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Boyce S, Fletcher S, Jones A, Kohli R, Mangles S, Ong M, Pollard D, Sivasubramaniyam S, Stephensen D, Stoner N, Kazmi R. Educational needs of patients, families, and healthcare professionals to support the patient journey in haemophilia gene therapy in the UK. Orphanet J Rare Dis 2023; 18:366. [PMID: 38007560 PMCID: PMC10676600 DOI: 10.1186/s13023-023-02977-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/18/2023] [Indexed: 11/27/2023] Open
Abstract
With the first gene therapies for haemophilia approved by the European Commission, the US Food and Drug Administration, and the Medicines and Healthcare products Regulatory Agency, it is important to consider the remaining unmet needs and challenges that may arise throughout patients' treatment journeys. We discuss existing unmet needs and important considerations prior to, during, and following haemophilia gene therapy treatment in the UK, and propose potential next steps. Key areas for attention are education, psychological support, and guidance on implementation. Strategies are urgently required to fulfil these needs. An immediate priority for information providers should be comprehensive education for people with haemophilia (PWH) and healthcare professionals (HCPs). Greater access to resources and training in psychological services will be required throughout the treatment pathway. More specific guidance is required to define the implementation model, criteria for accreditation, and responsibilities of care centres. Furthermore, PWH may revisit discussions with HCPs multiple times pre-infusion, thus the patient journey is unlikely to be linear. Consideration of these challenges, and of potential strategies to address them, will be integral to optimising the future success of this promising therapy.
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Affiliation(s)
- Sara Boyce
- University Hospital Southampton, Southampton, UK.
| | - Simon Fletcher
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - April Jones
- The Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | | - Sarah Mangles
- Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Min Ong
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Debra Pollard
- Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | | | | | - Nicola Stoner
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rashid Kazmi
- University Hospital Southampton, Southampton, UK
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McKone EL, Breen W, Foster NR, Bogan AW, Alstat RA, Boyce S, Schwartz JD, Ahmed SK, Mahajan A, Laack NN. Memantine for Pediatric Patients Receiving Cranial Irradiation: A Pilot Study. Int J Radiat Oncol Biol Phys 2023; 117:S134-S135. [PMID: 37784344 DOI: 10.1016/j.ijrobp.2023.06.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) While memantine has become standard in certain adults receiving brain RT to decrease the cognitive impacts of RT, it is unknown whether pediatric patients can take and tolerate memantine or experience benefit. In this prospective single-arm feasibility study, we hypothesized pediatric patients receiving brain RT would tolerate memantine with good treatment adherence. MATERIALS/METHODS Patients aged 4-18 years with a primary CNS malignancy (excluding WHO Grade IV astrocytoma and glioblastoma) receiving intracranial RT were eligible. A 6-month course of memantine was given during and after RT. Dosing began once daily at 5 mg with up-titration in 5 mg increments over 4 weeks to a weight-based maximum (0.4 mg/kg to the closest 5 mg), not to exceed 10 mg BID. To reduce patient and clinical research associate (CRA) burden, medication adherence was tracked via the Medisafe Pill and Reminder application which study staff helped install on the patient or parent's smart phone. A paper pill diary was provided for those unable to use the app. The primary endpoint was to achieve 80% adherence rate to memantine in 80% of patients measured 1-month post-RT. RESULTS Eighteen patients (14 male and 4 female, median age 11.5 years (range: 4-18)) were enrolled from 2020-2022. The study closed early after enrolling 18 of 20 planned patients to avoid competing with the phase III randomized Children's Oncology Group (COG) study AACL2031. One patient withdrew for cognition-altering substance-use, leaving 17 patients with data available for analysis. Histologies included germ cell tumor (n = 6), craniopharyngioma (n = 3), choroid plexus papilloma (n = 2), ependymoma (n = 2), glial/astrocytoma (n = 2), medulloblastoma (n = 1), and meningioma (n = 1). Thirteen had surgery, and 9 received chemotherapy. Eight received craniospinal irradiation (CSI). Median RT dose was 54 Gy (range 36-59.4) in 30 fractions (range: 20-33). At data freeze, all 17 had passed the 1-month post-RT time point. One patient discontinued memantine after a single dose due to nausea. Pill-reports were available for 14 of the remaining 16; two patients did not complete digital pill logs. For those with complete logs, all adherence rates were above 80%, with a median of 99.32% pill completion rate (range: 92.67-100). Seven (50%) took 100% of prescribed doses. Irrespective of adherence for the 2 unavailable for evaluation, the primary endpoint was still achieved. Grade 1 toxicities included headache (n = 6, 35%) and constipation (n = 1, 6%); there were no grade 2+ toxicities. At last follow-up, 15/16 have completed the full 6-month memantine course. Secondary endpoints including neurocognitive evaluations have not yet been met and will be the subject of future reports. CONCLUSION Memantine is a feasible and well-tolerated addition to multi-modality treatment for pediatric brain tumors. Secondary endpoints of this study and results of the ongoing COG study are awaited to define the value of memantine in this population.
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Affiliation(s)
- E L McKone
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - W Breen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - N R Foster
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - A W Bogan
- Department of Qualitative Health Sciences, Section of Biostatistics, Mayo Clinic, Scottsdale, AZ
| | | | - S Boyce
- Mayo Clinic College of Medicine and Science Rochester, Rochester, MN
| | - J D Schwartz
- Department of Pediatric Hematology/Oncology, Mayo Clinic, Rochester, MN
| | - S K Ahmed
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - A Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - N N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
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Boyce S, Rangarajan S. RNAi for the Treatment of People with Hemophilia: Current Evidence and Patient Selection. J Blood Med 2023; 14:317-327. [PMID: 37123985 PMCID: PMC10132380 DOI: 10.2147/jbm.s390521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/31/2023] [Indexed: 05/02/2023] Open
Abstract
Severe hemophilia is associated with spontaneous, prolonged and recurrent bleeding. Inadequate prevention and treatment of bleeding can lead to serious morbidity and mortality. Due to the limitations of intravenous clotting factor replacement, including the risk of inhibitory antibodies, innovative novel therapies have been developed that have dramatically changed the landscape of hemophilia therapy. Ribonucleic acid interference (RNAi) has brought the opportunity for multiple strategies to manipulate the hemostatic system and ameliorate the bleeding phenotype in severe bleeding disorders. Fitusiran is a RNAi therapeutic that inhibits the expression of the natural anticoagulant serpin antithrombin. Reduction in antithrombin is known to cause thrombosis if coagulation parameters are otherwise normal and can rebalance hemostasis in severe hemophilia. Reports from late stage clinical trials of fitusiran in hemophilia A and B participants, with and without inhibitory antibodies to exogenous clotting factor, have demonstrated efficacy in preventing bleeding events showing promise for a future "universal" prophylactic treatment of individuals with moderate-severe hemophilia.
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Affiliation(s)
- Sara Boyce
- Haemophilia Comprehensive Care Centre, University Hospital Southampton, Southampton, UK
- Correspondence: Sara Boyce, Email
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Zwagemaker AF, Kloosterman FR, Gouw SC, Boyce S, Brons P, Cnossen MH, Collins PW, Eikenboom J, Hay C, Hengeveld RCC, Jackson S, Klopper-Tol CAM, Kruip MJHA, Gorkom BLV, Male C, Nieuwenhuizen L, Shapiro S, Fijnvandraat K, Coppens M. Little discrepancy between one-stage and chromogenic factor VIII (FVIII)/IX assays in a large international cohort of persons with nonsevere hemophilia A and B. J Thromb Haemost 2022; 21:850-861. [PMID: 36696222 DOI: 10.1016/j.jtha.2022.11.040] [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] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 11/03/2022] [Accepted: 11/28/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Accurate measurements of coagulation factor activity form an essential part of hemophilia management and are performed by the one-stage or chromogenic assay. Current literature suggests that approximately one-third of persons with nonsevere hemophilia A exhibit assay discrepancy, albeit with a high variability between studies. Such data are scarce in nonsevere hemophilia B. OBJECTIVES To investigate the extent of factor VIII/IX one-stage and chromogenic assay discrepancy in moderate and mild hemophilia A and B. METHODS Persons with previously diagnosed nonsevere hemophilia A and B with a factor level of 2 to 35 IU/dL were included from the international DYNAMO cohort study. Central measurements of the factor VIII and IX activity levels were performed by the one-stage and chromogenic assay. Relative and absolute discrepancy definitions were used, with the International Society on Thrombosis and Haemostasis-Scientific and Standardization Committee proposed ratio of >2.0 or <0.5 being the primary outcome. Discrepancy was also evaluated in a subgroup of 13 persons with mutations previously associated with discrepancy (≥3 cases reported in literature). RESULTS A total of 220 persons were included, of whom 3 (1%) showed assay discrepancy: 2/175 hemophilia A and 1/45 hemophilia B. Six persons (3%) exhibited an absolute difference >10 IU/dL between the assay results. In addition, with more lenient definitions, over 90% of participants (n = 197) had no discrepant results. Only 1 out of 13 persons with a mutation previously associated with discrepancy had significant assay discrepancy. CONCLUSION Little assay discrepancy was observed despite the presence of mutations previously associated with discrepancy, suggesting that the presence and magnitude of assay discrepancy are largely determined by laboratory variables.
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Affiliation(s)
- Anne-Fleur Zwagemaker
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Pediatric Hematology, Meibergdreef, Amsterdam, The Netherlands
| | - Fabienne R Kloosterman
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Pediatric Hematology, Meibergdreef, Amsterdam, The Netherlands
| | - Samantha C Gouw
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Pediatric Hematology, Meibergdreef, Amsterdam, The Netherlands
| | - Sara Boyce
- Department of Haematology, University Hospital Southampton, Southampton, United Kingdom
| | - Paul Brons
- Department of Pediatric Hemato-Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marjon H Cnossen
- Department of Pediatric Hematology, Erasmus MC Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Peter W Collins
- Cardiff Haemophilia Centre, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Jeroen Eikenboom
- Department of Internal Medicine, Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Charles Hay
- Manchester University Department of Haematology, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Rutger C C Hengeveld
- Amsterdam UMC, University of Amsterdam, Clinical Chemistry, Meibergdreef, Amsterdam, The Netherlands
| | - Shannon Jackson
- Adult Bleeding Disorders Program of BC - Adult Division St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Caroline A M Klopper-Tol
- Amsterdam UMC, University of Amsterdam, Clinical Chemistry, Meibergdreef, Amsterdam, The Netherlands
| | - Marieke J H A Kruip
- Department of Hematology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Christoph Male
- Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | | | - Susan Shapiro
- Department of Haematology, Oxford University Hospitals NHS Foundation, Oxford NIHR Biomedical Research Centre, Oxford, United Kingdom; Radcliffe Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Karin Fijnvandraat
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Pediatric Hematology, Meibergdreef, Amsterdam, The Netherlands; Department of Molecular Cellular Hemostasis, Sanquin Research and Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Michiel Coppens
- Amsterdam UMC, University of Amsterdam, Vascular Medicine, Meibergdreef, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension & Thrombosis, Amsterdam, The Netherlands.
