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Tajima T, Martinez OM, Bernstein D, Boyd SD, Gratzinger D, Lum G, Sasaki K, Tan B, Twist CJ, Weinberg K, Armstrong B, Desai DM, Mazariegos GV, Chin C, Fishbein TM, Tekin A, Venick RS, Krams SM, Esquivel CO. Epstein-Barr virus-associated post-transplant lymphoproliferative disorders in pediatric transplantation: A prospective multicenter study in the United States. Pediatr Transplant 2024; 28:e14763. [PMID: 38682750 DOI: 10.1111/petr.14763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/26/2024] [Accepted: 04/08/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Epstein-Barr virus (EBV)-associated post-transplant lymphoproliferative disorders (PTLD) is the most common malignancy in children after transplant; however, difficulties for early detection may worsen the prognosis. METHODS The prospective, multicenter, study enrolled 944 children (≤21 years of age). Of these, 872 received liver, heart, kidney, intestinal, or multivisceral transplants in seven US centers between 2014 and 2019 (NCT02182986). In total, 34 pediatric EBV+ PTLD (3.9%) were identified by biopsy. Variables included sex, age, race, ethnicity, transplanted organ, EBV viral load, pre-transplant EBV serology, immunosuppression, response to chemotherapy and rituximab, and histopathological diagnosis. RESULTS The uni-/multivariable competing risk analyses revealed the combination of EBV-seropositive donor and EBV-naïve recipient (D+R-) was a significant risk factor for PTLD development (sub-hazard ratio: 2.79 [1.34-5.78], p = .006) and EBV DNAemia (2.65 [1.72-4.09], p < .001). Patients with D+R- were significantly more associated with monomorphic/polymorphic PTLD than those with the other combinations (p = .02). Patients with monomorphic/polymorphic PTLD (n = 21) had significantly more EBV DNAemia than non-PTLD patients (p < .001) and an earlier clinical presentation of PTLD than patients with hyperplasias (p < .001), within 6-month post-transplant. Among non-liver transplant recipients, monomorphic/polymorphic PTLD were significantly more frequent than hyperplasias in patients ≥5 years of age at transplant (p = .01). CONCLUSIONS D+R- is a risk factor for PTLD and EBV DNAemia and associated with the incidence of monomorphic/polymorphic PTLD. Intensive follow-up of EBV viral load within 6-month post-transplant, especially for patients with D+R- and/or non-liver transplant recipients ≥5 years of age at transplant, may help detect monomorphic/polymorphic PTLD early in pediatric transplant.
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Affiliation(s)
- Tetsuya Tajima
- Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Olivia M Martinez
- Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Daniel Bernstein
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Scott D Boyd
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Dita Gratzinger
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Grant Lum
- Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Kazunari Sasaki
- Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Brent Tan
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Clare J Twist
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Kenneth Weinberg
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Brian Armstrong
- Rho Federal Systems Division, Rho, Durham, North Carolina, USA
| | - Dev M Desai
- Division of Surgical Transplantation, University of Texas (UT) Southwestern Medical Center, Dallas, Texas, USA
| | - George V Mazariegos
- Department of Pediatrics, University of Pittsburgh Medical Center (UPMC) Children's Hospital, Pittsburgh, Pennsylvania, USA
| | - Clifford Chin
- Department of Pediatrics and Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio, USA
| | - Thomas M Fishbein
- Department of Surgery and Pediatrics, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Akin Tekin
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Robert S Venick
- Department of Pediatric Gastroenterology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Sheri M Krams
- Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Carlos O Esquivel
- Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
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Lee S, Vander Roest AS, Blair CA, Kao K, Bremner SB, Childers MC, Pathak D, Heinrich P, Lee D, Chirikian O, Mohran SE, Roberts B, Smith JE, Jahng JW, Paik DT, Wu JC, Gunawardane RN, Ruppel KM, Mack DL, Pruitt BL, Regnier M, Wu SM, Spudich JA, Bernstein D. Incomplete-penetrant hypertrophic cardiomyopathy MYH7 G256E mutation causes hypercontractility and elevated mitochondrial respiration. Proc Natl Acad Sci U S A 2024; 121:e2318413121. [PMID: 38683993 PMCID: PMC11087781 DOI: 10.1073/pnas.2318413121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 03/05/2024] [Indexed: 05/02/2024] Open
Abstract
Determining the pathogenicity of hypertrophic cardiomyopathy-associated mutations in the β-myosin heavy chain (MYH7) can be challenging due to its variable penetrance and clinical severity. This study investigates the early pathogenic effects of the incomplete-penetrant MYH7 G256E mutation on myosin function that may trigger pathogenic adaptations and hypertrophy. We hypothesized that the G256E mutation would alter myosin biomechanical function, leading to changes in cellular functions. We developed a collaborative pipeline to characterize myosin function across protein, myofibril, cell, and tissue levels to determine the multiscale effects on structure-function of the contractile apparatus and its implications for gene regulation and metabolic state. The G256E mutation disrupts the transducer region of the S1 head and reduces the fraction of myosin in the folded-back state by 33%, resulting in more myosin heads available for contraction. Myofibrils from gene-edited MYH7WT/G256E human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) exhibited greater and faster tension development. This hypercontractile phenotype persisted in single-cell hiPSC-CMs and engineered heart tissues. We demonstrated consistent hypercontractile myosin function as a primary consequence of the MYH7 G256E mutation across scales, highlighting the pathogenicity of this gene variant. Single-cell transcriptomic and metabolic profiling demonstrated upregulated mitochondrial genes and increased mitochondrial respiration, indicating early bioenergetic alterations. This work highlights the benefit of our multiscale platform to systematically evaluate the pathogenicity of gene variants at the protein and contractile organelle level and their early consequences on cellular and tissue function. We believe this platform can help elucidate the genotype-phenotype relationships underlying other genetic cardiovascular diseases.
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Affiliation(s)
- Soah Lee
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA94305
- Department of Biopharmaceutical Convergence, Sungkyunkwan University School of Pharmacy, Suwon, Gyeonggi-do16419South Korea
- School of Pharmacy, Sungkyunkwan University School of Pharmacy, Suwon, Gyeonggi-do16419, South Korea
| | - Alison S. Vander Roest
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Stanford, CA94305
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI48109
| | - Cheavar A. Blair
- Biological Engineering, University of California, Santa Barbara, CA93106
- Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY40536
| | - Kerry Kao
- Department of Bioengineering, University of Washington School of Medicine and College of Engineering, Seattle, WA98195
| | - Samantha B. Bremner
- Department of Bioengineering, University of Washington School of Medicine and College of Engineering, Seattle, WA98195
| | - Matthew C. Childers
- Department of Bioengineering, University of Washington School of Medicine and College of Engineering, Seattle, WA98195
| | - Divya Pathak
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA94305
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA94305
| | - Paul Heinrich
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA94305
| | - Daniel Lee
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA94305
| | - Orlando Chirikian
- Biological Engineering, University of California, Santa Barbara, CA93106
| | - Saffie E. Mohran
- Department of Bioengineering, University of Washington School of Medicine and College of Engineering, Seattle, WA98195
| | | | | | - James W. Jahng
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA94305
| | - David T. Paik
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA94305
| | - Joseph C. Wu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA94305
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA94305
| | | | - Kathleen M. Ruppel
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA94305
| | - David L. Mack
- Department of Bioengineering, University of Washington School of Medicine and College of Engineering, Seattle, WA98195
| | - Beth L. Pruitt
- Biological Engineering, University of California, Santa Barbara, CA93106
| | - Michael Regnier
- Department of Bioengineering, University of Washington School of Medicine and College of Engineering, Seattle, WA98195
| | - Sean M. Wu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA94305
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA94305
| | - James A. Spudich
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA94305
| | - Daniel Bernstein
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA94305
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Stanford, CA94305
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Watkins WS, Hernandez EJ, Miller TA, Blue NR, Zimmerman R, Griffiths ER, Frise E, Bernstein D, Boskovski MT, Brueckner M, Chung WK, Gaynor JW, Gelb BD, Goldmuntz E, Gruber PJ, Newburger JW, Roberts AE, Morton SU, Mayer JE, Seidman CE, Seidman JG, Shen Y, Wagner M, Yost HJ, Yandell M, Tristani-Firouzi M. Genome Sequencing is Critical for Forecasting Outcomes following Congenital Cardiac Surgery. medRxiv 2024:2024.05.03.24306784. [PMID: 38746151 PMCID: PMC11092705 DOI: 10.1101/2024.05.03.24306784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
While genome sequencing has transformed medicine by elucidating the genetic underpinnings of both rare and common complex disorders, its utility to predict clinical outcomes remains understudied. Here, we used artificial intelligence (AI) technologies to explore the predictive value of genome sequencing in forecasting clinical outcomes following surgery for congenital heart defects (CHD). We report results for a cohort of 2,253 CHD patients from the Pediatric Cardiac Genomics Consortium with a broad range of complex heart defects, pre- and post-operative clinical variables and exome sequencing. Damaging genotypes in chromatin-modifying and cilia-related genes were associated with an elevated risk of adverse post-operative outcomes, including mortality, cardiac arrest and prolonged mechanical ventilation. The impact of damaging genotypes was further amplified in the context of specific CHD phenotypes, surgical complexity and extra-cardiac anomalies. The absence of a damaging genotype in chromatin-modifying and cilia-related genes was also informative, reducing the risk for adverse postoperative outcomes. Thus, genome sequencing enriches the ability to forecast outcomes following congenital cardiac surgery.
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Milan AM, Barnett MP, McNabb WC, Roy NC, Coutinho S, Hoad CL, Marciani L, Nivins S, Sharif H, Calder S, Du P, Gharibans AA, O'Grady G, Fraser K, Bernstein D, Rosanowski SM, Sharma P, Shrestha A, Mithen RF. The impact of heat treatment of bovine milk on gastric emptying and nutrient appearance in peripheral circulation in healthy females: a randomized controlled trial comparing pasteurized and ultra-high temperature milk. Am J Clin Nutr 2024; 119:1200-1215. [PMID: 38452857 DOI: 10.1016/j.ajcnut.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Heat treatments of dairy, including pasteurization and ultra-high temperature (UHT) processing, alter milk macromolecular structures, and ultimately affect digestion. In vitro, animal, and human studies show faster nutrient release or circulating appearance after consuming UHT milk (UHT-M) compared with pasteurized milk (PAST-M), with a faster gastric emptying (GE) rate proposed as a possible mechanism. OBJECTIVES To investigate the impact of milk heat treatment on GE as a mechanism of faster nutrient appearance in blood. We hypothesized that GE and circulating nutrient delivery following consumption would be faster for UHT-M than PAST-M. METHODS In this double-blind randomized controlled cross-over trial, healthy female (n = 20; 27.3 ± 1.4 y, mean ± SD) habitual dairy consumers, consumed 500 mL of either homogenized bovine UHT-M or PAST-M (1340 compared with 1320 kJ). Gastric content volume (GCV) emptying half-time (T50) was assessed over 3 h by magnetic resonance imaging subjective digestive symptoms, plasma amino acid, lipid and B vitamin concentrations, and gastric myoelectrical activity were measured over 5 h. RESULTS Although GCV T50 did not differ (102 ± 7 min compared with 89 ± 8 min, mean ± SEM, UHT-M and PAST-M, respectively; P = 0.051), GCV time to emptying 25% of the volume was 31% longer following UHT-M compared with PAST-M (42 ± 2 compared with 32 ± 4 min, P = 0.004). Although GCV remained larger for a longer duration following UHT-M (treatment × time interaction, P = 0.002), plasma essential amino acid AUC was greater following UHT-M than PAST-M (55,324 ± 3809 compared with 36,598 ± 5673 μmol·min·L-1, P = 0.006). Heat treatment did not impact gastric myoelectrical activity, plasma appetite hormone markers or subjective appetite scores. CONCLUSIONS Contrary to expectations, GE was slower with UHT-M, yet, as anticipated, aminoacidemia was greater. The larger GCV following UHT-M suggests that gastric volume may poorly predict circulating nutrient appearance from complex food matrices. Dairy heat treatment may be an effective tool to modify nutrient release by impacting digestion kinetics. CLINICAL TRIAL REGISTRY www.anzctr.org.au (ACTRN12620000172909).
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Affiliation(s)
- Amber Marie Milan
- The Liggins Institute, The University of Auckland, Auckland, New Zealand; AgResearch Limited, Palmerston North, New Zealand; The High-Value Nutrition National Science Challenge, Auckland, New Zealand.
| | - Matthew Pg Barnett
- AgResearch Limited, Palmerston North, New Zealand; The Riddet Institute, Palmerston North, New Zealand
| | - Warren C McNabb
- The High-Value Nutrition National Science Challenge, Auckland, New Zealand; The Riddet Institute, Palmerston North, New Zealand
| | - Nicole C Roy
- The High-Value Nutrition National Science Challenge, Auckland, New Zealand; The Riddet Institute, Palmerston North, New Zealand; Department of Human Nutrition, The University of Otago, Otago, New Zealand
| | - Schynell Coutinho
- The Liggins Institute, The University of Auckland, Auckland, New Zealand; AgResearch Limited, Palmerston North, New Zealand
| | - Caroline L Hoad
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom; NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Luca Marciani
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom; Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, United Kingdom
| | - Samson Nivins
- The Liggins Institute, The University of Auckland, Auckland, New Zealand; Department of Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Hayfa Sharif
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom; Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, United Kingdom; Amiri Hospital, Ministry of Health, Civil Service Commission, Kuwait City, Kuwait
| | - Stefan Calder
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Peng Du
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Armen A Gharibans
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand; Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Greg O'Grady
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand; Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Karl Fraser
- AgResearch Limited, Palmerston North, New Zealand; The High-Value Nutrition National Science Challenge, Auckland, New Zealand; The Riddet Institute, Palmerston North, New Zealand
| | | | | | - Pankaja Sharma
- The Liggins Institute, The University of Auckland, Auckland, New Zealand; AgResearch Limited, Palmerston North, New Zealand
| | - Aahana Shrestha
- The Liggins Institute, The University of Auckland, Auckland, New Zealand; AgResearch Limited, Palmerston North, New Zealand
| | - Richard F Mithen
- The Liggins Institute, The University of Auckland, Auckland, New Zealand; The High-Value Nutrition National Science Challenge, Auckland, New Zealand; The Riddet Institute, Palmerston North, New Zealand
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Delwarde C, Toquet C, Boureau AS, Le Ruz R, Le Scouarnec S, Mérot J, Kyndt F, Bernstein D, Bernstein JA, Aalberts JJJ, Le Marec H, Schott JJ, Roussel JC, Le Tourneau T, Capoulade R. Filamin A heart valve disease as a genetic cause of inherited bicuspid and tricuspid aortic valve disease. Heart 2024; 110:666-674. [PMID: 38148157 DOI: 10.1136/heartjnl-2023-323491] [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] [Received: 09/22/2023] [Accepted: 12/11/2023] [Indexed: 12/28/2023] Open
Abstract
OBJECTIVE Variants in the FLNA gene have been associated with mitral valve dystrophy (MVD), and even polyvalvular disease has been reported. This study aimed to analyse the aortic valve and root involvement in FLNA-MVD families and its impact on outcomes. METHODS 262 subjects (37 (18-53) years, 140 male, 79 carriers: FLNA+) from 4 FLNA-MVD families were included. Echocardiography was performed in 185 patients and histological analysis in 3 explanted aortic valves. The outcomes were defined as aortic valve surgery or all-cause mortality. RESULTS Aortic valve alterations were found in 58% of FLNA+ compared with 6% of FLNA- (p<0.001). 9 (13.4%) FLNA+ had bicuspid aortic valve compared with 4 (3.4%) FLNA- (p=0.03). Overall, the transvalvular mean gradient was slightly increased in FLNA+ (4.8 (4.1-6.1) vs 4.0 (2.9-4.9) mm Hg, p=0.02). The sinuses of Valsalva and sinotubular junction diameters were enlarged in FLNA+ subjects (all p<0.05). 8 FLNA+ patients underwent aortic valve surgery (0 in relatives; p<0.001). Myxomatous remodelling with an infiltration of immune cells was observed. Overall survival was similar between FLNA+ versus FLNA- subjects (86±5% vs 85±6%, p=0.36). There was no statistical evidence for an interaction between genetic status and sex (p=0.15), but the survival tended to be impaired in FLNA+ men (p=0.06) whereas not in women (p=0.71). CONCLUSION The patients with FLNA variants present frequent aortic valve disease and worse outcomes. Bicuspid aortic valve is more frequent in patients carrying the FLNA-MVD variants. These unique features should be factored into the management of patients with dystrophic and/or bicuspid aortic valve.
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Affiliation(s)
- Constance Delwarde
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, Nantes, France
| | - Claire Toquet
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, Nantes, France
| | - Anne Sophie Boureau
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, Nantes, France
| | - Robin Le Ruz
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, Nantes, France
| | - Solena Le Scouarnec
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, Nantes, France
| | - Jean Mérot
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, Nantes, France
| | - Florence Kyndt
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, Nantes, France
| | - Daniel Bernstein
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Jonathan A Bernstein
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Jan J J Aalberts
- Department of Cardiology, Reinier de Graaf Hospital, Delft, Netherlands
| | - Hervé Le Marec
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, Nantes, France
| | - Jean-Jacques Schott
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, Nantes, France
| | - Jean-Christian Roussel
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, Nantes, France
| | - Thierry Le Tourneau
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, Nantes, France
| | - Romain Capoulade
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, Nantes, France
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Ulluwishewa D, Nicholls G, Henderson H, Bernstein D, Fraser K, Barnett MPG, Barnes MJ. Effects of bovine whey protein on exercise-induced gut permeability in healthy adults: a randomised controlled trial. Eur J Appl Physiol 2024:10.1007/s00421-024-05423-4. [PMID: 38386104 DOI: 10.1007/s00421-024-05423-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/16/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Intestinal permeability is a critical component of gut barrier function. Barrier dysfunction can be triggered by certain stressors such as exercise, and if left unmanaged can lead to local and systemic disorders. The aim of this study was to investigate the effects of a specific whey protein fraction in alleviating exercise-induced gut permeability as assessed by recovery of lactulose/rhamnose (L/R) and lactulose/mannitol (L/M) urinary probes. METHODS Eight males and eight females (aged 18-50) completed two arms of a double-blind, placebo-controlled, crossover study. For each arm participants performed two baseline intestinal permeability assessments, following which they consumed the treatment (2 g/day of milk powder containing 200 mg of whey protein) or placebo (2 g/day of milk powder) for 14 days, before performing a post-exercise permeability assessment. The exercise protocol involved a 20-min run at 80% of maximal oxygen uptake on a 1% incline. RESULTS Mixed model analysis revealed an increase in L/R (23%; P < 0.001) and L/M (20%; P < 0.01) recovery following exercise. However, there was no treatment or treatment × exercise effect. CONCLUSION The exercise protocol utilised in our study induces gut permeability. However, consuming whey protein, at the dose and timing prescribed, is not able to mitigate this effect.
