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Rambojun AM, Komber H, Rossdale J, Suntharalingam J, Rodrigues JCL, Ehrhardt MJ, Repetti A. Uncertainty quantification in computed tomography pulmonary angiography. PNAS Nexus 2024; 3:pgad404. [PMID: 38737009 PMCID: PMC11087828 DOI: 10.1093/pnasnexus/pgad404] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 10/26/2023] [Indexed: 05/14/2024]
Abstract
Computed tomography (CT) imaging of the thorax is widely used for the detection and monitoring of pulmonary embolism (PE). However, CT images can contain artifacts due to the acquisition or the processes involved in image reconstruction. Radiologists often have to distinguish between such artifacts and actual PEs. We provide a proof of concept in the form of a scalable hypothesis testing method for CT, to enable quantifying uncertainty of possible PEs. In particular, we introduce a Bayesian Framework to quantify the uncertainty of an observed compact structure that can be identified as a PE. We assess the ability of the method to operate under high-noise environments and with insufficient data.
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Affiliation(s)
- Adwaye M Rambojun
- Department of Mathematical Sciences, University of Bath, Bath BA2 7JU, UK
| | | | | | - Jay Suntharalingam
- Royal United Hospital, Bath BA1 3NG, UK
- Department of Life Sciences, University of Bath, Bath BA2 7JU, UK
| | | | | | - Audrey Repetti
- School of Engineering and Physical Sciences, School of Mathematical and Computer Sciences, Heriot-Watt University, Edinburgh EH14 4AS, UK
- Maxwell Institute for Mathematical Sciences, Edinburgh EH8 9BT, UK
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2
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Varian F, Dick J, Battersby C, Roman S, Ablott J, Watson L, Binmahfooz S, Zafar H, Colgan G, Cannon J, Suntharalingam J, Lordan J, Howard L, McCabe C, Wort J, Price L, Church C, Hamilton N, Armstrong I, Hameed A, Hurdman J, Elliot C, Condliffe R, Wilkins M, Webb A, Adlam D, Benza RL, Rahimi K, Shojaei‐Shahrokhabadi M, Lin NX, Wason JMS, McIntosh A, McConnachie A, Middleton JT, Thompson R, Kiely DG, Toshner M, Rothman A. Pulmonary Hypertension: Intensification and Personalization of Combination Rx (PHoenix): A phase IV randomized trial for the evaluation of dose-response and clinical efficacy of riociguat and selexipag using implanted technologies. Pulm Circ 2024; 14:e12337. [PMID: 38500737 PMCID: PMC10945040 DOI: 10.1002/pul2.12337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 03/20/2024] Open
Abstract
Approved therapies for the treatment of patients with pulmonary arterial hypertension (PAH) mediate pulmonary vascular vasodilatation by targeting distinct biological pathways. International guidelines recommend that patients with an inadequate response to dual therapy with a phosphodiesterase type-5 inhibitor (PDE5i) and endothelin receptor antagonist (ERA), are recommended to either intensify oral therapy by adding a selective prostacyclin receptor (IP) agonist (selexipag), or switching from PDE5i to a soluble guanylate-cyclase stimulator (sGCS; riociguat). The clinical equipoise between these therapeutic choices provides the opportunity for evaluation of individualized therapeutic effects. Traditionally, invasive/hospital-based investigations are required to comprehensively assess disease severity and demonstrate treatment benefits. Regulatory-approved, minimally invasive monitors enable equivalent measurements to be obtained while patients are at home. In this 2 × 2 randomized crossover trial, patients with PAH established on guideline-recommended dual therapy and implanted with CardioMEMS™ (a wireless pulmonary artery sensor) and ConfirmRx™ (an insertable cardiac rhythm monitor), will receive ERA + sGCS, or PDEi + ERA + IP agonist. The study will evaluate clinical efficacy via established clinical investigations and remote monitoring technologies, with remote data relayed through regulatory-approved online clinical portals. The primary aim will be the change in right ventricular systolic volume measured by magnetic resonance imaging (MRI) from baseline to maximal tolerated dose with each therapy. Using data from MRI and other outcomes, including hemodynamics, physical activity, physiological measurements, quality of life, and side effect reporting, we will determine whether remote technology facilitates early evaluation of clinical efficacy, and investigate intra-patient efficacy of the two treatment approaches.
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Affiliation(s)
- Frances Varian
- Division of Clinical MedicineUniversity of SheffieldSheffieldUK
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Jennifer Dick
- Division of Clinical MedicineUniversity of SheffieldSheffieldUK
| | | | - Stefan Roman
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Jenna Ablott
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Lisa Watson
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | | | - Hamza Zafar
- Division of Clinical MedicineUniversity of SheffieldSheffieldUK
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | | | - John Cannon
- Royal Papworth Hospital NHS Foundation TrustCambridgeUK
| | | | - Jim Lordan
- Newcastle Hospitals NHS Foundation TrustNewcastleUK
| | - Luke Howard
- Imperial College Healthcare NHS TrustLondonUK
| | - Colm McCabe
- Royal Brompton and HarefieldGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - John Wort
- NHS Greater Glasgow and ClydeGlasgowUK
| | | | - Colin Church
- National Heart and Lung Institute, Faculty of Medicine, Imperial College LondonLondonUK
| | - Neil Hamilton
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Iain Armstrong
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Abdul Hameed
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Judith Hurdman
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Charlie Elliot
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Martin Wilkins
- National Heart and Lung Institute, Faculty of Medicine, Imperial College LondonLondonUK
| | - Alastair Webb
- Wolfson Centre for Prevention of Stroke and DementiaUniversity of OxfordOxfordUK
| | - David Adlam
- Cardiovascular Research Unit of LeicesterLeicesterUK
| | - Ray L. Benza
- Mount Sinai HeartIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Kazem Rahimi
- Deep Medicine, Nuffield Department of Women's and Reproductive HealthUniversity of OxfordOxfordUK
| | | | - Nan X. Lin
- Biostatistics Research Group, Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - James M. S. Wason
- Biostatistics Research Group, Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Alasdair McIntosh
- Robertson Centre for Biostatistics, School of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, School of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Jennifer T. Middleton
- Division of Clinical MedicineUniversity of SheffieldSheffieldUK
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Roger Thompson
- Division of Clinical MedicineUniversity of SheffieldSheffieldUK
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - David G. Kiely
- Division of Clinical MedicineUniversity of SheffieldSheffieldUK
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Mark Toshner
- Department of Medicine, Heart and Lung Research InstituteUniversity of CambridgeCambridgeUK
| | - Alexander Rothman
- Division of Clinical MedicineUniversity of SheffieldSheffieldUK
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
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Keir HR, Long MB, Abo-Leyah H, Giam YH, Vadiveloo T, Pembridge T, Hull RC, Delgado L, Band M, McLaren-Neil F, Adamson S, Lahnsteiner E, Gilmour A, Hughes C, New BJ, Connell D, Dowey R, Turton H, Richardson H, Cassidy D, Cooper J, Suntharalingam J, Diwakar L, Russell P, Underwood J, Hicks A, Dosanjh DP, Sage B, Dhasmana D, Spears M, Thompson AR, Brightling C, Smith A, Patel M, George J, Condliffe AM, Shoemark A, MacLennan G, Chalmers JD. Dipeptidyl peptidase-1 inhibition in patients hospitalised with COVID-19: a multicentre, double-blind, randomised, parallel-group, placebo-controlled trial. Lancet Respir Med 2022; 10:1119-1128. [PMID: 36075243 PMCID: PMC9442496 DOI: 10.1016/s2213-2600(22)00261-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/02/2022] [Accepted: 07/04/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Neutrophil serine proteases are involved in the pathogenesis of COVID-19 and increased serine protease activity has been reported in severe and fatal infection. We investigated whether brensocatib, an inhibitor of dipeptidyl peptidase-1 (DPP-1; an enzyme responsible for the activation of neutrophil serine proteases), would improve outcomes in patients hospitalised with COVID-19. METHODS In a multicentre, double-blind, randomised, parallel-group, placebo-controlled trial, across 14 hospitals in the UK, patients aged 16 years and older who were hospitalised with COVID-19 and had at least one risk factor for severe disease were randomly assigned 1:1, within 96 h of hospital admission, to once-daily brensocatib 25 mg or placebo orally for 28 days. Patients were randomly assigned via a central web-based randomisation system (TruST). Randomisation was stratified by site and age (65 years or ≥65 years), and within each stratum, blocks were of random sizes of two, four, or six patients. Participants in both groups continued to receive other therapies required to manage their condition. Participants, study staff, and investigators were masked to the study assignment. The primary outcome was the 7-point WHO ordinal scale for clinical status at day 29 after random assignment. The intention-to-treat population included all patients who were randomly assigned and met the enrolment criteria. The safety population included all participants who received at least one dose of study medication. This study was registered with the ISRCTN registry, ISRCTN30564012. FINDINGS Between June 5, 2020, and Jan 25, 2021, 406 patients were randomly assigned to brensocatib or placebo; 192 (47·3%) to the brensocatib group and 214 (52·7%) to the placebo group. Two participants were excluded after being randomly assigned in the brensocatib group (214 patients included in the placebo group and 190 included in the brensocatib group in the intention-to-treat population). Primary outcome data was unavailable for six patients (three in the brensocatib group and three in the placebo group). Patients in the brensocatib group had worse clinical status at day 29 after being randomly assigned than those in the placebo group (adjusted odds ratio 0·72 [95% CI 0·57-0·92]). Prespecified subgroup analyses of the primary outcome supported the primary results. 185 participants reported at least one adverse event; 99 (46%) in the placebo group and 86 (45%) in the brensocatib group. The most common adverse events were gastrointestinal disorders and infections. One death in the placebo group was judged as possibly related to study drug. INTERPRETATION Brensocatib treatment did not improve clinical status at day 29 in patients hospitalised with COVID-19. FUNDING Sponsored by the University of Dundee and supported through an Investigator Initiated Research award from Insmed, Bridgewater, NJ; STOP-COVID19 trial.
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Affiliation(s)
- Holly R Keir
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Merete B Long
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Hani Abo-Leyah
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Yan Hui Giam
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | | | - Thomas Pembridge
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Rebecca C Hull
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Lilia Delgado
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Margaret Band
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | | | - Simon Adamson
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Eva Lahnsteiner
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Amy Gilmour
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Chloe Hughes
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Benjamin Jm New
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - David Connell
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Rebecca Dowey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Helena Turton
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Diane Cassidy
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | | | | | | | | | | | | | | | | | | | - Mark Spears
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Aa Roger Thompson
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | | | | | - Jacob George
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Alison M Condliffe
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Amelia Shoemark
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - James D Chalmers
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK.
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Slegg OG, Willis JA, Wilkinson F, Sparey J, Wild CB, Rossdale J, Ross RM, Pauling JD, Carson K, Kandan SR, Oxborough D, Knight D, Peacock OJ, Suntharalingam J, Coghlan JG, Augustine DX. IMproving PULmonary hypertension Screening by Echocardiography: IMPULSE. Echo Res Pract 2022; 9:9. [PMID: 36258244 PMCID: PMC9580132 DOI: 10.1186/s44156-022-00010-9] [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] [Received: 06/02/2022] [Accepted: 09/24/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The world symposium on pulmonary hypertension (PH) has proposed that PH be defined as a mean pulmonary artery pressure (mPAP) > 20 mmHg as assessed by right heart catheterisation (RHC). Transthoracic echocardiography (TTE) is an established screening tool used for suspected PH. International guidelines recommend a multi-parameter assessment of the TTE PH probability although effectiveness has not been established using real world data. STUDY AIMS To determine accuracy of the European Society of Cardiology (ESC) and British Society of Echocardiography (BSE) TTE probability algorithm in detecting PH in patients attending a UK PH centre. To identify echocardiographic markers and revised algorithms to improve the detection of PH in those with low/intermediate BSE/ESC TTE PH probability. METHODS TTE followed by RHC (within 4 months after) was undertaken in patients for suspected but previously unconfirmed PH. BSE/ESC PH TTE probabilities were calculated alongside additional markers of right ventricular (RV) longitudinal and radial function, and RV diastolic function. A refined IMPULSE algorithm was devised and evaluated in patients with low and/or intermediate ESC/BSE TTE PH probability. RESULTS Of 310 patients assessed, 236 (76%) had RHC-confirmed PH (average mPAP 42.8 ± 11.7). Sensitivity and specificity for detecting PH using the BSE/ESC recommendations was 89% and 68%, respectively. 36% of those with low BSE/ESC TTE probability had RHC-confirmed PH and BSE/ESC PH probability parameters did not differ amongst those with and without PH in the low probability group. Conversely, RV free wall longitudinal strain (RVFWLS) was lower in patients with vs. without PH in low BSE/ESC probability group (- 20.6 ± 4.1% vs - 23.8 ± 3.9%) (P < 0.02). Incorporating RVFWLS and TTE features of RV radial and diastolic function (RVFAC and IVRT) within the IMPULSE algorithm reduced false negatives in patients with low BSE/ESC PH probability by 29%. The IMPULSE algorithm had excellent specificity and positive predictive value in those with low (93%/80%, respectively) or intermediate (82%/86%, respectively) PH probability. CONCLUSION Existing TTE PH probability guidelines lack sensitivity to detect patients with milder haemodynamic forms of PH. Combining additional TTE makers assessing RV radial, longitudinal and diastolic function enhance identification of milder forms of PH, particularly in those who have a low BSE/ESC TTE PH probability.
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Affiliation(s)
- Oliver Graham Slegg
- Royal United Hospitals Bath NHS Foundation Trust, Bath, BA13NG, UK
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | | | - Fiona Wilkinson
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | - Joseph Sparey
- Royal United Hospitals Bath NHS Foundation Trust, Bath, BA13NG, UK
| | | | | | | | - John D Pauling
- Royal United Hospitals Bath NHS Foundation Trust, Bath, BA13NG, UK
| | - Kevin Carson
- Royal United Hospitals Bath NHS Foundation Trust, Bath, BA13NG, UK
| | | | | | | | | | | | | | - Daniel Xavier Augustine
- Royal United Hospitals Bath NHS Foundation Trust, Bath, BA13NG, UK.
- Department for Health, University of Bath, Bath, UK.
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5
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Charters PFP, Rossdale J, Brown W, Burnett TA, Komber HMEI, Thompson C, Robinson G, MacKenzie Ross R, Suntharalingam J, Rodrigues JCL. Diagnostic accuracy of an automated artificial intelligence derived right ventricular to left ventricular diameter ratio tool on CT pulmonary angiography to predict pulmonary hypertension at right heart catheterisation. Clin Radiol 2022; 77:e500-e508. [PMID: 35487778 DOI: 10.1016/j.crad.2022.03.009] [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: 10/20/2021] [Accepted: 03/09/2022] [Indexed: 11/25/2022]
Abstract
AIM To determine the diagnostic accuracy of an automated artificial intelligence derived right ventricle/left ventricle diameter ratio (RV/LV) computed tomography pulmonary angiography (CTPA) analysis tool to detect pulmonary hypertension (PH) in patients with suspected PH referred to a specialist centre. MATERIALS AND METHODS The present study was a retrospective analysis of a prospectively maintained database of 202 consecutive patients with suspected PH, who underwent CTPA within 12 months of right heart catheterisation (RHC). Automated ventricular segmentation and RV/LV calculation (Imbio LLC, Minneapolis, MN, USA) was undertaken on the CTPA images. PH diagnosis was made using the RHC reference standard. RESULTS The automated RV/LV correlated more strongly with RHC metrics than main pulmonary artery (MPA) diameter and MPA to ascending aorta diameter ratio (MPA/AA) measured manually (mean pulmonary arterial pressure [mPAP] r=0.535, R2 = 0.287 p<0.001; pulmonary vascular resistance [PVR] r=0.607, R2 = 0.369 p<0.001). In the derivation cohort (n=100), the area under the receiver-operating curve for automated RV/LV discriminating PH was 0.752 (95% confidence interval [CI] 0.677-0.827, p<0.001). Using an optimised Youden's Index of ≥1.12 classified from derivation, automated RV/LV ratio analysis was more sensitive for the detection of PH with higher positive predictive value (PPV) when compared with manual MPA and MPA/AA in the validation cohort (n=102). Automated RV/LV compromise (1.12) and specific (1.335) thresholds were strongly predictive of mortality (log-rank 7.401, p=0.007 and log-rank 16.075, p<0.001 respectively). CONCLUSION In suspected PH, automated RV/LV diameter thresholds have high sensitivity for PH, outperform manual MPA and MPA/AA and can predict survival.
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Affiliation(s)
- P F P Charters
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - J Rossdale
- Department of Respiratory Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK; Department of Pharmacy and Pharmacology, University of Bath, UK
| | - W Brown
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - T A Burnett
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - H M E I Komber
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - C Thompson
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - G Robinson
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - R MacKenzie Ross
- Department of Respiratory Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - J Suntharalingam
- Department of Respiratory Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK; Department of Pharmacy and Pharmacology, University of Bath, UK
| | - J C L Rodrigues
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK; Department for Health, University of Bath, Bath, UK.
