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Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, Ettner R, Fraser L, Goodman M, Green J, Hancock AB, Johnson TW, Karasic DH, Knudson GA, Leibowitz SF, Meyer-Bahlburg HFL, Monstrey SJ, Motmans J, Nahata L, Nieder TO, Reisner SL, Richards C, Schechter LS, Tangpricha V, Tishelman AC, Van Trotsenburg MAA, Winter S, Ducheny K, Adams NJ, Adrián TM, Allen LR, Azul D, Bagga H, Başar K, Bathory DS, Belinky JJ, Berg DR, Berli JU, Bluebond-Langner RO, Bouman MB, Bowers ML, Brassard PJ, Byrne J, Capitán L, Cargill CJ, Carswell JM, Chang SC, Chelvakumar G, Corneil T, Dalke KB, De Cuypere G, de Vries E, Den Heijer M, Devor AH, Dhejne C, D'Marco A, Edmiston EK, Edwards-Leeper L, Ehrbar R, Ehrensaft D, Eisfeld J, Elaut E, Erickson-Schroth L, Feldman JL, Fisher AD, Garcia MM, Gijs L, Green SE, Hall BP, Hardy TLD, Irwig MS, Jacobs LA, Janssen AC, Johnson K, Klink DT, Kreukels BPC, Kuper LE, Kvach EJ, Malouf MA, Massey R, Mazur T, McLachlan C, Morrison SD, Mosser SW, Neira PM, Nygren U, Oates JM, Obedin-Maliver J, Pagkalos G, Patton J, Phanuphak N, Rachlin K, Reed T, Rider GN, Ristori J, Robbins-Cherry S, Roberts SA, Rodriguez-Wallberg KA, Rosenthal SM, Sabir K, Safer JD, Scheim AI, Seal LJ, Sehoole TJ, Spencer K, St Amand C, Steensma TD, Strang JF, Taylor GB, Tilleman K, T'Sjoen GG, Vala LN, Van Mello NM, Veale JF, Vencill JA, Vincent B, Wesp LM, West MA, Arcelus J. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Int J Transgend Health 2022; 23:S1-S259. [PMID: 36238954 PMCID: PMC9553112 DOI: 10.1080/26895269.2022.2100644] [Citation(s) in RCA: 455] [Impact Index Per Article: 227.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.
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Affiliation(s)
- E Coleman
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A E Radix
- Callen-Lorde Community Health Center, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - W P Bouman
- Nottingham Centre for Transgender Health, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - G R Brown
- James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
- James H. Quillen VAMC, Johnson City, TN, USA
| | - A L C de Vries
- Department of Child and Adolescent Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M B Deutsch
- Department of Family & Community Medicine, University of California-San Francisco, San Francisco, CA, USA
- UCSF Gender Affirming Health Program, San Francisco, CA, USA
| | - R Ettner
- New Health Foundation Worldwide, Evanston, IL, USA
- Weiss Memorial Hospital, Chicago, IL, USA
| | - L Fraser
- Independent Practice, San Francisco, CA, USA
| | - M Goodman
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - J Green
- Independent Scholar, Vancouver, WA, USA
| | - A B Hancock
- The George Washington University, Washington, DC, USA
| | - T W Johnson
- Department of Anthropology, California State University, Chico, CA, USA
| | - D H Karasic
- University of California San Francisco, San Francisco, CA, USA
- Independent Practice at dankarasic.com
| | - G A Knudson
- University of British Columbia, Vancouver, Canada
- Vancouver Coastal Health, Vancouver, Canada
| | - S F Leibowitz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - H F L Meyer-Bahlburg
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - J Motmans
- Transgender Infopunt, Ghent University Hospital, Gent, Belgium
- Centre for Research on Culture and Gender, Ghent University, Gent, Belgium
| | - L Nahata
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Endocrinology and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - T O Nieder
- University Medical Center Hamburg-Eppendorf, Interdisciplinary Transgender Health Care Center Hamburg, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Hamburg, Germany
| | - S L Reisner
- Harvard Medical School, Boston, MA, USA
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - C Richards
- Regents University London, UK
- Tavistock and Portman NHS Foundation Trust, London, UK
| | | | - V Tangpricha
- Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - A C Tishelman
- Boston College, Department of Psychology and Neuroscience, Chestnut Hill, MA, USA
| | - M A A Van Trotsenburg
- Bureau GenderPRO, Vienna, Austria
- University Hospital Lilienfeld-St. Pölten, St. Pölten, Austria
| | - S Winter
- School of Population Health, Curtin University, Perth, WA, Australia
| | - K Ducheny
- Howard Brown Health, Chicago, IL, USA
| | - N J Adams
- University of Toronto, Ontario Institute for Studies in Education, Toronto, Canada
- Transgender Professional Association for Transgender Health (TPATH)
| | - T M Adrián
- Asamblea Nacional de Venezuela, Caracas, Venezuela
- Diverlex Diversidad e Igualdad a Través de la Ley, Caracas, Venezuela
| | - L R Allen
- University of Nevada, Las Vegas, NV, USA
| | - D Azul
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - H Bagga
- Monash Health Gender Clinic, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - K Başar
- Department of Psychiatry, Hacettepe University, Ankara, Turkey
| | - D S Bathory
- Independent Practice at Bathory International PLLC, Winston-Salem, NC, USA
| | - J J Belinky
- Durand Hospital, Guemes Clinic and Urological Center, Buenos Aires, Argentina
| | - D R Berg
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J U Berli
- Oregon Health & Science University, Portland, OR, USA
| | - R O Bluebond-Langner
- NYU Langone Health, New York, NY, USA
- Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
| | - M-B Bouman
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Plastic Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - M L Bowers
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - P J Brassard
- GrS Montreal, Complexe CMC, Montreal, Quebec, Canada
- Université de Montreal, Quebec, Canada
| | - J Byrne
- University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - L Capitán
- The Facialteam Group, Marbella International Hospital, Marbella, Spain
| | | | - J M Carswell
- Harvard Medical School, Boston, MA, USA
- Boston's Children's Hospital, Boston, MA, USA
| | - S C Chang
- Independent Practice, Oakland, CA, USA
| | - G Chelvakumar
- Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University, College of Medicine, Columbus, OH, USA
| | - T Corneil
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - K B Dalke
- Penn State Health, PA, USA
- Penn State College of Medicine, Hershey, PA, USA
| | - G De Cuypere
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
| | - E de Vries
- Nelson Mandela University, Gqeberha, South Africa
- University of Cape Town, Cape Town, South Africa
| | - M Den Heijer
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Endocrinology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - A H Devor
- University of Victoria, Victoria, BC, Canada
| | - C Dhejne
- ANOVA, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - A D'Marco
- UCTRANS-United Caribbean Trans Network, Nassau, The Bahamas
- D M A R C O Organization, Nassau, The Bahamas
| | - E K Edmiston
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - L Edwards-Leeper
- Pacific University, Hillsboro, OR, USA
- Independent Practice, Beaverton, OR, USA
| | - R Ehrbar
- Whitman Walker Health, Washington, DC, USA
- Independent Practice, Maryland, USA
| | - D Ehrensaft
- University of California San Francisco, San Francisco, CA, USA
| | - J Eisfeld
- Transvisie, Utrecht, The Netherlands
| | - E Elaut
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Clinical Experimental and Health Psychology, Ghent University, Gent, Belgium
| | - L Erickson-Schroth
- The Jed Foundation, New York, NY, USA
- Hetrick-Martin Institute, New York, NY, USA
| | - J L Feldman
- Institute for Sexual and Gender Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A D Fisher
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | - M M Garcia
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Departments of Urology and Anatomy, University of California San Francisco, San Francisco, CA, USA