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Zwagemaker A, Kloosterman FR, Coppens M, Gouw SC, Boyce S, Bagot CN, Beckers EAM, Brons P, Castaman G, Eikenboom J, Jackson S, Kruip MJHA, Leebeek FWG, Meijer K, Nieuwenhuizen L, Pabinger I, Fijnvandraat K. Desmopressin for bleeding in non‐severe hemophilia A: Suboptimal use in a real‐world setting. Res Pract Thromb Haemost 2022; 6:e12777. [PMID: 36090159 PMCID: PMC9433315 DOI: 10.1002/rth2.12777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/28/2022] [Accepted: 06/23/2022] [Indexed: 12/03/2022] Open
Abstract
Background Desmopressin is an important treatment option in nonsevere hemophilia A because it has several benefits compared with factor (F) concentrates, including no inhibitor risk and much lower costs. Despite these advantages, data are limited on the real‐world use of desmopressin in the treatment of bleeds. Objective To describe the clinical use of desmopressin in relation to other therapeutic modalities in the treatment of bleeding episodes in patients with nonsevere hemophilia A. Methods Patients with nonsevere hemophilia A aged 12–55 years were included from the DYNAMO cohort study. Data on the desmopressin test response and treated bleeding events in the period January 2009 to July 2020 were retrospectively collected from medical files. An adequate desmopressin test response was defined based on a peak FVIII level of ≥30 IU/dl. Results A total of 248 patients with a median age of 38 years (interquartile range 25–49) were included. An adequate desmopressin test response was documented in 25% and 73% of patients with moderate and mild hemophilia, respectively. In adequate responders, 51% of bleeds were exclusively treated with FVIII concentrates, 24% exclusively with desmopressin, 21% with a combination of both and 4% with other treatments. In 54% of bleeds treated with a single dose of factor concentrates, the expected FVIII level after desmopressin exceeded the level targeted. Conclusion Most bleeds in patients with an adequate response to desmopressin are treated with factor concentrates. These findings may indicate a suboptimal use of desmopressin and that barriers to the use of desmopressin should be explored.
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Affiliation(s)
- Anne‐Fleur Zwagemaker
- Amsterdam UMC University of Amsterdam, Emma Children's Hospital, Pediatric Hematology Amsterdam The Netherlands
| | - Fabienne R. Kloosterman
- Amsterdam UMC University of Amsterdam, Emma Children's Hospital, Pediatric Hematology Amsterdam The Netherlands
| | - Michiel Coppens
- Department of Vascular Medicine Amsterdam University Medical Centers Amsterdam The Netherlands
| | - Samantha C. Gouw
- Amsterdam UMC University of Amsterdam, Emma Children's Hospital, Pediatric Hematology Amsterdam The Netherlands
| | - Sara Boyce
- Department of Haematology University Hospital Southampton Southampton UK
| | | | - Erik A. M. Beckers
- Department of Internal Medicine, Division of Hematology, CARIM School for Cardiovascular Diseases Maastricht University Medical Center Maastricht The Netherlands
| | - Paul Brons
- Department of Pediatric Hemato‐Oncology Radboud University Medical Center Nijmegen The Netherlands
| | - Giancarlo Castaman
- Department of Oncology, Center for Bleeding Disorders Careggi University Hospital Florence Italy
| | - Jeroen Eikenboom
- Department of Internal Medicine, Division of Thrombosis and Hemostasis Leiden University Medical Center Leiden The Netherlands
| | - Shannon Jackson
- Adult Bleeding Disorders Program of BC ‐ Adult Division St. Paul's Hospital Vancouver British Columbia Canada
| | - Marieke J. H. A. Kruip
- Department of Hematology Erasmus MC, Erasmus University Medical Center Rotterdam The Netherlands
| | - Frank W. G. Leebeek
- Department of Hematology Erasmus MC, Erasmus University Medical Center Rotterdam The Netherlands
| | - Karina Meijer
- Department of Hematology University Medical Center Groningen, University of Groningen Groningen The Netherlands
| | | | - Ingrid Pabinger
- Clinical Division of Hematology and Hemostaseology Medical University of Vienna Vienna Austria
| | - Karin Fijnvandraat
- Amsterdam UMC University of Amsterdam, Emma Children's Hospital, Pediatric Hematology Amsterdam The Netherlands
- Department of Molecular Cellular Hemostasis Sanquin Research and Landsteiner Laboratory Amsterdam The Netherlands
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Chowdary P, Shapiro S, Makris M, Evans G, Boyce S, Talks K, Dolan G, Reiss U, Phillips M, Riddell A, Peralta MR, Quaye M, Patch DW, Tuddenham E, Dane A, Watissée M, Long A, Nathwani A. Phase 1-2 Trial of AAVS3 Gene Therapy in Patients with Hemophilia B. N Engl J Med 2022; 387:237-247. [PMID: 35857660 DOI: 10.1056/nejmoa2119913] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND FLT180a (verbrinacogene setparvovec) is a liver-directed adeno-associated virus (AAV) gene therapy that uses a synthetic capsid and a gain-of-function protein to normalize factor IX levels in patients with hemophilia B. METHODS In this multicenter, open-label, phase 1-2 trial, we assessed the safety and efficacy of varying doses of FLT180a in patients with severe or moderately severe hemophilia B (factor IX level, ≤2% of normal value). All the patients received glucocorticoids with or without tacrolimus for immunosuppression to decrease the risk of vector-related immune responses. After 26 weeks, patients were enrolled in a long-term follow-up study. The primary end points were safety and efficacy, as assessed by factor IX levels at week 26. RESULTS Ten patients received one of four FLT180a doses of vector genomes (vg) per kilogram of body weight: 3.84×1011 vg, 6.40×1011 vg, 8.32×1011 vg, or 1.28×1012 vg. After receiving the infusion, all the patients had dose-dependent increases in factor IX levels. At a median follow-up of 27.2 months (range, 19.1 to 42.4), sustained factor IX activity was observed in all the patients except one, who resumed factor IX prophylaxis. As of the data-cutoff date (September 20, 2021), five patients had normal factor IX levels (range, 51 to 78%), three patients had levels from 23 to 43%, and one had a level of 260%. Of the reported adverse events, approximately 10% were related to FLT180a and 24% to immunosuppression. Increases in liver aminotransferase levels were the most common FLT180a-related adverse events. Late increases in aminotransferase levels occurred in patients who had received prolonged tacrolimus beyond the glucocorticoid taper. A serious adverse event of arteriovenous fistula thrombosis occurred in the patient with high factor IX levels. CONCLUSIONS Sustained factor IX levels in the normal range were observed with low doses of FLT180a but necessitated immunosuppression with glucocorticoids with or without tacrolimus. (Funded by Freeline Therapeutics; ClinicalTrials.gov numbers, NCT03369444 and NCT03641703; EudraCT numbers, 2017-000852-24 and 2017-005080-40.).
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Affiliation(s)
- Pratima Chowdary
- From the Katharine Dormandy Haemophilia and Thrombosis Centre (P.C., M.P., A.R., M.R.P., E.T., A.N.), Health Services Laboratory, Sonic Healthcare (A.R.), and the Department of Hepatology and Liver Transplantation (D.W.P.), Royal Free Hospital, University College London (P.C., M.P., M.Q., A.N.), Guy's and St. Thomas' Hospital (G.D.), and Wstats (M.W.), London, Oxford University Hospitals Foundation Trust, Oxford NIHR Biomedical Research Centre, and Oxford University, Oxford (S.S.), the University of Sheffield, Sheffield (M.M.), East Kent Hospitals NHS University Foundation Trust, Canterbury (G.E.), University Hospital Southampton, Southampton (S.B.), Newcastle upon Tyne Hospitals NHS Trust, Newcastle (K.T.), and Freeline Therapeutics, Stevenage (A.D., A.N.) - all in the United Kingdom; St. Jude Children's Research Hospital, Memphis, TN (U.R.); and Freeline Therapeutics, New York (A.L.)
| | - Susan Shapiro
- From the Katharine Dormandy Haemophilia and Thrombosis Centre (P.C., M.P., A.R., M.R.P., E.T., A.N.), Health Services Laboratory, Sonic Healthcare (A.R.), and the Department of Hepatology and Liver Transplantation (D.W.P.), Royal Free Hospital, University College London (P.C., M.P., M.Q., A.N.), Guy's and St. Thomas' Hospital (G.D.), and Wstats (M.W.), London, Oxford University Hospitals Foundation Trust, Oxford NIHR Biomedical Research Centre, and Oxford University, Oxford (S.S.), the University of Sheffield, Sheffield (M.M.), East Kent Hospitals NHS University Foundation Trust, Canterbury (G.E.), University Hospital Southampton, Southampton (S.B.), Newcastle upon Tyne Hospitals NHS Trust, Newcastle (K.T.), and Freeline Therapeutics, Stevenage (A.D., A.N.) - all in the United Kingdom; St. Jude Children's Research Hospital, Memphis, TN (U.R.); and Freeline Therapeutics, New York (A.L.)
| | - Mike Makris
- From the Katharine Dormandy Haemophilia and Thrombosis Centre (P.C., M.P., A.R., M.R.P., E.T., A.N.), Health Services Laboratory, Sonic Healthcare (A.R.), and the Department of Hepatology and Liver Transplantation (D.W.P.), Royal Free Hospital, University College London (P.C., M.P., M.Q., A.N.), Guy's and St. Thomas' Hospital (G.D.), and Wstats (M.W.), London, Oxford University Hospitals Foundation Trust, Oxford NIHR Biomedical Research Centre, and Oxford University, Oxford (S.S.), the University of Sheffield, Sheffield (M.M.), East Kent Hospitals NHS University Foundation Trust, Canterbury (G.E.), University Hospital Southampton, Southampton (S.B.), Newcastle upon Tyne Hospitals NHS Trust, Newcastle (K.T.), and Freeline Therapeutics, Stevenage (A.D., A.N.) - all in the United Kingdom; St. Jude Children's Research Hospital, Memphis, TN (U.R.); and Freeline Therapeutics, New York (A.L.)
| | - Gillian Evans
- From the Katharine Dormandy Haemophilia and Thrombosis Centre (P.C., M.P., A.R., M.R.P., E.T., A.N.), Health Services Laboratory, Sonic Healthcare (A.R.), and the Department of Hepatology and Liver Transplantation (D.W.P.), Royal Free Hospital, University College London (P.C., M.P., M.Q., A.N.), Guy's and St. Thomas' Hospital (G.D.), and Wstats (M.W.), London, Oxford University Hospitals Foundation Trust, Oxford NIHR Biomedical Research Centre, and Oxford University, Oxford (S.S.), the University of Sheffield, Sheffield (M.M.), East Kent Hospitals NHS University Foundation Trust, Canterbury (G.E.), University Hospital Southampton, Southampton (S.B.), Newcastle upon Tyne Hospitals NHS Trust, Newcastle (K.T.), and Freeline Therapeutics, Stevenage (A.D., A.N.) - all in the United Kingdom; St. Jude Children's Research Hospital, Memphis, TN (U.R.); and Freeline Therapeutics, New York (A.L.)
