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Park HJ, Kim M, Lee D, Kim HJ, Jung HW. CRISPR-Cas9 and beyond: identifying target genes for developing disease-resistant plants. Plant Biol (Stuttg) 2024; 26:369-377. [PMID: 38363032 DOI: 10.1111/plb.13625] [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: 05/15/2023] [Accepted: 01/23/2024] [Indexed: 02/17/2024]
Abstract
Throughout the history of crop domestication, desirable traits have been selected in agricultural products. However, such selection often leads to crops and vegetables with weaker vitality and viability than their wild ancestors when exposed to adverse environmental conditions. Considering the increasing human population and climate change challenges, it is crucial to enhance crop quality and quantity. Accordingly, the identification and utilization of diverse genetic resources are imperative for developing disease-resistant plants that can withstand unexpected epidemics of plant diseases. In this review, we provide a brief overview of recent progress in genome-editing technologies, including zinc-finger nucleases (ZFNs), transcription activator-like effector nucleases (TALENs), and clustered regularly interspaced short palindromic repeats (CRISPR)-associated protein 9 (Cas9) technologies. In particular, we classify disease-resistant mutants of Arabidopsis thaliana and several crop plants based on the roles or functions of the mutated genes in plant immunity and suggest potential target genes for molecular breeding of genome-edited disease-resistant plants. Genome-editing technologies are resilient tools for sustainable development and promising solutions for coping with climate change and population increases.
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Affiliation(s)
- H J Park
- Institute of Agricultural Life Science, Dong-A University, Busan, Korea
- Department of Biological Sciences and Research Center of Ecomimetics, Chonnam National University, Gwangju, Korea
| | - M Kim
- Department of Applied Bioscience, Dong-A University, Busan, Korea
| | - D Lee
- Department of Applied Bioscience, Dong-A University, Busan, Korea
| | - H J Kim
- Department of Molecular Genetics, Dong-A University, Busan, Korea
| | - H W Jung
- Institute of Agricultural Life Science, Dong-A University, Busan, Korea
- Department of Applied Bioscience, Dong-A University, Busan, Korea
- Department of Molecular Genetics, Dong-A University, Busan, Korea
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Keith P, Bohn RIC, Nguyen T, Scott LK, Richmond M, Day M, Choe C, Perkins L, Burnside R, Pyke R, Rikard B, Guffey A, Saini A, Park HJ, Carcillo J. Improved survival in COVID-19 related sepsis and ARDS treated with a unique "triple therapy" including therapeutic plasma exchange: A single center retrospective analysis. J Clin Apher 2024; 39:e22107. [PMID: 38404046 DOI: 10.1002/jca.22107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/09/2024] [Accepted: 02/10/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Throughout the COVID-19 pandemic, the mortality of critically ill patients remained high. Our group developed a treatment regimen targeting sepsis and ARDS which we labeled "triple therapy" consisting of (1) corticosteroids, (2) therapeutic plasma exchange (TPE), and (3) timely intubation with lung protective ventilation. Our propensity analysis assesses the impact of triple therapy on survival in COVID-19 patients with sepsis and ARDS. METHODS Retrospective propensity analysis comparing triple therapy to no triple therapy in adult critically ill COVID-19 patients admitted to the Intensive Care Unit at Lexington Medical Center from 1 March 2020 through 31 October 2021. RESULTS Eight hundred and fifty-one patients were admitted with COVID-19 and 53 clinical and laboratory variables were analyzed. Multivariable analysis revealed that triple therapy was associated with increased survival (OR: 1.91; P = .008). Two propensity score-adjusted models demonstrated an increased likelihood of survival in patients receiving triple therapy. Patients with thrombocytopenia were among those most likely to experience increased survival if they received early triple therapy. Decreased survival was observed with endotracheal intubation ≥7 days from hospital admission (P < .001) and there was a trend toward decreased survival if TPE was initiated ≥6 days from hospital admission (P = .091). CONCLUSION Our analysis shows that early triple therapy, defined as high-dose methylprednisolone, TPE, and timely invasive mechanical ventilation within the first 96 hours of admission, may improve survival in critically ill septic patients with ARDS secondary to COVID-19 infection. Further studies are needed to define specific phenotypes and characteristics that will identify those patients most likely to benefit.
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Affiliation(s)
- Philip Keith
- Lexington Medical Center, West Columbia, South Carolina, USA
| | | | - Trung Nguyen
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - L Keith Scott
- Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Monty Richmond
- Medical Center Downtown, MUSC Health Columbia, Columbia, South Carolina, USA
| | - Matthew Day
- Lexington Medical Center, West Columbia, South Carolina, USA
| | - Carol Choe
- Lexington Medical Center, West Columbia, South Carolina, USA
| | - Linda Perkins
- Lexington Medical Center, West Columbia, South Carolina, USA
| | | | - Richard Pyke
- Lexington Medical Center, West Columbia, South Carolina, USA
| | - Ben Rikard
- Lexington Medical Center, West Columbia, South Carolina, USA
| | - Amanda Guffey
- Lexington Medical Center, West Columbia, South Carolina, USA
| | - Arun Saini
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - H J Park
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joseph Carcillo
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Kuonqui K, Campbell AC, Sarker A, Roberts A, Pollack BL, Park HJ, Shin J, Brown S, Mehrara BJ, Kataru RP. Dysregulation of Lymphatic Endothelial VEGFR3 Signaling in Disease. Cells 2023; 13:68. [PMID: 38201272 PMCID: PMC10778007 DOI: 10.3390/cells13010068] [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: 11/15/2023] [Revised: 12/20/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
Vascular endothelial growth factor (VEGF) receptor 3 (VEGFR3), a receptor tyrosine kinase encoded by the FLT4 gene, plays a significant role in the morphogenesis and maintenance of lymphatic vessels. Under both normal and pathologic conditions, VEGF-C and VEGF-D bind VEGFR3 on the surface of lymphatic endothelial cells (LECs) and induce lymphatic proliferation, migration, and survival by activating intracellular PI3K-Akt and MAPK-ERK signaling pathways. Impaired lymphatic function and VEGFR3 signaling has been linked with a myriad of commonly encountered clinical conditions. This review provides a brief overview of intracellular VEGFR3 signaling in LECs and explores examples of dysregulated VEGFR3 signaling in various disease states, including (1) lymphedema, (2) tumor growth and metastasis, (3) obesity and metabolic syndrome, (4) organ transplant rejection, and (5) autoimmune disorders. A more complete understanding of the molecular mechanisms underlying the lymphatic pathology of each disease will allow for the development of novel strategies to treat these chronic and often debilitating illnesses.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Babak J. Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Raghu P. Kataru
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Flerlage T, Fan K, Qin Y, Agulnik A, Arias AV, Cheng C, Elbahlawan L, Ghafoor S, Hurley C, McArthur J, Morrison RR, Zhou Y, Park HJ, Carcillo JA, Hines MR. Mortality Risk Factors in Pediatric Onco-Critical Care Patients and Machine Learning Derived Early Onco-Critical Care Phenotypes in a Retrospective Cohort. Crit Care Explor 2023; 5:e0976. [PMID: 37780176 PMCID: PMC10538916 DOI: 10.1097/cce.0000000000000976] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVES To use supervised and unsupervised statistical methodology to determine risk factors associated with mortality in critically ill pediatric oncology patients to identify patient phenotypes of interest for future prospective study. DESIGN This retrospective cohort study included nonsurgical pediatric critical care admissions from January 2017 to December 2018. We determined the prevalence of multiple organ failure (MOF), ICU mortality, and associated factors. Consensus k-means clustering analysis was performed using 35 bedside admission variables for early, onco-critical care phenotype development. SETTING Single critical care unit in a subspeciality pediatric hospital. INTERVENTION None. PATIENTS There were 364 critical care admissions in 324 patients with underlying malignancy, hematopoietic cell transplant, or immunodeficiency reviewed. MEASUREMENTS Prevalence of multiple organ failure, ICU mortality, determination of early onco-critical care phenotypes. MAIN RESULTS ICU mortality was 5.2% and was increased in those with MOF (18.4% MOF, 1.7% single organ failure [SOF], 0.6% no organ failure; p ≤ 0.0001). Prevalence of MOF was 23.9%. Significantly increased ICU mortality risk was associated with day 1 MOF (hazards ratio [HR] 2.27; 95% CI, 1.10-6.82; p = 0.03), MOF during ICU admission (HR 4.16; 95% CI, 1.09-15.86; p = 0.037), and with invasive mechanical ventilation requirement (IMV; HR 5.12; 95% CI, 1.31-19.94; p = 0.018). Four phenotypes were derived (PedOnc1-4). PedOnc1 and 2 represented patient groups with low mortality and SOF. PedOnc3 was enriched in patients with sepsis and MOF with mortality associated with liver and renal dysfunction. PedOnc4 had the highest frequency of ICU mortality and MOF characterized by acute respiratory failure requiring invasive mechanical ventilation at admission with neurologic dysfunction and/or severe sepsis. Notably, most of the mortality in PedOnc4 was early (i.e., within 72 hr of ICU admission). CONCLUSIONS Mortality was lower than previously reported in critically ill pediatric oncology patients and was associated with MOF and IMV. These findings were further validated and expanded by the four derived nonsynonymous computable phenotypes. Of particular interest for future prospective validation and correlative biological study was the PedOnc4 phenotype, which was composed of patients with hypoxic respiratory failure requiring IMV with sepsis and/or neurologic dysfunction at ICU admission.
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Affiliation(s)
- Tim Flerlage
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN
| | - Kimberly Fan
- Division of Critical Care, Department of Pediatrics, MD Anderson Cancer Center, Houston, TX
| | - Yidi Qin
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Asya Agulnik
- Department of Global Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Anita V Arias
- Division of Critical Care, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Cheng Cheng
- Division of Critical Care, Department Biostatistics, St Jude Children's Research Hospital, Memphis, TN
| | - Lama Elbahlawan
- Division of Critical Care, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Saad Ghafoor
- Division of Critical Care, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Caitlin Hurley
- Division of Critical Care, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Jennifer McArthur
- Division of Critical Care, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - R Ray Morrison
- Division of Critical Care, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Yinmei Zhou
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN
| | - H J Park
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Joseph A Carcillo
- Division of Pediatric Critical Care, Department of Critical Care Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Melissa R Hines
- Division of Critical Care, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
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Park HJ, Kim K, Kim YB, Chang JS, Shin KH. Patterns and Longitudinal Changes in The Practice of Breast Cancer Radiotherapy in Korea: Korean Radiation Oncology Group 22-01. Int J Radiat Oncol Biol Phys 2023; 117:e197-e198. [PMID: 37784841 DOI: 10.1016/j.ijrobp.2023.06.1069] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To analyze contemporary practice patterns in breast cancer radiotherapy (RT) and to assess longitudinal changes therein over 5 years in Korea. MATERIALS/METHODS A nationwide survey was conducted among board-certified radiation oncologists in Korea by the Division for Breast Cancer of the Korean Radiation Oncology Group in March 2022. The survey consisted of 44 questions related to six domains: hypofractionated (HypoFx) whole breast RT, accelerated partial breast RT (APBI), regional nodal irradiation (RNI), RT for ductal carcinoma in situ (DCIS), postmastectomy RT (PMRT), and tumor bed boost. RESULTS In total, 70 radiation oncologists from 61 of 101 (60%) institutions participated in the survey. HypoFx RT was used by 62 respondents (89%), which has significantly increased from 36% in 2017. The HypoFx RT was commonly administered at 40-42.5 Gy in 15-16 fractions. APBI was used by 12 respondents (17%), which has increased from 5% in 2017. The use of RNI did not change significantly: ≥ pN2 (6%), ≥ pN1 (33%), and ≥ pN1 with pathological risk factors (61%). However, the indications for use of internal mammary lymph node (IMN) irradiation have expanded. In particular, the rates of routine treatment of IMN (11% from 6% in 2017) and treatment in cases of ≥ pN2 (27% from 14% in 2017) have doubled; however, the rate of treatment for only IMN involvement, identified on imaging, has decreased to 31% from 47% in 2017. With regard to DCIS, the use of hypoFx RT increased to 75% from 25%, and the rate of omission on of RT after breast-conserving surgery decreased to 38% from 48% in 2017. The use of hypoFx RT for PMRT also increased to 36% from 8% in 2017. CONCLUSION The adoption of HypoFx RT after breast-conserving surgery in invasive breast cancer and DCIS has increased significantly, whereas that for PMRT has increased moderately, compared to 2017. Further studies are required to determine the optimal use of RNI.
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Affiliation(s)
- H J Park
- Hanyang University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - K Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - Y B Kim
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - J S Chang
- Department of Radiation Oncology, Gangnam Severance Hospital, Seoul, Korea, Republic of (South) Korea
| | - K H Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea, Republic of (South) Korea
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Fan Z, Kernan KF, Qin Y, Canna S, Berg RA, Wessel D, Pollack MM, Meert K, Hall M, Newth C, Lin JC, Doctor A, Shanley T, Cornell T, Harrison RE, Zuppa AF, Sward K, Dean JM, Park HJ, Carcillo JA. Hyperferritinemic sepsis, macrophage activation syndrome, and mortality in a pediatric research network: a causal inference analysis. Crit Care 2023; 27:347. [PMID: 37674218 PMCID: PMC10481565 DOI: 10.1186/s13054-023-04628-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/27/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND One of five global deaths are attributable to sepsis. Hyperferritinemic sepsis (> 500 ng/mL) is associated with increased mortality in single-center studies. Our pediatric research network's objective was to obtain rationale for designing anti-inflammatory clinical trials targeting hyperferritinemic sepsis. METHODS We assessed differences in 32 cytokines, immune depression (low whole blood ex vivo TNF response to endotoxin) and thrombotic microangiopathy (low ADAMTS13 activity) biomarkers, seven viral DNAemias, and macrophage activation syndrome (MAS) defined by combined hepatobiliary dysfunction and disseminated intravascular coagulation, and mortality in 117 children with hyperferritinemic sepsis (ferritin level > 500 ng/mL) compared to 280 children with sepsis without hyperferritinemia. Causal inference analysis of these 41 variables, MAS, and mortality was performed. RESULTS Mortality was increased in children with hyperferritinemic sepsis (27/117, 23% vs 16/280, 5.7%; Odds Ratio = 4.85, 95% CI [2.55-9.60]; z = 4.728; P-value < 0.0001). Hyperferritinemic sepsis had higher C-reactive protein, sCD163, IL-22, IL-18, IL-18 binding protein, MIG/CXCL9, IL-1β, IL-6, IL-8, IL-10, IL-17a, IFN-γ, IP10/CXCL10, MCP-1/CCL2, MIP-1α, MIP-1β, TNF, MCP-3, IL-2RA (sCD25), IL-16, M-CSF, and SCF levels; lower ADAMTS13 activity, sFasL, whole blood ex vivo TNF response to endotoxin, and TRAIL levels; more Adenovirus, BK virus, and multiple virus DNAemias; and more MAS (P-value < 0.05). Among these variables, only MCP-1/CCL2 (the monocyte chemoattractant protein), MAS, and ferritin levels were directly causally associated with mortality. MCP-1/CCL2 and hyperferritinemia showed direct causal association with depressed ex vivo whole blood TNF response to endotoxin. MCP-1/CCL2 was a mediator of MAS. MCP-1/CCL2 and MAS were mediators of hyperferritinemia. CONCLUSIONS These findings establish hyperferritinemic sepsis as a high-risk condition characterized by increased cytokinemia, viral DNAemia, thrombotic microangiopathy, immune depression, macrophage activation syndrome, and death. The causal analysis provides rationale for designing anti-inflammatory trials that reduce macrophage activation to improve survival and enhance infection clearance in pediatric hyperferritinemic sepsis.