| | - L Gijs
- Institute of Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | | | - B P Hall
- Duke University Medical Center, Durham, NC, USA
- Duke Adult Gender Medicine Clinic, Durham, NC, USA
| | - T L D Hardy
- Alberta Health Services, Edmonton, Alberta, Canada
- MacEwan University, Edmonton, Alberta, Canada
| | - M S Irwig
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - A C Janssen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - K Johnson
- RMIT University, Melbourne, Australia
- University of Brighton, Brighton, UK
| | - D T Klink
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital, Gent, Belgium
- Division of Pediatric Endocrinology and Diabetes, ZNA Queen Paola Children's Hospital, Antwerp, Belgium
| | - B P C Kreukels
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - L E Kuper
- Department of Psychiatry, Southwestern Medical Center, University of Texas, Dallas, TX, USA
- Department of Endocrinology, Children's Health, Dallas, TX, USA
| | - E J Kvach
- Denver Health, Denver, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
| | - M A Malouf
- Malouf Counseling and Consulting, Baltimore, MD, USA
| | - R Massey
- WPATH Global Education Institute
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - T Mazur
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- John R. Oishei Children's Hospital, Buffalo, NY, USA
| | - C McLachlan
- Professional Association for Transgender Health, South Africa
- Gender DynamiX, Cape Town, South Africa
| | - S D Morrison
- Division of Plastic Surgery, Seattle Children's Hospital, Seattle, WA, USA
- Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - S W Mosser
- Gender Confirmation Center, San Francisco, CA, USA
- Saint Francis Memorial Hospital, San Francisco, CA, USA
| | - P M Neira
- Johns Hopkins Center for Transgender Health, Baltimore, MD, USA
- Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity, Baltimore, MD, USA
| | - U Nygren
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
| | - J M Oates
- La Trobe University, Melbourne, Australia
- Melbourne Voice Analysis Centre, East Melbourne, Australia
| | - J Obedin-Maliver
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford, CA, USA
| | - G Pagkalos
- Independent PracticeThessaloniki, Greece
- Military Community Mental Health Center, 424 General Military Training Hospital, Thessaloniki, Greece
| | - J Patton
- Talkspace, New York, NY, USA
- CytiPsychological LLC, San Diego, CA, USA
| | - N Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand
| | - K Rachlin
- Independent Practice, New York, NY, USA
| | - T Reed
- Gender Identity Research and Education Society, Leatherhead, UK
| | - G N Rider
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J Ristori
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | | | - S A Roberts
- Harvard Medical School, Boston, MA, USA
- Division of Endocrinology, Boston's Children's Hospital, Boston, MA, USA
| | - K A Rodriguez-Wallberg
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - S M Rosenthal
- Division of Pediatric Endocrinology, UCSF, San Francisco, CA, USA
- UCSF Child and Adolescent Gender Center
| | - K Sabir
- FtM Phoenix Group, Krasnodar Krai, Russia
| | - J D Safer
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Center for Transgender Medicine and Surgery, New York, NY, USA
| | - A I Scheim
- Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - L J Seal
- Tavistock and Portman NHS Foundation Trust, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - K Spencer
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - C St Amand
- University of Houston, Houston, TX, USA
- Mayo Clinic, Rochester, MN, USA
| | - T D Steensma
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - J F Strang
- Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
| | - G B Taylor
- Atrium Health Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Charlotte, NC, USA
| | - K Tilleman
- Department for Reproductive Medicine, Ghent University Hospital, Gent, Belgium
| | - G G T'Sjoen
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Endocrinology, Ghent University Hospital, Gent, Belgium
| | - L N Vala
- Independent Practice, Campbell, CA, USA
| | - N M Van Mello
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - J F Veale
- School of Psychology, University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - J A Vencill
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - B Vincent
- Trans Learning Partnership at https://spectra-london.org.uk/trans-learning-partnership, UK
| | - L M Wesp
- College of Nursing, University of Wisconsin MilwaukeeMilwaukee, WI, USA
- Health Connections Inc., Glendale, WI, USA
| | - M A West
- North Memorial Health Hospital, Robbinsdale, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | - J Arcelus
- School of Medicine, University of Nottingham, Nottingham, UK
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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Bruno VD, Sammut E, Gall A, Baz-Lopez D, Ascione R, Johnson TW. Quantitative evaluation of coronary artery occlusion by 3D coronary volume reconstruction in a large animal model of acute myocardial infarction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Large animal models of acute myocardial infarction (MI) offer an important platform to test novel therapies. Consistency of infarct size between animals is critical to ensure an accurate assessment of therapies against control. However, anatomical variation challenges the ability to achieve a consistent infarct size and care must be taken to respect the principles of the 3Rs through minimisation of interventional fatalities.
Purpose
To standardise the approach of a closed chest model of balloon occlusion-facilitated MI. Novel 3-dimensional quantitative coronary angiography (3DQCA) software has been used retrospectively to identify a correlation between coronary volume occlusion and the extension of the myocardial scar.
Methods
Twenty-four Yorkshire pigs (mean weight 63.1±3 kg) underwent a closed chest MI model via percutaneous occlusion of the mid portion of the left anterior descending artery (LAD) for 60 minutes. The evaluation of the myocardial damage was obtained via cardiac magnetic resonance imaging (CMR) between 24 and 48 hours after the MI model (Acute) and at 4–5 weeks after MI (Chronic). Troponin I was also measured at multiple timepoints. 3DQCA reconstruction (QAngio XA 3D, Medis medical imaging systems NL) was generated from 2 angiographic projections with segmental analysis of all 3 major epicardial vessels including lumen volume, reference diameters, and segment length. The occlusive volume and vessel length was identified through co-registration of balloon position.
Results
At the short term timepoint, a significant correlation was found between the LAD volume occluded and the scar size as percentage of the LV mass (Spearman correlation 0.72, p value <0.01, Fig. 1). Using Youden index analysis we identified a cut-off point of 32.8% of the LAD volume to determine a scar volume >20% (Fig. 2). At chronic phase the correlation between these two variables was not significant, although there was a trend towards significance (p value = 0.06, Cor = 0.54). No significant correlation was found with serum Troponin I.
Conclusions
There is a significant correlation between the LAD volume occluded and the overall scar size in the acute phase and at least 32.8% of the LAD volume should be occluded to determine a scar volume >20% of the entire LV. This indicates that a prospective measure of occluded LAD volume might minimise the intra-experimental variability in studies aiming to reduce infarct size and acute myocardial injury.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): This research work was supported by grants awarded to Professor Ascione: the British Heart Foundation (BHF) (BHF IG/14/2/30991, BHF RM/13/2/30158), and the Medical Research Council (MRC) (MRC MR/L012723/1).