| | - Sara Boyce
- From the Katharine Dormandy Haemophilia and Thrombosis Centre (P.C., M.P., A.R., M.R.P., E.T., A.N.), Health Services Laboratory, Sonic Healthcare (A.R.), and the Department of Hepatology and Liver Transplantation (D.W.P.), Royal Free Hospital, University College London (P.C., M.P., M.Q., A.N.), Guy's and St. Thomas' Hospital (G.D.), and Wstats (M.W.), London, Oxford University Hospitals Foundation Trust, Oxford NIHR Biomedical Research Centre, and Oxford University, Oxford (S.S.), the University of Sheffield, Sheffield (M.M.), East Kent Hospitals NHS University Foundation Trust, Canterbury (G.E.), University Hospital Southampton, Southampton (S.B.), Newcastle upon Tyne Hospitals NHS Trust, Newcastle (K.T.), and Freeline Therapeutics, Stevenage (A.D., A.N.) - all in the United Kingdom; St. Jude Children's Research Hospital, Memphis, TN (U.R.); and Freeline Therapeutics, New York (A.L.)
| | - Kate Talks
- From the Katharine Dormandy Haemophilia and Thrombosis Centre (P.C., M.P., A.R., M.R.P., E.T., A.N.), Health Services Laboratory, Sonic Healthcare (A.R.), and the Department of Hepatology and Liver Transplantation (D.W.P.), Royal Free Hospital, University College London (P.C., M.P., M.Q., A.N.), Guy's and St. Thomas' Hospital (G.D.), and Wstats (M.W.), London, Oxford University Hospitals Foundation Trust, Oxford NIHR Biomedical Research Centre, and Oxford University, Oxford (S.S.), the University of Sheffield, Sheffield (M.M.), East Kent Hospitals NHS University Foundation Trust, Canterbury (G.E.), University Hospital Southampton, Southampton (S.B.), Newcastle upon Tyne Hospitals NHS Trust, Newcastle (K.T.), and Freeline Therapeutics, Stevenage (A.D., A.N.) - all in the United Kingdom; St. Jude Children's Research Hospital, Memphis, TN (U.R.); and Freeline Therapeutics, New York (A.L.)
| | - Gerard Dolan
- From the Katharine Dormandy Haemophilia and Thrombosis Centre (P.C., M.P., A.R., M.R.P., E.T., A.N.), Health Services Laboratory, Sonic Healthcare (A.R.), and the Department of Hepatology and Liver Transplantation (D.W.P.), Royal Free Hospital, University College London (P.C., M.P., M.Q., A.N.), Guy's and St. Thomas' Hospital (G.D.), and Wstats (M.W.), London, Oxford University Hospitals Foundation Trust, Oxford NIHR Biomedical Research Centre, and Oxford University, Oxford (S.S.), the University of Sheffield, Sheffield (M.M.), East Kent Hospitals NHS University Foundation Trust, Canterbury (G.E.), University Hospital Southampton, Southampton (S.B.), Newcastle upon Tyne Hospitals NHS Trust, Newcastle (K.T.), and Freeline Therapeutics, Stevenage (A.D., A.N.) - all in the United Kingdom; St. Jude Children's Research Hospital, Memphis, TN (U.R.); and Freeline Therapeutics, New York (A.L.)
| | - Ulrike Reiss
- From the Katharine Dormandy Haemophilia and Thrombosis Centre (P.C., M.P., A.R., M.R.P., E.T., A.N.), Health Services Laboratory, Sonic Healthcare (A.R.), and the Department of Hepatology and Liver Transplantation (D.W.P.), Royal Free Hospital, University College London (P.C., M.P., M.Q., A.N.), Guy's and St. Thomas' Hospital (G.D.), and Wstats (M.W.), London, Oxford University Hospitals Foundation Trust, Oxford NIHR Biomedical Research Centre, and Oxford University, Oxford (S.S.), the University of Sheffield, Sheffield (M.M.), East Kent Hospitals NHS University Foundation Trust, Canterbury (G.E.), University Hospital Southampton, Southampton (S.B.), Newcastle upon Tyne Hospitals NHS Trust, Newcastle (K.T.), and Freeline Therapeutics, Stevenage (A.D., A.N.) - all in the United Kingdom; St. Jude Children's Research Hospital, Memphis, TN (U.R.); and Freeline Therapeutics, New York (A.L.)
| | - Mark Phillips
- From the Katharine Dormandy Haemophilia and Thrombosis Centre (P.C., M.P., A.R., M.R.P., E.T., A.N.), Health Services Laboratory, Sonic Healthcare (A.R.), and the Department of Hepatology and Liver Transplantation (D.W.P.), Royal Free Hospital, University College London (P.C., M.P., M.Q., A.N.), Guy's and St. Thomas' Hospital (G.D.), and Wstats (M.W.), London, Oxford University Hospitals Foundation Trust, Oxford NIHR Biomedical Research Centre, and Oxford University, Oxford (S.S.), the University of Sheffield, Sheffield (M.M.), East Kent Hospitals NHS University Foundation Trust, Canterbury (G.E.), University Hospital Southampton, Southampton (S.B.), Newcastle upon Tyne Hospitals NHS Trust, Newcastle (K.T.), and Freeline Therapeutics, Stevenage (A.D., A.N.) - all in the United Kingdom; St. Jude Children's Research Hospital, Memphis, TN (U.R.); and Freeline Therapeutics, New York (A.L.)
| | - Anne Riddell
- From the Katharine Dormandy Haemophilia and Thrombosis Centre (P.C., M.P., A.R., M.R.P., E.T., A.N.), Health Services Laboratory, Sonic Healthcare (A.R.), and the Department of Hepatology and Liver Transplantation (D.W.P.), Royal Free Hospital, University College London (P.C., M.P., M.Q., A.N.), Guy's and St. Thomas' Hospital (G.D.), and Wstats (M.W.), London, Oxford University Hospitals Foundation Trust, Oxford NIHR Biomedical Research Centre, and Oxford University, Oxford (S.S.), the University of Sheffield, Sheffield (M.M.), East Kent Hospitals NHS University Foundation Trust, Canterbury (G.E.), University Hospital Southampton, Southampton (S.B.), Newcastle upon Tyne Hospitals NHS Trust, Newcastle (K.T.), and Freeline Therapeutics, Stevenage (A.D., A.N.) - all in the United Kingdom; St. Jude Children's Research Hospital, Memphis, TN (U.R.); and Freeline Therapeutics, New York (A.L.)
| | - Maria R Peralta
- From the Katharine Dormandy Haemophilia and Thrombosis Centre (P.C., M.P., A.R., M.R.P., E.T., A.N.), Health Services Laboratory, Sonic Healthcare (A.R.), and the Department of Hepatology and Liver Transplantation (D.W.P.), Royal Free Hospital, University College London (P.C., M.P., M.Q., A.N.), Guy's and St. Thomas' Hospital (G.D.), and Wstats (M.W.), London, Oxford University Hospitals Foundation Trust, Oxford NIHR Biomedical Research Centre, and Oxford University, Oxford (S.S.), the University of Sheffield, Sheffield (M.M.), East Kent Hospitals NHS University Foundation Trust, Canterbury (G.E.), University Hospital Southampton, Southampton (S.B.), Newcastle upon Tyne Hospitals NHS Trust, Newcastle (K.T.), and Freeline Therapeutics, Stevenage (A.D., A.N.) - all in the United Kingdom; St. Jude Children's Research Hospital, Memphis, TN (U.R.); and Freeline Therapeutics, New York (A.L.)
| | - Michelle Quaye
- From the Katharine Dormandy Haemophilia and Thrombosis Centre (P.C., M.P., A.R., M.R.P., E.T., A.N.), Health Services Laboratory, Sonic Healthcare (A.R.), and the Department of Hepatology and Liver Transplantation (D.W.P.), Royal Free Hospital, University College London (P.C., M.P., M.Q., A.N.), Guy's and St. Thomas' Hospital (G.D.), and Wstats (M.W.), London, Oxford University Hospitals Foundation Trust, Oxford NIHR Biomedical Research Centre, and Oxford University, Oxford (S.S.), the University of Sheffield, Sheffield (M.M.), East Kent Hospitals NHS University Foundation Trust, Canterbury (G.E.), University Hospital Southampton, Southampton (S.B.), Newcastle upon Tyne Hospitals NHS Trust, Newcastle (K.T.), and Freeline Therapeutics, Stevenage (A.D., A.N.) - all in the United Kingdom; St. Jude Children's Research Hospital, Memphis, TN (U.R.); and Freeline Therapeutics, New York (A.L.)
| | - David W Patch
- From the Katharine Dormandy Haemophilia and Thrombosis Centre (P.C., M.P., A.R., M.R.P., E.T., A.N.), Health Services Laboratory, Sonic Healthcare (A.R.), and the Department of Hepatology and Liver Transplantation (D.W.P.), Royal Free Hospital, University College London (P.C., M.P., M.Q., A.N.), Guy's and St. Thomas' Hospital (G.D.), and Wstats (M.W.), London, Oxford University Hospitals Foundation Trust, Oxford NIHR Biomedical Research Centre, and Oxford University, Oxford (S.S.), the University of Sheffield, Sheffield (M.M.), East Kent Hospitals NHS University Foundation Trust, Canterbury (G.E.), University Hospital Southampton, Southampton (S.B.), Newcastle upon Tyne Hospitals NHS Trust, Newcastle (K.T.), and Freeline Therapeutics, Stevenage (A.D., A.N.) - all in the United Kingdom; St. Jude Children's Research Hospital, Memphis, TN (U.R.); and Freeline Therapeutics, New York (A.L.)
| | - Edward Tuddenham
- From the Katharine Dormandy Haemophilia and Thrombosis Centre (P.C., M.P., A.R., M.R.P., E.T., A.N.), Health Services Laboratory, Sonic Healthcare (A.R.), and the Department of Hepatology and Liver Transplantation (D.W.P.), Royal Free Hospital, University College London (P.C., M.P., M.Q., A.N.), Guy's and St. Thomas' Hospital (G.D.), and Wstats (M.W.), London, Oxford University Hospitals Foundation Trust, Oxford NIHR Biomedical Research Centre, and Oxford University, Oxford (S.S.), the University of Sheffield, Sheffield (M.M.), East Kent Hospitals NHS University Foundation Trust, Canterbury (G.E.), University Hospital Southampton, Southampton (S.B.), Newcastle upon Tyne Hospitals NHS Trust, Newcastle (K.T.), and Freeline Therapeutics, Stevenage (A.D., A.N.) - all in the United Kingdom; St. Jude Children's Research Hospital, Memphis, TN (U.R.); and Freeline Therapeutics, New York (A.L.)
| | - Allison Dane
- From the Katharine Dormandy Haemophilia and Thrombosis Centre (P.C., M.P., A.R., M.R.P., E.T., A.N.), Health Services Laboratory, Sonic Healthcare (A.R.), and the Department of Hepatology and Liver Transplantation (D.W.P.), Royal Free Hospital, University College London (P.C., M.P., M.Q., A.N.), Guy's and St. Thomas' Hospital (G.D.), and Wstats (M.W.), London, Oxford University Hospitals Foundation Trust, Oxford NIHR Biomedical Research Centre, and Oxford University, Oxford (S.S.), the University of Sheffield, Sheffield (M.M.), East Kent Hospitals NHS University Foundation Trust, Canterbury (G.E.), University Hospital Southampton, Southampton (S.B.), Newcastle upon Tyne Hospitals NHS Trust, Newcastle (K.T.), and Freeline Therapeutics, Stevenage (A.D., A.N.) - all in the United Kingdom; St. Jude Children's Research Hospital, Memphis, TN (U.R.); and Freeline Therapeutics, New York (A.L.)