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Affiliation(s)
- Zhenziang Fan
- Department of Computer Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kate F Kernan
- Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, Faculty Pavilion, Children's Hospital of Pittsburgh, Center for Critical Care Nephrology and Clinical Research Investigation and Systems Modeling of Acute Illness Center, University of Pittsburgh, Suite 2000, 4400 Penn Avenue, Pittsburgh, PA, 15421, USA
| | - Yidi Qin
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Scott Canna
- Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Robert A Berg
- Department of Anesthesiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - David Wessel
- Division of Critical Care Medicine, Department of Pediatrics, Children's National Hospital, Washington, DC, USA
| | - Murray M Pollack
- Division of Critical Care Medicine, Department of Pediatrics, Children's National Hospital, Washington, DC, USA
| | - Kathleen Meert
- Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
- Central Michigan University, Mt Pleasant, MI, USA
| | - Mark Hall
- Division of Critical Care Medicine, Department of Pediatrics, The Research Institute at Nationwide Children's Hospital Immune Surveillance Laboratory, and Nationwide Children's Hospital, Columbus, OH, USA
| | - Christopher Newth
- Division of Pediatric Critical Care Medicine, Department of Anesthesiology and Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - John C Lin
- Division of Critical Care Medicine, Department of Pediatrics, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Allan Doctor
- Division of Critical Care Medicine, Department of Pediatrics, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Tom Shanley
- Division of Critical Care Medicine, Department of Pediatrics, C. S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Tim Cornell
- Division of Critical Care Medicine, Department of Pediatrics, C. S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Rick E Harrison
- Division of Critical Care Medicine, Department of Pediatrics, Mattel Children's Hospital at University of California Los Angeles, Los Angeles, CA, USA
| | - Athena F Zuppa
- Department of Anesthesiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Katherine Sward
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - J Michael Dean
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - H J Park
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joseph A Carcillo
- Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, Faculty Pavilion, Children's Hospital of Pittsburgh, Center for Critical Care Nephrology and Clinical Research Investigation and Systems Modeling of Acute Illness Center, University of Pittsburgh, Suite 2000, 4400 Penn Avenue, Pittsburgh, PA, 15421, USA.
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Brown S, Nores GDG, Sarker A, Ly C, Li C, Park HJ, Hespe GE, Gardenier J, Kuonqui K, Campbell A, Shin J, Kataru RP, Aras O, Mehrara BJ. Topical captopril: a promising treatment for secondary lymphedema. Transl Res 2023; 257:43-53. [PMID: 36736951 PMCID: PMC10192126 DOI: 10.1016/j.trsl.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [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: 01/25/2023] [Indexed: 02/04/2023]
Abstract
Transforming growth factor-beta 1 (TGF-β1)-mediated tissue fibrosis is an important regulator of lymphatic dysfunction in secondary lymphedema. However, TGF-β1 targeting can cause toxicity and autoimmune complications, limiting clinical utility. Angiotensin II (Ang II) modulates intracellular TGF-β1 signaling, and inhibition of Ang II production using angiotensin-converting enzyme (ACE) inhibitors, such as captopril, has antifibrotic efficacy in some pathological settings. Therefore, we analyzed the expression of ACE and Ang II in clinical lymphedema biopsy specimens from patients with unilateral breast cancer-related lymphedema (BCRL) and mouse models, and found that cutaneous ACE expression is increased in lymphedematous tissues. Furthermore, topical captopril decreases fibrosis, activation of intracellular TGF-β1 signaling pathways, inflammation, and swelling in mouse models of lymphedema. Captopril treatment also improves lymphatic function and immune cell trafficking by increasing collecting lymphatic pumping. Our results show that the renin-angiotensin system in the skin plays an important role in the regulation of fibrosis in lymphedema, and inhibition of this signaling pathway may hold merit for treating lymphedema.
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Affiliation(s)
- Stav Brown
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gabriela D G Nores
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ananta Sarker
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Catherine Ly
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Claire Li
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hyeung Ju Park
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Geoffrey E Hespe
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jason Gardenier
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kevin Kuonqui
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Adana Campbell
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jinyeon Shin
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Raghu P Kataru
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Omer Aras
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Babak J Mehrara
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York.
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Brown S, Campbell AC, Kuonqui K, Sarker A, Park HJ, Shin J, Kataru RP, Coriddi M, Dayan JH, Mehrara BJ. The Future of Lymphedema: Potential Therapeutic Targets for Treatment. Curr Breast Cancer Rep 2023; 15:1-9. [PMID: 37359311 PMCID: PMC10233555 DOI: 10.1007/s12609-023-00491-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 06/28/2023]
Abstract
Purpose of Review This review aims to summarize the current knowledge regarding the pharmacological interventions studied in both experimental and clinical trials for secondary lymphedema. Recent Findings Lymphedema is a progressive disease that results in tissue swelling, pain, and functional disability. The most common cause of secondary lymphedema in developed countries is an iatrogenic injury to the lymphatic system during cancer treatment. Despite its high incidence and severe sequelae, lymphedema is usually treated with palliative options such as compression and physical therapy. However, recent studies on the pathophysiology of lymphedema have explored pharmacological treatments in preclinical and early phase clinical trials. Summary Many potential treatment options for lymphedema have been explored throughout the past two decades including systemic agents and topical approaches to decrease the potential toxicity of systemic treatment. Treatment strategies including lymphangiogenic factors, anti-inflammatory agents, and anti-fibrotic therapies may be used independently or in conjunction with surgical approaches.
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Affiliation(s)
- Stav Brown
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
| | - Adana C. Campbell
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
| | - Kevin Kuonqui
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
| | - Ananta Sarker
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
| | - Hyeung Ju Park
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
| | - Jinyeon Shin
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
| | - Raghu P. Kataru
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
| | - Michelle Coriddi
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
| | - Joseph H. Dayan
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
| | - Babak J. Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
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Park HJ, Kataru RP, Shin J, Garc A Nores GD, Encarnacion EM, Klang MG, Riedel E, Coriddi M, Dayan JH, Mehrara BJ. Keratinocytes coordinate inflammatory responses and regulate development of secondary lymphedema. bioRxiv 2023:2023.01.20.524936. [PMID: 36711669 PMCID: PMC9882288 DOI: 10.1101/2023.01.20.524936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Epidermal changes are histological hallmarks of secondary lymphedema, but it is unknown if keratinocytes contribute to its pathophysiology. Using clinical lymphedema specimens and mouse models, we show that keratinocytes play a primary role in lymphedema development by producing T-helper 2 (Th2) -inducing cytokines. Specifically, we find that keratinocyte proliferation and expression of protease-activated receptor 2 (PAR2) are early responses following lymphatic injury and regulate the expression of Th2-inducing cytokines, migration of Langerhans cells, and skin infiltration of Th2-differentiated T cells. Furthermore, inhibition of PAR2 activation with a small molecule inhibitor or the proliferation inhibitor teriflunomide (TF) prevents activation of keratinocytes stimulated with lymphedema fluid. Finally, topical TF is highly effective for decreasing swelling, fibrosis, and inflammation in a preclinical mouse model. Our findings suggest that lymphedema is a chronic inflammatory skin disease, and topically targeting keratinocyte activation may be a clinically effective therapy for this condition.
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Park MJ, Lee SE, Yoon W, Park HJ, Kim SH, Oh SH, Lee DG, Pyeon DB, Kim EY, Park SP. Effect of supplementation of cryoprotectant solution with hydroxypropyl cellulose for vitrification of bovine oocytes. Cryo Letters 2023; 44:37-46. [PMID: 36629840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Successful cryopreservation of bovine oocytes is very important for research and commercial applications. However, the survival and development rate of vitrified-thawed (VT) oocytes are lower than those of non-vitrified-thawed (non-VT) oocytes. OBJECTIVE To investigate the effect of adding hydroxypropyl cellulose (HPC) to the vitrification solution for bovine oocytes. MATERIALS AND METHODS For vitrification, bovine metaphase II oocytes were pretreated with a solution containing 10% ethylene glycol supplemented with 0, 10, 50, or 100 ug/mL HPC for 5 min, exposed to a solution containing 30% ethylene glycol supplemented with 0, 10, 50, or 100 ug/mL HPC for 30 s, and then directly plunged into liquid nitrogen. RESULTS The survival rate of oocytes was significantly higher in the 50 HPC group than in the 0, 10, and 100 HPC groups. The reactive oxygen species level was lower in the non-VT and 50 HPC groups than in the other groups. The mRNA levels of proapoptotic genes (Bax) were lower in the non-VT, 0, and 50 HPC groups than in the other groups. The mRNA levels of antiapoptotic genes (BCl2) were higher in the non-VT than in the other groups. The development rates of embryos (day 8) obtained via parthenogenetic activation (PA) were determined in the non-VT, 0 HPC, and 50 HPC groups. The cleavage rate was significantly higher in the non-VT group. CONCLUSION Supplementation of vitrification solution with HPC improves the survival of VT bovine oocytes and the development capacity of embryos derived from these oocytes via PA. doi.org/10.54680/fr23110110212.
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Affiliation(s)
- M J Park
- Jeju National University Stem Cell Research Center, Seoul 63243; Faculty of Biotechnology, College of Applied Life Sciences, Jeju National University, Jeju 63243, Korea
| | - S E Lee
- Jeju National University Stem Cell Research Center, Seoul 63243; Faculty of Biotechnology, College of Applied Life Sciences, Jeju National University, Jeju 63243, Korea
| | - W Yoon
- Faculty of Biotechnology, College of Applied Life Sciences, Jeju National University, Jeju 63243, Korea
| | - H J Park
- Jeju National University Stem Cell Research Center, Seoul 63243; Faculty of Biotechnology, College of Applied Life Sciences, Jeju National University, Jeju 63243, Korea
| | - S H Kim
- Jeju National University Stem Cell Research Center, Seoul 63243; Faculty of Biotechnology, College of Applied Life Sciences, Jeju National University, Jeju 63243, Korea
| | - S H Oh
- Jeju National University Stem Cell Research Center, Seoul 63243; Faculty of Biotechnology, College of Applied Life Sciences, Jeju National University, Jeju 63243, Korea
| | - D G Lee
- Jeju National University Stem Cell Research Center, Seoul 63243; Faculty of Biotechnology, College of Applied Life Sciences, Jeju National University, Jeju 63243, Korea
| | - D B Pyeon
- Faculty of Biotechnology, College of Applied Life Sciences, Jeju National University, Jeju 63243, Korea
| | - E Y Kim
- Jeju National University Stem Cell Research Center, Seoul 63243; Faculty of Biotechnology, College of Applied Life Sciences, Jeju National University, Jeju 63243; Mirae Cell Bio Inc., Seoul 04795, Korea
| | - S P Park
- Jeju National University Stem Cell Research Center, Seoul 63243; Faculty of Biotechnology, College of Applied Life Sciences, Jeju National University, Jeju 63243; Mirae Cell Bio Inc., Seoul 04795, Korea.
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11
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Campbell AC, Fei T, Baik JE, Park HJ, Shin J, Kuonqui K, Brown S, Sarker A, Kataru RP, Mehrara BJ. Skin microbiome alterations in upper extremity secondary lymphedema. PLoS One 2023; 18:e0283609. [PMID: 37196005 DOI: 10.1371/journal.pone.0283609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/13/2023] [Indexed: 05/19/2023] Open
Abstract
Lymphedema is a chronic condition that commonly occur from lymphatic injury following surgical resection of solid malignancies. While many studies have centered on the molecular and immune pathways that perpetuate lymphatic dysfunction, the role of the skin microbiome in lymphedema development remains unclear. In this study, skin swabs collected from normal and lymphedema forearms of 30 patients with unilateral upper extremity lymphedema were analyzed by 16S ribosomal RNA sequencing. Statistical models for microbiome data were utilized to correlate clinical variables with microbial profiles. Overall, 872 bacterial taxa were identified. There were no significant differences in microbial alpha diversity of the colonizing bacteria between normal and lymphedema skin samples (p = 0.25). Notably, for patients without a history of infection, a one-fold change in relative limb volume was significantly associated with a 0.58-unit increase in Bray-Curtis microbial distance between paired limbs (95%CI = 0.11,1.05, p = 0.02). Additionally, several genera, including Propionibacterium and Streptococcus, demonstrated high variability between paired samples. In summary, we demonstrate high compositional heterogeneity in the skin microbiome in upper extremity secondary lymphedema, supporting future studies into the role of host-microbe interactions on lymphedema pathophysiology.
