Mechanisms of Interferon-associated Bone Marrow Suppression with or without Ribavirin. K. Zhdanov
|
|
- Darrell Bell
- 7 years ago
- Views:
Transcription
1 EASL endorsed conference White Nights of Hepatology 2012 Adverse events during antiviral therapy: how to predict, manage and monitor June 7-8 Saint-Petersburg Mechanisms of Interferon-associated Bone Marrow Suppression with or without Ribavirin K. Zhdanov
2 Multiple factors can cause or contribute to the development of cytopenia in patients with chronic viral hepatitis Portal Hypertension / Hypersplenism Cirrhosis Antibodies to blood cells Cytopenia HCC / Chemotherapy Viral Suppression / Antiviral therapy Decreased TPO, EPO, G-СSF Levels/Activity Afdhal N. et al. J. Hepatol., 2008
3 Hematologic events during Peg-IFN + Ribavirin therapy Hematologic events, Discontinuation of treatment, and Dose reduction Peg-IFN α-2a/rbv (%) Peg-IFN α-2b/rbv (%) Neutropenia 31,5 25,8 Neutrophil counts < 750 mm Neutrophil counts < 500 mm 3 5,9 2,8 Thrombocytopenia 31* 8** Platelet counts < mm 3 4* 4** Platelet counts < mm 3 < 1* < 1** Anemia 33,6 33,9 Hemoglobin < 100 g/l 29,6 30,7 Hemoglobin < 85 g/l 3,8 2,5 Serious hematologic disorders 0,8 0,4 McHutchison J. et al. N Engl J Med 2009; 361: * Sulkowski M. Clin Liver Dis 2005; 9: **Poynard T. et al. Gastroenterology 2009; 136:
4 Suppression of haematopoiesis during therapy of chronic hepatitis C Haemoglobin (mg/dl) EOT Leucocytes (10 3 мcl) EOT 4 24 IFN-a2b 5 MU TIW IFN-a2b 5 MU TIW + RBV Peg-IFN-a2a 180 мсg + RBV Peg-IFN-a2b 1,5 мсg/kg + RBV Schmid M., Kreil A., Jessner W., Homoncik M., Datz C., Gangl A., Ferenci P., Peck-Radosavljevic M. Gut, Platelets (10 3 мcl) EOT 4 24
5 Mechanisms of cytopenia during Peg-IFN/RBV therapy Bone marrow suppression Maturation and proliferation suppression of bone marrow progenitor cells leads to a 30-50% decline in the neutrophil and platelet counts and a lesser decline in hemoglobin Antiviral therapy Inhibition of growth factors Appearance of antibodies Immediate effect on mature circulating cells This leads to a 14-38% decline in the platelet and neutrophil counts and a 4% decline in the hemoglobin Shiffman M. et al. In book Advanced Therapy for Hepatitis C, 2012, P
6 Mechanisms of interferon-associated bone marrow suppression JAK Tovey M., Lallemand C. Pharmaceuticals, 2010 Masumi A. et al. Advances in Hematopoietic Stem Cell Research, 2012
7 Mechanisms of IFN action Bekisz J. et al. Pharmaceuticals,2010
8 Mechanisms of interferon-associated bone marrow suppression JAK CYTOPENIA Аctivation of genes transcription Apo 1 Proteins translation Аро 2 FAS TNF TRAIL PK TNF ОАS PK IRF-2 EN-L Receptor Sca1 expression of bone marrow stem cells АPOPTOSIS in bone marrow stem cells Decreased proteins synthesis in haematopoiesis cells Increased production of bone marrow stem cells, their depletion Reduced production, differentiation, maturation of bone marrow cells Tovey M., Lallemand C. Pharmaceuticals, 2010 Masumi A. et al. Advances in Hematopoietic Stem Cell Research, 2012 Inhibition of factors expression: GATA1, p45, MaFg Decreased differentiation and maturation
9 Mechanisms of interferon-associated bone marrow suppression JAK CYTOPENIA Аctivation of genes transcription Apo 1 Proteins translation Аро 2 FAS TNF TRAIL PK TNF ОАS PK IRF-2 EN-L Decreased proteins synthesis in haematopoiesis cells Reduced production, differentiation, maturation of bone marrow cells Tovey M., Lallemand C. Pharmaceuticals, 2010 Masumi A. et al. Advances in Hematopoietic Stem Cell Research, 2012
10 Mechanisms of interferon-associated bone marrow suppression JAK CYTOPENIA Аctivation of genes transcription Apo 1 Proteins translation Аро 2 FAS TNF TRAIL PK TNF ОАS PK IRF-2 EN-L Receptor Sca1 expression of bone marrow stem cells Increased production of bone marrow stem cells, their depletion Reduced production, differentiation, maturation of bone marrow cells Tovey M., Lallemand C. Pharmaceuticals, 2010 Masumi A. et al. Advances in Hematopoietic Stem Cell Research, 2012
11 Interferon regulatory factor-2 (IRF-2) regulates cell growth and differentiation through the target gene promoters Colony-forming assay showed reduced numbers of megakaryocyte progenitors in cells derived from bone marrow of IRF-2/mice vs wild-tipe/mice Masumi A. et al., Advances in Hematopoietic Stem Cell Research, 2012
12 Mechanisms of interferon-associated bone marrow suppression JAK CYTOPENIA Аctivation of genes transcription Apo 1 Proteins translation Аро 2 FAS TNF TRAIL PK TNF ОАS PK IRF-2 EN-L АPOPTOSIS in bone marrow stem cells Tovey M., Lallemand C. Pharmaceuticals, 2010 Masumi A. et al. Advances in Hematopoietic Stem Cell Research, 2012
13 Mechanisms of interferon-associated bone marrow suppression JAK CYTOPENIA Reduced production, differentiation, maturation of bone marrow cells Tovey M., Lallemand C. Pharmaceuticals, 2010 Masumi A. et al. Advances in Hematopoietic Stem Cell Research, 2012 Inhibition of factors expression: GATA1, p45, MaFg Decreased differentiation and maturation