| | - Marie Watissée
- From the Katharine Dormandy Haemophilia and Thrombosis Centre (P.C., M.P., A.R., M.R.P., E.T., A.N.), Health Services Laboratory, Sonic Healthcare (A.R.), and the Department of Hepatology and Liver Transplantation (D.W.P.), Royal Free Hospital, University College London (P.C., M.P., M.Q., A.N.), Guy's and St. Thomas' Hospital (G.D.), and Wstats (M.W.), London, Oxford University Hospitals Foundation Trust, Oxford NIHR Biomedical Research Centre, and Oxford University, Oxford (S.S.), the University of Sheffield, Sheffield (M.M.), East Kent Hospitals NHS University Foundation Trust, Canterbury (G.E.), University Hospital Southampton, Southampton (S.B.), Newcastle upon Tyne Hospitals NHS Trust, Newcastle (K.T.), and Freeline Therapeutics, Stevenage (A.D., A.N.) - all in the United Kingdom; St. Jude Children's Research Hospital, Memphis, TN (U.R.); and Freeline Therapeutics, New York (A.L.)
| | - Alison Long
- From the Katharine Dormandy Haemophilia and Thrombosis Centre (P.C., M.P., A.R., M.R.P., E.T., A.N.), Health Services Laboratory, Sonic Healthcare (A.R.), and the Department of Hepatology and Liver Transplantation (D.W.P.), Royal Free Hospital, University College London (P.C., M.P., M.Q., A.N.), Guy's and St. Thomas' Hospital (G.D.), and Wstats (M.W.), London, Oxford University Hospitals Foundation Trust, Oxford NIHR Biomedical Research Centre, and Oxford University, Oxford (S.S.), the University of Sheffield, Sheffield (M.M.), East Kent Hospitals NHS University Foundation Trust, Canterbury (G.E.), University Hospital Southampton, Southampton (S.B.), Newcastle upon Tyne Hospitals NHS Trust, Newcastle (K.T.), and Freeline Therapeutics, Stevenage (A.D., A.N.) - all in the United Kingdom; St. Jude Children's Research Hospital, Memphis, TN (U.R.); and Freeline Therapeutics, New York (A.L.)
| | - Amit Nathwani
- From the Katharine Dormandy Haemophilia and Thrombosis Centre (P.C., M.P., A.R., M.R.P., E.T., A.N.), Health Services Laboratory, Sonic Healthcare (A.R.), and the Department of Hepatology and Liver Transplantation (D.W.P.), Royal Free Hospital, University College London (P.C., M.P., M.Q., A.N.), Guy's and St. Thomas' Hospital (G.D.), and Wstats (M.W.), London, Oxford University Hospitals Foundation Trust, Oxford NIHR Biomedical Research Centre, and Oxford University, Oxford (S.S.), the University of Sheffield, Sheffield (M.M.), East Kent Hospitals NHS University Foundation Trust, Canterbury (G.E.), University Hospital Southampton, Southampton (S.B.), Newcastle upon Tyne Hospitals NHS Trust, Newcastle (K.T.), and Freeline Therapeutics, Stevenage (A.D., A.N.) - all in the United Kingdom; St. Jude Children's Research Hospital, Memphis, TN (U.R.); and Freeline Therapeutics, New York (A.L.)
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7
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Boyce S, James I, Rangarajan S, Curry N, Bagot C, Austin S, Laffan M, Mangles S, Chandrakumaran K, Mundy C. Seroprevalence to adeno‐associated virus type 6 in people with hemophilia B from a UK adult cohort. Res Pract Thromb Haemost 2022; 6:e12705. [PMID: 35677030 PMCID: PMC9166283 DOI: 10.1002/rth2.12705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 03/05/2022] [Accepted: 03/13/2022] [Indexed: 11/06/2022] Open
Abstract
Background Gene therapy shows promise as a potential “cure” for hemophilia A and B. Adeno‐associated virus (AAV) vectors are the leading platform to deliver modified genetic code of factor VIII or IX to the liver effecting endogenous production. Patient exposure to wild‐type AAV leads to the formation of neutralizing factors, which can prevent successful transduction. It is thus important to establish the seroprevalence of the AAV serotypes in people with hemophilia to aid prediction of successful gene transfer. The seroprevalence of AAV6 in UK people with hemophilia B is not yet reported. Objectives We studied the prevalence of anti‐AAV6 neutralizing factors in UK people with hemophilia B (n = 49). We collected data on people’s hepatitis C exposure and treatment with plasma‐derived factor IX (FIX) to identify if there was correlation with AAV6 exposure. Methods Serum samples and patient data were collected from 49 people with hemophilia B registered at UK hemophilia comprehensive care centers. The samples were tested for neutralizing factors to AAV6 using a cell‐based transduction inhibition assay. Results Thirty‐one percent of patients had serum neutralization against AAV6. There was no correlation between AAV6 seropositivity and previous treatment with plasma‐derived FIX products or hepatitis C exposure. Conclusion Based on limited data, there is no evidence of association between the presence of AAV6 neutralizing factors in people with hemophilia B and exposure to contaminated plasma derivatives. The frequency of AAV6 neutralizing factors in our hemophilia B cohort is similar to UK people with hemophilia A and non‐hemophilia populations.
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Affiliation(s)
- Sara Boyce
- Southampton Haemophilia Comprehensive Care Centre University Hospital Southampton NHS Foundation Trust Southampton UK
| | - Izabela James
- Southampton Haemophilia Comprehensive Care Centre University Hospital Southampton NHS Foundation Trust Southampton UK
| | | | - Nicola Curry
- Oxford Haemophilia and Thrombosis Centre Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - Catherine Bagot
- West of Scotland Haemophilia Centre Glasgow Royal Infirmary Glasgow UK
| | - Steven Austin
- St Georges Haemophilia Comprehensive Care Centre St George’s University Hospitals NHS Foundation Trust London UK
| | - Mike Laffan
- Centre for Haematology Imperial College London UK
| | - Sarah Mangles
- Hemophilia, Haemostasis and Thrombosis Centre Hampshire Hospitals NHS Foundation Trust Basingstoke UK
| | - Kandiah Chandrakumaran
- Peritoneal Malignancy Institute and Surgery Hampshire Hospitals NHS Foundation Trust Basingstoke UK
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8
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Sehgal T, Altohami M, Lafferty N, Desborough M, Boyce S, Kazmi R, Jenner M. Acquired Bernard-Soulier syndrome and hypodysfibrinogenaemia because of multiple myeloma. Blood Coagul Fibrinolysis 2022; 33:130-133. [PMID: 34799506 DOI: 10.1097/mbc.0000000000001104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We describe a case of a patient with multiple myeloma with initial presentation simulating a bleeding disorder. Detailed coagulation work-up showed hypodysfibrinogenaemia along with a platelet function defect consistent with acquired Bernard-Soulier syndrome (BSS). Multiple plasma exchanges led to significant improvement in his bleeding symptoms. To the best of our knowledge, this is the first described case of simultaneous presentation of hypodysfibrinogenaemia and BSS secondary to multiple myeloma.
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Affiliation(s)
- Tushar Sehgal
- Department of Clinical Hematology, University Hospital Southampton, NHS Foundation Trust, United Kingdom
- Department of Laboratory Medicine (Hematology), All India Institute of Medical Sciences, New Delhi, India
| | - Mohammed Altohami
- Department of Clinical Hematology, University Hospital Southampton, NHS Foundation Trust, United Kingdom
| | - Nicholas Lafferty
- Department of Clinical Hematology, University Hospital Southampton, NHS Foundation Trust, United Kingdom
| | - Michael Desborough
- Department of Clinical Hematology, Oxford University Hospitals, United Kingdom
| | - Sara Boyce
- Department of Clinical Hematology, University Hospital Southampton, NHS Foundation Trust, United Kingdom
| | - Rashid Kazmi
- Department of Clinical Hematology, University Hospital Southampton, NHS Foundation Trust, United Kingdom
| | - Matthew Jenner
- Department of Clinical Hematology, University Hospital Southampton, NHS Foundation Trust, United Kingdom
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9
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Williams H, Boyce S, Lim J, Patel M, Jacobs C, Muirhead R. Rectal Squamous Cell Carcinomas - Are They Really Rectal? Clin Oncol (R Coll Radiol) 2020; 32:343-344. [PMID: 31992487 DOI: 10.1016/j.clon.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/24/2019] [Accepted: 01/09/2020] [Indexed: 11/16/2022]
Affiliation(s)
- H Williams
- Department of Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - S Boyce
- Department of Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - J Lim
- Department of Surgery, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - M Patel
- Department of Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - C Jacobs
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R Muirhead
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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10
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Shah P, Mahr C, Rogers J, Kiernan M, Boyce S, Mokadam N, Pagani F, Vassiliades T, Teuteberg J. Impact of Stroke Onset Severity on 2-Year Survival in Destination Therapy Patients Supported by Centrifugal Flow versus Axial Flow Ventricular Assist Devices. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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11
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Desai M, Peer S, Oliveri L, Mass P, Opfermann J, Boyce S, Jonas R, Sinha P. Continuous Flow Ventricular Assist Device Implantation in Non Dilated Cardiomyopathy Pediatric Patients Using Complimentary 3D Techniques. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1221] [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: 11/16/2022] Open
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12
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Dwight M, Bullock T, Dowling K, Ricks J, Jenner M, Boyce S, Narayanan S, Latham T. Haemolytic transfusion reaction in a Gy(a-) patient with anti-Gya
: a case report. Transfus Med 2019; 29:211-213. [DOI: 10.1111/tme.12583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/16/2019] [Accepted: 01/27/2019] [Indexed: 11/28/2022]
Affiliation(s)
- M. Dwight
- Red Cell Immunohaematology; NHSBT - Filton Centre; Bristol UK
| | - T. Bullock
- Red Cell Immunohaematology; NHSBT - Filton Centre; Bristol UK
| | - K. Dowling
- University Hospitals Southampton; NHS Foundation Trust; Southampton UK
| | - J. Ricks
- University Hospitals Southampton; NHS Foundation Trust; Southampton UK
| | - M. Jenner
- University Hospitals Southampton; NHS Foundation Trust; Southampton UK
| | - S. Boyce
- University Hospitals Southampton; NHS Foundation Trust; Southampton UK
| | - S. Narayanan
- University Hospitals Southampton; NHS Foundation Trust; Southampton UK
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13
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Cornwall H, Edwards B, Curran J, Boyce S. #22 Postoperative coffee consumption for accelerated resolution of ileus following abdominal surgery: a systematic review and meta-analysis of randomised controlled trials (poster presentation). Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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14
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Affiliation(s)
- Sara Boyce
- Department of Haematology, University Hospital Southampton, Southampton, United Kingdom
| | - Efrem Eren
- Department of Immunology, University Hospital Southampton, Southampton, United Kingdom
| | - Bashir Lwaleed
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Rashid Kazmi
- Department of Haematology, University Hospital Southampton, Southampton, United Kingdom
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Abstract
Forming an interface with virtually every other organ, endothelium has a strategic role in modulating vascular homeostasis. While its miscellany of functions includes regulation of vasomotor tone, promotion, and prevention of vascular growth, and modulation of inflammatory and hemostatic processes, it functions critically in maintaining the balance of hemostasis in health. Whereas endothelium has been recognized to influence all stages of hemostasis, new evidence suggests it to have a primary role for thrombin generation. Endothelial dysfunction is being increasingly appreciated in several pathological states and particularly, by virtue of its critical role in hemostasis, in causing thrombosis in a multitude of diseases.