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Anstey R, Rossdale J, Dereham A, Peter E, Tan R, Ross RM, Robinson G, Hartley T, Suntharalingam J, Rodrigues JC. Screening success: A virtual MDT can reduce the number of patients requiring respiratory follow-up post-COVID-19 pneumonia in line with British Thoracic Society guidance. Clin Med (Lond) 2022; 22:45-50. [PMID: 38589100 DOI: 10.7861/clinmed.2021-0124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES The ongoing respiratory sequelae of COVID-19 pneumonia remain unclear, and the ideal follow-up of these patients is still a work in progress. We describe our experience of using a pre-follow-up multidisciplinary team (MDT) to decide the follow-up stream in patients hospitalised for COVID-19 pneumonia. METHODS We reviewed all patients with a clinico-radiological diagnosis of COVID-19 admitted to hospital during a 3-month period and assigned a follow-up stream based on British Thoracic Society guidance. RESULTS We changed the follow-up pathway in 71% (277/392) and refined the pathway in 67% (261/392) of indeterminate cases. We also created an automated process for the general practitioner to book follow-up imaging and will use this process going forward. CONCLUSION These findings highlight the importance of the MDT review of cases with suspected COVID-19 pneumonia prior to clinic attendance to ensure appropriate patients are followed up and to optimise utilisation of outpatient imaging and clinics.
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Affiliation(s)
| | | | | | | | - Rey Tan
- Royal United Hospital, Bath, UK
| | | | | | | | | | - Jonathan Cl Rodrigues
- Bristol Medical School, Bristol, UK, University of Bath, Bath, UK and Royal United Hospital, Bath, UK.
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7
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Hardacre CJ, Robertshaw JA, Barratt SL, Adams HL, MacKenzie Ross RV, Robinson GRE, Suntharalingam J, Pauling JD, Rodrigues JCL. Diagnostic test accuracy of artificial intelligence analysis of cross-sectional imaging in pulmonary hypertension: a systematic literature review. Br J Radiol 2021; 94:20210332. [PMID: 34541861 PMCID: PMC8631018 DOI: 10.1259/bjr.20210332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/28/2021] [Accepted: 08/31/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To undertake the first systematic review examining the performance of artificial intelligence (AI) applied to cross-sectional imaging for the diagnosis of acquired pulmonary arterial hypertension (PAH). METHODS Searches of Medline, Embase and Web of Science were undertaken on 1 July 2020. Original publications studying AI applied to cross-sectional imaging for the diagnosis of acquired PAH in adults were identified through two-staged double-blinded review. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies and Checklist for Artificial Intelligence in Medicine frameworks. Narrative synthesis was undertaken following Synthesis Without Meta-Analysis guidelines. This review received no funding and was registered in the International Prospective Register of Systematic Reviews (ID:CRD42020196295). RESULTS Searches returned 476 citations. Three retrospective observational studies, published between 2016 and 2020, were selected for data-extraction. Two methods applied to cardiac-MRI demonstrated high diagnostic accuracy, with the best model achieving AUC=0.90 (95% CI: 0.85-0.93), 89% sensitivity and 81% specificity. Stronger results were achieved using cardiac-MRI for classification of idiopathic PAH, achieving AUC=0.97 (95% CI: 0.89-1.0), 96% sensitivity and 87% specificity. One study reporting CT-based AI demonstrated lower accuracy, with 64.6% sensitivity and 97.0% specificity. CONCLUSIONS Automated methods for identifying PAH on cardiac-MRI are emerging with high diagnostic accuracy. AI applied to cross-sectional imaging may provide non-invasive support to reduce diagnostic delay in PAH. This would be helped by stronger solutions in other modalities. ADVANCES IN KNOWLEDGE There is a significant shortage of research in this important area. Early detection of PAH would be supported by further research advances on the promising emerging technologies identified.
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Affiliation(s)
| | | | - Shaney L Barratt
- Department of Respiratory Medicine, North Bristol NHS Trust, Bristol, UK
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8
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Slegg O, Willis JA, Gibson C, Kendler-Rhodes A, Wilkinson F, Rossdale J, Charters P, MacKenzie Ross R, Pauling JD, Easaw J, Carson K, Kandan SR, Robinson G, Suntharalingam J, Augustine DX. Accuracy of echocardiographic doppler measures of pulmonary hypertension compared with right heart catheterisation in a real world population referred to a specialist centre. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1968] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Right heart catheterisation (RHC) is the gold standard investigation for the diagnosis of pulmonary hypertension (PH). Transthoracic echocardiography (TTE) allows non-invasive screening for PH. This retrospective audit sought to compare the accuracy of non-invasive Doppler estimates of pulmonary artery pressure and pulmonary vascular resistance (PVR) compared to RHC in a real world cohort referred to a shared care PH centre.
Method
Between 2010 and 2019, a total of 310 patients referred for initial assessment of PH underwent TTE followed by RHC (mean interval 31±30 days). Bland-Altman analysis was used to retrospectively investigate the accuracy of Doppler estimates of Pulmonary Artery Systolic Pressure (PASP), mean Pulmonary Artery Pressure (mPAP), Right Atrial Pressure (RAP) and PVR compared to RHC. TTE mPAP estimates were made using the pulmonary regurgitation velocity at the beginning of diastole (mPAP = 4(PRVBD)2 + RAP). TTE PVR estimates were calculated using the equation 10(TRV / RVOTVTI) + 0.16.
Results
Seventy-six percent of the cohort (n=235) had RHC diagnosed PH (average mPAP 42.8±11.7mmHg). The peak tricuspid regurgitation velocity (TRV) was measurable in 87% (n=269) and was unmeasurable in 8% (n=19) of those with confirmed RHC PH. Ten percent (n=30) had inadequate IVC imaging. TTE estimates of PASP (n=239) had a good correlation to RHC PASP (rs=0.82, 95% CI 0.75–0.84). TTE PASP estimates tended to underestimate RHC PASP (bias −3.7±15.2mmHg) with wide limits of agreement (95% limits of agreement −33.5–26.1mmHg) (figure 1); highlighting the imprecision of Doppler estimates alone. Only 44% of TTE PASP estimates were within 10mmHg of RHC PASP readings. Underestimation occurred more frequently accounting for 66% of inaccurate TTE PASP estimates. TTE RAP estimates (n=292) were weakly correlated to RHC RAP (rs=0.38, 95% CI 0.27–0.48).
TTE estimates of mPAP were only measurable in 81 patients and demonstrated moderate correlation to RHC mPAP (rs=0.58, 95% CI 0.4–0.71). TTE estimates tended to underestimate RHC mPAP (bias of −10±10.9mmHg) with wide limits of agreement (95% limits of agreement −31.3–11.3mmHg) (figure 1) suggesting poor accuracy and precision. Only 51% of TTE estimates were within 10mmHg of RHC mPAP with 93% of inaccuracies due to an underestimation of RHC mPAP. TTE PVR estimates (n=238) correlated well with RHC PVR measures (rs=0.68, 95% CI 0.6–0.74). However, Bland-Altman analysis (figure 2) demonstrated bias of −2.2±3.1WU with wide limits of agreement (95% limits of agreement −8.2–3.8WU), highlighting significant inaccuracy.
Conclusion
Doppler TTE measures to assess PH lack accuracy when compared with the gold standard RHC. Furthermore, the peak TRV was unmeasurable in 8% of those with confirmed RHC diagnosed PH. These findings further support the use of a multi parameter TTE approach for screening of PH.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- O Slegg
- Royal United Hospital Bath NHS Trust, Bath, United Kingdom
| | - J A Willis
- Royal United Hospital Bath NHS Trust, Bath, United Kingdom
| | - C Gibson
- University of Bristol, Bristol, United Kingdom
| | | | - F Wilkinson
- Manchester Metropolitan University, Manchester, United Kingdom
| | - J Rossdale
- Royal United Hospital Bath NHS Trust, Bath, United Kingdom
| | - P Charters
- Royal United Hospital Bath NHS Trust, Bath, United Kingdom
| | | | - J D Pauling
- Royal United Hospital Bath NHS Trust, Bath, United Kingdom
| | - J Easaw
- Royal United Hospital Bath NHS Trust, Bath, United Kingdom
| | - K Carson
- Royal United Hospital Bath NHS Trust, Bath, United Kingdom
| | - S R Kandan
- Royal United Hospital Bath NHS Trust, Bath, United Kingdom
| | - G Robinson
- Royal United Hospital Bath NHS Trust, Bath, United Kingdom
| | | | - D X Augustine
- Royal United Hospital Bath NHS Trust, Bath, United Kingdom
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9
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Wilkins MR, Mckie MA, Law M, Roussakis AA, Harbaum L, Church C, Coghlan JG, Condliffe R, Howard LS, Kiely DG, Lordan J, Rothman A, Suntharalingam J, Toshner M, Wort SJ, Villar SS. Positioning imatinib for pulmonary arterial hypertension: A phase I/II design comprising dose finding and single-arm efficacy. Pulm Circ 2021; 11:20458940211052823. [PMID: 34868551 PMCID: PMC8642118 DOI: 10.1177/20458940211052823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/19/2021] [Indexed: 12/21/2022] Open
Abstract
Pulmonary arterial hypertension is an unmet clinical need. Imatinib, a tyrosine kinase inhibitor, 200 to 400 mg daily reduces pulmonary artery pressure and increases functional capacity in this patient group, but is generally poorly tolerated at the higher dose. We have designed an open-label, single-arm clinical study to investigate whether there is a tolerated dose of imatinib that can be better targeted to patients who will benefit. The study consists of two parts. Part 1 seeks to identify the best tolerated dose of Imatinib in the range from 100 and up to 400 mg using a Bayesian Continuous Reassessment Method. Part 2 will measure efficacy after 24 weeks treatment with the best tolerated dose using a Simon's two-stage design. The primary efficacy endpoint is a binary variable. For patients with a baseline pulmonary vascular resistance (PVR) >1000 dynes · s · cm-5, success is defined by an absolute reduction in PVR of ≥300 dynes · s · cm-5 at 24 weeks. For patients with a baseline PVR ≤1000 dynes · s · cm-5, success is a 30% reduction in PVR at 24 weeks. PVR will also be evaluated as a continuous variable by genotype as an exploratory analysis. Evaluating the response to that dose by genotype may inform a prospective biomarker-driven study.
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Affiliation(s)
- Martin R. Wilkins
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Mikel A. Mckie
- MRC Biostatistics Unit, School of Clinical Medicine, Cambridge Institute of Public Health, Cambridge, UK
| | - Martin Law
- MRC Biostatistics Unit, School of Clinical Medicine, Cambridge Institute of Public Health, Cambridge, UK
| | | | - Lars Harbaum
- Golden Jubilee National Hospital, University of Glasgow, Scotland, UK
| | - Colin Church
- Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - J Gerry Coghlan
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Luke S Howard
- National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - David G Kiely
- Newcastle Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne, UK
| | - Jim Lordan
- Royal United Hospital, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Alexander Rothman
- Heart Lung Research Institute, University of Cambridge, Cambridge, UK
| | | | - Mark Toshner
- Royal Brompton Hospital, Guy’s and St Thomas’s Trust, London, UK
| | - Stephen J Wort
- Royal Brompton Hospital, Guy’s and St Thomas’s Trust, London, UK
| | - Sofía S. Villar
- MRC Biostatistics Unit, School of Clinical Medicine, Cambridge Institute of Public Health, Cambridge, UK
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10
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Toshner M, Church C, Harbaum L, Rhodes C, Villar Moreschi SS, Liley J, Jones R, Arora A, Batai K, Desai AA, Coghlan JG, Gibbs JSR, Gor D, Gräf S, Harlow L, Hernandez-Sanchez J, Howard LS, Humbert M, Karnes J, Kiely DG, Kittles R, Knightbridge E, Lam B, Lutz KA, Nichols WC, Pauciulo MW, Pepke-Zaba J, Suntharalingam J, Soubrier F, Trembath RC, Schwantes-An THL, Wort SJ, Wilkins M, Gaine S, Morrell NW, Corris PA. Mendelian randomisation and experimental medicine approaches to IL-6 as a drug target in PAH. Eur Respir J 2021; 59:13993003.02463-2020. [PMID: 34588193 PMCID: PMC8907935 DOI: 10.1183/13993003.02463-2020] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/15/2021] [Indexed: 11/21/2022]
Abstract
Background Inflammation and dysregulated immunity are important in the development of pulmonary arterial hypertension (PAH). Compelling preclinical data supports the therapeutic blockade of interleukin-6 (IL-6) signalling. Methods We conducted a phase 2 open-label study of intravenous tocilizumab (8 mg·kg−1) over 6 months in patients with group 1 PAH. Co-primary end-points were safety, defined by incidence and severity of adverse events, and change in pulmonary vascular resistance. Separately, a mendelian randomisation study was undertaken on 11 744 individuals with European ancestry including 2085 patients with idiopathic/heritable disease for the IL-6 receptor (IL6R) variant (rs7529229), known to associate with circulating IL-6R levels. Results We recruited 29 patients (male/female 10/19; mean±sd age 54.9±11.4 years). Of these, 19 had heritable/idiopathic PAH and 10 had connective tissue disease-associated PAH. Six were withdrawn prior to drug administration; 23 patients received at least one dose of tocilizumab. Tocilizumab was discontinued in four patients owing to serious adverse events. There were no deaths. Despite evidence of target engagement in plasma IL-6 and C-reactive protein levels, both intention-to-treat and modified intention-to-treat analyses demonstrated no change in pulmonary vascular resistance. Inflammatory markers did not predict treatment response. Mendelian randomisation did not support an effect of the lead IL6R variant on risk of PAH (OR 0.99, p=0.88). Conclusion Adverse events were consistent with the known safety profile of tocilizumab. Tocilizumab did not show any consistent treatment effect. Tocilizumab did not block IL-6 signalling in pulmonary arterial hypertension. Multicentre mendelian randomisation studies additionally did not demonstrate evidence for IL-6R in pulmonary arterial hypertension.https://bit.ly/3xkDxS5
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Affiliation(s)
- Mark Toshner
- Department of Medicine, University of Cambridge, Cambridge, UK .,Royal Papworth Hospital, Cambridge, UK.,Authors contributed equally to this work
| | - Colin Church
- Golden Jubilee Hospital, Glasgow, UK.,Authors contributed equally to this work
| | - Lars Harbaum
- Heart Lung Research Institute, Imperial College, London, UK
| | | | | | - James Liley
- Department of Medicine, University of Cambridge, Cambridge, UK.,MRC Biostatistical Unit, University of Cambridge, Cambridge, UK
| | - Rowena Jones
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Amit Arora
- Department of Epidemiology and Biostatistics, University of Arizona, Arizona, US
| | - Ken Batai
- Department of Urology, University of Arizona, Arizona, US
| | - Ankit A Desai
- Department of Medicine, Indiana University, Indiana, US
| | | | | | - Dee Gor
- Roche Products Limited, Welwyn Garden City, UK
| | - Stefan Gräf
- Department of Medicine, University of Cambridge, Cambridge, UK
| | | | | | - Luke S Howard
- Heart Lung Research Institute, Imperial College, London, UK
| | - Marc Humbert
- Université Paris-Sud, Le Kremlin-Bicêtre, Paris, France
| | - Jason Karnes
- Department of Epidemiology and Biostatistics, University of Arizona, Arizona, US
| | | | - Rick Kittles
- Department of Epidemiology and Biostatistics, University of Arizona, Arizona, US
| | | | - Brian Lam
- Institute of Metabolic Sciences, University of Cambridge, Cambridge, UK
| | - Katie A Lutz
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, US
| | - William C Nichols
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, US
| | - Michael W Pauciulo
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, US
| | | | | | | | | | | | - S John Wort
- Heart Lung Research Institute, Imperial College, London, UK
| | - Martin Wilkins
- Heart Lung Research Institute, Imperial College, London, UK
| | - Sean Gaine
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Nicholas W Morrell
- Department of Medicine, University of Cambridge, Cambridge, UK.,Authors contributed equally to this work
| | - Paul A Corris
- Department of Medicine, Newcastle University, Newcastle, UK.,Authors contributed equally to this work
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11
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Foley RW, Kaneria N, Ross RVM, Suntharalingam J, Hudson BJ, Rodrigues JC, Robinson G. Computed tomography appearances of the lung parenchyma in pulmonary hypertension. Br J Radiol 2021; 94:20200830. [PMID: 32915646 DOI: 10.1259/bjr.20200830] [Citation(s) in RCA: 5] [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] [Indexed: 11/05/2022] Open
Abstract
Computed tomography (CT) is a valuable tool in the workup of patients under investigation for pulmonary hypertension (PH) and may be the first test to suggest the diagnosis. CT parenchymal lung changes can help to differentiate the aetiology of PH. CT can demonstrate interstitial lung disease, emphysema associated with chronic obstructive pulmonary disease, features of left heart failure (including interstitial oedema), and changes secondary to miscellaneous conditions such as sarcoidosis. CT also demonstrates parenchymal changes secondary to chronic thromboembolic disease and venous diseases such as pulmonary venous occlusive disease (PVOD) and pulmonary capillary haemangiomatosis (PCH). It is important for the radiologist to be aware of the various manifestations of PH in the lung, to help facilitate an accurate and timely diagnosis. This pictorial review illustrates the parenchymal lung changes that can be seen in the various conditions causing PH.