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Affiliation(s)
| | - Grayson Nicholls
- School of Sport, Exercise and Nutrition, Massey University, Palmerston North, New Zealand
| | | | | | - Karl Fraser
- AgResearch, Te Ohu Rangahau Kai, Palmerston North, New Zealand
| | - Matthew P G Barnett
- AgResearch, Te Ohu Rangahau Kai, Palmerston North, New Zealand
- Riddet Institute, Palmerston North, New Zealand
| | - Matthew J Barnes
- School of Sport, Exercise and Nutrition, Massey University, Palmerston North, New Zealand
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Reddy S, Hu D, Zhao M, Ichimura S, Barnes EA, Cornfield DN, Alejandre Alcázar MA, Spiekerkoetter E, Fajardo G, Bernstein D. MicroRNA-34a-Dependent Attenuation of Angiogenesis in Right Ventricular Failure. J Am Heart Assoc 2024; 13:e029427. [PMID: 38293915 PMCID: PMC11056115 DOI: 10.1161/jaha.123.029427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND The right ventricle (RV) is at risk in patients with complex congenital heart disease involving right-sided obstructive lesions. We have shown that capillary rarefaction occurs early in the pressure-loaded RV. Here we test the hypothesis that microRNA (miR)-34a, which is induced in RV hypertrophy and RV failure (RVF), blocks the hypoxia-inducible factor-1α-vascular endothelial growth factor (VEGF) axis, leading to the attenuated angiogenic response and increased susceptibility to RV failure. METHODS AND RESULTS Mice underwent pulmonary artery banding to induce RV hypertrophy and RVF. Capillary rarefaction occurred immediately. Although hypoxia-inducible factor-1α expression increased (0.12±0.01 versus 0.22±0.03, P=0.05), VEGF expression decreased (0.61±0.03 versus 0.22±0.05, P=0.01). miR-34a expression was most upregulated in fibroblasts (4-fold), but also in cardiomyocytes and endothelial cells (2-fold). Overexpression of miR-34a in endothelial cells increased cell senescence (10±3% versus 22±2%, P<0.05) by suppressing sirtulin 1 expression, and decreased tube formation by 50% via suppression of hypoxia-inducible factor-1α, VEGF A, VEGF B, and VEGF receptor 2. miR-34a was induced by stretch, transforming growth factor-β1, adrenergic stimulation, and hypoxia in cardiac fibroblasts and cardiomyocytes. In mice with RVF, locked nucleic acid-antimiR-34a improved RV shortening fraction and survival half-time and restored capillarity and VEGF expression. In children with congenital heart disease-related RVF, RV capillarity was decreased and miR-34a increased 5-fold. CONCLUSIONS In summary, miR-34a from fibroblasts, cardiomyocytes, and endothelial cells mediates capillary rarefaction by suppressing the hypoxia-inducible factor-1α-VEGF axis in RV hypertrophy/RVF, raising the potential for anti-miR-34a therapeutics in patients with at-risk RVs.
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Affiliation(s)
- Sushma Reddy
- Department of Pediatrics (Cardiology) and Cardiovascular InstituteStanford UniversityStanfordCA
| | - Dong‐Qing Hu
- Department of Pediatrics (Cardiology) and Cardiovascular InstituteStanford UniversityStanfordCA
| | - Mingming Zhao
- Department of Pediatrics (Cardiology) and Cardiovascular InstituteStanford UniversityStanfordCA
| | - Shoko Ichimura
- Department of Pediatrics (Cardiology) and Cardiovascular InstituteStanford UniversityStanfordCA
| | | | | | | | | | - Giovanni Fajardo
- Department of Pediatrics (Cardiology) and Cardiovascular InstituteStanford UniversityStanfordCA
| | - Daniel Bernstein
- Department of Pediatrics (Cardiology) and Cardiovascular InstituteStanford UniversityStanfordCA
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8
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Muftah M, Bernstein D, Patel A. Eosinophilic Esophagitis: Lessons Learned from Its Evolution. Dig Dis Sci 2024; 69:318-319. [PMID: 37968558 DOI: 10.1007/s10620-023-08166-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/18/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Mayssan Muftah
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Daniel Bernstein
- Division of Gastroenterology, Duke University School of Medicine, Durham, NC, USA
| | - Amit Patel
- Division of Gastroenterology, Duke University School of Medicine and the Durham Veterans Affairs Medical Center, DUMC Box 3913, Durham, NC, 27710, USA.
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Haileselassie B, Mukherjee R, Joshi AU, Napier BA, Massis LM, Ostberg NP, Queliconi BB, Monack D, Bernstein D, Mochly-Rosen D. Corrigendum to "Drp1/Fis1 interaction mediates mitochondrial dysfunction in septic cardiomyopathy" [Journal: Molecular of and Cellular Cardiology (2019) May 130;160-169]. J Mol Cell Cardiol 2024; 187:120. [PMID: 38000978 DOI: 10.1016/j.yjmcc.2023.11.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Affiliation(s)
- Bereketeab Haileselassie
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Riddhita Mukherjee
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Amit U Joshi
- Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Brooke A Napier
- Department of Microbiology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Liliana M Massis
- Department of Microbiology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Nicolai Patrick Ostberg
- Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Bruno B Queliconi
- Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Denise Monack
- Department of Microbiology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Daniel Bernstein
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Daria Mochly-Rosen
- Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
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10
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Seo K, Yamamoto Y, Kirillova A, Kawana M, Yadav S, Huang Y, Wang Q, Lane KV, Pruitt BL, Perez MV, Bernstein D, Wu JC, Wheeler MT, Parikh VN, Ashley EA. Improved Cardiac Performance and Decreased Arrhythmia in Hypertrophic Cardiomyopathy With Non-β-Blocking R-Enantiomer Carvedilol. Circulation 2023; 148:1691-1704. [PMID: 37850394 DOI: 10.1161/circulationaha.123.065017] [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] [Received: 04/03/2023] [Accepted: 09/05/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Hypercontractility and arrhythmia are key pathophysiologic features of hypertrophic cardiomyopathy (HCM), the most common inherited heart disease. β-Adrenergic receptor antagonists (β-blockers) are the first-line therapy for HCM. However, β-blockers commonly selected for this disease are often poorly tolerated in patients, where heart-rate reduction and noncardiac effects can lead to reduced cardiac output and fatigue. Mavacamten, myosin ATPase inhibitor recently approved by the US Food and Drug Administration, has demonstrated the ability to ameliorate hypercontractility without lowering heart rate, but its benefits are so far limited to patients with left ventricular (LV) outflow tract obstruction, and its effect on arrhythmia is unknown. METHODS We screened 21 β-blockers for their impact on myocyte contractility and evaluated the antiarrhythmic properties of the most promising drug in a ventricular myocyte arrhythmia model. We then examined its in vivo effect on LV function by hemodynamic pressure-volume loop analysis. The efficacy of the drug was tested in vitro and in vivo compared with current therapeutic options (metoprolol, verapamil, and mavacamten) for HCM in an established mouse model of HCM (Myh6R403Q/+ and induced pluripotent stem cell (iPSC)-derived cardiomyocytes from patients with HCM (MYH7R403Q/+). RESULTS We identified that carvedilol, a β-blocker not commonly used in HCM, suppresses contractile function and arrhythmia by inhibiting RyR2 (ryanodine receptor type 2). Unlike metoprolol (a β1-blocker), carvedilol markedly reduced LV contractility through RyR2 inhibition, while maintaining stroke volume through α1-adrenergic receptor inhibition in vivo. Clinically available carvedilol is a racemic mixture, and the R-enantiomer, devoid of β-blocking effect, retains the ability to inhibit both α1-receptor and RyR2, thereby suppressing contractile function and arrhythmias without lowering heart rate and cardiac output. In Myh6R403Q/+ mice, R-carvedilol normalized hyperdynamic contraction, suppressed arrhythmia, and increased cardiac output better than metoprolol, verapamil, and mavacamten. The ability of R-carvedilol to suppress contractile function was well retained in MYH7R403Q/+ iPSC-derived cardiomyocytes. CONCLUSIONS R-enantiomer carvedilol attenuates hyperdynamic contraction, suppresses arrhythmia, and at the same time, improves cardiac output without lowering heart rate by dual blockade of α1-adrenergic receptor and RyR2 in mouse and human models of HCM. This combination of therapeutic effects is unique among current therapeutic options for HCM and may particularly benefit patients without LV outflow tract obstruction.
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Affiliation(s)
- Kinya Seo
- From the Departments of Medicine (K.S., Y.Y., A.K., M.K., S.Y., Y.H., Q.W., M.V.P., M.T.W., V.N.P., E.A.A.), Stanford University School of Medicine, CA
| | - Yuta Yamamoto
- From the Departments of Medicine (K.S., Y.Y., A.K., M.K., S.Y., Y.H., Q.W., M.V.P., M.T.W., V.N.P., E.A.A.), Stanford University School of Medicine, CA
| | - Anna Kirillova
- From the Departments of Medicine (K.S., Y.Y., A.K., M.K., S.Y., Y.H., Q.W., M.V.P., M.T.W., V.N.P., E.A.A.), Stanford University School of Medicine, CA
| | - Masataka Kawana
- From the Departments of Medicine (K.S., Y.Y., A.K., M.K., S.Y., Y.H., Q.W., M.V.P., M.T.W., V.N.P., E.A.A.), Stanford University School of Medicine, CA
| | - Sunil Yadav
- From the Departments of Medicine (K.S., Y.Y., A.K., M.K., S.Y., Y.H., Q.W., M.V.P., M.T.W., V.N.P., E.A.A.), Stanford University School of Medicine, CA
| | - Yong Huang
- From the Departments of Medicine (K.S., Y.Y., A.K., M.K., S.Y., Y.H., Q.W., M.V.P., M.T.W., V.N.P., E.A.A.), Stanford University School of Medicine, CA
| | - Qianru Wang
- From the Departments of Medicine (K.S., Y.Y., A.K., M.K., S.Y., Y.H., Q.W., M.V.P., M.T.W., V.N.P., E.A.A.), Stanford University School of Medicine, CA
| | - Kerry V Lane
- Departments of Mechanical Engineering (K.V.L., B.L.P.), University of California, Santa Barbara, CA
| | - Beth L Pruitt
- Departments of Mechanical Engineering (K.V.L., B.L.P.), University of California, Santa Barbara, CA
- BioMolecular Science and Engineering (B.L.P.), University of California, Santa Barbara, CA
| | - Marco V Perez
- From the Departments of Medicine (K.S., Y.Y., A.K., M.K., S.Y., Y.H., Q.W., M.V.P., M.T.W., V.N.P., E.A.A.), Stanford University School of Medicine, CA
| | | | - Joseph C Wu
- Cardiovascular Research Institute (J.C.W.), Stanford University School of Medicine, CA
| | - Matthew T Wheeler
- From the Departments of Medicine (K.S., Y.Y., A.K., M.K., S.Y., Y.H., Q.W., M.V.P., M.T.W., V.N.P., E.A.A.), Stanford University School of Medicine, CA
| | - Victoria N Parikh
- From the Departments of Medicine (K.S., Y.Y., A.K., M.K., S.Y., Y.H., Q.W., M.V.P., M.T.W., V.N.P., E.A.A.), Stanford University School of Medicine, CA
| | - Euan A Ashley
- From the Departments of Medicine (K.S., Y.Y., A.K., M.K., S.Y., Y.H., Q.W., M.V.P., M.T.W., V.N.P., E.A.A.), Stanford University School of Medicine, CA
- Genetics (E.A.A.), Stanford University School of Medicine, CA
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11
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Woldeyes RA, Nishiga M, Vander Roest AS, Engel L, Giri P, Montenegro GC, Wu AC, Dunn AR, Spudich JA, Bernstein D, Schmid MF, Wu JC, Chiu W. Cryo-electron tomography reveals the structural diversity of cardiac proteins in their cellular context. bioRxiv 2023:2023.10.26.564098. [PMID: 37961228 PMCID: PMC10634850 DOI: 10.1101/2023.10.26.564098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Cardiovascular diseases are a leading cause of death worldwide, but our understanding of the underlying mechanisms is limited, in part because of the complexity of the cellular machinery that controls the heart muscle contraction cycle. Cryogenic electron tomography (cryo-ET) provides a way to visualize diverse cellular machinery while preserving contextual information like subcellular localization and transient complex formation, but this approach has not been widely applied to the study of heart muscle cells (cardiomyocytes). Here, we deploy a platform for studying cardiovascular disease by combining cryo-ET with human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs). After developing a cryo-ET workflow for visualizing macromolecules in hiPSC-CMs, we reconstructed sub-nanometer resolution structures of the human thin filament, a central component of the contractile machinery. We also visualized a previously unobserved organization of a regulatory complex that connects muscle contraction to calcium signaling (the troponin complex), highlighting the value of our approach for interrogating the structures of cardiac proteins in their cellular context.
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Affiliation(s)
- Rahel A. Woldeyes
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Masataka Nishiga
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Alison S. Vander Roest
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Engineering, University of Michigan, MI, USA
| | - Leeya Engel
- Faculty of Mechanical Engineering, Technion - Israel Institute of Technology, Haifa, Israel
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA
| | - Prerna Giri
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Andrew C. Wu
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Alexander R. Dunn
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA
| | - James A. Spudich
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA, USA
| | - Daniel Bernstein
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael F. Schmid
- Department of Bioengineering, Stanford University, Stanford, CA, USA
- Division of Cryo-EM and Bioimaging, SSRL, SLAC National Accelerator Laboratory, Stanford University, Menlo Park, CA, USA
| | - Joseph C. Wu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Wah Chiu
- Department of Bioengineering, Stanford University, Stanford, CA, USA
- Division of Cryo-EM and Bioimaging, SSRL, SLAC National Accelerator Laboratory, Stanford University, Menlo Park, CA, USA
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12
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Tajima T, Bernstein D, Boyd SD, Gratzinger D, Lum G, Sasaki K, Tan B, Weinberg K, Armstrong B, Brown M, Chin C, Desai D, Fishbein TM, Mazariegos G, Robien MA, Tekin A, Twist CJ, Venick RS, Krams SM, Martinez OM, Esquivel CO. 311.2: Risk factors for Epstein-Barr virus DNAemia in pediatric transplantation: A multicenter study in the United States. Transplantation 2023; 107:71-72. [PMID: 37845955 DOI: 10.1097/01.tp.0000993400.94644.c0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Affiliation(s)
- Tetsuya Tajima
- Department of Surgery, Division of Abdominal Transplantation, Stanford University School of Medicine, Stanford, CA, United States
| | - Daniel Bernstein
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Scott D Boyd
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - Dita Gratzinger
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - Grant Lum
- Department of Surgery, Division of Abdominal Transplantation, Stanford University School of Medicine, Stanford, CA, United States
| | - Kazunari Sasaki
- Department of Surgery, Division of Abdominal Transplantation, Stanford University School of Medicine, Stanford, CA, United States
| | - Brent Tan
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - Kenneth Weinberg
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | | | - Meredith Brown
- National Institute of Allergy and Infectious Diseases, Rockville, MD, United States
| | - Clifford Chin
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Dev Desai
- Division of Surgical Transplantation, UT Southwestern Medical Center, Dallas, TX, United States
| | - Thomas M Fishbein
- Departments of Surgery and Pediatrics, MedStar Georgetown University Hospital, Washington, DC, United States
| | - George Mazariegos
- Department of Pediatrics, UPMC Children's Hospital, Pittsburgh, PA, United States
| | - Mark A Robien
- National Institute of Allergy and Infectious Diseases, Rockville, MD, United States
| | - Akin Tekin
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Clare J Twist
- Department of Pediatric Oncology, Rosewell Park, Buffalo, NY, United States
| | - Robert S Venick
- Department of Pediatric Gastroenterology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Sheri M Krams
- Department of Surgery, Division of Abdominal Transplantation, Stanford University School of Medicine, Stanford, CA, United States
| | - Olivia M Martinez
- Department of Surgery, Division of Abdominal Transplantation, Stanford University School of Medicine, Stanford, CA, United States
| | - Carlos O Esquivel
- Department of Surgery, Division of Abdominal Transplantation, Stanford University School of Medicine, Stanford, CA, United States
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13
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Miller TA, Hernandez EJ, Gaynor JW, Russell MW, Newburger JW, Chung W, Goldmuntz E, Cnota JF, Zyblewski SC, Mahle WT, Zak V, Ravishankar C, Kaltman JR, McCrindle BW, Clarke S, Votava-Smith JK, Graham EM, Seed M, Rudd N, Bernstein D, Lee TM, Yandell M, Tristani-Firouzi M. Genetic and clinical variables act synergistically to impact neurodevelopmental outcomes in children with single ventricle heart disease. Commun Med (Lond) 2023; 3:127. [PMID: 37758840 PMCID: PMC10533527 DOI: 10.1038/s43856-023-00361-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Recent large-scale sequencing efforts have shed light on the genetic contribution to the etiology of congenital heart defects (CHD); however, the relative impact of genetics on clinical outcomes remains less understood. Outcomes analyses using genetics are complicated by the intrinsic severity of the CHD lesion and interactions with conditionally dependent clinical variables. METHODS Bayesian Networks were applied to describe the intertwined relationships between clinical variables, demography, and genetics in a cohort of children with single ventricle CHD. RESULTS As isolated variables, a damaging genetic variant in a gene related to abnormal heart morphology and prolonged ventilator support following stage I palliative surgery increase the probability of having a low Mental Developmental Index (MDI) score at 14 months of age by 1.9- and 5.8-fold, respectively. However, in combination, these variables act synergistically to further increase the probability of a low MDI score by 10-fold. The absence of a damaging variant in a known syndromic CHD gene and a shorter post-operative ventilator support increase the probability of a normal MDI score 1.7- and 2.4-fold, respectively, but in combination increase the probability of a good outcome by 59-fold. CONCLUSIONS Our analyses suggest a modest genetic contribution to neurodevelopmental outcomes as isolated variables, similar to known clinical predictors. By contrast, genetic, demographic, and clinical variables interact synergistically to markedly impact clinical outcomes. These findings underscore the importance of capturing and quantifying the impact of damaging genomic variants in the context of multiple, conditionally dependent variables, such as pre- and post-operative factors, and demography.
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Grants
- UM1 HL098123 NHLBI NIH HHS
- P50 HD105351 NICHD NIH HHS
- U01 HL068269 NHLBI NIH HHS
- U01 HL068279 NHLBI NIH HHS
- U01 HL068288 NHLBI NIH HHS
- U10 HL068270 NHLBI NIH HHS
- U01 HL068270 NHLBI NIH HHS
- UM1 HL128711 NHLBI NIH HHS
- S10 OD021644 NIH HHS
- UM1 HL098147 NHLBI NIH HHS
- U01 HL068292 NHLBI NIH HHS
- U01 HL085057 NHLBI NIH HHS
- U01 HL068285 NHLBI NIH HHS
- U01 HL098163 NHLBI NIH HHS
- U01 HL128711 NHLBI NIH HHS
- UM1 HL098162 NHLBI NIH HHS
- U01 HL098153 NHLBI NIH HHS
- U01 HL131003 NHLBI NIH HHS
- R01 GM104390 NIGMS NIH HHS
- U01 HL068290 NHLBI NIH HHS
- U01 HL068281 NHLBI NIH HHS
- UM1 HL128761 NHLBI NIH HHS
- The clinical data for this project was supported by National Heart, Lung, and Blood Institute (NHLBI) Pediatric Heart Network grants HL068269, HL068270, HL068279, HL068281, HL068285, HL068288, HL068290, HL068292, and HL085057. The genomic data for this project was supported by the NHLBI Pediatric Cardiac Genomics Consortium (UM1-HL098147, UM1-HL128761, UM1-HL098123, UM1-HL128711, UM1-HL098162, U01-HL131003, U01-HL098153, U01-HL098163), the National Center for Research Resources (U01-HL098153), and the National Institutes for Health (R01-GM104390, 1S10OD021644-01A1).
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Affiliation(s)
- Thomas A Miller
- Department of Pediatrics, Maine Medical Center, Portland, ME, USA.
| | - Edgar J Hernandez
- Department of Human Genetics and Utah Center for Genetic Discovery, University of Utah, Salt Lake City, UT, USA
| | - J William Gaynor
- Department of Surgery, Children's Hospital of Philadelphia, and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark W Russell
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Wendy Chung
- Departments of Pediatrics and Medicine, Columbia University, New York, NY, USA
| | - Elizabeth Goldmuntz
- Division of Cardiology, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - James F Cnota
- Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Sinai C Zyblewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | | | | | - Chitra Ravishankar
- Division of Cardiology, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan R Kaltman
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Brian W McCrindle
- Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Shanelle Clarke
- Department of Pediatrics Emory University School of Medicine, Atlanta, GA, USA
| | | | - Eric M Graham
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Mike Seed
- Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Nancy Rudd
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Teresa M Lee
- Departments of Pediatrics and Medicine, Columbia University, New York, NY, USA
| | - Mark Yandell
- Department of Human Genetics and Utah Center for Genetic Discovery, University of Utah, Salt Lake City, UT, USA.