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Affiliation(s)
- V D Bruno
- University of Bristol, Bristol, United Kingdom
| | - E Sammut
- University of Bristol, Bristol, United Kingdom
| | - A Gall
- Bristol Heart Institute, Bristol, United Kingdom
| | - D Baz-Lopez
- University of Bristol, Bristol, United Kingdom
| | - R Ascione
- University of Bristol, Bristol, United Kingdom
| | - T W Johnson
- University of Bristol, Bristol, United Kingdom
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Williams MGL, Liang K, De Garate E, Spagnoli L, Fiori E, Lawton CB, Dastidar A, Johnson TW, Biglino G, Bucciarelli-Ducci C. Diagnostic and prognostic role of peak troponin T in patients with acute coronary syndromes and non-obstructive coronary arteries. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Up to 10% of patients who present with an acute coronary syndrome have a myocardial infarction with non-obstructive coronary arteries (MINOCA). Troponin T predicts infarct size and outcomes in patients with ST-elevation myocardial infarction. The value of peak troponin T in patients with a working diagnosis of MINOCA is not well understood.
Purpose
The aim of this study is to investigate the diagnostic and prognostic role of troponin in patients with MINOCA.
Methods
Consecutive patients with a working diagnosis of MINOCA from a single tertiary centre who underwent comprehensive cardiovascular magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) were followed prospectively. Peak troponin T was identified during the index admission and divided into deciles and quartiles for analysis. The primary endpoint was all-cause mortality.
Results
Among 796 patients undergoing CMR, 719 met the study criteria and had underwent a diagnostic quality scan. The peak Troponin T threshold for optimal diagnostic sensitivity and specificity was 211 ng/L. Peak troponin T ≥211 ng/L and time to CMR of ≤14 days has a sensitivity of 94%, specificity of 35%, PPV 57% and NPV 94% for the CMR making a diagnosis. Each increase in troponin decile increases the mean diagnostic yield of the CMR by 3.65% (p<0.001, 95% CI 3.38 – 3.91; R2 0.84; Figure 1).
If the troponin is in the lowest decile and the CMR is performed at ≤14 days, the diagnostic yield is still 72%. There is no overall difference in median troponin in patients who died and those who survived (229 ng/l v. 424 ng/l; p=0.157), however mortality is significantly lower in the highest two troponin quartiles (6.9% versus 11.9%; p=0.009; Figure 2).
Conclusion
Peak troponin T is readily available during the index admission in patients presenting with MINOCA and provides useful diagnostic and prognostic information for the attending cardiologist.
Funding Acknowledgement
Type of funding sources: None. Figure 1. CMR diagnosis by troponin decileFigure 2. Mortality by troponin quartile
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Affiliation(s)
- M G L Williams
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - K Liang
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - E De Garate
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - L Spagnoli
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - E Fiori
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - C B Lawton
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - A Dastidar
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - T W Johnson
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - G Biglino
- University of Bristol, Bristol, United Kingdom
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Williams MGL, Dastidar A, Liang K, Johnson TW, Baritussio A, Strange JW, Joshi N, Dorman S, De Garate E, Spagnoli L, Fiori E, Lawton CB, Biglino G, Plein S, Bucciarelli-Ducci C. Sex and age differences in patients with acute coronary syndrome and non-obstructive coronary arteries: presentation and outcome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
A substantial number of patients present with acute coronary syndrome (ACS) and non-obstructive coronary arteries. Sex and age differences in these patients are not well understood. This study aims to evaluate the impact of sex and age on clinical presentation and outcome in patients with ACS and non-obstructive coronary arteries, with either an ischaemic or non-ischaemic cause.
Methods and results
Consecutive patients with an ACS and non-obstructive coronary arteries (n=719) from a single tertiary centre underwent comprehensive cardiovascular magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE). The primary endpoint was all-cause mortality. CMR was performed at a median time of 30 days after presentation and identified a diagnosis in 74% of patients. Patients with an ischaemic or non-ischaemic aetiology (n=529) on CMR were followed prospectively. All-cause mortality was 11% over a median follow up of 4.9 years, with no significant difference between sexes (11% versus 11% p=0.732). Women were more likely to have an ischaemic aetiology on CMR (40% v 31%, p=0.037). Age group (HR 1.48, p=0.002), log peak troponin (HR 0.78, p=0.033) and LVEF (HR 0.98, p=0.032) were independent predictors of mortality. Men aged >60 years with a non-ischaemic aetiology on their CMR were at higher risk of death than women >60 years (p=0.003).
Conclusions
There is no difference in all-cause mortality between sexes in patients presenting with ACS and non-obstructive coronary arteries but increasing age is an important predictor of mortality in both sexes.
Funding Acknowledgement
Type of funding sources: None. Sex differences in CMR diagnosisSex, age and mortality
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Affiliation(s)
- M G L Williams
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - A Dastidar
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - K Liang
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - T W Johnson
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - A Baritussio
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - J W Strange
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - N Joshi
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - S Dorman
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - E De Garate
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - L Spagnoli
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - E Fiori
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - C B Lawton
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - G Biglino
- University of Bristol, Bristol, United Kingdom
| | - S Plein
- University of Leeds, Department of Biomedical Imaging Science, Leeds, United Kingdom
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5
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Baz-Lopez D, Bruno VD, Johnson TW, Ascione R, Sammut E. Impaired transcriptional compensation for oxidative damage in a porcine model of ischaemic cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The prognosis of heart failure remains poor. Energetic imbalances related to mitochondrial dysfunction, impaired oxidative phosphorylation and oxidative damage have been implicated in the pathogenesis or worsening of heart failure (1,2). Improved understanding of the metabolic alterations in heart failure may provide new biomarkers or therapeutic targets.
Purpose
We explored mutation rate, mitochondrial copy number and regional mitochondrial gene transcription in a porcine model of ischaemic cardiomyopathy. Specifically, we investigated the Dloop region – a promotor for mitochondrial DNA- in which mutations have been implicated in many cancers. We hypothesised that there may be differences in mutation rate and oxidative damage within the mitochondrial genome.
Methods
15 female Yorkshire pigs were studied. 7 animals underwent percutaneous balloon catheter myocardial infarction followed by termination at 4 weeks. A group of 8 healthy animals served as controls. Reverse transcription quantitative PCR (RT-qPCR) assays were performed to determine the gene expression levels of mitochondrial DNA codified genes (ND1, ND2, ND4, ATP6 and ND6). Quantitative PCR (qPCR) methodology was modified to obtain the relative mitochondrial copy number, mutation rate, and oxidative damage according to established methods (3–5).
Results
Significant mitochondrial transcriptional activity of the genes studied was seen in both groups (see Table 1 and 2). When examining the ND2-ND6 region (excluding the Dloop) in control animals, we note an inverse correlation with increased oxidative damage corresponding to a significantly lower mutation rate (p=0.017). There was no correlation between the mutation rate and oxidative damage in the ND6-ND2- including Dloop- region. However, when examining the Dloop specifically, there was a marked inverse correlation between oxidative damage and mutation rate (p=0.007). This suggests that in controls, there is regional variation in the susceptibility to damage within the mitochondrial genome which may trigger repair mechanisms. Indeed, the relative mitochondrial copy number was inversely associated to the mutation rate (p=0.08) in controls.
In contrast, in the chronic animals, we noted no correlation with the level of oxidative damage in the ND2-ND6, D-loop, or ND6–2 regions compared to mutation rate (p=0.52, p=0.53 and p=0.17 respectively). This indicates that there is a loss in the ability to instigate repair mechanisms in the setting of ischaemic cardiomyopathy.
Conclusions
This study demonstrates that in control animals, there appears to be regional variation in the ability to mitigate against mutations in response to oxidative damage within the mitochondrial genome. In contrast, this protection and/or the effectiveness of repair mechanisms appear to be impaired in the setting of ischaemic cardiomyopathy. This may be a driver, and in turn a therapeutic target, for adverse remodelling in this setting.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): This research work was supported by grants awarded to Professor Ascione: the British Heart Foundation (BHF) (BHF IG/14/2/30991, BHF RM/13/2/30158), and the Medical Research Council (MRC) (MRC MR/L012723/1).
