122 results on '"Anand Rotte"'
Search Results
2. Dose fractionation of CAR-T cells. A systematic review of clinical outcomes
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Matthew Frigault, Anand Rotte, Ayub Ansari, Bradford Gliner, Christopher Heery, and Bijal Shah
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CAR-T cells ,Dose ,Efficacy ,Safety ,Tumor burden ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract CAR-T cells are widely recognized for their potential to successfully treat hematologic cancers and provide durable response. However, severe adverse events such as cytokine release syndrome (CRS) and neurotoxicity are concerning. Our goal is to assess CAR-T cell clinical trial publications to address the question of whether administration of CAR-T cells as dose fractions reduces toxicity without adversely affecting efficacy. Systematic literature review of studies published between January 2010 and May 2022 was performed on PubMed and Embase to search clinical studies that evaluated CAR-T cells for hematologic cancers. Studies published in English were considered. Studies in children (age
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- 2023
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3. Dose–response correlation for CAR-T cells: a systematic review of clinical studies
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Christopher Heery, Matthew J Frigault, Bijal Shah, Anand Rotte, Ayub Ansari, and Brad Gliner
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Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
The potential of chimeric antigen receptor (CAR) T cells to successfully treat hematological cancers is widely recognized. Multiple CAR-T cell therapies are currently under clinical development, with most in early stage, during which dose selection is a key goal. The objective of this review is to address the question of dose-dependent effects on response and/or toxicity from available CAR-T cell clinical trial data. For that purpose, systematic literature review of studies published between January 2010 and May 2022 was performed on PubMed and Embase to search clinical studies that evaluated CAR-T cells for hematological cancers. Studies published in English were considered. Studies in children (age 1 patient at each dose level. Thirteen studies observed dose-related increase in disease response and 23 studies observed dose-related increase in toxicity across a median of three dose levels. Optimal clinical efficacy was seen at doses 50–100 million cells for anti-CD19 CAR-T cells and >100 million cells for anti-BCMA CAR-T cells in majority of studies. The findings suggest, for a given construct, there exists a dose at which a threshold of optimal efficacy occurs. Dose escalation may reveal increasing objective response rates (ORRs) until that threshold is reached. However, when ORR starts to plateau despite increasing dose, further dose escalation is unlikely to result in improved ORR but is likely to result in higher incidence and/or severity of mechanistically related adverse events.
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- 2022
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4. Pharmacology-based ranking of anti-cancer drugs to guide clinical development of cancer immunotherapy combinations
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Vincent Lemaire, Colby S. Shemesh, and Anand Rotte
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Clinical trials ,Cancer immunotherapy ,Combination development ,Cancer ,Pharmacology ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract The success of antibodies targeting Programmed cell death protein 1 (PD-1) and its ligand L1 (PD-L1) in cancer treatment and the need for improving response rates has led to an increased demand for the development of combination therapies with anti-PD-1/PD-L1 blockers as a backbone. As more and more drugs with translational potential are identified, the number of clinical trials evaluating combinations has increased considerably and the demand to prioritize combinations having potential for success over the ones that are unlikely to be successful is rising. This review aims to address the unmet need to prioritize cancer immunotherapy combinations through comprehensive search of potential drugs and ranking them based on their mechanism of action, clinical efficacy and safety. As lung cancer is one of the most frequently studied cancer types, combinations that showed potential for the treatment of lung cancer were prioritized. A literature search was performed to identify drugs with potential in combination with PD-1/PD-L1 blockers and the drugs were ranked based on their mechanism of action and known clinical efficacy. Nineteen drugs or drug classes were identified from an internal list of lead molecules and were scored for their clinical potential. Efficacy and safety data from pivotal studies was summarized for the selected drugs. Further, overlap of mechanisms of action and adverse events was visualized using a heat map illustration to help screen drugs for combinations. The quantitative scoring methodology provided in this review could serve as a template for preliminary ranking of novel combinations.
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- 2021
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5. Amelioration of lower limb pain and foot drop with 10 kHz spinal cord stimulation: A case series
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Honghui Feng, Patrick Doherty, Anand Rotte, and Christopher Bovinet
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Medicine (General) ,R5-920 - Abstract
There are limited treatment options for patients with foot drop and associated lower back and/or leg pain. We present a case series of three patients who received permanent implantation of 10 kHz spinal cord stimulation (10 kHz SCS) devices. Following treatment, all patients reported sustained improvements in lower back and leg pain, foot mechanics and function which resulted in increased mobility and cessation of opioid use for pain management. Patients were followed up for approximately four years. Treatment with 10 kHz SCS may be a promising alternative to other interventional procedures commonly used for these patients.
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- 2021
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6. Combination of CTLA-4 and PD-1 blockers for treatment of cancer
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Anand Rotte
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Immunotherapy ,CTLA-4 ,PD-1 ,Combination therapy ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Targeting checkpoints of immune cell activation has been demonstrated to be the most effective approach for activation of anti-tumor immune responses. Cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death protein 1 (PD-1), both inhibitory checkpoints commonly seen on activated T-cells have been found to be the most reliable targets for the treatment of cancer. Six drugs targeting PD-1 or its ligand PD-L1 and one drug targeting CTLA-4 have been approved for treatment of different types of cancers and several others are in advanced stages of development. The drugs when administered as monotherapy had dramatic increase in durable response rates and had manageable safety profile, but more than 50% of patients failed to respond to treatment. Combination of CTLA-4 and PD-1 blockers was then evaluated to increase the response rates in patients, and ipilimumab (anti-CTLA-4) plus nivolumab (anti-PD-1) combination was shown to significantly enhance efficacy in metastatic melanoma patients. Subsequently, ipilimumab plus nivolumab was approved for treatment of metastatic melanoma, advanced renal cell carcinoma and metastatic colorectal cancer with MMR/MSI-H aberrations. The success of combination encouraged multiple clinical studies in other cancer types. Efficacy of the combination has been shown in a number of published studies and is under evaluation in multiple ongoing studies. This review aims to support future research in combination immunotherapy by discussing the basic details of CTLA-4 and PD-1 pathways and the results from clinical studies that evaluated combination of CTLA-4 and PD-1/PD-L1 blockers.
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- 2019
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7. A Retrospective Review of Lead Migration Rate in Patients Permanently Implanted with Percutaneous Leads and a 10 kHz SCS Device
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Mayank Gupta, Alaa Abd-Elsayed, Meghan Hughes, and Anand Rotte
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Medicine (General) ,R5-920 - Abstract
Background. Spinal cord stimulation (SCS) has been used over decades for pain management, but migration of percutaneous leads has been the most common complication. Better surgical techniques and newer SCS technologies likely reduced the incidence of lead migration requiring surgical revision, although data are sparse. This study aimed to retrospectively evaluate the incidence of clinically significant percutaneous lead migration in patients permanently implanted with a 10 kHz SCS system. Methods. Consecutive patients with chronic trunk and/or limb pain, permanently implanted between January 2016 and June 2019, were included in the analysis. Data were collected from the hospital’s electronic medical records and the manufacturer’s database. Clinically significant lead migration, defined as diminished pain relief followed by surgery to correct lead location, was assessed at the 6-month follow-up. Results. At the 6-month follow-up, there were no cases of clinically significant lead migration, average pain relief was 65.2%, 82% of patients had response (≥50% pain relief), improvement of function was noted in 72% of patients, and decrease of medication was observed in 42% of patients. Therapy efficacy was sustained in patients with >12 months follow-up; the average pain relief was 58.5%, and the response rate was 82%. Conclusions. The surgical techniques in use today are designed to minimise the risk of percutaneous lead migration and may have reduced its incidence. In addition, new SCS systems may give greater opportunity to mitigate cases of minor lead movement using alternative stimulation programs.