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14
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Lee S, Roest ASV, Blair CA, Kao K, Bremner SB, Childers MC, Pathak D, Heinrich P, Lee D, Chirikian O, Mohran S, Roberts B, Smith JE, Jahng JW, Paik DT, Wu JC, Gunawardane RN, Spudich JA, Ruppel K, Mack D, Pruitt BL, Regnier M, Wu SM, Bernstein D. Multi-scale models reveal hypertrophic cardiomyopathy MYH7 G256E mutation drives hypercontractility and elevated mitochondrial respiration. bioRxiv 2023:2023.06.08.544276. [PMID: 37333118 PMCID: PMC10274883 DOI: 10.1101/2023.06.08.544276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Rationale Over 200 mutations in the sarcomeric protein β-myosin heavy chain (MYH7) have been linked to hypertrophic cardiomyopathy (HCM). However, different mutations in MYH7 lead to variable penetrance and clinical severity, and alter myosin function to varying degrees, making it difficult to determine genotype-phenotype relationships, especially when caused by rare gene variants such as the G256E mutation. Objective This study aims to determine the effects of low penetrant MYH7 G256E mutation on myosin function. We hypothesize that the G256E mutation would alter myosin function, precipitating compensatory responses in cellular functions. Methods We developed a collaborative pipeline to characterize myosin function at multiple scales (protein to myofibril to cell to tissue). We also used our previously published data on other mutations to compare the degree to which myosin function was altered. Results At the protein level, the G256E mutation disrupts the transducer region of the S1 head and reduces the fraction of myosin in the folded-back state by 50.9%, suggesting more myosins available for contraction. Myofibrils isolated from hiPSC-CMs CRISPR-edited with G256E (MYH7 WT/G256E ) generated greater tension, had faster tension development and slower early phase relaxation, suggesting altered myosin-actin crossbridge cycling kinetics. This hypercontractile phenotype persisted in single-cell hiPSC-CMs and engineered heart tissues. Single-cell transcriptomic and metabolic profiling demonstrated upregulation of mitochondrial genes and increased mitochondrial respiration, suggesting altered bioenergetics as an early feature of HCM. Conclusions MYH7 G256E mutation causes structural instability in the transducer region, leading to hypercontractility across scales, perhaps from increased myosin recruitment and altered crossbridge cycling. Hypercontractile function of the mutant myosin was accompanied by increased mitochondrial respiration, while cellular hypertrophy was modest in the physiological stiffness environment. We believe that this multi-scale platform will be useful to elucidate genotype-phenotype relationships underlying other genetic cardiovascular diseases.
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15
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Jang MY, Patel PN, Pereira AC, Willcox JA, Haghighi A, Tai AC, Ito K, Morton SU, Gorham JM, McKean DM, DePalma SR, Bernstein D, Brueckner M, Chung WK, Giardini A, Goldmuntz E, Kaltman JR, Kim R, Newburger JW, Shen Y, Srivastava D, Tristani-Firouzi M, Gelb BD, Porter GA, Seidman CE, Seidman JG. Contribution of Previously Unrecognized RNA Splice-Altering Variants to Congenital Heart Disease. Circ Genom Precis Med 2023; 16:224-231. [PMID: 37165897 PMCID: PMC10404383 DOI: 10.1161/circgen.122.003924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/13/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Known genetic causes of congenital heart disease (CHD) explain <40% of CHD cases, and interpreting the clinical significance of variants with uncertain functional impact remains challenging. We aim to improve diagnostic classification of variants in patients with CHD by assessing the impact of noncanonical splice region variants on RNA splicing. METHODS We tested de novo variants from trio studies of 2649 CHD probands and their parents, as well as rare (allele frequency, <2×10-6) variants from 4472 CHD probands in the Pediatric Cardiac Genetics Consortium through a combined computational and in vitro approach. RESULTS We identified 53 de novo and 74 rare variants in CHD cases that alter splicing and thus are loss of function. Of these, 77 variants are in known dominant, recessive, and candidate CHD genes, including KMT2D and RBFOX2. In 1 case, we confirmed the variant's predicted impact on RNA splicing in RNA transcripts from the proband's cardiac tissue. Two probands were found to have 2 loss-of-function variants for recessive CHD genes HECTD1 and DYNC2H1. In addition, SpliceAI-a predictive algorithm for altered RNA splicing-has a positive predictive value of ≈93% in our cohort. CONCLUSIONS Through assessment of RNA splicing, we identified a new loss-of-function variant within a CHD gene in 78 probands, of whom 69 (1.5%; n=4472) did not have a previously established genetic explanation for CHD. Identification of splice-altering variants improves diagnostic classification and genetic diagnoses for CHD. REGISTRATION URL: https://clinicaltrials.gov; Unique identifier: NCT01196182.
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Affiliation(s)
- Min Young Jang
- Departments of Genetics (M.Y.J., P.N.P., A.C.P., J.A.L.W., A.H., A.C.T., S.U.M., J.M.G., D.M.M., S.R.D., C.E.S., J.G.S.), Harvard Medical School, Boston, MA
- Department of Medicine (M.Y.J., A.H.), Brigham and Women’s Hospital, Boston, MA
| | - Parth N. Patel
- Departments of Genetics (M.Y.J., P.N.P., A.C.P., J.A.L.W., A.H., A.C.T., S.U.M., J.M.G., D.M.M., S.R.D., C.E.S., J.G.S.), Harvard Medical School, Boston, MA
- Division of Cardiology, Massachusetts General Hospital, Boston, MA (P.N.P.)
| | - Alexandre C. Pereira
- Departments of Genetics (M.Y.J., P.N.P., A.C.P., J.A.L.W., A.H., A.C.T., S.U.M., J.M.G., D.M.M., S.R.D., C.E.S., J.G.S.), Harvard Medical School, Boston, MA
| | - Jon A.L. Willcox
- Departments of Genetics (M.Y.J., P.N.P., A.C.P., J.A.L.W., A.H., A.C.T., S.U.M., J.M.G., D.M.M., S.R.D., C.E.S., J.G.S.), Harvard Medical School, Boston, MA
| | - Alireza Haghighi
- Departments of Genetics (M.Y.J., P.N.P., A.C.P., J.A.L.W., A.H., A.C.T., S.U.M., J.M.G., D.M.M., S.R.D., C.E.S., J.G.S.), Harvard Medical School, Boston, MA
- Department of Medicine (M.Y.J., A.H.), Brigham and Women’s Hospital, Boston, MA
| | - Angela C. Tai
- Departments of Genetics (M.Y.J., P.N.P., A.C.P., J.A.L.W., A.H., A.C.T., S.U.M., J.M.G., D.M.M., S.R.D., C.E.S., J.G.S.), Harvard Medical School, Boston, MA
| | - Kaoru Ito
- Laboratory for Cardiovascular Diseases, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan (K.I.)
| | - Sarah U. Morton
- Departments of Genetics (M.Y.J., P.N.P., A.C.P., J.A.L.W., A.H., A.C.T., S.U.M., J.M.G., D.M.M., S.R.D., C.E.S., J.G.S.), Harvard Medical School, Boston, MA
- Pediatrics (S.U.M.), Harvard Medical School, Boston, MA
| | - Joshua M. Gorham
- Departments of Genetics (M.Y.J., P.N.P., A.C.P., J.A.L.W., A.H., A.C.T., S.U.M., J.M.G., D.M.M., S.R.D., C.E.S., J.G.S.), Harvard Medical School, Boston, MA
| | - David M. McKean
- Departments of Genetics (M.Y.J., P.N.P., A.C.P., J.A.L.W., A.H., A.C.T., S.U.M., J.M.G., D.M.M., S.R.D., C.E.S., J.G.S.), Harvard Medical School, Boston, MA
| | - Steven R. DePalma
- Departments of Genetics (M.Y.J., P.N.P., A.C.P., J.A.L.W., A.H., A.C.T., S.U.M., J.M.G., D.M.M., S.R.D., C.E.S., J.G.S.), Harvard Medical School, Boston, MA
- Division of Cardiology (S.R.D., C.E.S.), Brigham and Women’s Hospital, Boston, MA
| | - Daniel Bernstein
- Department of Pediatrics, Stanford University, Palo Alto, CA (D.B.)
| | - Martina Brueckner
- Departments of Genetics (M.B.), Yale University School of Medicine, New Haven, CT
- Pediatric Cardiology (M.B.), Yale University School of Medicine, New Haven, CT
| | - Wendy K. Chung
- Departments of Pediatrics (W.K.C.), Columbia University Medical Center, New York, NY
- Medicine (W.K.C.), Columbia University Medical Center, New York, NY
| | - Alessandro Giardini
- Cardiorespiratory Unit, Great Ormond Street Hospital, London, United Kingdom (A.G.)
| | - Elizabeth Goldmuntz
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (E.G.)
| | - Jonathan R. Kaltman
- Heart Development and Structural Diseases Branch, Division of Cardiovascular Sciences, National Institute of Heart, Lung, and Blood, National Institutes of Health, Bethesda, MD (J.R.K.)
| | - Richard Kim
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (R.K.)
| | - Jane W. Newburger
- Department of Cardiology (J.W.N.), Boston Children’s Hospital, MA
- Department of Cardiology (J.W.N.), Boston Children’s Hospital, MA
| | - Yufeng Shen
- Systems Biology (Y.S.), Columbia University Medical Center, New York, NY
- Biomedical Informatics (Y.S.), Columbia University Medical Center, New York, NY
| | - Deepak Srivastava
- Gladstone Institute of Cardiovascular Disease, San Francisco, CA (D.S.)
| | - Martin Tristani-Firouzi
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT (M.T.-F.)
| | - Bruce D. Gelb
- Mindich Child Health and Development Institute (B.D.G.), Icahn School of Medicine at Mount Sinai, New York
- Department of Pediatrics (B.D.G.), Icahn School of Medicine at Mount Sinai, New York
- Department of Genetics (B.D.G.), Icahn School of Medicine at Mount Sinai, New York
- Department of Genomic Sciences (B.D. co-occurrence G.), Icahn School of Medicine at Mount Sinai, New York
| | - George A. Porter
- Department of Pediatrics, University of Rochester Medical Center, NY (G.A.P.)
| | - Christine E. Seidman
- Departments of Genetics (M.Y.J., P.N.P., A.C.P., J.A.L.W., A.H., A.C.T., S.U.M., J.M.G., D.M.M., S.R.D., C.E.S., J.G.S.), Harvard Medical School, Boston, MA
- Division of Cardiology (S.R.D., C.E.S.), Brigham and Women’s Hospital, Boston, MA
- Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Jonathan G. Seidman
- Departments of Genetics (M.Y.J., P.N.P., A.C.P., J.A.L.W., A.H., A.C.T., S.U.M., J.M.G., D.M.M., S.R.D., C.E.S., J.G.S.), Harvard Medical School, Boston, MA
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16
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Woo JP, Dong ML, Kong F, McElhinney DB, Schiavone N, Chan F, Lui GK, Haddad F, Bernstein D, Marsden A. Improved Right Ventricular Energy Efficiency by 4-Dimensional Flow Magnetic Resonance Imaging After Harmony Valve Implantation. JACC Adv 2023; 2:100284. [PMID: 37691969 PMCID: PMC10487049 DOI: 10.1016/j.jacadv.2023.100284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Affiliation(s)
| | | | - Fanwei Kong
- Stanford University School of Medicine, 300 Pasteur Drive, 3rd Floor, Clinic A32 Rm A345 – MC: 5844 Stanford, California 94305, USA
| | - Doff B. McElhinney
- Stanford University School of Medicine, 300 Pasteur Drive, 3rd Floor, Clinic A32 Rm A345 – MC: 5844 Stanford, California 94305, USA
| | - Nicole Schiavone
- Stanford University School of Medicine, 300 Pasteur Drive, 3rd Floor, Clinic A32 Rm A345 – MC: 5844 Stanford, California 94305, USA
| | - Frandics Chan
- Stanford University School of Medicine, 300 Pasteur Drive, 3rd Floor, Clinic A32 Rm A345 – MC: 5844 Stanford, California 94305, USA
| | - George K. Lui
- Stanford University School of Medicine, 300 Pasteur Drive, 3rd Floor, Clinic A32 Rm A345 – MC: 5844 Stanford, California 94305, USA
| | - Francois Haddad
- Stanford University School of Medicine, 300 Pasteur Drive, 3rd Floor, Clinic A32 Rm A345 – MC: 5844 Stanford, California 94305, USA
| | - Daniel Bernstein
- Stanford University School of Medicine, 300 Pasteur Drive, 3rd Floor, Clinic A32 Rm A345 – MC: 5844 Stanford, California 94305, USA
| | - Alison Marsden
- Stanford University School of Medicine, 300 Pasteur Drive, 3rd Floor, Clinic A32 Rm A345 – MC: 5844 Stanford, California 94305, USA
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17
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Martinez OM, Krams SM, Robien MA, Lapasaran MG, Arvedson MP, Reitsma A, Balachandran Y, Harris-Arnold A, Weinberg K, Boyd SD, Armstrong B, Trickey A, Twist CJ, Gratzinger D, Tan B, Brown M, Chin C, Desai DM, Fishbein TM, Mazariegos GV, Tekin A, Venick RS, Bernstein D, Esquivel CO. Mutations in latent membrane protein 1 of Epstein-Barr virus are associated with increased risk of posttransplant lymphoproliferative disorder in children. Am J Transplant 2023; 23:611-618. [PMID: 36796762 PMCID: PMC10159954 DOI: 10.1016/j.ajt.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/04/2023] [Indexed: 02/17/2023]
Abstract
Epstein-Barr virus (EBV)-positive posttransplant lymphoproliferative disorder (PTLD) results in significant morbidity and mortality in pediatric transplant recipients. Identifying individuals at an increased risk of EBV-positive PTLD could influence clinical management of immunosuppression and other therapies, improving posttransplant outcomes. A 7-center prospective, observational clinical trial of 872 pediatric transplant recipients evaluated the presence of mutations at positions 212 and 366 of EBV latent membrane protein 1 (LMP1) as an indicator of risk of EBV-positive PTLD (clinical trials: NCT02182986). DNA was isolated from peripheral blood of EBV-positive PTLD case patients and matched controls (1:2 nested case:control), and the cytoplasmic tail of LMP1 was sequenced. Thirty-four participants reached the primary endpoint of biopsy-proven EBV-positive PTLD. DNA was sequenced from 32 PTLD case patients and 62 matched controls. Both LMP1 mutations were present in 31 of 32 PTLD cases (96.9%) and in 45 of 62 matched controls (72.6%) (P = .005; OR = 11.7; 95% confidence interval, 1.5, 92.6). The presence of both G212S and S366T carries a nearly 12-fold increased risk of development of EBV-positive PTLD. Conversely, transplant recipients without both LMP1 mutations carry a very low risk of PTLD. Analysis of mutations at positions 212 and 366 of LMP1 can be informative in stratifying patients for risk of EBV-positive PTLD.
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Affiliation(s)
- Olivia M Martinez
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA; Stanford Immunology, Stanford University School of Medicine, Palo Alto, California, USA.
| | - Sheri M Krams
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA; Stanford Immunology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Mark A Robien
- National Institute of Allergy and Infectious Disease, Rockville, Maryland, USA
| | - Mary G Lapasaran
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Matthew P Arvedson
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Andrea Reitsma
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Yarl Balachandran
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Aleishia Harris-Arnold
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA; Stanford Immunology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Kenneth Weinberg
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Scott D Boyd
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | | | - Amber Trickey
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Clare J Twist
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Dita Gratzinger
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Brent Tan
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Merideth Brown
- National Institute of Allergy and Infectious Disease, Rockville, Maryland, USA
| | - Clifford Chin
- Department of Pediatrics and Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio, USA
| | - Dev M Desai
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Thomas M Fishbein
- Departments of Surgery and Pediatrics, MedStar Georgetown University Hospital, Georgetown, Washington, DC, USA
| | - George V Mazariegos
- University of Pittsburgh Medical Center, Children's Hospital Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Akin Tekin
- Miller School of Medicine, University of Medicine, Florida, USA
| | - Robert S Venick
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Daniel Bernstein
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Carlos O Esquivel
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
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18
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Selamet Tierney ES, Palaniappan L, Leonard M, Long J, Myers J, Dávila T, Lui MC, Kogan F, Olson I, Punn R, Desai M, Schneider LM, Wang CH, Cooke JP, Bernstein D. Design and rationale of re-energize fontan: Randomized exercise intervention designed to maximize fitness in fontan patients. Am Heart J 2023; 259:68-78. [PMID: 36796574 PMCID: PMC10085861 DOI: 10.1016/j.ahj.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/22/2023] [Accepted: 02/05/2023] [Indexed: 05/11/2023]
Abstract
In this manuscript, we describe the design and rationale of a randomized controlled trial in pediatric Fontan patients to test the hypothesis that a live-video-supervised exercise (aerobic+resistance) intervention will improve cardiac and physical capacity; muscle mass, strength, and function; and endothelial function. Survival of children with single ventricles beyond the neonatal period has increased dramatically with the staged Fontan palliation. Yet, long-term morbidity remains high. By age 40, 50% of Fontan patients will have died or undergone heart transplantation. Factors that contribute to onset and progression of heart failure in Fontan patients remain incompletely understood. However, it is established that Fontan patients have poor exercise capacity which is associated with a greater risk of morbidity and mortality. Furthermore, decreased muscle mass, abnormal muscle function, and endothelial dysfunction in this patient population is known to contribute to disease progression. In adult patients with 2 ventricles and heart failure, reduced exercise capacity, muscle mass, and muscle strength are powerful predictors of poor outcomes, and exercise interventions can not only improve exercise capacity and muscle mass, but also reverse endothelial dysfunction. Despite these known benefits of exercise, pediatric Fontan patients do not exercise routinely due to their chronic condition, perceived restrictions to exercise, and parental overprotection. Limited exercise interventions in children with congenital heart disease have demonstrated that exercise is safe and effective; however, these studies have been conducted in small, heterogeneous groups, and most had few Fontan patients. Critically, adherence is a major limitation in pediatric exercise interventions delivered on-site, with adherence rates as low as 10%, due to distance from site, transportation difficulties, and missed school or workdays. To overcome these challenges, we utilize live-video conferencing to deliver the supervised exercise sessions. Our multidisciplinary team of experts will assess the effectiveness of a live-video-supervised exercise intervention, rigorously designed to maximize adherence, and improve key and novel measures of health in pediatric Fontan patients associated with poor long-term outcomes. Our ultimate goal is the translation of this model to clinical application as an "exercise prescription" to intervene early in pediatric Fontan patients and decrease long-term morbidity and mortality.