14 IFN-α2b suppressed expression of transcription factors regulating late-stage megakaryopoiesis Human bone marrow derived CD34 + cells were incubated with 10 ng/ml TPO for 7 days. Large megakaryocytes were enriched by velocity sedimentation, followed by 6 days of incubation with 10 ng/ml TPO and 0, 1, or 10 ng/ml IFN-α2b. mrna expression of GATA1, p45nf-f2, MafG, vwf was analyzed using quantitative PCR. Yamane A et al. Blood 2008;112:
15 Ultrastructure of megakaryocytes cultured with or without IFN-α2b. (A) Ultrastructures of representative human megakaryocytes сultured with 10 ng/ml TPO, 10 ng/ml TPO + 10 ng/ml IFN-α2b, and 10 ng/ml TPO + 10 ng/ml IFN-α2b + 1 μg/ml NIP-004. Type 1 - immature megakaryocytes; Type 2 - intermediate megakaryocytes; Type 3 - fully matured megakaryocytes. The definition of each type is in Electron microscopy. Original magnification, N indicates nucleus; Dm, demarcation membranes. (B) The percentage of each type of megakaryocytes. IFN-α2b decreased type 3 megakaryocytes and increased type 2 compared with control (TPO) with statistically significant differences, indicating that IFN-α2b inhibits the development of the demarcation membrane system of megakaryocytes (*P <.05 vs TPO). NIP-004 prevented the inhibitory effects of IFN-α2b on the development of the demarcation membrane system of megakaryocytes (#P <.05 vs TPO + IFN). Yamane A et al. Blood 2008;112:
16 Mechanisms of interferon-associated bone marrow suppression JAK CYTOPENIA Аctivation of genes transcription Apo 1 Proteins translation Аро 2 FAS TNF TRAIL PK TNF ОАS PK IRF-2 EN-L Receptor Sca1 expression of bone marrow stem cells АPOPTOSIS in bone marrow stem cells Decreased proteins synthesis in haematopoiesis cells Increased production of bone marrow stem cells, their depletion Reduced production, differentiation, maturation of bone marrow cells Tovey M., Lallemand C. Pharmaceuticals, 2010 Masumi A. et al. Advances in Hematopoietic Stem Cell Research, 2012 Inhibition of factors expression: GATA1, p45, MaFg Decreased differentiation and maturation
17 Interferon-associated bone marrow suppression (with or without ribavirin) Stem cell Multipotent progenitor cell Committed progenitor cell Immature cell Mature cell 1 Cytokines and growth factors (TPO, G-CSF, EPO) Ribavirin 1. Suppression of late erythroid precursors 2. Leads to an increase in EPO release, which enhances red cell and platelet production 3. Causes alterations in the erythrocyte membrane known to be associated with erythrophagocytic extravasclar destruction and haemolysis IFN 1. Sequestration of mature cells 2. Reduced maturation and production of progenitor cells 3. Reduced secretion of growth factors 4. Enhanced secretion of cytokines, which inhabit the proliferation and maturation of progenitor cells 1 Peripheral capillary beds Shiffman M. et al. In book Advanced Therapy for Hepatitis C, 2012, P
18 EPO and TPO during therapy of chronic hepatitis C EPO (miu/ml) EOT TPO (pg/ml) EOT 4 24 IFN-a2b 5 MU TIW IFN-a2b 5 MU TIW + RBV Peg-IFN-a2a 180 мсg + RBV Peg-IFN-a2b 1,5 мсg/kg + RBV Schmid M., Kreil A., Jessner W., Homoncik M., Datz C., Gangl A., Ferenci P., Peck-Radosavljevic M. Gut, 2005
19
20 In the majority of patients treated with IFN/RBV, the decrease in Hb results from RBV-related hemolysis and IFN-related bone marrow suppression of erythroprogenitor cells, representing a mixed anemia 250 IFN may limit the ability of the bone marrow to respond to ongoing hemolysis (reticulocytes, x 103 μl) 58% 42% RBV-related hemolysis Bone marrow suppression 50 0 RBV P=0,002 IFN/RBV 4,3% P<0,001 2,4% De Franceschi L. et al. Hepatology, 2000 Rendo P. et al. Antiviral Ther, 2000 reticulocytes
21 Lowest absolute neutrophil count in patients receiving IFN or Peg-IFN combined with RBV 46% 38% 36% 16% 24% 21% 5% 8% 1% 5% Normal > 2000/mcL Grade /mcL Grade /mcL Grade /mcL Grade 4 < 500/mcL IFN/RBV Peg-IFN/RBV Fried MW et al. N Engl J Med, 2002
22 Lowest platelet count during treatment with IFN/RBV or Peg-IFN with or without RBV 88% 67% 48% 29% 8% 17% 4% 16% 10% 4% 6% 0% 0% 0% 0% Normal > /mcL Grade /mcL Grade /mcL Grade /mcL Grade 4 < 25000/mcL IFN/RBV Peg-IFN/RBV Peg-IFN Sulkowski M. Clin Liver Dis, 2005
23 CONCLUSION Antiviral therapy with interferon alfa and ribavirin induces anaemia, leucopenia and thrombocytopenia, necessitating dose reduction in some cases and discontinuation sometimes. The main mechanisms leading to cytopenia during antiviral therapy seems to be bone marrow suppression by IFN-α and red cells hemolysis by ribavirin. Suppressive action can be observed for pluripotent progenitor cells of all lineages after activation of the latent cytoplasmic signal transducers and activators of transcription, formation of a transcription complex together with IFN regulatory factors, and activation of a specific set of genes that encode the effector molecules responsible for mediating the biological activities of IFN-α. Except main bone marrow suppression, IFN-α has an immediate effect on mature circulating cells, reduces the secretion of hematopoietic growth factors and enhances secretion of cytokines, which inhibit the proliferation and maturation of bone marrow progenitor cells. Ribavirin (except main red cells haemolysis) can lead to suppression of late erythroid precursors in the bone marrow.