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Affiliation(s)
- Rashid S Kazmi
- Departmental of Haematology, University Hospital Southampton, Southampton, United Kingdom
| | - Sara Boyce
- Departmental of Haematology, University Hospital Southampton, Southampton, United Kingdom
| | - Bashir A Lwaleed
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
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16
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Sewell L, Mitchell-Issitt C, Barley K, Chebbout C, Msimanga S, Clinch L, Boyce S, Steiner M, Singh S. P156 Can Specialist Nurses Predict Which Patients Will Readmit Following Delivery Of A Copd Care Bundle? Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.285] [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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17
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Sewell L, Mitchell-Issitt C, Barley K, Chebbout C, Msimanga S, Clinch L, Boyce S, Steiner M, Singh S. S84 Is There A Relationship Between Acceptance Of Referral To Smoking Cessation Services Or Pulmonary Rehabilitation And Readmission Rates For Patients With Copd? Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.90] [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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18
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Sewell L, Cheung M, Mitchell-Issitt C, Barley K, Chebbout C, Msimanga S, Boyce S, Steiner MC, Singh SJ. S70 Implementing a COPD discharge bundle on a large scale. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.77] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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19
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Boyce S, Barrington C, Bolanos JH, Arandi CG, Paz-Bailey G. P5-S6.17 Facilitating access to sexual health services for men who have sex with men (MSM) and transgender persons in Guatemala city. Sex Transm Infect 2011. [DOI: 10.1136/sextrans-2011-050108.573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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20
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Miller W, Alvarez B, Boyce S, Alvarado A, Barrington C, Paz-Bailey G. P1-S2.23 Transgender persons in Guatemala - over-exposed and under-protected - the findings of an RDS behavioural survey. Sex Transm Infect 2011. [DOI: 10.1136/sextrans-2011-050108.80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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21
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Farach N, Boyce S, Barrington C, Galindo C, Paz-Bailey G. P2-S6.04 Needs assessment on STI prevention services among men who have sex with men with HIV in Guatemala City, 2010. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.356] [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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22
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Miller RE, Boyce S, Whelan JS. Mobile phone use within an oncology department. Clin Oncol (R Coll Radiol) 2009; 22:86-7. [PMID: 20015623 DOI: 10.1016/j.clon.2009.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 11/04/2009] [Indexed: 11/16/2022]
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23
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Morris L, Supp D, Ripberger M, Klingenberg J, Maldonado A, Parvadia J, Boyce S, Lim F, Crombleholme T. 78. The Role of the Stromal Cell-Derived Factor-1 Alpha (SDF-1A)/Chemokine Receptor 4 (CXCR4) Axis in a Novel Model of De Novo Neovascularization. J Surg Res 2009. [DOI: 10.1016/j.jss.2008.11.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Vicanová J, Ponec M, Weerheim A, Swope V, Westbrook M, Harriger D, Boyce S. Epidermal lipid metabolism of cultured skin substitutes during healing of full-thickness wounds in athymic mice. Wound Repair Regen 2007; 5:329-38. [PMID: 16984443 DOI: 10.1046/j.1524-475x.1997.50407.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cultured epidermal keratinocytes provide an abundant supply of biologic material for wound treatment. Because restoration of barrier function is a definitive criterion for efficacy of wound closure and depends on the lipids present in the epidermis, we analyzed lipid composition of the epidermis in cultured skin substitutes in vitro and after grafting to athymic mice. The cultured skin substitutes were prepared from human keratinocytes and fibroblasts attached to collagen-glycosaminoglycan substrates. After 14 days of incubation, cultured skin substitutes were grafted orthotopically onto full-thickness wounds in athymic mice. Samples for lipid analysis were collected after 14 and 34 days of in vitro incubation, and 3 weeks and 4 months after grafting. Both in vitro samples show disproportions in epidermal lipid profile as compared with the native human epidermis, i.e., a low amount of phospholipids (indicating imbalance in proliferation and differentiation); a large excess of triglycerides (storage lipids); and low levels of free fatty acids, gluco-sphingolipids, cholesterol sulfate, and ceramides-suggesting abnormal composition of stratum corneum barrier lipids. Fatty acid analysis of cultured skin substitutes in vitro revealed insufficient uptake of linoleic acid, which resulted in increased synthesis of and substitution with monounsaturated fatty acids, mainly oleic acid. These abnormalities were partially corrected by 3 weeks after grafting; and 4 months after grafting, all epidermal lipids, with some minor exceptions, were synthesized in proportions very similar to human epidermis. Results of this study show that grafting of cultured skin substitutes to a physiologic host permits the recovery of lipid in proportion to that required for barrier formation in normal human epidermis.
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Affiliation(s)
- J Vicanová
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
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25
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Mincey B, Duh M, Thomas S, Moyneur E, Marynchencko M, Boyce S, Perez E. Risk of cancer treatment-related osteoporosis and fractures among women with breast cancer receiving aromatase inhibitors. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
557 Background: Aromatase inhibitors (AIs) are a novel hormonal therapy for breast cancer. However, AIs can cause bone loss by blocking estrogen production. This study aims to assess the association between AIs and treatment-related bone loss in a large managed care population of women with breast cancer. Methods: Using medical and pharmacy claims data from over 5 million beneficiaries between 01/01/1998 and 01/31/2005, we identified 12,368 patients with ≥ 2 breast cancer claims in a 6-month period, who also had no bone metastasis and no prior osteoporosis or fracture claims. Patients who received anti-estrogen therapy were also excluded to remove the protective confounding effects. 1,354 patients receiving an AI (anastrozole, exemestane, letrozole) were compared to 11,014 controls who did not receive an AI with respect to their risk of bone loss. The observation start date for the AI and control groups was defined as the service date of the first AI claim and breast cancer claim, respectively. The bone loss endpoints analyzed were osteoporosis (including osteopenia) and clinical fractures. Results: The univariate analysis found that the prevalence of osteoporosis was 8.7% in the AI group vs. 7.1% in the control group, resulting in a statistically significant relative risk of 1.3 (95% CI=1.1–1.6, p=0.01). The prevalence of bone fracture was also statistically significantly elevated in the AI group compared to the controls (13.5% vs. 10.3%) with a relative risk of 1.4 (95% CI=1.2–1.6, p=0.001). Multivariate Cox proportional hazards regressions showed that after adjusting for age and comorbidities, the risk of bone loss remained statistically significantly higher in the AI group than the non-AI group, with 27% (95% CI=4%-55%, p=0.02) and 21% (95% CI=3%-43%, p=0.02) increase in the risk of osteoporosis and fractures, respectively. Conclusions: This retrospective longitudinal analysis of a large cohort of breast cancer patients corroborates previous findings from smaller clinical trials and demonstrates that AI therapies carry an increased risk of bone loss. Monitoring and treatment management strategies to alleviate bone loss risk are warranted in women receiving AI for breast cancer. [Table: see text]
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Affiliation(s)
- B. Mincey
- First Coast Dematology and Internal Medicine, Jacksonville, FL; Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Mayo Clinic, Jacksonville, FL
| | - M. Duh
- First Coast Dematology and Internal Medicine, Jacksonville, FL; Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Mayo Clinic, Jacksonville, FL
| | - S. Thomas
- First Coast Dematology and Internal Medicine, Jacksonville, FL; Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Mayo Clinic, Jacksonville, FL
| | - E. Moyneur
- First Coast Dematology and Internal Medicine, Jacksonville, FL; Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Mayo Clinic, Jacksonville, FL
| | - M. Marynchencko
- First Coast Dematology and Internal Medicine, Jacksonville, FL; Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Mayo Clinic, Jacksonville, FL
| | - S. Boyce
- First Coast Dematology and Internal Medicine, Jacksonville, FL; Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Mayo Clinic, Jacksonville, FL
| | - E. Perez
- First Coast Dematology and Internal Medicine, Jacksonville, FL; Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Mayo Clinic, Jacksonville, FL
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Abstract
Leg ulcerations can occur in systemic lupus erythematosus (SLE) patients with antiphospholipid (aPL) antibodies and/or vasculitis, and it has been suggested that aPL antibodies may play a pathogenetic role in skin manifestations of SLE. To our knowledge, there is only one report of an aPL antibody-negative patient who developed pyoderma gangrenosum (PG) several years before the diagnosis of SLE. We describe a case of a young male affected by SLE who developed leg ulcers diagnosed as PG in the absence of aPL antibodies, where the onset of PG was associated with reactivation of SLE. Effective treatment led to significant improvement in skin lesions and SLE activity.
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Affiliation(s)
- Venkat Reddy
- Arthritis Centre, Northwick Park Hospital, Watford Road, London HA1 3UJ, UK,
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27
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Dziadzio M, Hamdulay S, Reddy V, Boyce S, Keat A, Andrews J. A still image of a transient rash captured by a mobile phone. Clin Rheumatol 2006; 26:979-80. [PMID: 16586047 DOI: 10.1007/s10067-006-0221-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Revised: 01/19/2006] [Accepted: 01/19/2006] [Indexed: 11/30/2022]
Abstract
The diagnosis of adult onset Still's disease (AOSD) can be difficult as the differential diagnosis is broad, it is based on clinical criteria and the signs, for example rash, can be transient. Clinical photography has an obvious role, and with modern technology, is now in the hands of physicians. We report a case of AOSD where an image of a transient rash taken with a camera phone allowed the diagnosis to be established. Further, we discuss the controversies around hospital bans on mobile phones (due to potential incompatibility with medical devices) and the reality of their widespread use. We conclude that, providing safeguards of consent and data storage are in place, the camera phone is a useful tool in rheumatology practice.
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Affiliation(s)
- Magdalena Dziadzio
- Arthritis Centre, Northwick Park Hospital, Watford Road, Harrow, London, HA1 3UJ, UK.