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Affiliation(s)
- Elif Seda Selamet Tierney
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, School of Medicine, Palo Alto, CA, USA.
| | - Latha Palaniappan
- Department of Medicine, Stanford University, School of Medicine, Palo Alto, CA, USA
| | - Mary Leonard
- Department of Pediatrics, Division of Pediatric Nephrology, Stanford University, School of Medicine, Palo Alto, CA, USA
| | - Jin Long
- Department of Pediatrics, Division of Pediatric Nephrology, Stanford University, School of Medicine, Palo Alto, CA, USA
| | - Jonathan Myers
- Department of Medicine, Health Research Science, Palo Alto VA Health Care System, Palo Alto, CA, USA
| | - Tania Dávila
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, School of Medicine, Palo Alto, CA, USA
| | - Mavis C Lui
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, School of Medicine, Palo Alto, CA, USA
| | - Feliks Kogan
- Department of Radiology, Stanford University, School of Medicine, Palo Alto, CA, USA
| | - Inger Olson
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, School of Medicine, Palo Alto, CA, USA
| | - Rajesh Punn
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, School of Medicine, Palo Alto, CA, USA
| | - Manisha Desai
- Department of Biomedical Data Science, Stanford University, School of Medicine, Palo Alto, CA, USA
| | - Lauren M Schneider
- Psychiatry and Behavioral Sciences - Child & Adolescent Psychiatry and Child Development, Palo Alto, CA, USA
| | - Chih-Hung Wang
- Department of Pediatrics, Health Policy, Stanford University, School of Medicine, Palo Alto, CA, USA
| | - John P Cooke
- Houston Methodist Research Institute Houston Methodist Hospital & Research Institute, Houston, Texas, USA
| | - Daniel Bernstein
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, School of Medicine, Palo Alto, CA, USA
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19
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Mukherjee R, Tetri LH, Li SJ, Fajardo G, Ostberg NP, Tsegay KB, Gera K, Cornell TT, Bernstein D, Mochly-Rosen D, Haileselassie B. Drp1/p53 interaction mediates p53 mitochondrial localization and dysfunction in septic cardiomyopathy. J Mol Cell Cardiol 2023; 177:28-37. [PMID: 36841153 PMCID: PMC10358757 DOI: 10.1016/j.yjmcc.2023.01.008] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Previous studies have implicated p53-dependent mitochondrial dysfunction in sepsis induced end organ injury, including sepsis-induced myocardial dysfunction (SIMD). However, the mechanisms behind p53 localization to the mitochondria have not been well established. Dynamin-related protein 1 (Drp1), a mediator of mitochondrial fission, may play a role in p53 mitochondrial localization. Here we examined the role of Drp1/p53 interaction in SIMD using in vitro and murine models of sepsis. METHODS H9c2 cardiomyoblasts and BALB/c mice were exposed to lipopolysaccharide (LPS) to model sepsis phenotype. Pharmacologic inhibitors of Drp1 activation (ψDrp1) and of p53 mitochondrial binding (pifithrin μ, PFTμ) were utilized to assess interaction between Drp1 and p53, and the subsequent downstream impact on mitochondrial morphology and function, cardiomyocyte function, and sepsis phenotype. RESULTS Both in vitro and murine models demonstrated an increase in physical Drp1/p53 interaction following LPS treatment, which was associated with increased p53 mitochondrial localization, and mitochondrial dysfunction. This Drp1/p53 interaction was inhibited by ΨDrp1, suggesting that this interaction is dependent on Drp1 activation. Treatment of H9c2 cells with either ΨDrp1 or PFTμ inhibited the LPS mediated localization of Drp1/p53 to the mitochondria, decreased oxidative stress, improved cellular respiration and ATP production. Similarly, treatment of BALB/c mice with either ΨDrp1 or PFTμ decreased LPS-mediated mitochondrial localization of p53, mitochondrial ROS in cardiac tissue, and subsequently improved cardiomyocyte contractile function and survival. CONCLUSION Drp1/p53 interaction and mitochondrial localization is a key prodrome to mitochondrial damage in SIMD and inhibiting this interaction may serve as a therapeutic target.
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Affiliation(s)
- Riddhita Mukherjee
- Department of Pediatrics, Division of Critical Care Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Laura H Tetri
- Department of Pediatrics, Division of Critical Care Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Anesthesia, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Sin-Jin Li
- Department of Pediatrics, Division of Critical Care Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Giovanni Fajardo
- Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Nicolai P Ostberg
- Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Kaleb B Tsegay
- Department of Pediatrics, Division of Critical Care Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Kanika Gera
- Department of Pediatrics, Division of Critical Care Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Timothy T Cornell
- Department of Pediatrics, Division of Critical Care Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Daniel Bernstein
- Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Daria Mochly-Rosen
- Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Bereketeab Haileselassie
- Department of Pediatrics, Division of Critical Care Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA 94305, USA.
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20
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Hsueh B, Chen R, Jo Y, Tang D, Raffiee M, Kim YS, Inoue M, Randles S, Ramakrishnan C, Patel S, Kim DK, Liu TX, Kim SH, Tan L, Mortazavi L, Cordero A, Shi J, Zhao M, Ho TT, Crow A, Yoo ACW, Raja C, Evans K, Bernstein D, Zeineh M, Goubran M, Deisseroth K. Cardiogenic control of affective behavioural state. Nature 2023; 615:292-299. [PMID: 36859543 PMCID: PMC9995271 DOI: 10.1038/s41586-023-05748-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/20/2023] [Indexed: 03/03/2023]
Abstract
Emotional states influence bodily physiology, as exemplified in the top-down process by which anxiety causes faster beating of the heart1-3. However, whether an increased heart rate might itself induce anxiety or fear responses is unclear3-8. Physiological theories of emotion, proposed over a century ago, have considered that in general, there could be an important and even dominant flow of information from the body to the brain9. Here, to formally test this idea, we developed a noninvasive optogenetic pacemaker for precise, cell-type-specific control of cardiac rhythms of up to 900 beats per minute in freely moving mice, enabled by a wearable micro-LED harness and the systemic viral delivery of a potent pump-like channelrhodopsin. We found that optically evoked tachycardia potently enhanced anxiety-like behaviour, but crucially only in risky contexts, indicating that both central (brain) and peripheral (body) processes may be involved in the development of emotional states. To identify potential mechanisms, we used whole-brain activity screening and electrophysiology to find brain regions that were activated by imposed cardiac rhythms. We identified the posterior insular cortex as a potential mediator of bottom-up cardiac interoceptive processing, and found that optogenetic inhibition of this brain region attenuated the anxiety-like behaviour that was induced by optical cardiac pacing. Together, these findings reveal that cells of both the body and the brain must be considered together to understand the origins of emotional or affective states. More broadly, our results define a generalizable approach for noninvasive, temporally precise functional investigations of joint organism-wide interactions among targeted cells during behaviour.
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Affiliation(s)
- Brian Hsueh
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Ritchie Chen
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - YoungJu Jo
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Daniel Tang
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Misha Raffiee
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Yoon Seok Kim
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Masatoshi Inoue
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Sawyer Randles
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | | | - Sneha Patel
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Doo Kyung Kim
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Tony X Liu
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Soo Hyun Kim
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Longzhi Tan
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Leili Mortazavi
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Arjay Cordero
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Jenny Shi
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Mingming Zhao
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Theodore T Ho
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Ailey Crow
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Ai-Chi Wang Yoo
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Cephra Raja
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Kathryn Evans
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Daniel Bernstein
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Michael Zeineh
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Maged Goubran
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Karl Deisseroth
- Department of Bioengineering, Stanford University, Stanford, CA, USA.
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
- Howard Hughes Medical Institute, Stanford University, Stanford, CA, USA.
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Bousquet J, Melén E, Haahtela T, Koppelman GH, Togias A, Valenta R, Akdis CA, Czarlewski W, Rothenberg M, Valiulis A, Wickmann M, Aguilar D, Akdis M, Ansotegui IJ, Barbara C, Bedbrook A, Bindslev Jensen C, Bosnic-Anticevich S, Boulet LP, Brightling CE, Brussino L, Burte E, Bustamante M, Canonica GW, Cecchi L, Celedon JC, Chaves-Loureiro C, Costa E, Cruz AA, Erhola M, Gemicioglu B, Fokkens WJ, Garcia Aymerich J, Guerra S, Heinrich J, Ivancevich JC, Keil T, Klimek L, Kuna P, Kupczyk M, Kvedariene V, Larenas-Linnemann DE, Lemonnier N, Lodrup Carlsen KC, Louis R, Makris M, Maurer M, Momas I, Morais-Almeida M, Mullol J, Naclerio RN, Nadeau K, Nadif R, Niedoszytko M, Okamoto Y, Ollert M, Papadopoulos NG, Passalacqua G, Patella V, Pawankar R, Pham-Thi N, Pfaar O, Regateiro FS, Ring J, Rouadi PW, Samolinski B, Sastre J, Savouré M, Scichilone N, Shamji MH, Sheikh A, Siroux V, Sousa-Pinto B, Standl M, Sunyer J, Taborda-Barata L, Toppila-Salmi S, Torres MJ, Tsiligianni I, Valovirta E, Vandenplas O, Ventura MT, Weiss S, Yorgancioglu A, Zhang L, Abdul Latiff AH, Aberer W, Agache I, Al-Ahmad M, Alobid I, Arshad HS, Asayag E, Baharudin A, Battur L, Bennoor KS, Berghea EC, Bergmann KC, Bernstein D, Bewick M, Blain H, Bonini M, Braido F, Buhl R, Bumbacea R, Bush A, Calderon M, Calvo G, Camargos P, Caraballo L, Cardona V, Carr W, Carreiro-Martins P, Casale T, Cepeda Sarabia AM, Chandrasekharan R, Charpin D, Chen YZ, Cherrez-Ojeda I, Chivato T, Chkhartishvili E, Christoff G, Chu DK, Cingi C, Correia da Sousa J, Corrigan C, Custovic A, D'Amato G, Del Giacco S, De Blay F, Devillier P, Didier A, do Ceu Teixeira M, Dokic D, Douagui H, Doulaptsi M, Durham S, Dykewicz M, Eiwegger T, El-Sayed ZA, Emuzyte R, Emuzyte R, Fiocchi A, Fyhrquist N, Gomez RM, Gotua M, Guzman MA, Hagemann J, Hamamah S, Halken S, Halpin DMG, Hofmann M, Hossny E, Hrubiško M, Irani C, Ispayeva Z, Jares E, Jartti T, Jassem E, Julge K, Just J, Jutel M, Kaidashev I, Kalayci O, Kalyoncu O, Kardas P, Kirenga B, Kraxner H, Kull I, Kulus M, La Gruta S, Lau S, Le Tuyet Thi L, Levin M, Lipworth B, Lourenço O, Mahboub B, Mäkelä MJ, Martinez-Infante E, Matricardi P, Miculinic N, Migueres N, Mihaltan F, Mohamad Y, Moniusko M, Montefort S, Neffen H, Nekam K, Nunes E, Nyembue Tshipukane D, O'Hehir RE, Ogulur I, Ohta K, Okubo K, Ouedraogo S, Olze H, Pali-Schöll I, Palomares O, Palosuo K, Panaitescu C, Panzner P, Park HS, Pitsios C, Plavec D, Popov TA, Puggioni F, Quirce S, Recto M, Repka-Ramirez R, Roballo-Cordeiro C, Roche N, Rodriguez-Gonzales M, Romantowski J, Rosario Filho N, Rottem M, Sagara H, Sarquis-Serpa F, Sayah Z, Scheire S, Schmid-Grendelmeier P, Sisul JC, Sole D, Soto-Martinez M, Sova M, Sperl A, Spranger O, Stelmach R, Suppli Ulrik C, Thomas M, To T, Todo-Bom A, Tomazic PV, Urrutia-Pereira M, Valentin-Rostan M, van Ganse E, Van Hage M, Vasankari T, Vichyanond P, Viegi G, Wallace D, Wang DY, Williams S, Worm M, Yiallouros P, Yiallouros P, Yusuf O, Zaitoun F, Zernotti M, Zidarn M, Zuberbier J, Fonseca JA, Zuberbier T, Anto JM. Rhinitis associated with asthma is distinct from rhinitis alone: The ARIA-MeDALL hypothesis. Allergy 2023; 78:1169-1203. [PMID: 36799120 DOI: 10.1111/all.15679] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 09/10/2022] [Revised: 02/06/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023]
Abstract
Asthma, rhinitis and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of "one-airway-one-disease", coined over 20 years ago, is a simplistic approach of the links between upper- and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitisation and multimorbidity, (iii) advances in mHealth for novel phenotype definition, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper- and lower-airway allergic diseases with skin, gut and neuropsychiatric multimorbidities, is the "Epithelial Barrier Hypothesis". This review determined that the "one-airway-one-disease" concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme "allergic" (asthma) phenotype combining asthma, rhinitis and conjunctivitis. Rhinitis alone and rhinitis and asthma multimorbidity represent two distinct diseases with the following differences: (i) genomic and transcriptomic background (Toll-Like Receptors and IL-17 for rhinitis alone as a local disease; IL-33 and IL-5 for allergic and non-allergic multimorbidity as a systemic disease), (ii) allergen sensitisation patterns (mono- or pauci-sensitisation versus polysensitisation), (iii) severity of symptoms and (iv) treatment response. In conclusion, rhinitis alone (local disease) and rhinitis with asthma multimorbidity (systemic disease) should be considered as two distinct diseases, possibly modulated by the microbiome, and may be a model for understanding the epidemics of chronic and auto-immune diseases.
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Affiliation(s)
- J Bousquet
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.,University Hospital Montpellier, Montpellier, France.,Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France
| | - E Melén
- Sach´s Children and Youth Hospital, Södersjukhuset, and Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - T Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - G H Koppelman
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatric Pulmonology and Pediatric Allergology, GRIAC Research Institute, Groningen, the Netherlands
| | - A Togias
- Division of Allergy, Immunology, and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases, NIH, Bethesda, USA
| | - R Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - C A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - W Czarlewski
- Medical Consulting Czarlewski, Levallois, France.,MASK-air, Montpellier, France
| | - M Rothenberg
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - A Valiulis
- Institute of Clinical Medicine and Institute of Health Sciences, Vilnius, Lithuania.,Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - M Wickmann
- Institute of Environmental medicine, Karolinska Institutet, Stockholm, Sweden
| | - D Aguilar
- Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBEREHD), Barcelona, Spain
| | - M Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - I J Ansotegui
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
| | - C Barbara
- Portuguese Nacional Programme for Respiratory Diseases, Direção -Geral da Saúde, Faculdade de Medicina de Lisboa, Instituto de Saúde Ambiental, Lisbon, Portugal
| | | | - C Bindslev Jensen
- Odense Research Center for Anaphylaxis (ORCA), and Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Finland
| | - S Bosnic-Anticevich
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
| | - L P Boulet
- Quebec Heart and Lung Institute, Laval University, Québec City, Quebec, Canada
| | - C E Brightling
- Institute of Lung Health, NIHR Biomedical Research Centre, Department of Respiratory and Infection Sciences, University of Leicester, Leicester, UK
| | - L Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino, Torino, Italy.,Mauriziano Hospital, Torino, Italy
| | - E Burte
- Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France.,Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France
| | - M Bustamante
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.,ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - G W Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - L Cecchi
- SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
| | - J C Celedon
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - C Chaves-Loureiro
- Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - E Costa
- UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (Porto4Ageing), Porto, Portugal
| | - A A Cruz
- Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Bahia, Brazil
| | - M Erhola
- Pirkanmaa Welfare district, Tampere, Finland
| | - B Gemicioglu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - W J Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - J Garcia Aymerich
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.,ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - S Guerra
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - J Heinrich
- Ludwig Maximilians University Munich, University Hospital Munich - Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Munich
| | - J C Ivancevich
- Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina
| | - T Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany.,State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - L Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Germany.,Center for Rhinology and Allergology, Wiesbaden, Germany
| | - P Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Poland
| | - M Kupczyk
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Poland
| | - V Kvedariene
- Institute of Clinical medicine, Clinic of Chest diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - D E Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
| | - N Lemonnier
- Institute for Advanced Biosciences, UGA - INSERM U1209 - CNRS UMR5309, Site Santé, Allée des Alpes, La Tronche, France
| | | | - R Louis
- Department of Pulmonary Medicine, CHU, Liege, Liège, Belgium.,GIGA I3 research group, University of Liege, Belgium
| | - M Makris
- Allergy Unit "D Kalogeromitros", 2nd Dpt of Dermatology and Venereology, National & Kapodistrian University of Athens, "Attikon" University Hospital, Greece
| | - M Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - I Momas
- Department of Public health and health products, Paris Descartes University-Sorbonne Paris Cité, EA 4064 and Paris Municipal Department of social action, childhood, and health, Paris, France
| | | | - J Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Barcelona, Spain.,Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Spain
| | - R N Naclerio
- Department of Otolaryngology - Head and Neck Surgery - Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - K Nadeau
- Stanford University School of Medicine, Sean N. Parker Center for Allergy and Asthma Research, Stanford, USA
| | - R Nadif
- Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France.,Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France
| | - M Niedoszytko
- Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
| | - Y Okamoto
- Chiba University Hospital, Chiba, Japan.,Chiba Rosai Hospital, Chiba, Japan
| | - M Ollert
- Odense Research Center for Anaphylaxis (ORCA), and Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Finland.,Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - N G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - G Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
| | - V Patella
- Division of Allergy and Clinical Immunology, Department of Medicine, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy.,Agency of Health ASL, Salerno, Italy
| | - R Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - N Pham-Thi
- Ecole Polytechnique Palaiseau, IRBA (Institut de Recherche bio-Médicale des Armées), Bretigny, France
| | - O Pfaar
- Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - F S Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (ICBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - J Ring
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany.,Christine Kühne Center for Allergy Research and Education (CK-Care), Davos, Switzerland
| | - P W Rouadi
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon.,Department of Otorhinolaryngology-Head and Neck Surgery, Dar Al Shifa Hospital, Salmiya, Kuwait
| | - B Samolinski
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Poland
| | - J Sastre
- Fundacion Jimenez Diaz, CIBERES, Faculty of Medicine, Autonoma University of Madrid, Madrid, Spain
| | - M Savouré
- Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France.,Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France
| | - N Scichilone
- PROMISE Department, University of Palermo, Palermo, Italy
| | - M H Shamji
- National Heart and Lung Institute, Imperial College, and NIHR Imperial Biomedical Research Centre, London, UK
| | - A Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - V Siroux
- INSERM, Université Grenoble Alpes, IAB, U 1209, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Université Joseph Fourier, Grenoble, France
| | - B Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research; University of Porto, Porto, Portugal.,RISE - Health Research Network; University of Porto, Porto, Portugal
| | - M Standl
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - J Sunyer
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.,ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - L Taborda-Barata
- Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal.,UBIAir - Clinical & Experimental Lung Centre and CICS-UBI Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - S Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - M J Torres
- Allergy Unit, Málaga Regional University Hospital-IBIMA, Málaga, Spain
| | - I Tsiligianni
- International Primary Care Respiratory Group IPCRG, Aberdeen, Scotland.,Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - E Valovirta
- Department of Lung Diseases and Clinical Immunology, University of Turku, Turku, Finland.,Terveystalo Allergy Clinic, Turku, Finland
| | - O Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL, Namur, and Université Catholique de Louvain, Yvoir, Belgium
| | - M T Ventura
- Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
| | - S Weiss
- Harvard Medical School and Channing Division of Network Medicine, Boston, USA
| | - A Yorgancioglu
- Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - L Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital and Beijing Institute of Otolaryngology, Beijing, China
| | - A H Abdul Latiff
- Allergy & Immunology Centre, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - W Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - I Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - M Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait
| | - I Alobid
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
| | - H S Arshad
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton.,David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
| | - E Asayag
- Argentine Society of Allergy and Immunopathology, Buenos Ayres, Argentian
| | - A Baharudin
- Department of Otorhinolaryngology, Head and Neck, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - L Battur
- Mongolian Association of Hospital Managers, Ulaanbaatar, Mongolia
| | - K S Bennoor
- Department of Respiratory Medicine, National Institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh
| | - E C Berghea
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - K C Bergmann
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - D Bernstein
- Division of Immunology, Allergy and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - M Bewick
- University of Central Lancashire Medical School, Preston, UK
| | - H Blain