HIV/HCV Co-infection. HIV/HCV Co-infection. Epidemiology. Dr Ranjababu Kulasegaram Guy s & St Thomas Hospital London. Extrahepatic manifestations
HIV/HCV Co-infection Dr Ranjababu Kulasegaram Guy s & St Thomas Hospital London HIV/HCV Co-infection Epidemiology Impact of HIV on HCV Epidemiology Impact of HCV on HIV Management issues Future Extrahepatic
More informationSide effects of peginterferon and ribavirin treatment for hepatitis C and their management
Symposium Ⅲ Current and future issues in hepatitis C treatment Side effects of peginterferon and ribavirin treatment for hepatitis C and their management Seung Woon Paik Department of Medicine, Samsung
More informationManaging the hematologic side effects of antiviral therapy for chronic hepatitis C: Anemia, neutropenia, and thrombocytopenia
Managing the hematologic side effects of antiviral therapy for chronic hepatitis C: Anemia, neutropenia, and thrombocytopenia JANUS P. ONG, MD, AND ZOBAIR M. YOUNOSSI, MD, MPH ABSTRACT Hematologic abnormalities
More informationInnovazione farmacologica e farmacologia clinica
Innovazione farmacologica e farmacologia clinica Francesco Scaglione, MD, PhD Department of Medical Biotechnology and Translational Medicine School of medicine Postgradute School of clinical pharmacology
More informationPlatelet Review July 2012. Thomas S. Kickler M.D. Johns Hopkins University School of Medicine
Platelet Review July 2012 Thomas S. Kickler M.D. Johns Hopkins University School of Medicine Hemostasis Hemostasis is the process that leads to the stopping of bleeding Hemostasis involves blood vessels,
More informationGRANIX (tbo-filgrastim)
RATIONALE FOR INCLUSION IN PA PROGRAM Background Neutropenia is a hematological disorder characterized by an abnormally low number of neutrophils. A person with severe neutropenia has an absolute neutrophil
More informationHepatitis C Glossary of Terms
Acute Hepatitis C A short-term illness that usually occurs within the first six months after someone is exposed to the hepatitis C virus (HCV). 1 Antibodies Proteins produced as part of the body s immune
More informationHCV Treatment Failure
بسم االله الرحمن الرحيم HCV Treatment Failure Gamal Esmat PROF.OF HEPATOLOGY&TROPICAL MEDICINE CAIRO UNIVERSITY Director of Viral Hepatitis Treatment Centers (VHTCs( VHTCs) MOH-EGYPT www.gamalesmat.com
More informationStudy of Thrombocytopenia in Chronic Hepatitis C
Thrombocytopenia in Chronic Hepatitis C Mihai Olariu 1, Cristina Olariu 2, Dan Olteanu 2 1) National Institute of Infectious Diseases Prof. Dr. Matei Balş ; 2) University of Medicine and Pharmacy Carol
More informationManagement of hepatitis C: pre- and post-liver transplantation. Piyawat Komolmit Bangkok
Management of hepatitis C: pre- and post-liver transplantation Piyawat Komolmit Bangkok Liver transplantation and CHC Cirrhosis secondary to HCV is the leading cause of liver transplantation in the US
More informationCauses of Anemia in Patients with Heart Failure. Adriaan Voors, MD, PhD, Cardiologist Professor of Cardiology, UMC Groningen, Netherlands
Causes of Anemia in Patients with Heart Failure Adriaan Voors, MD, PhD, Cardiologist Professor of Cardiology, UMC Groningen, Netherlands Background Anemia is common in patients with CHF Prevalence 15 55%
More informationPeg-IFN and ribavirin: what sustained virologic response can be achieved by using HCV genotyping and viral kinetics?
Peg-IFN and ribavirin: what sustained virologic response can be achieved by using HCV genotyping and viral kinetics? Prof. I. Bakulin Gastroenterology Department Key Questions Background Worldwide prevalence
More informationManaging Treatment Naive Pa/ents in the DAA Era. An Interac/ve Case study
Managing Treatment Naive Pa/ents in the DAA Era. An Interac/ve Case study Case Prepared by Sinēad Sheils CNC Royal Prince Alfred Hospital, Sydney Friday 17 th May 2013 Nigel 63 yrs old caucasian male HCV
More informationHCV Case Study. Optimizing Outcomes with Current Therapies
HCV Case Study Optimizing Outcomes with Current Therapies This program is supported by educational grants from Kadmon and Merck Pharmaceuticals. Program Disclosure This activity has been planned and implemented
More informationHematology Morphology Critique
Survey Slide: History: 60-year-old female presenting with pneumonia Further Laboratory Data: Hgb : 90 g/l RBC : 2.92 10 12 /L Hct : 0.25 L/L MCV : 87 fl MCH : 30.8 pg MCHC : 355 g/l RDW : 17.7 % WBC :
More informationWhat Does My Bone Marrow Do?
