 PDA and 18,042 UDA). MC was seen in older patients (mean age 74 ± 13 years) and women (72.5% vs. 27.5% males). Most MCs were poorly differentiated (63.3%), and 82.4% of patients with MC had microsatellite instability. Fewer patients with MC had perineural invasion (15.6% vs. 22.0% in PDA and 22.4% in UDA, p < 0.001) and positive lymph nodes (38.4% versus 59.9% with PDA and 59.7% with UDA, p < 0.0001). MC diagnosis increased by year (Cochran-Armitage trend test, p < 0.0001). Kaplan Meir analysis revealed a better prognosis for patients with MC when compared to PDA or UDA (p < 0.001). CONCLUSION Given the rarity, pathologists should maintain a high suspicion for MC when encountering poorly differentiated or undifferentiated right-sided colon cancer with associated MSI-H.
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Affiliation(s)
- Iktej S Jabbal
- Department of Hematology/Oncology, Cleveland Clinic, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Arun Nagarajan
- Department of Hematology/Oncology, Cleveland Clinic, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
| | - Carlos Rivera
- Department of Hematology/Oncology, Cleveland Clinic, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Marita Yaghi
- Department of Hematology/Oncology, Cleveland Clinic, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Hong Liang
- Department of Clinical Research, Cleveland Clinic, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Zeina Nahleh
- Department of Hematology/Oncology, Cleveland Clinic, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Pablo Bejarano
- Department of Pathology, Cleveland Clinic, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Mariana Berho
- Department of Pathology, Cleveland Clinic, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Steven Wexner
- Department of Colon and Rectal Surgery, Cleveland Clinic, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
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Emile SH, Horesh N, Freund MR, Parlade A, Nagarajan A, Garoufalia Z, Gefen R, Silva-Alvarenga E, Dasilva G, Wexner SD. Assessment of mesorectal fascia status in MRI compared with circumferential resection margin after total mesorectal excision and predictors of involved margins. Surgery 2022; 172:1085-1092. [PMID: 35970606 DOI: 10.1016/j.surg.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/19/2022] [Accepted: 06/05/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Circumferential resection margin is an important prognosticator for total mesorectal excision outcome. We investigated the status of mesorectal fascia on magnetic resonance imaging compared with circumferential resection margin on pathology and factors associated with status change. METHODS This was a retrospective analysis of a prospective database of rectal cancer patients who underwent surgery. Mesorectal fascia status on magnetic resonance imaging done before neoadjuvant therapy and circumferential resection margin status on pathology were compared. The study outcomes were factors associated with a margin status conversion between magnetic resonance imaging and pathology, and predictors of involved circumferential resection margin. RESULTS In total, 244 patients (average follow-up of 25.4 months) were included. Eighty-one (33.2%) patients had potentially involved mesorectal fascia in magnetic resonance imaging and 12 (4.9%) had involved circumferential resection margin in pathology. A total of 2.8% of patients had a conversion of clear mesorectal fascia in magnetic resonance imaging to involved circumferential resection margin. Abdominoperineal resection was significantly associated with this status change (odds ratio: 25, 95% confidence interval: 2.4-255.8, P = .007). In total, 7.4% of patients with potentially involved mesorectal fascia had persistently involved circumferential resection margin. Lack of total neoadjuvant therapy was associated with higher, yet statistically insignificant, odds of persistently involved circumferential resection margin (odds ratio: 12, 95% confidence interval: 0.65-220.8, P = .09). The significant independent predictors of involved circumferential resection margin were body mass index (odds ratio: 1.2, P = .016) and abdominoperineal resection (odds ratio: 4.22, P = .04). CONCLUSION Change of clear mesorectal fascia in magnetic resonance imaging to an involved circumferential resection margin in pathology was recorded in 2.8% of patients; abdominoperineal resection might be associated with this change. Approximately 7% of patients had persistent involvement of circumferential resection margin as determined by pathology. Omission of total neoadjuvant therapy might be associated with persistent margin involvement.
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Affiliation(s)
- Sameh Hany Emile
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL; Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt. https://twitter.com/dr_samehhany81
| | - Nir Horesh
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL. https://twitter.com/nirhoresh
| | - Michael R Freund
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL. https://twitter.com/mikifreund
| | - Albert Parlade
- Department of Imaging, Cleveland Clinic Florida, Weston, FL. https://twitter.com/ajparlade
| | - Arun Nagarajan
- Department of Hematology and Medical Oncology, Cleveland Clinic Florida, Weston, FL. https://twitter.com/ArunNagarajanMD
| | - Zoe Garoufalia
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL. https://twitter.com/ZGaroufalia
| | - Rachel Gefen
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL
| | - Emanuela Silva-Alvarenga
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL. https://twitter.com/EmanuelaSilvaA1
| | - Giovanna Dasilva
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL. https://twitter.com/dasilvg
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL.
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Zerdan MB, Moukarzel R, Naji NS, Bilen Y, Nagarajan A. The Urogenital System’s Role in Diseases: A Synopsis. Cancers (Basel) 2022; 14:cancers14143328. [PMID: 35884388 PMCID: PMC9319963 DOI: 10.3390/cancers14143328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The urinary tract microbiome has come under a lot of scrutiny, and this has led to the rejection of the pre-established concept of sterility in the urinary bladder. Microbial communities in the urinary tract have been implicated in the maintenance of health. Thus, alterations in their composition have also been associated with different urinary pathologies, such as urinary tract infections. For that reason, tackling the urinary microbiome of healthy individuals, as well as its involvement in disease through the proliferation of opportunistic pathogens, could open a potential field of study, leading to new insights into prevention, diagnosis, and treatment strategies for different diseases. Abstract The human microbiota contains ten times more microbial cells than human cells contained by the human body, constituting a larger genetic material than the human genome itself. Emerging studies have shown that these microorganisms represent a critical determinant in human health and disease, and the use of probiotic products as potential therapeutic interventions to modulate homeostasis and treat disease is being explored. The gut is a niche for the largest proportion of the human microbiota with myriad studies suggesting a strong link between the gut microbiota composition and disease development throughout the body. More specifically, there is mounting evidence on the relevance of gut microbiota dysbiosis in the development of urinary tract disease including urinary tract infections (UTIs), chronic kidney disease, and kidney stones. Fewer emerging reports, however, are suggesting that the urinary tract, which has long been considered ‘sterile’, also houses its unique microbiota that might have an important role in urologic health and disease. The implications of this new paradigm could potentially change the therapeutic perspective in urological disease.