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- 2021
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8. Concept of the Number Needed to Treat for the Analysis of Pain Relief Outcomes in Patients Treated with Spinal Cord Stimulation
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Ashley Bailey-Classen, Amar Parikh, Nima Adimi, Deborah Edgar, Alice Yan, Anand Rotte, and David Caraway
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NNT ,SCS ,pain relief ,back pain ,Biology (General) ,QH301-705.5 - Abstract
In the rapidly evolving field of spinal cord stimulation (SCS), measures of treatment effects are needed to help understand the benefits of new therapies. The present article elaborates the number needed to treat (NNT) concept and applies it to the SCS field. We reviewed the basic theory of the NNT, its calculation method, and its application to historical controlled trials of SCS. We searched the literature for controlled studies with ≥20 implanted SCS patients with chronic axial back and/or leg pain followed for ≥3 months and a reported responder rate defined as ≥50% pain relief. Relevant data necessary to estimate the NNT were extracted from the included articles. In total, 12 of 1616 records were eligible for inclusion. The records reported 10 clinical studies, including 7 randomized controlled trials, 2 randomized crossover trials, and 1 controlled cohort study. The studies investigated traditional SCS and more recently developed SCS modalities, including 10 kHz SCS. In conclusion, the NNT estimate may help SCS stakeholders better understand the effect size difference between compared treatments; however, interpretation of any NNT should take into account its full context. In addition, comparisons across trials of different therapies should be avoided since they are prone to interpretation biases.
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- 2022
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9. Targeting TIGIT for Immunotherapy of Cancer: Update on Clinical Development
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Anand Rotte, Srikumar Sahasranaman, and Nageshwar Budha
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TIGIT ,immune checkpoints ,immunotherapy and cancer ,Biology (General) ,QH301-705.5 - Abstract
Immune checkpoint blockers have dramatically improved the chances of survival in patients with metastatic cancer, but only a subset of the patients respond to treatment. Search for novel targets that can improve the responder rates and overcome the limitations of adverse events commonly seen with combination therapies, like PD-1 plus CTLA-4 blockade and PD-1/PD-L1 plus chemotherapy, led to the development of monoclonal antibodies blocking T-cell immunoglobulin and ITIM domain (TIGIT), a inhibitory checkpoint receptor expressed on activated T cells and NK cells. The strategy showed potential in pre-clinical and early clinical studies, and 5 molecules are now in advanced stages of evaluation (phase II and above). This review aims to provide an overview of clinical development of anti-TIGIT antibodies and describes the factors considered and thought process during early clinical development. Critical aspects that can decide the fate of clinical programs, such as origin of the antibody, Ig isotype, FCγR binding, and the dose as well as dosing schedule, are discussed along with the summary of available efficacy and safety data from clinical studies and the challenges in the development of anti-TIGIT antibodies, such as identifying patients who can benefit from therapy and getting payer coverage.
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- 2021
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10. Nobel committee honors tumor immunologists
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Anand Rotte, Gabriella D’Orazi, and Madhuri Bhandaru
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Immunotherapy ,Immune checkpoints ,CTLA-4 ,PD-1 ,PD-L1 ,Anti-tumor immune response ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract This commentary wishes to highlight the 2018 Nobel Prize in Medicine awarded to two cancer immunotherapy scientists, Prof James Allison and Prof Tasuku Honjo, for their discovery on unleashing the body’s immune system to attack cancer. Their studies have led to the development of an entire class of drugs that hopefully will bring lasting remissions to many patients who had run out of options.
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- 2018
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11. Impact of Cyclin-Dependent Kinase CDK4 Inhibition on Eryptosis
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Elisabeth Lang, Christine Zelenak, Matthias Eberhard, Rosi Bissinger, Anand Rotte, Mehrdad Ghashghaeinia, Adrian Lupescu, Florian Lang, and Syed M. Qadri
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Apoptosis ,Eryptosis ,Cell shrinkage ,Calcium ,CDK4 ,Physiology ,QP1-981 ,Biochemistry ,QD415-436 - Abstract
Background/Aims: The cyclin-dependent kinase 4 (CDK4) participates in the regulation of apoptosis of nucleated cells by altering transcriptional regulation of genes governing cell proliferation and cell death. Similar to apoptosis of nucleated cells, erythrocytes may enter eryptosis, which is characterized by cell shrinkage and cell membrane scrambling with phosphatidylserine (PS) exposure at the cell surface. As mature erythrocytes lack nuclei, acute stimulation of eryptosis cannot result from altered gene expression. Eryptosis is triggered by isotonic cell shrinkage following Cl- removal (replacement with the impermeant organic anion gluconate) or by oxidative stress (exposure to 0.3 mM tertbutyl-hydroperoxide [tBOOH]). The present study explored whether CDK4 is expressed in erythrocytes and whether the CDK4 inhibitors II (NSC625987) and III (ryuvidine) influence eryptosis. Methods: Western blotting was utilized for determination of the presence of CDK4 protein in human erythrocytes, and FACS analysis to determine Fluo3 fluorescence (reflecting cytosolic Ca2+), annexin-V-binding (reflecting PS-exposure) and forward scatter (reflecting cell volume). Results: CDK4 protein was present in human erythrocytes. Cl- removal was followed by decrease of forward scatter and increase of both annexin-V-binding and Fluo3 fluorescence, an effect significantly curtailed by CDK4 inhibitors II and III. Furthermore, CDK4 inhibition blunted enhanced PS-exposure elicited by tBOOH treatment. Conclusions: The present observations disclose the presence of CDK4 protein in human erythrocytes and the suppression of suicidal erythrocyte death by pharmacological inhibition of CDK4.