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Affiliation(s)
- Robert W Foley
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Avon, Bath, United Kingdom
| | - Nirav Kaneria
- Department of Respiratory Medicine, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Avon, Bath, United Kingdom
| | - Rob V MacKenzie Ross
- Department of Respiratory Medicine, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Avon, Bath, United Kingdom
| | - Jay Suntharalingam
- Department of Respiratory Medicine, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Avon, Bath, United Kingdom
| | - Benjamin J Hudson
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Avon, Bath, United Kingdom
| | - Jonathan Cl Rodrigues
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Avon, Bath, United Kingdom
| | - Graham Robinson
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Avon, Bath, United Kingdom
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12
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Swietlik EM, Greene D, Zhu N, Megy K, Cogliano M, Rajaram S, Pandya D, Tilly T, Lutz KA, Welch CC, Pauciulo MW, Southgate L, Martin JM, Treacy CM, Penkett CJ, Stephens JC, Bogaard HJ, Church C, Coghlan G, Coleman AW, Condliffe R, Eichstaedt CA, Eyries M, Gall H, Ghio S, Girerd B, Grünig E, Holden S, Howard L, Humbert M, Kiely DG, Kovacs G, Lordan J, Machado RD, MacKenzie Ross RV, McCabe C, Moledina S, Montani D, Olschewski H, Pepke-Zaba J, Price L, Rhodes CJ, Seeger W, Soubrier F, Suntharalingam J, Toshner MR, Vonk Noordegraaf A, Wharton J, Wild JM, Wort SJ, Lawrie A, Wilkins MR, Trembath RC, Shen Y, Chung WK, Swift AJ, Nichols WC, Morrell NW, Gräf S. Bayesian Inference Associates Rare KDR Variants with Specific Phenotypes in Pulmonary Arterial Hypertension. Circ Genom Precis Med 2020; 14. [PMID: 33320693 PMCID: PMC7892262 DOI: 10.1161/circgen.120.003155] [Citation(s) in RCA: 10] [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: 12/19/2019] [Accepted: 11/29/2020] [Indexed: 11/26/2022]
Abstract
Background - Approximately 25% of patients with pulmonary arterial hypertension (PAH) have been found to harbor rare mutations in disease-causing genes. To identify missing heritability in PAH we integrated deep phenotyping with whole-genome sequencing data using Bayesian statistics. Methods - We analyzed 13,037 participants enrolled in the NIHR BioResource - Rare Diseases (NBR) study, of which 1,148 were recruited to the PAH domain. To test for genetic associations between genes and selected phenotypes of pulmonary hypertension (PH), we used the Bayesian rare-variant association method BeviMed. Results - Heterozygous, high impact, likely loss-of-function variants in the Kinase Insert Domain Receptor (KDR) gene were strongly associated with significantly reduced transfer coefficient for carbon monoxide (KCO, posterior probability (PP)=0.989) and older age at diagnosis (PP=0.912). We also provide evidence for familial segregation of a rare nonsense KDR variant with these phenotypes. On computed tomographic imaging of the lungs, a range of parenchymal abnormalities were observed in the five patients harboring these predicted deleterious variants in KDR. Four additional PAH cases with rare likely loss-of-function variants in KDR were independently identified in the US PAH Biobank cohort with similar phenotypic characteristics. Conclusions - The Bayesian inference approach allowed us to independently validate KDR, which encodes for the Vascular Endothelial Growth Factor Receptor 2 (VEGFR2), as a novel PAH candidate gene. Furthermore, this approach specifically associated high impact likely loss-of-function variants in the genetically constrained gene with distinct phenotypes. These findings provide evidence for KDR being a clinically actionable PAH gene and further support the central role of the vascular endothelium in the pathobiology of PAH.
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Affiliation(s)
- Emilia M. Swietlik
- Department of Medicine (E.M.S., D.P., T.T., C.M.T., M.R.T., N.W.M., S. Gräf), University of Cambridge
| | - Daniel Greene
- Department of Haematology (D.G., K.M., C.J.P., J.C.S., S. Gräf), University of Cambridge
- NIHR BioResource for Translational Research, Cambridge, United Kingdom (D.G., K.M., J.M.M., C.J.P., J.C.S., N.W.M., S. Gräf)
| | - Na Zhu
- Department of Pediatrics (N.Z., C.C.L.W.), Columbia University, NY
- Department of Systems Biology (N.Z., Y.S.), Columbia University, NY
| | - Karyn Megy
- Department of Haematology (D.G., K.M., C.J.P., J.C.S., S. Gräf), University of Cambridge
- NIHR BioResource for Translational Research, Cambridge, United Kingdom (D.G., K.M., J.M.M., C.J.P., J.C.S., N.W.M., S. Gräf)
| | - Marcella Cogliano
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield (M.C., J.M.W., A.L., A.J.S.)
| | - Smitha Rajaram
- Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom (S.R.)
| | - Divya Pandya
- Department of Medicine (E.M.S., D.P., T.T., C.M.T., M.R.T., N.W.M., S. Gräf), University of Cambridge
| | - Tobias Tilly
- Department of Medicine (E.M.S., D.P., T.T., C.M.T., M.R.T., N.W.M., S. Gräf), University of Cambridge
| | - Katie A. Lutz
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center (K.A.L., M.W.P., A.W.C., W.C.N.)
| | | | - Michael W. Pauciulo
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center (K.A.L., M.W.P., A.W.C., W.C.N.)
- Department of Pediatrics, University of Cincinnati College of Medicine, OH (M.W.P., W.C.N.)
| | - Laura Southgate
- Molecular & Clinical Sciences Research Institute, St George’s, University of London, United Kingdom (L.S., R.D.M.)
| | - Jennifer M. Martin
- NIHR BioResource for Translational Research, Cambridge, United Kingdom (D.G., K.M., J.M.M., C.J.P., J.C.S., N.W.M., S. Gräf)
| | - Carmen M. Treacy
- Department of Medicine (E.M.S., D.P., T.T., C.M.T., M.R.T., N.W.M., S. Gräf), University of Cambridge
| | - Christopher J. Penkett
- Department of Haematology (D.G., K.M., C.J.P., J.C.S., S. Gräf), University of Cambridge
- NIHR BioResource for Translational Research, Cambridge, United Kingdom (D.G., K.M., J.M.M., C.J.P., J.C.S., N.W.M., S. Gräf)
| | - Jonathan C. Stephens
- Department of Haematology (D.G., K.M., C.J.P., J.C.S., S. Gräf), University of Cambridge
- NIHR BioResource for Translational Research, Cambridge, United Kingdom (D.G., K.M., J.M.M., C.J.P., J.C.S., N.W.M., S. Gräf)
| | - Harm J. Bogaard
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands (H.J.B., A.V.N.)
| | - Colin Church
- Golden Jubilee National Hospital, Glasgow (C.C.)
| | | | - Anna W. Coleman
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center (K.A.L., M.W.P., A.W.C., W.C.N.)
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, United Kingdom (R.C., D.G.K.)
| | - Christina A. Eichstaedt
- Laboratory for Molecular Genetic Diagnostics, Institute of Human Genetics, Heidelberg University (C.A.E.)
- Center for Pulmonary Hypertension, Thoraxklinik gGmbH Heidelberg at Heidelberg University Hospital (C.A.E., E.G.)
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany (C.A.E., E.G.)
| | - Mélanie Eyries
- Département de génétique, hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris & UMR_S 1166-ICAN, INSERM, UPMC Sorbonne Universités, Paris, France (M.E., F.S.)
| | - Henning Gall
- University of Giessen & Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL) and of the Excellence Cluster Cardio-Pulmonary Institute (CPI), Giessen, Germany (H.G., W.S.)
| | - Stefano Ghio
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (S. Ghio)
| | - Barbara Girerd
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay (B.G., M.H., D.M.)
- AP-HP, Service de Pneumologie, Centre de référence de l’hypertension pulmonaire (B.G., M.H., D.M.)
- INSERM UMR_S 999, Hôpital Bicêtre, Le Kremlin-Bicêtre, Paris, France (B.G., M.H., D.M.)
| | - Ekkehard Grünig
- Center for Pulmonary Hypertension, Thoraxklinik gGmbH Heidelberg at Heidelberg University Hospital (C.A.E., E.G.)
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany (C.A.E., E.G.)
| | - Simon Holden
- Addenbrooke’s Hospital NHS Foundation Trust, Cambridge (S.H., N.W.M.)
| | - Luke Howard
- National Heart & Lung Institute, Imperial College London, United Kingdom (L.H., C.M., L.P., C.J.R., J.W., S.J.W., M.R.W.)
| | - Marc Humbert
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay (B.G., M.H., D.M.)
- AP-HP, Service de Pneumologie, Centre de référence de l’hypertension pulmonaire (B.G., M.H., D.M.)
- INSERM UMR_S 999, Hôpital Bicêtre, Le Kremlin-Bicêtre, Paris, France (B.G., M.H., D.M.)
| | - David G. Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, United Kingdom (R.C., D.G.K.)
| | - Gabor Kovacs
- Ludwig Boltzmann Institute for Lung Vascular Research (G.K., H.O.)
- Medical University of Graz, Austria (G.K., H.O.)
| | - Jim Lordan
- Freeman Hospital, Newcastle upon Tyne (J.L.)
| | - Rajiv D. Machado
- Molecular & Clinical Sciences Research Institute, St George’s, University of London, United Kingdom (L.S., R.D.M.)
| | | | - Colm McCabe
- National Heart & Lung Institute, Imperial College London, United Kingdom (L.H., C.M., L.P., C.J.R., J.W., S.J.W., M.R.W.)
- Royal Brompton & Harefield NHS Foundation Trust (C.M., L.P., S.J.W.)
| | | | - David Montani
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay (B.G., M.H., D.M.)
- AP-HP, Service de Pneumologie, Centre de référence de l’hypertension pulmonaire (B.G., M.H., D.M.)
- INSERM UMR_S 999, Hôpital Bicêtre, Le Kremlin-Bicêtre, Paris, France (B.G., M.H., D.M.)
| | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research (G.K., H.O.)
- Medical University of Graz, Austria (G.K., H.O.)
| | - Joanna Pepke-Zaba
- Royal Papworth Hospital NHS Foundation Trust (J.P.-Z., M.R.T., N.W.M.)
| | - Laura Price
- National Heart & Lung Institute, Imperial College London, United Kingdom (L.H., C.M., L.P., C.J.R., J.W., S.J.W., M.R.W.)
- Royal Brompton & Harefield NHS Foundation Trust (C.M., L.P., S.J.W.)
| | - Christopher J. Rhodes
- National Heart & Lung Institute, Imperial College London, United Kingdom (L.H., C.M., L.P., C.J.R., J.W., S.J.W., M.R.W.)
| | - Werner Seeger
- University of Giessen & Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL) and of the Excellence Cluster Cardio-Pulmonary Institute (CPI), Giessen, Germany (H.G., W.S.)
| | - Florent Soubrier
- Département de génétique, hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris & UMR_S 1166-ICAN, INSERM, UPMC Sorbonne Universités, Paris, France (M.E., F.S.)
| | | | - Mark R. Toshner
- Department of Medicine (E.M.S., D.P., T.T., C.M.T., M.R.T., N.W.M., S. Gräf), University of Cambridge
- Royal Papworth Hospital NHS Foundation Trust (J.P.-Z., M.R.T., N.W.M.)
| | - Anton Vonk Noordegraaf
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands (H.J.B., A.V.N.)
| | - John Wharton
- National Heart & Lung Institute, Imperial College London, United Kingdom (L.H., C.M., L.P., C.J.R., J.W., S.J.W., M.R.W.)
| | - James M. Wild
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield (M.C., J.M.W., A.L., A.J.S.)
| | - Stephen John Wort
- National Heart & Lung Institute, Imperial College London, United Kingdom (L.H., C.M., L.P., C.J.R., J.W., S.J.W., M.R.W.)
- Royal Brompton & Harefield NHS Foundation Trust (C.M., L.P., S.J.W.)
| | | | | | | | - Allan Lawrie
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield (M.C., J.M.W., A.L., A.J.S.)
| | - Martin R. Wilkins
- National Heart & Lung Institute, Imperial College London, United Kingdom (L.H., C.M., L.P., C.J.R., J.W., S.J.W., M.R.W.)
| | - Richard C. Trembath
- Department of Medical & Molecular Genetics, King’s College London, United Kingdom (R.C.T.)
| | - Yufeng Shen
- Department of Systems Biology (N.Z., Y.S.), Columbia University, NY
- Department of Biomedical Informatics (Y.S.), Columbia University, NY
| | | | - Andrew J. Swift
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield (M.C., J.M.W., A.L., A.J.S.)
| | - William C. Nichols
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center (K.A.L., M.W.P., A.W.C., W.C.N.)
- Department of Pediatrics, University of Cincinnati College of Medicine, OH (M.W.P., W.C.N.)
| | - Nicholas W. Morrell
- Department of Medicine (E.M.S., D.P., T.T., C.M.T., M.R.T., N.W.M., S. Gräf), University of Cambridge
- NIHR BioResource for Translational Research, Cambridge, United Kingdom (D.G., K.M., J.M.M., C.J.P., J.C.S., N.W.M., S. Gräf)
- Addenbrooke’s Hospital NHS Foundation Trust, Cambridge (S.H., N.W.M.)
- Royal Papworth Hospital NHS Foundation Trust (J.P.-Z., M.R.T., N.W.M.)
| | - Stefan Gräf
- Department of Medicine (E.M.S., D.P., T.T., C.M.T., M.R.T., N.W.M., S. Gräf), University of Cambridge
- Department of Haematology (D.G., K.M., C.J.P., J.C.S., S. Gräf), University of Cambridge
- NIHR BioResource for Translational Research, Cambridge, United Kingdom (D.G., K.M., J.M.M., C.J.P., J.C.S., N.W.M., S. Gräf)
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13
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Willis JA, Kendler-Rhodes A, Slegg O, Carson K, Easaw J, Kandan SR, Rodrigues JCL, MacKenzie-Ross R, Hall T, Robinson G, Little D, Hudson B, Pauling J, Redman S, Graham R, Coghlan G, Suntharalingam J, Augustine DX. Abstract 5: BSE pulmonary hypertension guidelines: audit and future perspectives. Echo Res Pract 2020. [DOI: 10.1007/bf03651757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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14
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Sharma V, Al Saikhan L, Park C, Hughes A, Gu H, Saeed S, Boguslavskyi A, Carr-White G, Chambers J, Chowienczyk P, Jain M, Jessop H, Turner C, Bassindale-Maguire G, Baig W, Kidambi A, Abdel-Rahman ST, Schlosshan D, Sengupta A, Fitzpatrick A, Sandoval J, Hickman S, Procter H, Taylor J, Kaur H, Knowles C, Wheatcroft S, Witte K, Gatenby K, Willis JA, Kendler-Rhodes A, Slegg O, Carson K, Easaw J, Kandan SR, Rodrigues JCL, MacKenzie-Ross R, Hall T, Robinson G, Little D, Hudson B, Pauling J, Redman S, Graham R, Coghlan G, Suntharalingam J, Augustine DX, Nowak JWM, Masters AT. Report from the Annual Conference of the British Society of Echocardiography, October 2018, ACC Liverpool, Liverpool. Echo Res Pract 2020; 7:M1. [PMID: 33112840 PMCID: PMC8693154 DOI: 10.1530/erp-20-0037] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- V Sharma
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - L Al Saikhan
- MRC Unit for Lifelong Health and Aging at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiac Technology, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - C Park
- MRC Unit for Lifelong Health and Aging at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - A Hughes
- MRC Unit for Lifelong Health and Aging at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - H Gu
- British Heart Foundation Centre, King's College London, London, UK
| | - S Saeed
- Haukeland University Hospital, Bergen, Norway
| | - A Boguslavskyi
- British Heart Foundation Centre, King's College London, London, UK
| | - G Carr-White
- British Heart Foundation Centre, King's College London, London, UK.,Cardiothoracic Centre, St Thomas' Hospital, London, UK
| | - J Chambers
- Cardiothoracic Centre, St Thomas' Hospital, London, UK
| | - P Chowienczyk
- British Heart Foundation Centre, King's College London, London, UK
| | - M Jain
- Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
| | - H Jessop
- Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
| | - C Turner
- Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK.,Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - W Baig
- Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
| | - A Kidambi
- Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
| | | | - D Schlosshan
- Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
| | - A Sengupta
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Fitzpatrick
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Sandoval
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S Hickman
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - H Procter
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Taylor
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - H Kaur
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - C Knowles
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S Wheatcroft
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - K Witte
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - K Gatenby
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J A Willis
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | | | - O Slegg
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - K Carson
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - J Easaw
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - S R Kandan
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | | | | | - T Hall
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - G Robinson
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - D Little
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - B Hudson
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - J Pauling
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - S Redman
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - R Graham
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - G Coghlan
- Department of Cardiology, Royal Free Hospital, London, UK
| | - J Suntharalingam
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK.,University of Bath, Bath, UK
| | - D X Augustine
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - J W M Nowak
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - A T Masters
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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15
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Condliffe R, Albert P, Alikhan R, Gee E, Horner D, Hunter L, Jacobs P, Limbrey R, Newnham M, Preston W, Patel S, Smith LJ, Suntharalingam J. British Thoracic Society Quality Standards for outpatient management of pulmonary embolism. BMJ Open Respir Res 2020; 7:7/1/e000636. [PMID: 32816797 PMCID: PMC7437715 DOI: 10.1136/bmjresp-2020-000636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for outpatient management of pulmonary embolism in the UK, together with measurable markers of good practice. Quality statements are based on the British Thoracic Society (BTS) Guideline for the Initial Outpatient Management of Pulmonary Embolism. METHODS Development of BTS Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards. RESULTS Six quality statements have been developed, each describing a standard of care for the outpatient management of pulmonary embolism in the UK, together with measurable markers of good practice. DISCUSSION BTS Quality Standards for Outpatient Management of Pulmonary Embolism form a key part of the range of supporting materials that the society produces to assist in the dissemination and implementation of a guideline's recommendations.