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Affiliation(s)
- D Baz-Lopez
- University of Bristol, Bristol, United Kingdom
| | - V D Bruno
- University of Bristol, Bristol, United Kingdom
| | - T W Johnson
- University of Bristol, Bristol, United Kingdom
| | - R Ascione
- University of Bristol, Bristol, United Kingdom
| | - E Sammut
- University of Bristol, Bristol, United Kingdom
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Baz-Lopez D, Bruno VD, Johnson TW, Ascione R, Sammut E. Distinct metabolic transcriptional patterns and Warburg effect in porcine model of ischaemic cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Despite improvements in therapy for heart failure, the prognosis remains poor. Energetic imbalances related to mitochondrial dysfunction, impaired oxidative phosphorylation and oxidative damage have been implicated in the pathogenesis or worsening of heart failure. Improved understanding of the metabolic alterations of the heart may provide new biomarkers or therapeutic targets.
Purpose
It has been speculated that aerobic glycolysis, known as the Warburg effect, may be advantageous for cell survival whereby there is the opportunity for simultaneous energy production and production of intermediary metabolites crucial for anabolic pathways that sustain cell division and maintenance, and protein synthesis (1,2). In this study, we studied a preclinical model of ischaemic cardiomyopathy to investigate transcriptional patterns in two defined areas; peri-infarct and remote locations. Specifically, we investigated if aerobic glycolysis may be present in this setting.
Methods
18 female Yorkshire pigs were studied. 10 animals underwent balloon catheter myocardial infarction followed by termination at 4 weeks. A group of 8 healthy animals served as controls. All animals underwent cardiac MRI prior to termination confirming ventricular impairment and remodelling in the chronic animals (see Table 1). Gene expression profiles of glucose mobilisation and glucose metabolic markers (GLUT1, GLUT4, ANK2, GAPDH and LDHA), oxidative phosphorylation and mitochondrial function (ND1, TFAM, and PGC1-alpha), key markers of insulin resistance (AKT1, AS160) and a hypoxia marker (HIF1-alpha) were measured.
Results
Our results indicate the presence of two distinct metabolic profiles at the gene expression level, differing from control tissue but more interestingly with striking differences regionally. In the remote region compared to controls, we demonstrate a picture suggestive of increased glycolysis with significant transcriptional upregulation of GLUT1 and GLUT4 glucose transporters (p=0.01 and p=0.02 respectively), alongside a significant reduction in PGC1-alpha (p=0.04) with maintained transcriptional levels of LDHA and HIF1-alpha. Combined, these results are suggestive of reduced oxidative phosphorylation alongside compensated, or early stage, aerobic glycolytic metabolism in this region. In contrast, in peri-infarct tissue versus controls, we demonstrate a reduction in glycolysis (GLUT1 p=0.09, GLUT4 p=0.01 with a dramatic increase in GLUT1/GLUT4 ratio of 6.7 times) and reduced markers of mitochondrial function indicative of insulin-resistance with evidence of a fetal-pattern metabolic profile (see Table 2 for detailed results).
Conclusions
This study demonstrates distinct transcriptional profiles within hearts with ischaemic cardiomyopathy and for the first time suggests that the Warburg effect may be present in remote myocardium in this setting supporting the need for further work in this area.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): This research work was supported by grants awarded to Professor Ascione: the British Heart Foundation (BHF) (BHF IG/14/2/30991, BHF RM/13/2/30158), and the Medical Research Council (MRC) (MRC MR/L012723/1). Table 1. CMR parameters for animals studiedTable 2. Transcriptional signals
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Affiliation(s)
- D Baz-Lopez
- University of Bristol, Bristol, United Kingdom
| | - V D Bruno
- University of Bristol, Bristol, United Kingdom
| | - T W Johnson
- University of Bristol, Bristol, United Kingdom
| | - R Ascione
- University of Bristol, Bristol, United Kingdom
| | - E Sammut
- University of Bristol, Bristol, United Kingdom
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7
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Williams MGL, Liang K, De Garate E, Spagnoli L, Fiori E, Lawton CB, Biglino G, Dastidar A, Johnson TW, Bucciarelli-Ducci C. The role of peak troponin in patients with a working diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA). Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Rosetrees Trust James Tudor Foundation
Background
6-10% of patients who present with an acute coronary syndrome have a myocardial infarction with non-obstructive coronary arteries (MINOCA). Troponin T predicts infarct size and outcomes in patients with ST-elevation myocardial infarction. The value of peak troponin T in patients with a working diagnosis of MINOCA is not well understood.
Purpose
The aim of this study is to investigate the diagnostic and prognostic role of troponin in patients with MINOCA.
Methods
Consecutive patients with a working diagnosis of MINOCA (n = 719) from a single tertiary centre who underwent comprehensive cardiovascular magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) were followed prospectively. The primary endpoint was all-cause mortality.
Results
Peak troponin T ≥211 ng/L and time to CMR of ≤17 days have a positive predictive value of 94% for being able to make a diagnosis on CMR. If the scan was performed in ≤17 days the diagnostic yield was still 75% even in the lowest troponin decile, but this was 59% if performed after 17 days. Each increase in troponin decile increases the mean diagnostic yield of the CMR by 3.7% (p < 0.001, 95% CI 3.4 – 3.9; R2 0.84; Figure 1). There is no overall difference in median troponin in patients who died and those who survived (229 ng/l v. 424 ng/l; p = 0.157), however mortality is significantly lower in the highest two troponin quartiles (11.9% versus 6.9%; p = 0.009, figure 2).
Conclusions
Peak troponin T and time to CMR can be used by cardiologists to determine the likelihood of making a diagnosis using CMR. A higher troponin quartile is associated with lower mortality.
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Affiliation(s)
- MGL Williams
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - K Liang
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - E De Garate
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - L Spagnoli
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - E Fiori
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - CB Lawton
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - G Biglino
- University of Bristol, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - A Dastidar
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - TW Johnson
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - C Bucciarelli-Ducci
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
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8
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Williams MGL, Dastidar A, Liang K, Johnson TW, Baritussio A, Strange JW, Joshi N, Dorman S, Dr Garate E, Spagnoli L, Fiori E, Lawton CB, Biglino G, Plein S, Bucciarelli-Ducci C. Sex and age differences in patients with a working diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA): presentation and outcome. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Rosetrees Trust James Tudor Foundation
Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) is an increasingly recognised working diagnosis. Sex and age differences in MINOCA are not well understood.
Purpose This study aims to evaluate the impact of sex and age in patients with MINOCA due to ischaemic and non-ischaemic causes on clinical presentation and outcome.
Methods and Results Consecutive patients with a working diagnosis of MINOCA (n = 719) from a single tertiary centre who underwent comprehensive cardiovascular magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) were followed prospectively. The primary endpoint was all-cause mortality. CMR was performed at a median time of 30 days after presentation and identified a diagnosis in 74% of patients. Men were more likely to have a non-ischaemic cause on CMR (55% v. 41%, p < 0.001) and less likely to have a normal/non-specific scan (21% v. 32%, p = 0.001, figure 1). All-cause mortality was 9.5% over a median follow up of 4.9 years, with no significant difference between sexes (8.7% versus 10.1% p = 0.456). Age group (HR 1.61, p < 0.001) and LVEF (HR 0.98, p = 0.020) were independent predictors of mortality. Men aged >60 years with a non-ischaemic aetiology on their CMR were at higher risk of death than women with non-ischaemic causes >60 years (p = 0.003, figure 2).