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- 2015
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12. Regulation of Na+/H+ Exchanger in Dendritic Cells by Akt1
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Yuetao Zhou, Venkanna Pasham, Soumya Chatterjee, Anand Rotte, Wenting Yang, Madhuri Bhandaru, Yogesh Singh, and Florian Lang
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LPS ,Oxidative stress ,Cytosolic pH ,Na+/H+ exchanger ,ROS ,Cell volume ,Physiology ,QP1-981 ,Biochemistry ,QD415-436 - Abstract
Background/Aims: Dendritic cells (DCs), antigen-presenting cells critically important for primary immune response and establishment of immunological memory, are activated by bacterial lipopolysaccharides (LPS) resulting in stimulation of Na+/H+ exchanger, ROS formation and migration. The effects are dependent on phosphoinositide 3 (PI3) kinase and paralleled by Akt phosphorylation. The present study explored the contribution of the Akt isoform Akt1. Methods: Cytosolic pH (pHi) (2',7'-bis-(2-carboxyethyl)-5-(and-6)-carboxyfluorescein [BCECF] fluorescence), Na+/H+ exchanger activity (Na+ dependent realkalinization after an ammonium pulse), cell volume (forward scatter in FACS analysis), and ROS production (2′,7′-dichlorodihydrofluorescein diacetate [DCFDA] fluorescence) were determined in DCs isolated from bone marrow of mice lacking functional Akt1/PKBα (akt1-/-) and their wild type littermates (akt1+/+). Results: Forward scatter was lower in akt1-/- than in akt1+/+ DCs, whereas pHi, Na+/H+ exchanger activity and ROS formation were less in untreated akt1-/- and akt1+/+ DCs. Exposure of DCs to LPS was followed by increase of forward scatter and ROS formation to a similar extent in akt1-/- and in akt1+/+ DCs. A 4 hours treatment with either LPS (1µg/ml) or tert-butylhydroperoxide (tBOOH, 5 µM) significantly stimulated Na+/H+ exchanger activity in both genotypes, effects, however, significantly blunted in akt1-/- DCs. Conclusion: The present observations demonstrate that Akt1 is required for the full stimulation of Na+/H+ exchanger activity by LPS or oxidative stress in dendritic cells.
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- 2015
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13. Annexin 7 in the Regulation of Gastric Acid Secretion
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Venkanna Pasham, Anand Rotte, Sobuj Mia, Ioana Alesutan, Soumya Chatterjee, Zohreh Hosseinzadeh, Madhuri Bhandaru, Angelika A. Noegel, and Florian Lang
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Stomach ,H+/K+ ATPase ,K+ recycling ,H+ secretion ,glucocorticoids ,Physiology ,QP1-981 ,Biochemistry ,QD415-436 - Abstract
Background/Aims: Glucocorticoids enhance gastric acid secretion and inhibit gastric cyclooxygenase, thus downregulating formation of PGE2, an inhibitor of gastric acid secretion. In erythrocytes, PGE2 formation is inhibited by annexin 7. The present study thus explored whether annexin 7 participates in the regulation of gastric acid secretion. Methods: Annexin 7 protein expression was determined by Western blotting, cytosolic pH (pHi) of parietal cells utilizing BCECF-fluorescence, and gastric acid secretion by determination of Na+-independent pHi recovery from an ammonium pulse (∆pHi/min). Experiments were performed in isolated glands from gene targeted mice lacking annexin 7 (anx7-/-) and in respective wild type animals (anx7+/+). Results: Prior to treatment pHi and ∆pHi/min were similar in isolated gastric glands from anx7-/- and from anx7+/+ mice. Aspirin (100 µM added to the glands 1 hr prior to the experiment) significantly increased ∆pHi/min to similar values in both genotypes. The administration of dexamethasone (10 µg/g BW subcutaneously for 4 consecutive days prior to the experiments) significantly increased ∆pH/min in anx7+/+ mice but not in anx7-/- mice. Following dexamethasone treatment, the luminal pH was significantly lower and the acid content significantly higher in anx7+/+ mice than in anx7-/- mice. An increase of extracellular K+ concentration to 35 mM (replacing Na+/NMDG+) significantly increased ∆pHi/min in both genotypes. In neither genotype dexamethasone increased ∆pH/min further in the presence of 35 mM K+ or presence of aspirin. Conclusions: Annexin 7 is required for the stimulation of gastric acid secretion by glucocorticoids.
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- 2013
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14. Upregulation of Intestinal NHE3 Following Saline Ingestion
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Venkanna Pasham, Anand Rotte, Shuchen Gu, Wenting Yang, Madhuri Bhandaru, Rexhep Rexhepaj, Ganesh Pathare, and Florian Lang
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Na+/H+ exchanger ,Osmolarity ,Fluid intake ,Water ,Salt ,Dermatology ,RL1-803 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Background: Little is known about the effect of salt content of ingested fluid on intestinal transport processes. Osmosensitive genes include the serum- and glucocorticoid-inducible kinase SGK1, which is up-regulated by hyperosmolarity and cell shrinkage. SGK1 is in turn a powerful stimulator of the intestinal Na+/H+ exchanger NHE3. The present study was thus performed to elucidate, whether the NaCl content of beverages influences NHE3 activity. Methods: Mice were offered access to either plain water or isotonic saline ad libitum. NHE3 transcript levels and protein abundance in intestinal tissue were determined by confocal immunofluorescent microscopy, RT-PCR and western blotting, cytosolic pH (pHi) in intestinal cells from 2',7'-bis-(2-carboxyethyl)-5-(and-6)-carboxyfluorescein (BCECF) fluorescence and Na+/H+ exchanger activity from the Na+ dependent realkalinization following an ammonium pulse. Results: Saline drinking significantly enhanced fluid intake and increased NHE3 transcript levels, NHE3 protein and Na+/H+ exchanger activity. Conclusions: Salt content of ingested fluid has a profound effect on intestinal Na+/H+ exchanger expression and activity.
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- 2013
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15. Prognostic Significance of Nuclear Phospho-ATM Expression in Melanoma.
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Madhuri Bhandaru, Magdalena Martinka, Kevin J McElwee, and Anand Rotte
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Medicine ,Science - Abstract
UV radiation induced genomic instability is one of the leading causes for melanoma. Phosphorylation of Ataxia Telangiectasia Mutated (ATM) is one of the initial events that follow DNA damage. Phospho-ATM (p-ATM) plays a key role in the activation of DNA repair and several oncogenic pathways as well as in the maintenance of genomic integrity. The present study was therefore performed to understand the significance of p-ATM in melanoma progression and to correlate it with patient prognosis. Tissue microarray and immunohistochemical analysis were employed to study the expression of p-ATM in melanoma patients. A total of 366 melanoma patients (230 primary melanoma and 136 metastatic melanoma) were used for the study. Chi-square test, Kaplan-Meier, univariate and multivariate Cox regression analysis were used to elucidate the prognostic significance of p-ATM expression. Results revealed that both loss of, and gain in, p-ATM expression were associated with progression of melanoma from normal nevi to metastatic melanoma. Patients whose samples showed negative or strong p-ATM staining had significantly worse 5-year survival compared to patients who had weak to moderate expression. Loss of p-ATM expression was associated with relatively better 5-year survival, but the corresponding 10-year survival curve almost overlapped with that of strong p-ATM expression. p-ATM expression was found to be an independent prognostic factor for 5-year but not for 10-year patient survival. In conclusion our findings show that loss of p-ATM expression and gain-in p-ATM expression are indicators of worse melanoma patient survival.
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- 2015
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16. Decreased expression of nuclear p300 is associated with disease progression and worse prognosis of melanoma patients.