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Affiliation(s)
- Robin Condliffe
- Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Paul Albert
- Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Raza Alikhan
- Haematology, University Hospital of Wales, Cardiff, UK
| | - Emma Gee
- Thrombosis and Coagulation, King's College Hospital, London, UK
| | - Daniel Horner
- Emergency Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Laura Hunter
- Emergency Medicine, St Thomas' Hospital, London, UK
| | | | - Rachel Limbrey
- Respiratory Medicine, Southampton General Hospital, Southampton, UK
| | - Michael Newnham
- Respiratory Medicine, Papworth Hospital NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Wendy Preston
- Respiratory Medicine, George Eliot Hospital NHS Trust, Nuneaton, Warwickshire, UK
| | - Sheena Patel
- Anticoagulation and Medication Safety/Clinical Governance, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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16
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Hodgson J, Swietlik EM, Salmon RM, Hadinnapola C, Nikolic I, Wharton J, Guo J, Liley J, Haimel M, Bleda M, Southgate L, Machado RD, Martin JM, Treacy CM, Yates K, Daugherty LC, Shamardina O, Whitehorn D, Holden S, Bogaard HJ, Church C, Coghlan G, Condliffe R, Corris PA, Danesino C, Eyries M, Gall H, Ghio S, Ghofrani HA, Gibbs JSR, Girerd B, Houweling AC, Howard L, Humbert M, Kiely DG, Kovacs G, Lawrie A, MacKenzie Ross RV, Moledina S, Montani D, Olschewski A, Olschewski H, Ouwehand WH, Peacock AJ, Pepke-Zaba J, Prokopenko I, Rhodes CJ, Scelsi L, Seeger W, Soubrier F, Suntharalingam J, Toshner MR, Trembath RC, Noordegraaf AV, Wort SJ, Wilkins MR, Yu PB, Li W, Gräf S, Upton PD, Morrell NW. Characterization of GDF2 Mutations and Levels of BMP9 and BMP10 in Pulmonary Arterial Hypertension. Am J Respir Crit Care Med 2020; 201:575-585. [PMID: 31661308 PMCID: PMC7047445 DOI: 10.1164/rccm.201906-1141oc] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [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: 02/02/2023] Open
Abstract
Rationale: Recently, rare heterozygous mutations in GDF2 were identified in patients with pulmonary arterial hypertension (PAH). GDF2 encodes the circulating BMP (bone morphogenetic protein) type 9, which is a ligand for the BMP2 receptor.Objectives: Here we determined the functional impact of GDF2 mutations and characterized plasma BMP9 and BMP10 levels in patients with idiopathic PAH.Methods: Missense BMP9 mutant proteins were expressed in vitro and the impact on BMP9 protein processing and secretion, endothelial signaling, and functional activity was assessed. Plasma BMP9 and BMP10 levels and activity were assayed in patients with PAH with GDF2 variants and in control subjects. Levels were also measured in a larger cohort of control subjects (n = 120) and patients with idiopathic PAH (n = 260).Measurements and Main Results: We identified a novel rare variation at the GDF2 and BMP10 loci, including copy number variation. In vitro, BMP9 missense proteins demonstrated impaired cellular processing and secretion. Patients with PAH who carried these mutations exhibited reduced plasma levels of BMP9 and reduced BMP activity. Unexpectedly, plasma BMP10 levels were also markedly reduced in these individuals. Although overall BMP9 and BMP10 levels did not differ between patients with PAH and control subjects, BMP10 levels were lower in PAH females. A subset of patients with PAH had markedly reduced plasma levels of BMP9 and BMP10 in the absence of GDF2 mutations.Conclusions: Our findings demonstrate that GDF2 mutations result in BMP9 loss of function and are likely causal. These mutations lead to reduced circulating levels of both BMP9 and BMP10. These findings support therapeutic strategies to enhance BMP9 or BMP10 signaling in PAH.
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Affiliation(s)
| | - Emilia M. Swietlik
- Department of Medicine and,Royal Papworth Hospital, Papworth, United Kingdom
| | | | | | - Ivana Nikolic
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Matthias Haimel
- Department of Medicine and,Department of Haematology, University of Cambridge, Cambridge, United Kingdom,National Institute for Health Research BioResource–Rare Diseases, Cambridge, United Kingdom
| | | | - Laura Southgate
- Department of Medical and Molecular Genetics, King’s College London, London, United Kingdom,Molecular and Clinical Sciences Research Institute, St. George’s University of London, London, United Kingdom
| | - Rajiv D. Machado
- Molecular and Clinical Sciences Research Institute, St. George’s University of London, London, United Kingdom
| | - Jennifer M. Martin
- Department of Medicine and,Department of Haematology, University of Cambridge, Cambridge, United Kingdom,National Institute for Health Research BioResource–Rare Diseases, Cambridge, United Kingdom
| | - Carmen M. Treacy
- Department of Medicine and,Royal Papworth Hospital, Papworth, United Kingdom
| | - Katherine Yates
- Department of Medicine and,Department of Haematology, University of Cambridge, Cambridge, United Kingdom,National Institute for Health Research BioResource–Rare Diseases, Cambridge, United Kingdom
| | - Louise C. Daugherty
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom,National Institute for Health Research BioResource–Rare Diseases, Cambridge, United Kingdom
| | - Olga Shamardina
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom,National Institute for Health Research BioResource–Rare Diseases, Cambridge, United Kingdom
| | - Deborah Whitehorn
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom,National Institute for Health Research BioResource–Rare Diseases, Cambridge, United Kingdom
| | - Simon Holden
- Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Harm J. Bogaard
- Département de Génétique, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and UMR_S 1166-ICAN, INSERM, UPMC Sorbonne Universités, Paris, France
| | - Colin Church
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | | | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | | | - Cesare Danesino
- Department of Molecular Medicine, University of Pavia, Pavia, Italy,Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mélanie Eyries
- Département de Génétique, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and UMR_S 1166-ICAN, INSERM, UPMC Sorbonne Universités, Paris, France
| | - Henning Gall
- University of Giessen and Marburg Lung Center, member of the German Center for Lung Research (DZL) and of the Excellence Cluster Cardio-Pulmonary Institute, Giessen, Germany
| | - Stefano Ghio
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Hossein-Ardeschir Ghofrani
- Department of Medicine and,University of Giessen and Marburg Lung Center, member of the German Center for Lung Research (DZL) and of the Excellence Cluster Cardio-Pulmonary Institute, Giessen, Germany
| | - J. Simon R. Gibbs
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Barbara Girerd
- Faculté de Médecine, Université Paris-Saclay, Université Paris-Sud, Paris, France,Service de Pneumologie, Centre de Référence de l’Hypertension Pulmonaire, Assistance Publique–Hôpitaux de Paris, Paris, France,Hôpital Bicêtre, Le Kremlin-Bicêtre, INSERM UMR_S 999, Paris, France
| | - Arjan C. Houweling
- Department of Clinical Genetics, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Marc Humbert
- Faculté de Médecine, Université Paris-Saclay, Université Paris-Sud, Paris, France,Service de Pneumologie, Centre de Référence de l’Hypertension Pulmonaire, Assistance Publique–Hôpitaux de Paris, Paris, France,Hôpital Bicêtre, Le Kremlin-Bicêtre, INSERM UMR_S 999, Paris, France
| | - David G. Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Gabor Kovacs
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria,Medical University of Graz, Graz, Austria
| | - Allan Lawrie
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | | | | | - David Montani
- Faculté de Médecine, Université Paris-Saclay, Université Paris-Sud, Paris, France,Service de Pneumologie, Centre de Référence de l’Hypertension Pulmonaire, Assistance Publique–Hôpitaux de Paris, Paris, France,Hôpital Bicêtre, Le Kremlin-Bicêtre, INSERM UMR_S 999, Paris, France
| | - Andrea Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria,Medical University of Graz, Graz, Austria
| | - Willem H. Ouwehand
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom,National Institute for Health Research BioResource–Rare Diseases, Cambridge, United Kingdom
| | | | | | | | | | - Laura Scelsi
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Werner Seeger
- University of Giessen and Marburg Lung Center, member of the German Center for Lung Research (DZL) and of the Excellence Cluster Cardio-Pulmonary Institute, Giessen, Germany
| | - Florent Soubrier
- Département de Génétique, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and UMR_S 1166-ICAN, INSERM, UPMC Sorbonne Universités, Paris, France
| | | | - Mark R. Toshner
- Department of Medicine and,Royal Papworth Hospital, Papworth, United Kingdom
| | - Richard C. Trembath
- Department of Medical and Molecular Genetics, King’s College London, London, United Kingdom
| | - Anton Vonk Noordegraaf
- Service de Pneumologie, Centre de Référence de l’Hypertension Pulmonaire, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Stephen J. Wort
- National Heart and Lung Institute, Imperial College London, London, United Kingdom,Royal Brompton Hospital, London, United Kingdom
| | | | - Paul B. Yu
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Wei Li
- Department of Medicine and
| | - Stefan Gräf
- Department of Medicine and,Department of Haematology, University of Cambridge, Cambridge, United Kingdom,National Institute for Health Research BioResource–Rare Diseases, Cambridge, United Kingdom
| | | | - Nicholas W. Morrell
- Department of Medicine and,National Institute for Health Research BioResource–Rare Diseases, Cambridge, United Kingdom
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17
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Kaneria N, Hall T, Hudson B, MacKenzie-Ross R, Rodrigues J, Suntharalingam J, Robinson G. CT parenchymal lung changes in pulmonary hypertension. Clin Radiol 2019. [DOI: 10.1016/j.crad.2019.09.124] [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: 11/27/2022]
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18
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Bohnen MS, Ma L, Zhu N, Qi H, McClenaghan C, Gonzaga-Jauregui C, Dewey FE, Overton JD, Reid JG, Shuldiner AR, Baras A, Sampson KJ, Bleda M, Hadinnapola C, Haimel M, Bogaard HJ, Church C, Coghlan G, Corris PA, Eyries M, Gibbs JSR, Girerd B, Houweling AC, Humbert M, Guignabert C, Kiely DG, Lawrie A, MacKenzie Ross RV, Martin JM, Montani D, Peacock AJ, Pepke-Zaba J, Soubrier F, Suntharalingam J, Toshner M, Treacy CM, Trembath RC, Vonk Noordegraaf A, Wharton J, Wilkins MR, Wort SJ, Yates K, Gräf S, Morrell NW, Krishnan U, Rosenzweig EB, Shen Y, Nichols CG, Kass RS, Chung WK. Loss-of-Function ABCC8 Mutations in Pulmonary Arterial Hypertension. Circ Genom Precis Med 2019; 11:e002087. [PMID: 30354297 DOI: 10.1161/circgen.118.002087] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In pulmonary arterial hypertension (PAH), pathological changes in pulmonary arterioles progressively raise pulmonary artery pressure and increase pulmonary vascular resistance, leading to right heart failure and high mortality rates. Recently, the first potassium channelopathy in PAH, because of mutations in KCNK3, was identified as a genetic cause and pharmacological target. METHODS Exome sequencing was performed to identify novel genes in a cohort of 99 pediatric and 134 adult-onset group I PAH patients. Novel rare variants in the gene identified were independently identified in a cohort of 680 adult-onset patients. Variants were expressed in COS cells and function assessed by patch-clamp and rubidium flux analysis. RESULTS We identified a de novo novel heterozygous predicted deleterious missense variant c.G2873A (p.R958H) in ABCC8 in a child with idiopathic PAH. We then evaluated all individuals in the original and a second cohort for rare or novel variants in ABCC8 and identified 11 additional heterozygous predicted damaging ABCC8 variants. ABCC8 encodes SUR1 (sulfonylurea receptor 1)-a regulatory subunit of the ATP-sensitive potassium channel. We observed loss of ATP-sensitive potassium channel function for all ABCC8 variants evaluated and pharmacological rescue of all channel currents in vitro by the SUR1 activator, diazoxide. CONCLUSIONS Novel and rare missense variants in ABCC8 are associated with PAH. Identified ABCC8 mutations decreased ATP-sensitive potassium channel function, which was pharmacologically recovered.
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Affiliation(s)
- Michael S Bohnen
- Department of Pharmacology, College of Physicians and Surgeons (M.S.B., K.J.S., R.S.K.), Columbia University, New York, NY
| | - Lijiang Ma
- Department of Pediatrics, College of Physicians and Surgeons (L.M., N.Z., U.K., E.B.R., W.K.C.), Columbia University, New York, NY
| | - Na Zhu
- Department of Pediatrics, College of Physicians and Surgeons (L.M., N.Z., U.K., E.B.R., W.K.C.), Columbia University, New York, NY.,Department of Systems Biology (N.Z., H.Q., Y.S.), Columbia University, New York, NY
| | - Hongjian Qi
- Department of Applied Physics and Applied Mathematics (H.Q., Y.S.), Columbia University, New York, NY.,Department of Systems Biology (N.Z., H.Q., Y.S.), Columbia University, New York, NY
| | - Conor McClenaghan
- Department of Cell Biology and Physiology (C.M., C.G.N.) and Center for the Investigation of Membrane Excitability Diseases (C.M., C.G.N.), Washington University School of Medicine, Washington University in St. Louis, MO
| | - Claudia Gonzaga-Jauregui
- Regeneron Genetics Center, Regeneron Pharmaceuticals, Inc, Tarrytown, NY (C.G.-J., F.E.D., J.D.O., J.G.R., A.R.S., A.B.)
| | - Frederick E Dewey
- Regeneron Genetics Center, Regeneron Pharmaceuticals, Inc, Tarrytown, NY (C.G.-J., F.E.D., J.D.O., J.G.R., A.R.S., A.B.)
| | - John D Overton
- Regeneron Genetics Center, Regeneron Pharmaceuticals, Inc, Tarrytown, NY (C.G.-J., F.E.D., J.D.O., J.G.R., A.R.S., A.B.)
| | - Jeffrey G Reid
- Regeneron Genetics Center, Regeneron Pharmaceuticals, Inc, Tarrytown, NY (C.G.-J., F.E.D., J.D.O., J.G.R., A.R.S., A.B.)
| | - Alan R Shuldiner
- Regeneron Genetics Center, Regeneron Pharmaceuticals, Inc, Tarrytown, NY (C.G.-J., F.E.D., J.D.O., J.G.R., A.R.S., A.B.)
| | - Aris Baras
- Regeneron Genetics Center, Regeneron Pharmaceuticals, Inc, Tarrytown, NY (C.G.-J., F.E.D., J.D.O., J.G.R., A.R.S., A.B.)
| | - Kevin J Sampson
- Department of Pharmacology, College of Physicians and Surgeons (M.S.B., K.J.S., R.S.K.), Columbia University, New York, NY
| | - Marta Bleda
- Department of Medicine (M.B., C.H., M.H., J.M.M., M.T., C.M.T., K.Y., S.G., N.W.M.), University of Cambridge, United Kingdom
| | - Charaka Hadinnapola
- Department of Medicine (M.B., C.H., M.H., J.M.M., M.T., C.M.T., K.Y., S.G., N.W.M.), University of Cambridge, United Kingdom
| | - Matthias Haimel
- Department of Medicine (M.B., C.H., M.H., J.M.M., M.T., C.M.T., K.Y., S.G., N.W.M.), University of Cambridge, United Kingdom
| | - Harm J Bogaard
- VU University Medical Center, Amsterdam, the Netherlands (H.J.B., A.C.H., A.V.N.)
| | - Colin Church
- Golden Jubilee National Hospital, Glasgow, Scotland (C.C., A.J.P.)
| | | | - Paul A Corris
- Newcastle University (P.A.C.) and Newcastle upon Tyne Hospitals National Health Service Foundation Trust (P.A.C.), United Kingdom
| | - Mélanie Eyries
- Dépat de Génétique, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (M.E., F.S.) and UMR_S 1166-ICAN, INSERM (Institut National de la Santé et de la Recherche Médicale) (M.E., F.S.), UPMC (Pierre and Marie Curie University) Sorbonne Universités, France
| | - J Simon R Gibbs
- National Heart and Lung Institute, Imperial College London, United Kingdom (J.S.R.G., S.J.W.)