Conclusions There is no difference in all-cause mortality between sexes in MINOCA but increasing age is the most important predictor of mortality in both sexes.
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Affiliation(s)
- MGL Williams
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - A Dastidar
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - K Liang
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - TW Johnson
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - A Baritussio
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - JW Strange
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - N Joshi
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - S Dorman
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - E Dr Garate
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - L Spagnoli
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - E Fiori
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - CB Lawton
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - G Biglino
- University of Bristol, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - S Plein
- University of Leeds, Department of Biomedical Imaging Science, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - C Bucciarelli-Ducci
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
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9
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Affiliation(s)
- T. W. Johnson
- Department of Botany Duke University Durham, North Carolina
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10
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Affiliation(s)
- T. W. Johnson
- Department of Botany, University of Michigan, Ann Arbor, Michigan
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12
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Johnson TW. A New Species of Achlya With Coiled Oogonial Stalks. Mycologia 2018. [DOI: 10.1080/00275514.1949.12017811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- T. W. Johnson
- Department of Botany, University of Michigan, Ann Arbor, Michigan
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Affiliation(s)
- T. W. Johnson
- Department of Botany, University of Michigan, Ann Arbor, Michigan
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14
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Weber GF, Johnson TW, Ziegler AW, Linthicum B. Brief Articles. Mycologia 2018. [DOI: 10.1080/00275514.1951.12024167] [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: 10/28/2022]
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15
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Affiliation(s)
- T. W. Johnson
- Department of Botany, Duke University, Durham, North Carolina 27706
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Affiliation(s)
- R. L. Seymour
- Department of Botany, The Ohio State University, Columbus, Ohio 43210
| | - T. W. Johnson
- Department of Botany, Duke University, Durham, N. C. 27706
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Bo L, Johnson TW. A Brief Historical Survey of Fungal Taxonomy and Floristics in China. Mycologia 2018. [DOI: 10.1080/00275514.1981.12021444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Liu Bo
- Department of Biology, Shansi University, Taiyuan, Shansi Province, The People's Republic of China
| | - T. W. Johnson
- Department of Botany, Duke University, Durham, North Carolina 27706
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18
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Affiliation(s)
- T. W. Johnson
- Department of Botany, Duke University, Durham, N. C. 27706
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19
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Affiliation(s)
| | - T. W. Johnson
- Department of Botany, Duke University, Durham, N. C. 27706
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20
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Affiliation(s)
- T. W. Johnson
- Department of Botany, Duke University, Durham, N. C. 27706
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Cavaliere AR, Johnson TW. A New Marine Ascomycete from Australia. Mycologia 2018. [DOI: 10.1080/00275514.1965.12018282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A. R. Cavaliere
- Department of Botany Duke University Durham, North Carolina 27706
| | - T. W. Johnson
- Department of Botany Duke University Durham, North Carolina 27706
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Johnson TW, Autery CL, Miller CW, Anderson NA, Kevorkian AG, Stevenson JA, Benjamin CR, Drechsler C. Notes and Brief Articles. Mycologia 2018. [DOI: 10.1080/00275514.1961.12017972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- T. W. Johnson
- Department of Botany, Duke University, Durham, North Carolina, and the Marine Laboratory, Beaufort
| | - Charlotte L. Autery
- Department of Botany, Duke University, Durham, North Carolina, and the Marine Laboratory, Beaufort
| | - C. W. Miller
- Department of Plant Pathology, University of Minnesota, St. Paul 1, Minnesota
| | - N. A. Anderson
- Department of Plant Pathology, University of Minnesota, St. Paul 1, Minnesota
| | | | - John A. Stevenson
- National Fungus Collections, Crops Research Division, Beltsville, Maryland
| | | | - Charles Drechsler
- Crops Research Division, Agricultural Research Service, United States Department of Agriculture, Plant Industry Station, Beltsville, Maryland
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23
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Affiliation(s)
- T. W. Johnson
- Department of Botany Duke University Durham, North Carolina
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24
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Affiliation(s)
- Shira Y. Borut
- Department of Botany, Duke University, Durham, North Carolina and Duke Marine Laboratory, Beaufort, North Carolina
| | - T. W. Johnson
- Department of Botany, Duke University, Durham, North Carolina and Duke Marine Laboratory, Beaufort, North Carolina
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25
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Affiliation(s)
- T. W. Johnson
- Department of Botany Duke University Durham, North Carolina
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26
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Affiliation(s)
- D. E. Padgett
- Department of Biological Sciences, University of North Carolina at Wilmington, 601 S. College Road, Wilmington, North Carolina 28403-5915
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27
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Guan J, Tucker ER, Wan H, Chand D, Danielson LS, Ruuth K, El Wakil A, Witek B, Jamin Y, Umapathy G, Robinson SP, Johnson TW, Smeal T, Martinsson T, Chesler L, Palmer RH, Hallberg B. The ALK inhibitor PF-06463922 is effective as a single agent in neuroblastoma driven by expression of ALK and MYCN. Dis Model Mech 2016; 9:941-52. [PMID: 27483357 PMCID: PMC5047689 DOI: 10.1242/dmm.024448] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 07/04/2016] [Indexed: 12/24/2022] Open
Abstract
The first-in-class inhibitor of ALK, c-MET and ROS1, crizotinib (Xalkori), has shown remarkable clinical efficacy in treatment of ALK-positive non-small cell lung cancer. However, in neuroblastoma, activating mutations in the ALK kinase domain are typically refractory to crizotinib treatment, highlighting the need for more potent inhibitors. The next-generation ALK inhibitor PF-06463922 is predicted to exhibit increased affinity for ALK mutants prevalent in neuroblastoma. We examined PF-06463922 activity in ALK-driven neuroblastoma models in vitro and in vivo In vitro kinase assays and cell-based experiments examining ALK mutations of increasing potency show that PF-06463922 is an effective inhibitor of ALK with greater activity towards ALK neuroblastoma mutants. In contrast to crizotinib, single agent administration of PF-06463922 caused dramatic tumor inhibition in both subcutaneous and orthotopic xenografts as well as a mouse model of high-risk neuroblastoma driven by Th-ALK(F1174L)/MYCN Taken together, our results suggest PF-06463922 is a potent inhibitor of crizotinib-resistant ALK mutations, and highlights an important new treatment option for neuroblastoma patients.