What Does My Bone Marrow Do? the myelodysplastic syndromes foundation, inc. Illustrations by Kirk Moldoff Published by The Myelodysplastic Syndromes Foundation, Inc. First Edition, 2009. 2012. Table of
More informationBoehringer Ingelheim- sponsored Satellite Symposium. HCV Beyond the Liver
Boehringer Ingelheim- sponsored Satellite Symposium HCV Beyond the Liver HCV AS A METABOLIC MODIFIER: STEATOSIS AND INSULIN RESISTANCE Francesco Negro University Hospital of Geneva Switzerland Clinical
More informationHIV/Hepatitis C co-infection. Update on treatment Eoin Feeney
HIV/Hepatitis C co-infection Update on treatment Eoin Feeney HIV/Hepatitis C coinfection Where we are now Current treatment regimens and outcomes What s coming soon Direct acting antivirals (DAAs) What
More informationPHARMACY PRIOR AUTHORIZATION
PHARMACY PRIOR AUTHORIZATION Hepatitis C Clinical Guideline Harvoni (sofosbuvir/ledipasvir), Sovaldi (sofosbuvir), Viekira PAK (ombitsavir, paritapravir/ritonavir, dasubavir), and Olysio (simeprevir) Authorization
More informationSIDE EFFECTS PROFILE OF THERAPY FOR CHRONIC HEPATITIS C AND THEIR MANAGEMENT
ORIGINAL ARTICLE, Print) July 2011, Vol. 19, No. 3: 133-137 SIDE EFFECTS PROFILE OF THERAPY FOR CHRONIC HEPATITIS C AND THEIR MANAGEMENT Wazir Muhammad Khan 1, Iqbal Haider 1, Zahid Marwat 1, Iftikhar
More informationAND AND. c. Hgb < 10 g/dl or are symptomatic and have Hgb <11 g/dl.** AND
Recombinant Erythropoietin Criteria for Use VHA Pharmacy Benefits Management Strategic Healthcare Group and Medical Advisory Panel Prepared by: K. Tortorice, PharmD BCPS, H. Yee Pharm D BCPS,E. Bini MD,
More informationThe immune system. Bone marrow. Thymus. Spleen. Bone marrow. NK cell. B-cell. T-cell. Basophil Neutrophil. Eosinophil. Myeloid progenitor
The immune system Basophil Neutrophil Bone marrow Eosinophil Myeloid progenitor Dendritic cell Pluripotent Stem cell Lymphoid progenitor Platelets Bone marrow Thymus NK cell T-cell B-cell Spleen Cancer
More informationCirrhosis and HCV. Jonathan Israel M.D.
Cirrhosis and HCV Jonathan Israel M.D. Outline Relationship of fibrosis and cirrhosisprevalence and epidemiology. Sequelae of cirrhosis Diagnosis of cirrhosis Effect of cirrhosis on efficacy of treatment
More informationLong-term Results of Pegylated Interferon alfa-2a and Tenofovir for Hepatitis B
Long-term Results of Pegylated Interferon alfa-2a and Tenofovir for Hepatitis B Patrick Marcellin Viral Hepatitis Research Center Hôpital Beaujon, University of Paris France OBJECTIVES OF THERAPY IN CHRONIC
More informationHepatitis C Monitoring and Complications (and Treatment!) Dr Mark Douglas
Hepatitis C Monitoring and Complications (and Treatment!) Dr Mark Douglas Hepatitis C Virus Shimizu et al., 1996 Positive single strand RNA virus Flaviviridae family, Hepacivirus genus 9.6 kbp genome ~3000
More informationCardiovascular System. Blood Components
Cardiovascular System Blood Components 1 Components of Blood Formed elements: erythrocytes, leukocytes, platelets Plasma: water, proteins, other solutes The components of blood can be divided into two
More informationLeukemias and Lymphomas: A primer
Leukemias and Lymphomas: A primer Normal blood contains circulating white blood cells, red blood cells and platelets 700 red cells (oxygen) 1 white cell Neutrophils (60%) bacterial infection Lymphocytes
More informationAntiviral treatment for cirrhosis due to hepatitis C: a review
Singapore Med J 2012; 53(4) : 231 Antiviral treatment for cirrhosis due to hepatitis C: a review Aravindh Somasundaram 1, MD, Jayanthi Venkataraman 1, MD, DM ABSTRACT Chronic hepatitis C infection is an
More informationRibavirin/Pegylated Interferon Combination Therapy for People with Hepatitis C
Ribavirin/Pegylated Combination Therapy for People with Hepatitis C 1. Introduction 2. What the treatment does 3. When to take it 4. What is? 5. What is interferon? 6. What is pegylated interferon? 7.