| | - Barbara Girerd
- AP-HP (Assistance Publique - Hôpitaux de Paris), Centre de référence de l'hypertension pulmonaire sévère, INSERM UMR_S 999, Hôpital Bicêtre, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France (B.G., M.H., C.G., D.M.)
| | - Arjan C Houweling
- VU University Medical Center, Amsterdam, the Netherlands (H.J.B., A.C.H., A.V.N.)
| | - Marc Humbert
- AP-HP (Assistance Publique - Hôpitaux de Paris), Centre de référence de l'hypertension pulmonaire sévère, INSERM UMR_S 999, Hôpital Bicêtre, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France (B.G., M.H., C.G., D.M.)
| | - Christophe Guignabert
- AP-HP (Assistance Publique - Hôpitaux de Paris), Centre de référence de l'hypertension pulmonaire sévère, INSERM UMR_S 999, Hôpital Bicêtre, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France (B.G., M.H., C.G., D.M.)
| | - David G Kiely
- Sheffield Clinical Research Facility, Royal Hallamshire, Sheffield, United Kingdom (D.G.K.)
| | - Allan Lawrie
- Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom (A.L.)
| | | | - Jennifer M Martin
- Department of Medicine (M.B., C.H., M.H., J.M.M., M.T., C.M.T., K.Y., S.G., N.W.M.), University of Cambridge, United Kingdom
| | - David Montani
- AP-HP (Assistance Publique - Hôpitaux de Paris), Centre de référence de l'hypertension pulmonaire sévère, INSERM UMR_S 999, Hôpital Bicêtre, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France (B.G., M.H., C.G., D.M.)
| | - Andrew J Peacock
- Golden Jubilee National Hospital, Glasgow, Scotland (C.C., A.J.P.)
| | | | - Florent Soubrier
- Dépat de Génétique, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (M.E., F.S.) and UMR_S 1166-ICAN, INSERM (Institut National de la Santé et de la Recherche Médicale) (M.E., F.S.), UPMC (Pierre and Marie Curie University) Sorbonne Universités, France
| | | | - Mark Toshner
- Department of Medicine (M.B., C.H., M.H., J.M.M., M.T., C.M.T., K.Y., S.G., N.W.M.), University of Cambridge, United Kingdom.,Papworth Hospital, Cambridge, United Kingdom (J.P.-Z., M.T.)
| | - Carmen M Treacy
- Department of Medicine (M.B., C.H., M.H., J.M.M., M.T., C.M.T., K.Y., S.G., N.W.M.), University of Cambridge, United Kingdom
| | - Richard C Trembath
- Division of Genetics and Molecular Medicine, King's College London, London, England (R.C.T.)
| | | | - John Wharton
- Department of Medicine, Imperial College London, Hammersmith Campus, London, United Kingdom (J.W., M.R.W.)
| | - Martin R Wilkins
- Department of Medicine, Imperial College London, Hammersmith Campus, London, United Kingdom (J.W., M.R.W.)
| | - Stephen J Wort
- National Heart and Lung Institute, Imperial College London, United Kingdom (J.S.R.G., S.J.W.).,Royal Brompton Hospital, London, United Kingdom (S.J.W.)
| | - Katherine Yates
- Department of Medicine (M.B., C.H., M.H., J.M.M., M.T., C.M.T., K.Y., S.G., N.W.M.), University of Cambridge, United Kingdom
| | - Stefan Gräf
- Department of Medicine (M.B., C.H., M.H., J.M.M., M.T., C.M.T., K.Y., S.G., N.W.M.), University of Cambridge, United Kingdom.,Department of Hematology (S.G.), Addenbrookes Hospital, University of Cambridge, United Kingdom
| | - Nicholas W Morrell
- Department of Medicine (M.B., C.H., M.H., J.M.M., M.T., C.M.T., K.Y., S.G., N.W.M.), University of Cambridge, United Kingdom
| | - Usha Krishnan
- Department of Pediatrics, College of Physicians and Surgeons (L.M., N.Z., U.K., E.B.R., W.K.C.), Columbia University, New York, NY
| | - Erika B Rosenzweig
- Department of Pediatrics, College of Physicians and Surgeons (L.M., N.Z., U.K., E.B.R., W.K.C.), Columbia University, New York, NY
| | - Yufeng Shen
- Department of Applied Physics and Applied Mathematics (H.Q., Y.S.), Columbia University, New York, NY.,Department of Systems Biology (N.Z., H.Q., Y.S.), Columbia University, New York, NY
| | - Colin G Nichols
- Department of Cell Biology and Physiology (C.M., C.G.N.) and Center for the Investigation of Membrane Excitability Diseases (C.M., C.G.N.), Washington University School of Medicine, Washington University in St. Louis, MO
| | - Robert S Kass
- Department of Pharmacology, College of Physicians and Surgeons (M.S.B., K.J.S., R.S.K.), Columbia University, New York, NY
| | - Wendy K Chung
- Department of Pediatrics, College of Physicians and Surgeons (L.M., N.Z., U.K., E.B.R., W.K.C.), Columbia University, New York, NY
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Sofianopoulou E, Kaptoge S, Gräf S, Hadinnapola C, Treacy CM, Church C, Coghlan G, Gibbs JSR, Haimel M, Howard LS, Johnson M, Kiely DG, Lawrie A, Lordan J, MacKenzie Ross RV, Martin JM, Moledina S, Newnham M, Peacock AJ, Price LC, Rhodes CJ, Suntharalingam J, Swietlik EM, Toshner MR, Wharton J, Wilkins MR, Wort SJ, Pepke-Zaba J, Condliffe R, Corris PA, Di Angelantonio E, Provencher S, Morrell NW. Traffic exposures, air pollution and outcomes in pulmonary arterial hypertension: a UK cohort study analysis. Eur Respir J 2019; 53:13993003.01429-2018. [PMID: 30923185 DOI: 10.1183/13993003.01429-2018] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 03/02/2019] [Indexed: 01/03/2023]
Abstract
While traffic and air pollution exposure is associated with increased mortality in numerous diseases, its association with disease severity and outcomes in pulmonary arterial hypertension (PAH) remains unknown.Exposure to particulate matter with a 50% cut-off aerodynamic diameter ≤2.5 μm (PM2.5), nitrogen dioxide (NO2) and indirect measures of traffic-related air pollution (distance to main road and length of roads within buffer zones surrounding residential addresses) were estimated for 301 patients with idiopathic/heritable PAH recruited in the UK National Cohort Study of Idiopathic and Heritable PAH. Associations with transplant-free survival and pulmonary haemodynamic severity at baseline were assessed, adjusting for confounding variables defined a prioriHigher estimated exposure to PM2.5 was associated with higher risk of death or lung transplant (unadjusted hazard ratio (HR) 2.68 (95% CI 1.11-6.47) per 3 μg·m-3; p=0.028). This association remained similar when adjusted for potential confounding variables (HR 4.38 (95% CI 1.44-13.36) per 3 μg·m-3; p=0.009). No associations were found between NO2 exposure or other traffic pollution indicators and transplant-free survival. Conversely, indirect measures of exposure to traffic-related air pollution within the 500-1000 m buffer zones correlated with the European Society of Cardiology/European Respiratory Society risk categories as well as pulmonary haemodynamics at baseline. This association was strongest for pulmonary vascular resistance.In idiopathic/heritable PAH, indirect measures of exposure to traffic-related air pollution were associated with disease severity at baseline, whereas higher PM2.5 exposure may independently predict shorter transplant-free survival.
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Affiliation(s)
- Eleni Sofianopoulou
- MRC/BHF Cardiovascular Epidemiology Unit, Dept of Public Health and Primary Care, Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, UK.,Joint supervision
| | - Stephen Kaptoge
- MRC/BHF Cardiovascular Epidemiology Unit, Dept of Public Health and Primary Care, Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Stefan Gräf
- Dept of Medicine, University of Cambridge, Cambridge, UK.,Dept of Haematology, University of Cambridge, Cambridge, UK.,NIHR BioResource - Rare Diseases, Cambridge, UK
| | | | - Carmen M Treacy
- Dept of Medicine, University of Cambridge, Cambridge, UK.,Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge, UK
| | - Colin Church
- Scottish Pulmonary Vascular Unit, Regional Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK.,BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | | | - J Simon R Gibbs
- National Heart and Lung Institute, Imperial College London, London, UK.,National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| | - Matthias Haimel
- Dept of Medicine, University of Cambridge, Cambridge, UK.,Dept of Haematology, University of Cambridge, Cambridge, UK.,NIHR BioResource - Rare Diseases, Cambridge, UK
| | - Luke S Howard
- National Heart and Lung Institute, Imperial College London, London, UK.,National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| | - Martin Johnson
- Scottish Pulmonary Vascular Unit, Regional Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Allan Lawrie
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - James Lordan
- NIHR Biomedical Research Centre in Ageing, University of Newcastle, Newcastle, UK
| | - Robert V MacKenzie Ross
- National Pulmonary Hypertension Service, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Jennifer M Martin
- Dept of Medicine, University of Cambridge, Cambridge, UK.,Dept of Haematology, University of Cambridge, Cambridge, UK.,NIHR BioResource - Rare Diseases, Cambridge, UK
| | - Shahin Moledina
- National Paediatric Pulmonary Hypertension Service, Great Ormond Street Hospital, London, UK
| | | | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Regional Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Laura C Price
- National Heart and Lung Institute, Imperial College London, London, UK.,National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK
| | - Christopher J Rhodes
- Centre for Pharmacology and Therapeutics, Dept of Medicine, Imperial College London, London, UK
| | - Jay Suntharalingam
- National Pulmonary Hypertension Service, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Emilia M Swietlik
- Dept of Medicine, University of Cambridge, Cambridge, UK.,Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge, UK
| | - Mark R Toshner
- Dept of Medicine, University of Cambridge, Cambridge, UK.,Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge, UK
| | - John Wharton
- Centre for Pharmacology and Therapeutics, Dept of Medicine, Imperial College London, London, UK
| | - Martin R Wilkins
- Centre for Pharmacology and Therapeutics, Dept of Medicine, Imperial College London, London, UK
| | - Stephen J Wort
- National Heart and Lung Institute, Imperial College London, London, UK.,National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK
| | - Joanna Pepke-Zaba
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Paul A Corris
- NIHR Biomedical Research Centre in Ageing, University of Newcastle, Newcastle, UK
| | - Emanuele Di Angelantonio
- MRC/BHF Cardiovascular Epidemiology Unit, Dept of Public Health and Primary Care, Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, UK.,National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, Dept of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,NHS Blood and Transplant, Cambridge, UK
| | - Steeve Provencher
- Pulmonary Hypertension Research Group, Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec, QC, Canada
| | - Nicholas W Morrell
- Dept of Medicine, University of Cambridge, Cambridge, UK.,NIHR BioResource - Rare Diseases, Cambridge, UK.,Joint supervision
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Gorman KM, Meyer E, Grozeva D, Spinelli E, McTague A, Sanchis-Juan A, Carss KJ, Bryant E, Reich A, Schneider AL, Pressler RM, Simpson MA, Debelle GD, Wassmer E, Morton J, Sieciechowicz D, Jan-Kamsteeg E, Paciorkowski AR, King MD, Cross JH, Poduri A, Mefford HC, Scheffer IE, Haack TB, McCullagh G, Millichap JJ, Carvill GL, Clayton-Smith J, Maher ER, Raymond FL, Kurian MA, McRae JF, Clayton S, Fitzgerald TW, Kaplanis J, Prigmore E, Rajan D, Sifrim A, Aitken S, Akawi N, Alvi M, Ambridge K, Barrett DM, Bayzetinova T, Jones P, Jones WD, King D, Krishnappa N, Mason LE, Singh T, Tivey AR, Ahmed M, Anjum U, Archer H, Armstrong R, Awada J, Balasubramanian M, Banka S, Baralle D, Barnicoat A, Batstone P, Baty D, Bennett C, Berg J, Bernhard B, Bevan AP, Bitner-Glindzicz M, Blair E, Blyth M, Bohanna D, Bourdon L, Bourn D, Bradley L, Brady A, Brent S, Brewer C, Brunstrom K, Bunyan DJ, Burn J, Canham N, Castle B, Chandler K, Chatzimichali E, Cilliers D, Clarke A, Clasper S, Clayton-Smith J, Clowes V, Coates A, Cole T, Colgiu I, Collins A, Collinson MN, Connell F, Cooper N, Cox H, Cresswell L, Cross G, Crow Y, D’Alessandro M, Dabir T, Davidson R, Davies S, de Vries D, Dean J, Deshpande C, Devlin G, Dixit A, Dobbie A, Donaldson A, Donnai D, Donnelly D, Donnelly C, Douglas A, Douzgou S, Duncan A, Eason J, Ellard S, Ellis I, Elmslie F, Evans K, Everest S, Fendick T, Fisher R, Flinter F, Foulds N, Fry A, Fryer A, Gardiner C, Gaunt L, Ghali N, Gibbons R, Gill H, Goodship J, Goudie D, Gray E, Green A, Greene P, Greenhalgh L, Gribble S, Harrison R, Harrison L, Harrison V, Hawkins R, He L, Hellens S, Henderson A, Hewitt S, Hildyard L, Hobson E, Holden S, Holder M, Holder S, Hollingsworth G, Homfray T, Humphreys M, Hurst J, Hutton B, Ingram S, Irving M, Islam L, Jackson A, Jarvis J, Jenkins L, Johnson D, Jones E, Josifova D, Joss S, Kaemba B, Kazembe S, Kelsell R, Kerr B, Kingston H, Kini U, Kinning E, Kirby G, Kirk C, Kivuva E, Kraus A, Kumar D, Kumar VKA, Lachlan K, Lam W, Lampe A, Langman C, Lees M, Lim D, Longman C, Lowther G, Lynch SA, Magee A, Maher E, Male A, Mansour S, Marks K, Martin K, Maye U, McCann E, McConnell V, McEntagart M, McGowan R, McKay K, McKee S, McMullan DJ, McNerlan S, McWilliam C, Mehta S, Metcalfe K, Middleton A, Miedzybrodzka Z, Miles E, Mohammed S, Montgomery T, Moore D, Morgan S, Morton J, Mugalaasi H, Murday V, Murphy H, Naik S, Nemeth A, Nevitt L, Newbury-Ecob R, Norman A, O’Shea R, Ogilvie C, Ong KR, Park SM, Parker MJ, Patel C, Paterson J, Payne S, Perrett D, Phipps J, Pilz DT, Pollard M, Pottinger C, Poulton J, Pratt N, Prescott K, Price S, Pridham A, Procter A, Purnell H, Quarrell O, Ragge N, Rahbari R, Randall J, Rankin J, Raymond L, Rice D, Robert L, Roberts E, Roberts J, Roberts P, Roberts G, Ross A, Rosser E, Saggar A, Samant S, Sampson J, Sandford R, Sarkar A, Schweiger S, Scott R, Scurr I, Selby A, Seller A, Sequeira C, Shannon N, Sharif S, Shaw-Smith C, Shearing E, Shears D, Sheridan E, Simonic I, Singzon R, Skitt Z, Smith A, Smith K, Smithson S, Sneddon L, Splitt M, Squires M, Stewart F, Stewart H, Straub V, Suri M, Sutton V, Swaminathan GJ, Sweeney E, Tatton-Brown K, Taylor C, Taylor R, Tein M, Temple IK, Thomson J, Tischkowitz M, Tomkins S, Torokwa A, Treacy B, Turner C, Turnpenny P, Tysoe C, Vandersteen A, Varghese V, Vasudevan P, Vijayarangakannan P, Vogt J, Wakeling E, Wallwark S, Waters J, Weber A, Wellesley D, Whiteford M, Widaa S, Wilcox S, Wilkinson E, Williams D, Williams N, Wilson L, Woods G, Wragg C, Wright M, Yates L, Yau M, Nellåker C, Parker M, Firth HV, Wright CF, FitzPatrick DR, Barrett JC, Hurles ME, Al Turki S, Anderson C, Anney R, Antony D, Artigas MS, Ayub M, Balasubramaniam S, Barrett JC, Barroso I, Beales P, Bentham J, Bhattacharya S, Birney E, Blackwood D, Bobrow