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Affiliation(s)
- Maroun Bou Zerdan
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA;
- Department of Hematology and Oncology, Cleveland Clinic Florida, Weston, FL 33331, USA
| | - Rita Moukarzel
- Faculty of Medicine, Lebanese American University Medical Center, Lebanese American University, Beirut 1102, Lebanon;
| | - Nour Sabiha Naji
- Faculty of Medicine, American University of Beirut, Beirut 2020, Lebanon;
| | - Yara Bilen
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA;
| | - Arun Nagarajan
- Department of Hematology and Oncology, Cleveland Clinic Florida, Weston, FL 33331, USA
- Correspondence:
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Jabbal IS, Nagarajan A, Roy M, Rivera C, Yaghi M, Liang H, Nguyen TQ, George TL, Nahleh ZA, Simpfendorfer CH. Can CA 19-9 predict inferior surgical and pathological outcomes for resectable pancreatic cancer? J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e16228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16228 Background: Previous data have established that patients with pancreatic surgical specimens showing lymphovascular invasion (LVI) and positive surgical resection margins are associated with poor survival outcomes. However, there are no biomarkers to identify these high-risk patients preoperatively. In this study, we hypothesized that increased carbohydrate antigen 19-9 (CA 19-9) levels could be used to predict high-risk resectable pancreatic cancer features, including LVI and positive residual margins, thereby guiding the surgical decision-making process. Methods: We sampled the National Cancer Database for patients undergoing pancreatic cancer resection between 2004-2018. Logistic regression analysis was performed to analyze sociodemographic and disease characteristics associated with elevated CA 19-9 levels (> 98 U/ml) versus low CA 19-9 levels (< 98 U/ml). Additionally, Cox regression analyses were used to compare hazard ratios for demographic and disease characteristics. A p < 0.05 was considered statistically significant. Results: 12208 patients (50.76% males) with pancreatic cancer were sampled. Pathological findings of LVI (n = 5963), microscopic residual tumor margins (R1) (n = 1547), and residual margins (R), not otherwise specified (NOS) (n = 885) had a stronger association with high preoperative CA 19-9 levels when compared to those with low CA 19-9 levels (LVI: OR 1.212, 95% CI 1.125–1.305, p < 0.001, R1: OR 1.260, 95% CI 1.129–1.408, p = 0.001 and R NOS: OR 1.212, 95% CI 1.052–1.395, p = 0.008). Macroscopic residual margins (R2) (n = 85) were also associated with high CA 19-9 but statistically not significant (OR 1.242, 95% CI 0.802–1.924, p = 0.332) probably due to the low sample size for this subpopulation. Furthermore, all the factors listed below were independently associated with poor prognosis: (A) Elevated CA 19-9 levels: HR 1.411, 95% CI 1.350–1.475, p < 0.001, (B) LVI: HR 1.333, 95% CI 1.275–1.394, p < 0.001, (C) R NOS: HR = 1.517, 95% CI = 1.401–1.643, p < 0.001, (D) R1: HR 1.594, 95% CI 1.499–1.695, p < 0.001, (E) R2: HR 2.015, 95% CI 1.597–2.543, p < 0.001. Conclusions: Elevated CA 19-9 can be used as a biomarker to identify a subset of pancreatic cancer patients with high-risk surgical pathological features such as LVI or residual tumor margins. In these patients, perhaps neoadjuvant chemotherapy can facilitate downstaging and provide superior surgical and oncological outcomes.
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Nagarajan A. Total neoadjuvant therapy: Fact, fantasy, or fallacy? Surg Oncol 2022; 43:101738. [DOI: 10.1016/j.suronc.2022.101738] [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] [Received: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 12/01/2022]
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Jabbal IS, Nagarajan A, Rivera C, Yaghi M, Liang H, Nahleh ZA, Bejarano P, Berho M, Wexner S. Medullary carcinoma of the colon: A comprehensive analysis of a large cancer database. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
180 Background: Medullary carcinoma (MC) of the colon was described first in 1999 and is characterized by undifferentiated sheets of epithelial cells in a solid growth pattern with pushing borders and prominent lymphoplasmacytic infiltrates. It frequently shows microsatellite instability (MSI). However, the clinicopathological and survival outcomes between MC and the more common adenocarcinoma of the colon (AC) are not well defined in a large database. Therefore, we used a large national registry to explore the association of survival characteristics with sociodemographic, geographic, and disease variables in this cohort of patients. Methods: We sampled the National Cancer Database (NCDB) for colon cancer patients diagnosed with MC from 2004-2018. Multivariate cox regression models were used to compare hazard ratios for demographic, geographic, and disease characteristics. In addition, Kaplan-Meier survival plots were utilized to assess survival rate differences between MC and AC tumors located in the ascending, transverse, or descending colon. A p-value<0.05 was considered statistically significant. Results: Only 2,709 (0.29%) of the 922,667 patients with AC had MC. MC was seen in older patients than AC (76 vs. 69 years). MC was also more common in females than AC (72.5 vs. 49%). The most striking finding in our analysis was the predominance of poorly differentiated (63%) and undifferentiated (21.7%) pathologies in MC. This was in sharp contrast to AC, where 15.8% of patients were poorly differentiated, and only 2% were undifferentiated. Furthermore, undifferentiated and poorly differentiated MC tumors had a poor prognosis (HR 1.45, 95% CI 1.26-1.68, p<0.001 and HR 1.44, 95% CI 1.29-1.62, p<0.001 respectively) as compared to the other histological grades. Another notable finding in our analysis was the high prevalence of MSI in MC vs. AC (82.4% vs. 25.9%). Cecal MC (HR 1) had the worst prognosis of any colonic site. Left-sided MC tumors also had an inferior prognosis compared to AC (63.21 vs. 87.72 months), although not statistically significant (p=0.217). Conclusions: Colon cancer presenting as undifferentiated or poorly differentiated with associated MSI should raise the possibility of a medullary carcinoma diagnosis. However, given the rarity and difficulty in its pathological delineation, MC may remain underdiagnosed. In the modern treatment era, with the approval of immunotherapy for metastatic MSI colon cancer patients, survival and outcomes for metastatic MC may be improved.
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Horesh N, Freund MR, Garoufalia Z, Gefen R, Nagarajan A, Suarez E, Emile SH, Wexner SD. Total Neoadjuvant Therapy Is a Predictor for Complete Pathological Response in Patients Undergoing Surgery for Rectal Cancer. J Gastrointest Surg 2022; 26:2579-2584. [PMID: 36224480 PMCID: PMC9555694 DOI: 10.1007/s11605-022-05463-1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/10/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Total neoadjuvant therapy (TNT) is a new therapeutic strategy in patients with rectal cancer. We examined the role of TNT, in addition to other pre-operative factors, as a predictor for pathologic complete response (pCR). METHODS A retrospective analysis of all rectal cancer patients who underwent surgery between 2016 and 2021 was conducted. Patients were classified into two groups-pCR group and residual tumor group. Patient data were reviewed and entered into univariate and multivariate analyses to determine predictors of pCR. RESULTS A total of 172 patients were treated with neoadjuvant therapy and underwent surgery during the study period. Sixty patients (34.9%) were treated with TNT while 112 (65.1%) were treated with traditional neoadjuvant chemoradiation. The overall pCR rate was 25.6% (44 patients), with 31.6% (19 patients) in patients who received TNT compared to 22.3% (25 patients) in patients who received neoadjuvant chemoradiation (NCRT). Univariate analysis of clinical and radiological factors correlated with pCR demonstrated no significant differences between the two groups in cT stage (p = 0.46), cN stage (p = 0.52), positive circumferential resection margin (CRM) (p = 0.72), tumor location (p = 0.35), symptomatic presentation (p = 0.09), and anal sphincter involvement (p = 0.68). Multivariate logistic analysis demonstrated that only pre-operative TNT (OR:2.35; 95% CI 1.06-5.25; p = 0.03) was predictive of pCR, while extramural vascular invasion (EMVI) was a predictor for lower rates of pCR (OR: 0.28; 95% CI 0.09-0.9; p = 0.03). CONCLUSION Rectal cancer patients undergoing TNT prior to surgery have a higher chance of developing a complete pathologic response. Evaluation of this therapy should be continued and extended to larger numbers of patients to see if the differences we observed are real.