- Department of Geriatrics, Montpellier University hospital, MUSE, Montpellier, France
| | - M Bonini
- Department of Clinical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy and National Heart and Lung Institute, Royal Brompton Hospital & Imperial College London, UK
| | - F Braido
- University of Genoa, Department of Internal Medicine (DiMI), and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - R Buhl
- Dept of Pulmonary Medicine, Mainz University Hospital, Mainz, Germany
| | - R Bumbacea
- Department of Allergy, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania
| | - A Bush
- Imperial College and Royal Brompton Hospital, London, UK
| | - M Calderon
- Imperial College and National Heart and Lung Institute, London, UK
| | - G Calvo
- Pediatrics Department, Universidad Austral de Chile, Valvidia, Chile
| | - P Camargos
- Federal University of Minas Gerais, Medical School, Department of Pediatrics, Belo Horizonte, Brazil
| | - L Caraballo
- Institute for Immunological Research, University of Cartagena, Campus de Zaragocilla, Edificio Biblioteca Primer piso, Cartagena, Colombia
| | - V Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain.,ARADyAL research network, Barcelona, Spain
| | - W Carr
- Allergy & Asthma Associates of Southern California, A Medical Group , Southern California Research, Mission Viejo, CA, USA
| | - P Carreiro-Martins
- NOVA Medical School/Comprehensive Health Research Centre (CHRC), Lisbon, Portugal.,Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - T Casale
- Division of Allergy/immunology, University of South Florida, Tampa, FLA, USA
| | - A M Cepeda Sarabia
- Allergy and Immunology Laboratory, Metropolitan University, Simon Bolivar University, Barranquilla, Colombia and SLaai, Sociedad Latinoamericana de Allergia, Asma e Immunologia, Branquilla, Columbia
| | - R Chandrasekharan
- Department of ENT, Badr al Samaa Hospital, Salalah, Sultanate of Oman
| | - D Charpin
- Clinique des bronches, allergie et sommeil, Hôpital Nord, Marseille, France
| | - Y Z Chen
- The capital institute of pediatrics, Beijing, China
| | - I Cherrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Guayas, Ecuador
| | - T Chivato
- School of Medicine, University CEU San Pablo, Madrid, Spain
| | - E Chkhartishvili
- David Tatishvili Medical Center; David Tvildiani Medical University-AIETI Medical School, Tbilisi, Georgia
| | - G Christoff
- Medical University - Sofia, Faculty of Public Health, Sofia, Bulgaria
| | - D K Chu
- Department of Health Research Methods, Evidence, and Impact & Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - C Cingi
- skisehir Osmangazi University, Medical Faculty, ENT Department, Eskisehir, Turkey
| | - J Correia da Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - C Corrigan
- Division of Asthma, Allergy & Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
| | - A Custovic
- National Heart and Lung Institute, Imperial College London, UK
| | - G D'Amato
- Division of Respiratory and Allergic Diseases,Hospital 'A Cardarelli', University of Naples Federico II, Naples, Italy
| | - S Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy
| | - F De Blay
- Allergy Division, Chest Disease Department, University Hospital of Strasbourg, and Federation of translational medicine, University of Strasbourg, Strasbourg, France
| | - P Devillier
- VIM Suresnes, UMR 0892, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France
| | - A Didier
- Department of Respiratory Diseases, Larrey Hospital, Toulouse University Hospital, Toulouse, France
| | - M do Ceu Teixeira
- Hospital Dr Agostinho Neto,Praia, Faculdade de Medicina de Cabo Verde
| | - D Dokic
- University Clinic of Pulmology and Allergy, Medical Faculty Skopje, Republic of Macedonia
| | - H Douagui
- Service de Pneumo-Allergologie, Centre Hospitalo-Universitaire de Béni-Messous, Algiers, Algeria
| | - M Doulaptsi
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Crete, Heraklion, Crete
| | - S Durham
- Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London, London, UK
| | - M Dykewicz
- Section of Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - T Eiwegger
- The Hospital for Sick Children, Department of Paediatrics, Division of Clinical Immunology and Allergy, Food allergy and Anaphylaxis Program, The University of Toronto, Toronto, Ontario, Canada
| | - Z A El-Sayed
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - R Emuzyte
- Clinic of Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - R Emuzyte
- Clinic of Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - A Fiocchi
- Allergy, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - N Fyhrquist
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - R M Gomez
- School of Health Sciences, Catholic University of Salta, Salta, Argentina
| | - M Gotua
- Center of Allergy and Immunology, Georgian Association of Allergology and Clinical Center of Allergy and Immunology, David Tvildiani Medical University, Tbilisi, Georgia
| | - M A Guzman
- Immunology and Allergy Division, Clinical Hospital, University of Chile, Santiago, Chile
| | - J Hagemann
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Germany
| | - S Hamamah
- Biology of reproduction department, INSERM 1203, University hospital, Montpellier, France
| | - S Halken
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - D M G Halpin
- University of Exeter, Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - M Hofmann
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - E Hossny
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - M Hrubiško
- Department of Clinical Immunology and Allergy, Oncology Institute of St Elisabeth, Bratislava, Slovakia
| | - C Irani
- Department of Internal Medicine and Infectious Diseases, St Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Z Ispayeva
- President of Kazakhstan Association of Allergology and Clinical Immunology, Department of Allergology and clinical immunology of the Kazakh National Medical University, Almaty, Kazakhstan
| | - E Jares
- Servicio de Alergia, Consultorios Médicos Privados, Buenos Aires, Argentina
| | - T Jartti
- EDEGO Research Unit, University of Oulu, Oulu, Finland
| | - E Jassem
- Medical University of Gdańsk, Department of Pneumology, Gdansk, Poland
| | - K Julge
- Tartu University Institute of Clinical Medicine, Children's Clinic, Tartu, Estonia
| | - J Just
- Sorbonne université, Hôpital américain de Paris, Neuilly, France
| | - M Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland.,ALL-MED Medical Research Institute, Wroclaw, Poland
| | | | - O Kalayci
- Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey
| | - O Kalyoncu
- Hacettepe University, School of Medicine, Department of Chest Diseases, Immunology and Allergy Division, Ankara, Turkey
| | - P Kardas
- Department of Family Medicine, Medical University of Lodz, Poland
| | - B Kirenga
- Makerere University Lung Institute, Kampala, Uganda
| | - H Kraxner
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - I Kull
- Sach´s Children and Youth Hospital, Södersjukhuset, and Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - M Kulus
- Department of Pediatric Respiratory Diseases and Allergology, Medical University of Warsaw, Poland
| | - S La Gruta
- Institute of Translational Pharmacology, National Research Council, Palermo, Italy
| | - S Lau
- Department of Paediatric Respiratory Medicine, Immunology and Crital Care Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - L Le Tuyet Thi
- University of Medicine and Pharmacy, Hochiminh City, Vietnam
| | - M Levin
- Division Paediatric Allergology, University of Cape Town, Cape Town, South Africa
| | - B Lipworth
- Scottish Centre for Respiratory Research, Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, University of Dundee, UK
| | - O Lourenço
- Faculty of Health Sciences and CICS - UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - B Mahboub
- Department of Pulmonary Medicine, Rashid Hospital, Dubai, UAE
| | - M J Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - P Matricardi
- Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - N Migueres
- Allergy Division, Chest Disease Department, University Hospital of Strasbourg, and Federation of translational medicine, University of Strasbourg, Strasbourg, France
| | - F Mihaltan
- National Institute of Pneumology M Nasta, Bucharest, Romania
| | - Y Mohamad
- National Center for Research in Chronic Respiratory Diseases, Tishreen University School of Medicine, Latakia and Syrian Private University-, Damascus, Syria
| | - M Moniusko
- Department of Regenerative Medicine and Immune Regulation, Medical University of Bialystok, Bialystock, Poland
| | - S Montefort
- Department of Medicine, Faculty of Medicine and Surgery, University of Malta, Msida, MSD, Malta
| | - H Neffen
- Director of Center of Allergy, Immunology and Respiratory Diseases, Santa Fe, Argentina
| | - K Nekam
- Hungarian Allergy Association, Budapest, Hungary
| | - E Nunes
- Eduardo Mondlane University · Faculty of Medicine, Maputo, Mozambique
| | | | - R E O'Hehir
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - I Ogulur
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - K Ohta
- National Hospital Organization Tokyo National Hospital, and JATA Fukujuji Hospital, Tokyo, Japan
| | - K Okubo
- Dept of Otolaryngology, Nippon Medical School, Tokyo, Japan
| | - S Ouedraogo
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - H Olze
- Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, and Berlin Institute of Health, Berlin, Germany
| | - I Pali-Schöll
- Dept of Comparative Medicine; Messerli Research Institute of the University of Veterinary Medicine, Medical University, and University of Vienna, Vienna, Austria
| | - O Palomares
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, Madrid, Spain
| | - K Palosuo
- Department of Dermatology, University of Helsinki and Hospital for Skin and Allergic Diseases, Helsinki, Finland
| | - C Panaitescu
- OncoGen Center, County Clinical Emergency Hospital "Pius Branzeu," and University of Medicine and Pharmacy V Babes, Timisoara, Romania
| | - P Panzner
- Department of Immunology and Allergology, Faculty of Medicine and Faculty Hospital in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - H S Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - C Pitsios
- Medical School, University of Cyprus, Nicosia, Cyprus
| | - D Plavec
- Srebrnjak Children's Hospital, Zagreb; Medical Faculty, University JJ Strossmayer of Osijek, Croatia
| | - T A Popov
- Clinic of Occupational Diseases, University Hospital Sveti Ivan Rilski, Sofia, Bulgaria
| | - F Puggioni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - S Quirce
- QDepartment of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - M Recto
- Asian Hospital And Medical Center, Manilla, Philippines
| | - R Repka-Ramirez
- Division of Allergy, Asthma and Immunology, Clinics Hospital, San Lorenzo, Paraguay
| | | | - N Roche
- Pneumologie, AP-HP, Centre Université de Paris Cité, Hôpital Cochin, Paris, France.,UMR 1016, Institut Cochin, Paris, France
| | - M Rodriguez-Gonzales
- Pediatric Allergy and Clinical Immunology, Hospital Espanol de Mexico, Mexico City, Mexico
| | - J Romantowski
- Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
| | - N Rosario Filho
- Department of Pediatrics, Federal University of Parana, Curitiba, Brazil
| | - M Rottem
- Division of Allergy, Asthma and Clinical Immunology, Emek Medical Center, Afula, Israel
| | - H Sagara
- Showa University School of Medicine, Tokyo, Japan
| | - F Sarquis-Serpa
- Asthma Reference Center - School of Medicine of Santa Casa de Misericórdia of Vitória, Espírito Santo, Brazil
| | - Z Sayah
- SMAIC Société Marocaine d' Allergologie et Immunologie Clinique, Rabat, Morocco
| | - S Scheire
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - P Schmid-Grendelmeier
- Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zürich, Switzerland
| | - J C Sisul
- Allergy & Asthma, Medical Director, CLINICA SISUL, FACAAI, SPAAI, Asuncion, Paraguay
| | - D Sole
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - M Soto-Martinez
- Division of Respiratory Medicine, Department of Pediatrics, Hospital Nacional de Niños, Universidad de Costa Rica, San Jose, Costa Rica
| | - M Sova
- Department of Respiratory Medicine and Tuberculosis, University Hospital, Brno, Czech Republic
| | - A Sperl
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Germany
| | - O Spranger
- Global Allergy and Asthma Platform GAAPP, Vienna, Austria
| | - R Stelmach
- Pulmonary Division, Heart Institute (InCor), Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - C Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, and Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - M Thomas
- University of Southampton, Southampton, UK
| | - T To
- The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - A Todo-Bom
- Imunoalergologia, Centro Hospitalar Universitário de Coimbra, Faculty of Medicine, University of Coimbra, Portugal
| | - P V Tomazic
- Dept of General ORL, H&NS, Medical University of Graz, ENT-University Hospital Graz, Austria
| | | | | | - E van Ganse
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon1, Lyon, France
| | - M Van Hage
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - T Vasankari
- Fihla, Finnish Lung Association, Helsinki, Finland.,University of Turku, Turku, Finland
| | - P Vichyanond
- Division of Allergy and Immunology, Department of Pediatrics, Siriraj Hospital, Mahidol University Faculty of Medicine, Bangkok, Thailand
| | - G Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa
| | - D Wallace
- Nova Southeastern University, Florida, USA
| | - D Y Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - S Williams
- International Primary Care Respiratory Group IPCRG, Aberdeen, Scotland
| | - M Worm
- Division of Allergy and Immunology Department of Dermatology, Allergy and Venerology Charité Universitätsmedizin Berlin Berlin, Germany
| | - P Yiallouros
- Medical School, University of Cyprus, Nicosia, Cyprus
| | - P Yiallouros
- Medical School, University of Cyprus, Nicosia, Cyprus
| | - O Yusuf
- The Allergy and Asthma Institute, Islamabad, Pakistan
| | - F Zaitoun
- Lebanese-American University, Clemenceau Medical Center DHCC, Dubai, UAE
| | - M Zernotti
- Universidad Católica de Córdoba, Universidad Nacional de Villa Maria, Argentina
| | - M Zidarn
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia.,University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - J Zuberbier
- Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, and Berlin Institute of Health, Berlin, Germany
| | - J A Fonseca
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research; University of Porto, Porto, Portugal.,RISE - Health Research Network; University of Porto, Porto, Portugal
| | - T Zuberbier
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - J M Anto
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.,ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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22
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Giri P, Vander Roest AS, Lee S, Heinrich P, Dunn AR, Wu S, Bernstein D. The Z-disc: Mechanosensor at the interface between myosin biomechanics and hypertrophic signaling. Biophys J 2023; 122:404a. [PMID: 36784062 DOI: 10.1016/j.bpj.2022.11.2198] [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: 02/12/2023] Open
Affiliation(s)
- Prerna Giri
- Pediatrics, Stanford University, Stanford, CA, USA
| | | | - Soah Lee
- Biopharmaceutical Convergence, School of Pharmacy, Sungkyunkwan University (SKKU), Suwon, Republic of Korea
| | - Paul Heinrich
- Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | | | - Sean Wu
- Cardiovascular Institute, Stanford University, Stanford, CA, USA
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23
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Bernstein D, Vander Roest AS, Wu S, Pruitt B, Zhao M, Fajardo G, Ruppel K, Spudich JA. Changes in myosin biomechanics influence growth and maturation of iPSC-cardiomyocytes. Biophys J 2023; 122:148a. [PMID: 36782680 DOI: 10.1016/j.bpj.2022.11.1014] [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: 02/12/2023] Open
Affiliation(s)
| | | | - Sean Wu
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Beth Pruitt
- Mechanical Engineering, University of California Santa Barbara, Santa Barbara, CA, USA; Biomolecular Science and Engineering, University of California Santa Barbara, Santa Barbara, CA, USA; Molecular, Cellular, and Developmental Biology, University of California Santa Barbara, Santa Barbara, CA, USA
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24
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Ahmed H, Lee J, Bernstein D, Rosenthal D, Dykes J, Lee D, Barkoff L, Weinberg K, Hollander SA, Chen S. Increased risk of infections in pediatric Fontan patients after heart transplantation. Pediatr Transplant 2023; 27:e14421. [PMID: 36303275 DOI: 10.1111/petr.14421] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/16/2022] [Accepted: 09/22/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Infectious complications are a major cause of morbidity and mortality after HT. Fontan patients may be more susceptible to post-HT infections. METHODS This was a single-center, retrospective cohort analysis of pediatric patients undergoing HT for FF physiology or DCM, who underwent induction with ATG. The primary endpoint was an infection in the first 180 days post-HT, defined as positive (1) blood/urine/respiratory culture; (2) viral PCR; (3) skin or wound infection; and/or (4) culture-negative infection if ≥5 days of antibiotics were completed. Secondary endpoints included (1) cell counts after ATG; (2) PTLD; and (3) rejection (≥Grade 2R ACR or pAMR2) in the first 180 days post-HT. RESULTS A total of 59 patients (26 FF, 33 DCM) underwent HT at 14.7 (IQR 10.6, 19.5) and 11.7 (IQR 1.4, 13.6) years of age, respectively. The median total ATG received was 7.4 (IQR 4.9, 7.7) vs 7.5 (IQR 7.3, 7.6) mg/kg (p = NS) for FF and DCM patients, respectively. Twenty-three patients (39%) developed an infection 180 days post-HT, with a higher rate of infection in FF patients (54% vs 27%, p = .03). Adjusted for pre-transplant absolute lymphocyte count, FF patients had a higher risk of infection at 30 days post-HT (OR 7.62, 95% CI 1.13-51.48, p = .04). There was no difference in the incidence of PTLD (12% vs 0%; p = .08) or rejection (12% vs 21%; p = .49). CONCLUSION Compared to DCM patients, FF patients have a higher risk of infection. Modifications to induction therapy for FF patients should be considered.
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Affiliation(s)
- Humera Ahmed
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - Joanne Lee
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - Daniel Bernstein
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - David Rosenthal
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - John Dykes
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - Donna Lee
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - Lynsey Barkoff
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - Kenneth Weinberg
- Division of Hematology-Oncology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - Seth A Hollander
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - Sharon Chen
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
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25
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Mackay K, Bernstein D, Glocker B, Kamnitsas K, Taylor A. A Review of the Metrics Used to Assess Auto-Contouring Systems in Radiotherapy. Clin Oncol (R Coll Radiol) 2023; 35:354-369. [PMID: 36803407 DOI: 10.1016/j.clon.2023.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 09/25/2022] [Revised: 12/05/2022] [Accepted: 01/23/2023] [Indexed: 02/01/2023]
Abstract
Auto-contouring could revolutionise future planning of radiotherapy treatment. The lack of consensus on how to assess and validate auto-contouring systems currently limits clinical use. This review formally quantifies the assessment metrics used in studies published during one calendar year and assesses the need for standardised practice. A PubMed literature search was undertaken for papers evaluating radiotherapy auto-contouring published during 2021. Papers were assessed for types of metric and the methodology used to generate ground-truth comparators. Our PubMed search identified 212 studies, of which 117 met the criteria for clinical review. Geometric assessment metrics were used in 116 of 117 studies (99.1%). This includes the Dice Similarity Coefficient used in 113 (96.6%) studies. Clinically relevant metrics, such as qualitative, dosimetric and time-saving metrics, were less frequently used in 22 (18.8%), 27 (23.1%) and 18 (15.4%) of 117 studies, respectively. There was heterogeneity within each category of metric. Over 90 different names for geometric measures were used. Methods for qualitative assessment were different in all but two papers. Variation existed in the methods used to generate radiotherapy plans for dosimetric assessment. Consideration of editing time was only given in 11 (9.4%) papers. A single manual contour as a ground-truth comparator was used in 65 (55.6%) studies. Only 31 (26.5%) studies compared auto-contours to usual inter- and/or intra-observer variation. In conclusion, significant variation exists in how research papers currently assess the accuracy of automatically generated contours. Geometric measures are the most popular, however their clinical utility is unknown. There is heterogeneity in the methods used to perform clinical assessment. Considering the different stages of system implementation may provide a framework to decide the most appropriate metrics. This analysis supports the need for a consensus on the clinical implementation of auto-contouring.
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Affiliation(s)
- K Mackay
- The Institute of Cancer Research, London, UK; The Royal Marsden Hospital, London, UK.
| | - D Bernstein
- The Institute of Cancer Research, London, UK; The Royal Marsden Hospital, London, UK
| | - B Glocker
- Department of Computing, Imperial College London, South Kensington Campus, London, UK
| | - K Kamnitsas
- Department of Computing, Imperial College London, South Kensington Campus, London, UK; Department of Engineering Science, University of Oxford, Oxford, UK
| | - A Taylor
- The Institute of Cancer Research, London, UK; The Royal Marsden Hospital, London, UK
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26
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Mai DH, Sedler J, Weinberg K, Bernstein D, Schroeder A, Mathew R, Chen S, Lee D, Dykes JC, Hollander SA. Fatal nocardiosis infection in a pediatric patient with an immunodeficiency after heart re-transplantation. Pediatr Transplant 2022; 26:e14344. [PMID: 35726843 DOI: 10.1111/petr.14344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/05/2022] [Accepted: 06/09/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Nocardia infections are rare opportunistic infections in SOT recipients, with few reported pediatric cases. Pediatric patients with single ventricle congenital heart defects requiring HT may be more susceptible to opportunistic infections due to a decreased T-cell repertoire from early thymectomy and potential immunodeficiencies related to their congenital heart disease. Other risk factors in SOT recipients include the use of immunosuppressive medications and the development of persistent lymphopenia, delayed count recovery and/or lymphocyte dysfunction. METHODS We report the case of a patient with hypoplastic left heart syndrome who underwent neonatal congenital heart surgery (with thymectomy) prior to palliative surgery and 2 HTs. RESULTS After developing respiratory and neurological symptoms, the patient was found to be positive for Nocardia farcinica by BAL culture and cerebrospinal fluid PCR. Immune cell phenotyping demonstrated an attenuated T and B-cell repertoire. Despite antibiotic and immunoglobulin therapy, his symptoms worsened and he was subsequently discharged with hospice care. CONCLUSION Pediatric patients with a history of congenital heart defects who undergo neonatal thymectomy prior to heart transplantation and a long-term history of immunosuppression should undergo routine immune system profiling to evaluate for T- and B-cell deficiency as risk factors for opportunistic infection. Such patients could benefit from long-term therapy with TMP/SMX for optimal antimicrobial prophylaxis, with desensitization as needed for allergies. Disseminated nocardiosis should be considered when evaluating acutely ill SOT recipients, especially those with persistent lymphopenia and known or suspected secondary immunodeficiencies.