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Affiliation(s)
- Adana-Christine Campbell
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, NY, United States of America
| | - Teng Fei
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Jung Eun Baik
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, NY, United States of America
| | - Hyeung Ju Park
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, NY, United States of America
| | - Jinyeon Shin
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, NY, United States of America
| | - Kevin Kuonqui
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, NY, United States of America
| | - Stav Brown
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, NY, United States of America
| | - Ananta Sarker
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, NY, United States of America
| | - Raghu P Kataru
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, NY, United States of America
| | - Babak J Mehrara
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, NY, United States of America
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Lee SE, Choi YS, Park HJ, Do JH. Gastrointestinal: Ampullary tumor growing into ventral pancreatic duct in incomplete pancreas divisum. J Gastroenterol Hepatol 2022. [PMID: 36524451 DOI: 10.1111/jgh.16080] [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] [Received: 09/30/2022] [Revised: 11/04/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Affiliation(s)
- S E Lee
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Y-S Choi
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - H J Park
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Korea
| | - J H Do
- Division of Gastroenterology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
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Li CY, Park HJ, Shin J, Baik JE, Mehrara BJ, Kataru RP. Tumor-Associated Lymphatics Upregulate MHC-II to Suppress Tumor-Infiltrating Lymphocytes. Int J Mol Sci 2022; 23:ijms232113470. [PMID: 36362253 PMCID: PMC9654328 DOI: 10.3390/ijms232113470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 09/22/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
Steady-state lymphatic endothelial cells (LECs) can induce peripheral tolerance by presenting endogenous antigens on MHC class I (MHC-I) molecules. Recent evidence suggests that lymph node LECs can cross-present tumor antigens on MHC-I to suppress tumor-specific CD8+ T cells. Whether LECs can act as immunosuppressive cells in an MHC-II dependent manner in the local tumor microenvironment (TME) is not well characterized. Using murine heterotopic and spontaneous tumor models, we show that LECs in the TME increase MHC-II expression in the context of increased co-inhibitory signals. We provide evidence that tumor lymphatics in human melanoma and breast cancer also upregulate MHC-II compared to normal tissue lymphatics. In transgenic mice that lack LEC-specific MHC-II expression, heterotopic tumor growth is attenuated, which is associated with increased numbers of tumor-specific CD8+ and effector CD4+ T cells, as well as decreased numbers of T regulatory CD4+ cells in the TME. Mechanistically, we show that murine and human dermal LECs can take up tumor antigens in vitro. Antigen-loaded LECs in vitro can induce antigen-specific proliferation of CD8+ T cells but not CD4+ T cells; however, these proliferated CD8+ T cells have reduced effector function in the presence of antigen-loaded LECs. Taken together, our study suggests LECs can act as immunosuppressive cells in the TME in an MHC-II dependent manner. Whether this is a result of direct tumor antigen presentation on MHC-II requires additional investigation.
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Affiliation(s)
| | | | | | | | - Babak J. Mehrara
- Correspondence: (B.J.M.); (R.P.K.); Tel.: +1-646-888-3201 (B.J.M. & R.P.K.); Fax: +1-646-888-3200 (B.J.M. & R.P.K.)
| | - Raghu P. Kataru
- Correspondence: (B.J.M.); (R.P.K.); Tel.: +1-646-888-3201 (B.J.M. & R.P.K.); Fax: +1-646-888-3200 (B.J.M. & R.P.K.)
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Park HJ, An WS, Rha SH, Kim SE, Lee SM. Minimal change glomerulonephritis following the second dose of the Moderna COVID-19 vaccine. QJM 2022; 115:490-491. [PMID: 35380707 PMCID: PMC9383619 DOI: 10.1093/qjmed/hcac094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 03/30/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - S H Rha
- Department of Pathology, College of Medicine, Dong-A University, 26, Daesingongwon-ro, Dongdaesin-dong 3-ga, Seo-gu, Busan 49201, Republic of Korea
| | | | - S M Lee
- Address correspondence to Dr Su Mi Lee, Department of Internal Medicine, College of Medicine, Dong-A University, 26 Daesingongwon-ro, Seo-gu, Busan 49201, Republic of Korea.
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Baik JE, Park HJ, Kataru RP, Savetsky IL, Ly CL, Shin J, Encarnacion EM, Cavali MR, Klang MG, Riedel E, Coriddi M, Dayan JH, Mehrara BJ. TGF-β1 mediates pathologic changes of secondary lymphedema by promoting fibrosis and inflammation. Clin Transl Med 2022; 12:e758. [PMID: 35652284 PMCID: PMC9160979 DOI: 10.1002/ctm2.758] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 11/01/2021] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 11/15/2022] Open
Abstract
Background Secondary lymphedema is a common complication of cancer treatment, and previous studies have shown that the expression of transforming growth factor‐beta 1 (TGF‐β1), a pro‐fibrotic and anti‐lymphangiogenic growth factor, is increased in this disease. Inhibition of TGF‐β1 decreases the severity of the disease in mouse models; however, the mechanisms that regulate this improvement remain unknown. Methods Expression of TGF‐β1 and extracellular matrix molecules (ECM) was assessed in biopsy specimens from patients with unilateral breast cancer‐related lymphedema (BCRL). The effects of TGF‐β1 inhibition using neutralizing antibodies or a topical formulation of pirfenidone (PFD) were analyzed in mouse models of lymphedema. We also assessed the direct effects of TGF‐β1 on lymphatic endothelial cells (LECs) using transgenic mice that expressed a dominant‐negative TGF‐β receptor selectively on LECs (LECDN‐RII). Results The expression of TGF‐β1 and ECM molecules is significantly increased in BCRL skin biopsies. Inhibition of TGF‐β1 in mouse models of lymphedema using neutralizing antibodies or with topical PFD decreased ECM deposition, increased the formation of collateral lymphatics, and inhibited infiltration of T cells. In vitro studies showed that TGF‐β1 in lymphedematous tissues increases fibroblast, lymphatic endothelial cell (LEC), and lymphatic smooth muscle cell stiffness. Knockdown of TGF‐β1 responsiveness in LECDN‐RII resulted in increased lymphangiogenesis and collateral lymphatic formation; however, ECM deposition and fibrosis persisted, and the severity of lymphedema was indistinguishable from controls. Conclusions Our results show that TGF‐β1 is an essential regulator of ECM deposition in secondary lymphedema and that inhibition of this response is a promising means of treating lymphedema.
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Affiliation(s)
- Jung Eun Baik
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hyeung Ju Park
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Raghu P Kataru
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ira L Savetsky
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Catherine L Ly
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jinyeon Shin
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elizabeth M Encarnacion
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michele R Cavali
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark G Klang
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elyn Riedel
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michelle Coriddi
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph H Dayan
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Babak J Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Park HJ, Kataru RP, Shin JP, Mehrara BJ. Epithelial mesenchymal transition of epithelial cells induced by TGF-β signaling in lymphedema. The Journal of Immunology 2022. [DOI: 10.4049/jimmunol.208.supp.48.07] [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] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Abstract
TGF-β driven fibrosis of the skin is a key pathologic feature of secondary lymphedema. However, the cellular mechanisms that regulate this process remain unknown. Epithelial mesenchymal transition (EMT) is a mechanism by which TGF-β induces fibrosis in other skin diseases. This process is characterized by loss of epithelial cell markers and polarity and increased migratory capacity and invasiveness. Therefore, the purpose of this study was to determine if EMT of skin keratinocytes is activated in lymphedema and if this process is mediated by TGF-β.
Using clinical lymphedema biopsy specimens and mouse models of lymphedema, we found that lymphedema results in fibrosis in the papillary dermis and a greater number of rete ridges in the basal layer of epithelium. Keratinocytes in the basal layer of lymphedematous skin express EMT markers (vimentin, fsp1, itgb4, slug, mmp9, twist) and fail to express epithelial markers (keratin14, E-cadherin). Interestingly, we found psamd3 expression in these EMT-like epithelial cells with accumulated TGF-β in papillary dermis by immunohistochemistry. Inhibition of TGF-β signaling markedly decreased EMT and prevented development of fibrosis in a mouse model. To determine if EMT of epithelial cells is induced by lymphedema fluid in skin, we treated keratinocytes with lymph fluid obtained from patients with lymphedema and analyzed in cultures with or without TGF-β inhibitors. We found that keratinocytes cultured with arm fluid only rapidly underwent EMT. In contrast, inhibition of TGF-β signaling prevented this response. Taken together, our findings show for the first time that EMT is activated by TGF-β signaling in lymphedema and that this process plays an important role in the pathology of this disease.
Supported by grants from NIH (R01HL111130).
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Affiliation(s)
- Hyeung Ju Park
- 1Plastic surgery, Memorial Sloan Kettering Cancer Center
| | - Raghu P Kataru
- 1Plastic surgery, Memorial Sloan Kettering Cancer Center
| | - Jinyeon P Shin
- 1Plastic surgery, Memorial Sloan Kettering Cancer Center
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17
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Kataru RP, Park HJ, Shin J, Baik JE, Sarker A, Brown S, Mehrara BJ. Structural and Functional Changes in Aged Skin Lymphatic Vessels. Front Aging 2022; 3:864860. [PMID: 35821848 PMCID: PMC9261401 DOI: 10.3389/fragi.2022.864860] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/11/2022] [Indexed: 11/13/2022]
Abstract
Lymphatic structure and function play a critical role in fluid transport, antigen delivery, and immune homeostasis. A dysfunctional lymphatic system is associated with chronic low-grade inflammation of peripheral tissues, poor immune responses, and recurrent infections, which are also hallmarks of aging pathology. Previous studies have shown that aging impairs lymphatic structure and function in a variety of organ systems, including the intestines and central nervous system. However, previous studies are mostly limited to qualitative analysis of lymphatic structural changes and quantification of intestinal collecting vessel contractile function. It is not clear whether decreased lymphatic function contributes to pathological conditions related to aging, nor how it affects the skin immune microenvironment. Further, the effects of aging on skin initial and collecting lymphatic vessels, dendritic cell (DC) migration, cutaneous lymphatic pumping, and VEGFR-3 signaling in lymphatic endothelial cells (LECs) have not been quantitatively analyzed. Here, using fluorescent immunohistochemistry and flow cytometry, we confirm that aging decreases skin initial and collecting lymphatic vessel density. Indocyanine green (ICG) lymphangiography and DC migration assays confirm that aging decreases both fluid pumping and cell migration via lymphatic vessels. At the cellular level, aging causes decreased VEGFR-3 signaling, leading to increased LEC apoptosis and senescence. Finally, we determined that aging causes decreased lymphatic production of chemokines and alters LEC expression of junctional and adhesion molecules. This in turn leads to increased peri-lymphatic inflammation and nitrosative stress that might contribute to aging pathology in a feed-forward manner. Taken together, our study, in addition to quantitatively corroborating previous findings, suggests diverse mechanisms that contribute to lymphatic dysfunction in aging that in turn exacerbate the pathology of aging in a feed-forward manner.
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Affiliation(s)
- Raghu P. Kataru
- The Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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Brown S, Dayan JH, Coriddi M, Campbell A, Kuonqui K, Shin J, Park HJ, Mehrara BJ, Kataru RP. Pharmacological Treatment of Secondary Lymphedema. Front Pharmacol 2022; 13:828513. [PMID: 35145417 PMCID: PMC8822213 DOI: 10.3389/fphar.2022.828513] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/07/2022] [Indexed: 12/12/2022] Open
Abstract
Lymphedema is a chronic disease that results in swelling and decreased function due to abnormal lymphatic fluid clearance and chronic inflammation. In Western countries, lymphedema most commonly develops following an iatrogenic injury to the lymphatic system during cancer treatment. It is estimated that as many as 10 million patients suffer from lymphedema in the United States alone. Current treatments for lymphedema are palliative in nature, relying on compression garments and physical therapy to decrease interstitial fluid accumulation in the affected extremity. However, recent discoveries have increased the hopes of therapeutic interventions that may promote lymphatic regeneration and function. The purpose of this review is to summarize current experimental pharmacological strategies in the treatment of lymphedema.
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Park MJ, Lee SE, Yoon W, Park HJ, Kim SH, Oh SH, Lee DG, Pyeon DB, Kim EY, Park SP. Effect of supplementation of cryoprotectant solution with hydroxypropyl cellulose for vitrification of bovine oocytes. Cryo Letters 2022; 44:37-46. [PMID: 36625874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Successful cryopreservation of bovine oocytes is very important for research and commercial applications. However, the survival and development rate of vitrified-thawed (VT) oocytes are lower than those of non-vitrified-thawed (non-VT) oocytes. OBJECTIVE To investigate the effect of adding hydroxypropyl cellulose (HPC) to the vitrification solution for bovine oocytes. MATERIALS AND METHODS For vitrification, bovine metaphase II oocytes were pretreated with a solution containing 10% ethylene glycol supplemented with 0, 10, 50, or 100 ug/mL HPC for 5 min, exposed to a solution containing 30% ethylene glycol supplemented with 0, 10, 50, or 100 ug/mL HPC for 30 s, and then directly plunged into liquid nitrogen. RESULTS The survival rate of oocytes was significantly higher in the 50 HPC group than in the 0, 10, and 100 HPC groups. The reactive oxygen species level was lower in the non-VT and 50 HPC groups than in the other groups. The mRNA levels of proapoptotic genes (Bax) were lower in the non-VT, 0, and 50 HPC groups than in the other groups. The mRNA levels of antiapoptotic genes (BCl2) were higher in the non-VT than in the other groups. The development rates of embryos (day 8) obtained via parthenogenetic activation (PA) were determined in the non-VT, 0 HPC, and 50 HPC groups. The cleavage rate was significantly higher in the non-VT group. CONCLUSION Supplementation of vitrification solution with HPC improves the survival of VT bovine oocytes and the development capacity of embryos derived from these oocytes via PA. doi.org/10.54680/fr23110110212.
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Affiliation(s)
- M J Park
- Jeju National University Stem Cell Research Center, Seoul 63243; Faculty of Biotechnology, College of Applied Life Sciences, Jeju National University, Jeju 63243, Korea
| | - S E Lee
- Jeju National University Stem Cell Research Center, Seoul 63243; Faculty of Biotechnology, College of Applied Life Sciences, Jeju National University, Jeju 63243, Korea
| | - W Yoon
- Faculty of Biotechnology, College of Applied Life Sciences, Jeju National University, Jeju 63243, Korea
| | - H J Park
- Jeju National University Stem Cell Research Center, Seoul 63243; Faculty of Biotechnology, College of Applied Life Sciences, Jeju National University, Jeju 63243, Korea
| | - S H Kim
- Jeju National University Stem Cell Research Center, Seoul 63243; Faculty of Biotechnology, College of Applied Life Sciences, Jeju National University, Jeju 63243, Korea
| | - S H Oh
- Jeju National University Stem Cell Research Center, Seoul 63243; Faculty of Biotechnology, College of Applied Life Sciences, Jeju National University, Jeju 63243, Korea
| | - D G Lee
- Jeju National University Stem Cell Research Center, Seoul 63243; Faculty of Biotechnology, College of Applied Life Sciences, Jeju National University, Jeju 63243, Korea
| | - D B Pyeon
- Faculty of Biotechnology, College of Applied Life Sciences, Jeju National University, Jeju 63243, Korea
| | - E Y Kim
- Jeju National University Stem Cell Research Center, Seoul 63243; Faculty of Biotechnology, College of Applied Life Sciences, Jeju National University, Jeju 63243; Mirae Cell Bio Inc., Seoul 04795, Korea
| | - S P Park
- Jeju National University Stem Cell Research Center, Seoul 63243; Faculty of Biotechnology, College of Applied Life Sciences, Jeju National University, Jeju 63243; Mirae Cell Bio Inc., Seoul 04795, Korea.