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28
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Rupniak NMJ, Fisher A, Boyce S, Clarke D, Pike A, O'Connor D, Watt A. P-Glycoprotein efflux reduces the brain concentration of the substance P (NK1 receptor) antagonists SR140333 and GR205171: a comparative study using mdr1a-/- and mdr1a+/+ mice. Behav Pharmacol 2004; 14:457-63. [PMID: 14501258 DOI: 10.1097/01.fbp.0000087734.21047.ae] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Investigation of the antidepressant-like actions of substance P (NK1 receptor) antagonists has been hindered by the few available compounds that bind with high affinity to the rat and mouse NK1 receptor, as these are the most commonly used preclinical species. The best available compounds for such studies are SR140333 and GR205171. However, SR140333 does not penetrate the central nervous system (CNS) after systemic administration, and GR205171 is active only at high doses, where unspecific pharmacological effects occur, so that changes in behaviour cannot be attributed to selective NK1 receptor blockade. These compounds may be substrates for P-glycoprotein (P-gp) and hence are actively excluded from the brain. The present studies used mdr1a-/- mice, a spontaneously occurring mutant that is deficient in P-gp, to examine the CNS penetration of SR140333 and GR205171. Following systemic administration of SR140333 and GR205171 (0.01-10 mg/kg i.v.), considerably higher drug concentrations were achieved in the brains of mdr1a-/- than in mdr1a+/+ mice, and this corresponded with a greater ability to inhibit NK1-agonist-induced behaviours in the mdr1a-/- mutants. Moreover, an NK1-receptor-specific inhibition of aggressive behaviour by GR205171 (10 mg/kg) could be demonstrated in mdr1a-/-, but not mdr1a+/+, mice. These findings suggest that P-gp deficient mice may have useful applications in behavioural pharmacology studies, especially when highly brain-penetrant compounds are not yet available.
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Affiliation(s)
- N M J Rupniak
- Department of Pharmacology, Merck Sharp and Dohme Research Laboratories, Neuroscience Research Centre, Harlow, Essex, UK.
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29
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Clark NC, Nagano N, Kuenzi FM, Jarolimek W, Huber I, Walter D, Wietzorrek G, Boyce S, Kullmann DM, Striessnig J, Seabrook GR. Neurological phenotype and synaptic function in mice lacking the CaV1.3 alpha subunit of neuronal L-type voltage-dependent Ca2+ channels. Neuroscience 2003; 120:435-42. [PMID: 12890513 DOI: 10.1016/s0306-4522(03)00329-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Neuronal L-type calcium channels have been implicated in pain perception and neuronal synaptic plasticity. To investigate this we have examined the effect of disrupting the gene encoding the CaV1.3 (alpha 1D) alpha subunit of L-type Ca2+ channels on neurological function, acute nociceptive behavior, and hippocampal synaptic function in mice. CaV1.3 alpha 1 subunit knockout (CaV1.3 alpha 1(-/-)) mice had relatively normal neurological function with the exception of reduced auditory evoked behavioral responses and lower body weight. Baseline thermal and mechanical thresholds were unaltered in these animals. CaV1.3 alpha 1(-/-) mice were also examined for differences in N-methyl-D-aspartate (NMDA) receptor-dependent (100 Hz tetanization for 1 s) and NMDA receptor-independent (200 Hz in 100 microM DL-2-amino-5-phosphopentanoic acid) long-term potentiation within the CA1 region of the hippocampus. Both NMDA receptor-dependent and NMDA receptor-independent forms of long-term potentiation were expressed normally. Radioligand binding studies revealed that the density of (+)[3H]isradipine binding sites in brain homogenates was reduced by 20-25% in CaV1.3 alpha 1(-/-) mice, without any detectable change in CaV1.2 (alpha 1C) protein levels as detected using Western blot analysis. Taken together these data indicate that following loss of CaV1.3 alpha 1 subunit expression there is sufficient residual activity of other Ca2+ channel subtypes to support NMDA receptor-independent long-term potentiation and some forms of sensory behavior/function.
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Affiliation(s)
- N C Clark
- The Neuroscience Research Centre, Merck Sharp and Dohme Research Laboratories, Terlings Park, Eastwick Road, Harlow, Essex CM20 2QR, UK
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30
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Joshi D, Boyce S. Notes - Chemical Investigation of Roots of Corissa Congesta, Santapau. I. Isolation of Carissone and D-Glucoside of β-Sisterol. J Org Chem 2003. [DOI: 10.1021/jo01352a617] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
The ability of the substance P (NK(1) receptor) antagonist (SPA) L-760735 to inhibit conditioned fear was assessed in gerbils using a four plate apparatus. Animals that had been treated with diazepam (3 mg/kg) or L-760735 (3 mg/kg) 30 min before a 3 min conditioning session in the apparatus exhibited a release of plate crossings during the retest session approximately 3 h later. Plate crossings were also increased when animals received diazepam or L-760735 30 min before the retest session. In contrast, fluoxetine and venlafaxine (30 mg/kg) did not exhibit anxiolytic-like effects. During the retest session, gerbils drummed their hind feet on the floor; this behaviour was not observed spontaneously in gerbils that were naïve to the apparatus. Foot drumming was abolished by pretreatment with L-760735 or diazepam (3 mg/kg) but was markedly increased following administration of fluoxetine or venlafaxine (30 mg/kg). Foot drumming elicited by aversive conditioning alone or in combination with fluoxetine was abolished by administration of L-760735 and by amygdala lesions involving the basolateral and lateral nuclei, indicating that this behaviour is an alarm signal or fear response mediated via release of substance P in brain circuits involving the amygdala. The observations provide further evidence for an anxiolytic-like profile of SPAs in preclinical assays and demonstrate a clear difference between the actions of SPAs and established antidepressant drugs.
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Affiliation(s)
- N M J Rupniak
- Department of Pharmacology, Merck Sharp and Dohme Research Laboratories, Neuroscience Research Centre, Terlings Park, Harlow, Essex CM20 2QR, UK.
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Boyce S, Huang CC. Surgical Pearl: hemostat-assisted nail avulsion revisited. J Am Acad Dermatol 2001; 45:943-4. [PMID: 11712045 DOI: 10.1067/mjd.2001.118544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- S Boyce
- Department of Dermatology, University of Alabama at Birmingham, USA
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33
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Boyce S, Rupniak NM, Steventon MJ, Iversen SD. Differential effects of D1 and D2 agonists in MPTP-treated primates: functional implications for Parkinson's disease. 1990. Neurology 2001; 57:S27-33. [PMID: 11775597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
MESH Headings
- 1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine/adverse effects
- 1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine/history
- Animals
- Dopamine Agents/adverse effects
- Dopamine Agents/history
- Dopamine Agonists/history
- Dopamine Agonists/therapeutic use
- History, 20th Century
- Parkinson Disease/history
- Parkinson Disease, Secondary/chemically induced
- Receptors, Dopamine D1/agonists
- Receptors, Dopamine D1/history
- Receptors, Dopamine D2/agonists
- Receptors, Dopamine D2/history
- Saimiri
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34
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Klatte K, Chaitman BR, Theroux P, Gavard JA, Stocke K, Boyce S, Bartels C, Keller B, Jessel A. Increased mortality after coronary artery bypass graft surgery is associated with increased levels of postoperative creatine kinase-myocardial band isoenzyme release: results from the GUARDIAN trial. J Am Coll Cardiol 2001; 38:1070-7. [PMID: 11583884 DOI: 10.1016/s0735-1097(01)01481-4] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We sought to determine if elevated cardiac serum biomarkers after coronary artery bypass graft surgery (CABG) are associated with increased medium-term mortality and to identify patients that may benefit from better postoperative myocardial protection. BACKGROUND The relationship between the magnitude of cardiac serum protein elevation and subsequent mortality after CABG is not well defined, partly because of the lack of large, prospectively studied patient cohorts in whom postoperative elevations of cardiac serum markers have been correlated to medium- and long-term mortality. METHODS The GUARD during Ischemia Against Necrosis (GUARDIAN) study enrolled 2,918 patients assigned to the entry category of CABG and considered as high risk for myocardial necrosis. Creatine kinase-myocardial band (CK-MB) isoenzyme measurements were obtained at baseline and at 8, 12, 16 and 24 h after CABG. RESULTS The unadjusted six-month mortality rates were 3.4%, 5.8%, 7.8% and 20.2% for patients with a postoperative peak CK-MB ratio (peak CK-MB value/upper limits of normal [ULN] for laboratory test) of < 5, > or = 5 to <10, > or =10 to < 20 and > or =20 ULN, respectively (p < 0.0001). The relationship remained statistically significant after adjustment for ejection fraction, congestive heart failure, cerebrovascular disease, peripheral vascular disease, cardiac arrhythmias and the method of cardioplegia delivery. Receiver operating characteristic curve analysis revealed an area under the curve of 0.648 (p < 0.001); the optimal cut-point to predict six-month mortality ranged from 5 to 10 ULN. CONCLUSIONS Progressive elevation of the CK-MB ratio in clinically high-risk patients is associated with significant elevations of medium-term mortality after CABG. Strategies to afford myocardial protection both during CABG and in the postoperative phase may serve to improve the clinical outcome.
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Affiliation(s)
- K Klatte
- St. Louis University Health Sciences Center, St. Louis, Missouri 63110-0250, USA
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35
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36
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Boyce S, Smith D, Carlson E, Hewson L, Rigby M, O'Donnell R, Harrison T, Rupniak NM. Intra-amygdala injection of the substance P [NK(1) receptor] antagonist L-760735 inhibits neonatal vocalisations in guinea-pigs. Neuropharmacology 2001; 41:130-7. [PMID: 11445193 DOI: 10.1016/s0028-3908(01)00051-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The involvement of the basolateral amygdala in mediating the inhibition of neonatal vocalisation by substance P (NK(1) receptor) antagonists was examined. These studies determined whether the time course for separation-induced vocalisations in guinea-pig pups coincided with NK(1) receptor internalisation (a marker of substance P release) in the amygdala, and whether vocalisations could be blocked by focal injection of the NK(1) receptor antagonist L-760735 into this brain region. The peak period for neonatal vocalisations occurred 5-10 min following maternal separation. This coincided with the peak increase in the number of cells in the basolateral amygdala exhibiting NK(1) receptor endocytosis, consistent with the proposal that substance P is released in the amygdala as a result of isolation stress. Focal injection of L-760735 (15 nmol per side) but not L-770765 (an analogue of L-760735 which has low NK(1) receptor affinity) into the basolateral amygdala attenuated separation-induced vocalisations. In contrast, injection of L-760735 (15 nmol per side) into the dorsal ventricular nucleus of the thalamus, a region with relatively low density of NK(1) receptors, had no effect on neonatal vocalisations. These findings are consistent with other evidence that the amygdala is one possible site of action for the inhibition of neonatal vocalisations by substance P antagonists.
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Affiliation(s)
- S Boyce
- Merck, Sharp and Dohme Research Laboratories, Neuroscience Research Centre, Terlings Park, Eastwick Road, Harlow, Essex CM20 2QR, UK
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37
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Abstract
The mortality associated with acute respiratory distress syndrome (ARDS) remains high. It has been suggested that use of the prone position may improve survival. However, approaches to the use of the position are often haphazard. The development of clinical guidelines indicating the need for the prone position in ARDS and the process by which the manoeuvre may be performed were thought to be important for two reasons. Primarily, we sought to improve oxygenation through the use of the prone position whilst promoting patient safety. Secondly, we wished to standardize our approach to the use of the prone position and make recommendations for practice so that its use was no longer seen as a last resort in the management of ARDS. The process associated with the development of clinical guidelines is first described. This is followed by presentation of the clinical guidelines. Included in these are the criteria and discussion which indicate consideration of the prone position, potential exclusion criteria, pre-turn considerations, the turning technique, monitoring the effectiveness of the prone position, passive movements and limb positioning and, finally, documentation of the problems associated with use of the prone position. The paper concludes with discussion concerning the potential for future research in this area.