M, Bochukova E, Bolton P, Bounds R, Boustred C, Breen G, Calissano M, Carss K, Chatterjee K, Chen L, Ciampi A, Cirak S, Clapham P, Clement G, Coates G, Collier D, Cosgrove C, Cox T, Craddock N, Crooks L, Curran S, Curtis D, Daly A, Day-Williams A, Day IN, Down T, Du Y, Dunham I, Edkins S, Ellis P, Evans D, Faroogi S, Fatemifar G, Fitzpatrick DR, Flicek P, Flyod J, Foley AR, Franklin CS, Futema M, Gallagher L, Geihs M, Geschwind D, Griffin H, Grozeva D, Guo X, Guo X, Gurling H, Hart D, Hendricks A, Holmans P, Howie B, Huang L, Hubbard T, Humphries SE, Hurles ME, Hysi P, Jackson DK, Jamshidi Y, Jing T, Joyce C, Kaye J, Keane T, Keogh J, Kemp J, Kennedy K, Kolb-Kokocinski A, Lachance G, Langford C, Lawson D, Lee I, Lek M, Liang J, Lin H, Li R, Li Y, Liu R, Lönnqvist J, Lopes M, Iotchkova V, MacArthur D, Marchini J, Maslen J, Massimo M, Mathieson I, Marenne G, McGuffin P, McIntosh A, McKechanie AG, McQuillin A, Metrustry S, Mitchison H, Moayyeri A, Morris J, Muntoni F, Northstone K, O'Donnovan M, Onoufriadis A, O'Rahilly S, Oualkacha K, Owen MJ, Palotie A, Panoutsopoulou K, Parker V, Parr JR, Paternoster L, Paunio T, Payne F, Pietilainen O, Plagnol V, Quaye L, Quail MA, Raymond L, Rehnström K, Ring S, Ritchie GR, Roberts N, Savage DB, Scambler P, Schiffels S, Schmidts M, Schoenmakers N, Semple RK, Serra E, Sharp SI, Shin SY, Skuse D, Small K, Southam L, Spasic-Boskovic O, St Clair D, Stalker J, Stevens E, St Pourcian B, Sun J, Suvisaari J, Tachmazidou I, Tobin MD, Valdes A, Van Kogelenberg M, Vijayarangakannan P, Visscher PM, Wain LV, Walters JT, Wang G, Wang J, Wang Y, Ward K, Wheeler E, Whyte T, Williams H, Williamson KA, Wilson C, Wong K, Xu C, Yang J, Zhang F, Zhang P, Aitman T, Alachkar H, Ali S, Allen L, Allsup D, Ambegaonkar G, Anderson J, Antrobus R, Armstrong R, Arno G, Arumugakani G, Ashford S, Astle W, Attwood A, Austin S, Bacchelli C, Bakchoul T, Bariana TK, Baxendale H, Bennett D, Bethune C, Bibi S, Bitner-Glindzicz M, Bleda M, Boggard H, Bolton-Maggs P, Booth C, Bradley JR, Brady A, Brown M, Browning M, Bryson C, Burns S, Calleja P, Canham N, Carmichael J, Carss K, Caulfield M, Chalmers E, Chandra A, Chinnery P, Chitre M, Church C, Clement E, Clements-Brod N, Clowes V, Coghlan G, Collins P, Cooper N, Creaser-Myers A, DaCosta R, Daugherty L, Davies S, Davis J, De Vries M, Deegan P, Deevi SV, Deshpande C, Devlin L, Dewhurst E, Doffinger R, Dormand N, Drewe E, Edgar D, Egner W, Erber WN, Erwood M, Everington T, Favier R, Firth H, Fletcher D, Flinter F, Fox JC, Frary A, Freson K, Furie B, Furnell A, Gale D, Gardham A, Gattens M, Ghali N, Ghataorhe PK, Ghurye R, Gibbs S, Gilmour K, Gissen P, Goddard S, Gomez K, Gordins P, Gräf S, Greene D, Greenhalgh A, Greinacher A, Grigoriadou S, Grozeva D, Hackett S, Hadinnapola C, Hague R, Haimel M, Halmagyi C, Hammerton T, Hart D, Hayman G, Heemskerk JW, Henderson R, Hensiek A, Henskens Y, Herwadkar A, Holden S, Holder M, Holder S, Hu F, Huissoon A, Humbert M, Hurst J, James R, Jolles S, Josifova D, Kazmi R, Keeling D, Kelleher P, Kelly AM, Kennedy F, Kiely D, Kingston N, Koziell A, Krishnakumar D, Kuijpers TW, Kumararatne D, Kurian M, Laffan MA, Lambert MP, Allen HL, Lawrie A, Lear S, Lees M, Lentaigne C, Liesner R, Linger R, Longhurst H, Lorenzo L, Machado R, Mackenzie R, MacLaren R, Maher E, Maimaris J, Mangles S, Manson A, Mapeta R, Markus HS, Martin J, Masati L, Mathias M, Matser V, Maw A, McDermott E, McJannet C, Meacham S, Meehan S, Megy K, Mehta S, Michaelides M, Millar CM, Moledina S, Moore A, Morrell N, Mumford A, Murng S, Murphy E, Nejentsev S, Noorani S, Nurden P, Oksenhendler E, Ouwehand WH, Papadia S, Park SM, Parker A, Pasi J, Patch C, Paterson J, Payne J, Peacock A, Peerlinck K, Penkett CJ, Pepke-Zaba J, Perry DJ, Pollock V, Polwarth G, Ponsford M, Qasim W, Quinti I, Rankin S, Rankin J, Raymond FL, Rehnstrom K, Reid E, Rhodes CJ, Richards M, Richardson S, Richter A, Roberts I, Rondina M, Rosser E, Roughley C, Rue-Albrecht K, Samarghitean C, Sanchis-Juan A, Sandford R, Santra S, Sargur R, Savic S, Schulman S, Schulze H, Scott R, Scully M, Seneviratne S, Sewell C, Shamardina O, Shipley D, Simeoni I, Sivapalaratnam S, Smith K, Sohal A, Southgate L, Staines S, Staples E, Stauss H, Stein P, Stephens J, Stirrups K, Stock S, Suntharalingam J, Tait RC, Talks K, Tan Y, Thachil J, Thaventhiran J, Thomas E, Thomas M, Thompson D, Thrasher A, Tischkowitz M, Titterton C, Toh CH, Toshner M, Treacy C, Trembath R, Tuna S, Turek W, Turro E, Van Geet C, Veltman M, Vogt J, von Ziegenweldt J, Vonk Noordegraaf A, Wakeling E, Wanjiku I, Warner TQ, Wassmer E, Watkins H, Webster A, Welch S, Westbury S, Wharton J, Whitehorn D, Wilkins M, Willcocks L, Williamson C, Woods G, Wort J, Yeatman N, Yong P, Young T, Yu P. Bi-allelic Loss-of-Function CACNA1B Mutations in Progressive Epilepsy-Dyskinesia. Am J Hum Genet 2019; 104:948-956. [PMID: 30982612 DOI: 10.1016/j.ajhg.2019.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/04/2019] [Indexed: 12/11/2022] Open
Abstract
The occurrence of non-epileptic hyperkinetic movements in the context of developmental epileptic encephalopathies is an increasingly recognized phenomenon. Identification of causative mutations provides an important insight into common pathogenic mechanisms that cause both seizures and abnormal motor control. We report bi-allelic loss-of-function CACNA1B variants in six children from three unrelated families whose affected members present with a complex and progressive neurological syndrome. All affected individuals presented with epileptic encephalopathy, severe neurodevelopmental delay (often with regression), and a hyperkinetic movement disorder. Additional neurological features included postnatal microcephaly and hypotonia. Five children died in childhood or adolescence (mean age of death: 9 years), mainly as a result of secondary respiratory complications. CACNA1B encodes the pore-forming subunit of the pre-synaptic neuronal voltage-gated calcium channel Cav2.2/N-type, crucial for SNARE-mediated neurotransmission, particularly in the early postnatal period. Bi-allelic loss-of-function variants in CACNA1B are predicted to cause disruption of Ca2+ influx, leading to impaired synaptic neurotransmission. The resultant effect on neuronal function is likely to be important in the development of involuntary movements and epilepsy. Overall, our findings provide further evidence for the key role of Cav2.2 in normal human neurodevelopment.
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Whitworth J, Smith PS, Martin JE, West H, Luchetti A, Rodger F, Clark G, Carss K, Stephens J, Stirrups K, Penkett C, Mapeta R, Ashford S, Megy K, Shakeel H, Ahmed M, Adlard J, Barwell J, Brewer C, Casey RT, Armstrong R, Cole T, Evans DG, Fostira F, Greenhalgh L, Hanson H, Henderson A, Hoffman J, Izatt L, Kumar A, Kwong A, Lalloo F, Ong KR, Paterson J, Park SM, Chen-Shtoyerman R, Searle C, Side L, Skytte AB, Snape K, Woodward ER, Tischkowitz MD, Maher ER, Aitman T, Alachkar H, Ali S, Allen L, Allsup D, Ambegaonkar G, Anderson J, Antrobus R, Armstrong R, Arno G, Arumugakani G, Ashford S, Astle W, Attwood A, Austin S, Bacchelli C, Bakchoul T, Bariana TK, Baxendale H, Bennett D, Bethune C, Bibi S, Bitner-Glindzicz M, Bleda M, Boggard H, Bolton-Maggs P, Booth C, Bradley JR, Brady A, Brown M, Browning M, Bryson C, Burns S, Calleja P, Canham N, Carmichael J, Carss K, Caulfield M, Chalmers E, Chandra A, Chinnery P, Chitre M, Church C, Clement E, Clements-Brod N, Clowes V, Coghlan G, Collins P, Cookson V, Cooper N, Corris P, Creaser-Myers A, DaCosta R, Daugherty L, Davies S, Davis J, De Vries M, Deegan P, Deevi SV, Deshpande C, Devlin L, Dewhurst E, Dixon P, Doffinger R, Dormand N, Drewe E, Edgar D, Egner W, Erber WN, Erwood M, Erwood M, Everington T, Favier R, Firth H, Fletcher D, Flinter F, Frary A, Freson K, Furie B, Furnell A, Gale D, Gardham A, Gattens M, Ghali N, Ghataorhe PK, Ghurye R, Gibbs S, Gilmour K, Gissen P, Goddard S, Gomez K, Gordins P, Graf S, Gräf S, Greene D, Greenhalgh A, Greinacher A, Grigoriadou S, Grozeva D, Hackett S, Hadinnapola C, Hague R, Haimel M, Halmagyi C, Hammerton T, Hart D, Hayman G, Heemskerk JW, Henderson R, Hensiek A, Henskens Y, Herwadkar A, Holden S, Holder M, Holder S, Hu F, Huis in’t Veld A, Huissoon A, Humbert M, Hurst J, James R, Jolles S, Josifova D, Kazmi R, Keeling D, Kelleher P, Kelly AM, Kennedy F, Kiely D, Kingston N, Koziell A, Krishnakumar D, Kuijpers TW, Kuijpers T, Kumararatne D, Kurian M, Laffan MA, Lambert MP, Allen HL, Lango-Allen H, Lawrie A, Lear S, Lees M, Lentaigne C, Liesner R, Linger R, Longhurst H, Lorenzo L, Louka E, Machado R, Ross RM, MacLaren R, Maher E, Maimaris J, Mangles S, Manson A, Mapeta R, Markus HS, Martin J, Masati L, Mathias M, Matser V, Maw A, McDermott E, McJannet C, Meacham S, Meehan S, Megy K, Mehta S, Michaelides M, Millar CM, Moledina S, Moore A, Morrell N, Mumford A, Murng S, Murphy E, Nejentsev S, Noorani S, Nurden P, Oksenhendler E, Othman S, Ouwehand WH, Ouwehand WH, Papadia S, Park SM, Parker A, Pasi J, Patch C, Paterson J, Payne J, Peacock A, Peerlinck K, Penkett CJ, Pepke-Zaba J, Perry D, Perry DJ, Pollock V, Polwarth G, Ponsford M, Qasim W, Quinti I, Rankin S, Rankin J, Raymond FL, Rayner-Matthews P, Rehnstrom K, Reid E, Rhodes CJ, Richards M, Richardson S, Richter A, Roberts I, Rondina M, Rosser E, Roughley C, Roy N, Rue-Albrecht K, Samarghitean C, Sanchis-Juan A, Sandford R, Santra S, Sargur R, Savic S, Schotte G, Schulman S, Schulze H, Scott R, Scully M, Seneviratne S, Sewell C, Shamardina O, Shipley D, Simeoni I, Sivapalaratnam S, Smith KG, Sohal A, Southgate L, Staines S, Staples E, Stark H, Stauss H, Stein P, Stephens J, Stirrups K, Stock S, Suntharalingam J, Talks K, Tan Y, Thachil J, Thaventhiran J, Thomas E, Thomas M, Thompson D, Thrasher A, Tischkowitz M, Titterton C, Toh CH, Toshner M, Treacy C, Trembath R, Tuna S, Turek W, Turro E, Van Geet C, Veltman M, Vogt J, von Ziegenweldt J, Vonk Noordegraaf A, Wakeling E, Wanjiku I, Warner TQ, Wassmer E, Watkins H, Watt C, Webster N, Welch S, Westbury S, Wharton J, Whitehorn D, Wilkins M, Willcocks L, Williamson C, Woods G, Woods G, Wort J, Yeatman N, Yong P, Young T, Yu P. Comprehensive Cancer-Predisposition Gene Testing in an Adult Multiple Primary Tumor Series Shows a Broad Range of Deleterious Variants and Atypical Tumor Phenotypes. Am J Hum Genet 2018; 103:3-18. [PMID: 29909963 PMCID: PMC6037202 DOI: 10.1016/j.ajhg.2018.04.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/25/2018] [Indexed: 12/17/2022] Open
Abstract
Multiple primary tumors (MPTs) affect a substantial proportion of cancer survivors and can result from various causes, including inherited predisposition. Currently, germline genetic testing of MPT-affected individuals for variants in cancer-predisposition genes (CPGs) is mostly targeted by tumor type. We ascertained pre-assessed MPT individuals (with at least two primary tumors by age 60 years or at least three by 70 years) from genetics centers and performed whole-genome sequencing (WGS) on 460 individuals from 440 families. Despite previous negative genetic assessment and molecular investigations, pathogenic variants in moderate- and high-risk CPGs were detected in 67/440 (15.2%) probands. WGS detected variants that would not be (or were not) detected by targeted resequencing strategies, including low-frequency structural variants (6/440 [1.4%] probands). In most individuals with a germline variant assessed as pathogenic or likely pathogenic (P/LP), at least one of their tumor types was characteristic of variants in the relevant CPG. However, in 29 probands (42.2% of those with a P/LP variant), the tumor phenotype appeared discordant. The frequency of individuals with truncating or splice-site CPG variants and at least one discordant tumor type was significantly higher than in a control population (χ2 = 43.642; p ≤ 0.0001). 2/67 (3%) probands with P/LP variants had evidence of multiple inherited neoplasia allele syndrome (MINAS) with deleterious variants in two CPGs. Together with variant detection rates from a previous series of similarly ascertained MPT-affected individuals, the present results suggest that first-line comprehensive CPG analysis in an MPT cohort referred to clinical genetics services would detect a deleterious variant in about a third of individuals.
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Gräf S, Haimel M, Bleda M, Hadinnapola C, Southgate L, Li W, Hodgson J, Liu B, Salmon RM, Southwood M, Machado RD, Martin JM, Treacy CM, Yates K, Daugherty LC, Shamardina O, Whitehorn D, Holden S, Aldred M, Bogaard HJ, Church C, Coghlan G, Condliffe R, Corris PA, Danesino C, Eyries M, Gall H, Ghio S, Ghofrani HA, Gibbs JSR, Girerd B, Houweling AC, Howard L, Humbert M, Kiely DG, Kovacs G, MacKenzie Ross RV, Moledina S, Montani D, Newnham M, Olschewski A, Olschewski H, Peacock AJ, Pepke-Zaba J, Prokopenko I, Rhodes CJ, Scelsi L, Seeger W, Soubrier F, Stein DF, Suntharalingam J, Swietlik EM, Toshner MR, van Heel DA, Vonk Noordegraaf A, Waisfisz Q, Wharton J, Wort SJ, Ouwehand WH, Soranzo N, Lawrie A, Upton PD, Wilkins MR, Trembath RC, Morrell NW. Identification of rare sequence variation underlying heritable pulmonary arterial hypertension. Nat Commun 2018; 9:1416. [PMID: 29650961 PMCID: PMC5897357 DOI: 10.1038/s41467-018-03672-4] [Citation(s) in RCA: 231] [Impact Index Per Article: 38.5] [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: 09/05/2017] [Accepted: 03/02/2018] [Indexed: 12/20/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a rare disorder with a poor prognosis. Deleterious variation within components of the transforming growth factor-β pathway, particularly the bone morphogenetic protein type 2 receptor (BMPR2), underlies most heritable forms of PAH. To identify the missing heritability we perform whole-genome sequencing in 1038 PAH index cases and 6385 PAH-negative control subjects. Case-control analyses reveal significant overrepresentation of rare variants in ATP13A3, AQP1 and SOX17, and provide independent validation of a critical role for GDF2 in PAH. We demonstrate familial segregation of mutations in SOX17 and AQP1 with PAH. Mutations in GDF2, encoding a BMPR2 ligand, lead to reduced secretion from transfected cells. In addition, we identify pathogenic mutations in the majority of previously reported PAH genes, and provide evidence for further putative genes. Taken together these findings contribute new insights into the molecular basis of PAH and indicate unexplored pathways for therapeutic intervention.
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Affiliation(s)
- Stefan Gräf
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom.
- Department of Haematology, University of Cambridge, Cambridge, CB2 0PT, United Kingdom.