More informationPRIOR AUTHORIZATION PROTOCOL FOR HEPATITIS C TREATMENT
PRIOR AUTHORIZATION PROTOCOL FOR HEPATITIS C TREATMENT HARVONI (90mg ledipasvir/400mg sofosbuvir): tablet (PREFERRED AGENT) SOVALDI (sofosbuvir ): 400mg tablets (PREFERRED AGENT ) OLYSIO (simeprivir) PEG-INTRON
More informationHCV in 2020: Any cases left? Rafael Esteban Hospital General Universitario Valle Hebron Barcelona. Spain
HCV in 2020: Any cases left? Rafael Esteban Hospital General Universitario Valle Hebron Barcelona. Spain Yes, still too many Measures to eradicate an Infectious Disease Prevention: Vaccination Screening
More informationLaboratory Studies in the Diagnosis of Iron Deficiency, Latent Iron Deficiency and Iron Deficient Erythropoiesis
Laboratory Studies in the Diagnosis of Iron Deficiency, Latent Iron Deficiency and Iron Deficient Erythropoiesis General Comments The laboratory studies listed below are helpful in the diagnosis and management
More informationThe following should be current within the past 6 months:
EVALUATION Baseline Labs Obtain at time or prior to initial evaluation CBC with diff PT/INR CMP HCV Genotype (obtained PRIOR TO consult visit) HCV RNA (obtained PRIOR TO consult visit) Hep A IgG Hep BsAg,
More informationSTEM CELL FELLOWSHIP
Module I: The Basic Principles of Stem Cells 1. Basics of Stem Cells a. Understanding the development of embryonic stem cells i. Embryonic stem cells ii. Embryonic germ cells iii. Differentiated stem cell
More informationRobert G. Knodell, M.D. Maryland Chapter, American College of Physicians Fb February 3, 2012
Treatment of Hepatitis C:Present and Future Robert G. Knodell, M.D. Scientific Meeting Maryland Chapter, American College of Physicians Fb February 3, 2012 Presentation Objectives Appreciate the Public
More informationPatients with HCV and F1 and F2 fibrosis stage: treat now or wait?
Liver International ISSN 1478-3223 REVIEW ARTICLE Patients with HCV and F1 and F2 fibrosis stage: treat now or wait? Mitchell L. Shiffman 1 and Yves Benhamou 2 1 Liver Institute of Virginia, Bon Secours
More informationB Cells and Antibodies
B Cells and Antibodies Andrew Lichtman, MD PhD Brigham and Women's Hospital Harvard Medical School Lecture outline Functions of antibodies B cell activation; the role of helper T cells in antibody production
More informationThyroid pathology in the Presence of antiviral treatment of chronic hepatitis C. Professor Nikitin Igor G Russian State Medical University MOSCOW
Thyroid pathology in the Presence of antiviral treatment of chronic hepatitis C Professor Nikitin Igor G Russian State Medical University MOSCOW The structure of the side effects associated with antiviral
More informationIntroduction. About 10,500 new cases of acute myelogenous leukemia are diagnosed each
Introduction 1.1 Introduction: About 10,500 new cases of acute myelogenous leukemia are diagnosed each year in the United States (Hope et al., 2003). Acute myelogenous leukemia has several names, including
More information17/01/14. What are special patient groups? Management of hepatitis C in special patient groups. Management of hepatitis C in
Management of hepatitis C in special patient groups Minisymposium Challenges in viral hepatitis 14 Lausanne 16.1.14 B. Müllhaupt Gastroenterology and Hepatology Swiss HPB- and Transplant-Center University
More informationMonitoring of Treatment of viral hepatitis C
Monitoring of Treatment of viral hepatitis C J.Boubaker Department of Gastroenterology La Rabta hospital Tunis-Tunisia Monitoring of Hepatitis C Treatment Aims of Monitoring : Evaluate Efficacy. Detect
More informationB Cell Generation, Activation & Differentiation. B cell maturation
B Cell Generation, Activation & Differentiation Naïve B cells- have not encountered Ag. Have IgM and IgD on cell surface : have same binding VDJ regions but different constant region leaves bone marrow
More informationRecognition of T cell epitopes (Abbas Chapter 6)
Recognition of T cell epitopes (Abbas Chapter 6) Functions of different APCs (Abbas Chapter 6)!!! Directon Routes of antigen entry (Abbas Chapter 6) Flow of Information Barrier APCs LNs Sequence of Events
More informationStem Cell Transplantation In Patients with Fanconi Anemia
Stem Cell Transplantation In Patients with Fanconi Anemia FARF Annual Family Meeting 6/28/15 Casco, ME Parinda A. Mehta, M.D. Cincinnati Children s Hospital Medical Center Improvements in Unrelated Donor
More informationSafety and Efficacy of DAA + PR in HCV/HIV co-infected patients. Mark Sulkowski, MD Johns Hopkins University Baltimore Maryland USA
Safety and Efficacy of DAA + PR in HCV/HIV co-infected patients Mark Sulkowski, MD Johns Hopkins University Baltimore Maryland USA Liver disease is the second leading cause of death amongst HIV-positive
More informationAcute HCV was defined as (3 out of 4 within the preceding 4 months):
Christoph Boesecke, Patrick Ingiliz, Hans-Jürgen Stellbrink, Mark Nelson, Sanjay Bhagani, Marguerite Guiguet, Marc-Antoine Valantin, Thomas Reiberger, Martin Vogel, Jürgen K. Rockstroh, and the NEAT study
More informationBlood Sticky, opaque fluid with a metallic taste (Fe 2+ ) Varies from scarlet (P O2 = 100) to dark red (P O2 = 40) ph is between 7.35 and 7.45 Average volume in an adult is 5 L (7% of body weight) 2 L
More informationDE VERSCHILLENDE ANTIVIRALE MIDDELEN EN HUN WERKINGSMECHANISME
DE VERSCHILLENDE ANTIVIRALE MIDDELEN EN HUN WERKINGSMECHANISME Johan Neyts Rega Institute for Medical Research, University of Leuven, Belgium Johan.neyts@rega.kuleuven.be www.antivirals.be Pentalfa, 28
More informationT Cell Maturation,Activation and Differentiation