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Affiliation(s)
- C Ball
- St Bartholomew's School of Nursing and Midwifery, City University, London, UK.
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38
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Riendeau D, Percival MD, Brideau C, Charleson S, Dubé D, Ethier D, Falgueyret JP, Friesen RW, Gordon R, Greig G, Guay J, Mancini J, Ouellet M, Wong E, Xu L, Boyce S, Visco D, Girard Y, Prasit P, Zamboni R, Rodger IW, Gresser M, Ford-Hutchinson AW, Young RN, Chan CC. Etoricoxib (MK-0663): preclinical profile and comparison with other agents that selectively inhibit cyclooxygenase-2. J Pharmacol Exp Ther 2001; 296:558-66. [PMID: 11160644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
We report here the preclinical profile of etoricoxib (MK-0663) [5-chloro-2-(6-methylpyridin-3-yl)-3-(4-methylsulfonylphenyl) pyridine], a novel orally active agent that selectively inhibits cyclooxygenase-2 (COX-2), that has been developed for high selectivity in vitro using whole blood assays and sensitive COX-1 enzyme assays at low substrate concentration. Etoricoxib selectively inhibited COX-2 in human whole blood assays in vitro, with an IC(50) value of 1.1 +/- 0.1 microM for COX-2 (LPS-induced prostaglandin E2 synthesis), compared with an IC(50) value of 116 +/- 8 microM for COX-1 (serum thromboxane B2 generation after clotting of the blood). Using the ratio of IC(50) values (COX-1/COX-2), the selectivity ratio for the inhibition of COX-2 by etoricoxib in the human whole blood assay was 106, compared with values of 35, 30, 7.6, 7.3, 2.4, and 2.0 for rofecoxib, valdecoxib, celecoxib, nimesulide, etodolac, and meloxicam, respectively. Etoricoxib did not inhibit platelet or human recombinant COX-1 under most assay conditions (IC(50) > 100 microM). In a highly sensitive assay for COX-1 with U937 microsomes where the arachidonic acid concentration was lowered to 0.1 microM, IC(50) values of 12, 2, 0.25, and 0.05 microM were obtained for etoricoxib, rofecoxib, valdecoxib, and celecoxib, respectively. These differences in potency were in agreement with the dissociation constants (K(i)) for binding to COX-1 as estimated from an assay based on the ability of the compounds to delay the time-dependent inhibition by indomethacin. Etoricoxib was a potent inhibitor in models of carrageenan-induced paw edema (ID(50) = 0.64 mg/kg), carrageenan-induced paw hyperalgesia (ID(50) = 0.34 mg/kg), LPS-induced pyresis (ID(50) = 0.88 mg/kg), and adjuvant-induced arthritis (ID(50) = 0.6 mg/kg/day) in rats, without effects on gastrointestinal permeability up to a dose of 200 mg/kg/day for 10 days. In squirrel monkeys, etoricoxib reversed LPS-induced pyresis by 81% within 2 h of administration at a dose of 3 mg/kg and showed no effect in a fecal 51Cr excretion model of gastropathy at 100 mg/kg/day for 5 days, in contrast to lower doses of diclofenac or naproxen. In summary, etoricoxib represents a novel agent that selectively inhibits COX-2 with 106-fold selectivity in human whole blood assays in vitro and with the lowest potency of inhibition of COX-1 compared with other reported selective agents.
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Affiliation(s)
- D Riendeau
- Department of Pharmacology, Biochemistry, and Molecular Biology, Merck Frosst Centre for Therapeutic Research, Kirkland, Quebec, Canada.
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Souslova V, Cesare P, Ding Y, Akopian AN, Stanfa L, Suzuki R, Carpenter K, Dickenson A, Boyce S, Hill R, Nebenuis-Oosthuizen D, Smith AJ, Kidd EJ, Wood JN. Warm-coding deficits and aberrant inflammatory pain in mice lacking P2X3 receptors. Nature 2000; 407:1015-7. [PMID: 11069182 DOI: 10.1038/35039526] [Citation(s) in RCA: 355] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ATP activates damage-sensing neurons (nociceptors) and can evoke a sensation of pain. The ATP receptor P2X3 is selectively expressed by nociceptors and is one of seven ATP-gated, cation-selective ion channels. Here we demonstrate that ablation of the P2X3 gene results in the loss of rapidly desensitizing ATP-gated cation currents in dorsal root ganglion neurons, and that the responses of nodose ganglion neurons to ATP show altered kinetics and pharmacology resulting from the loss of expression of P2X(2/3) heteromultimers. Null mutants have normal sensorimotor function. Behavioural responses to noxious mechanical and thermal stimuli are also normal, although formalin-induced pain behaviour is reduced. In contrast, deletion of the P2X3 receptor causes enhanced thermal hyperalgesia in chronic inflammation. Notably, although dorsal-horn neuronal responses to mechanical and noxious heat application are normal, P2X3-null mice are unable to code the intensity of non-noxious 'warming' stimuli.
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Affiliation(s)
- V Souslova
- Department of Biology, University College London, UK
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40
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41
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Abstract
The present study directly compared the antinociceptive and toxic effects of the neuronal nicotinic receptor agonist ABT-594 ((R)-5-(2-azetidinylmethoxy)-2-chloropyridine) with (-)-nicotine and (+)-epibatidine. Like (-)-nicotine (0.8 and 1.6 mg/kg s.c.) and (+)-epibatidine (0.005 and 0.01 mg/kg s.c.), ABT-594 (0.05 and 0.1 mg/kg s.c.) increased response latencies in the hot-plate test in rats, indicating that it has antinociceptive activity. In contrast to (-)-nicotine and (+)-epibatidine, ABT-594 did not cause rotarod impairment at antinociceptive doses but did cause hypothermia and life-threatening adverse effects including seizures. ABT-594 (0.01 and 0.1 mg/kg i.v.) also produced a dose-dependent increase in blood pressure resembling that observed with (-)-nicotine (0.03, 0.1 and 0. 03 mg/kg i.v.) and (+)-epibatidine (0.001 and 0.003 mg/kg i.v.). Both the antinociceptive and toxic effects (convulsions and hypertension) were abolished by pretreatment with the brain penetrant neuronal nAChR antagonist mecamylamine (1 mg/kg s.c.; i.v. for cardiovascular studies), demonstrating that these actions of ABT-594 were mediated via activation of neuronal nicotinic receptors. Continuous infusion of ABT-594 (0.2 mg/kg per day s.c.) to rats for 7 days followed by challenge with mecamylamine (1 mg/kg i.p.) induced a nicotine-like abstinence syndrome suggesting that ABT-594 has nicotine-like dependence liability. These findings indicate that the acute safety profile of ABT-594 is not significantly improved over other nicotinic analgesics.
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Affiliation(s)
- S Boyce
- Merck Sharp and Dohme Research Laboratories, Neuroscience Research Centre, Terlings Park, Eastwick Road, Harlow, Essex CM20 2QR, UK
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Gunton JE, McElduff A, Sulway M, Stiel J, Kelso I, Boyce S, Fulcher G, Robinson B, Clifton-Bligh P, Wilmshurst E. Outcome of pregnancies complicated by pre-gestational diabetes mellitus. Aust N Z J Obstet Gynaecol 2000; 40:38-43. [PMID: 10870777 DOI: 10.1111/j.1479-828x.2000.tb03164.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pregestational diabetes mellitus (DM) is associated with adverse fetal and maternal outcomes. Studies suggest that optimal control of diabetes before and during pregnancy minimises these risks. There are few recent reviews of outcomes of pregnancies complicated by DM in Australia. Ninety-three pregnancies in women with DM at our hospital since 1989 were identified. We collected data for maternal age, type of diabetes, duration of therapy, complications of diabetes, maternal complications of pregnancy and fetal outcomes including malformations. The rate of pregnancy planning with optimal glycaemic control at conception was low in our population, particularly in patients with Type 1 diabetes. Women who smoked had worse glycaemic control, and a higher rate of miscarriage. There was a high rate of Caesarean section, particularly in those women with Type 1 diabetes (77.4%). The rate of Caesarean section was lower in planned pregnancies. There were no perinatal deaths. The number of neonates with major congenital anomalies was high (13%) in the Type 1 population. It is important to increase the rates of prepregnancy planning and to optimise glycaemic control before pregnancy. In many cases there has been a long interval between diagnosis and pregnancy, so all women with diabetes should receive counselling at frequent intervals about pregnancy and the importance of planning. Women who planned their pregnancies had improved outcomes, with decreased rate of Caesarean section, better glycaemic control and better neonatal Apgar scores. Women with diabetes should not smoke during pregnancy because of the increased risk of miscarriage and poorer glycaemic control.
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Affiliation(s)
- J E Gunton
- Department of Endocrinology, Royal North Shore Hospital, Sydney, New South Wales
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43
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Abstract
Naming things is essential for people to understand one another, no matter what language or field of interest is involved. This is as true for enzymes, genes and chemicals as it is for birds, food, flowers, etc. Effective communication requires a lack of ambiguity, but, in practice, ambiguities abound even between people who use the same language in different parts of the world, or even within the same country. Whereas ambiguities in the words used for common objects or actions have been the basis for many, more-or-less memorable jokes, they can also cause a great deal of confusion. Such linguistic chaos is welcomed by many as being a part of a diverse heritage that should be preserved at all costs to prevent us from descending into Orwellian 'newspeak'. However, in the sciences, there are distinct advantages in others being able to understand what one is doing. Many groups have stressed the need for standardized, universally accepted systems of nomenclature in chemistry, genetics, enzymology, etc. However, it is the universal acceptance that usually causes the problem. It is rare to find people who will admit that they find nomenclature to be an interesting subject, but many who profess contempt for it will get very excited if it is suggested that their pet nomenclature should be changed in the interest of clarity or uniformity. This account will consider the development of the enzyme nomenclature system, its benefits, shortcomings and future prospects.
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Affiliation(s)
- K Tipton
- Department of Biochemistry, Trinity College, Dublin, Ireland.
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44
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Shepheard S, Edvinsson L, Cumberbatch M, Williamson D, Mason G, Webb J, Boyce S, Hill R, Hargreaves R. Possible antimigraine mechanisms of action of the 5HT1F receptor agonist LY334370. Cephalalgia 1999; 19:851-8. [PMID: 10668103 DOI: 10.1046/j.1468-2982.1999.1910851.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study investigated whether the selective 5HT1F receptor agonist LY334370 has other possible antimigraine mechanisms in addition to the proposed inhibition of dural plasma extravasation. LY334370 (up to 10(-5) M) had no vasoconstrictor effects on human cerebral arteries in vitro. It had no effect (up to 10 mg kg-1, i.v.) on neurogenic vasodilation of dural blood vessels produced by electrical stimulation of the dura mater in anesthetized rats. Nor had it any effect (at 3 mg kg-1, i.v.) on the hyperalgesia produced by injection of carrageenan into the paw of conscious rats or on nociceptive reflex responses in the spinalized, decerebrate rabbit (up to 3 mg kg-1, i.v.), indicating that it has no general analgesic properties. However, it significantly inhibited activation of second-order neurons in the trigeminal nucleus caudalis produced by electrical stimulation of the dura mater in anesthetised rats at 3 mg kg-1, i.v. These results provide evidence to suggest that LY334370 has a central mechanism of action in blocking the transmission of nociceptive impulses within the trigeminal nucleus caudalis and that this may represent a mechanism through which it has its antimigraine effect.