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Affiliation(s)
- Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331 USA ,Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, Israel, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael R. Freund
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331 USA ,Department of General Surgery, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331 USA
| | - Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331 USA
| | - Arun Nagarajan
- Department of Hematology/Oncology, Cleveland Clinic Florida, Weston, FL USA
| | - Eva Suarez
- Department of Radiation Oncology, Cleveland Clinic Florida, Weston, FL USA
| | - Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331 USA ,Colorectal Surgery Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Steven D. Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331 USA
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Smith MJ, Dempsey SG, Veale RWF, Duston-Fursman CG, Rayner CAF, Javanapong C, Gerneke D, Dowling SG, Bosque BA, Karnik T, Jerram MJ, Nagarajan A, Rajam R, Jowsey A, Cutajar S, Mason I, Stanley RG, Campbell A, Malmstrom J, Miller CH, May BCH. Further structural characterization of ovine forestomach matrix and multi-layered extracellular matrix composites for soft tissue repair. J Biomater Appl 2022; 36:996-1010. [PMID: 34747247 PMCID: PMC8721687 DOI: 10.1177/08853282211045770] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Decellularized extracellular matrix (dECM)-based biomaterials are of great clinical utility in soft tissue repair applications due to their regenerative properties. Multi-layered dECM devices have been developed for clinical indications where additional thickness and biomechanical performance are required. However, traditional approaches to the fabrication of multi-layered dECM devices introduce additional laminating materials or chemical modifications of the dECM that may impair the biological functionality of the material. Using an established dECM biomaterial, ovine forestomach matrix, a novel method for the fabrication of multi-layered dECM constructs has been developed, where layers are bonded via a physical interlocking process without the need for additional bonding materials or detrimental chemical modification of the dECM. The versatility of the interlocking process has been demonstrated by incorporating a layer of hyaluronic acid to create a composite material with additional biological functionality. Interlocked composite devices including hyaluronic acid showed improved in vitro bioactivity and moisture retention properties.
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Affiliation(s)
- Matthew J Smith
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Sandi G Dempsey
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Robert WF Veale
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | | | - Chloe A F Rayner
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Chettha Javanapong
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Dane Gerneke
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Shane G Dowling
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Brandon A Bosque
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Tanvi Karnik
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Michael J Jerram
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Arun Nagarajan
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Ravinder Rajam
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Alister Jowsey
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Samuel Cutajar
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Isaac Mason
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Roderick G Stanley
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Andrew Campbell
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Jenny Malmstrom
- Department of Chemical and Materials Engineering, The University of Auckland, Auckland, New Zealand
| | - Chris H Miller
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Barnaby C H May
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
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Hong Y, Ghuman A, Poh KS, Krizzuk D, Nagarajan A, Amarnath S, Nogueras JJ, Wexner SD, DaSilva G. Can normalized carcinoembryonic antigen following neoadjuvant chemoradiation predict tumour recurrence after curative resection for locally advanced rectal cancer? Colorectal Dis 2021; 23:1346-1356. [PMID: 33570756 DOI: 10.1111/codi.15583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 12/12/2022]
Abstract
AIM The aim of this work was to evaluate whether normalized carcinoembryonic antigen (CEA) following neoadjuvant chemoradiation predicts the prognosis following curative resection in locally advanced rectal cancer. METHOD Patients who underwent neoadjuvant chemoradiation and curative resection for locally advanced rectal cancer between 2010 and 2015 were divided into three groups: Group A (n = 119, normal-to-normal): normal CEA before and after neoadjuvant chemoradiation; Group B (n = 37, high-to-normal): elevated CEA before and normal CEA after neoadjuvant chemoradiation; Group C (n = 36, high-to-high): elevated CEA before and after neoadjuvant chemoradiation. Overall and disease-free survival were compared. Univariate and multivariate analyses identified potential predictors for recurrence. RESULTS One hundred and ninety two patients [median age 59 years (range 31-87), 65.1% male] were identified: 54.7% had low rectal cancer: 12.5% were clinical stage T4 and 70.3% were clinically node positive; 21.9% achieved complete pathological response; 24.5% had abdominoperineal resection (APR); and 70.3% underwent adjuvant chemotherapy following curative resection. Significantly more patients in Group C underwent APR (p = 0.0209), had advanced pathological T stage (P = 0.0065) and a higher prevalence of perineural invasion (p = 0.0042). Overall and disease-free survival were significantly higher for Group A than for Group C [hazard ratio (HR) = 4.32, 95% CI = 1.66-11.21, p = 0.0026 and HR=2.68, 95% CI = 1.33-5.40, p = 0.0057, respectively]. No significant difference was noted between Groups A and B for overall (p = 0.0591) or disease-free (p = 0.2834) survival. Another risk factor associated with recurrence and death was clinical T4 stage; nodal positivity was a risk factor only for recurrence. CONCLUSION Elevated CEA after neoadjuvant chemoradiation and clinical stage T4 disease were unfavourable predictors for overall and disease-free survival. Normalized CEA during neoadjuvant chemoradiation may serve as a prognosticator, although pretreatment CEA may significantly affect survival.