T Cell Maturation,Activation and Differentiation Positive Selection- In thymus, permits survival of only those T cells whose TCRs recognize self- MHC molecules (self-mhc restriction) Negative Selection-
More informationHepatitis Update. Study 110: SVR at post-treatment week 24 (SVR24) Jürgen Rockstroh, MD. No ART EFV/TDF/FTC ART/r/TDF/FTC Total
Hepatitis Update Jürgen Rockstroh, MD Study 11: SVR at post-treatment week 24 (SVR24) Patients with Undetectable HCV RNA (Percentage) 8 7 6 5 4 3 2 1 71 No ART EFV/TDF/FTC ART/r/TDF/FTC Total 69 8 74 n/n
More informationDrug Development Services
Drug Development Services USING BLOOD AND BONE MARROW PRIMARY CELL SYSTEMS Clinically Relevant In Vitro Assays Broad Spectrum of Drug Classes Multi-Species Platforms Enhancing Drug Development through
More informationA combined model of human erythropoiesis and granulopoiesis under growth factor and chemotherapy treatment
Schirm et al. Theoretical Biology and Medical Modelling 2014, 11:24 Research Open Access A combined model of human erythropoiesis and granulopoiesis under growth factor and chemotherapy treatment Sibylle
More informationAdult Medical-Surgical Nursing H A E M A T O L O G Y M O D U L E : L E U K A E M I A 2
Adult Medical-Surgical Nursing H A E M A T O L O G Y M O D U L E : L E U K A E M I A 2 Leukaemia: Description A group of malignant disorders affecting: White blood cells (lymphocytes or leucocytes) Bone
More informationControversies in the management of patients with PMF 0/1
State of the art treatments of patients with MPNs Turracher Höhe 2010 Controversies in the management of patients with PMF 0/1 Heinz Gisslinger Medical University of Vienna Divison for Hematology, Vienna
More informationAn overview of CLL care and treatment. Dr Dean Smith Haematology Consultant City Hospital Nottingham
An overview of CLL care and treatment Dr Dean Smith Haematology Consultant City Hospital Nottingham What is CLL? CLL (Chronic Lymphocytic Leukaemia) is a type of cancer in which the bone marrow makes too
More informationBLOOD-Chp. Chp.. 6 What are the functions of blood? What is the composition of blood? 3 major types of plasma proteins
6.1 Blood: An overview BLOOD-Chp Chp.. 6 What are the functions of blood? Transportation: oxygen, nutrients, wastes, carbon dioxide and hormones Defense: against invasion by pathogens Regulatory functions:
More informationCollect and label sample according to standard protocols. Gently invert tube 8-10 times immediately after draw. DO NOT SHAKE. Do not centrifuge.
Complete Blood Count CPT Code: CBC with Differential: 85025 CBC without Differential: 85027 Order Code: CBC with Differential: C915 Includes: White blood cell, Red blood cell, Hematocrit, Hemoglobin, MCV,
More informationEmerging Direct-Acting Antivirals for Treatment of Chronic Hepatitis C
Emerging Direct-Acting Antivirals for Treatment of Chronic Hepatitis C Debra Birnkrant, MD Director, DAVP DILI Conference March 20, 2013 1 HCV in the United States 3 to 4 million people have chronic HCV
More informationReview article: the management of side-effects during therapy for hepatitis C
Aliment Pharmacol Ther 24; 2: 917 929. doi: 1.1111/j.1365-236.24.2192.x Review article: the management of side-effects during therapy for hepatitis C R. J. ASPINALL & P. J. POCKROS Division of Gastroenterology/Hepatology,
More informationDisclosure of Conflicts of Interest Learner Assurance Statement:
Raj Reddy, MD Ruimy Family President's Distinguished Professor of Medicine Professor of Medicine in Surgery Director of Hepatology Director, Viral Hepatitis Center Medical Director, Liver Transplantation
More informationTreatment Options for Hepatitis C in the Post Transplant Patient
Treatment Options for Hepatitis C in the Post Transplant Patient Caroline Rochon, MD, FACS,FRCSC Transplant and Hepatobiliary Surgery Hartford Hospital Assistant Professor of Surgery, University of Connecticut
More informationUNDERSTANDING MULTIPLE MYELOMA AND LABORATORY VALUES Benjamin Parsons, DO bmparson@gundersenhealth.org Gundersen Health System Center for Cancer and
UNDERSTANDING MULTIPLE MYELOMA AND LABORATORY VALUES Benjamin Parsons, DO bmparson@gundersenhealth.org Gundersen Health System Center for Cancer and Blood Disorders La Crosse, WI UNDERSTANDING MULTIPLE
More informationNew treatment options for HCV: implications for the Optimal Use of HCV Assays
New treatment options for HCV: implications for the Optimal Use of HCV Assays Hans Orlent Dept. of Gastroenterology & Hepatology AZ Sint Jan Brugge-Oostende, Brugge This program is supported by educational
More informationMEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES. I. Requirements for Prior Authorization of Hepatitis C Agents
MEDICAL ASSISTANCE HBOOK PRI AUTHIZATION OF PHARMACEUTICAL SERVICES I. Requirements for Prior Authorization of Hepatitis C Agents A. Prescriptions That Require Prior Authorization Prescriptions for Interferon,
More informationOverview. Transcriptional cascades. Amazing aspects of lineage plasticity. Conventional (B2) B cell development
Overview B cell development Transcriptional cascades Amazing aspects of lineage plasticity Conventional (B2) B cell development What happens to an autoreactive B cell? B1 vs B2 cells Key anatomical sites
More informationHepatitis C Treatment: Tailoring Therapy To Maximize Response
PRINTER-FRIENDLY VERSION AT GASTROENDONEWS.COM Hepatitis C Treatment: Tailoring Therapy To Maximize Response PATRICK J. AMAR, MD Department of Gastroenterology and Hepatology Holy Cross Medical Group Fort
More informationStem cells possess 2 main characteristics: Sources of pluripotent stem cells: -Long-term self renewal. -The inner cell mass of the blastocyst.