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Affiliation(s)
- J Guan
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-405 30, Sweden
| | - E R Tucker
- Division of Clinical Studies Cancer Therapeutics, The Institute of Cancer Research, London and Royal Marsden NHS Foundation Trust, Sutton SM2 5NG, UK
| | - H Wan
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-405 30, Sweden
| | - D Chand
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-405 30, Sweden
| | - L S Danielson
- Division of Clinical Studies Cancer Therapeutics, The Institute of Cancer Research, London and Royal Marsden NHS Foundation Trust, Sutton SM2 5NG, UK
| | - K Ruuth
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-405 30, Sweden Department of Molecular Biology, Building 6L, Umeå University, Umeå 901 87, Sweden
| | - A El Wakil
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-405 30, Sweden Department of Molecular Biology, Building 6L, Umeå University, Umeå 901 87, Sweden
| | - B Witek
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-405 30, Sweden Department of Molecular Biology, Building 6L, Umeå University, Umeå 901 87, Sweden
| | - Y Jamin
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London and Royal Marsden NHS Foundation Trust, Sutton SM2 5NG, UK
| | - G Umapathy
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-405 30, Sweden
| | - S P Robinson
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London and Royal Marsden NHS Foundation Trust, Sutton SM2 5NG, UK
| | - T W Johnson
- La Jolla Laboratories, Pfizer Worldwide Research and Development, San Diego, CA 92121, USA
| | - T Smeal
- La Jolla Laboratories, Pfizer Worldwide Research and Development, San Diego, CA 92121, USA
| | - T Martinsson
- Department of Clinical Genetics, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-405 30, Sweden
| | - L Chesler
- Division of Clinical Studies Cancer Therapeutics, The Institute of Cancer Research, London and Royal Marsden NHS Foundation Trust, Sutton SM2 5NG, UK
| | - R H Palmer
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-405 30, Sweden
| | - B Hallberg
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-405 30, Sweden
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Guan J, Danielson L, Chand D, Jamin Y, Ruuth K, Tucker E, Umapathy G, Wakil AE, Witek B, Johnson TW, Smeal T, Chesler L, Palmer RH, Hallberg B. Abstract B12: The ALK inhibitor PF-06463922 shows significant response as a single agent in ALK/MYCN driven models of neuroblastoma. Cancer Res 2016. [DOI: 10.1158/1538-7445.pedca15-b12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
ALK inhibitors such as the ALK/MET/ROS1 inhibitor crizotinib (Xalkori) have shown clinical efficacy in a number of tumour types. However, in ALK positive neuroblastoma treatment with the ALK inhibitor crizotinib has proved more difficult, highlighting the exploration of new drugs as a clinical priority. A recent report of an increased percentage of ALK positive cases in the relapsed neuroblastoma patient population, together with the increased repertoire of ALK inhibitors now available, led to the investigation of alternative ALK inhibitors with potential for use in treatment of neuroblastoma. Here we report an investigation of the activity of a next generation ALK inhibitor in a range of in vitro and pre-clinical ALK driven neuroblastoma models.
Initially PF-06463922 was tested in various neuroblastoma cell lines and a range of gain-of-function ALK neuroblastoma mutations were subsequently analyzed in more detail in engineered Ba/F3 and PC12 cell models and by in vitro kinase assays, comparing the effect of PF-06463922 in abrogating cell growth and induced pharmacodynamics markers of response with the ALK inhibitor crizotinib. These results clearly show PF-06463922 to be a superior inhibitor of ALK kinase activity inhibiting all neuroblastoma mutant ALK forms assayed. Finally, single agent oral administration of PF-06463922 lead to induction of apoptosis and a dramatic reduction in tumour volume in a genetically engineered mouse model of treatment-resistant high-risk neuroblastoma driven by aberrant expression of MYCN and activated ALK. Taken together, our results suggest that PF-06463922 represents an important potential step forward in the treatment of relapsed neuroblastoma with mutated ALK.
Statement of significance: Our results together with PK/PD analysis of PF-06463922 suggest future clinical trial investigation of ALK positive neuroblastoma
Citation Format: J. Guan, L. Danielson, D. Chand, Y. Jamin, K. Ruuth, E. Tucker, G. Umapathy, A. El Wakil, B. Witek, T. W. Johnson, T. Smeal, L. Chesler, R. H. Palmer, B. Hallberg. The ALK inhibitor PF-06463922 shows significant response as a single agent in ALK/MYCN driven models of neuroblastoma. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Pediatric Cancer Research: From Mechanisms and Models to Treatment and Survivorship; 2015 Nov 9-12; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Res 2016;76(5 Suppl):Abstract nr B12.
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Affiliation(s)
- J. Guan
- 1Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
| | - L. Danielson
- 1Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
| | - D. Chand
- 1Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
| | - Y. Jamin
- 2The Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom,
| | - K. Ruuth
- 1Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
| | - E. Tucker
- 1Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
| | - G. Umapathy
- 1Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
| | - A. El Wakil
- 1Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
| | - B. Witek
- 1Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
| | - T. W. Johnson
- 3La Jolla Laboratories, Pfizer Worldwide Research and Development, San Diego, CA
| | - T. Smeal
- 3La Jolla Laboratories, Pfizer Worldwide Research and Development, San Diego, CA
| | - L. Chesler
- 2The Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom,
| | - R. H. Palmer
- 1Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
| | - B. Hallberg
- 1Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
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Frontera A, Johnson TW, Thomas G, Duncan E. Transcoronary ethanol ablation for incessant ventricular tachycardia: a salvage technique when faced with left ventricular thrombus. Neth Heart J 2015; 23:555-6. [PMID: 26353765 PMCID: PMC4608922 DOI: 10.1007/s12471-015-0746-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- A Frontera
- Bristol Heart Institute, University Hospitals of Bristol NHS Foundation Trust, BS2 8HW, Bristol, UK.
| | - T W Johnson
- Bristol Heart Institute, University Hospitals of Bristol NHS Foundation Trust, BS2 8HW, Bristol, UK
| | - G Thomas
- Bristol Heart Institute, University Hospitals of Bristol NHS Foundation Trust, BS2 8HW, Bristol, UK
| | - E Duncan
- Bristol Heart Institute, University Hospitals of Bristol NHS Foundation Trust, BS2 8HW, Bristol, UK
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Johnson TW, White S, Gnanadesigan M, Bourenane H, Strange JW, Newby AC, van Soest G, Baumbach A. 023 An ex-vivo “whole human heart model” for the development of intravascular imaging. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Johnson TW, Strange JW, Oriolo V, Edmond J, Davies A, Reeves BC, Baumbach A. 132 Combined prasugrel and bivalirudin treatment during primary PCI offers a safe and effective strategy in ST-elevation MI. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.132] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Johnson TW, French A, Tan TY, Strange JW. Diagnosing an MI: don't trust the monitor! Heart 2010; 96:1254. [DOI: 10.1136/hrt.2010.198515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rasmussen LS, O'Brien JT, Silverstein JH, Johnson TW, Siersma VD, Canet J, Jolles J, Hanning CD, Kuipers HM, Abildstrom H, Papaioannou A, Raeder J, Yli-Hankala A, Sneyd JR, Munoz L, Moller JT. Is peri-operative cortisol secretion related to post-operative cognitive dysfunction? Acta Anaesthesiol Scand 2005; 49:1225-31. [PMID: 16146456 DOI: 10.1111/j.1399-6576.2005.00791.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [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: 12/17/2022]
Abstract
BACKGROUND The pattern of cortisol secretion is influenced by surgery. As cortisol can adversely affect neuronal function, this may be an important factor in the development of post-operative cognitive dysfunction (POCD). We hypothesized that the incidence of POCD would be related to changes in cortisol level. METHODS We studied 187 patients aged over 60 years undergoing major non-cardiac surgery with general or regional anaesthesia. Saliva cortisol levels were measured pre-operatively and at 1 day, 7 days and 3 months post-operatively in the morning (08.00 h) and in the afternoon (16.00 h) using salivettes. Cognitive function was assessed pre-operatively, on day 7 and at 3 months using four neuropsychological tests. POCD was defined as a combined Z score of greater than 1.96. RESULTS After surgery, salivary cortisol concentrations increased significantly. POCD was detected in 18.8% of subjects at 1 week and in 15.2% after 3 months. The pre-operative ratios between the morning and afternoon cortisol concentrations (am/pm ratios) were 2.8 and 2.7 in patients with POCD at 1 week vs. those without POCD at 1 week, respectively. The am/pm ratios decreased significantly post-operatively to 1.9 and 1.6 at 1 week, respectively (P = 0.02 for both). In an analysis considering all am/pm ratios, it was found that the persistent flattening in am/pm ratio was significantly related to POCD at 1 week. CONCLUSION The pattern of diurnal variation in cortisol level was significantly related to POCD. Thus, circadian rhythm disturbance or metabolic endocrine stress could be an important mechanism in the development of cognitive dysfunction after major surgery.