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Anand Rotte, Madhuri Bhandaru, Yabin Cheng, Cecilia Sjoestroem, Magdalena Martinka, and Gang Li
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Medicine ,Science - Abstract
Genomic instability due to UV radiation is one of the leading causes for melanoma. Histone acetyltransferase p300 plays an indispensible role in DNA repair and maintenance of genomic integrity. The present study was performed to analyze the correlation between p300 expression, melanoma progression and patient survival.Tissue microarray and immunohistochemical analysis was employed to study the expression of p300 in melanoma patients. A total of 358 melanoma patients (250 primary melanoma and 108 metastatic melanoma) were used for the study. Kaplan-Meier, univariate and multivariate Cox regression analysis, and receiver-operating characteristic curves, were used to elucidate the prognostic significance of p300 expression.Our results demonstrate that p300 is expressed in both nucleus and cytoplasm but the nuclear expression of p300 is predominant. The progression of disease from dysplastic nevi to primary melanoma and to metastatic melanoma was associated with decreased nuclear and increased cytoplasmic p300 expression. Especially, the loss of nuclear and gain in cytoplasmic p300 was correlated with the progression of melanoma from AJCC stage II to stage III, which requires the migration and metastasis of cancer cells from primary sites to lymph nodes. Similarly, decrease in nuclear, and increase in cytoplasmic p300 expression correlated with worse survival of melanoma patients. Nuclear p300 but not cytoplasmic p300 could predict the patient survival independent of AJCC stage, age and gender.Loss of nuclear p300 expression is an indicator of worse patient survival and is an independent prognostic marker for melanoma.
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- 2013
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17. High-frequency (10 kHz) spinal cord stimulation for the treatment of focal, chronic postsurgical neuropathic pain: results from a prospective study in Belgium
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Bart Billet, Veerle Minne, Olivier De Coster, Karel Hanssens, Angela Santos, and Anand Rotte
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Visual analogue scale ,Spinal cord stimulation ,03 medical and health sciences ,0302 clinical medicine ,Belgium ,030202 anesthesiology ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Pain, Postoperative ,Spinal Cord Stimulation ,business.industry ,Chronic pain ,General Medicine ,medicine.disease ,Neuromodulation (medicine) ,Clinical trial ,Treatment Outcome ,Spinal Cord ,Anesthesia ,Neuropathic pain ,Neuralgia ,Chronic Pain ,Complication ,business ,030217 neurology & neurosurgery - Abstract
Aim: Chronic postsurgical pain (CPSP) is a common complication of surgery. This study was conducted to evaluate the efficacy and safety of paresthesia-free, 10-kHz spinal cord stimulation (SCS) as a treatment for CPSP. Patients & methods: Subjects in this prospective, single-arm study had an average pain intensity of ≥5 cm on a 10-cm visual analog scale. The subjects who had pain relief of ≥50% (response) with temporary trial stimulation were permanently implanted with 10-kHz SCS and assessed for 1 year. Results: At 12 months, 94% of subjects were responders to 10-kHz SCS, and 88% had pain remission (visual analog scale ≤2.5 cm). Conclusion: The pain relief was durable in CPSP subjects and the safety profile of 10-kHz SCS was as expected. Clinical Trial registration number: VT005076953 (Privacy Commission of Belgium)
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- 2022
18. Safety and Efficacy of 10 kHz Spinal Cord Stimulation for the Treatment of Refractory Chronic Migraine: A Prospective Long-Term Open-Label Study
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Adnan Al-Kaisy, Stefano Palmisani, Angela Santos, Anand Rotte, Giorgio Lambru, Samuel Wesley, David Pang, and Roy Carganillo
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Adult ,Migraine Disorders ,medicine.medical_treatment ,03 medical and health sciences ,0302 clinical medicine ,Chronic Migraine ,Refractory ,Quality of life ,Humans ,Medicine ,Prospective Studies ,Prospective cohort study ,Adverse effect ,Neurostimulation ,Spinal Cord Stimulation ,business.industry ,General Medicine ,medicine.disease ,Neuromodulation (medicine) ,Treatment Outcome ,Anesthesiology and Pain Medicine ,Neurology ,Migraine ,Anesthesia ,Quality of Life ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
BACKGROUND Refractory chronic migraine (rCM) is a highly disabling condition for which novel safe and effective treatments are needed. Safety and long-term efficacy of paresthesia-free high cervical 10 kHz spinal cord stimulation (SCS) were here prospectively evaluated for the treatment of rCM. MATERIALS AND METHODS Twenty adults with rCM (mean numbers of preventive treatments failed: 12.2 ± 3.1) were enrolled in this single-center, open-label, prospective study and implanted with a 10 kHz SCS system (Senza™ system, Nevro Corp.), with the distal tip of the lead(s) positioned epidurally at the C2 vertebral level. Safety and effectiveness outcomes, such as adverse events, headache and migraine reductions, responder rates, Migraine Disability Assessment (MIDAS), Headache Impact Test-6 (HIT-6), and Migraine-Specific Quality-of-Life (MSQ), were captured up to 52 weeks after implantation. RESULTS Compared to baseline, at 52 weeks postimplantation, there was a significant reduction of mean monthly migraine days (MMD) by 9.3 days (p
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- 2022
19. Phase 1 Study of CART-Ddbcma for the Treatment of Subjects with Relapsed and /or Refractory Multiple Myeloma
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Matthew Frigault, Jacalyn Rosenblatt, Binod Dhakal, Noopur Raje, Daniella Cook, Mahmoud R. Gaballa, Estelle Emmanuel-Alejandro, Danielle Nissen, Christine Cornwell, Kamalika Banerjee, Anand Rotte, Christopher R. Heery, David Avigan, Andrzej Jakubowiak, and Michael R. Bishop
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Immunology ,Cell Biology ,Hematology ,Biochemistry - Published
- 2022
20. Pain relief and opioid usage in upper limb and neck pain patients after 10-kHz spinal cord stimulation treatment: subanalysis of USA studies
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Kasra Amirdelfan, Ramsin M Benyamin, Ricardo Vallejo, David Caraway, Steven M. Rosen, Peter Kosek, Abram H. Burgher, and Anand Rotte
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Adult ,Male ,Visual analogue scale ,Upper Extremity ,Outcome Assessment, Health Care ,Post-hoc analysis ,medicine ,Humans ,Prospective cohort study ,Aged ,Pain Measurement ,Spinal Cord Stimulation ,Neck pain ,Neck Pain ,business.industry ,Chronic pain ,General Medicine ,Middle Aged ,medicine.disease ,Combined Modality Therapy ,United States ,Analgesics, Opioid ,medicine.anatomical_structure ,Opioid ,Anesthesia ,Morphine ,Upper limb ,Female ,Chronic Pain ,medicine.symptom ,business ,medicine.drug - Abstract
Aim: It is argued that chronic pain patients who reduce/eliminate their opioids may have compromised pain relief. This study therefore aimed to analyze if reduced opioid consumption associated with 10-kHz spinal cord stimulation adversely affected pain relief. Methods: Post hoc analysis was performed on data from two prospective studies in subjects with upper limbs and neck pain conducted in USA. Results & conclusion: A 10-kHz spinal cord stimulation treatment was associated with reduction in mean visual analog scale scores for upper limbs and neck pain and mean daily opioid consumption. Pain scores decreased in subjects who decreased opioid use and in those who maintained/increased use. Opioid reduction and pain relief was also achieved in subjects taking >90 mg morphine equivalents of opioids at baseline.