Stem cells possess 2 main characteristics: -Long-term self renewal. - They give rise to all types of differentiate cells. Sources of pluripotent stem cells: -The inner cell mass of the blastocyst. - Fetal
More informationDebate: To Treat Now or Not to Treat Now. Age, Disease Stage, Resistance, and Comorbidities
Debate: To Treat Now or Not to Treat Now Age, Disease Stage, Resistance, and Comorbidities Moderator: Raymond T. Chung, MD Associate Professor of Medicine, Harvard Medical School Director of Hepatology
More informationMedical publications on HBV and HCV Coinfection
Recent advances of HBV and HCV co-infection 台 中 榮 總 內 科 部 胃 腸 肝 膽 科 呂 宜 達 醫 師 2013.03.28 Outline Epidemiology of HBV and HCV coinfection Clinical significance of HBV and HCV coinfection Interplay between
More informationguides BIOLOGY OF AGING STEM CELLS An introduction to aging science brought to you by the American Federation for Aging Research
infoaging guides BIOLOGY OF AGING STEM CELLS An introduction to aging science brought to you by the American Federation for Aging Research WHAT ARE STEM CELLS? Stem cells are cells that, in cell cultures
More informationUnderstanding West Nile Virus Infection
Understanding West Nile Virus Infection The QIAGEN Bioinformatics Solution: Biomedical Genomics Workbench (BXWB) + Ingenuity Pathway Analysis (IPA) Functional Genomics & Predictive Medicine, May 21-22,
More informationBlood. Functions of Blood. Components of Blood. Transporting. Distributing body heat. A type of connective tissue. Formed elements.
Blood Functions of Blood Transporting nutrients respiratory gases waste products Distributing body heat Components of Blood A type of connective tissue Formed elements Living blood cells Plasma Nonliving
More informationStem Cell Transplantation
Harmony Behavioral Health, Inc. Harmony Behavioral Health of Florida, Inc. Harmony Health Plan of Illinois, Inc. HealthEase of Florida, Inc. Ohana Health Plan, a plan offered by WellCare Health Insurance
More information3. The Circulatory System
3. The Circulatory System A. Introduction B. Blood 1. Circulatory system transports water, electrolytes, hormones, enzymes, antibodies, cell, gases and nutrients to all cells and carries away metabolic
More informationAnti-HCV therapy in HCV-related NHL
Gabriele Pozzato M.D. University of Trieste Anti-HCV therapy in HCV-related NHL Questions about HCV+ in NHL Is the NHL related with HCV infection? Which is the best therapeutic strategy? Is the antiviral
More informationWeek 12 study results
Week 12 study results 15 April 2015 Copyright 2015 Galapagos NV Disclaimer This document may contain certain statements, including forward-looking statements, such as statements concerning the safety and
More informationOZONE THERAPY IN PATIENTS WITH VIRAL HEPATITIS C A CLINICAL STUDY
OZONE THERAPY IN PATIENTS WITH VIRAL HEPATITIS C A CLINICAL STUDY By Prof. Dr. Mohamed Nabil Mawsouf*, **, Dr. Taha Tarek Tanbouli**& Dr.Wagdy Ibrahim El-Tayar** * Cancer Institute, Cairo University **
More informationWhat to Do with the Patient With Abnormal Liver Enzymes? Nizar N. Zein, M.D. The Cleveland Clinic
What to Do with the Patient With Abnormal Liver Enzymes? Nizar N. Zein, M.D. The Cleveland Clinic Introduction Elevated liver enzymes is often not a clinical problem by itself. However it is a warning
More informationCurrent Opinion in Hepatitis C Treatment
White Nights of Hepatology 2011 Current Opinion in Hepatitis C Treatment George V. Papatheodoridis, MD Associate Professor in Medicine & Gastroenterology 2nd Department of Internal Medicine, Athens University
More informationBlood & Marrow Transplant Glossary. Pediatric Blood and Marrow Transplant Program Patient Guide
Blood & Marrow Transplant Glossary Pediatric Blood and Marrow Transplant Program Patient Guide Glossary Absolute Neutrophil Count (ANC) -- Also called "absolute granulocyte count" amount of white blood
More informationImmunological studies, fibrosis and oxidative stress
Pathogenesis of hepatitis C virus (HCV) infection: role of genetic, immunologic and environmental factors in HCV-related liver disease and in symptomfree HCV carriers. Hepatitis C virus (HCV) infection
More informationNewton Kendig, MD RADM, Assistant Surgeon General, USPHS Assistant Director Health Services Division, FBOP
Newton Kendig, MD RADM, Assistant Surgeon General, USPHS Assistant Director Health Services Division, FBOP I do not have any relevant financial relationships with any commercial interests. At the end of
More informationBiotechnology. Srivatsan Kidambi, Ph.D.
