52 research outputs found
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Community exercise is feasible for neuromuscular diseases and can improve aerobic capacity
Objective: The aim of this phase 2 trial was to ascertain the feasibility and effect of community based aerobic exercise training for people with two of the more common neuromuscular diseases: Charcot-Marie-Tooth disease type 1A (CMT) and Inclusion Body Myositis (IBM).
Methods: A randomised single blinded cross over trial design was used to compare a 12-week aerobic training programme using recombinant exercise bicycles compared to a control period. The training occurred three times per week in community gyms local to the participants. Support was available from trained gym staff and a research physiotherapist. The two disease groups were analysed separately. The primary outcome measure was peak oxygen uptake (VO2 peak) during a maximal exercise test, with secondary measures of muscle strength, function and patient reported measures.
Results: Data from 23 people with CMT and 17 people with IBM was included in the analysis. Both disease groups had high levels of participation and demonstrated improvements in VO2 peak, with a moderate effect size in the CMT participants (Cohen’s d = 0.53) and a strong effect size in the IBM group (Cohen’s d = 1.72). No major changes were observed in the secondary outcome measures. Qualitative interviews revealed that participants valued the support of gym instructors and the research physiotherapists in overcoming challenges to participation.
Conclusion: Twelve weeks of aerobic training in community gyms was feasible, safe and improved aerobic capacity in people with CMT and IBM.
Classification of Evidence: This study provides Class II evidence that for patients with CMT type 1A and IBM, an aerobic training program increases aerobic capacity
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Cardiopulmonary exercise performance and factors associated with aerobic capacity in neuromuscular diseases
Introduction/Aims: Aerobic deconditioning, due to lower levels of physical activity, could impact independence for people with neuromuscular conditions. We report the maximal cardiopulmonary response in a cohort of people with Charcot Marie Tooth disease type 1A (CMT 1A) and inclusion body myositis (IBM). We also explored potential predictors of aerobic capacity with measures of physical impairment and functional performance.
Methods: Participants underwent maximal cardiopulmonary exercise testing (CPET) using a semi-recumbent cycle ergometer. Data were analyzed to determine the peak O2 consumption (VO2 peak), anaerobic threshold (AT), maximum heart rate (MHR), ventilatory equivalent for CO2 slope (VE/VCO2), and respiratory exchange ratio (RER). Impairment, functional and patient reported measures were also recorded. Predicted CPET variables were calculated based on published normative data for age, gender, and weight.
Results: Twenty-two people with CMT and 17 people with IBM were recruited. Both groups showed significantly lower VO2 peak, MHR, AT, and VE/VCO2. The CMT group overall performed better than the IBM group, with significantly higher VO2 peak, MHR, and AT, but lower VE/VCO2. Linear regression analysis demonstrated that VO2 peak was related to body fat percentage and 6-min walk distance for both groups, and steps per day for the IBM group.
Discussion: Lower than predicted CPET variables were observed that were not explained by cardiopulmonary limitations or reduced effort, implicating peripheral factors in limiting the cycling task. Regression analysis implied prediction of VO2 peak by body fat percentage and 6-min walk distance. Six-minute walk distance could be a potential proxy measure of cardiopulmonary fitness
An evaluation of urinary microRNA reveals a high sensitivity for bladder cancer
Background: Urinary biomarkers are needed to improve the care and reduce the cost of managing bladder cancer. Current
biomarkers struggle to identify both high and low-grade cancers due to differing molecular pathways. Changes in microRNA (miR) expression are seen in urothelial carcinogenesis in a phenotype-specific manner. We hypothesised that urinary miRs reflecting low- and high-grade pathways could detect bladder cancers and overcome differences in genetic events seen within the disease.
Methods: We investigated urinary samples (n ¼ 121) from patients with bladder cancer (n ¼ 68) and age-matched controls (n ¼ 53). Fifteen miRs were quantified using real-time PCR.
Results: We found that miR is stable within urinary cells despite adverse handling and detected differential expression of 10 miRs from patients with cancer and controls (miRs 15a/15b/24-1/27b/100/135b/203/212/328/1224, ANOVA Po0.05). Individually, miR-1224-3p had the best individual performance with specificity, positive and negative predictive values and concordance of 83%, 83%, 75% and 77%, respectively. The combination of miRs-135b/15b/1224-3p detected bladder cancer with a high sensitivity (94.1%), sufficient specificity (51%) and was correct in 86% of patients (concordance).