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Affiliation(s)
- Youngki Hong
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Amandeep Ghuman
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Keat Seong Poh
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Dimitri Krizzuk
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Arun Nagarajan
- Department of Hematology and Oncology, Cleveland Clinic Florida, Weston, FL, USA
| | - Sudha Amarnath
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Juan J Nogueras
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Giovanna DaSilva
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
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Kamath SD, Roopkumar J, Ni Y, Shen M, Bejarano P, Allende D, Nagarajan A, Nguyen T, Dergham B, Shepard DR, Shapiro MA, McNamara MJ, Estfan BN, Nair KG, Khorana AA. Number of nonsynonymous genomic variants may correlate with prognosis in advanced pancreatic cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
432 Background: Pancreatic cancer is associated with poor outcomes at any stage. A very small number of patients - approximately 3% of those with metastatic disease - experience long-term survival through 5 years but the biologic mechanisms underlying the benefit observed with these “exceptional responders” are incompletely understood. We explored potential genomic differences between exceptional responders and typical responders to treatment for advanced pancreatic cancer that could confer a more favorable biology. Methods: We included consecutive exceptional responders and matched controls (MCs) with advanced pancreatic cancer in a 1:3 ratio from the Cleveland Clinic from April, 2013 – August, 2017. ERs were defined as patients with overall survival (OS) > 18 months for metastatic disease and > 24 months for locally advanced disease. Controls were matched by age, gender, stage and type of chemotherapy given and experienced OS at or below median survival for their stages. Clinical variables including demographics, comorbidities, stage, histology and treatment history were collected. Next generation sequencing (NGS) was performed for DNA sequencing of 648 genes and tumor mutation burden (TMB) on available tissue. The study population initially comprised of 14 exceptional responders and 42 MCs. However, only 4 exceptional responders and 6 MCs were included for analysis due to insufficient tissue for NGS for the remaining patients. Descriptive statistics were used for statistical analysis. Differences in survival outcomes were assessed using the Kaplan-Meier method and log-rank test. Results: The median ages for the exceptional responders and MCs were 69 and 67.5 years, respectively. Both groups were at least 75% male and white. Of the exceptional responders, 50% had pancreatic tail primaries compared to 0% of the MCs. There were no differences between groups in first-line chemotherapy used. Exceptional responders had significantly fewer non-synonymous mutations compared to MCs (2.25 vs. 5.17, p = 0.014). Mutation count < 3 was associated with significantly better progression-free survival (PFS) and OS as shown in the Table. TMB did not differ between exceptional responders and MCs (4.88 vs. 5.70 Muts/Mb, p = 0.39). Of the exceptional responders, 50% had alterations in BAGE2 versus 0% of MCs. Conversely, 50% of MCs had alterations in LRP1B, CUL4B or APC vs. 0% of exceptional responders. Conclusions: Having a lower number of non-synonymous mutations may correlate with exceptional response to systemic therapy and therefore with improved survival in pancreatic cancer. Pancreatic tail primary may also be associated with improved outcomes. These findings, though limited by small sample size, should encourage future study into genomic signatures of exceptional response. [Table: see text]
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Affiliation(s)
| | | | - Ying Ni
- Genomic Medicine Institute, Cleveland Clinic Lerner Research Institute, Cleveland, OH
| | | | | | | | - Arun Nagarajan
- Charleston Area Medical Center, David Lee Cancer Center, Charleston, WV
| | | | | | | | | | | | | | - Kanika G. Nair
- George Washington University School of Medicine, Washington, DC
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Gilshtein H, Ghuman A, Dawoud M, Yellinek S, Kent I, Sharp SP, Nagarajan A, Wexner SD. Total Neoadjuvant Treatment for Rectal Cancer: Preliminary Experience. Am Surg 2020; 87:708-713. [PMID: 33169626 DOI: 10.1177/0003134820951499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Administration of chemotherapeutic regimens such as FOLFOX or CAPEOX with chemoradiation in the neoadjuvant setting, termed total neoadjuvant treatment (TNT), was introduced in recent years. By increasing the complete pathologic and clinical responses, patients with locally advanced rectal cancer may have better oncologic outcomes and potentially abstain from undergoing a proctectomy. METHODS All patients who underwent TNT at a single National Accreditation Program for Rectal Cancer accredited referral center were included. A retrospective analysis was performed using a computerized Institutional Review Board-approved database. Patient demographics, diagnostic workup, treatment regimens, and surgical and pathological reports were reviewed. Complete pathological response was the primary outcome. Univariable and multivariable logistic regression analyses were performed to identify potential factors predisposing to complete pathological response. RESULTS Thirty patients met the inclusion criteria, 14(46.6%) of whom had complete pathologic response. There was no difference in baseline demographic characteristics between patients who achieved complete pathological response and those who did not. Pathology revealed a 92% intact mesorectum rate in the complete pathologic response group and a mean of 24 harvested lymph nodes in the entire study cohort. Both univariable and multivariable logistic regression analyses failed to demonstrate statistically significant factors predicting complete pathologic response, magnetic resonance imaging (MRI) tumor size, and posttreatment MRI lymph node positivity. CONCLUSION TNT is safe and efficient for patients with locally advanced rectal cancer. It increases complete pathological and clinical response rates and may more widely evolve to be the treatment of choice in this group of patients in the near future.
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Affiliation(s)
- Hayim Gilshtein
- Department of Colorectal Surgery, Cleveland Clinic Florida, FL, USA
| | - Amandeep Ghuman
- Department of Colorectal Surgery, Cleveland Clinic Florida, FL, USA
| | - Mirelle Dawoud
- Department of Colorectal Surgery, Cleveland Clinic Florida, FL, USA
| | - Shlomo Yellinek
- Department of Colorectal Surgery, Cleveland Clinic Florida, FL, USA
| | - Ilan Kent
- Department of Colorectal Surgery, Cleveland Clinic Florida, FL, USA
| | - Stephen P Sharp
- Department of Colorectal Surgery, Cleveland Clinic Florida, FL, USA
| | - Arun Nagarajan
- Department of Hematology and Medical Oncology, Cleveland Clinic Florida, FL, USA
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, FL, USA
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Sadler D, Chaulagain C, Alvarado B, Cubeddu R, Stone E, Samuel T, Bastos B, Grossman D, Fu CL, Alley E, Nagarajan A, Nguyen T, Ahmed W, Elson L, Nahleh Z. Practical and cost-effective model to build and sustain a cardio-oncology program. Cardiooncology 2020; 6:9. [PMID: 32690995 PMCID: PMC7363993 DOI: 10.1186/s40959-020-00063-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cardio-Oncology (CO) is a new subspecialty that thrives mostly in large academic quaternary centers. This study describes how to establish a successful cardio-oncology program, with limited resources, in order to effectively manage the unique care required by this patient population. METHODS Clinical data was collected from 25 consecutive months. There were four foundational elements to establish a CO program: 1. Clinical program: integrating staff and resources from the Heart and Vascular, and Cancer Centers; 2. Education Program: establishing a platform to educate/advocate with respect to CO; 3. Engagement with professional societies: active engagement allowed for the successful establishment of the proposed CO program; and 4. Research program: establishing data collection modalities/cooperation with other institutions. RESULTS 474 consecutive patients were treated by our CO program during the first 25 months of operation. Clinical data, information about cancer treatment, cardiovascular co morbidities, cardiac testing and impact of CO management are reported. CONCLUSIONS A successful CO program can be established utilizing existing resources without the need for significant additional assets. Integration with professional societies, advocacy, education and research, provide a platform for learning and growth. This model improves access to care and can be reproduced in a variety of settings.