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Cho SG, Kim YH, Park HJ, Park KS, Kim JH, Ahn SJ, Bom HS. Prediction of radiation-related cardiotoxicity using F-18 FDG PET in non-small-cell lung cancer. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2844] [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
Radiation-related cardiotoxicity has been refocused nowadays as the follow-up was increased amomg the patients with advanced lung cancer. The early recognition of the occult cardiotoxicity enables the early intervention preventing clinically significant cardiac events or worsening of severity.
Purpose
We aim to search whether the F-18 fluorodeoxyglucose positron emission tomography (FDG PET) performed immediately after radiotherapy could predict the late cardiac events.
Methods
We retrospectively enrolled 133 patients with locally advanced, unresectable stage III NSCLC who underwent F-18 fluorodeoxyglucose positron emission tomography (FDG PET) immediately after CCRT for the response evaluation and survived at least for 6 months. Heart was recontoured according to the RTOG 0617 secondary analysis atlas for the dose volume analysis. Standardized uptake values (SUV) of the left ventricular myocardium were measured on FDG PET images. The patients were regularly followed up for the disease progression and complications. The primary end-point was the cardiac events grade ≥2 based on the Common Terminology Criteria for Adverse Events (version 5.0).
Results
FDG PET was performed at median interval of 11 days after CCRT. Fourty-two patients experienced cardiotoxicity during a median follow-up of 47 months (range, 12 – 123 months). In univariable analysis, mean heart dose, maximum SUV of the left ventricle (LV SUVmax), white blood cell count, and diabetes were associated with the risk of cardiotoxicity. In multivariable analysis, only higher mean heart dose (>11.1 Gy, hazard ratio 3.930 [95% confidence interval 1.933–7.988]; p=0.0002) and higher LV SUVmax (>12.84, 2.189 [1.162–4.124]; p=0.0152) were independently associated with increased risk of cardiotoxicity. In subgroup analyses, LV SUVmax remained predictive of cardiotoxicity among those with higher mean heart dose, but not among those with lower mean heart dose.
Conclusion
Early FDG PET after CCRT for NSCLC could predict the late cardiac events, especially in patients with high dose cardiac irradiation.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by a grant of the Basic Science Research Program through the National Research Foundation funded by the Ministry of Education, Republic of Korea (Principal Investigator: Sang-Geon Cho)
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Affiliation(s)
- S G Cho
- Chonnam National University Hospital, Nuclear Medicine, Gwangju, Korea (Republic of)
| | - Y H Kim
- Chonnam National University Hwasun Hospital, Radiation Oncology, Hwasun, Korea (Republic of)
| | - H J Park
- Chonnam National University Hwasun Hospital, Cardiololgy, Hwasun, Korea (Republic of)
| | - K S Park
- Chonnam National University Hospital, Nuclear Medicine, Gwangju, Korea (Republic of)
| | - J H Kim
- Chonnam National University Hospital, Nuclear Medicine, Gwangju, Korea (Republic of)
| | - S J Ahn
- Chonnam National University Hwasun Hospital, Radiation Oncology, Hwasun, Korea (Republic of)
| | - H S Bom
- Chonnam National University Hwasun Hospital, Nuclear Medicine, Hwasun, Korea (Republic of)
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21
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Kataru RP, Baik JE, Park HJ, Ly CL, Shin J, Schwartz N, Lu TT, Ortega S, Mehrara BJ. Lymphatic-specific intracellular modulation of receptor tyrosine kinase signaling improves lymphatic growth and function. Sci Signal 2021; 14:14/695/eabc0836. [PMID: 34376570 DOI: 10.1126/scisignal.abc0836] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Exogenous administration of lymphangiogenic growth factors is widely used to study changes in lymphatic function in pathophysiology. However, this approach can result in off-target effects, thereby generating conflicting data. To circumvent this issue, we modulated intracellular VEGF-C signaling by conditionally knocking out the lipid phosphatase PTEN using the Vegfr3 promoter to drive the expression of Cre-lox in lymphatic endothelial cells (LECs). PTEN is an intracellular brake that inhibits the downstream effects of the activation of VEGFR3 by VEGF-C. Activation of Cre-lox recombination in adult mice resulted in an expanded functional lymphatic network due to LEC proliferation that was independent of lymphangiogenic growth factor production. Furthermore, compared with lymphangiogenesis induced by VEGF-C injection, LECPTEN animals had mature, nonleaky lymphatics with intact cell-cell junctions and reduced local tissue inflammation. Last, compared with wild-type or VEGF-C-injected mice, LECPTEN animals had an improved capacity to resolve inflammatory responses. Our findings indicate that intracellular modulation of lymphangiogenesis is effective in inducing functional lymphatic networks and has no off-target inflammatory effects.
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Affiliation(s)
- Raghu P Kataru
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY 10065, USA.
| | - Jung Eun Baik
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY 10065, USA
| | - Hyeung Ju Park
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY 10065, USA
| | - Catherine L Ly
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY 10065, USA
| | - Jinyeon Shin
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY 10065, USA
| | - Noa Schwartz
- Autoimmunity and Inflammation Program and Rheumatology, Hospital for Special Surgery, New York, NY 10021, USA
| | - Theresa T Lu
- Autoimmunity and Inflammation Program and Rheumatology, Hospital for Special Surgery, New York, NY 10021, USA.,Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Sagrario Ortega
- Transgenic Mice Unit, Biotechnology Programme, Spanish National Cancer Research Center (CNIO), Madrid, 20829, Spain
| | - Babak J Mehrara
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY 10065, USA
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22
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Dasoveanu DC, Park HJ, Ly CL, Shipman WD, Chyou S, Kumar V, Tarlinton D, Ludewig B, Mehrara BJ, Lu TT. Lymph node stromal CCL2 limits antibody responses. Sci Immunol 2020; 5:5/45/eaaw0693. [PMID: 32198221 DOI: 10.1126/sciimmunol.aaw0693] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 11/26/2019] [Accepted: 02/11/2020] [Indexed: 12/12/2022]
Abstract
Nonhematopoietic stromal cells in lymph nodes such as fibroblastic reticular cells (FRCs) can support the survival of plasmablasts and plasma cells [together, antibody-forming cells (AFCs)]. However, a regulatory function for the stromal compartment in AFC accumulation has not been appreciated. Here, we show that chemokine ligand 2 (CCL2)-expressing stromal cells limit AFC survival. FRCs express high levels of CCL2 in vessel-rich areas of the T cell zone and the medulla, where AFCs are located. FRC CCL2 is up-regulated during AFC accumulation, and we use lymph node transplantation to show that CCL2 deficiency in BP3+ FRCs and lymphatic endothelial cells increases AFC survival without affecting B or germinal center cell numbers. Monocytes are key expressers of the CCL2 receptor CCR2, as monocyte depletion and transfer late in AFC responses increases and decreases AFC accumulation, respectively. Monocytes express reactive oxygen species (ROS) in an NADPH oxidase 2 (NOX2)-dependent manner, and NOX2-deficient monocytes fail to reduce AFC numbers. Stromal CCL2 modulates both monocyte accumulation and ROS production, and is regulated, in part, by manipulations that modulate vascular permeability. Together, our results reveal that the lymph node stromal compartment, by influencing monocyte accumulation and functional phenotype, has a regulatory role in AFC survival. Our results further suggest a role for inflammation-induced vascular activity in tuning the lymph node microenvironment. The understanding of stromal-mediated AFC regulation in vessel-rich environments could potentially be harnessed to control antibody-mediated autoimmunity.
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Affiliation(s)
- Dragos C Dasoveanu
- Physiology Biophysics and Systems Biology, Weill Cornell Graduate School of Medical Sciences, New York, NY 10065, USA.,Autoimmunity and Inflammation Program, Hospital for Special Surgery Research Institute, New York, NY 10021, USA
| | - Hyeung Ju Park
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Catherine L Ly
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - William D Shipman
- Autoimmunity and Inflammation Program, Hospital for Special Surgery Research Institute, New York, NY 10021, USA.,Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program, New York, NY 10065, USA.,Immunology and Microbial Pathogenesis Program, Weill Cornell Graduate School of Medical Sciences, New York, NY 10065, USA
| | - Susan Chyou
- Autoimmunity and Inflammation Program, Hospital for Special Surgery Research Institute, New York, NY 10021, USA
| | - Varsha Kumar
- Autoimmunity and Inflammation Program, Hospital for Special Surgery Research Institute, New York, NY 10021, USA
| | - David Tarlinton
- Department of Immunology and Pathology, Monash University, Melbourne, Victoria 3004, Australia
| | - Burkhard Ludewig
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen CH-9007, Switzerland.,Institute of Experimental Immunology, University of Zürich, Zürich CH-8057, Switzerland
| | - Babak J Mehrara
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Theresa T Lu
- Autoimmunity and Inflammation Program, Hospital for Special Surgery Research Institute, New York, NY 10021, USA. .,Immunology and Microbial Pathogenesis Program, Weill Cornell Graduate School of Medical Sciences, New York, NY 10065, USA.,Pediatric Rheumatology, Hospital for Special Surgery, New York, NY 10021, USA.,Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY 10065, USA
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23
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Li C, Kataru R, Shin J, Ju Park H, Baik J, Mehrara BJ. Major Histocompatibility Complex II (MHC-II) Dependent Programmed Death-Ligand 1 (PD-L1) Expression on Lymphatic Endothelial Cells (LECs) Promotes Growth of B16F10 Melanoma. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.597] [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: 11/26/2022]
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24
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Cho BH, Cheon K, Lee KY, Jung YH, Han SW, Park JH, Choi HY, Cho HJ, Park HJ, Nam HS, Heo JH, Lee HS, Kim S, Kim YD. Association between body mass index and stroke severity in acute ischaemic stroke with non-valvular atrial fibrillation. Eur J Neurol 2020; 27:1672-1679. [PMID: 32392368 DOI: 10.1111/ene.14304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 04/30/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE The objective of this study was to investigate the association between body mass index (BMI) and both initial stroke severity at presentation and functional outcomes after acute ischaemic stroke (AIS) in patients with non-valvular atrial fibrillation (NVAF). METHODS Patients were categorized on the basis of their BMI into underweight (BMI <18.5, n = 111), normal (18.5 ≤ BMI <25, n = 1036) and overweight to obese (BMI ≥25, n = 472) groups. Initial stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) score and functional outcomes were assessed using the modified Rankin Scale score at discharge. The differences in stroke severity and functional outcomes were compared between groups using robust log-linear regression with a Poisson distribution and binary logistic regression analysis. RESULTS A total of 1619 AIS patients with NVAF from six hospitals were included. Compared with the NIHSS scores [median 5, interquartile range (IQR) 2-14] of normal-weight patients, the NIHSS scores (median 9, IQR 4-19) of underweight patients were more likely to be higher, whereas those of overweight to obese patients were lower (median 4, IQR 1-12) (P < 0.001). In terms of functional outcomes after stroke, underweight patients had a higher risk of poor functional outcomes (odds ratio 1.78, 95% confidence interval 1.09-2.56, P = 0.01) but overweight to obese patients had no significant difference in functional outcomes compared with normal-weight patients. CONCLUSION An inverse association was found between BMI and stroke severity in AIS patients with NVAF. This suggests the presence of an obesity paradox for short-term outcomes in patients with NVAF.
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Affiliation(s)
- B-H Cho
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.,Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea
| | - K Cheon
- Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea
| | - K-Y Lee
- Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea
| | - Y H Jung
- Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea.,Department of Neurology, Changwon Fatima Hospital, Changwon, Korea
| | - S W Han
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - J H Park
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - H-Y Choi
- Department of Neurology, Kyung Hee University School of Medicine, Kyung Hee University Hospital, Gangdong, Seoul, Korea
| | - H-J Cho
- Department of Neurology, Pusan National University Hospital, Pusan National University College of Medicine and Biomedical Research Institute, Busan, Korea
| | - H J Park
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.,Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu, Korea
| | - H S Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - J H Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - H S Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - S Kim
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Y D Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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25
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Ko A, Park HJ, Lee ES, Park SB, Kim YK, Choi SY, Ahn S. Comparison of the diagnostic performance of the 2017 and 2018 versions of LI-RADS for hepatocellular carcinoma on gadoxetic acid enhanced MRI. Clin Radiol 2019; 75:319.e1-319.e9. [PMID: 31858990 DOI: 10.1016/j.crad.2019.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 11/13/2019] [Indexed: 12/18/2022]
Abstract
AIM To compare the diagnostic performance of the 2017 (v2017) and 2018 versions (v2018) of the Liver Imaging-Reporting and Data System (LI-RADS) for hepatocellular carcinoma (HCC) using gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-MRI) and to evaluate the effect in v2018. MATERIALS AND METHODS Treatment-naive patients at high-risk for HCC who underwent Gd-EOB-MRI were included. The LI-RADS categories were assigned according to v2017 and v2018. The diagnostic performances were compared between v2017 and v2018 according to the size and combination of imaging features. RESULTS A total of 117 patients with 137 observations were identified, including 89 HCCs; 76.2% (64/84) of observations with threshold growth were re-classified as subthreshold growth when using v2018 instead of v2017. The final categories changed in nine (14%) cases. For the combination of LR-5/LR-5V, there were no significant differences in sensitivity and specificity between the two versions (sensitivity, 64% versus 58.4%; specificity, 87.5% versus 85.4%; all p>0.05). For the combination of LR-4 and LR-5/5V, the diagnostic performance of v2018 was inferior to that of v2017 when considering only major features (accuracy, 86.1% versus 80.3%, respectively; p=0.013), particularly in observations measuring 10-20 mm, but was comparable after adding the ancillary features (accuracy, 86.9% versus 86.1%, respectively; p=1.00). CONCLUSION In LI-RADS v2018, although a considerable number of observations re-classified subthreshold growth, changes in the assigned categories were insignificant; overall diagnostic performance was comparable to that of v2017, but v2018 might emphasise the value of ancillary features in combination with major features for determining the probability of HCC.