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Affiliation(s)
- Daniel H Mai
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Jennifer Sedler
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Kenneth Weinberg
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Daniel Bernstein
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Alan Schroeder
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Roshni Mathew
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Sharon Chen
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Donna Lee
- Lucile Salter Packard Children's Hospital at Stanford, Palo Alto, California, USA
| | - John C Dykes
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Seth A Hollander
- Stanford University School of Medicine, Palo Alto, California, USA
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27
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Ziaie N, Bernstein D. METHOTREXATE TREATMENT FOR SEVERE ATOPIC DERMATITIS PATIENTS WITH PERSISTENT KERATOCONJUNCTIVITIS ASSOCIATED WITH DUPILUMAB. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.955] [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: 11/11/2022]
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28
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Sen A, Enriquez J, Rao M, Glass M, Balachandran Y, Syed S, Twist CJ, Weinberg K, Boyd SD, Bernstein D, Trickey AW, Gratzinger D, Tan B, Lapasaran MG, Robien MA, Brown M, Armstrong B, Desai D, Mazariegos G, Chin C, Fishbein TM, Venick RS, Tekin A, Zimmermann H, Trappe RU, Anagnostopoulos I, Esquivel CO, Martinez OM, Krams SM. Host microRNAs are decreased in pediatric solid-organ transplant recipients during EBV+ Post-transplant Lymphoproliferative Disorder. Front Immunol 2022; 13:994552. [PMID: 36304469 PMCID: PMC9595046 DOI: 10.3389/fimmu.2022.994552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Post-transplant lymphoproliferative disorder (PTLD) is a serious complication of solid organ transplantation. Predisposing factors include primary Epstein-Barr virus (EBV) infection, reactivation of EBV in recipient B cells, and decreased T cell immunity due to immunosuppression. In our previous studies EBV infection was demonstrated to markedly alter the expression of host B cell microRNA (miR). Specifically, miR-194 expression was uniquely suppressed in EBV+ B cell lines from PTLD patients and the 3’untranslated region of IL-10 was determined to be targeted by miR-194. Although EBV has been shown to regulate host miR expression in B cell lymphoma cell lines, the expression of miRs in the circulation of patients with EBV-associated PTLD has not been studied. The objective of this study was to determine if changes in miR expression are associated with EBV+ PTLD. In this study, we have shown that miR-194 is significantly decreased in EBV+PTLD tumors and that additional miRs, including miRs-17, 19 and 106a are also reduced in EBV+PTLD as compared to EBV-PTLD. We quantitated the levels of miRs-17, 19, 106a, 155, and 194 in the plasma and extracellular vesicles (EV; 50-70 nm as determined by nanoparticle tracking analysis) from pediatric recipients of solid organ transplants with EBV+ PTLD+ that were matched 1:2 with EBV+ PTLD- pediatric transplant recipients as part of the NIH-sponsored Clinical Trials in Organ Transplantation in Children, (CTOTC-06) study. Levels of miRs-17, 19, 106a, and 194 were reduced in the plasma and extracellular vesicles (EV) of EBV+ PTLD+ group compared to matched controls, with miRs-17 (p = 0.034; plasma), miRs-19 (p = 0.029; EV) and miR-106a (p = 0.007; plasma and EV) being significantly reduced. Similar levels of miR-155 were detected in the plasma and EV of all pediatric SOT recipients. Importantly, ~90% of the cell-free miR were contained within the EV supporting that EBV+ PTLD tumor miR are detected in the circulation and suggesting that EVs, containing miRs, may have the potential to target and regulate cells of the immune system. Further development of diagnostic, mechanistic and potential therapeutic uses of the miRs in PTLD is warranted.
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Affiliation(s)
- Ayantika Sen
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Jeanna Enriquez
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Mahil Rao
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Marla Glass
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Yarl Balachandran
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Sharjeel Syed
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Clare J. Twist
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Kenneth Weinberg
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Scott D. Boyd
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - Daniel Bernstein
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Amber W. Trickey
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Dita Gratzinger
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - Brent Tan
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - Mary Gay Lapasaran
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Mark A. Robien
- Division of Allergy Immunity Transplantation, National Institute of Allergy and Infectious Diseases, Rockville, MD, United States
| | - Merideth Brown
- Division of Allergy Immunity Transplantation, National Institute of Allergy and Infectious Diseases, Rockville, MD, United States
| | - Brian Armstrong
- Rho Federal Systems Division, Rho, Durham, NC, United States
| | - Dev Desai
- Division of Surgical Transplantation, University of Texas (UT) Southwestern Medical Center, Dallas, TX, United States
| | - George Mazariegos
- Department of Pediatrics, University of Pittsburgh Medical Center (UPMC) Children’s Hospital, Pittsburgh, PA, United States
| | - Clifford Chin
- Department of Pediatrics and Cincinnati Children’s Hospital, University of Cincinnati, Cincinnati, OH, United States
| | - Thomas M. Fishbein
- Departments of Surgery and Pediatrics, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Robert S. Venick
- Department of Pediatric Gastroenterology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Akin Tekin
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Heiner Zimmermann
- Department of Internal Medicine II: Hematology and Oncology, DIAKO Ev. Diakoniekrankenhaus, Bremen, Germany
| | - Ralf U. Trappe
- Department of Internal Medicine II: Hematology and Oncology, DIAKO Ev. Diakoniekrankenhaus, Bremen, Germany
- Department of Internal Medicine II: Hematology and Oncology , University Medical Center Schleswig-Holstein, Kiel, Germany
- Department of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Carlos O. Esquivel
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Olivia M. Martinez
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Sheri M. Krams
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
- *Correspondence: Sheri M. Krams,
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Coster D, Kodesh A, Fardman A, Tiosano S, Moshkovits Y, Bernstein D, Kaplan A, Shamir R, Maor E. Decreasing albumin within normal range is associated with increased likelihood of ischemic heart disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Albumin (ALB) is a known biomarker of frailty, and cardiovascular disease and frailty are interdependent. Epidemiological evidence demonstrates that low serum albumin levels are linked to events of ischemic heart disease (IHD), venous thromboembolism, heart failure, atrial fibrillation, and stroke.
Purpose
We aimed to investigate the association of variations in ALB levels that are within normal range with IHD events among apparently healthy adults.
Methods
A case-control retrospective study of self-referred adults participating in an executive screening program between 2002 and 2017. All subjects were free of IHD and diabetes at baseline and had their ALB documented in each visit. Only subjects with at least two ALB measurements and whose ALB levels were within the normal range at all visits were included. Relationships between ALB trend and occurrence of IHD (acute coronary syndrome or percutaneous coronary intervention) within 2 years from the last visit were investigated.
Results
The final study cohort included 16,386 subjects. Median age was 53 (IQR 45–60), 11,461 (70%) were men. Analysis included a total of 99,127 visits. Median number of visits per subject was 5 (IQR 3–9, median inter-visit time 1.02 years) and median ALB level was 4.4 (IQR 4.2–4.6). IHD within 2 years was diagnosed in 545 (3%) subjects. Of those, only 36 were female and they tended to have lower variations in ALB throughout the years. Hence, we conducted an analysis of the 509 males only, and created an equal-size age-matched cohort of IHD-free subjects. Our analysis demonstrated a progressive and significant decrease in ALB levels among IHD cases, but not among controls (mean decrease of 0.021 g/DL vs. 0.004 g/DL per year, p<0.01; OR [CI] = 0.82 [0.72–0.93]; Figure 1). Similar results were found among subjects with at least 3 or 4 visits (0.015 g/DL vs. 0.006 g/DL per year, p=0.027, and 0.009 g/DL vs. 0.003 g/DL per year, p=0.045, respectively).
Conclusions
Kinetics of ALB within the normal range can identify men at risk for IHD in preventive healthcare screening programs.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Coster
- Tel Aviv University, Computer Science , Tel Aviv , Israel
| | - A Kodesh
- Tel Aviv University, Sackler Faculty of Medicine , Tel Aviv , Israel
| | - A Fardman
- Tel Aviv University, Sackler Faculty of Medicine , Tel Aviv , Israel
| | - S Tiosano
- Tel Aviv University, Sackler Faculty of Medicine , Tel Aviv , Israel
| | - Y Moshkovits
- Tel Aviv University, Sackler Faculty of Medicine , Tel Aviv , Israel
| | - D Bernstein
- Tel Aviv University, Sackler Faculty of Medicine , Tel Aviv , Israel
| | - A Kaplan
- Tel Aviv University, Sackler Faculty of Medicine , Tel Aviv , Israel
| | - R Shamir
- Tel Aviv University, Computer Science , Tel Aviv , Israel
| | - E Maor
- Tel Aviv University, Sackler Faculty of Medicine , Tel Aviv , Israel
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30
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Anbazhakan S, Rios Coronado PE, Sy-Quia ANL, Seow LW, Hands AM, Zhao M, Dong ML, Pfaller MR, Amir ZA, Raftrey BC, Cook CK, D’Amato G, Fan X, Williams IM, Jha SK, Bernstein D, Nieman K, Pașca AM, Marsden AL, Horse KR. Blood flow modeling reveals improved collateral artery performance during the regenerative period in mammalian hearts. Nat Cardiovasc Res 2022; 1:775-790. [PMID: 37305211 PMCID: PMC10256232 DOI: 10.1038/s44161-022-00114-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 07/07/2022] [Indexed: 06/13/2023]
Abstract
Collateral arteries bridge opposing artery branches, forming a natural bypass that can deliver blood flow downstream of an occlusion. Inducing coronary collateral arteries could treat cardiac ischemia, but more knowledge on their developmental mechanisms and functional capabilities is required. Here we used whole-organ imaging and three-dimensional computational fluid dynamics modeling to define spatial architecture and predict blood flow through collaterals in neonate and adult mouse hearts. Neonate collaterals were more numerous, larger in diameter and more effective at restoring blood flow. Decreased blood flow restoration in adults arose because during postnatal growth coronary arteries expanded by adding branches rather than increasing diameters, altering pressure distributions. In humans, adult hearts with total coronary occlusions averaged 2 large collaterals, with predicted moderate function, while normal fetal hearts showed over 40 collaterals, likely too small to be functionally relevant. Thus, we quantify the functional impact of collateral arteries during heart regeneration and repair-a critical step toward realizing their therapeutic potential.
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Affiliation(s)
- Suhaas Anbazhakan
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
- These authors contributed equally
| | - Pamela E. Rios Coronado
- Department of Biology, Stanford University, Stanford, CA 94305, USA
- These authors contributed equally
| | | | - Lek Wei Seow
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Aubrey M. Hands
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Mingming Zhao
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Melody L. Dong
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Martin R. Pfaller
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305
| | - Zhainib A. Amir
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Brian C. Raftrey
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | | | - Gaetano D’Amato
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Xiaochen Fan
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Ian M. Williams
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Sawan K. Jha
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Daniel Bernstein
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Koen Nieman
- Departments of Cardiovascular Medicine and Radiology, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Anca M. Pașca
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305
| | - Alison L. Marsden
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Kristy Red Horse
- Department of Biology, Stanford University, Stanford, CA 94305, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Howard Hughes Medical Institute, Stanford, CA, 94305, USA
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31
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Nasirov T, Dykes JC, Hollander SA, Almond CS, Reinhartz O, Maeda K, Martin E, Murray J, Chen S, Chen CY, Kaufman BD, Bernstein D, Profita EL, Rosenthal DN, Ma M. PEDS3: Twenty Years of Pediatric Ventricular Assist Device Support at a Single Institution. ASAIO J 2022. [DOI: 10.1097/01.mat.0000841104.02767.6a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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32
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Fajardo G, Coronado M, Matthews M, Bernstein D. Mitochondrial Quality Control in the Heart: The Balance between Physiological and Pathological Stress. Biomedicines 2022; 10:biomedicines10061375. [PMID: 35740401 PMCID: PMC9220167 DOI: 10.3390/biomedicines10061375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 12/12/2022] Open
Abstract
Alterations in mitochondrial function and morphology are critical adaptations to cardiovascular stress, working in concert in an attempt to restore organelle-level and cellular-level homeostasis. Processes that alter mitochondrial morphology include fission, fusion, mitophagy, and biogenesis, and these interact to maintain mitochondrial quality control. Not all cardiovascular stress is pathologic (e.g., ischemia, pressure overload, cardiotoxins), despite a wealth of studies to this effect. Physiological stress, such as that induced by aerobic exercise, can induce morphologic adaptations that share many common pathways with pathological stress, but in this case result in improved mitochondrial health. Developing a better understanding of the mechanisms underlying alterations in mitochondrial quality control under diverse cardiovascular stressors will aid in the development of pharmacologic interventions aimed at restoring cellular homeostasis.
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Affiliation(s)
- Giovanni Fajardo
- Department of Pediatrics and the Cardiovascular Institute, Stanford University, Stanford, CA 94305, USA;
| | | | - Melia Matthews
- Department of Biomedical and Biological Sciences, Cornell University, Ithaca, NY 14850, USA;
| | - Daniel Bernstein
- Department of Pediatrics and the Cardiovascular Institute, Stanford University, Stanford, CA 94305, USA;
- Correspondence: ; Tel.: +1-650-723-7913
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33
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Willcox JAL, Geiger JT, Morton SU, McKean D, Quiat D, Gorham JM, Tai AC, DePalma S, Bernstein D, Brueckner M, Chung WK, Giardini A, Goldmuntz E, Kaltman JR, Kim R, Newburger JW, Shen Y, Srivastava D, Tristani-Firouzi M, Gelb B, Porter GA, Seidman JG, Seidman CE. Neither cardiac mitochondrial DNA variation nor copy number contribute to congenital heart disease risk. Am J Hum Genet 2022; 109:961-966. [PMID: 35397206 PMCID: PMC9118105 DOI: 10.1016/j.ajhg.2022.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/11/2022] [Indexed: 11/28/2022] Open
Abstract
The well-established manifestation of mitochondrial mutations in functional cardiac disease (e.g., mitochondrial cardiomyopathy) prompted the hypothesis that mitochondrial DNA (mtDNA) sequence and/or copy number (mtDNAcn) variation contribute to cardiac defects in congenital heart disease (CHD). MtDNAcns were calculated and rare, non-synonymous mtDNA mutations were identified in 1,837 CHD-affected proband-parent trios, 116 CHD-affected singletons, and 114 paired cardiovascular tissue/blood samples. The variant allele fraction (VAF) of heteroplasmic variants in mitochondrial RNA from 257 CHD cardiovascular tissue samples was also calculated. On average, mtDNA from blood had 0.14 rare variants and 52.9 mtDNA copies per nuclear genome per proband. No variation with parental age at proband birth or CHD-affected proband age was seen. mtDNAcns in valve/vessel tissue (320 ± 70) were lower than in atrial tissue (1,080 ± 320, p = 6.8E-21), which were lower than in ventricle tissue (1,340 ± 280, p = 1.4E-4). The frequency of rare variants in CHD-affected individual DNA was indistinguishable from the frequency in an unaffected cohort, and proband mtDNAcns did not vary from those of CHD cohort parents. In both the CHD and the comparison cohorts, mtDNAcns were significantly correlated between mother-child, father-child, and mother-father. mtDNAcns among people with European (mean = 52.0), African (53.0), and Asian haplogroups (53.5) were calculated and were significantly different for European and Asian haplogroups (p = 2.6E-3). Variant heteroplasmic fraction (HF) in blood correlated well with paired cardiovascular tissue HF (r = 0.975) and RNA VAF (r = 0.953), which suggests blood HF is a reasonable proxy for HF in heart tissue. We conclude that mtDNA mutations and mtDNAcns are unlikely to contribute significantly to CHD risk.
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Affiliation(s)
- Jon A L Willcox
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Joshua T Geiger
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Sarah U Morton
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA; Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA 02115, USA
| | - David McKean
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Daniel Quiat
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA; Department of Cardiology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Joshua M Gorham
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Angela C Tai
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Steven DePalma
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Daniel Bernstein
- Department of Pediatrics, Stanford University, Palo Alto, CA 94305, USA
| | - Martina Brueckner
- Departments of Genetics and Pediatric Cardiology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Wendy K Chung
- Departments of Pediatrics and Medicine, Columbia University Medical Center, New York, NY 10019, USA
| | - Alessandro Giardini
- Cardiorespiratory Unit, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK
| | - Elizabeth Goldmuntz
- Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jonathan R Kaltman
- Heart Development and Structural Diseases Branch, Division of Cardiovascular Sciences, NHLBI/NIH, Bethesda, MD 20892, USA
| | - Richard Kim
- Cardiothoracic Surgery, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Yufeng Shen
- Departments of Systems Biology and Biomedical Informatics, Columbia University Medical Center, New York, NY 10019, USA
| | - Deepak Srivastava
- Gladstone Institute of Cardiovascular Disease, San Francisco, CA 94158, USA
| | - Martin Tristani-Firouzi
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT 84132, USA
| | - Bruce Gelb
- Mindich Child Health and Development Institute and Departments of Pediatrics, Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - George A Porter
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - J G Seidman
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA.
| | - Christine E Seidman
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA; Department of Cardiology, Brigham and Women's Hospital, Boston, MA 02115, USA; Howard Hughes Medical Institute, Harvard University, Boston, MA 02138, USA
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34
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Morton SU, Pereira AC, Quiat D, Richter F, Kitaygorodsky A, Hagen J, Bernstein D, Brueckner M, Goldmuntz E, Kim RW, Lifton RP, Porter GA, Tristani-Firouzi M, Chung WK, Roberts A, Gelb BD, Shen Y, Newburger JW, Seidman JG, Seidman CE. Genome-Wide De Novo Variants in Congenital Heart Disease Are Not Associated With Maternal Diabetes or Obesity. Circ Genom Precis Med 2022; 15:e003500. [PMID: 35130025 PMCID: PMC9295870 DOI: 10.1161/circgen.121.003500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Congenital heart disease (CHD) is the most common anomaly at birth, with a prevalence of ≈1%. While infants born to mothers with diabetes or obesity have a 2- to 3-fold increased incidence of CHD, the cause of the increase is unknown. Damaging de novo variants (DNV) in coding regions are more common among patients with CHD, but genome-wide rates of coding and noncoding DNVs associated with these prenatal exposures have not been studied in patients with CHD. METHODS DNV frequencies were determined for 1812 patients with CHD who had whole-genome sequencing and prenatal history data available from the Pediatric Cardiac Genomics Consortium's CHD GENES study (Genetic Network). The frequency of DNVs was compared between subgroups using t test or linear model. RESULTS Among 1812 patients with CHD, the number of DNVs per patient was higher with maternal diabetes (76.5 versus 72.1, t test P=3.03×10-11), but the difference was no longer significant after including parental ages in a linear model (paternal and maternal correction P=0.42). No interaction was observed between diabetes risk and parental age (paternal and maternal interaction P=0.80 and 0.68, respectively). No difference was seen in DNV count per patient based on maternal obesity (72.0 versus 72.2 for maternal body mass index <25 versus maternal body mass index >30, t test P=0.86). CONCLUSIONS After accounting for parental age, the offspring of diabetic or obese mothers have no increase in DNVs compared with other children with CHD. These results emphasize the role for other mechanisms in the cause of CHD associated with these prenatal exposures. REGISTRATION URL: https://clinicaltrials.gov; NCT01196182.