Conclusion: The use of this panel in patients with haematuria would have found 94% of urothelial cell carcinoma, while reducing cystoscopy rates by 26%. However, two invasive cancers (3%) would have been missed
Integrated Epigenome Profiling of Repressive Histone Modifications, DNA Methylation and Gene Expression in Normal and Malignant Urothelial Cells
Epigenetic regulation of gene expression is commonly altered in human cancer. We have observed alterations of DNA
methylation and microRNA expression that reflect the biology of bladder cancer. This common disease arises by distinct
pathways with low and high-grade differentiation. We hypothesized that epigenetic gene regulation reflects an interaction
between histone and DNA modifications, and differences between normal and malignant urothelial cells represent
carcinogenic events within bladder cancer. To test this we profiled two repressive histone modifications (H3K9m3 and
H3K27m3) using ChIP-Seq, cytosine methylation using MeDIP and mRNA expression in normal and malignant urothelial cell
lines. In genes with low expression we identified H3K27m3 and DNA methylation each in 20–30% of genes and both marks
in 5% of genes. H3K9m3 was detected in 5–10% of genes but was not associated with overall expression. DNA methylation
was more closely related to gene expression in malignant than normal cells. H3K27m3 was the epigenetic mark most
specifically correlated to gene silencing. Our data suggest that urothelial carcinogenesis is accompanied by a loss of control
of both DNA methylation and H3k27 methylation. From our observations we identified a panel of genes with cancer
specific-epigenetic mediated aberrant expression including those with reported carcinogenic functions and members
potentially mediating a positive epigenetic feedback loop. Pathway enrichment analysis revealed genes marked by H3K9m3
were involved with cell homeostasis, those marked by H3K27m3 mediated pro-carcinogenic processes and those marked
with cytosine methylation were mixed in function. In 150 normal and malignant urothelial samples, our gene panel correctly
estimated expression in 65% of its members. Hierarchical clustering revealed that this gene panel stratified samples
according to the presence and phenotype of bladder cancer
SPIRE - combining SGI-110 with cisplatin and gemcitabine chemotherapy for solid malignancies including bladder cancer: study protocol for a phase Ib/randomised IIa open label clinical trial
Background
Urothelial bladder cancer (UBC) accounts for 10,000 new diagnoses and 5000 deaths annually in the UK (Cancer Research UK, http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bladder-cancer, Cancer Research UK, Accessed 26 Mar 2018). Cisplatin-based chemotherapy is standard of care therapy for UBC for both palliative first-line treatment of advanced/metastatic disease and radical neoadjuvant treatment of localised muscle invasive bladder cancer. However, cisplatin resistance remains a critical cause of treatment failure and a barrier to therapeutic advance in UBC. Based on supportive pre-clinical data, we hypothesised that DNA methyltransferase inhibition would circumvent cisplatin resistance in UBC and potentially other cancers.
Methods
The addition of SGI-110 (guadecitabine, a DNA methyltransferase inhibitor) to conventional doublet therapy of gemcitabine and cisplatin (GC) is being tested within the phase Ib/IIa SPIRE clinical trial. SPIRE incorporates an initial, modified rolling six-dose escalation phase Ib design of up to 36 patients with advanced solid tumours followed by a 20-patient open-label randomised controlled dose expansion phase IIa component as neoadjuvant treatment for UBC. Patients are being recruited from UK secondary care sites. The dose escalation phase will determine a recommended phase II dose (RP2D, primary endpoint) of SGI-110, by subcutaneous injection, on days 1–5 for combination with GC at conventional doses (cisplatin 70 mg/m2, IV infusion, day 8; gemcitabine 1000 mg/m2, IV infusion, days 8 and 15) in every 21-day cycle. In the dose expansion phase, patients will be randomised 1:1 to GC with or without SGI-110 at the proposed RP2D. Secondary endpoints will include toxicity profiles, SGI-110 pharmacokinetics and pharmacodynamic biomarkers, and pathological complete response rates in the dose expansion phase. Analyses will not be powered for formal statistical comparisons and descriptive statistics will be used to describe rates of toxicity, efficacy and translational endpoints by treatment arm.