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Affiliation(s)
- A Ko
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - H J Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea.
| | - E S Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - S B Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Y K Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - S-Y Choi
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - S Ahn
- Department of Mathematics, Ajou University, Suwon, Republic of Korea
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26
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Park HJ, Cho JH, Kim HJ, Park JY, Lee HS, Byun MK. The effect of low body mass index on the development of chronic obstructive pulmonary disease and mortality. J Intern Med 2019; 286:573-582. [PMID: 31215064 DOI: 10.1111/joim.12949] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sarcopenia may worsen disease progression and lead to poor outcomes in chronic obstructive pulmonary disease (COPD). OBJECTIVES We aimed to determine the effect of BMI on the development of COPD and mortality. METHODS We enrolled 437 584 participants registered in the physical health check-up cohort database of the Korean National Health Interview Survey from 2002 to 2003, and we defined COPD diagnosis based on the ICD-10 code and prescribed medication. BMI (kg m-2 ) classified them to five groups (low BMI < 18.5, normal BMI 18.5-23, overweight 23-25, obesity 25-30, severe obesity ≥30) at baseline. RESULTS Participants in the low BMI group had a significantly higher rate of COPD development for 13 years (7.6%) than those in other groups (3.4-4.1%, P < 0.0001). Amongst never or light smokers, COPD development in the low BMI group (5.6-6.7%) was significantly higher than that in other groups (2.8-4.7%). Similarly, amongst participants with a smoking history of ≥30 years, COPD development in the low BMI group (20.1%) was higher than those in other groups (8.4-12.4%). On multivariable analysis, normal or higher than normal body weight was significantly protective against the development of COPD (hazard ratio [HR], 0.609-0.739,) compared to low BMI. COPD-free-survival (HR, 0.491-0.622) and overall survival (HR, 0.440-0.585) were also better in them compared to those with low BMI (all P < 0.0001). CONCLUSIONS Low BMI is an important risk factor for COPD development and mortality. Maintaining adequate body weight may reduce the risk for COPD development and mortality.
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Affiliation(s)
- H J Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - J H Cho
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - H J Kim
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - J-Y Park
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - H S Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - M K Byun
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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27
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Bae SA, Yoon HJ, Kim KH, Kim HY, Park HJ, Cho JY, Jeong MH, Park JC. P671Impacts of echocardiography-defined pulmonary hypertension on clinical outcome in patients with multiple myeloma. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0277] [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: 11/14/2022] Open
Abstract
Abstract
Background
Pulmonary hypertension (PH) is a rarely reported complication of multiple myeloma (MM). PH of MM is usually mild to moderate and can be secondary to a variety of conditions, including left ventricular dysfunction, diastolic dysfunction, chronic heart failure, treatment-related toxicity, thrombophilic condition and precapillary involvement. However, only few reports regarding PH in MM incidence and prognosis exist up to now.
Purpose
The purpose of this study was to investigate the risk factors of transthoracic echocardiography-defined PH and its impact on clinical outcome in patients with MM.
Methods
A total of 277 MM patients was included and divided into 2 groups–those non-pulmonary hypertension (PH) or those with PH, based on the results of the transthoracic echocardiography (TTE); PH group (n=143, 60.9±9.2 years, 68 males) versus non-PH group (n=134, 55.9±11.5 years, 72 males). We analyzed propensity score matching and multiple imputation method were used to deal with the missing data in echocardiographic characteristics.
Results
During the follow-up period (median 618 days), all-cause death occurred in 79 (28.5%) patients and 41 patients (14.8%) died from cardiovascular causes (including acute decompensated heart failure, fatal MI, sudden cardiac arrest). In the Kaplan-Meier survival analysis of crude population and propensity-matched population, cumulative overall survival and cardiovascular death (CVD)-free survival were significantly lower in the PH group than in the non-PH group (p<0.001). In propensity-matched population, estimated pulmonary artery pressure >35mmHg in TTE, congestive heart failure, and DM were significant independent predictors of all-cause death.
KM curves in MM stratified by PH
Conclusion
This study demonstrates that the presence of PH, congestive heart failure, and DM is an independent prognostic factor for all-cause death in MM patients with MM. These results highlight the risk associated cardiovascular disease in MM patients and emphasize that management strategies that prevent deterioration of cardiac function are essential.
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Affiliation(s)
- S A Bae
- Chonnam National University Medical School, Department of Cardiovascular Medicine, Gwangju, Korea (Republic of)
| | - H J Yoon
- Chonnam National University Medical School, Department of Cardiovascular Medicine, Gwangju, Korea (Republic of)
| | - K H Kim
- Chonnam National University Medical School, Department of Cardiovascular Medicine, Gwangju, Korea (Republic of)
| | - H Y Kim
- Chonnam National University Medical School, Department of Cardiovascular Medicine, Gwangju, Korea (Republic of)
| | - H J Park
- Chonnam National University Medical School, Department of Cardiovascular Medicine, Gwangju, Korea (Republic of)
| | - J Y Cho
- Chonnam National University Medical School, Department of Cardiovascular Medicine, Gwangju, Korea (Republic of)
| | - M H Jeong
- Chonnam National University Medical School, Department of Cardiovascular Medicine, Gwangju, Korea (Republic of)
| | - J C Park
- Chonnam National University Medical School, Department of Cardiovascular Medicine, Gwangju, Korea (Republic of)
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28
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Kataru RP, Wiser I, Baik JE, Park HJ, Rehal S, Shin JY, Mehrara BJ. Fibrosis and secondary lymphedema: chicken or egg? Transl Res 2019; 209:68-76. [PMID: 31022376 PMCID: PMC7400991 DOI: 10.1016/j.trsl.2019.04.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/26/2019] [Accepted: 04/02/2019] [Indexed: 01/06/2023]
Abstract
Secondary lymphedema is a common complication of cancer treatment resulting in progressive fibroadipose tissue deposition, increased risk of infections, and, in rare cases, secondary malignancies. Until recently, the pathophysiology of secondary lymphedema was thought to be related to impaired collateral lymphatic formation after surgical injury. However, more recent studies have shown that chronic inflammation-induced fibrosis plays a key role in the pathophysiology of this disease. In this review, we will discuss the evidence supporting this hypothesis and summarize recent publications demonstrating that lymphatic injury activates chronic immune responses that promote fibrosis and lymphatic leakiness, decrease collecting lymphatic pumping, and impair collateral lymphatic formation. We will review how chronic mixed T-helper cell inflammatory reactions regulate this process and how this response may be used to design novel therapies for lymphedema.
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Affiliation(s)
- Raghu P Kataru
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Itay Wiser
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jung Eun Baik
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hyeung Ju Park
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sonia Rehal
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jin Yeon Shin
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Babak J Mehrara
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York.
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29
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Kataru RP, Ly CL, Shin J, Park HJ, Baik JE, Rehal S, Ortega S, Lyden D, Mehrara BJ. Tumor Lymphatic Function Regulates Tumor Inflammatory and Immunosuppressive Microenvironments. Cancer Immunol Res 2019; 7:1345-1358. [PMID: 31186247 DOI: 10.1158/2326-6066.cir-18-0337] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/17/2018] [Accepted: 06/05/2019] [Indexed: 02/06/2023]
Abstract
Proliferation of aberrant, dysfunctional lymphatic vessels around solid tumors is a common histologic finding. Studies have shown that abnormalities in lymphatic function result in accumulation of inflammatory cells with an immunosuppressive profile. We tested the hypothesis that dysfunctional lymphatic vessels surrounding solid tumors regulate changes in the tumor microenvironment and tumor-specific immune responses. Using subcutaneously implanted mouse melanoma and breast cancer tumors in a lymphatic endothelial cell-specific diphtheria toxin receptor transgenic mouse, we found that local ablation of lymphatic vessels increased peritumoral edema, as compared with controls. Comparative analysis of the peritumoral fluid demonstrated increases in the number of macrophages, CD4+ inflammatory cells, F4/80+/Gr-1+ (myeloid-derived suppressor cells), CD4+/Foxp3+ (Tregs) immunosuppressive cells, and expression of inflammatory cytokines such as TNFα, IFNγ, and IL1β following lymphatic ablation. Tumors grown in lymphatic ablated mice exhibited reduced intratumoral accumulation of cytotoxic T cells and increased tumor PD-L1 expression, causing rapid tumor growth, compared with tumors grown in nonlymphatic-ablated mice. Our study suggests that lymphatic dysfunction plays a role in regulating tumor microenvironments and may be therapeutically targeted in combination with immunotherapy to prevent tumor growth and progression.
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Affiliation(s)
- Raghu P Kataru
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Catherine L Ly
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jinyeon Shin
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hyeung Ju Park
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jung Eun Baik
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sonia Rehal
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sagrario Ortega
- Transgenic Mice Unit, Biotechnology Programme, Spanish National Cancer Research Center (CNIO), Madrid, Spain
| | - David Lyden
- Children's Cancer and Blood Foundation Laboratories, Departments of Pediatrics and Cell and Developmental Biology, Drukier Institute for Children's Health, Meyer Cancer Center, Weill Cornell Medicine, New York, New York
| | - Babak J Mehrara
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York.
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30
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Ha EH, Choi JP, Kwon HS, Park HJ, Lah SJ, Moon KA, Lee SH, Kim I, Cho YS. Endothelial Sox17 promotes allergic airway inflammation. J Allergy Clin Immunol 2019; 144:561-573.e6. [PMID: 30928652 DOI: 10.1016/j.jaci.2019.02.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 01/24/2019] [Accepted: 02/22/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND IL-33, levels of which are known to be increased in patients with eosinophilic asthma and which is suggested as a therapeutic target for it, activates endothelial cells in which Sry-related high-mobility-group box (Sox) 17, an endothelium-specific transcription factor, was upregulated. OBJECTIVE We investigated the relationship between Sox17 and IL-33 and the possible role of Sox17 in the pathogenesis of asthma using a mouse model of airway inflammation. METHODS We used ovalbumin (OVA) to induce airway inflammation in endothelium-specific Sox17 null mutant mice and used IL-33 neutralizing antibody to evaluate the interplay between IL-33 and Sox17. We evaluated airway inflammation and measured levels of various cytokines, chemokines, and adhesion molecules. We also carried out loss- or gain-of-function experiments for Sox17 in human endothelial cells. RESULTS Levels of IL-33 and Sox17 were significantly increased in the lungs of OVA-challenged mice. Anti-IL-33 neutralizing antibody treatment attenuated not only OVA-induced airway inflammation but also Sox17 expression in pulmonary endothelial cells. Importantly, endothelium-specific deletion of Sox17 resulted in significant alleviation of various clinical features of asthma, including airway inflammation, immune cell infiltration, cytokine/chemokine production, and airway hyperresponsiveness. Sox17 deletion also resulted in decreased densities of Ly6chigh monocytes and inflammatory dendritic cells in the lungs. In IL-33-stimulated human endothelial cells, Sox17 showed positive correlation with CCL2 and intercellular adhesion molecule 1 levels. Lastly, Sox17 promoted monocyte adhesion to endothelial cells and upregulated the extracellular signal-regulated kinase-signal transducer and activator of transcription 3 pathway. CONCLUSION Sox17 was regulated by IL-33, and its genetic ablation in endothelial cells resulted in alleviation of asthma-related pathophysiologic features. Sox17 might be a potential target for asthma management.
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Affiliation(s)
- Eun Hee Ha
- Biomedical Science and Engineering Interdisciplinary Program, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | | | - Hyouk-Soo Kwon
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyeung Ju Park
- Biomedical Science and Engineering Interdisciplinary Program, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | - Sang Joon Lah
- Biomedical Science and Engineering Interdisciplinary Program, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | | | - Seung-Hyo Lee
- Biomedical Science and Engineering Interdisciplinary Program, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea; Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | - Injune Kim
- Biomedical Science and Engineering Interdisciplinary Program, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea; Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | - You Sook Cho
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Kataru RP, Baik JE, Park HJ, Wiser I, Rehal S, Shin JY, Mehrara BJ. Regulation of Immune Function by the Lymphatic System in Lymphedema. Front Immunol 2019; 10:470. [PMID: 30936872 PMCID: PMC6431610 DOI: 10.3389/fimmu.2019.00470] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 02/21/2019] [Indexed: 12/13/2022] Open
Abstract
The lymphatic vasculature has traditionally been thought to play a passive role in the regulation of immune responses by transporting antigen presenting cells and soluble antigens to regional lymph nodes. However, more recent studies have shown that lymphatic endothelial cells regulate immune responses more directly by modulating entry of immune cells into lymphatic capillaries, presenting antigens on major histocompatibility complex proteins, and modulating antigen presenting cells. Secondary lymphedema is a disease that develops when the lymphatic system is injured during surgical treatment of cancers or is damaged by infections. We have used mouse models of lymphedema in order to understand the effects of chronic lymphatic injury on immune responses and have shown that lymphedema results in a mixed T helper cell and T regulatory cell (Treg) inflammatory response. Prolonged T helper 2 biased immune responses in lymphedema regulate the pathology of this disease by promoting tissue fibrosis, inhibiting formation of collateral lymphatics, decreasing lymphatic vessel pumping capacity, and increasing lymphatic leakiness. Treg infiltration following lymphatic injury results from proliferation of natural Tregs and suppresses innate and adaptive immune responses. These studies have broad clinical relevance since understanding how lymphatic injury in lymphedema can modulate immune responses may provide a template with which we can study more subtle forms of lymphatic injury that may occur in physiologic conditions such as aging, obesity, metabolic tumors, and in the tumor microenvironment.
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Affiliation(s)
- Raghu P Kataru
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Jung Eun Baik
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Hyeung Ju Park
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Itay Wiser
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Sonia Rehal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Jin Yeon Shin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Babak J Mehrara
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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32
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Kim H, Park W, Choi DH, Ahn SJ, Kim SS, Kim ES, Lee JH, Lee KC, Kim JH, Lee HS, Kim JH, Kim MY, Park HJ, Kim K, Song SH, Kwon J, Lee IJ, Kim TH, Kim TG, Chang AR, Cho O, Jeong BK, Ha B, Lee J, Ki Y. Abstract OT2-04-02: A phase 3 study of post-lumpectomy radiotherapy to whole breast + regional lymph nodes vs whole breast alone for patients with pN1 breast cancer treated with taxane-based chemotherapy (KROG 1701): Trial in progress. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot2-04-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
In patients with early stage breast cancer, regional nodal irradiation (RNI) is added to whole breast irradiation (WBI) in order to control microscopic regional disease and to prevent systemic spread of cancer. According to recent randomized trials (MA.20 and EORTC 22922-10925), prophylactic RNI was associated with improvement in disease-free survival (DFS) in the patients with high-risk node negative or pN1 breast cancer. However, systemic agents now known to improve loco-regional control, such as taxane or endocrine therapy, were prescribed to a small percentage of patients in the studies. The benefit of RNI found in the previous studies might be attributed to incorporation of less effective systemic treatments. The impact of prophylactic RNI in pN1 breast cancer should be evaluated in the patients receiving modern systemic treatment. The current study was conducted to compare the effect of post-lumpectomy WBI vs WBI plus RNI on DFS in pN1 breast cancer patients who received adjuvant taxane-based chemotherapy.