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Affiliation(s)
- Diego Sadler
- Cleveland Clinic Florida, Heart and Vascular Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Chakra Chaulagain
- Cleveland Clinic Florida, Maroone Cancer Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Beatrice Alvarado
- Cleveland Clinic Florida, Heart and Vascular Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Robert Cubeddu
- Cleveland Clinic Florida, Heart and Vascular Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Elizabeth Stone
- Cleveland Clinic Florida, Maroone Cancer Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Thomas Samuel
- Cleveland Clinic Florida, Maroone Cancer Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Bruno Bastos
- Cleveland Clinic Florida, Maroone Cancer Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - David Grossman
- Cleveland Clinic Florida, Maroone Cancer Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Chieh-Lin Fu
- Cleveland Clinic Florida, Maroone Cancer Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Evan Alley
- Cleveland Clinic Florida, Maroone Cancer Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Arun Nagarajan
- Cleveland Clinic Florida, Maroone Cancer Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Timmy Nguyen
- Cleveland Clinic Florida, Maroone Cancer Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Wesam Ahmed
- Cleveland Clinic Florida, Maroone Cancer Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Leah Elson
- Cleveland Clinic Florida, Maroone Cancer Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
| | - Zeina Nahleh
- Cleveland Clinic Florida, Maroone Cancer Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331 USA
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Nagarajan A, van Erve K, Gerini G. Ultra-narrowband polarization insensitive transmission filter using a coupled dielectric-metal metasurface. Opt Express 2020; 28:773-787. [PMID: 32118999 DOI: 10.1364/oe.383781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/22/2019] [Indexed: 06/10/2023]
Abstract
A coupled dielectric-metal metasurface (CDMM) filter consisting of amorphous silicon (a-Si) rings and subwavelength holes in Au layer separated by a SiO2 layer is presented. The design parameters of the CDMM filter is numerically optimized to have a polarization independent peak transmittance of 0.55 at 1540 nm with a Full Width at Half Maximum (FWHM) of 10 nm. The filter also has a 100 nm quiet zone with ∼10-2 transmittance. A radiating two-oscillator model reveals the fundamental resonances in the filter which interfere to produce the electromagnetically induced transparency (EIT) like effect. Multipole expansion of the currents in the structure validates the fundamental resonances predicted by the two-oscillator model. The presented CDMM filter is robust to artifacts in device fabrication and has performances comparable to a conventional Fabry-Pérot filter. However, it is easier to be integrated in image sensors as the transmittance peak can be tuned by only changing the periodicity resulting in a planar structure with a fixed height.
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Karnik T, Dempsey SG, Jerram MJ, Nagarajan A, Rajam R, May BCH, Miller CH. Ionic silver functionalized ovine forestomach matrix - a non-cytotoxic antimicrobial biomaterial for tissue regeneration applications. Biomater Res 2019; 23:6. [PMID: 30834142 PMCID: PMC6387525 DOI: 10.1186/s40824-019-0155-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/06/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Antimicrobial technologies, including silver-containing medical devices, are increasingly utilized in clinical regimens to mitigate risks of microbial colonization. Silver-functionalized resorbable biomaterials for use in wound management and tissue regeneration applications have a narrow therapeutic index where antimicrobial effectiveness may be outweighed by adverse cytotoxicity. We examined the effects of ionic silver functionalization of an extracellular matrix (ECM) biomaterial derived from ovine forestomach (OFM-Ag) in terms of material properties, antimicrobial effectiveness and cytotoxicity profile. METHODS Material properties of OFM-Ag were assessed by via biochemical analysis, microscopy, atomic absorption spectroscopy (AAS) and differential scanning calorimetry. The silver release profile of OFM-Ag was profiled by AAS and antimicrobial effectiveness testing utilized to determine the minimum effective concentration of silver in OFM-Ag in addition to the antimicrobial spectrum and wear time. Biofilm prevention properties of OFM-Ag in comparison to silver containing collagen dressing materials was quantified via in vitro crystal violet assay using a polymicrobial model. Toxicity of ionic silver, OFM-Ag and silver containing collagen dressing materials was assessed toward mammalian fibroblasts using elution cytoxicity testing. RESULTS OFM-Ag retained the native ECM compositional and structural characteristic of non-silver functionalized ECM material while imparting broad spectrum antimicrobial effectiveness toward 11 clinically relevant microbial species including fungi and drug resistant strains, maintaining effectiveness over a wear time duration of 7-days. OFM-Ag demonstrated significant prevention of polymicrobial biofilm formation compared to non-antimicrobial and silver-containing collagen dressing materials. Where silver-containing collagen dressing materials exhibited cytotoxic effects toward mammalian fibroblasts, OFM-Ag was determined to be non-cytotoxic, silver elution studies indicated sustained retention of silver in OFM-Ag as a possible mechanism for the attenuated cytotoxicity. CONCLUSIONS This work demonstrates ECM biomaterials may be functionalized with silver to favourably shift the balance between detrimental cytotoxic potential and beneficial antimicrobial effects, while preserving the ECM structure and function of utility in tissue regeneration applications.
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Affiliation(s)
- Tanvi Karnik
- Aroa Biosurgery, 2 Kingsford Smith Place, PO Box 107111, Auckland Airport, Auckland, 2150 New Zealand
| | - Sandi G. Dempsey
- Aroa Biosurgery, 2 Kingsford Smith Place, PO Box 107111, Auckland Airport, Auckland, 2150 New Zealand
| | - Micheal J. Jerram
- Aroa Biosurgery, 2 Kingsford Smith Place, PO Box 107111, Auckland Airport, Auckland, 2150 New Zealand
| | - Arun Nagarajan
- Aroa Biosurgery, 2 Kingsford Smith Place, PO Box 107111, Auckland Airport, Auckland, 2150 New Zealand
| | - Ravindra Rajam
- Aroa Biosurgery, 2 Kingsford Smith Place, PO Box 107111, Auckland Airport, Auckland, 2150 New Zealand
| | - Barnaby C. H. May
- Aroa Biosurgery, 2 Kingsford Smith Place, PO Box 107111, Auckland Airport, Auckland, 2150 New Zealand
| | - Christopher H. Miller
- Aroa Biosurgery, 2 Kingsford Smith Place, PO Box 107111, Auckland Airport, Auckland, 2150 New Zealand
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Stoffel EM, McKernin SE, Brand R, Canto M, Goggins M, Moravek C, Nagarajan A, Petersen GM, Simeone DM, Yurgelun M, Khorana AA. Evaluating Susceptibility to Pancreatic Cancer: ASCO Provisional Clinical Opinion. J Clin Oncol 2019; 37:153-164. [DOI: 10.1200/jco.18.01489] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose An ASCO provisional clinical opinion (PCO) offers timely clinical direction to ASCO’s membership and other health care providers. This PCO addresses identification and management of patients and family members with possible predisposition to pancreatic adenocarcinoma. Methods ASCO convened an Expert Panel and conducted a systematic review of the literature published from January 1998 to June 2018. Results of the databases searched were supplemented with hand searching of the bibliographies of systematic reviews and selected seminal articles and contributions from Expert Panel members’ curated files. Provisional Clinical Opinion All patients diagnosed with pancreatic adenocarcinoma should undergo assessment of risk for hereditary syndromes known to be associated with an increased risk for pancreatic adenocarcinoma. Assessment of risk should include a comprehensive review of family history of cancer. Individuals with a family history of pancreatic cancer affecting two first-degree relatives meet criteria for familial pancreatic cancer (FPC). Individuals (cancer affected or unaffected) with a family history of pancreatic cancer meeting criteria for FPC, those with three or more diagnoses of pancreatic cancer in same side of the family, and individuals meeting criteria for other genetic syndromes associated with increased risk for pancreatic cancer have an increased risk for pancreatic cancer and are candidates for genetic testing. Germline genetic testing for cancer susceptibility may be discussed with individuals diagnosed with pancreatic cancer, even if family history is unremarkable. Benefits and limitations of pancreatic cancer screening should be discussed with individuals whose family history meets criteria for FPC and/or genetic susceptibility to pancreatic cancer. Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines .
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Affiliation(s)
| | | | | | | | | | | | - Arun Nagarajan
- Taussig Cancer Institute and Case Comprehensive Cancer Center, Cleveland Clinic, Cleveland, OH
| | | | | | | | - Alok A. Khorana
- Taussig Cancer Institute and Case Comprehensive Cancer Center, Cleveland Clinic, Cleveland, OH
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Tarhini AA, Lee SJ, Li X, Rao UNM, Nagarajan A, Albertini MR, Mitchell JW, Wong SJ, Taylor MA, Laudi N, Truong PV, Conry RM, Kirkwood JM. E3611-A Randomized Phase II Study of Ipilimumab at 3 or 10 mg/kg Alone or in Combination with High-Dose Interferon-α2b in Advanced Melanoma. Clin Cancer Res 2018; 25:524-532. [PMID: 30420448 DOI: 10.1158/1078-0432.ccr-18-2258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/30/2018] [Accepted: 11/02/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Interferon-α favors a Th1 shift in immunity, and combining with ipilimumab (ipi) at 3 or 10 mg/kg may downregulate CTLA4-mediated suppressive effects, leading to more durable antitumor immune responses. A study of tremelimumab and high-dose interferon-α (HDI) showed promising efficacy, supporting this hypothesis. PATIENTS AND METHODS E3611 followed a 2-by-2 factorial design (A: ipi10+HDI; B: ipi10; C: ipi3+HDI; D: ipi3) to evaluate (i) no HDI versus HDI (across ipilimumab doses) and (ii) ipi3 versus ipi10 (across HDI status). We hypothesized that median progression-free survival (PFS) would improve from 3 to 6 months with HDI versus no HDI and with ipi10 versus ipi3. RESULTS For eligible and treated patients (N = 81) at a median follow-up time of 29.8 months, median PFS was 4.4 months [95% confidence interval (CI), 2.7-8.2] when ipilimumab was used alone and 7.5 months (95% CI, 5.1-11.0) when HDI was added. Median PFS was 3.8 months (95% CI, 2.6-7.5) with 3 mg/kg ipilimumab and 6.5 months (95% CI, 5.1-13.5) with 10 mg/kg. By study arm, median PFS was 8.0 months (95% CI, 2.8-20.2) in arm A, 6.2 months (95% CI, 2.7-25.7) in B, 5.7 months (95% CI, 1.5-11.1) in C, and 2.8 months (95% CI, 2.6-5.7) in D. The differences in PFS and overall survival (OS) did not reach statistical significance. Adverse events were consistent with the known profiles of ipilimumab and HDI and significantly higher with HDI and ipi10. CONCLUSIONS Although PFS was increased, the differences resulting from adding interferon-α or a higher dose of ipilimumab did not reach statistical significance and do not outweigh the added toxicity risks.
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Affiliation(s)
- Ahmad A Tarhini
- Cleveland Clinic and Case Comprehensive Cancer Center, Cleveland, Ohio. .,University of Pittsburgh Cancer Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sandra J Lee
- ECOG-ACRIN Biostatistics Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Xiaoxue Li
- Dana-Farber Cancer Institute, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Uma N M Rao
- University of Pittsburgh Cancer Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Mark R Albertini
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | | | | | - Mark A Taylor
- Lewis Cancer and Research Pavilion at St. Joseph's, Savannah, Georgia
| | - Noel Laudi
- Minnesota Oncology Hematology PA, Minneapolis, Minnesota
| | | | - Robert M Conry
- University of Alabama at Birmingham, Birmingham, Alabama
| | - John M Kirkwood
- University of Pittsburgh Cancer Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Nayak M, Nagarajan A, Majeed M, Jamsheeda M, Choudhury AK. Flavonoids from Artocarpus hirsutus Lam: Synthesis of new prenyl ethers, acetates and their anti-acne activity. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/23312009.2017.1416557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Mahadeva Nayak
- Sami Labs Limited-R&D Centre, 19/1, 19/2, 1st Main, 2nd Phase, Peenya Industrial Area, Peenya, Bangalore 560058, India
| | - A. Nagarajan
- Sami Labs Limited-R&D Centre, 19/1, 19/2, 1st Main, 2nd Phase, Peenya Industrial Area, Peenya, Bangalore 560058, India
| | - Muhammed Majeed
- Sami Labs Limited-R&D Centre, 19/1, 19/2, 1st Main, 2nd Phase, Peenya Industrial Area, Peenya, Bangalore 560058, India
- Sabinsa Corporation, 20-Lake Drive, East Windsor NJ-08520, USA
| | - M. Jamsheeda
- Sami Labs Limited-R&D Centre, 19/1, 19/2, 1st Main, 2nd Phase, Peenya Industrial Area, Peenya, Bangalore 560058, India
| | - Ambar K. Choudhury
- Sami Labs Limited-R&D Centre, 19/1, 19/2, 1st Main, 2nd Phase, Peenya Industrial Area, Peenya, Bangalore 560058, India
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Nayak M, Nagarajan A, Majeed M, Nagabhushanam K, Choudhury AK. In vitro anti-acne activity of phytoactives from the stem bark of Artocarpus hirsutus Lam. and characterisation of pyranocycloartobiloxanthone A as a mixture of two anomers. Nat Prod Res 2017; 32:2116-2120. [DOI: 10.1080/14786419.2017.1365068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Mahadeva Nayak
- R&D Centre - Sami Labs Limited, Bangalore, Karnataka, India
| | - A. Nagarajan
- R&D Centre - Sami Labs Limited, Bangalore, Karnataka, India
| | - Muhammed Majeed
- R&D Centre - Sami Labs Limited, Bangalore, Karnataka, India
- Sabinsa Corporation, East Windsor, NJ, USA
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Tarhini AA, Lee SJ, Rao UNM, Nagarajan A, Albertini MR, Mitchell JW, Wong SJ, Taylor MA, Laudi N, Truong PV, Conry RM, Kirkwood JM. A randomized phase II study of ipilimumab at 3 (ipi3) or 10 mg/kg (ipi10) alone or in combination with high dose interferon-alfa (HDI) in advanced melanoma (E3611). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.9542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9542 Background: Interferon-α (IFN) favors a Th1 shift in immunity. Combining CTLA4 blockade with IFN may downregulate CTLA4 suppressive elements. Prior data from a phase II of tremelimumab and HDI showed promising efficacy supporting the current study. Methods: E3611 had a 2x2 factorial design (A: ipi10 + HDI; B: ipi10; C: ipi3 + HDI; D: ipi3) to evaluate (i) no HDI vs. HDI (across ipi doses) and (ii) ipi3 vs. ipi10 (across HDI status). We hypothesized that median progression free survival (PFS) would improve from 3 to 6 months (mos) with HDI vs. no HDI and with ipi10 vs. ipi3. Based on the log-rank test for 80 patients (pts) these comparisons would have 82% power at 2-sided type I error of 0.10. Results: Median follow up 26.4 mos. PFS and overall survival (OS) (eligible and treated pts; N = 80: 18 III/M1a, 24 M1b, 38 M1c) are shown in Table 1. There were no significant differences in PFS or OS when evaluating HDI vs. no HDI or ipi10 vs. ipi3 (Table 1). Response (RECIST) among response evaluable pts (and 4 pts with early death) (N = 76) is shown in Table 1. Stable disease (SD) in 7 (A), 6 (B), 8 (C) and 6 (D). Adverse events (AEs) were consistent with the toxicity profiles of ipi and HDI and included 3 grade 5 AEs considered at least possibly related: 1 in A (suicide), 1 in B (lung infection and hemorrhage) and 1 in C (adult respiratory distress syndrome). One patient in B died of gastrointestinal bleed and cardiac arrest while on corticosteroids to treat temporal arteritis and vision loss. Conclusions: Within the limitations of the sample size, there were no significant differences in PFS with HDI vs. no HDI or ipi10 vs. ipi3. Response and PFS with ipi10 were superior to historical controls and similar to the combination. Correlative studies are ongoing. Clinical trial information: NCT01708941. [Table: see text]
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Affiliation(s)
| | - Sandra J. Lee
- Dana-Farber Cancer Institute/Harvard Medical School, Boston, MA
| | - Uma N. M. Rao