Stem Stem Cell Cell Engineering-What, Biology and it Application Why, How?? to Biotechnology Srivatsan Kidambi, Ph.D. Assistant Professor Department of Chemical & Biomolecular Engineering University of
More informationFunctions of Blood. Collects O 2 from lungs, nutrients from digestive tract, and waste products from tissues Helps maintain homeostasis
Blood Objectives Describe the functions of blood Describe blood plasma Explain the functions of red blood cells, white blood cells, and platelets Summarize the process of blood clotting What is Blood?
More informationMEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES. I. Requirements for Prior Authorization of Hepatitis C Agents
MEDICAL ASSISTANCE HBOOK I. Requirements for Prior Authorization of Hepatitis C Agents A. Prescriptions That Require Prior Authorization Prescriptions for Hepatitis C Agents that meet any of the following
More informationPrior Authorization Policy
Prior Authorization Policy http://www.paramounthealthcare.com/providers Ribavirin Rebetol (ribavirin capsule or oral solution) Copegus (ribavirin tablet), Moderiba (ribavirin tablet), Ribasphere (ribavirin
More informationCD34+ CD45- Cells Isolated from Human Blood Have Molecular and Functional Characteristics of Vascular Endothelial Progenitors
CD34+ CD45- Cells Isolated from Human Blood Have Molecular and Functional Characteristics of Vascular Endothelial Progenitors Yajuan Jiang 1, Alexander M. Tsankov 2, Alexander Meissner 2 and David W. O
More informationAutoimmunity and immunemediated. FOCiS. Lecture outline
1 Autoimmunity and immunemediated inflammatory diseases Abul K. Abbas, MD UCSF FOCiS 2 Lecture outline Pathogenesis of autoimmunity: why selftolerance fails Genetics of autoimmune diseases Therapeutic
More informationBlood. Blood. Blood Composition. Blood Composition. Fractionation & Hemopoesis
Blood Blood Chapter 19 Blood is a specialized fluid connective tissue that contains cells suspended in a fluid matrix Functions of blood include: Transport of dissolved gases, nutrients, hormones and metabolic
More informationHepatitis C Treatment Expansion Initiative Multi-Site Conference Call. March 16, 2011
Hepatitis C Treatment Expansion Initiative Multi-Site Conference Call March 16, 2011 Case Presentations Kansas City Free Health Clinic Carilion Clinic Didactic Session Challenges in Determining HCV Treatment
More informationANIMALS FORM & FUNCTION BODY DEFENSES NONSPECIFIC DEFENSES PHYSICAL BARRIERS PHAGOCYTES. Animals Form & Function Activity #4 page 1
AP BIOLOGY ANIMALS FORM & FUNCTION ACTIVITY #4 NAME DATE HOUR BODY DEFENSES NONSPECIFIC DEFENSES PHYSICAL BARRIERS PHAGOCYTES Animals Form & Function Activity #4 page 1 INFLAMMATORY RESPONSE ANTIMICROBIAL
More informationNjeri Thande. 2 ND YEAR RESEARCH ELECTIVE RESIDENT S JOURNAL Volume X 2005-2006. A. Study Purpose and Rationale
Etanercept as an adjuvant to pegylated interferon alpha and ribavirin in treatment-naive patients with chronic hepatitis C virus infection: a randomized, double-blind, placebocontrolled study Njeri Thande
More informationHepatitis C. Laboratory Tests and Hepatitis C
Hepatitis C Laboratory Tests and Hepatitis C If you have hepatitis C, your doctor will use laboratory tests to check your health. This handout will help you understand what the major tests are and what
More informationUnit 1 Higher Human Biology Summary Notes
Unit 1 Higher Human Biology Summary Notes a. Cells tissues organs body systems Division of labour occurs in multicellular organisms (rather than each cell carrying out every function) Most cells become
More informationHCV treatment today: pegylated interferons and ribavirin
HCV treatment today: pegylated interferons and ribavirin Other special patient populations Patients with cirrhosis Higher SVR rates are achieved in patients without cirrhosis Patients without bridging
More informationLA TERAPIA PER HBV ed HCV Differenze di Genere? Alfredo Alberti. Dipartimento di Medicina Molecolare UOC Medicina Generale VIMM Università di Padova
LA TERAPIA PER HBV ed HCV Differenze di Genere? Alfredo Alberti Dipartimento di Medicina Molecolare UOC Medicina Generale VIMM Università di Padova HBV ed HCV Due virus Diversi ma con molte Cose in Comune
More informationspecific B cells Humoral immunity lymphocytes antibodies B cells bone marrow Cell-mediated immunity: T cells antibodies proteins
Adaptive Immunity Chapter 17: Adaptive (specific) Immunity Bio 139 Dr. Amy Rogers Host defenses that are specific to a particular infectious agent Can be innate or genetic for humans as a group: most microbes
More informationTEMA 10. REACCIONES INMUNITARIAS MEDIADAS POR CÉLULAS.
TEMA 10. REACCIONES INMUNITARIAS MEDIADAS POR CÉLULAS. The nomenclature of cytokines partly reflects their first-described function and also the order of their discovery. There is no single unified nomenclature,
More informationHow To Expand Hematopoietic Stem Cells
Purification and Expansion of Hematopoietic Stem Cells Based on Proteins Expressed by a Novel Stromal Cell Population Our bodies are constantly killing old, nonfunctional, and unneeded cells and making
More informationUpdate on hepatitis C: treatment and care and future directions
Update on hepatitis C: treatment and care and future directions Professor Greg Dore Viral Hepatitis Clinical Research Program, National Centre in HIV Epidemiology and Clinical Research, University of New
More information