Methods
This study is a multicenter, phase 3, randomized controlled non-inferiority trial (NCT03269981). Eligibility criteria are ≥ 20 years female; pathologically proven invasive carcinoma of the breast; one to three positive axillary lymph nodes (pN1) in pathologic specimen; receiving breast-conserving surgery followed by taxane-based chemotherapy; having adjuvant endocrine therapy or anti-HER2 treatment according to molecular subtype of tumor. Patients are randomly assigned in a 1:1 ratio to receive WBI or WBI plus RNI. Patient randomization was stratified by molecular subtype of tumor (i.e. luminal A/luminal B/luminal HER2/HER2-enriched/triple-negative) and methods of axillary management (i.e. sentinel lymph node biopsy/axillary lymph node dissection). The primary outcome is DFS. The secondary outcomes include DFS according to molecular subtype, treatment-related toxicity, and patient's quality of life per EORTC QLQ-C30 and QLQ-BR23. Patients will be followed for survival and disease recurrence for seven years. A total of 1,926 patients are planned to be enrolled, with recruitment initiated in April 2017. As of June 2018, a total of 236 patients were enrolled.
Acknowledgement
This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea (grant number: HA17C0043010018).
Citation Format: Kim H, Park W, Choi DH, Ahn SJ, Kim SS, Kim ES, Lee JH, Lee KC, Kim JH, Lee H-S, Kim JH, Kim MY, Park HJ, Kim K, Song SH, Kwon J, Lee IJ, Kim TH, Kim TG, Chang AR, Cho O, Jeong BK, Ha B, Lee J, Ki Y. A phase 3 study of post-lumpectomy radiotherapy to whole breast + regional lymph nodes vs whole breast alone for patients with pN1 breast cancer treated with taxane-based chemotherapy (KROG 1701): Trial in progress [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT2-04-02.
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Affiliation(s)
- H Kim
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - W Park
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - DH Choi
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - SJ Ahn
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - SS Kim
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - ES Kim
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - JH Lee
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - KC Lee
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - JH Kim
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - H-S Lee
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - JH Kim
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - MY Kim
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - HJ Park
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - K Kim
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - SH Song
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - J Kwon
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - IJ Lee
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - TH Kim
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - TG Kim
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - AR Chang
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - O Cho
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - BK Jeong
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - B Ha
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - J Lee
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - Y Ki
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
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Kim K, Jeong Y, Shin KH, Kim JH, Ahn SD, Kim SS, Suh CO, Kim YB, Choi DH, Park W, Cha J, Chun M, Lee DS, Lee SY, Kim JH, Park HJ. Abstract P3-12-12: Impact of regional nodal irradiation for breast cancer patients with supraclavicular and/or internal mammary lymph node involvement: A multicenter, retrospective study (KROG 16-14). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-12-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: To evaluate the treatment outcomes of radiotherapy (RT) for breast cancer with ipsilateral supraclavicular (SCL) and/or internal mammary (IMN) lymph node involvement.
Methods: A total of 353 patients from 11 institutions were included. One hundred and thirty-six patients had SCL involvement, 148 had IMN involvement, and 69 had both. All patients received neoadjvant systemic therapy followed by breast conserving surgery or mastectomy, and postoperative RT to whole breast/chest wall. As for regional lymph node irradiation, SCL RT was given to 344 patients, and IMN RT to 236 patients. The median RT dose was 50.4 Gy.
Results: The median follow-up duration was 61 months (range, 7-173). In-field progression was present in SCL (n=20) and/or IMN (n=7). The 5-year disease-free survival (DFS) and overall survival rates were 57.8% and 75.1%, respectively. On multivariate analysis, both SCL/IMN involvement, number of axillary lymph node ≥4, triple negative subtype, and mastectomy were significant adverse prognosticators for DFS (p = 0.022, 0.001, 0.001, and 0.004, respectively). Regarding the impact of regional nodal irradiation, SCL RT dose ≥54 Gy was not associated with DFS (5-yr rate, 52.9% vs. 50.9%, p = 0.696) in SCL-involved patients, and the receipt of IMN RT was not associated with DFS (5-yr rate, 56.1% vs. 78.1%, p = 0.099) in IMN-involved patients.
Conclusion: Neoadjuvant chemotherapy followed by surgery and postoperative RT achieved an acceptable in-field regional control rate in patients with SCL and/or IMN involvement. However, a higher RT dose to SCL or IMN RT was not associated with the improved DFS in these patients.
Citation Format: Kim K, Jeong Y, Shin KH, Kim JH, Ahn SD, Kim SS, Suh C-O, Kim YB, Choi DH, Park W, Cha J, Chun M, Lee DS, Lee SY, Kim JH, Park HJ. Impact of regional nodal irradiation for breast cancer patients with supraclavicular and/or internal mammary lymph node involvement: A multicenter, retrospective study (KROG 16-14) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-12-12.
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Affiliation(s)
- K Kim
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - Y Jeong
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - KH Shin
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - JH Kim
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - SD Ahn
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - SS Kim
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - C-O Suh
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - YB Kim
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - DH Choi
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - W Park
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - J Cha
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - M Chun
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - DS Lee
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - SY Lee
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - JH Kim
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - HJ Park
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
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Jeong Y, Jin B, Lee HW, Park HJ, Park JY, Kim DY, Han KH, Ahn SH, Kim S. Evolution and persistence of resistance-associated substitutions of hepatitis C virus after direct-acting antiviral treatment failures. J Viral Hepat 2018; 25:1251-1259. [PMID: 29768695 DOI: 10.1111/jvh.12932] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 03/01/2018] [Accepted: 04/03/2018] [Indexed: 01/19/2023]
Abstract
Daclatasvir plus asunaprevir (DCV+ASV) treatment is an all-oral direct-acting antiviral (DAA) therapy for the genotype 1b HCV-infected patients. In this study, we investigated how resistance-associated substitutions (RASs) evolved after treatment failures and assessed the effect of those substitutions on viral fitness. Sequencing of NS5A and NS3 revealed typical RASs after treatment failures. Interestingly, the RASs of NS3 reverted to the wild-type amino acid within 1 year after treatment failures. However, the RASs of NS5A were stable and did not change. The effect of NS5A and NS3 RASs on viral RNA replication was assessed after mutagenic substitution in the genotype 1b HCV RNA. Among single substitutions, the effect of D168V was more substantial than the others and the effect of the triple mutant combination (D168V+L31V+Y93H) was the most severe. The RAS at NS5A Y93 affected both viral RNA replication and virus production. Finally, the effect of trans-complementation of NS5A was demonstrated in our co-transfection experiments and these results suggest that such a trans-complementation effect of NS5A may help maintain the NS5A RASs for a long time even after cessation of the DAA treatment. In conclusion, the results from this investigation would help understand the emergence and persistence of RASs.
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Affiliation(s)
- Y Jeong
- Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Liver Center, Severance Hospital, Seoul, Korea
| | - B Jin
- Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Liver Center, Severance Hospital, Seoul, Korea
| | - H W Lee
- Yonsei Liver Center, Severance Hospital, Seoul, Korea.,Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - H J Park
- Yonsei Liver Center, Severance Hospital, Seoul, Korea
| | - J Y Park
- Yonsei Liver Center, Severance Hospital, Seoul, Korea.,Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - D Y Kim
- Yonsei Liver Center, Severance Hospital, Seoul, Korea.,Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - K-H Han
- Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Liver Center, Severance Hospital, Seoul, Korea.,Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - S H Ahn
- Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Liver Center, Severance Hospital, Seoul, Korea.,Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - S Kim
- Yonsei Liver Center, Severance Hospital, Seoul, Korea.,Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.,Institut Pasteur Korea, Seongnam-si, Gyeonggi-do, Korea
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Jang JK, Lee JL, Park SH, Park HJ, Park IJ, Kim JH, Choi SH, Kim J, Yu CS, Kim JC. Magnetic resonance tumour regression grade and pathological correlates in patients with rectal cancer. Br J Surg 2018; 105:1671-1679. [PMID: 29893988 DOI: 10.1002/bjs.10898] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/15/2018] [Accepted: 05/03/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Evidence to support the specific use of magnetic resonance tumour regression grade (mrTRG) is inadequate. The aim of this study was to investigate the pathological characteristics of mrTRG after chemoradiotherapy (CRT) for rectal cancer and the implications for surgery. METHODS Patients undergoing long-course CRT (45-50 Gy plus a booster dose of 4-6 Gy) for mid or low rectal cancer (cT3-4 or cN+ without metastasis) between 2011 and 2015 who had post-CRT rectal MRI before surgery were included retrospectively. Three board-certified experienced radiologists assessed mrTRG. mrTRG was correlated with pathological tumour regression grade (pTRG), ypT and ypN. In a subgroup of patients with mrTRG1-2 and no tumour spread (such as nodal metastasis) on MRI, the projected rate of completion total mesorectal excision (TME) if they underwent transanal excision (TAE) and had a ypT status of ypT2 or higher was estimated, and recurrence-free survival was calculated according to the operation (TME or TAE) that patients had actually received. RESULTS Some 439 patients (290 men and 149 women of mean(s.d.) age 62·2(11·4) years) were analysed. The accuracy of mrTRG1 for predicting pTRG1 was 61 per cent (40 of 66), and that for ypT1 or less was 74 per cent (49 of 66). For mrTRG2, these values were 22·3 per cent (25 of 112) and 36·6 per cent (41 of 112) respectively. Patients with mrTRG1 and mrTRG2 without tumour spread were ypN+ in 3 per cent (1 of 29) and 16 per cent (8 of 50) respectively. Assuming mrTRG1 or mrTRG1-2 with no tumour spread on post-CRT MRI as the criteria for TAE, the projected completion TME rate was 26 per cent (11 of 43) and 41·0 per cent (41 of 100) respectively. For the 100 patients with mrTRG1-2 and no tumour spread, recurrence-free survival did not differ significantly between TME (79 patients) and TAE (21) (adjusted hazard ratio 1·86, 95 per cent c.i. 0·42 to 8·18). CONCLUSION Patients with mrTRG1 without tumour spread may be suitable for TAE.
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Affiliation(s)
- J K Jang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - J L Lee
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - S H Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - H J Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - I J Park
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - J H Kim
- Department of Radiation Oncology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - S H Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - J Kim
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - C S Yu
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
| | - J C Kim
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea
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Park HJ, Yuk CM, Shin K, Lee SH. Interleukin-17A negatively regulates lymphangiogenesis in T helper 17 cell-mediated inflammation. Mucosal Immunol 2018; 11:590-600. [PMID: 28930285 DOI: 10.1038/mi.2017.76] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 07/20/2017] [Indexed: 02/07/2023]
Abstract
During inflammation lymphatic vessels (LVs) are enlarged and their density is increased to facilitate the migration of activated immune cells and antigens. However, after antigen clearance, the expanded LVs shrink to maintain homeostasis. Here we show that interleukin (IL)-17A, secreted from T helper type 17 (TH17) cells, is a negative regulator of lymphangiogenesis during the resolution phase of TH17-mediated immune responses. Moreover, IL-17A suppresses the expression of major lymphatic markers in lymphatic endothelial cells and decreases in vitro LV formation. To investigate the role of IL-17A in vivo, we utilized a cholera toxin-mediated inflammation model and identified inflammation and resolution phases based on the numbers of recruited immune cells. IL-17A, markedly produced by TH17 cells even after the peak of inflammation, was found to participate in the negative regulation of LV formation. Moreover, blockade of IL-17A resulted in not only increased density of LVs in tissues but also their enhanced function. Taken together, these findings improve the current understanding of the relationship between LVs and inflammatory cytokines in pathologic conditions.
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Affiliation(s)
- H J Park
- Biomedical Science and Engineering Interdisciplinary Program, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - C M Yuk
- Biomedical Science and Engineering Interdisciplinary Program, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - K Shin
- Graduate School of Medical Science and Engineering, Biomedical Research Center, Korea Advanced Institute of Science and Technology, Daejeon, Korea.,Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
| | - S-H Lee
- Biomedical Science and Engineering Interdisciplinary Program, Korea Advanced Institute of Science and Technology, Daejeon, Korea.,Graduate School of Medical Science and Engineering, Biomedical Research Center, Korea Advanced Institute of Science and Technology, Daejeon, Korea
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Lee H, Sohn YM, Ko JY, Lee SY, Jhun BW, Park HY, Jeon K, Kim DH, Kim SY, Choi JE, Moon IJ, Shin SJ, Park HJ, Koh WJ. Once-daily dosing of amikacin for treatment of Mycobacterium abscessus lung disease. Int J Tuberc Lung Dis 2018. [PMID: 28633708 DOI: 10.5588/ijtld.16.0791] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Tertiary referral centre, Samsung Medical Center, South Korea. OBJECTIVE To evaluate the pharmacokinetic parameters and toxicities of once-daily amikacin (AMK) dosing for lung disease due to Mycobacterium abscessus. DESIGN A retrospective review of 48 patients with M. abscessus lung disease who received once-daily AMK for 4 weeks between January 2012 and June 2015. RESULTS With a starting dose of 15 mg/kg/day and adjustment of AMK dose according to the peak serum level (Cmax), the Cmax target of 55-65 μg/ml was achieved in 31.3% (15/48) of patients in the first week, 68.8% (33/48) in week 2, 91.7% (44/48) in week 3 and 95.8% (46/48) in week 4. Transient nephrotoxicity developed in 6.3% (3/48) of patients and ototoxicity in 25.0% (6/24), which was determined by audiogram as hearing loss, asymptomatic in five patients and tinnitus in one. Multivariate analysis revealed that the highest drug concentration 12 h after administration was significantly associated with the development of toxicities (adjusted odds ratio 1.862, P = 0.047). CONCLUSION Our results suggest that once-daily AMK for 4 weeks with a target Cmax of 55-65 μg/ml can be used in patients with M. abscessus lung disease, with careful monitoring of toxicity.