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Affiliation(s)
- L S Rasmussen
- Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Padgett DE, Johnson TW. Zoosporangial Discharge in a Protoachlya hypogyna (Saprolegniaceae) Isolate from Southeastern North Carolina. Mycologia 2004. [DOI: 10.2307/3762054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Padgett DE, Johnson TW. Zoosporangial discharge in a Protoachlya hypogyna (Saprolegniaceae) isolate from southeastern North Carolina. Mycologia 2004; 96:205-207. [PMID: 21148845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Inadequate attention to zoosporangial discharge has led to confusion in watermold taxonomic literature. This problem is discussed in light of a specimen of Protoachlya hypogyna that manifests discharge characteristic of three watermold genera, and recommendations are made to reduce future inaccuracies.
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Affiliation(s)
- D E Padgett
- Department of Biological Sciences, University of North Carolina at Wilmington, 601 S. College Road, Wilmington, North Carolina 28403-5915
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Londono JD, Narten AH, Wignall GD, Honnell KG, Hsieh ET, Johnson TW, Bates FS. Composition Dependence of the Interaction Parameter in Isotopic Polymer Blends. Macromolecules 2002. [DOI: 10.1021/ma00088a029] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Johnson TW, Zybailov B, Jones AD, Bittl R, Zech S, Stehlik D, Golbeck JH, Chitnis PR. Recruitment of a foreign quinone into the A1 site of photosystem I. In vivo replacement of plastoquinone-9 by media-supplemented naphthoquinones in phylloquinone biosynthetic pathway mutants of Synechocystis sp. PCC 6803. J Biol Chem 2001; 276:39512-21. [PMID: 11470786 DOI: 10.1074/jbc.m104040200] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [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: 11/06/2022] Open
Abstract
Interruption of the phylloquinone (PhQ) biosynthetic pathway by interposon mutagenesis of the menA and menB genes in Synechocystis sp. PCC 6803 results in plastoquinone-9 (PQ-9) occupying the A(1) site and functioning in electron transfer from A(0) to the FeS clusters in photosystem (PS) I (Johnson, T. W., Shen, G., Zybailov, B., Kolling, D., Reategui, R., Beauparlant, S., Vassiliev, I. R., Bryant, D. A., Jones, A. D., Golbeck, J. H., and Chitnis, P. R. (2000) J. Biol. Chem. 275, 8523-8530. We report here the isolation of menB26, a strain of the menB mutant that grows in high light by virtue of a higher PS I to PS II ratio. PhQ can be reincorporated into the A(1) site of the menB26 mutant strain by supplementing the growth medium with authentic PhQ. The reincorporation of PhQ also occurs in cells that have been treated with protein synthesis inhibitors, consistent with a displacement of PQ-9 from the A(1) site by mass action. The doubling time of the menB26 mutant cells, but not the menA mutant cells, approaches the wild type when the growth medium is supplemented with naphthoquinone (NQ) derivatives such as 2-CO(2)H-1,4-NQ and 2-CH(3)-1,4-NQ. Since PhQ replaces PQ-9 in the supplemented menB26 mutant cells, but not in the menA mutant cells, the phytyl tail accompanies the incorporation of these quinones into the A(1) site. Studies with menB26 mutant cells and perdeuterated 2-CH(3)-1,4-NQ shows that phytylation occurs at position 3 of the NQ ring because the deuterated 2-methyl group remains intact. Therefore, the specificity of the phytyltransferase enzyme is selective with respect to the group present at ring positions 2 and 3. Supplementing the growth medium of menB26 mutant cells with 1,4-NQ also leads to its incorporation into the A(1) site, but typically without either the phytyl tail or the methyl group. These findings open the possibility of biologically incorporating novel quinones into the A(1) site by supplementing the growth medium of menB26 mutant cells.
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Affiliation(s)
- T W Johnson
- Department of Biochemistry, Biophysics and Molecular Biology, Iowa State University, Ames, IA 50011, USA
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Johnson TW, Corey EJ. Enantiospecific synthesis of the proposed structure of the antitubercular marine diterpenoid pseudopteroxazole: revision of stereochemistry. J Am Chem Soc 2001; 123:4475-9. [PMID: 11457233 DOI: 10.1021/ja010221k] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [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: 11/28/2022]
Abstract
An enantiospecific synthesis of structure 1, previously assigned to the antitubercular marine natural product pseudopteroxazole, has been accomplished as outlined in Scheme 1. Coupling of diene acid 3 and amino phenol 4 produced the amide 5, which was subjected to a novel oxidative intramolecular Diels-Alder reaction to generate the tricyclic lactam 6a stereoselectively. This product was transformed via intermediates 7-11 into the diene 13. Cationic cyclization of 13 afforded two diastereomeric tricyclic amphilectanes which were separated and transformed by parallel four-step sequences into 1 and 2, respectively. Neither 1 nor 2 were identical with pseudopteroxazole, indicating a need for revision of the structure, probably to 16.
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Affiliation(s)
- T W Johnson
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, Massachusetts 02138, USA
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Affiliation(s)
- J L Newton
- Post Coronary Care Unit, University Hospital, Oklahoma City, Okla., USA
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Yellin MW, Johnson TW. A case of Susac syndrome. J Am Acad Audiol 2000; 11:484-8. [PMID: 11057732] [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]
Abstract
Susac syndrome is a readily recognized but often misdiagnosed disorder almost exclusively affecting women in the 20- to 40-year age range. Characterized by the clinical triad of encephalopathy, branch retinal artery occlusions, and sensorineural hearing loss, patients with Susac syndrome are often misdiagnosed with multiple sclerosis (MS). Unlike MS, however, the disease process extends over a 1- to 2-year period and then goes into remission. This presentation describes the progression of symptoms of a patient eventually diagnosed with Susac syndrome.
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Affiliation(s)
- M W Yellin
- Department of Speech Pathology and Audiology, Northern Arizona University, Flagstaff 86011, USA
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Abstract
Hypotheses concerning the relationships among job stressors, job level, personality, and coping responses were investigated in a sample of 305 electrical contracting employees. Coping behaviors were measured with questionnaire items based on interviews conducted with a sample of the subjects. Neuroticism (N) and Extraversion (E) were the personality variables most strongly related to coping behavior. Overall, more coping variance was explained by personality than by job stressors; however, when the effects of job level and job stressors were combined, they explained more variance in complaining/quitting and seeking social support than did the personality variables. Both work situation and personality seem to be important variables in the choice of coping behaviors. There was no evidence of interactions among personality, stressors, and job level in explaining coping behavior.
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Affiliation(s)
- B T Mayes
- Department of Management, School of Business Administration and Economics, California State University, Fullerton 92834, USA.