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Affiliation(s)
- Sarah U. Morton
- Division of Newborn Medicine, Department of Medicine, Boston Children’s Hospital, Boston, MA USA,Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | | | - Daniel Quiat
- Department of Pediatrics, Harvard Medical School, Boston, MA USA,Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
| | - Felix Richter
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Alexander Kitaygorodsky
- Departments of Systems Biology and Biomedical Informatics, Columbia University Medical Center, New York, NY USA
| | - Jacob Hagen
- Departments of Systems Biology and Biomedical Informatics, Columbia University Medical Center, New York, NY USA
| | - Daniel Bernstein
- Department of Pediatrics (Cardiology), Stanford University, Stanford, CA USA
| | - Martina Brueckner
- Departments of Genetics and Pediatrics; Yale University School of Medicine, New Haven, CT USA
| | - Elizabeth Goldmuntz
- Division of Cardiology, Children’s Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | | | - Richard P. Lifton
- Laboratory of Human Genetics and Genomics, The Rockefeller University, New York, NY USA
| | - George A. Porter
- Department of Pediatrics, University of Rochester Medical Center, The School of Medicine and Dentistry, Rochester, NY USA
| | | | - Wendy K. Chung
- Departments of Pediatrics and Medicine, Columbia University Medical Center, New York, NY USA
| | - Amy Roberts
- Department of Pediatrics, Harvard Medical School, Boston, MA USA,Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
| | - Bruce D. Gelb
- Mindich Child Health and Development Institute and Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Yufeng Shen
- Departments of Systems Biology and Biomedical Informatics, Columbia University Medical Center, New York, NY USA
| | - Jane W. Newburger
- Department of Pediatrics, Harvard Medical School, Boston, MA USA,Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
| | - J. G. Seidman
- Department of Genetics, Harvard Medical School, Boston, MA USA
| | - Christine E. Seidman
- Department of Genetics, Harvard Medical School, Boston, MA USA,Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA USA,Howard Hughes Medical Institute, Chevy Chase, MD USA
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35
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Sedler J, Schroeder A, Mathew R, Chen S, Weinberg K, Bernstein D, Lee D, Dykes J, Hollander S. Memory B Cell Deficiency and Disseminated Nocardiosis in a Pediatric Patient with Congenital Single Ventricle Physiology and Heart Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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36
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Jordan K, Zajac R, Bernstein D, Joshi C, Garry M. Trivially informative semantic context inflates people's confidence they can perform a highly complex skill. R Soc Open Sci 2022; 9:211977. [PMID: 35308623 PMCID: PMC8924756 DOI: 10.1098/rsos.211977] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/22/2022] [Indexed: 05/03/2023]
Abstract
Some research suggests people are overconfident because of personality characteristics, lack of insight, or because overconfidence is beneficial in its own right. But other research fits with the possibility that fluent experience in the moment can rapidly drive overconfidence. For example, fluency can push people to become overconfident in their ability to throw a dart, know how rainbows form or predict the future value of a commodity. But surely there are limits to overconfidence. That is, even in the face of fluency manipulations known to increase feelings of confidence, reasonable people would reject the thought that they, for example, might be able to land a plane in an emergency. To address this question, we conducted two experiments comprising a total of 780 people. We asked some people (but not others) to watch a trivially informative video of a pilot landing a plane before they rated their confidence in their own ability to land a plane. We found watching the video inflated people's confidence that they could land a plane. Our findings extend prior work by suggesting that increased semantic context creates illusions not just of prior experience or understanding-but also of the ability to actually do something implausible.
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Affiliation(s)
- Kayla Jordan
- School of Psychology, The University of Waikato, 1 Knighton Road, Hamilton 3240, New Zealand
| | - Rachel Zajac
- School of Psychology, University of Otago, 362 Leith Street, Dunedin 9016, New Zealand
| | - Daniel Bernstein
- Department of Psychology, Kwantlen Polytechnic University, 12666 72 Ave, Surrey, British Columbia V3W2M8, Canada
| | - Chaitanya Joshi
- School of Psychology, The University of Waikato, 1 Knighton Road, Hamilton 3240, New Zealand
| | - Maryanne Garry
- School of Psychology, The University of Waikato, 1 Knighton Road, Hamilton 3240, New Zealand
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37
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Magdy T, Jouni M, Kuo H, Weddle CJ, Lyra–Leite D, Fonoudi H, Romero–Tejeda M, Gharib M, Javed H, Fajardo G, Ross CJD, Carleton BC, Bernstein D, Burridge PW. Identification of Drug Transporter Genomic Variants and Inhibitors That Protect Against Doxorubicin-Induced Cardiotoxicity. Circulation 2022; 145:279-294. [PMID: 34874743 PMCID: PMC8792344 DOI: 10.1161/circulationaha.121.055801] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [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] [Indexed: 01/27/2023]
Abstract
BACKGROUND Multiple pharmacogenomic studies have identified the synonymous genomic variant rs7853758 (G > A, L461L) and the intronic variant rs885004 in SLC28A3 (solute carrier family 28 member 3) as statistically associated with a lower incidence of anthracycline-induced cardiotoxicity. However, the true causal variant(s), the cardioprotective mechanism of this locus, the role of SLC28A3 and other solute carrier (SLC) transporters in anthracycline-induced cardiotoxicity, and the suitability of SLC transporters as targets for cardioprotective drugs has not been investigated. METHODS Six well-phenotyped, doxorubicin-treated pediatric patients from the original association study cohort were recruited again, and human induced pluripotent stem cell-derived cardiomyocytes were generated. Patient-specific doxorubicin-induced cardiotoxicity (DIC) was then characterized using assays of cell viability, activated caspase 3/7, and doxorubicin uptake. The role of SLC28A3 in DIC was then queried using overexpression and knockout of SLC28A3 in isogenic human-induced pluripotent stem cell-derived cardiomyocytes using a CRISPR/Cas9 (Clustered Regularly Interspaced Short Palindromic Repeats/CRISPR-associated protein 9). Fine-mapping of the SLC28A3 locus was then completed after SLC28A3 resequencing and an extended in silico haplotype and functional analysis. Genome editing of the potential causal variant was done using cytosine base editor. SLC28A3-AS1 overexpression was done using a lentiviral plasmid-based transduction and was validated using stranded RNA-sequencing after ribosomal RNA depletion. Drug screening was done using the Prestwick Chemical Library (n = 1200), followed by in vivo validation in mice. The effect of desipramine on doxorubicin cytotoxicity was also investigated in 8 cancer cell lines. RESULTS Here, using the most commonly used anthracycline, doxorubicin, we demonstrate that patient-derived cardiomyocytes recapitulate the cardioprotective effect of the SLC28A3 locus and that SLC28A3 expression influences the severity of DIC. Using Nanopore-based fine-mapping and base editing, we identify a novel cardioprotective single nucleotide polymorphism, rs11140490, in the SLC28A3 locus; its effect is exerted via regulation of an antisense long noncoding RNA (SLC28A3-AS1) that overlaps with SLC28A3. Using high-throughput drug screening in patient-derived cardiomyocytes and whole organism validation in mice, we identify the SLC competitive inhibitor desipramine as protective against DIC. CONCLUSIONS This work demonstrates the power of the human induced pluripotent stem cell model to take a single nucleotide polymorphism from a statistical association through to drug discovery, providing human cell-tested data for clinical trials to attenuate DIC.
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Affiliation(s)
- Tarek Magdy
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL.,Center for Pharmacogenomics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mariam Jouni
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL.,Center for Pharmacogenomics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Hui–Hsuan Kuo
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL.,Center for Pharmacogenomics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Carly J. Weddle
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL.,Center for Pharmacogenomics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Davi Lyra–Leite
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL.,Center for Pharmacogenomics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Hananeh Fonoudi
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL.,Center for Pharmacogenomics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Marisol Romero–Tejeda
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL.,Center for Pharmacogenomics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mennat Gharib
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL.,Center for Pharmacogenomics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Hoor Javed
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL.,Center for Pharmacogenomics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Giovanni Fajardo
- Department of Pediatrics (Division of Cardiology), Stanford University School of Medicine, Stanford, CA
| | - Colin J. D. Ross
- British Columbia Children’s Hospital Research Institute, Vancouver, British Columbia, Canada.,Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bruce C. Carleton
- British Columbia Children’s Hospital Research Institute, Vancouver, British Columbia, Canada.,Division of Translational Therapeutics Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,Pharmaceutical Outcomes Programme, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | - Daniel Bernstein
- Department of Pediatrics (Division of Cardiology), Stanford University School of Medicine, Stanford, CA
| | - Paul W. Burridge
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL.,Center for Pharmacogenomics, Northwestern University Feinberg School of Medicine, Chicago, IL
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Phansalkar R, Krieger J, Zhao M, Kolluru SS, Jones RC, Quake SR, Weissman I, Bernstein D, Winn VD, D'Amato G, Red-Horse K. Coronary blood vessels from distinct origins converge to equivalent states during mouse and human development. eLife 2021; 10:70246. [PMID: 34910626 PMCID: PMC8673841 DOI: 10.7554/elife.70246] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 12/02/2021] [Indexed: 12/17/2022] Open
Abstract
Most cell fate trajectories during development follow a diverging, tree-like branching pattern, but the opposite can occur when distinct progenitors contribute to the same cell type. During this convergent differentiation, it is unknown if cells ‘remember’ their origins transcriptionally or whether this influences cell behavior. Most coronary blood vessels of the heart develop from two different progenitor sources—the endocardium (Endo) and sinus venosus (SV)—but whether transcriptional or functional differences related to origin are retained is unknown. We addressed this by combining lineage tracing with single-cell RNA sequencing (scRNAseq) in embryonic and adult mouse hearts. Shortly after coronary development begins, capillary endothelial cells (ECs) transcriptionally segregated into two states that retained progenitor-specific gene expression. Later in development, when the coronary vasculature is well established but still remodeling, capillary ECs again segregated into two populations, but transcriptional differences were primarily related to tissue localization rather than lineage. Specifically, ECs in the heart septum expressed genes indicative of increased local hypoxia and decreased blood flow. Adult capillary ECs were more homogeneous with respect to both lineage and location. In agreement, SV- and Endo-derived ECs in adult hearts displayed similar responses to injury. Finally, scRNAseq of developing human coronary vessels indicated that the human heart followed similar principles. Thus, over the course of development, transcriptional heterogeneity in coronary ECs is first influenced by lineage, then by location, until heterogeneity declines in the homeostatic adult heart. These results highlight the plasticity of ECs during development, and the validity of the mouse as a model for human coronary development.
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Affiliation(s)
- Ragini Phansalkar
- Department of Genetics, Stanford University School of Medicine, Stanford, United States.,Department of Biology, Stanford University, Stanford, United States
| | | | - Mingming Zhao
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, United States.,Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, United States
| | - Sai Saroja Kolluru
- Department of Bioengineering and Department of Applied Physics, Stanford University, Stanford, United States.,Chan Zuckerberg Biohub, Stanford, United States
| | - Robert C Jones
- Department of Bioengineering and Department of Applied Physics, Stanford University, Stanford, United States
| | - Stephen R Quake
- Department of Bioengineering and Department of Applied Physics, Stanford University, Stanford, United States.,Chan Zuckerberg Biohub, Stanford, United States
| | - Irving Weissman
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, United States
| | - Daniel Bernstein
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, United States.,Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, United States
| | - Virginia D Winn
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, United States
| | - Gaetano D'Amato
- Department of Biology, Stanford University, Stanford, United States
| | - Kristy Red-Horse
- Department of Biology, Stanford University, Stanford, United States.,Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, United States.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, United States
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39
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Bernstein D, Coster D, Berliner S, Shapira I, Zeltser D, Rogowski O, Adler A, Halutz O, Levinson T, Ritter O, Shenhar-Tsarfaty S, Wasserman A. C-reactive protein velocity discriminates between acute viral and bacterial infections in patients who present with relatively low CRP concentrations. BMC Infect Dis 2021; 21:1210. [PMID: 34863104 PMCID: PMC8643010 DOI: 10.1186/s12879-021-06878-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 11/15/2021] [Indexed: 11/12/2022] Open
Abstract
Background To assess the utility of C-reactive protein (CRP) velocity to discriminate between patients with acute viral and bacterial infections who presented with relatively low CRP concentrations and were suspected of having a bacterial infection. Methods We analyzed a retrospective cohort of patients with acute infections who presented to the emergency department (ED) with a relatively low first CRP measurement (CRP1) ≤ 31.9 mg/L and received antibiotics shortly after. We then calculated C-reactive protein velocity (CRPv), milligram per liter per hour, for each patient based on CRP1 and the second CRP value (CRP2) measured within the first 24 h since admission. Finally, we compared CRPv between patients with bacterial and viral infections. Results We have presently analyzed 74 patients with acute bacterial infections and 62 patients with acute viral infections at the mean age of 80 and 66 years respectively, 68 male and 68 female. CRP1 did not differ between both groups of patients (16.2 ± 8.6 and 14.8 ± 8.5 for patients with viral and bacterial infections respectively, p value = 0.336). However, the CRP2 was significantly different between the groups (30.2 ± 21.9 and 75.6 ± 51.3 for patients with viral and bacterial infections respectively, p-value < 0.001) and especially the CRPv was much higher in patients with acute bacterial infections compared to patients with acute viral infections (0.9 ± 1.2 and 4.4 ± 2.7 respectively, p-value < 0.001). Conclusion CRPv and CRP2 are useful biomarkers that can discriminate significantly between patients who present with acute bacterial and viral infections, and relatively low CRP concentration upon admission who were suspected of having a bacterial infection. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06878-y.
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Affiliation(s)
- Daniel Bernstein
- Joyce & Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Dan Coster
- Blavatnik School of Computer Science, Tel-Aviv University, Tel-Aviv, Israel
| | - Shlomo Berliner
- Departments of Internal Medicine "C", "D" and "E", Tel-Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann Street, 64239, Tel Aviv, Israel
| | - Itzhak Shapira
- Departments of Internal Medicine "C", "D" and "E", Tel-Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann Street, 64239, Tel Aviv, Israel
| | - David Zeltser
- Departments of Internal Medicine "C", "D" and "E", Tel-Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann Street, 64239, Tel Aviv, Israel
| | - Ori Rogowski
- Departments of Internal Medicine "C", "D" and "E", Tel-Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann Street, 64239, Tel Aviv, Israel
| | - Amos Adler
- Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ora Halutz
- Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Tal Levinson
- Departments of Internal Medicine "C", "D" and "E", Tel-Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann Street, 64239, Tel Aviv, Israel. .,Infectious Diseases Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
| | - Omri Ritter
- Department of Emergency Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Shani Shenhar-Tsarfaty
- Departments of Internal Medicine "C", "D" and "E", Tel-Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann Street, 64239, Tel Aviv, Israel
| | - Asaf Wasserman
- Departments of Internal Medicine "C", "D" and "E", Tel-Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann Street, 64239, Tel Aviv, Israel
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40
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Ranjbarvaziri S, Kooiker KB, Ellenberger M, Fajardo G, Zhao M, Vander Roest AS, Woldeyes RA, Koyano TT, Fong R, Ma N, Tian L, Traber GM, Chan F, Perrino J, Reddy S, Chiu W, Wu JC, Woo JY, Ruppel KM, Spudich JA, Snyder MP, Contrepois K, Bernstein D. Altered Cardiac Energetics and Mitochondrial Dysfunction in Hypertrophic Cardiomyopathy. Circulation 2021; 144:1714-1731. [PMID: 34672721 PMCID: PMC8608736 DOI: 10.1161/circulationaha.121.053575] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is a complex disease partly explained by the effects of individual gene variants on sarcomeric protein biomechanics. At the cellular level, HCM mutations most commonly enhance force production, leading to higher energy demands. Despite significant advances in elucidating sarcomeric structure-function relationships, there is still much to be learned about the mechanisms that link altered cardiac energetics to HCM phenotypes. In this work, we test the hypothesis that changes in cardiac energetics represent a common pathophysiologic pathway in HCM. METHODS We performed a comprehensive multiomics profile of the molecular (transcripts, metabolites, and complex lipids), ultrastructural, and functional components of HCM energetics using myocardial samples from 27 HCM patients and 13 normal controls (donor hearts). RESULTS Integrated omics analysis revealed alterations in a wide array of biochemical pathways with major dysregulation in fatty acid metabolism, reduction of acylcarnitines, and accumulation of free fatty acids. HCM hearts showed evidence of global energetic decompensation manifested by a decrease in high energy phosphate metabolites (ATP, ADP, and phosphocreatine) and a reduction in mitochondrial genes involved in creatine kinase and ATP synthesis. Accompanying these metabolic derangements, electron microscopy showed an increased fraction of severely damaged mitochondria with reduced cristae density, coinciding with reduced citrate synthase activity and mitochondrial oxidative respiration. These mitochondrial abnormalities were associated with elevated reactive oxygen species and reduced antioxidant defenses. However, despite significant mitochondrial injury, HCM hearts failed to upregulate mitophagic clearance. CONCLUSIONS Overall, our findings suggest that perturbed metabolic signaling and mitochondrial dysfunction are common pathogenic mechanisms in patients with HCM. These results highlight potential new drug targets for attenuation of the clinical disease through improving metabolic function and reducing mitochondrial injury.