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Affiliation(s)
- H Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Y M Sohn
- Department of Pharmaceutical Services
| | - J Y Ko
- Department of Pharmaceutical Services
| | - S-Y Lee
- Department of Laboratory Medicine and Genetics
| | - B W Jhun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - H Y Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - K Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - D H Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - S-Y Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - J E Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - I J Moon
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - S J Shin
- Department of Microbiology, Yonsei University College of Medicine, Seoul, South Korea
| | - H J Park
- Department of Pharmaceutical Services
| | - W-J Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
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Kim HR, Kang HN, Shim HS, Kim EY, Kim J, Kim DJ, Lee JG, Lee CY, Hong MH, Kim SM, Kim H, Pyo KH, Yun MR, Park HJ, Han JY, Youn HA, Ahn MJ, Paik S, Kim TM, Cho BC. Co-clinical trials demonstrate predictive biomarkers for dovitinib, an FGFR inhibitor, in lung squamous cell carcinoma. Ann Oncol 2018; 28:1250-1259. [PMID: 28460066 DOI: 10.1093/annonc/mdx098] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background We conducted co-clinical trials in patient-derived xenograft (PDX) models to identify predictive biomarkers for the multikinase inhibitor dovitinib in lung squamous cell carcinoma (LSCC). Methods The PDX01-02 were established from LSCC patients enrolled in the phase II trial of dovitinib (NCT01861197) and PDX03-05 were established from LSCC patients receiving surgery. These five PDX tumors were subjected to in vivo test of dovitinib efficacy, whole exome sequencing and gene expression profiling. Results The PDX tumors recapitulate histopathological properties and maintain genomic characteristics of originating tumors. Concordant with clinical outcomes of the trial enrolled-LSCC patients, dovitinib produced substantial tumor regression in PDX-01 and PDX-05, whereas it resulted in tumor progression in PDX-02. PDX-03 and -04 also displayed poor antitumor efficacy to dovitinib. Mutational and genome-wide copy number profiles revealed no correlation between genomic alterations of FGFR1-3 and sensitivity to dovitinib. Of note, gene expression profiles revealed differentially expressed genes including FGF3 and FGF19 between PDX-01 and 05 and PDX-02-04. Pathway analysis identified two FGFR signaling-related gene sets, FGFR ligand binding/activation and SHC-mediated cascade pathway were substantially up-regulated in PDX-01 and 05, compared with PDX-02-04. The comparison of gene expression profiles between dovitinib-sensitive versus -resistant lung cancer cell lines in the Cancer Cell Line Encyclopedia database also found that transcriptional activation of 18 key signaling components in FGFR pathways can predict the sensitivity to dovitinib both in cell lines and PDX tumors. These results highlight FGFR pathway activation as a key molecular determinant for sensitivity to dovitinib. Conclusions FGFR gene expression signatures are predictors for the response to dovitinib in LSCC.
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Affiliation(s)
- H R Kim
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul
| | - H N Kang
- JE-UK Institute for Cancer Research, JEUK Co, Ltd, Gumi-City, Kyungbuk
| | | | - E Y Kim
- Pulmonology, Yonsei University College of Medicine, Seoul
| | - J Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul
| | - D J Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul
| | - J G Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul
| | - C Y Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul
| | - M H Hong
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul
| | - S-M Kim
- JE-UK Institute for Cancer Research, JEUK Co, Ltd, Gumi-City, Kyungbuk
| | - H Kim
- JE-UK Institute for Cancer Research, JEUK Co, Ltd, Gumi-City, Kyungbuk
| | - K-H Pyo
- JE-UK Institute for Cancer Research, JEUK Co, Ltd, Gumi-City, Kyungbuk
| | - M R Yun
- JE-UK Institute for Cancer Research, JEUK Co, Ltd, Gumi-City, Kyungbuk
| | - H J Park
- JE-UK Institute for Cancer Research, JEUK Co, Ltd, Gumi-City, Kyungbuk
| | - J Y Han
- JE-UK Institute for Cancer Research, JEUK Co, Ltd, Gumi-City, Kyungbuk
| | - H A Youn
- JE-UK Institute for Cancer Research, JEUK Co, Ltd, Gumi-City, Kyungbuk
| | - M-J Ahn
- Division of Hematology & Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - S Paik
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul
| | - T-M Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - B C Cho
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul.,JE-UK Institute for Cancer Research, JEUK Co, Ltd, Gumi-City, Kyungbuk
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Kim HA, Lee HS, Shin TH, Jung JY, Baek WY, Park HJ, Lee G, Paik MJ, Suh CH. Polyamine patterns in plasma of patients with systemic lupus erythematosus and fever. Lupus 2018; 27:930-938. [PMID: 29308729 DOI: 10.1177/0961203317751860] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with various clinical manifestations and serologic markers. In this study, we analyzed nine polyamine (PA) profiles of plasma from patients with SLE and healthy controls (HCs), and the relationship between the PA profiles and disease activity. PA alterations in plasma of 44 patients with SLE and fever were investigated using gas chromatography mass spectrometry (GC-MS) in selected ion monitoring mode using N-ethoxycarbonyl/ N-pentafluoropropionyl derivatives, and compared with those of 43 HCs. Patients with SLE and HCs showed differences in five of nine PA profiles. Among five changed PA levels, four PAs, namely N1-acetylcadaverine, spermidine, N1-acetylspermidine, and spermine, were dramatically decreased. However, the level of cadaverine was increased in patients with SLE. In the partial correlation with PA profiles and disease activity markers of SLE, several disease activity markers and nutritional markers were correlated with cadaverine, spermidine, and N 8-acetylspermidine. Thus, our results provide a comprehensive understanding of the relationship between PA metabolomics and disease activity markers in patients with SLE.
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Affiliation(s)
- H A Kim
- 1 Department of Rheumatology and BK21 Division of Cell Transformation and Restoration, 37977 Ajou University School of Medicine , Suwon, Republic of Korea
| | - H S Lee
- 2 College of Pharmacy, 65380 Sunchon National University , Suncheon, Republic of Korea
| | - T H Shin
- 3 Department of Physiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - J Y Jung
- 1 Department of Rheumatology and BK21 Division of Cell Transformation and Restoration, 37977 Ajou University School of Medicine , Suwon, Republic of Korea
| | - W Y Baek
- 1 Department of Rheumatology and BK21 Division of Cell Transformation and Restoration, 37977 Ajou University School of Medicine , Suwon, Republic of Korea
| | - H J Park
- 3 Department of Physiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - G Lee
- 3 Department of Physiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - M J Paik
- 2 College of Pharmacy, 65380 Sunchon National University , Suncheon, Republic of Korea
| | - C H Suh
- 1 Department of Rheumatology and BK21 Division of Cell Transformation and Restoration, 37977 Ajou University School of Medicine , Suwon, Republic of Korea
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Yang SY, Kim YH, Byun MK, Kim HJ, Ahn CM, Kim SH, Lee HS, Park HJ. Repeated Measurement of Fractional Exhaled Nitric Oxide Is Not Essential for Asthma Screening. J Investig Allergol Clin Immunol 2017; 28:98-105. [PMID: 29180311 DOI: 10.18176/jiaci.0215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJETIVE Older guidelines recommend that fractional exhaled nitric oxide (FeNO) should be checked more than twice during the same session to confirm an asthma diagnosis. Recent studies show the excellent reproducibility of FeNO measurements. Objetive: We aimed to determine whether repeated FeNO measurements during the same session are necessary for asthma screening. MATERIAL AND METHODS We retrospectively reviewed the electronic medical records of adult outpatients who visited the respiratory medicine department for diagnosis of asthma and assessed FeNO measurements obtained from June 2016 to July 2017. RESULTS Of the 132 patients enrolled, 79 (59.8%) were diagnosed with asthma. Repeated FeNO measurements taken during the same session showed high reproducibility (intraclass correlation coefficient >0.9; P<.001) and a strong correlation (Pearson coefficient >0.9; P<.001), although reproducibility and correlation were slightly weaker in patients with low FeNO values. The value of repeated measurement was not significant; however, the second FeNO measurement was significantly higher than the first measurement in patients with the worst and best lung function. The predictive power of the first measurement of FeNO (sensitivity, 80.5%; specificity, 85.1%) was not inferior to the second (sensitivity, 76.6%; specificity 85.1%). The same was true of the geometric mean of the two. CONCLUSIONS Repeated FeNO measurement during the same session is not essential for asthma screening in cases where the first acceptable FeNO measurement is performed using the proper method.
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Affiliation(s)
- S Y Yang
- Department of Internal Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Y H Kim
- Department of Pediatrics, Gangnam Severance Hospital, Seoul, Korea
| | - M K Byun
- Department of Internal Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - H J Kim
- Department of Internal Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - C M Ahn
- Department of Internal Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - S H Kim
- Department of Internal Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - H S Lee
- Biostatistics Collaboration Unit, Seoul, Korea
| | - H J Park
- Department of Internal Medicine, Gangnam Severance Hospital, Seoul, Korea.,Department of Internal Medicine, Yong-in Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Park HJ, Kang HK, Wang M, Jo J, Chung E, Kim S. A pilot study of planar coil based magnetic stimulation using acute hippocampal slice in mice. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2017:1118-1121. [PMID: 29060071 DOI: 10.1109/embc.2017.8037025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Micromagnetic stimulation using small-sized implantable coils has recently been studied. The main advantage of this method is that it can provide sustainable stimulation performance even if a fibrotic encapsulation layer is formed around the implanted coil by inflammation response, because indirectly induced currents are used to induce neural responses. In previous research, we optimized the geometrical and control parameters used in implantable magnetic stimulation. Based on those results, we fabricated the planar coil and studied the LTP effect in the hippocampal slice by two different magnetic stimulation protocols using the quadripulse stimulation (QPS) pattern. We found that direct magnetic stimulation (DMS) induced insignificant LTP effect and priming magnetic stimulation (PMS) occluded LTP effect after tetanic stimulation, when QPS patterned magnetic stimulation with 1 A current pulse was applied to the planar coil.
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Park HJ, Lee SY, Choi SH, Hong HP, Choi YJ, Kim MS. Reduced metallic artefacts in 3 T knee MRI using fast spin-echo multi-point Dixon compared to fast spin-echo T2-weighted sequences. Clin Radiol 2017; 72:996.e1-996.e6. [PMID: 28807564 DOI: 10.1016/j.crad.2017.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/18/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Abstract
AIM To compare multi-point Dixon magnetic resonance imaging (MRI) and fast spin-echo (FSE) T2-weighted imaging (WI) with regard to the size of metallic artefacts when imaging the knee joint. MATERIALS AND METHODS A total of 42 patients who underwent anterior cruciate ligament (ACL) reconstruction and follow-up imaging with 3 T MRI using the multi-point Dixon technique was included in this retrospective study. The maximal distance of the image distortion area around the metallic artefact was measured (interference screw of femoral tunnel area) on sagittal images of both FSE T2WI (T2WI and fat-suppressed [FS] T2WI) and multi-point Dixon (water only image and in-phase image) sequences. The maximal distance of the image distortion were compared using paired t-tests across the image sequences (multi-point Dixon water only image versus FS T2WI and multi-point Dixon in-phase image versus T2WI). RESULTS The mean distance of the image distortion from metallic artefacts regardless of the image sequence ranged from 16.6 mm to 24.5 mm (Table 2). The mean distances measured by two readers on multi-point Dixon (water only image) sequences were significantly shorter than those in FS T2WI sequences (p<0.001). In contrast, the mean distances measured by two readers on multi-point Dixon (in-phase image) sequences did not differ from those of T2WI (p>0.05) sequences. CONCLUSION The water-only image of multi-point Dixon technique reduces the amount of metallic artefacts compared to that in FS FSE T2WI sequences; however, the metallic artefacts were not significantly different between in-phase images of multi-point Dixon and FSE T2WI.
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Affiliation(s)
- H J Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - S Y Lee
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - S H Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - H P Hong
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Y J Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - M S Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Park MS, Kim SK, Park HJ, Seok H, Kang SW, Lee SH, Kim YG, Moon JY, Kim TH, Kim YH, Kang SW, Chung JH, Jeong KH. Association Studies of Bone Morphogenetic Protein 2 Gene Polymorphisms With Acute Rejection in Kidney Transplantation Recipients. Transplant Proc 2017; 49:1012-1017. [PMID: 28583517 DOI: 10.1016/j.transproceed.2017.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Bone morphogenetic proteins (BMP) belong to the transforming growth factor beta superfamily of proteins. This study was performed to evaluate the association of BMP gene polymorphisms with acute renal allograft rejection (AR) and graft dysfunction (GD) in Koreans. METHODS Three hundred thirty-one patients who had kidney transplantation procedures were recruited. Transplantation outcomes were determined in terms of AR and GD criteria. We selected six single nucleotide polymorphisms (SNPs): rs1979855 (5' near gene), rs1049007 (Ser87Ser), rs235767 (intron), rs1005464 (intron), rs235768 (Arg190Ser), and rs3178250 (3; untranslated region). RESULTS Among the six SNPs tested, the rs235767, rs1005464, and rs3178250 SNPs were significantly associated with AR (P < .05). The rs1049007 and rs235768 SNPs also showed an association with GD (P < .05). CONCLUSIONS In conclusion, these results suggest that the BMP2 gene polymorphism may be related to the development of AR and GD in kidney transplant recipients.