- NIHR BioResource-Rare Diseases, Cambridge, CB2 0PT, United Kingdom.
| | - Matthias Haimel
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
- Department of Haematology, University of Cambridge, Cambridge, CB2 0PT, United Kingdom
- NIHR BioResource-Rare Diseases, Cambridge, CB2 0PT, United Kingdom
| | - Marta Bleda
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
| | - Charaka Hadinnapola
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
| | - Laura Southgate
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London, SW17 0RE, United Kingdom
- Division of Genetics & Molecular Medicine, King's College London, London, WC2R 2LS, United Kingdom
| | - Wei Li
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
| | - Joshua Hodgson
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
| | - Bin Liu
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
| | - Richard M Salmon
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
| | - Mark Southwood
- Royal Papworth Hospital, Papworth Everard, Cambridge, CB23 3RE, United Kingdom
| | - Rajiv D Machado
- Institute of Medical and Biomedical Education, St George's University of London, London, SW17 0RE, United Kingdom
| | - Jennifer M Martin
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
- Department of Haematology, University of Cambridge, Cambridge, CB2 0PT, United Kingdom
- NIHR BioResource-Rare Diseases, Cambridge, CB2 0PT, United Kingdom
| | - Carmen M Treacy
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
- Royal Papworth Hospital, Papworth Everard, Cambridge, CB23 3RE, United Kingdom
| | - Katherine Yates
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
- Department of Haematology, University of Cambridge, Cambridge, CB2 0PT, United Kingdom
- NIHR BioResource-Rare Diseases, Cambridge, CB2 0PT, United Kingdom
| | - Louise C Daugherty
- Department of Haematology, University of Cambridge, Cambridge, CB2 0PT, United Kingdom
- NIHR BioResource-Rare Diseases, Cambridge, CB2 0PT, United Kingdom
| | - Olga Shamardina
- Department of Haematology, University of Cambridge, Cambridge, CB2 0PT, United Kingdom
- NIHR BioResource-Rare Diseases, Cambridge, CB2 0PT, United Kingdom
| | - Deborah Whitehorn
- Department of Haematology, University of Cambridge, Cambridge, CB2 0PT, United Kingdom
- NIHR BioResource-Rare Diseases, Cambridge, CB2 0PT, United Kingdom
| | - Simon Holden
- Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
| | | | - Harm J Bogaard
- VU University Medical Center, Amsterdam, 1007 MB, The Netherlands
| | - Colin Church
- Golden Jubilee National Hospital, Glasgow, G81 4DY, United Kingdom
| | - Gerry Coghlan
- Royal Free Hospital, London, NW3 2QG, United Kingdom
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, S10 2JF, United Kingdom
| | - Paul A Corris
- University of Newcastle, Newcastle, NE1 7RU, United Kingdom
| | - Cesare Danesino
- Department of Molecular Medicine, University of Pavia, Pavia, 27100, Italy
- Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Mélanie Eyries
- Département de génétique, hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and UMR_S 1166-ICAN, INSERM, UPMC Sorbonne Universités, Paris, 75252, France
| | - Henning Gall
- University of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL) and of the Excellence Cluster Cardio-Pulmonary System (ECCCPS), Giessen, 35392, Germany
| | - Stefano Ghio
- Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Hossein-Ardeschir Ghofrani
- University of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL) and of the Excellence Cluster Cardio-Pulmonary System (ECCCPS), Giessen, 35392, Germany
- Imperial College London, London, SW7 2AZ, United Kingdom
| | - J Simon R Gibbs
- National Heart & Lung Institute, Imperial College London, London, SW3 6LY, United Kingdom
| | - Barbara Girerd
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay; AP-HP, Service de Pneumologie, Centre de référence de l'hypertension pulmonaire; INSERM UMR_S 999, Hôpital Bicêtre, Le Kremlin-Bicêtre, Paris, 94270, France
| | | | - Luke Howard
- Imperial College London, London, SW7 2AZ, United Kingdom
| | - Marc Humbert
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay; AP-HP, Service de Pneumologie, Centre de référence de l'hypertension pulmonaire; INSERM UMR_S 999, Hôpital Bicêtre, Le Kremlin-Bicêtre, Paris, 94270, France
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, S10 2JF, United Kingdom
| | - Gabor Kovacs
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, 8010, Austria
- Medical University of Graz, Graz, 8036, Austria
| | | | - Shahin Moledina
- Great Ormond Street Hospital, London, WC1N 3JH, United Kingdom
| | - David Montani
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay; AP-HP, Service de Pneumologie, Centre de référence de l'hypertension pulmonaire; INSERM UMR_S 999, Hôpital Bicêtre, Le Kremlin-Bicêtre, Paris, 94270, France
| | - Michael Newnham
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
| | - Andrea Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, 8010, Austria
| | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, 8010, Austria
- Medical University of Graz, Graz, 8036, Austria
| | - Andrew J Peacock
- Golden Jubilee National Hospital, Glasgow, G81 4DY, United Kingdom
| | - Joanna Pepke-Zaba
- Royal Papworth Hospital, Papworth Everard, Cambridge, CB23 3RE, United Kingdom
| | | | | | - Laura Scelsi
- Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Werner Seeger
- University of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL) and of the Excellence Cluster Cardio-Pulmonary System (ECCCPS), Giessen, 35392, Germany
| | - Florent Soubrier
- Département de génétique, hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and UMR_S 1166-ICAN, INSERM, UPMC Sorbonne Universités, Paris, 75252, France
| | - Dan F Stein
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
| | - Jay Suntharalingam
- Royal United Hospitals Bath NHS Foundation Trust, Bath, BA1 3NG, United Kingdom
| | - Emilia M Swietlik
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
| | - Mark R Toshner
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
| | - David A van Heel
- Blizard Institute, Queen Mary University of London, London, E1 2AT, United Kingdom
| | | | - Quinten Waisfisz
- VU University Medical Center, Amsterdam, 1007 MB, The Netherlands
| | - John Wharton
- Imperial College London, London, SW7 2AZ, United Kingdom
| | - Stephen J Wort
- Imperial College London, London, SW7 2AZ, United Kingdom
- Royal Brompton Hospital, London, SW3 6NP, United Kingdom
| | - Willem H Ouwehand
- Department of Haematology, University of Cambridge, Cambridge, CB2 0PT, United Kingdom
- NIHR BioResource-Rare Diseases, Cambridge, CB2 0PT, United Kingdom
| | - Nicole Soranzo
- Department of Haematology, University of Cambridge, Cambridge, CB2 0PT, United Kingdom
- Wellcome Trust Sanger Institute, Hinxton, CB10 1SA, United Kingdom
| | - Allan Lawrie
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, S10 2RX, United Kingdom
| | - Paul D Upton
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
| | | | - Richard C Trembath
- Division of Genetics & Molecular Medicine, King's College London, London, WC2R 2LS, United Kingdom
| | - Nicholas W Morrell
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom.
- NIHR BioResource-Rare Diseases, Cambridge, CB2 0PT, United Kingdom.
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23
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Hadinnapola C, Bleda M, Haimel M, Screaton N, Swift A, Dorfmüller P, Preston SD, Southwood M, Hernandez-Sanchez J, Martin J, Treacy C, Yates K, Bogaard H, Church C, Coghlan G, Condliffe R, Corris PA, Gibbs S, Girerd B, Holden S, Humbert M, Kiely DG, Lawrie A, Machado R, MacKenzie Ross R, Moledina S, Montani D, Newnham M, Peacock A, Pepke-Zaba J, Rayner-Matthews P, Shamardina O, Soubrier F, Southgate L, Suntharalingam J, Toshner M, Trembath R, Vonk Noordegraaf A, Wilkins MR, Wort SJ, Wharton J, Gräf S, Morrell NW. Phenotypic Characterization of EIF2AK4 Mutation Carriers in a Large Cohort of Patients Diagnosed Clinically With Pulmonary Arterial Hypertension. Circulation 2017; 136:2022-2033. [PMID: 28972005 DOI: 10.1161/circulationaha.117.028351] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [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: 03/14/2017] [Accepted: 08/25/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is a rare disease with an emerging genetic basis. Heterozygous mutations in the gene encoding the bone morphogenetic protein receptor type 2 (BMPR2) are the commonest genetic cause of PAH, whereas biallelic mutations in the eukaryotic translation initiation factor 2 alpha kinase 4 gene (EIF2AK4) are described in pulmonary veno-occlusive disease/pulmonary capillary hemangiomatosis. Here, we determine the frequency of these mutations and define the genotype-phenotype characteristics in a large cohort of patients diagnosed clinically with PAH. METHODS Whole-genome sequencing was performed on DNA from patients with idiopathic and heritable PAH and with pulmonary veno-occlusive disease/pulmonary capillary hemangiomatosis recruited to the National Institute of Health Research BioResource-Rare Diseases study. Heterozygous variants in BMPR2 and biallelic EIF2AK4 variants with a minor allele frequency of <1:10 000 in control data sets and predicted to be deleterious (by combined annotation-dependent depletion, PolyPhen-2, and sorting intolerant from tolerant predictions) were identified as potentially causal. Phenotype data from the time of diagnosis were also captured. RESULTS Eight hundred sixty-four patients with idiopathic or heritable PAH and 16 with pulmonary veno-occlusive disease/pulmonary capillary hemangiomatosis were recruited. Mutations in BMPR2 were identified in 130 patients (14.8%). Biallelic mutations in EIF2AK4 were identified in 5 patients with a clinical diagnosis of pulmonary veno-occlusive disease/pulmonary capillary hemangiomatosis. Furthermore, 9 patients with a clinical diagnosis of PAH carried biallelic EIF2AK4 mutations. These patients had a reduced transfer coefficient for carbon monoxide (Kco; 33% [interquartile range, 30%-35%] predicted) and younger age at diagnosis (29 years; interquartile range, 23-38 years) and more interlobular septal thickening and mediastinal lymphadenopathy on computed tomography of the chest compared with patients with PAH without EIF2AK4 mutations. However, radiological assessment alone could not accurately identify biallelic EIF2AK4 mutation carriers. Patients with PAH with biallelic EIF2AK4 mutations had a shorter survival. CONCLUSIONS Biallelic EIF2AK4 mutations are found in patients classified clinically as having idiopathic and heritable PAH. These patients cannot be identified reliably by computed tomography, but a low Kco and a young age at diagnosis suggests the underlying molecular diagnosis. Genetic testing can identify these misclassified patients, allowing appropriate management and early referral for lung transplantation.
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Affiliation(s)
- Charaka Hadinnapola
- Department of Medicine, University of Cambridge, UK (C.H., M.B., M.H., J.M., C.T., K.Y., M.N., M.T., S. Gräf, N.W.M.)
| | - Marta Bleda
- Department of Medicine, University of Cambridge, UK (C.H., M.B., M.H., J.M., C.T., K.Y., M.N., M.T., S. Gräf, N.W.M.)
| | - Matthias Haimel
- Department of Medicine, University of Cambridge, UK (C.H., M.B., M.H., J.M., C.T., K.Y., M.N., M.T., S. Gräf, N.W.M.).,NIHR BioResource-Rare Diseases (M.H., J.M., K.Y., P.R.-M., O.S., S. Gräf, N.W.M.)
| | - Nicholas Screaton
- Papworth Hospital, Cambridge, UK (N.S., S.D.P., M.S., J.H.-S., J.P.-Z., M.T.)
| | | | | | - Stephen D Preston
- Papworth Hospital, Cambridge, UK (N.S., S.D.P., M.S., J.H.-S., J.P.-Z., M.T.)
| | - Mark Southwood
- Papworth Hospital, Cambridge, UK (N.S., S.D.P., M.S., J.H.-S., J.P.-Z., M.T.)
| | | | - Jennifer Martin
- Department of Medicine, University of Cambridge, UK (C.H., M.B., M.H., J.M., C.T., K.Y., M.N., M.T., S. Gräf, N.W.M.).,NIHR BioResource-Rare Diseases (M.H., J.M., K.Y., P.R.-M., O.S., S. Gräf, N.W.M.)
| | - Carmen Treacy
- Department of Medicine, University of Cambridge, UK (C.H., M.B., M.H., J.M., C.T., K.Y., M.N., M.T., S. Gräf, N.W.M.)
| | - Katherine Yates
- Department of Medicine, University of Cambridge, UK (C.H., M.B., M.H., J.M., C.T., K.Y., M.N., M.T., S. Gräf, N.W.M.).,NIHR BioResource-Rare Diseases (M.H., J.M., K.Y., P.R.-M., O.S., S. Gräf, N.W.M.)
| | - Harm Bogaard
- VU University Medical Centre, Amsterdam, the Netherlands (H.B., A.V.N.)
| | - Colin Church
- Golden Jubilee Hospital, Glasgow, UK (C.C., A.P.)
| | | | | | | | - Simon Gibbs
- Imperial College London, UK (S. Gibbs, M.R.W., J.W.)
| | | | | | - Marc Humbert
- Université Paris-Sud, France (P.D., B.G., M.H., D.M.)
| | - David G Kiely
- Royal Hallamshire Hospital, Sheffield, UK (R.C., D.G.K.)
| | | | | | | | | | - David Montani
- Université Paris-Sud, France (P.D., B.G., M.H., D.M.)
| | - Michael Newnham
- Department of Medicine, University of Cambridge, UK (C.H., M.B., M.H., J.M., C.T., K.Y., M.N., M.T., S. Gräf, N.W.M.)
| | | | - Joanna Pepke-Zaba
- Papworth Hospital, Cambridge, UK (N.S., S.D.P., M.S., J.H.-S., J.P.-Z., M.T.)
| | | | - Olga Shamardina
- NIHR BioResource-Rare Diseases (M.H., J.M., K.Y., P.R.-M., O.S., S. Gräf, N.W.M.)
| | | | - Laura Southgate
- King's College London, UK (L.S., R.T.).,St George's, University of London, UK (L.S.)
| | | | - Mark Toshner
- Department of Medicine, University of Cambridge, UK (C.H., M.B., M.H., J.M., C.T., K.Y., M.N., M.T., S. Gräf, N.W.M.).,Papworth Hospital, Cambridge, UK (N.S., S.D.P., M.S., J.H.-S., J.P.-Z., M.T.)
| | | | | | | | | | - John Wharton
- Imperial College London, UK (S. Gibbs, M.R.W., J.W.)
| | | | - Stefan Gräf
- Department of Medicine, University of Cambridge, UK (C.H., M.B., M.H., J.M., C.T., K.Y., M.N., M.T., S. Gräf, N.W.M.).,NIHR BioResource-Rare Diseases (M.H., J.M., K.Y., P.R.-M., O.S., S. Gräf, N.W.M.).,Department of Haematology, University of Cambridge, UK (S. Gräf)
| | - Nicholas W Morrell
- Department of Medicine, University of Cambridge, UK (C.H., M.B., M.H., J.M., C.T., K.Y., M.N., M.T., S. Gräf, N.W.M.) .,NIHR BioResource-Rare Diseases (M.H., J.M., K.Y., P.R.-M., O.S., S. Gräf, N.W.M.)
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24
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Suntharalingam J, Wilkinson T, Annandale J, Davey C, Fielding R, Freeman D, Gibbons M, Hardinge M, Hippolyte S, Knowles V, Lee C, MacNee W, Pollington J, Vora V, Watts T, Wijesinghe M. British Thoracic Society quality standards for home oxygen use in adults. BMJ Open Respir Res 2017; 4:e000223. [PMID: 29018527 PMCID: PMC5623332 DOI: 10.1136/bmjresp-2017-000223] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/14/2017] [Indexed: 11/26/2022] Open
Abstract
Introduction The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for home oxygen provision in the UK, together with measurable markers of good practice. Quality statements are based on the British Thoracic Society (BTS) Guideline for Home Oxygen Use in Adults. Methods Development of BTS Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards. Results 10 quality statements have been developed, each describing a key marker of high-quality, cost-effective care for home oxygen use, and each statement is supported by quality measures that aim to improve the structure, process and outcomes of healthcare. Discussion BTS Quality Standards for home oxygen use in adults form a key part of the range of supporting materials that the society produces to assist in the dissemination and implementation of a guideline’s recommendations.
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Affiliation(s)
- Jay Suntharalingam
- Royal United Hospital Bath NHS Foundation Trust, Bath, Bath and North East Somer, UK
| | | | | | - Claire Davey
- NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Rhea Fielding
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | | | | | | | | | - Vikki Knowles
- NHS Guildford and Waverley Clinical Commissioning Group, Guildford, UK
| | | | - William MacNee
- Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Vandana Vora
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Thew GR, MacCallam J, Salkovskis PM, Suntharalingam J. Anxiety and depression on an acute respiratory ward. SAGE Open Med 2016; 4:2050312116659604. [PMID: 27508081 PMCID: PMC4964151 DOI: 10.1177/2050312116659604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 06/15/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Psychological difficulties are a common complication among patients with respiratory disease, and are associated with poorer health outcomes and increased use of healthcare. As prevalence studies typically sample patients from community settings, this study aimed to explore the extent and nature of psychological difficulties during acute hospital admission. METHODS A case example of an acute respiratory ward is presented. In total, 41 acute respiratory inpatients completed standardised measures of depression, anxiety, and health anxiety. RESULTS Rates of clinically significant depression, anxiety, and health anxiety were 71%, 40%, and 21%, respectively, with 76% of participants showing clinically significant scores on at least one measure. Comparison to existing literature suggests depression rates may be elevated in the acute inpatient context. The difficulties experienced encompassed both contextual factors related to being in hospital and broader health concerns. CONCLUSION We suggest that psychological distress may be particularly prevalent in inpatient settings and that larger-scale studies are warranted.