- Published
- 2021
21. A Retrospective Review of Lead Migration Rate in Patients Permanently Implanted with Percutaneous Leads and a 10 kHz SCS Device
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Anand Rotte, Alaa Abd-Elsayed, Meghan Hughes, and Mayank Gupta
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Male ,Medicine (General) ,medicine.medical_specialty ,Percutaneous ,Article Subject ,R5-920 ,Humans ,Medicine ,Lead (electronics) ,Retrospective Studies ,Response rate (survey) ,Spinal Cord Stimulation ,business.industry ,Medical record ,Incidence (epidemiology) ,Retrospective cohort study ,Middle Aged ,Trunk ,Electrodes, Implanted ,Surgery ,Anesthesiology and Pain Medicine ,Neurology ,Female ,business ,Complication ,Research Article - Abstract
Background. Spinal cord stimulation (SCS) has been used over decades for pain management, but migration of percutaneous leads has been the most common complication. Better surgical techniques and newer SCS technologies likely reduced the incidence of lead migration requiring surgical revision, although data are sparse. This study aimed to retrospectively evaluate the incidence of clinically significant percutaneous lead migration in patients permanently implanted with a 10 kHz SCS system. Methods. Consecutive patients with chronic trunk and/or limb pain, permanently implanted between January 2016 and June 2019, were included in the analysis. Data were collected from the hospital’s electronic medical records and the manufacturer’s database. Clinically significant lead migration, defined as diminished pain relief followed by surgery to correct lead location, was assessed at the 6-month follow-up. Results. At the 6-month follow-up, there were no cases of clinically significant lead migration, average pain relief was 65.2%, 82% of patients had response (≥50% pain relief), improvement of function was noted in 72% of patients, and decrease of medication was observed in 42% of patients. Therapy efficacy was sustained in patients with >12 months follow-up; the average pain relief was 58.5%, and the response rate was 82%. Conclusions. The surgical techniques in use today are designed to minimise the risk of percutaneous lead migration and may have reduced its incidence. In addition, new SCS systems may give greater opportunity to mitigate cases of minor lead movement using alternative stimulation programs.
- Published
- 2021
22. Personalized Cancer Vaccines: Clinical Landscape, Challenges, and Opportunities
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Iraj Hosseini, Patrick Twomey, Colby S. Shemesh, Sandhya Girish, Anand Rotte, Joy C. Hsu, Ben-Quan Shen, and Benjamin Wu
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T-Lymphocytes ,medicine.medical_treatment ,Review ,Bioinformatics ,Cancer Vaccines ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Immune system ,Drug Development ,Cancer immunotherapy ,Antigens, Neoplasm ,law ,Neoplasms ,Drug Discovery ,Biomarkers, Tumor ,Genetics ,medicine ,Humans ,Dosing ,Precision Medicine ,Molecular Biology ,030304 developmental biology ,Pharmacology ,Clinical Trials as Topic ,0303 health sciences ,Clinical pharmacology ,business.industry ,Cancer ,Dendritic Cells ,medicine.disease ,Clinical trial ,Drug development ,030220 oncology & carcinogenesis ,Molecular Medicine ,Immunotherapy ,business ,Adjuvant - Abstract
Tremendous innovation is underway among a rapidly expanding repertoire of promising personalized immune-based treatments. Therapeutic cancer vaccines (TCVs) are attractive systemic immunotherapies that activate and expand antigen-specific CD8(+) and CD4(+) T cells to enhance anti-tumor immunity. Our review highlights key issues impacting TCVs in clinical practice and reports on progress in development. We review the mechanism of action, immune-monitoring, dosing strategies, combinations, obstacles, and regulation of cancer vaccines. Most trials of personalized TCVs are ongoing and represent diverse platforms with predominantly early investigations of mRNA, DNA, or peptide-based targeting strategies against neoantigens in solid tumors, with many in combination immunotherapies. Multiple delivery systems, routes of administration, and dosing strategies are used. Intravenous or intramuscular administration is common, including delivery by lipid nanoparticles. Absorption and biodistribution impact antigen uptake, expression, and presentation, affecting the strength, speed, and duration of immune response. The emerging trials illustrate the complexity of developing this class of innovative immunotherapies. Methodical testing of the multiple potential factors influencing immune responses, as well as refined quantitative methodologies to facilitate optimal dosing strategies, could help resolve uncertainty of therapeutic approaches. To increase the likelihood of success in bringing these medicines to patients, several unique development challenges must be overcome.
- Published
- 2021
23. Predictive models for response and survival in patients treated with anti-PD-1 monotherapy or with anti-PD-1 and ipilimumab combination: editorial commentary
- Author
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Anand Rotte
- Subjects
General Medicine - Published
- 2023
24. 10 kHz Spinal Cord Stimulation for the Treatment of Failed Back Surgery Syndrome with Predominant Leg Pain: Results from a Prospective Study in Patients from the Dutch Healthcare System
- Author
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Ismail Gültuna, Lars Elzinga, Jan Willem Kallewaard, Lisette Verbrugge, Jeyakumar Subbaroyan, Vincent Hoffmann, Veerle Minne, David Caraway, Pascalle Reiters, Angela Santos, Anand Rotte, and Renate Munnikes
- Subjects
Visual analogue scale ,Spinal cord stimulation ,leg pain and VAS ,Quality of life ,Back pain ,medicine ,Humans ,In patient ,Prospective Studies ,Prospective cohort study ,Leg ,Spinal Cord Stimulation ,business.industry ,Leg pain ,Original Articles ,10 kHz SCS ,Treatment Outcome ,Anesthesiology and Pain Medicine ,Spinal Cord ,Anesthesia ,Quality of Life ,Original Article ,failed back surgery syndrome ,medicine.symptom ,business ,Delivery of Health Care ,Failed back surgery - Abstract
Introduction Persistent back/and or leg pain is a common outcome after spinal surgery (otherwise known as failed back surgery syndrome [FBSS]). Studies have shown that spinal cord stimulation (SCS) at 10 kHz provides effective analgesia in FBSS patients with both back and leg pain symptoms and in those with predominant back pain. This study is the first to evaluate the therapy in FBSS patients with predominant leg pain. Methods The safety and efficacy of 10 kHz SCS was evaluated in an uncontrolled, open‐label, prospective study of FBSS patients with predominant leg pain in the Netherlands. Follow‐ups were performed at 1, 3, 6, and 12 months post implantation. Results Sixty out of 68 patients (88%) experienced sufficient pain relief during a stimulation trial. Of these, 58 proceeded to permanent implantation of a 10 kHz SCS system. After 12 months of treatment, 80% of patients experienced ≥ 50% reduction in baseline leg pain, and a similar proportion (76%) experienced ≥ 50% reduction in baseline back pain. At least two‐thirds of patients were also leg pain and back pain remitters (visual analog scale [VAS] ≤ 2.5 cm). The therapy was also associated with a general improvement in patients’ quality of life, as measured by secondary outcomes including disability, perception of health improvement, mental well‐being, and satisfaction. A positive impact on opioid consumption was also observed. Conclusions Consistent with previous findings, 10 kHz SCS for the treatment of FBSS patients with predominant radicular symptoms is safe and effective and is associated with improved quality of life.