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Affiliation(s)
- Sara Ranjbarvaziri
- Department of Pediatrics (S.Ranjbarvaziri, G.F., M.Z., A.S.V.R., S.Reddy, K.M.R., D.B.), Stanford University School of Medicine, CA
- Cardiovascular Research Institute (S.Ranjbarvaziri, G.F., M.Z., A.S.V.R., N.M., L.T., S.Reddy, J.C.W., D.B.), Stanford University School of Medicine, CA
| | - Kristina B Kooiker
- Department of Medicine, Division of Cardiology, University of Washington, Seattle (K.B.K.)
| | - Mathew Ellenberger
- Department of Genetics (M.E., G.M.T., M.P.S., K.C.), Stanford University School of Medicine, CA
| | - Giovanni Fajardo
- Department of Pediatrics (S.Ranjbarvaziri, G.F., M.Z., A.S.V.R., S.Reddy, K.M.R., D.B.), Stanford University School of Medicine, CA
- Cardiovascular Research Institute (S.Ranjbarvaziri, G.F., M.Z., A.S.V.R., N.M., L.T., S.Reddy, J.C.W., D.B.), Stanford University School of Medicine, CA
| | - Mingming Zhao
- Department of Pediatrics (S.Ranjbarvaziri, G.F., M.Z., A.S.V.R., S.Reddy, K.M.R., D.B.), Stanford University School of Medicine, CA
- Cardiovascular Research Institute (S.Ranjbarvaziri, G.F., M.Z., A.S.V.R., N.M., L.T., S.Reddy, J.C.W., D.B.), Stanford University School of Medicine, CA
| | - Alison Schroer Vander Roest
- Department of Pediatrics (S.Ranjbarvaziri, G.F., M.Z., A.S.V.R., S.Reddy, K.M.R., D.B.), Stanford University School of Medicine, CA
- Cardiovascular Research Institute (S.Ranjbarvaziri, G.F., M.Z., A.S.V.R., N.M., L.T., S.Reddy, J.C.W., D.B.), Stanford University School of Medicine, CA
| | - Rahel A Woldeyes
- Department of Bioengineering (R.A.W., W.C.), Stanford University, CA
| | - Tiffany T Koyano
- Department of Cardiothoracic Surgery (T.T.K., R.F., J.Y.W.), Stanford University, CA
| | - Robyn Fong
- Department of Cardiothoracic Surgery (T.T.K., R.F., J.Y.W.), Stanford University, CA
| | - Ning Ma
- Cardiovascular Research Institute (S.Ranjbarvaziri, G.F., M.Z., A.S.V.R., N.M., L.T., S.Reddy, J.C.W., D.B.), Stanford University School of Medicine, CA
- Department of Medicine, Division of Cardiology (N.M., L.T., J.C.W.), Stanford University, CA
| | - Lei Tian
- Cardiovascular Research Institute (S.Ranjbarvaziri, G.F., M.Z., A.S.V.R., N.M., L.T., S.Reddy, J.C.W., D.B.), Stanford University School of Medicine, CA
- Department of Medicine, Division of Cardiology (N.M., L.T., J.C.W.), Stanford University, CA
| | - Gavin M Traber
- Department of Genetics (M.E., G.M.T., M.P.S., K.C.), Stanford University School of Medicine, CA
| | - Frandics Chan
- Department of Radiology (F.C.), Stanford University, CA
| | - John Perrino
- Cell Sciences Imaging Facility (J.P.), Stanford University, CA
| | - Sushma Reddy
- Department of Pediatrics (S.Ranjbarvaziri, G.F., M.Z., A.S.V.R., S.Reddy, K.M.R., D.B.), Stanford University School of Medicine, CA
- Cardiovascular Research Institute (S.Ranjbarvaziri, G.F., M.Z., A.S.V.R., N.M., L.T., S.Reddy, J.C.W., D.B.), Stanford University School of Medicine, CA
| | - Wah Chiu
- Department of Bioengineering (R.A.W., W.C.), Stanford University, CA
- Division of Cryo-Electron Microscopy and Bioimaging, SLAC National Accelerator Laboratory (W.C.), Stanford University, CA
| | - Joseph C Wu
- Cardiovascular Research Institute (S.Ranjbarvaziri, G.F., M.Z., A.S.V.R., N.M., L.T., S.Reddy, J.C.W., D.B.), Stanford University School of Medicine, CA
- Department of Medicine, Division of Cardiology (N.M., L.T., J.C.W.), Stanford University, CA
| | - Joseph Y Woo
- Department of Cardiothoracic Surgery (T.T.K., R.F., J.Y.W.), Stanford University, CA
| | - Kathleen M Ruppel
- Department of Pediatrics (S.Ranjbarvaziri, G.F., M.Z., A.S.V.R., S.Reddy, K.M.R., D.B.), Stanford University School of Medicine, CA
- Department of Biochemistry (K.M.R.), Stanford University School of Medicine, CA
| | | | - Michael P Snyder
- Department of Genetics (M.E., G.M.T., M.P.S., K.C.), Stanford University School of Medicine, CA
| | - Kévin Contrepois
- Department of Genetics (M.E., G.M.T., M.P.S., K.C.), Stanford University School of Medicine, CA
| | - Daniel Bernstein
- Department of Pediatrics (S.Ranjbarvaziri, G.F., M.Z., A.S.V.R., S.Reddy, K.M.R., D.B.), Stanford University School of Medicine, CA
- Cardiovascular Research Institute (S.Ranjbarvaziri, G.F., M.Z., A.S.V.R., N.M., L.T., S.Reddy, J.C.W., D.B.), Stanford University School of Medicine, CA
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Bernstein D, Nelson H, Sussman G, Okubo K, Maekawa Y, Nolte H. P030 SIMILAR EFFICACY AND SAFETY BETWEEN ADOLESCENTS AND ADULTS RECEIVING HOUSE DUST MITE SUBLINGUAL IMMUNOTHERAPY TABLET. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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42
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Stranzl T, Bernstein D, Matsuoka T, Maekawa Y, Sejer Andersen P, Nolte J, Hulstrøm V, Nolte H. P031 SIMILARITIES IN EFFICACY AND SAFETY OF SUBLINGUAL IMMUNOTHERAPY TABLETS ACROSS GEOGRAPHIC REGIONS IN CLINICAL TRIALS. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.076] [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: 11/28/2022]
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43
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Bernstein D, West A, Preston E, Premakumaran P, Suleyman N, Undre S. 1473 Urology Consent Forms at a District General Hospital – a Quality Improvement Project. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1111] [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: 11/12/2022]
Abstract
Abstract
Aim
Consent is a core component of interaction between patients and healthcare professionals. Prior to surgery, forms are completed to record patient consent. As well as containing risks and benefits of the procedure, the consent form, as per guidelines1,2, must be legible and suitable to a patient’s capacity. To evaluate compliance with local and national guidelines, a quality improvement project was undertaken at a district general hospital.
Method
Over a three-week period 30 urology consent forms were selected to assess adherence to local and national guidelines. The appropriateness of consent form, patient signature, legibility, acronym use and whether the patient was offered a carbon copy were assessed. After initial data collection, all urology staff consenting patients were notified of the findings and how best to improve guideline adherence. A further three-week data collection was undertaken, though the sample set was small due to Coronavirus and Christmas.
Results
The results confirmed that patients had appropriate consent forms filled out and were signed appropriately. After intervention, there was clear improvement in legibility, with no low legibility consent forms, and 100% vs 83% high or moderate legibility between data sets. Intervention also resulted in significant reduction of acronym use; 33% vs 60%. More patients were also offered to retain a carbon copy; 89% vs 40%.
Conclusions
Through this intervention of highlighting local and national guidance as compared to current practice, compliance drastically improved. As the pandemic subsides, we hope regular emails to surgical teams will improve consent form completion to better patient care.
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Affiliation(s)
- D Bernstein
- Department of Urology, Lister Hospital, Stevenage, United Kingdom
| | - A West
- Department of Urology, Lister Hospital, Stevenage, United Kingdom
| | - E Preston
- Department of Urology, Lister Hospital, Stevenage, United Kingdom
| | - P Premakumaran
- Department of Urology, Lister Hospital, Stevenage, United Kingdom
| | - N Suleyman
- Department of Urology, Lister Hospital, Stevenage, United Kingdom
| | - S Undre
- Department of Urology, Lister Hospital, Stevenage, United Kingdom
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Woo J, Dong M, Kong F, McElhinney D, Schiavone N, Chan F, Lui G, Haddad F, Bernstein D, Marsden A. Increased right ventricular energy efficiency by 4DMR after harmony valve implantation. International Journal of Cardiology Congenital Heart Disease 2021. [DOI: 10.1016/j.ijcchd.2021.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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45
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Raftrey B, Williams I, Rios Coronado PE, Fan X, Chang AH, Zhao M, Roth R, Trimm E, Racelis R, D’Amato G, Phansalkar R, Nguyen A, Chai T, Gonzalez KM, Zhang Y, Ang LT, Loh K, Bernstein D, Red-Horse K. Dach1 Extends Artery Networks and Protects Against Cardiac Injury. Circ Res 2021; 129:702-716. [PMID: 34383559 PMCID: PMC8448957 DOI: 10.1161/circresaha.120.318271] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
| | - Ian Williams
- Biology, Stanford University, Stanford, CA, 94305
| | | | - Xiaochen Fan
- Biology, Stanford University, Stanford, CA, 94305
| | - Andrew H. Chang
- Biology, Stanford University, Stanford, CA, 94305
- Developmental Biology, Stanford University School of Medicine, Stanford, CA, 94305
| | - Mingming Zhao
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Robert Roth
- Biology, Stanford University, Stanford, CA, 94305
| | - Emily Trimm
- Biology, Stanford University, Stanford, CA, 94305
| | | | | | - Ragini Phansalkar
- Biology, Stanford University, Stanford, CA, 94305
- Genetics, Stanford University School of Medicine, Stanford, CA, 94305
| | - Alana Nguyen
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Timothy Chai
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Karen M. Gonzalez
- Biology, Stanford University, Stanford, CA, 94305
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Yue Zhang
- Biology, Stanford University, Stanford, CA, 94305
| | - Lay Teng Ang
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Kyle Loh
- Developmental Biology, Stanford University School of Medicine, Stanford, CA, 94305
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Daniel Bernstein
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Kristy Red-Horse
- Biology, Stanford University, Stanford, CA, 94305
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
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Duong SQ, Zhang Y, Hall M, Hollander SA, Thurm CW, Bernstein D, Feingold B, Godown J, Almond C. Impact of institutional routine surveillance endomyocardial biopsy frequency in the first year on rejection and graft survival in pediatric heart transplantation. Pediatr Transplant 2021; 25:e14035. [PMID: 34003559 DOI: 10.1111/petr.14035] [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: 12/29/2020] [Revised: 04/11/2021] [Accepted: 04/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Routine surveillance biopsy (RSB) is performed to detect asymptomatic acute rejection (AR) after heart transplantation (HT). Variation in pediatric RSB across institutions is high. We examined center-based variation in RSB and its relationship to graft loss, AR, coronary artery vasculopathy (CAV), and cost of care during the first year post-HT. METHODS We linked the Pediatric Health Information System (PHIS) and Scientific Registry of Transplant Recipients (SRTR, 2002-2016), including all primary-HT aged 0-21 years. We characterized centers by RSB frequency (defined as median biopsies performed among recipients aged ≥12 months without rejection in the first year). We adjusted for potential confounders and center effects with mixed-effects regression analysis. RESULTS We analyzed 2867 patients at 29 centers. After adjusting for patient and center differences, increasing RSB frequency was associated with diagnosed AR (OR 1.15 p = 0.004), a trend toward treated AR (OR 1.09 p = 0.083), and higher hospital-based cost (US$390 315 vs. $313 248, p < 0.001) but no difference in graft survival (HR 1.00, p = 0.970) or CAV (SHR 1.04, p = 0.757) over median follow-up 3.9 years. Center RSB-frequency threshold of ≥2/year was associated with increased unadjusted rates of treated AR, but no association was found at thresholds greater than this. CONCLUSION Center RSB frequency is positively associated with increased diagnosis of AR at 1 year post-HT. Graft survival and CAV appear similar at medium-term follow-up. We speculate that higher frequency RSB centers may have increased detection of clinically less important AR, though further study of the relationship between center RSB frequency and differences in treated AR is necessary.
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Affiliation(s)
- Son Q Duong
- Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, California, USA
| | - Yulin Zhang
- Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, California, USA
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas, USA
| | - Seth A Hollander
- Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, California, USA
| | - Cary W Thurm
- Children's Hospital Association, Lenexa, Kansas, USA
| | - Daniel Bernstein
- Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, California, USA
| | - Brian Feingold
- Pediatrics (Cardiology) and Clinical Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Justin Godown
- Pediatrics (Cardiology), Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Christopher Almond
- Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, California, USA
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47
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Pasrija C, Quinn RW, Bernstein D, Tran D, Alkhatib H, Rice M, Morales D, Shah A, Ghoreishi M, Strauss ER, Henderson R, D'Ambra MN, Gammie JS. Mitral Valve Translocation: A Novel Operation for the Treatment of Secondary Mitral Regurgitation. Ann Thorac Surg 2021; 112:1954-1961. [PMID: 34419436 DOI: 10.1016/j.athoracsur.2021.07.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/04/2021] [Accepted: 07/12/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Conventional annuloplasty repair of secondary (functional) ischemic mitral regurgitation (IMR) is associated with a 60% recurrence of moderate or greater mitral regurgitation at 2 years. We developed a novel repair technique for IMR that addresses the underlying geometric alterations of the mitral valve apparatus and compared outcomes with those of conventional repair in a swine model. METHODS Chronic IMR was induced by percutaneous embolization of the circumflex artery. Swine with severe IMR (median 9 weeks after infarction) underwent undersized rigid annuloplasty (n = 5) or translocation repair (n = 6). Translocation repair consisted of detaching the mitral valve en bloc at the annulus, creating a 1 cm wide frustum-shaped pericardial patch, and suturing the outer circumference of the patch to the annulus and inner circumference to the mitral valve. RESULTS Operative survival was 92% (11 of 12). All animals had none/trace residual central mitral regurgitation, and mean inflow gradients were similar (1 mm Hg [interquartile range, 1 to 2] vs 2 mm Hg [interquartile range, 1 to 2]; P = .75) in the annuloplasty and translocation groups, respectively. Median coaptation length marginally improved in conventional swine (3 to 4 mm, P = .05), but dramatically improved in translocation swine (3 to 8 mm, P = .003). Posterior leaflet angle increased from 39 to 80 degrees (P = .05) in annuloplasty swine but decreased from 50 to 31 degrees (P = .03) in translocation swine. The posterior leaflet was immobile after annuloplasty but had preserved motion after translocation (excursion, 1 degree vs 24 degrees; P = .045). CONCLUSIONS Mitral valve translocation effectively treats mitral regurgitation by relieving leaflet tethering. Compared with annuloplasty, mitral valve translocation creates a larger surface of coaptation and preserves leaflet mobility without compromising diastolic function.
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Affiliation(s)
- Chetan Pasrija
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Rachael W Quinn
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Douglas Tran
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Hani Alkhatib
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - MaryJoe Rice
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - David Morales
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Aakash Shah
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mehrdad Ghoreishi
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Erik R Strauss
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Reney Henderson
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael N D'Ambra
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - James S Gammie
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
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Da BL, Suchman K, Roth N, Rizvi A, Vincent M, Trindade AJ, Bernstein D, Satapathy SK. Cholestatic liver injury in COVID-19 is a rare and distinct entity and is associated with increased mortality. J Intern Med 2021; 290:470-472. [PMID: 33786906 PMCID: PMC8250628 DOI: 10.1111/joim.13292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/04/2021] [Accepted: 03/24/2021] [Indexed: 12/11/2022]
Affiliation(s)
- B L Da
- From the, Division of Hepatology, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY, USA
| | - K Suchman
- Department of Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY, USA
| | - N Roth
- From the, Division of Hepatology, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY, USA
| | - A Rizvi
- Division of Gastroenterology, Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, New Hyde Park, NY, USA
| | - M Vincent
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - A J Trindade
- Department of Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY, USA
| | - D Bernstein
- From the, Division of Hepatology, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY, USA
| | - S K Satapathy
- From the, Division of Hepatology, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY, USA
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49
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Dykes JC, Rosenthal DN, Bernstein D, McElhinney DB, Chrisant MRK, Daly KP, Ameduri RK, Knecht K, Richmond ME, Lin KY, Urschel S, Simmonds J, Simpson KE, Albers EL, Khan A, Schumacher K, Almond CS, Chen S. Clinical and hemodynamic characteristics of the pediatric failing Fontan. J Heart Lung Transplant 2021; 40:1529-1539. [PMID: 34412962 DOI: 10.1016/j.healun.2021.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 07/02/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022] Open
Abstract
AIM To describe the clinical and hemodynamic characteristics of Fontan failure in children listed for heart transplant. METHODS In a nested study of the Pediatric Heart Transplant Society, 16 centers contributed information on Fontan patients listed for heart transplant between 2005and 2013. Patients were classified into four mutually exclusive phenotypes: Fontan with abnormal lymphatics (FAL), Fontan with reduced systolic function (FRF), Fontan with preserved systolic function (FPF), and Fontan with "normal" hearts (FNH). Primary outcome was waitlist and post-transplant mortality. RESULTS 177 children listed for transplant were followed over a median 13 (IQR 4-31) months, 84 (47%) were FAL, 57 (32%) FRF, 22 (12%) FNH, and 14 (8%) FPF. Hemodynamic characteristics differed between the 4 groups: Fontan pressure (FP) was most elevated with FPF (median 22, IQR 18-23, mmHg) and lowest with FAL (16, 14-20, mmHg); cardiac index (CI) was lowest with FRF (2.8, 2.3-3.4, L/min/m2). In the entire cohort, 66% had FP >15 mmHg, 21% had FP >20 mmHg, and 10% had CI <2.2 L/min/m2. FRF had the highest risk of waitlist mortality (21%) and FNH had the highest risk of post-transplant mortality (36%). CONCLUSIONS Elevated Fontan pressure is more common than low cardiac output in pediatric failing Fontan patients listed for transplant. Subtle hemodynamic differences exist between the various phenotypes of pediatric Fontan failure. Waitlist and post-transplant mortality risks differ by phenotype.
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Affiliation(s)
- John C Dykes
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University.
| | - David N Rosenthal
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University
| | - Daniel Bernstein
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University
| | - Doff B McElhinney
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University; Department of Cardiovascular Surgery, Stanford University
| | | | - Kevin P Daly
- Boston Children's Hospital, Harvard Medical School
| | | | - Kenneth Knecht
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences
| | - Marc E Richmond
- Morgan Stanley Children's Hospital, Columbia University College of Physicians & Surgeons
| | - Kimberly Y Lin
- Children's Hospital of Philadelphia, University of Pennsylvania
| | | | | | | | - Erin L Albers
- Seattle Children's Hospital, University of Washington
| | - Asma Khan
- Ann and Robert H Lurie Children's Hospital, Northwestern University Feinberg School of Medicine
| | | | - Christopher S Almond
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University
| | - Sharon Chen
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University
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50
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Vander Roest AS, Liu C, Morck MM, Kooiker KB, Jung G, Song D, Dawood A, Jhingran A, Pardon G, Ranjbarvaziri S, Fajardo G, Zhao M, Campbell KS, Pruitt BL, Spudich JA, Ruppel KM, Bernstein D. Hypertrophic cardiomyopathy β-cardiac myosin mutation (P710R) leads to hypercontractility by disrupting super relaxed state. Proc Natl Acad Sci U S A 2021; 118:e2025030118. [PMID: 34117120 PMCID: PMC8214707 DOI: 10.1073/pnas.2025030118] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common inherited form of heart disease, associated with over 1,000 mutations, many in β-cardiac myosin (MYH7). Molecular studies of myosin with different HCM mutations have revealed a diversity of effects on ATPase and load-sensitive rate of detachment from actin. It has been difficult to predict how such diverse molecular effects combine to influence forces at the cellular level and further influence cellular phenotypes. This study focused on the P710R mutation that dramatically decreased in vitro motility velocity and actin-activated ATPase, in contrast to other MYH7 mutations. Optical trap measurements of single myosin molecules revealed that this mutation reduced the step size of the myosin motor and the load sensitivity of the actin detachment rate. Conversely, this mutation destabilized the super relaxed state in longer, two-headed myosin constructs, freeing more heads to generate force. Micropatterned human induced pluripotent derived stem cell (hiPSC)-cardiomyocytes CRISPR-edited with the P710R mutation produced significantly increased force (measured by traction force microscopy) compared with isogenic control cells. The P710R mutation also caused cardiomyocyte hypertrophy and cytoskeletal remodeling as measured by immunostaining and electron microscopy. Cellular hypertrophy was prevented in the P710R cells by inhibition of ERK or Akt. Finally, we used a computational model that integrated the measured molecular changes to predict the measured traction forces. These results confirm a key role for regulation of the super relaxed state in driving hypercontractility in HCM with the P710R mutation and demonstrate the value of a multiscale approach in revealing key mechanisms of disease.
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Affiliation(s)
- Alison Schroer Vander Roest
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA 94304
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305
- Department of Bioengineering, School of Engineering and School of Medicine, Stanford University, Stanford, CA 94305
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
| | - Chao Liu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA 94305
| | - Makenna M Morck
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA 94305
| | - Kristina Bezold Kooiker
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA 94304
- School of Medicine, University of Washington, Seattle, WA 98109
| | - Gwanghyun Jung
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA 94304
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
| | - Dan Song
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA 94305
| | - Aminah Dawood
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA 94305
| | - Arnav Jhingran
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA 94304
| | - Gaspard Pardon
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305
- Department of Bioengineering, School of Engineering and School of Medicine, Stanford University, Stanford, CA 94305
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
| | - Sara Ranjbarvaziri
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA 94304
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
| | - Giovanni Fajardo
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA 94304
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
| | - Mingming Zhao
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA 94304
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
| | - Kenneth S Campbell
- Department of Physiology, University of Kentucky, Lexington, KY 40536
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY 40536
| | - Beth L Pruitt
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305
- Department of Bioengineering, School of Engineering and School of Medicine, Stanford University, Stanford, CA 94305
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
- Mechanical and Biomolecular Science and Engineering, University of California, Santa Barbara, CA 93106
| | - James A Spudich
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305;
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA 94305
| | - Kathleen M Ruppel
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA 94305
| | - Daniel Bernstein
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA 94304;
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305
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