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Arun Nagarajan
- Charleston Area Medical Center, David Lee Cancer Center, Charleston, WV
| | | | | | | | | | | | | | | | - John M. Kirkwood
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
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Tzivelekis S, Stryker S, Klippel ZK, Sheldon W, Li Y, Chandler D, Nagarajan A, Reiner M. A prospective, real-world study of treatment patterns in early-stage breast cancer (ESBC) patients (pts) at high risk for febrile neutropenia (FN). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e21653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Yanli Li
- Amgen Inc., South San Francisco, CA
| | | | - Arun Nagarajan
- Charleston Area Medical Center, David Lee Cancer Center, Charleston, WV
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Li X, Barron R, Tzivelekis S, Li Y, Chandler D, Xu H, Morrow PK, Klippel Z, Nagarajan A, Reiner M, Page JH. Abstract P1-10-04: A prospective study of patterns of chemotherapy, colony-stimulating factor use, and burden of colony-stimulating factor injections in patients with early-stage breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-10-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Febrile neutropenia (FN) is a common side effect of myelosuppressive chemotherapy. Primary prophylaxis with colony-stimulating factors (CSFs) can reduce FN incidence and is recommended when a patient has a high risk of FN (> 20%). In the prophylactic setting, CSFs should be administered at least 24 hours after chemotherapy completion. Patient burden associated with CSF administration is not well understood. Here we describe current patterns of chemotherapy use and burden of CSF injections for patients with early-stage breast cancer (ESBC) in US clinical practice.
Methods: This was a prospective cohort study of adult ESBC patients receiving their first chemotherapy course who had a high risk of FN based on high- or intermediate-risk chemotherapy regimen and individual FN risk factors. The burden associated with CSF injections was assessed via questionnaires among patients who received CSF, and a subset analysis of patient burden in the first cycle of chemotherapy is reported.
Results: 598 patients completed the "burden of CSF injections" questionnaire following the first cycle of chemotherapy. Most patients were < 65 years old (76.8%), had a BMI < 30 kg/m2 (54.9%), and had few comorbidities (see table for additional characteristics and comorbidities). The three most common chemotherapy regimens received were ddAC-T (34.4%), TC (23.4%), and TCH (15.6%). 98.3% of patients received prophylaxis with CSF in the first chemotherapy cycle: 94.6% of these received pegfilgrastim, and 5.4% received filgrastim. Among all patients who received CSF, mean (SD) one-way travel time for a single CSF injection was 31 (25) minutes; mean (SD) time in office to receive a CSF injection was 41 (68) minutes. Across the first chemotherapy cycle, mean (SD) time missed from work for CSF administration was 3.1 (9.3) hours, and mean (SD) time missed from non-work activities was 5.5 (14.4) hours. 66.3% of patients had someone else assist them with travel to the clinic to receive CSF, of which 98.8% were helped by an unpaid caregiver. When patients were questioned about the subjective burden of CSF injections, 25.4% reported some degree of bother, and 15.9% reported at least moderate inconvenience.
Conclusions: Among the high- and intermediate-risk regimens investigated here, dose-dense and taxane-based chemotherapy regimens were common. As many high-risk patients with ESBC receive primary prophylaxis with CSF, travel and time needed to receive CSF can contribute to patient and caregiver burden.
Patient CharacteristicsN = 598 Age, mean (SD) years55.1 (11.3) BMI, mean (SD) kg/m230.7 (7.5) HER2+23.2% Luminal Aa52.0% Triple negative21.6% Stage at diagnosis 124.6% 253.7% 321.2% Missing0.5%Comorbidities > 10% Hypertension37.5% Hyperlipidemia24.7% Depression13.9% Diabetes mellitus13.4% Osteoarthritis12.7% Gastroesophageal reflux disease12.2% Hypothyroidism12.0% Anxiety11.9%aHormone receptor positive but HER2 negative.
Citation Format: Li X, Barron R, Tzivelekis S, Li Y, Chandler D, Xu H, Morrow PK, Klippel Z, Nagarajan A, Reiner M, Page JH. A prospective study of patterns of chemotherapy, colony-stimulating factor use, and burden of colony-stimulating factor injections in patients with early-stage breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-04.
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Affiliation(s)
- X Li
- Amgen Inc., Thousand Oaks, CA; Amgen Inc., So. San Francisco, CA; Charleston Area Medical Center, David Lee Cancer Center, Charleston, WV
| | - R Barron
- Amgen Inc., Thousand Oaks, CA; Amgen Inc., So. San Francisco, CA; Charleston Area Medical Center, David Lee Cancer Center, Charleston, WV
| | - S Tzivelekis
- Amgen Inc., Thousand Oaks, CA; Amgen Inc., So. San Francisco, CA; Charleston Area Medical Center, David Lee Cancer Center, Charleston, WV
| | - Y Li
- Amgen Inc., Thousand Oaks, CA; Amgen Inc., So. San Francisco, CA; Charleston Area Medical Center, David Lee Cancer Center, Charleston, WV
| | - D Chandler
- Amgen Inc., Thousand Oaks, CA; Amgen Inc., So. San Francisco, CA; Charleston Area Medical Center, David Lee Cancer Center, Charleston, WV
| | - H Xu
- Amgen Inc., Thousand Oaks, CA; Amgen Inc., So. San Francisco, CA; Charleston Area Medical Center, David Lee Cancer Center, Charleston, WV
| | - PK Morrow
- Amgen Inc., Thousand Oaks, CA; Amgen Inc., So. San Francisco, CA; Charleston Area Medical Center, David Lee Cancer Center, Charleston, WV
| | - Z Klippel
- Amgen Inc., Thousand Oaks, CA; Amgen Inc., So. San Francisco, CA; Charleston Area Medical Center, David Lee Cancer Center, Charleston, WV
| | - A Nagarajan
- Amgen Inc., Thousand Oaks, CA; Amgen Inc., So. San Francisco, CA; Charleston Area Medical Center, David Lee Cancer Center, Charleston, WV
| | - M Reiner
- Amgen Inc., Thousand Oaks, CA; Amgen Inc., So. San Francisco, CA; Charleston Area Medical Center, David Lee Cancer Center, Charleston, WV
| | - JH Page
- Amgen Inc., Thousand Oaks, CA; Amgen Inc., So. San Francisco, CA; Charleston Area Medical Center, David Lee Cancer Center, Charleston, WV
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Krishnan P, Nagarajan A, Suriakumar J. Virulence determinants of MRSA causing skin and soft tissue infections among HIV patients from Chennai. BMC Infect Dis 2014. [PMCID: PMC4080119 DOI: 10.1186/1471-2334-14-s3-e44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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N. Gummadi S, Nagarajan A, Thirunavuk N, Suryanaray T. Screening and Isolation of Novel Glutaminase Free L-asparaginase from Fungal Endophytes. ACTA ACUST UNITED AC 2014. [DOI: 10.3923/jm.2014.163.176] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lane S, Andrist C, Nagarajan A. Hemophagocytic lymphohistiocytosis (HLH) in a 25-year-old presenting with multisystem organ failure. W V Med J 2013; 109:22-23. [PMID: 24371860] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome of extreme inflammation caused by pathologic activation of the immune system. Diagnosis of HLH is challenging as the clinical presentation is similar to common medical entities such as sepsis. When a source of the extreme inflammation is not found, HLH should be considered in the differential diagnosis. In HLH, inflammatory markers such as soluble CD25 and ferritin levels are elevated. Ferritin assay is widely available at most institutions; a level greater than 10,000 is highly suggestive of HLH.2 Delayed diagnosis and failure to initiate cytotoxic chemotherapy will result in a fatal outcome.