- Published
- 2020
25. Ten kilohertz SCS for Treatment of Chronic Upper Extremity Pain (UEP): Results from Prospective Observational Study
- Author
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Anand Rotte, Mona Maneshi, Anu Kansal, Abram H. Burgher, Steven M. Rosen, Todd A. Bromberg, Michael Esposito, Steven Surrett, Ashish Gulve, Jeyakumar Subbaroyan, Bradford E. Gliner, Paul Wu, W. Porter McRoberts, Peter Kosek, and Ashish Udeshi
- Subjects
Neck pain ,education.field_of_study ,medicine.medical_specialty ,business.industry ,Visual analogue scale ,Population ,Upper limb pain ,Clinical trial ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,030202 anesthesiology ,Concomitant ,medicine ,Physical therapy ,Upper limb ,Observational study ,medicine.symptom ,business ,education ,030217 neurology & neurosurgery - Abstract
Background Chronic upper extremity pain (UEP) has complex etiologies and is often disabling. It has been shown that 10 kHz SCS can provide paresthesia-free and durable pain relief in multiple pain types and improve the quality of life of patients. Objective To gain additional evidence on the safety and effectiveness of 10 kHz SCS for the treatment of chronic UEP. Study design It was a prospective, multicenter, and observational study. The study was registered on ClinicalTrials.gov prospectively (clinical trial identifier: NCT02703818). Setting Multicenter. Patients intervention and main outcomes A total of 43 subjects with chronic UEP of ≥5 cm (on a 0-10 cm visual analog scale; VAS) underwent a trial of 10 kHz SCS, and subjects with ≥40% pain relief received a permanent implant. All subjects had upper limb pain at baseline, while some had concomitant shoulder or neck pain. Subject outcomes were assessed for 12 months, and the primary outcome was the responder rate (percentage of subjects experiencing ≥50% pain relief from baseline) at three months. Results Thirty-eight subjects successfully completed the trial (88.3% success rate), 33 received permanent implants (five withdrew consent), and 32 had device activation (per protocol population). There were no paresthesias or uncomfortable changes in stimulation related to changes in posture during the study and there were no neurological deficits. Responder rates at 12 months for upper limb, shoulder, and neck pain in per protocol population (N=32) were 78.1%, 85.2%, and 75.0%, respectively. At 12 months, 84.4% of subjects were satisfied or very satisfied with 10 kHz SCS, and 38.7% either reduced or eliminated opioid usage. Conclusion This study further supports the effectiveness of 10 kHz SCS for chronic UEP treatment and documents the safety profile of the therapy. Clinical trial identifier NCT02703818.
- Published
- 2020
26. 10-kHz spinal cord stimulation treatment for painful diabetic neuropathy: results from post-hoc analysis of the SENZA-PPN study
- Author
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Sean Li, Vincent Galan, Peter S. Staats, Paul Chang, Anand Rotte, James Scowcroft, and Jeyakumar Subbaroyan
- Subjects
business.industry ,Visual analogue scale ,General Medicine ,Spinal cord stimulation ,Trunk ,03 medical and health sciences ,0302 clinical medicine ,Painful diabetic neuropathy ,Anesthesia ,Neuropathic pain ,Post-hoc analysis ,Etiology ,Reflex ,Medicine ,030212 general & internal medicine ,business ,030217 neurology & neurosurgery - Abstract
Aim: Previous studies of 10 kHz spinal cord stimulation demonstrated its safety and efficacy for treatment of neuropathic pain of the trunk and/or limbs. This study analyzed data from a subset of subjects with painful diabetic neuropathy enrolled in a prospective, multicenter study of peripheral polyneuropathy with various etiologies. Materials & methods: Of the eight subjects that had permanent devices, seven attended the 12-month follow-up assessment. Results & conclusion: At 12 months, 6/7 subjects were treatment responders (≥50% pain relief) and had pain remission (visual analog scale ≤ 3.0 cm). Worsening of neurologic deficits was not reported in any subject. Instead, 5/7 subjects showed improvements in sensory testing and/or reflexes. These results support further investigation of 10 kHz spinal cord stimulation as a safe and effective treatment for intractable painful diabetic neuropathy.
- Published
- 2020
27. A Prospective, Multi‐Center, Clinical Trial of a 10‐kHz Spinal Cord Stimulation System in the Treatment of Chronic Pelvic Pain
- Author
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Jeyakumar Subbaroyan, Anand Rotte, Sean Li, Jordan L. Tate, and Thomas Stauss
- Subjects
Adult ,Male ,Visual analogue scale ,Pilot Projects ,Spinal cord stimulation ,chronic pelvic pain ,Pelvic Pain ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,030202 anesthesiology ,Humans ,Pain Management ,Medicine ,Prospective Studies ,Adverse effect ,Vas score ,Spinal Cord Stimulation ,business.industry ,Pelvic pain ,visual analog scale ,Original Articles ,Middle Aged ,Clinical trial ,Treatment Outcome ,Anesthesiology and Pain Medicine ,10‐kHz SCS ,McGill Pain Questionnaire ,Anesthesia ,Quality of Life ,Original Article ,Female ,Chronic Pain ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Background Chronic pelvic pain (CPP) is a debilitating condition that often leads to disability and does not respond to conventional treatments. This study was conducted to evaluate the effects of paresthesia‐independent 10‐kHz spinal cord stimulation (SCS) in subjects with CPP. Methods This prospective, single‐arm pilot study enrolled subjects with clinical diagnoses of CPP and mean pain scores of ≥ 5.0 cm on a 10‐cm VAS. Subjects underwent trial stimulations with 10‐kHz SCS, and those who had successful trial stimulations (≥40% pain relief) received permanently implanted devices and were followed for 12 months. Results Of the 21 subjects who underwent the 10‐kHz SCS trial, 17 were successful and 14 subjects received permanent implants. No neurological deficits were observed in any subjects and all adverse events (AEs) were resolved without sequelae during the study period. Over 12 months, mean VAS scores decreased by 72% from baseline, and 10 of 13 subjects (77%) were responders (≥50% pain relief). Pain remission (VAS score ≤ 3.0 cm) was reported by 8 of 13 subjects (62%), and mean pain scores on the short‐form McGill Pain Questionnaire 2 decreased as well. Pain Disability Index scores declined by 29 points, and 85% of the subjects reported satisfaction. Conclusions Paresthesia‐independent stimulation with 10‐kHz SCS reduced pelvic pain in subjects with CPP and was not associated with any unexpected AEs. While larger, controlled studies are needed, results of this study suggest that this therapeutic modality could potentially treat patients with CPP while improving their quality of life.