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Affiliation(s)
- M-S Park
- Department of Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - S K Kim
- Kohwang Medical Research Institute, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - H J Park
- Kohwang Medical Research Institute, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - H Seok
- Kohwang Medical Research Institute, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - S W Kang
- Kohwang Medical Research Institute, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - S H Lee
- Department of Nephrology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Y G Kim
- Department of Nephrology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - J Y Moon
- Department of Nephrology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - T H Kim
- Department of Nephrology, School of Medicine, In Je University, Busan, Republic of Korea
| | - Y H Kim
- Department of Nephrology, School of Medicine, In Je University, Busan, Republic of Korea
| | - S W Kang
- Department of Nephrology, School of Medicine, In Je University, Busan, Republic of Korea
| | - J-H Chung
- Kohwang Medical Research Institute, School of Medicine, Kyung Hee University, Seoul, Republic of Korea.
| | - K H Jeong
- Department of Nephrology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
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44
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Sohn CH, Kim CH, Sandilands LJ, Hien NTM, Kim SY, Park HJ, Kim KW, Moon SJ, Yamaura J, Hiroi Z, Noh TW. Strong Spin-Phonon Coupling Mediated by Single Ion Anisotropy in the All-In-All-Out Pyrochlore Magnet Cd_{2}Os_{2}O_{7}. Phys Rev Lett 2017; 118:117201. [PMID: 28368646 DOI: 10.1103/physrevlett.118.117201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Indexed: 06/07/2023]
Abstract
Spin-phonon coupling mediated by single ion anisotropy was investigated using optical spectroscopy and first-principles calculations in the all-in-all-out pyrochlore magnet Cd_{2}Os_{2}O_{7}. Clear anomalies were observed in both the phonon frequencies and linewidths at the magnetic ordering temperature. The renormalization of the phonon modes was exceptionally large, signifying the presence of an unconventional magnetoelastic term from large spin-orbit coupling. In addition, the relative phonon frequency shifts show a strong correlation with the modulation of noncubic crystal field by the corresponding lattice distortion. Our observation establishes a new type of spin-phonon coupling through single ion anisotropy, a second-order spin-orbit coupling term, in Cd_{2}Os_{2}O_{7}.
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Affiliation(s)
- C H Sohn
- Center for Correlated Electron Systems, Institute for Basic Science (IBS), Seoul 151-742, Republic of Korea
- Department of Physics and Astronomy, Seoul National University, Seoul 151-742, Republic of Korea
| | - C H Kim
- Center for Correlated Electron Systems, Institute for Basic Science (IBS), Seoul 151-742, Republic of Korea
- Department of Physics and Astronomy, Seoul National University, Seoul 151-742, Republic of Korea
| | - L J Sandilands
- Center for Correlated Electron Systems, Institute for Basic Science (IBS), Seoul 151-742, Republic of Korea
- Department of Physics and Astronomy, Seoul National University, Seoul 151-742, Republic of Korea
| | - N T M Hien
- Center for Correlated Electron Systems, Institute for Basic Science (IBS), Seoul 151-742, Republic of Korea
- Department of Physics and Astronomy, Seoul National University, Seoul 151-742, Republic of Korea
| | - S Y Kim
- Center for Correlated Electron Systems, Institute for Basic Science (IBS), Seoul 151-742, Republic of Korea
- Department of Physics and Astronomy, Seoul National University, Seoul 151-742, Republic of Korea
| | - H J Park
- Center for Correlated Electron Systems, Institute for Basic Science (IBS), Seoul 151-742, Republic of Korea
- Department of Physics and Astronomy, Seoul National University, Seoul 151-742, Republic of Korea
| | - K W Kim
- Department of Physics, Chungbuk National University, Cheongju, Chungbuk 28644, Republic of Korea
| | - S J Moon
- Department of Physics, Hanyang University, Seoul 133-791, Republic of Korea
| | - J Yamaura
- Materials Research Center for Element Strategy, Tokyo Institute of Technology, Kanagawa 226-8503, Japan
| | - Z Hiroi
- ISSP, University of Tokyo, Kashiwa 277-8581, Japan
| | - T W Noh
- Center for Correlated Electron Systems, Institute for Basic Science (IBS), Seoul 151-742, Republic of Korea
- Department of Physics and Astronomy, Seoul National University, Seoul 151-742, Republic of Korea
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Jin SM, Shim W, Oh BJ, Oh SH, Yu SJ, Choi JM, Park HJ, Park JB, Kim JH. Anakinra Protects Against Serum Deprivation-Induced Inflammation and Functional Derangement in Islets Isolated From Nonhuman Primates. Am J Transplant 2017; 17:365-376. [PMID: 27376767 DOI: 10.1111/ajt.13953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 06/09/2016] [Accepted: 06/25/2016] [Indexed: 01/25/2023]
Abstract
We investigated whether serum deprivation induces islet amyloid polypeptide (IAPP) oligomer accumulation and/or a proinflammatory response and, if so, whether the addition of interleukin (IL)-1 receptor antagonist to the culture medium can relieve the proinflammatory response during serum-deprived culture of nonhuman primate (NHP) islets. After culture in medium with and without Ana under serum-deprived culture conditions, IAPP oligomer/amyloid accumulation, in vitro viability, islet function, cytokine secretion, and posttransplantation outcome in streptozotocin-induced diabetic nude mice were determined in islets isolated from heterozygote human IAPP transgenic (hIAPP+/- ) mice and/or NHP islets. Serum deprivation induced accumulation of IAPP oligomer, but not amyloid, in NHP islets. Anakinra (Ana) protected islets from the serum deprivation-induced impairment of in vitro viability and glucose-stimulated insulin secretion and attenuated serum deprivation-induced caspase-1 activation, transcription, and secretion of IL-1β, IL-6, and tumor necrosis factor-α in hIAPP+/- mice and NHP islets. Supplementation of medium with Ana during serum-deprived culture also improved posttransplantation in vivo outcomes of NHP islets. In conclusion, serum deprivation induced accumulation of IAPP oligomers and proinflammatory responses in cultured isolated islets. Supplementation of the culture medium with Ana attenuated the functional impairment and proinflammatory responses induced by serum deprivation in ex vivo culture of NHP islets.
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Affiliation(s)
- S-M Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Diabetes and Endocrinology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - W Shim
- Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Korea.,Molecular Science and Technology Research Center, Ajou University, Suwon, Korea
| | - B J Oh
- Division of Endocrinology and Metabolism, Department of Medicine, Diabetes and Endocrinology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Korea
| | - S-H Oh
- Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Korea
| | - S J Yu
- Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Korea
| | - J M Choi
- Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Korea
| | - H J Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - J B Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - J H Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Diabetes and Endocrinology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST (Samsung Advanced Institute for Health Sciences & Technology), Seoul, Korea
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Kim JT, Hong SH, Park HJ, Kim YS, Suh JY, Lee JK, Park JM, Maity T, Eckert J, Kim KB. Deformation mechanisms to ameliorate the mechanical properties of novel TRIP/TWIP Co-Cr-Mo-(Cu) ultrafine eutectic alloys. Sci Rep 2017; 7:39959. [PMID: 28067248 PMCID: PMC5220307 DOI: 10.1038/srep39959] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/28/2016] [Indexed: 11/09/2022] Open
Abstract
In the present study, the microstructural evolution and the modulation of the mechanical properties have been investigated for a Co-Cr-Mo (CCM) ternary eutectic alloy by addition of a small amount of copper (0.5 and 1 at.%). The microstructural observations reveal a distinct dissimilarity in the eutectic structure such as a broken lamellar structure and a well-aligned lamellar structure and an increasing volume fraction of Co lamellae as increasing amount of copper addition. This microstructural evolution leads to improved plasticity from 1% to 10% without the typical tradeoff between the overall strength and compressive plasticity. Moreover, investigation of the fractured samples indicates that the CCMCu alloy exhibits higher plastic deformability and combinatorial mechanisms for improved plastic behavior. The improved plasticity of CCMCu alloys originates from several deformation mechanisms; i) slip, ii) deformation twinning, iii) strain-induced transformation and iv) shear banding. These results reveal that the mechanical properties of eutectic alloys in the Co-Cr-Mo system can be ameliorated by micro-alloying such as Cu addition.
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Affiliation(s)
- J T Kim
- Hybrid Materials Center (HMC), Faculty of Nanotechnology and Advanced Materials Engineering, Sejong University, 209 Neugdong-ro, Gwangjin-gu, Seoul 143-747, Republic of Korea
| | - S H Hong
- Hybrid Materials Center (HMC), Faculty of Nanotechnology and Advanced Materials Engineering, Sejong University, 209 Neugdong-ro, Gwangjin-gu, Seoul 143-747, Republic of Korea
| | - H J Park
- Hybrid Materials Center (HMC), Faculty of Nanotechnology and Advanced Materials Engineering, Sejong University, 209 Neugdong-ro, Gwangjin-gu, Seoul 143-747, Republic of Korea
| | - Y S Kim
- Hybrid Materials Center (HMC), Faculty of Nanotechnology and Advanced Materials Engineering, Sejong University, 209 Neugdong-ro, Gwangjin-gu, Seoul 143-747, Republic of Korea
| | - J Y Suh
- High Temperature Energy Materials Research Center, Korea Institute of Science and Technology, Hwarangno 14-gil 5, Seoungbuk-gu, Seoul 136-791, Republic of Korea
| | - J K Lee
- Division of Advanced Materials Engineering, Kongju National University, Cheonan 330-717, Republic of Korea
| | - J M Park
- Global Technology Center, Samsung Electronics Co., Ltd, 129 Samsung-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do 443-742, Republic of Korea
| | - T Maity
- Department Materials Physics, Montanuniversität Leoben, Jahnstraße 12, A-8700 Leoben, Austria
| | - J Eckert
- Department Materials Physics, Montanuniversität Leoben, Jahnstraße 12, A-8700 Leoben, Austria.,Erich Schmid Institute of Materials Science, Austrian Academy of Sciences, Jahnstraße 12, A-8700 Leoben, Austria
| | - K B Kim
- Hybrid Materials Center (HMC), Faculty of Nanotechnology and Advanced Materials Engineering, Sejong University, 209 Neugdong-ro, Gwangjin-gu, Seoul 143-747, Republic of Korea
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Lee KW, Park JB, Oh DK, Na BG, Choi JY, Cho WT, Lee SH, Park HJ, Cho D, Huh WS, Kim SJ. Short-Term Outcomes of ABO-Incompatible Living Donor Kidney Transplantation With Uniform Protocol: Significance of Baseline Anti-ABO Titer. Transplant Proc 2017; 48:820-6. [PMID: 27234744 DOI: 10.1016/j.transproceed.2016.01.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 01/21/2016] [Indexed: 02/06/2023]
Abstract
Antibody-mediated rejection (AMR) is one of the major causes of poor outcomes in ABO-incompatible kidney transplantation (ABOi KT). Studies investigating AMR risk factors found that anti-ABO titer is a major issue. However, the significance of antibody titer has been debated. This retrospective study analyzed AMR risk factors in 59 patients who underwent ABOi KT between August 2010 and January 2015. We also analyzed AMR risk factors in recipients with high anti-ABO baseline titers (≥1:64 on dithiothreitol at 37°C phase or ≥1:256 on antihuman globulin phase). The 2-year patient survival rate was 95.8%, and the 2-year graft survival rate was 94.9%. Nine patients (15.3%) experienced clinical (6 of 59 [10.2%]) or subclinical (3 of 59 [5.1%]) AMR. One patient experienced graft loss from hyperacute rejection. AMR risk factor analysis revealed that baseline antibody titer was associated with incidence of AMR. In patients with high baseline titers, low doses of rituximab (200-mg single-dose), an antibody against CD20, was predictive for AMR. Six patients who received pretransplant intravenous immunoglobulin did not experience AMR even when they had high baseline antibody titers. Our results indicate that a high baseline antibody titer affected the incidence of AMR. ABOi KT candidates with high baseline titers need to undergo an intensified preconditioning protocol, including high-dose rituximab (375 mg/m(2)) and intravenous immunoglobulin.
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Affiliation(s)
- K W Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - J B Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - D K Oh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - B G Na
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - J Y Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - W T Cho
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - S H Lee
- Department of Surgery, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - H J Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - D Cho
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - W S Huh
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - S J Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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48
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Park KH, Pai J, Song DG, Sim DW, Park HJ, Lee JH, Jeong KY, Pan CH, Shin I, Park JW. Ranitidine-induced anaphylaxis: clinical features, cross-reactivity, and skin testing. Clin Exp Allergy 2016; 46:631-9. [PMID: 26764898 DOI: 10.1111/cea.12708] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 08/18/2015] [Revised: 11/05/2015] [Accepted: 12/13/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Histamine H2 receptor antagonists are commonly prescribed medications and are known to be well tolerated. However, 99 cases of ranitidine-induced anaphylaxis occurred in Korea from 2007 to 2014. OBJECTIVE The purpose of this study was to determine the incidence, clinical features, and diagnostic methods for ranitidine-induced anaphylaxis. METHODS Ranitidine-related pharmacovigilance data from 2007 to 2014 were reviewed. Adverse drug reactions with causal relationships were selected, and clinical manifestations, outcomes, and drug-related information were assessed. For further investigation, 8 years of pharmacovigilance data were collected at a single centre. Twenty-three patients participated in in vivo and in vitro studies. Skin tests, oral provocation tests, and laboratory tests were performed, including tests using other kinds of histamine H2 receptor antagonists. RESULTS Over 7 years, 584 patients suffered adverse reactions to ranitidine. The most common manifestation was cutaneous symptoms. Among them, 99 patients (17.0%) experienced anaphylaxis. In a single-centre study, skin prick tests were positive in 91.7% of ranitidine-induced anaphylaxis patients (11/12); the optimal concentration was 20 mg/mL. Detection of ranitidine-specific immunoglobulin E failed. Cimetidine and proton pump inhibitors showed no cross-reactivity with ranitidine based on the skin prick test, oral provocation test, or clinical determination. Surprisingly, 82.6% of patients reintroduced ranitidine and re-experienced the same adverse reactions because ranitidine was not considered the culprit drug. CONCLUSIONS AND CLINICAL RELEVANCE Although ranitidine is known as a safe drug, it can also cause diverse adverse reactions, including anaphylaxis. This study demonstrates the need to pay attention to adverse reactions to ranitidine and consider ranitidine as a cause of anaphylaxis.
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Affiliation(s)
- K H Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - J Pai
- Department of Chemistry, Yonsei University, Seoul, Korea
| | - D-G Song
- Laboratory of Biomodulation, KIST Gangneung Institute of Natural Products, Gangneung, Korea
| | - D W Sim
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - H J Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - J-H Lee
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - K Y Jeong
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - C-H Pan
- Laboratory of Biomodulation, KIST Gangneung Institute of Natural Products, Gangneung, Korea.,Department of Biological Chemistry, Korea University of Science and Technology (UST), Daejeon, Korea
| | - I Shin
- Department of Chemistry, Yonsei University, Seoul, Korea
| | - J-W Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
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Choi Y, Jiang F, An H, Park HJ, Choi JH, Lee H. A pharmacogenomic study on the pharmacokinetics of tacrolimus in healthy subjects using the DMETTM Plus platform. Pharmacogenomics J 2016; 17:105-106. [PMID: 27958377 DOI: 10.1038/tpj.2016.85] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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50
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Affiliation(s)
- K Yokoyama
- Department of Orthopaedics, Machida Municipal Hospital, Machida, Tokyo, Japan
| | - HJ Park
- Department of Orthopaedics, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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