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Affiliation(s)
- S Shepheard
- Department of Pharmacology, Merck, Sharp and Dohme Neuroscience Research Laboratories, Harlow, Essex, UK.
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45
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Leblanc Y, Roy P, Boyce S, Brideau C, Chan CC, Charleson S, Gordon R, Grimm E, Guay J, Léger S, Li CS, Riendeau D, Visco D, Wang Z, Webb J, Xu LJ, Prasit P. SAR in the alkoxy lactone series: the discovery of DFP, a potent and orally active COX-2 inhibitor. Bioorg Med Chem Lett 1999; 9:2207-12. [PMID: 10465547 DOI: 10.1016/s0960-894x(99)00365-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Extensive SAR has been established in the alkoxy lactone series and this has lead to the discovery of DFP (5,5-dimethyl-3-(2-propoxy)-4-methanesulfonylphenyl)-2(5H)-furanon e), a potent COX-2 inhibitor exhibiting in vivo efficacy in all models studied.
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Affiliation(s)
- Y Leblanc
- Merck Frosst Centre for Therapeutic Research, Québec, Canada
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46
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Chan CC, Boyce S, Brideau C, Charleson S, Cromlish W, Ethier D, Evans J, Ford-Hutchinson AW, Forrest MJ, Gauthier JY, Gordon R, Gresser M, Guay J, Kargman S, Kennedy B, Leblanc Y, Leger S, Mancini J, O'Neill GP, Ouellet M, Patrick D, Percival MD, Perrier H, Prasit P, Rodger I. Rofecoxib [Vioxx, MK-0966; 4-(4'-methylsulfonylphenyl)-3-phenyl-2-(5H)-furanone]: a potent and orally active cyclooxygenase-2 inhibitor. Pharmacological and biochemical profiles. J Pharmacol Exp Ther 1999; 290:551-60. [PMID: 10411562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
The discoveries that cyclooxygenase (COX)-2 is an inducible form of COX involved in inflammation and that COX-1 is the major isoform responsible for the production of prostaglandins (PGs) in the gastrointestinal tract have provided a rationale for the development of specific COX-2 inhibitors as a new class of anti-inflammatory agents with improved gastrointestinal tolerability. In the present study, the preclinical pharmacological and biochemical profiles of rofecoxib [Vioxx, also known as MK-0966, 4-(4'-methylsulfonylphenyl)-3-phenyl-2-(5H)-furanone], an orally active COX-2 inhibitor, are described. Rofecoxib is a potent inhibitor of the COX-2-dependent production of PGE(2) in human osteosarcoma cells (IC(50) = 26 +/- 10 nM) and Chinese hamster ovary cells expressing human COX-2 (IC(50) = 18 +/- 7 nM) with a 1000-fold selectivity for the inhibition of COX-2 compared with the inhibition of COX-1 activity (IC(50) > 50 microM in U937 cells and IC(50) > 15 microM in Chinese hamster ovary cells expressing human COX-1). Rofecoxib is a time-dependent inhibitor of purified human recombinant COX-2 (IC(50) = 0.34 microM) but caused inhibition of purified human COX-1 in a non-time-dependent manner that could only be observed at a very low substrate concentration (IC(50) = 26 microM at 0.1 microM arachidonic acid concentration). In an in vitro human whole blood assay, rofecoxib selectively inhibited lipopolysaccharide-induced, COX-2-derived PGE(2) synthesis with an IC(50) value of 0.53 +/- 0.02 microM compared with an IC(50) value of 18.8 +/- 0.9 microM for the inhibition of COX-1-derived thromboxane B(2) synthesis after blood coagulation. Using the ratio of the COX-1 IC(50) values over the COX-2 IC(50) values in the human whole blood assay, selectivity ratios for the inhibition of COX-2 of 36, 6.6, 2, 3, and 0.4 were obtained for rofecoxib, celecoxib, meloxicam, diclofenac, and indomethacin, respectively. In several in vivo rodent models, rofecoxib is a potent inhibitor of carrageenan-induced paw edema (ID(50) = 1.5 mg/kg), carrageenan-induced paw hyperalgesia (ID(50) = 1.0 mg/kg), lipopolysaccharide-induced pyresis (ID(50) = 0.24 mg/kg), and adjuvant-induced arthritis (ID(50) = 0.74 mg/kg/day). Rofecoxib also has a protective effect on adjuvant-induced destruction of cartilage and bone structures in rats. In a (51)Cr excretion assay for detection of gastrointestinal integrity in either rats or squirrel monkeys, rofecoxib has no effect at doses up to 200 mg/kg/day for 5 days. Rofecoxib is a novel COX-2 inhibitor with a biochemical and pharmacological profile clearly distinct from that of current nonsteroidal anti-inflammatory drugs and represents a new therapeutic class of anti-inflammatory agents for the treatment of the symptoms of osteoarthritis and rheumatoid arthritis with improved gastrointestinal tolerability.
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Affiliation(s)
- C C Chan
- Departments of Pharmacology, Biochemistry and Molecular Biology, and Medicinal Chemistry, Merck Frosst Centre for Therapeutic Research, Kirkland, Quebec, Canada.
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47
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Affiliation(s)
- S Boyce
- University of Alabama at Birmingham, USA
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48
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Akopian AN, Souslova V, England S, Okuse K, Ogata N, Ure J, Smith A, Kerr BJ, McMahon SB, Boyce S, Hill R, Stanfa LC, Dickenson AH, Wood JN. The tetrodotoxin-resistant sodium channel SNS has a specialized function in pain pathways. Nat Neurosci 1999; 2:541-8. [PMID: 10448219 DOI: 10.1038/9195] [Citation(s) in RCA: 601] [Impact Index Per Article: 24.0] [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] [Indexed: 12/23/2022]
Abstract
Many damage-sensing neurons express tetrodotoxin (TTX)-resistant voltage-gated sodium channels. Here we examined the role of the sensory-neuron-specific (SNS) TTX-resistant sodium channel alpha subunit in nociception and pain by constructing sns-null mutant mice. These mice expressed only TTX-sensitive sodium currents on step depolarizations from normal resting potentials, showing that all slow TTX-resistant currents are encoded by the sns gene. Null mutants were viable, fertile and apparently normal, although lowered thresholds of electrical activation of C-fibers and increased current densities of TTX-sensitive channels demonstrated compensatory upregulation of TTX-sensitive currents in sensory neurons. Behavioral studies demonstrated a pronounced analgesia to noxious mechanical stimuli, small deficits in noxious thermoreception and delayed development of inflammatory hyperalgesia. These data show that SNS is involved in pain pathways and suggest that blockade of SNS expression or function may produce analgesia without side effects.
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Affiliation(s)
- A N Akopian
- Molecular Nociception Group, Department of Biology, Medawar Building, University College, London WC1E 6BT, UK
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49
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Boyce S, Wyatt A, Webb JK, O'Donnell R, Mason G, Rigby M, Sirinathsinghji D, Hill RG, Rupniak NM. Selective NMDA NR2B antagonists induce antinociception without motor dysfunction: correlation with restricted localisation of NR2B subunit in dorsal horn. Neuropharmacology 1999; 38:611-23. [PMID: 10340299 DOI: 10.1016/s0028-3908(98)00218-4] [Citation(s) in RCA: 265] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The present study investigated the regional distribution of the N-methyl-D-aspartate (NMDA) receptor containing the NR2B subunit protein in rat lumbar spinal cord and examined whether selective NR2B antagonists would exhibit antinociception with reduced side-effect liability than subtype non-selective NMDA antagonists and anticonvulsants. Immunocytochemical studies showed the NR2B subunit had a restricted distribution, with moderate labelling of fibres in laminas I and II of the dorsal horn suggesting a presynaptic location on primary afferent fibers and possible involvement in pain transmission. In the in vivo studies, the NMDA/glycine antagonists (MK-801, 0.02-1 mg/kg i.p., L-687,414 10-300 mg/kg i.p., and L-701,324 1-10 mg/kg i.p.) and the anticonvulsant, gabapentin (10-500 mg/kg p.o.), induced rotarod deficits at antinociceptive doses. In contrast, the selective NR2B antagonists, (+/-)-CP-101,606 (1-100 mg/kg p.o.) and (+/-)-Ro 25-6981 (3-100 mg/kg i.p.) showed a significant dose window. (+/-)-CP-101,606 caused no motor impairment or stimulation in rats at doses up to 100 mg/kg p.o., which is far in excess of those inhibiting allodynia in neuropathic rats (ID50 4.1 mg/kg, p.o.). (+/-)-Ro 25-6981 also showed a significant separation (ID50 allodynia 3.8 mg/kg, i.p.), however, some disruption of rotarod performance was observed at 100 mg/kg. The anticonvulsant lamotrigine (3-500 mg/kg p.o.) also showed a good dose window. These findings demonstrate that NR2B antagonists may have clinical utility for the treatment of neuropathic and other pain conditions in man with a reduced side-effect profile than existing NMDA antagonists.
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Affiliation(s)
- S Boyce
- Merck Sharp Laboratory, Neuroscience Research Centre, Harlow, UK.
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50
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Dawson GR, Seabrook GR, Zheng H, Smith DW, Graham S, O'Dowd G, Bowery BJ, Boyce S, Trumbauer ME, Chen HY, Van der Ploeg LH, Sirinathsinghji DJ. Age-related cognitive deficits, impaired long-term potentiation and reduction in synaptic marker density in mice lacking the beta-amyloid precursor protein. Neuroscience 1999; 90:1-13. [PMID: 10188929 DOI: 10.1016/s0306-4522(98)00410-2] [Citation(s) in RCA: 244] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Mutations in the beta-amyloid precursor protein are strongly associated with some cases of familial Alzheimer's disease. The normal physiological role of beta-amyloid precursor protein in the brain was evaluated in a cross-sectional analysis of mice deficient in beta-amyloid precursor protein. Compared with wild-type control mice the beta-amyloid precursor protein-null mice developed age-dependent deficits in cognitive function and also had impairments in long-term potentiation. In addition, the brains of the beta-amyloid precursor protein-null mice had marked reactive gliosis in many areas, especially in the cortex and hippocampus. A subpopulation of mice (n = 15) died prematurely (between three and 18 months of age). Analysis of another six mice from the same population that were showing weight loss and hypolocomotor activity exhibited a marked reactive gliosis as detected by immunoreactivity for glial fibrillary acidic protein and a profound loss of immunoreactivities for the presynaptic terminal vesicle marker proteins synaptophysin and synapsin and the dendritic marker microtubule-associated protein-2 in many brain areas, but most predominantly in the cortex and hippocampus. These results suggest that normal beta-amyloid precursor protein may serve an essential role in the maintenance of synaptic function during ageing. A compromise of this function of the beta-amyloid precursor protein may contribute to the progression of the memory decline and the neurodegenerative changes seen in Alzheimer's disease.
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Affiliation(s)
- G R Dawson
- Merck Sharp and Dohme Research Laboratories, Neuroscience Research Centre, Harlow, Essex, UK
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