- Published
- 2020
28. Retrospective Analysis of Real-World Outcomes of 10 kHz SCS in Patients with Upper Limb and Neck Pain
- Author
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Andrew M Sack, John Salmon, Adele Barnard, Anand Rotte, Talal W. Khan, Dawood Sayed, and Ted Braun
- Subjects
Neck pain ,medicine.medical_specialty ,business.industry ,Chronic pain ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Quality of life ,030202 anesthesiology ,Cohort ,medicine ,Physical therapy ,Etiology ,Upper limb ,In patient ,Observational study ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Background Patients living with chronic upper limb and neck (ULN) pain are reliant on often ineffective therapies as they face limited options for effective long-term treatment. Objective Prospective clinical studies have demonstrated that high-frequency spinal cord stimulation at 10 kHz (10 kHz SCS) is effective in treating chronic pain in multiple etiologies including ULN pain. This study aimed at validating the findings from clinical studies on ULN in a real-world cohort. Study design A retrospective, observational review. Setting A multicenter review between April 2016 and August 2019. Patients and methods Anonymized data were extracted from a real-world database of 47 consecutive patients aged ≥18 years of age with chronic upper limb and/or neck pain who were trialed and permanently implanted with 10 kHz SCS. Patient-reported pain relief, quality of life, function, sleep and medication use were extracted from anonymised patient records where available. Responder rates, defined as the proportion of patients with at least 50% pain relief at the end of trial and the last visit after implantation, were calculated. Results All patients reported successful response (≥50% pain relief) at the end of trial and >75% patients continued to respond to the therapy at the last follow-up period. Majority (72%) of patients reported improvement in function, about half of the patients (53%) reported improvement in sleep and one-third of the patients (36%) reported reducing their medication at last follow-up. Conclusion 10 kHz SCS provides durable pain relief to patients with chronic upper limb and neck pain.
- Published
- 2020
29. Nuclear localization of ING3 is required to suppress melanoma cell migration, invasion and angiogenesis
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Xiaolei Chen, Guangdi Chen, Anand Rotte, Madhuri Bhandaru, Ruiyao Zhou, and Gang Li
- Subjects
0301 basic medicine ,Angiogenesis ,Nuclear Localization Signals ,Mutant ,Biophysics ,Biochemistry ,03 medical and health sciences ,0302 clinical medicine ,Cell Movement ,Cell Line, Tumor ,medicine ,Humans ,NLS ,Neoplasm Invasiveness ,Melanoma ,Molecular Biology ,Cell Nucleus ,Homeodomain Proteins ,Neovascularization, Pathologic ,Chemistry ,Tumor Suppressor Proteins ,Cell migration ,Cell Biology ,medicine.disease ,Up-Regulation ,Cell biology ,HEK293 Cells ,030104 developmental biology ,Apoptosis ,Cytoplasm ,030220 oncology & carcinogenesis ,Mutation ,Nuclear localization sequence - Abstract
Inhibitor of growth family member 3 (ING3), a tumor suppressor, plays crucial roles in cell cycle regulation, apoptosis and transcription. Previous studies suggest important roles of nuclear ING3, however, the nuclear localization sequence (NLS) of ING3 is not defined and its biological functions remain to be elucidated. In this study, various ING3 mutants were generated to identify its NLS. The NLS of ING3 was determined as KKFK between 164 and 167 amino acids. More intriguingly, replacement of Lysine 164 residue of ING3 with alanine (K164A) resulted in retention of ING3 in the cytoplasm. Overexpression of ING3 led to inhibition of melanoma cell migration, invasion, and angiogenesis respectively, however, this inhibition was abrogated in cells with overexpression of ING3-K164A mutant. In conclusion, this study identified the NLS of ING3 and demonstrated the significance of ING3 nuclear localization for tumor suppressive functions of ING3, and future studies await to elucidate the role of ING3 (K164) post-modificaton in its nuclear transportation and cancer development.
- Published
- 2020
30. 10 kHz spinal cord stimulation for the treatment of non‐surgical refractory back pain: subanalysis of pooled data from two prospective studies
- Author
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Jeyakumar Subbaroyan, J. P. Van Buyten, D. Edgar, Kasra Amirdelfan, Adnan Al-Kaisy, David Caraway, Anand Rotte, Bradford E. Gliner, and Leo Kapural
- Subjects
Male ,Spinal cord stimulation ,law.invention ,03 medical and health sciences ,virgin back pain ,0302 clinical medicine ,Refractory ,030202 anesthesiology ,law ,Back pain ,medicine ,Humans ,Pain Management ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Pain Measurement ,Spinal Cord Stimulation ,business.industry ,Chronic pain ,opioids ,Original Articles ,Middle Aged ,10 kHz SCS ,medicine.disease ,Spinal cord stimulator ,maiden back pain ,Oswestry Disability Index ,non‐specific low back pain ,non‐surgical back pain ,Treatment Outcome ,Anesthesiology and Pain Medicine ,Back Pain ,Anesthesia ,Cohort ,Female ,Original Article ,Chronic Pain ,VAS ,medicine.symptom ,business ,axial back pain - Abstract
Summary Spinal cord stimulation at 10 kHz is a promising therapy for non‐surgical refractory back pain; however, published data are currently limited. We present a subanalysis of prospectively collected clinical outcome data for non‐surgical refractory back pain patients treated with 10 kHz spinal cord stimulation, from the independent cohorts of two previous studies (SENZA‐RCT and SENZA‐EU). Clinical outcomes were evaluated at pre‐implantation (baseline), 3 months, 6 months and 12 months following 10 kHz spinal cord stimulator implantation. These included: pain relief; responder rate (≥ 50% pain relief from baseline); remission rate (VAS ≤ 3.0 cm); disability (Oswestry Disability Index(ODI)); and opioid use. At 3 months, average back pain decreased by 70% in the combined cohort (60% in the SENZA‐RCT and 78% in the SENZA‐EU cohorts). This was sustained at 12 months, with a 73% back pain responder rate and 68% remission rate in the combined cohort. Leg pain relief results were generally comparable to those for back pain relief. At 12 months, the combined cohort had an average decrease in ODI scores of 15.7% points from baseline and opioid use more than halved. In conclusion, 10 kHz spinal cord stimulation reduced pain, disability and opioid consumption in non‐surgical refractory back pain subjects. Application of this therapy may improve the care of non‐surgical refractory back pain patients and reduce their opioid consumption.