Discussion
SPIRE will provide evidence for whether SGI-110 in combination with GC chemotherapy is safe and biologically effective prior to future phase II/III trials as a neoadjuvant therapy for UBC and potentially in other cancers treated with GC
Global Methylation Patterns in Idiopathic Pulmonary Fibrosis
BACKGROUND: Idiopathic Pulmonary Fibrosis (IPF) is characterized by profound changes in the lung phenotype including excessive extracellular matrix deposition, myofibroblast foci, alveolar epithelial cell hyperplasia and extensive remodeling. The role of epigenetic changes in determining the lung phenotype in IPF is unknown. In this study we determine whether IPF lungs exhibit an altered global methylation profile.\ud
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METHODOLOGY/PRINCIPAL FINDINGS: Immunoprecipitated methylated DNA from 12 IPF lungs, 10 lung adenocarcinomas and 10 normal histology lungs was hybridized to Agilent human CpG Islands Microarrays and data analysis was performed using BRB-Array Tools and DAVID Bioinformatics Resources software packages. Array results were validated using the EpiTYPER MassARRAY platform for 3 CpG islands. 625 CpG islands were differentially methylated between IPF and control lungs with an estimated False Discovery Rate less than 5%. The genes associated with the differentially methylated CpG islands are involved in regulation of apoptosis, morphogenesis and cellular biosynthetic processes. The expression of three genes (STK17B, STK3 and HIST1H2AH) with hypomethylated promoters was increased in IPF lungs. Comparison of IPF methylation patterns to lung cancer or control samples, revealed that IPF lungs display an intermediate methylation profile, partly similar to lung cancer and partly similar to control with 402 differentially methylated CpG islands overlapping between IPF and cancer. Despite their similarity to cancer, IPF lungs did not exhibit hypomethylation of long interspersed nuclear element 1 (LINE-1) retrotransposon while lung cancer samples did, suggesting that the global hypomethylation observed in cancer was not typical of IPF.\ud
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CONCLUSIONS/SIGNIFICANCE: Our results provide evidence that epigenetic changes in IPF are widespread and potentially important. The partial similarity to cancer may signify similar pathogenetic mechanisms while the differences constitute IPF or cancer specific changes. Elucidating the role of these specific changes will potentially allow better understanding of the pathogenesis of IPF.\ud
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Integrating genetics and epigenetics in breast cancer: biological insights, experimental, computational methods and therapeutic potential
The transposable element environment of human genes is associated with histone and expression changes in cancer
Patient and public involvement : how service user engagement has informed research into falls intervention in people with Charcot-Marie-Tooth disease
Patient and Public Involvement (PPI) is now a requirement
of many funders for clinical research. The INVOLVE
organisation defines PPI in research as “research being carried
out ‘with’ or ‘by’ members of the public rather than
‘to’, ‘about’ or ‘for’ them”. One aspect is consultation to
understand issues and identify research topics. Here we
present the method and results of a focused PPI activity
and how it has informed a research program for people
with Charcot-Marie-Tooth disease. This work aimed to consult
people with CMT on strategies they use to address the
problem of poor balance and falls. Two methods were used
to collate responses from people with CMT: (1) Workshops
were held as part of the CMT United Kingdom annual general
meeting. Attendees were asked to discuss and answer
two questions: 1-What have you found improves your balance?
2-What do you do or use to prevent falls? (2) The CMT
United Kingdom has a strong social media presence. They
gave permission for the two questions to be posted on their
Facebook page. Responses from both sourceswere collated.
Data was coded and thematic analysis was used to identify
the emergent topics. In total, 76 suggested strategies were
obtained for question 1 and 74 for question 2. For question 1,
the four most common strategies usedwere: use of orthoses
(22.4%); walking aids (21.1%); good footwear (19.7%); regular
exercise (17.1%). For question 2, the four most common
strategies used were: paying attention and planning ahead
(37.8%); using walking aids and support (28.4%); regular
exercise (9.5%); use of orthoses (6.8%). These results have
now been incorporated into a funded pilot home based falls
management/exercise intervention, and a PhD studentship
exploring the use of walking aids and the effect of orthoses
on balance
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