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Affiliation(s)
- Graham R Thew
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK; Department of Psychology, University of Bath, Bath, UK; Department of Experimental Psychology, University of Oxford, Oxford, UK
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Abstract
The introduction of pulmonary hypertension (PH)-specific drugs has allowed certain forms of PH to become more treatable. However, patients with these diseases can present to a number of medical specialties and can be challenging to identify, particularly in a non-specialist setting. This article provides guidance on who should be investigated and referred on to a specialist centre, highlighting the potential pitfalls during assessment.
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Affiliation(s)
| | | | - Jacob Easaw
- Cardiology Department, Royal United Hospital, Bath, UK
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Suntharalingam J, Hippolyte S, Knowles V, Freeman D, Patel I, Hardinge M. When should I be considering home oxygen for my patients? NPJ Prim Care Respir Med 2016; 26:15074. [PMID: 26742088 PMCID: PMC4704531 DOI: 10.1038/npjpcrm.2015.74] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 09/08/2015] [Indexed: 12/05/2022] Open
Abstract
The ability to provide oxygen in a patient’s home can offer enormous benefits, including improvements in life expectancy when given in the appropriate setting. Confusingly, however, home oxygen is available in many forms, including long-term oxygen therapy (LTOT), ambulatory oxygen therapy (AOT), palliative oxygen therapy (POT) and short-burst oxygen therapy (SBOT)—each with varying degrees of supporting evidence. The British Thoracic Society (BTS) has recently published new guidance on home oxygen therapy, after collating the available evidence. This article aims to summarise those guidelines, focusing on who should and should not be considered for oxygen therapy. Although the BTS guidelines target a UK audience, many of the principles covered below are applicable internationally, even if the availability of certain oxygen modalities and supporting service arrangements may vary between different healthcare systems.
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Affiliation(s)
- Jay Suntharalingam
- Respiratory Department, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Sabrine Hippolyte
- Respiratory Department, Respiratory SpR, Royal Brompton Hospital, London, UK
| | - Vikki Knowles
- Guildford and Waverley Clinical Commissioning Group, Guildford, UK
| | - Daryl Freeman
- Mundesley Medical Centre, NHS England, Midlands and East, Norfolk, UK
| | - Irem Patel
- Respiratory Department, Integrated Care, Kings Health Partners, King College London School of Medicine, London, UK
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Woolf S, Jitan J, Robinson J, Suntharalingam J. P43 How appropriately is NIV used as a ceiling of treatment? Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.180] [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: 11/03/2022]
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Thew G, MacCallam J, Robinson J, Salkovskis P, Suntharalingam J. M6 Can clinical psychology input improve care quality and reduce admissions among patients with respiratory disease? Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Harris EJA, Grant S, Yarde S, O’Connell-Ramsay G, Sturney S, Suntharalingam J. M16 Are we shouting loud enough? – A comparison of primary versus secondary care spirometry. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.443] [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: 11/03/2022]
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Hardinge M, Suntharalingam J, Wilkinson T. Guideline update: The British Thoracic Society Guidelines on home oxygen use in adults. Thorax 2015; 70:589-91. [PMID: 25918120 DOI: 10.1136/thoraxjnl-2015-206918] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 02/10/2015] [Accepted: 03/27/2015] [Indexed: 11/04/2022]
Abstract
The 2015 British Thoracic Society (BTS) Home Oxygen Guidelines provides detailed evidence-based guidance for the use of oxygen by patients in their own homes or other non-acute hospital settings.
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Affiliation(s)
- Maxine Hardinge
- Oxford Centre of Respiratory Medicine, The Churchill Hospital, Oxford University Hospitals NHS Trust, Headington, Oxford, UK
| | | | - Tom Wilkinson
- Department of Clinical and Experimental Sciences, University of Southampton, Southampton, UK
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Hardinge M, Annandale J, Bourne S, Cooper B, Evans A, Freeman D, Green A, Hippolyte S, Knowles V, MacNee W, McDonnell L, Pye K, Suntharalingam J, Vora V, Wilkinson T. British Thoracic Society guidelines for home oxygen use in adults: accredited by NICE. Thorax 2015; 70 Suppl 1:i1-43. [DOI: 10.1136/thoraxjnl-2015-206865] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Baggott C, Harris E, Suntharalingam J, Malin A. P95 Non Cf Bronchiectasis. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.236] [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: 11/03/2022]
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Suntharalingam J. Muragasu Suntharalingam. Assoc Med J 2014. [DOI: 10.1136/bmj.g5747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Pulmonary Langerhans cell histiocytosis (PLCH) is a rare interstitial lung disease of unknown aetiology. We aimed to characterise a UK-wide cohort of patients with PLCH and compare diagnostic and management methods in specialist and non-specialist centres. 106 cases (53 hospitals) identified. Complete data received in 67 cases (53.7% female, age 37.1±14.4 years). 96% current or ex-smokers. Treatment; smoking cessation (79%), corticosteroids (30.6%), cytotoxic therapy (26.9%) and lung transplant (6%). Patients at specialist centres received cytotoxic drugs more often (p=0.0001) and survival appeared higher. This dataset indicates a more even gender distribution than previously documented. It suggests variation in clinical management and outcomes achieved dependent on clinical experience.
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Affiliation(s)
- Rebecca H Mason
- Respiratory Department, Musgrove Park Hospital, Taunton, Somerset, UK
| | | | - Howard M Branley
- Respiratory Department, Ealing Hospital NHS Trust, London, Middlesex, UK
| | - Huzaifa I Adamali
- Bristol Interstitial Lung Disease (BILD) Service, North Bristol Lung Centre, Southmead General Hospital, Bristol, UK
| | - Martin Hetzel
- Respiratory Department, Bristol Royal Infirmary, Bristol, UK
| | - Toby M Maher
- Interstitial Lung Disease Unit, Royal Brompton, London, UK
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Harper J, Marchand C, Bevan H, Masani V, Suntharalingam J. P51 Follow-up of the incidental pulmonary nodule outcomes and costs: Abstract P51 Table 1. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Toshner M, Suntharalingam J, Fesler P, Soon E, Sheares KK, Jenkins D, White P, Morrell NW, Naeije R, Pepke-Zaba J. Occlusion pressure analysis role in partitioning of pulmonary vascular resistance in CTEPH. Eur Respir J 2012; 40:612-7. [PMID: 22362857 DOI: 10.1183/09031936.00134111] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Flow-directed pulmonary artery occlusion is posited to enable partitioning of vascular resistance into small and large vessels. As such it may have a role in assessment for pulmonary endarterectomy. To test if the occlusion technique distinguished small from large vessel disease we studied 59 subjects with chronic thromboembolic pulmonary hypertension (CTEPH), idiopathic pulmonary arterial hypertension (IPAH), and connective tissue disease (CTD)-associated PAH. At right heart catheterisation, occlusion pressures were recorded. With fitting of the pressure decay curve, pulmonary vascular resistance was partitioned into downstream (small vessels) and upstream (large vessels, Rup). 47 patients completed the study; 14 operable CTEPH, 15 inoperable CTEPH, 13 idiopathic or CTD-PAH and five post-operative CTEPH. There was a significant difference in mean Rup in the proximal operable CTEPH group 87.3 (95% CI 84.1-90.5); inoperable CTEPH mean 75.8 (95% CI 66.76-84.73), p=0.048; and IPAH/CTD, mean 77.1 (95% CI 71.86-82.33), p=0.003. Receiver operating characteristic curves to distinguish operable from inoperable CTEPH demonstrated an area under the curve of 0.75, p=0.0001. A cut-off of 79.3 gave 100% sensitivity (95% CI 73.5-100%) but 57.1% specificity (95% CI 28.9-82.3%). In a subgroup analysis of multiple lobar sampling there was demonstrable heterogeneity. Rup is significantly increased in operable proximal CTEPH compared with non-operable distal CTEPH and IPAH/CTD-PAH. Rup variability in patients with CTEPH and PAH is suggestive of pathophysiological heterogeneity.
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Abstract
β2 agonists are used as first-line treatment in acute asthma. However, they may paradoxically worsen respiratory failure through development of lactic acidosis
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Addy C, Sephton M, Suntharalingam J, De Winton E, Masani V, Taylor G. 53 Assessment of performance status in lung cancer Do oncologists and respiratory physicians agree? Lung Cancer 2012. [DOI: 10.1016/s0169-5002(12)70054-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Leahy A, Curtis K, Masani V, Suntharalingam J. 42 The value of fibre-optic bronchoscopy in patients with haemoptysis and non-diagnostic CT scans. Lung Cancer 2012. [DOI: 10.1016/s0169-5002(12)70043-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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White L, Mirrani G, Grover M, Rollason J, Malin A, Suntharalingam J. Outcomes of Pseudomonas eradication therapy in patients with non-cystic fibrosis bronchiectasis. Respir Med 2011; 106:356-60. [PMID: 22204744 DOI: 10.1016/j.rmed.2011.11.018] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 11/08/2011] [Accepted: 11/30/2011] [Indexed: 10/14/2022]
Abstract
Pseudomonas aeruginosa infection is associated with poorer outcomes in non-cystic fibrosis bronchiectasis. It is unknown whether early eradication improves outcomes. This retrospective study assessed clinical and microbiological outcomes of eradication therapy following initial Pseudomonas infection. All patients undergoing Pseudomonas eradication therapy from 2004 to 2010 were identified retrospectively and assessed for microbiological eradication, exacerbation frequency, hospital admissions, clinical symptoms and lung function. 30 patients were identified with median follow-up time 26.4 months. Eradication therapy involved intravenous antibiotics (n = 12), intravenous antibiotics followed by oral ciprofloxacin (n = 13) or ciprofloxacin alone (n = 5), combined with 3 months of nebulised colistin. Pseudomonas was initially eradicated from sputum in 24 patients (80.0%). 13/24 patients remained Pseudomonas-free and 11/24 were subsequently reinfected (median time 6.2 months). Exacerbation frequency was significantly reduced from 3.93 per year pre-eradication and 2.09 post-eradication (p = 0.002). Admission rates were similar, at 0.39 per year pre-eradication and 0.29 post-eradication (p = NS). 20/30 patients reported initial clinical improvement, whilst at one-year follow up, 19/21 had further improved or remained stable. Lung function was unchanged. This study demonstrates that Pseudomonas can be eradicated from a high proportion of patients, which may lead to prolonged clearance and reduced exacerbation rates. This important outcome requires confirmation in a prospective study.
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Affiliation(s)
- Laura White
- Respiratory Department, Royal United Hospital, Combe Park, Bath, BA1 3NG, United Kingdom
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42
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Addy C, Suntharalingam J, De Winton E, Masani V, Taylor G. P193 Assessment of performance status in lung cancer: do oncologists and respiratory physicians agree? Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054c.193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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43
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Jones C, Suntharalingam J. P38 Is nutritional status neglected in COPD patients admitted to hospital? Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054c.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mason RH, Foley NM, Hetzel MR, Branley H, Suntharalingam J. S58 Pulmonary Langerhans' Cell Histiocytosis (PLCH): a New National Register. Thorax 2010. [DOI: 10.1136/thx.2010.150938.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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White L, Mirrani G, Grover M, Rollason J, Malin A, Suntharalingam J. S130 Outcomes of pseudomonas eradication therapy in patients with non-cystic fibrosis bronchiectasis. Thorax 2010. [DOI: 10.1136/thx.2010.150946.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sturney S, Reddecliffe S, Davies H, Robinson G, Easaw J, Suntharalingam J, Coghlan G. P32 Delivering pulmonary hypertension services--5 year experience from a Satellite centre. Thorax 2010. [DOI: 10.1136/thx.2010.150961.32] [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: 11/03/2022]
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Sturney S, Robinson G, Coghlan G, Pepke-Zaba J, Easaw J, Suntharalingam J. P258 Is Chronic Thromboembolic Pulmonary Hypertension (CTEPH) under diagnosed in the UK? Thorax 2010. [DOI: 10.1136/thx.2010.151076.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Toshner MR, Gopalan D, Suntharalingam J, Treacy C, Soon E, Sheares KK, Morrell NW, Screaton N, Pepke-Zaba J. Pulmonary arterial size and response to sildenafil in chronic thromboembolic pulmonary hypertension. J Heart Lung Transplant 2010; 29:610-5. [PMID: 20227301 PMCID: PMC2954311 DOI: 10.1016/j.healun.2009.12.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 12/07/2009] [Accepted: 12/15/2009] [Indexed: 11/25/2022] Open
Abstract
Background Relative area change (RAC) of the proximal pulmonary artery is a measurement of pulmonary artery distensibility and has been shown to correlate with vasoreactivity studies in patients with idiopathic pulmonary arterial hypertension. We have previously noted a relationship between invasive hemodynamic vasoreactivity testing and long-term response to sildenafil in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). We therefore set out to determine whether RAC can provide useful correlatory non-invasive data. Methods Patients recruited to a randomized, controlled trial (RCT) of sildenafil at 40 mg 3 times daily underwent additional magnetic resonance imaging (MRI) at the baseline of the trial. Eighteen patients had an MRI that led to a diagnosis of inoperable distal CTEPH or significant residual CTEPH post-operatively. The primary end-point was improvement in 6-minute walk test (6MWT) with secondary end-points of right heart catheterization–based hemodynamics, N-terminal pro–brain natriuretic peptide (NT pro-BNP) and functional class. RAC assessed by MRI was correlated with trial end-points. Results Fourteen subjects with baseline MRI completed the protocol. RAC was the only baseline variable that correlated at 1 year to the primary end-point of improvement in 6MWT (r = 0.7, p = 0.006), and also to a change in NT pro-BNP (r = 0.59, p = 0.03). Using a cut-off of RAC over 20% there was an 87.5% sensitivity (95% confidence interval [CI]: 45% to 100%) and a 66.7% specificity (95% CI: 22% to 96%) for an improvement in 6MWT of >40 meters. Conclusions RAC correlates with functional response to sildenafil, as measured by the 6MWT, and improved heart function, as measured by NT pro-BNP. RAC shows potential in understanding and possibly predicting treatment response.
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Affiliation(s)
- Mark R Toshner
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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Toshner M, Voswinckel R, Southwood M, Al-Lamki R, Howard LSG, Marchesan D, Yang J, Suntharalingam J, Soon E, Exley A, Stewart S, Hecker M, Zhu Z, Gehling U, Seeger W, Pepke-Zaba J, Morrell NW. Evidence of dysfunction of endothelial progenitors in pulmonary arterial hypertension. Am J Respir Crit Care Med 2009; 180:780-7. [PMID: 19628780 PMCID: PMC2778151 DOI: 10.1164/rccm.200810-1662oc] [Citation(s) in RCA: 175] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 07/22/2009] [Indexed: 02/06/2023] Open
Abstract
RATIONALE Severe pulmonary arterial hypertension (PAH) is characterized by the formation of plexiform lesions and concentric intimal fibrosis in small pulmonary arteries. The origin of cells contributing to these vascular lesions is uncertain. Endogenous endothelial progenitor cells are potential contributors to this process. OBJECTIVES To determine whether progenitors are involved in the pathobiology of PAH. METHODS We performed immunohistochemistry to determine the expression of progenitor cell markers (CD133 and c-Kit) and the major homing signal pathway stromal cell-derived factor-1 and its chemokine receptor (CXCR4) in lung tissue from patients with idiopathic PAH, familial PAH, and PAH associated with congenital heart disease. Two separate flow cytometric methods were employed to determine peripheral blood circulating numbers of angiogenic progenitors. Late-outgrowth progenitor cells were expanded ex vivo from the peripheral blood of patients with mutations in the gene encoding bone morphogenetic protein receptor type II (BMPRII), and functional assays of migration, proliferation, and angiogenesis were undertaken. measurements and main results: There was a striking up-regulation of progenitor cell markers in remodeled arteries from all patients with PAH, specifically in plexiform lesions. These lesions also displayed increased stromal cell-derived factor-1 expression. Circulating angiogenic progenitor numbers in patients with PAH were increased compared with control subjects and functional studies of late-outgrowth progenitor cells from patients with PAH with BMPRII mutations revealed a hyperproliferative phenotype with impaired ability to form vascular networks. CONCLUSIONS These findings provide evidence of the involvement of progenitor cells in the vascular remodeling associated with PAH. Dysfunction of circulating progenitors in PAH may contribute to this process.
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Affiliation(s)
- Mark Toshner
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Robert Voswinckel
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Mark Southwood
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Rafia Al-Lamki
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Luke S. G. Howard
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Denis Marchesan
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Jun Yang
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Jay Suntharalingam
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Elaine Soon
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Andrew Exley
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Susan Stewart
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Markus Hecker
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Zhenping Zhu
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Ursula Gehling
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Werner Seeger
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Joanna Pepke-Zaba
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Nicholas W. Morrell
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
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