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Affiliation(s)
- Samantha Lane
- CAMC, Dept. of internal Medicine/Pediatrics, Charleston, WV 25302, USA.
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Nagarajan A, Arunkumar K, Saravanan M, Sivakumar G, Krishnan P. Detection of fusidic acid resistance determinants among Staphylococcus aureus isolates causing skin and soft tissue infections from a tertiary care centre in Chennai, South India. BMC Infect Dis 2012. [PMCID: PMC3344753 DOI: 10.1186/1471-2334-12-s1-p45] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Dass BS, Nagarajan A, Krishnan P, Sivakumar G. Clindamycin resistance among Staphylococcus aureus causing skin and ear infections from Chennai, South India. BMC Infect Dis 2012. [PMCID: PMC3344777 DOI: 10.1186/1471-2334-12-s1-p70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Abstract
Agenesis of lung is a rare congenital disorder. We are reporting varied degree of pulmonary agenesis in two adult patients.
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Affiliation(s)
- K H Kisku
- Department of Pulmonary Medicine, Pondicherry Institute of Medical Sciences, Pondicherry - 605014., India
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Nagarajan A, Ananthi M, Krishnan P, Reischl U, Prabha C, Linde HJ. Emergence of Panton–Valentine leucocidin among community- and hospital-associated meticillin-resistant Staphylococcus aureus in Chennai, South India. J Hosp Infect 2010; 76:269-71. [DOI: 10.1016/j.jhin.2009.12.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 12/29/2009] [Indexed: 11/28/2022]
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Kalyanam N, Nagarajan A, Majeed M. A Single‐Step Assembly of Coumarin Ring Skeleton from Oxygenated Phenols and Acetylenic Esters by Catalytic Indium Chloride in the Absence of Solvent. SYNTHETIC COMMUN 2006. [DOI: 10.1081/scc-120034175] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- N. Kalyanam
- a Research and Development, Sabinsa Corporation , 1 Deerpark Drive, Suite D, Monmouth Junction, New Jersey, 08852, USA
| | - A. Nagarajan
- a Research and Development, Sabinsa Corporation , 1 Deerpark Drive, Suite D, Monmouth Junction, New Jersey, 08852, USA
| | - M. Majeed
- a Research and Development, Sabinsa Corporation , 1 Deerpark Drive, Suite D, Monmouth Junction, New Jersey, 08852, USA
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Herrera R, Nagarajan A, Morales MA, Méndez F, Jiménez-Vázquez HA, Zepeda LG, Tamariz J. Regio- and stereoselectivity of captodative olefins in 1,3-dipolar cycloadditions. A DFT/HSAB theory rationale for the observed regiochemistry of nitrones. J Org Chem 2001; 66:1252-63. [PMID: 11312955 DOI: 10.1021/jo001393n] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Captodative olefins 1-acetylvinyl carboxylates proved to be highly regioselective dipolarophiles in 1,3-dipolar cycloadditon to propionitrile oxide, arylphenylnitrile imines, diazoalkanes, and nitrones to yield the corresponding 5-substituted heterocycles. The addition of the latter was also stereoselective, being slightly susceptible to steric demand of the carboxylate substituent in the olefin. All atempts to cleave the isoxazolidine N-O bond under reductive conditions failed, providing diverse products with side-group reduction. FMO theory was unsuccessful to explain the regioselectivity observed with nitrones, since the opposite orientation was predicted. The recently formulated DFT/HSAB theoretical model was able to rationalize this regioselectivity, identifying the nucleophilic and electrophilic atoms involved in the process via calculation of interaction energies, suggesting the specific direction of the electronic process at each of the reaction sites.
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Affiliation(s)
- R Herrera
- Departamento de Química Orgánica, Escuela Nacional de Ciencias Biológicas, IPN, Prol. Carpio y Plan de Ayala, 11340 México
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Nagarajan A, Meltsner BR, Delia TJ. Fused pyrimidines.7. Nucleosides of pyrimidopyrimidinediones and pteridinediones as potential chemotherapeutic agents. J Heterocycl Chem 1997. [DOI: 10.1002/jhet.5570340532] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Thiruvalluvar A, Parthasarathi V, Nagarajan A, Pillay MK. 5-Phenyl-3-oxa-4-azatricyclo[5.2.1.02,6]dec-4-ene. Acta Crystallogr C 1994. [DOI: 10.1107/s0108270194001125] [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: 11/10/2022] Open
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Abstract
The anaerobic biodegradation of picloram (3,5,6-trichloro-4-amino-2-pyridinecarboxylic acid) in freshwater sediment was favored under methanogenic conditions but not when sulfate or nitrate was available as a terminal electron acceptor. Under the former conditions, more than 85% of the parent substrate (340 μM) was removed from nonsterile incubations in 30 days, following a 50-day acclimation period. Concomitant with substrate decay, an intermediate transiently accumulated in the sediment slurries. By liquid chromatography-mass spectrometry, the intermediate was identified as an isomer of dichloro-4-amino-2-pyridinecarboxylic acid. Proton nuclear magnetic resonance evidence suggested that a chlorine was reductively removed from the parent substrate at the position
meta
to the nitrogen heteroatom. Upon continued incubation, the dechlorinated product was transformed into an unidentified compound which accumulated and resisted further decay. The addition of sulfate or bromoethanesulfonic acid to sediment slurries inhibited picloram dehalogenation, but molybdate reversed the inhibitory effect of sulfate on pesticide metabolism. These findings help clarify the fate of a halogenated nitrogen heterocyclic herbicide in anaerobic environments.
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Affiliation(s)
- K Ramanand
- Department of Botany and Microbiology and Department of Chemistry and Biochemistry, The University of Oklahoma, Norman, Oklahoma 73019
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