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Abstract
Revised structures are proposed for pseudopterosin G-J aglycon and helioporin E.
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Affiliation(s)
- S E Lazerwith
- Department of Chemistry and Chemical Biology Harvard University, 12 Oxford Street, Cambridge, Massachusetts 02138, USA
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Zybailov B, van der Est A, Zech SG, Teutloff C, Johnson TW, Shen G, Bittl R, Stehlik D, Chitnis PR, Golbeck JH. Recruitment of a foreign quinone into the A(1) site of photosystem I. II. Structural and functional characterization of phylloquinone biosynthetic pathway mutants by electron paramagnetic resonance and electron-nuclear double resonance spectroscopy. J Biol Chem 2000; 275:8531-9. [PMID: 10722691 DOI: 10.1074/jbc.275.12.8531] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.2] [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: 11/06/2022] Open
Abstract
Electron paramagnetic resonance (EPR) and electron-nuclear double resonance studies of the photosystem (PS) I quinone acceptor, A(1), in phylloquinone biosynthetic pathway mutants are described. Room temperature continuous wave EPR measurements at X-band of whole cells of menA and menB interruption mutants show a transient reduction and oxidation of an organic radical with a g-value and anisotropy characteristic of a quinone. In PS I complexes, the continuous wave EPR spectrum of the photoaccumulated Q(-) radical, measured at Q-band, and the electron spin-polarized transient EPR spectra of the radical pair P700(+) Q(-), measured at X-, Q-, and W-bands, show three prominent features: (i) Q(-) has a larger g-anisotropy than native phylloquinone, (ii) Q(-) does not display the prominent methyl hyperfine couplings attributed to the 2-methyl group of phylloquinone, and (iii) the orientation of Q(-) in the A(1) site as derived from the spin polarization is that of native phylloquinone in the wild type. Electron spin echo modulation experiments on P700(+) Q(-) show that the dipolar coupling in the radical pair is the same as in native PS I, i.e. the distance between P700(+) and Q(-) (25.3 +/- 0.3 A) is the same as between P700(+) and A(1)(-) in the wild type. Pulsed electron-nuclear double resonance studies show two sets of resolved spectral features with nearly axially symmetric hyperfine couplings. They are tentatively assigned to the two methyl groups of the recruited plastoquinone-9, and their difference indicates a strong inequivalence among the two groups when in the A(1) site. These results show that Q (i) functions in accepting an electron from A(0)(-) and in passing the electron forward to the iron-sulfur clusters, (ii) occupies the A(1) site with an orientation similar to that of phylloquinone in the wild type, and (iii) has spectroscopic properties consistent with its identity as plastoquinone-9.
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Affiliation(s)
- B Zybailov
- Department of Biochemistry and Molecular Biology, Pennsylvania State University, University Park, Pennsylvania 16802, USA
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Johnson TW, Shen G, Zybailov B, Kolling D, Reategui R, Beauparlant S, Vassiliev IR, Bryant DA, Jones AD, Golbeck JH, Chitnis PR. Recruitment of a foreign quinone into the A(1) site of photosystem I. I. Genetic and physiological characterization of phylloquinone biosynthetic pathway mutants in Synechocystis sp. pcc 6803. J Biol Chem 2000; 275:8523-30. [PMID: 10722690 DOI: 10.1074/jbc.275.12.8523] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.5] [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: 11/06/2022] Open
Abstract
Genes encoding enzymes of the biosynthetic pathway leading to phylloquinone, the secondary electron acceptor of photosystem (PS) I, were identified in Synechocystis sp. PCC 6803 by comparison with genes encoding enzymes of the menaquinone biosynthetic pathway in Escherichia coli. Targeted inactivation of the menA and menB genes, which code for phytyl transferase and 1,4-dihydroxy-2-naphthoate synthase, respectively, prevented the synthesis of phylloquinone, thereby confirming the participation of these two gene products in the biosynthetic pathway. The menA and menB mutants grow photoautotrophically under low light conditions (20 microE m(-2) s(-1)), with doubling times twice that of the wild type, but they are unable to grow under high light conditions (120 microE m(-2) s(-1)). The menA and menB mutants grow photoheterotrophically on media supplemented with glucose under low light conditions, with doubling times similar to that of the wild type, but they are unable to grow under high light conditions unless atrazine is present to inhibit PS II activity. The level of active PS II per cell in the menA and menB mutant strains is identical to that of the wild type, but the level of active PS I is about 50-60% that of the wild type as assayed by low temperature fluorescence, P700 photoactivity, and electron transfer rates. PS I complexes isolated from the menA and menB mutant strains contain the full complement of polypeptides, show photoreduction of F(A) and F(B) at 15 K, and support 82-84% of the wild type rate of electron transfer from cytochrome c(6) to flavodoxin. HPLC analyses show high levels of plastoquinone-9 in PS I complexes from the menA and menB mutants but not from the wild type. We propose that in the absence of phylloquinone, PS I recruits plastoquinone-9 into the A(1) site, where it functions as an efficient cofactor in electron transfer from A(0) to the iron-sulfur clusters.
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Affiliation(s)
- T W Johnson
- Department of Biochemistry, Biophysics and Molecular Biology, Iowa State University, Ames, Iowa 50011, USA
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Rätsep M, Johnson TW, Chitnis PR, Small GJ. The Red-Absorbing Chlorophyll a Antenna States of Photosystem I: A Hole-Burning Study of Synechocystis sp. PCC 6803 and Its Mutants. J Phys Chem B 2000. [DOI: 10.1021/jp9929418] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M. Rätsep
- Ames Laboratory−U.S. Department of Energy and Departments of Chemistry, and Biochemistry, Biophysics, and Molecular Biology, Iowa State University, Ames, Iowa 50011
| | - T. W. Johnson
- Ames Laboratory−U.S. Department of Energy and Departments of Chemistry, and Biochemistry, Biophysics, and Molecular Biology, Iowa State University, Ames, Iowa 50011
| | - P. R. Chitnis
- Ames Laboratory−U.S. Department of Energy and Departments of Chemistry, and Biochemistry, Biophysics, and Molecular Biology, Iowa State University, Ames, Iowa 50011
| | - G. J. Small
- Ames Laboratory−U.S. Department of Energy and Departments of Chemistry, and Biochemistry, Biophysics, and Molecular Biology, Iowa State University, Ames, Iowa 50011
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Abstract
[formula: see text] A novel pentacyclic polyhydroxylated sterol, xestobergsterol A (1a), has been synthesized in 24 steps and in good overall yield from stigmasterol 17. The key steps of the synthesis are the Breslow remote functionalization of the polyoxygenated steroid derived from 25 and the base-catalyzed epimerization-aldol condensation of the dione derived from 27.
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Affiliation(s)
- M E Jung
- Department of Chemistry and Biochemistry, University of California, Los Angeles 90095-1569, USA.
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Affiliation(s)
- S J Asirvatham
- Department of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, USA.
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Abstract
We have developed a simple instrument for pressure algometry. It can be made easily using components found in most anaesthetic rooms. Ten students were able to make the device using written instructions. All the resulting algometers performed within 10% accuracy limits for values up to 4 kg.cm-2.
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Affiliation(s)
- T W Johnson
- Manchester and Salford Pain Centre, Hope Hospital, UK
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Hargreaves JA, Johnson TW, Watt JW. Patient-controlled analgesia--who benefits? Anaesthesia 1997; 52:1017. [PMID: 9370851] [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: 02/05/2023]
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