- Published
- 2020
31. Pain relief and improvement in quality of life with 10 kHz SCS therapy: Summary of clinical evidence
- Author
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Anand Rotte, Jan Willem Kallewaard, Dawood Sayed, Jessica B Jameson, and David Caraway
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Review Article ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Quality of life ,law ,Physiology (medical) ,Back pain ,Humans ,Pain Management ,Medicine ,Pharmacology (medical) ,Prospective Studies ,Review Articles ,Pain Measurement ,Randomized Controlled Trials as Topic ,Retrospective Studies ,Pharmacology ,Spinal Cord Stimulation ,business.industry ,Pelvic pain ,Chronic pain ,opioids ,Retrospective cohort study ,medicine.disease ,10 kHz SCS ,Psychiatry and Mental health ,030104 developmental biology ,Complex regional pain syndrome ,quality of life ,Etiology ,Physical therapy ,VAS ,Chronic Pain ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Objective Chronic pain is a prevalent condition which has a significant effect on the lives of those it impacts. High‐frequency 10 kHz spinal cord stimulation (10 kHz SCS) has been shown to provide paresthesia‐free pain relief for a wide variety of pain indications. This article summarizes the current and emerging data as they relate to the clinical use of the therapy in various pain syndromes. Methods A literature search was conducted using the PubMed electronic database using keywords related to 10 kHz SCS. The database was queried from 2013 to May 2019. Articles reporting clinical studies that included human subjects permanently treated with 10 kHz SCS (Senza® system) were included in the review. Recent and relevant conference proceedings known to the authors were also included. Results The selected literature demonstrated significant evidence for the efficacy of 10 kHz SCS in treating chronic back and leg pain (CBLP), including a randomized, controlled trial as well as prospective and retrospective studies. One‐year follow‐up responder rates (pain relief ≥50%) ranged from 60% to 80%. Other studies and case series showed promising outcomes in specific conditions, including nonsurgical refractory back pain, neuropathic limb pain, complex regional pain syndrome, chronic widespread pain, chronic pelvic pain, and intractable headache. Subgroup analyses also pointed toward the potential of 10 kHz SCS being successful when low‐frequency SCS has failed. The vast majority of these studies reported improved quality of life (QOL) metrics and/or reduced opioid consumption. Conclusions Level I evidence already exists for the efficacy of 10 kHz SCS in treating CBLP, supported by real‐world clinical experience. Other studies demonstrate the potential of the therapy across a range of chronic pain etiologies, although larger confirmatory studies are recommended. Overall, the literature suggests that the therapy is associated with improved QOL as well as reduced opioid consumption.
- Published
- 2020
32. Dose–response correlation for CAR-T cells: a systematic review of clinical studies
- Author
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Anand Rotte, Matthew J Frigault, Ayub Ansari, Brad Gliner, Christopher Heery, and Bijal Shah
- Subjects
Pharmacology ,Cancer Research ,Adolescent ,T-Lymphocytes ,Immunology ,Immunotherapy, Adoptive ,Treatment Outcome ,Oncology ,Neoplasms ,Hematologic Neoplasms ,Humans ,Molecular Medicine ,Immunology and Allergy ,Child - Abstract
The potential of chimeric antigen receptor (CAR) T cells to successfully treat hematological cancers is widely recognized. Multiple CAR-T cell therapies are currently under clinical development, with most in early stage, during which dose selection is a key goal. The objective of this review is to address the question of dose-dependent effects on response and/or toxicity from available CAR-T cell clinical trial data. For that purpose, systematic literature review of studies published between January 2010 and May 2022 was performed on PubMed and Embase to search clinical studies that evaluated CAR-T cells for hematological cancers. Studies published in English were considered. Studies in children (age 1 patient at each dose level. Thirteen studies observed dose-related increase in disease response and 23 studies observed dose-related increase in toxicity across a median of three dose levels. Optimal clinical efficacy was seen at doses 50–100 million cells for anti-CD19 CAR-T cells and >100 million cells for anti-BCMA CAR-T cells in majority of studies. The findings suggest, for a given construct, there exists a dose at which a threshold of optimal efficacy occurs. Dose escalation may reveal increasing objective response rates (ORRs) until that threshold is reached. However, when ORR starts to plateau despite increasing dose, further dose escalation is unlikely to result in improved ORR but is likely to result in higher incidence and/or severity of mechanistically related adverse events.
- Published
- 2022
33. Pharmacology-based ranking of anti-cancer drugs to guide clinical development of cancer immunotherapy combinations
- Author
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Colby S. Shemesh, Vincent Lemaire, and Anand Rotte
- Subjects
Drug ,Cancer Research ,media_common.quotation_subject ,medicine.medical_treatment ,Antineoplastic Agents ,Cancer immunotherapy ,Review ,Treatment of lung cancer ,Bioinformatics ,Clinical trials ,Neoplasms ,medicine ,Animals ,Humans ,Combination development ,Lung cancer ,Adverse effect ,RC254-282 ,Cancer ,media_common ,Pharmacology ,business.industry ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,medicine.disease ,Clinical trial ,Pharmaceutical Preparations ,Oncology ,Mechanism of action ,Drug Therapy, Combination ,Immunotherapy ,medicine.symptom ,business - Abstract
The success of antibodies targeting Programmed cell death protein 1 (PD-1) and its ligand L1 (PD-L1) in cancer treatment and the need for improving response rates has led to an increased demand for the development of combination therapies with anti-PD-1/PD-L1 blockers as a backbone. As more and more drugs with translational potential are identified, the number of clinical trials evaluating combinations has increased considerably and the demand to prioritize combinations having potential for success over the ones that are unlikely to be successful is rising. This review aims to address the unmet need to prioritize cancer immunotherapy combinations through comprehensive search of potential drugs and ranking them based on their mechanism of action, clinical efficacy and safety. As lung cancer is one of the most frequently studied cancer types, combinations that showed potential for the treatment of lung cancer were prioritized. A literature search was performed to identify drugs with potential in combination with PD-1/PD-L1 blockers and the drugs were ranked based on their mechanism of action and known clinical efficacy. Nineteen drugs or drug classes were identified from an internal list of lead molecules and were scored for their clinical potential. Efficacy and safety data from pivotal studies was summarized for the selected drugs. Further, overlap of mechanisms of action and adverse events was visualized using a heat map illustration to help screen drugs for combinations. The quantitative scoring methodology provided in this review could serve as a template for preliminary ranking of novel combinations. Supplementary Information The online version contains supplementary material available at 10.1186/s13046-021-02111-5.
- Published
- 2021
34. Targeting TIGIT for Immunotherapy of Cancer: Update on Clinical Development
- Author
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Nageshwar Budha, Srikumar Sahasranaman, and Anand Rotte
- Subjects
Oncology ,medicine.medical_specialty ,medicine.drug_class ,TIGIT ,QH301-705.5 ,medicine.medical_treatment ,Medicine (miscellaneous) ,Review ,Monoclonal antibody ,General Biochemistry, Genetics and Molecular Biology ,immunotherapy and cancer ,Internal medicine ,Medicine ,Biology (General) ,Adverse effect ,biology ,business.industry ,Cancer ,Immunotherapy ,immune checkpoints ,medicine.disease ,Immune checkpoint ,Blockade ,biology.protein ,Antibody ,business - Abstract
Immune checkpoint blockers have dramatically improved the chances of survival in patients with metastatic cancer, but only a subset of the patients respond to treatment. Search for novel targets that can improve the responder rates and overcome the limitations of adverse events commonly seen with combination therapies, like PD-1 plus CTLA-4 blockade and PD-1/PD-L1 plus chemotherapy, led to the development of monoclonal antibodies blocking T-cell immunoglobulin and ITIM domain (TIGIT), a inhibitory checkpoint receptor expressed on activated T cells and NK cells. The strategy showed potential in pre-clinical and early clinical studies, and 5 molecules are now in advanced stages of evaluation (phase II and above). This review aims to provide an overview of clinical development of anti-TIGIT antibodies and describes the factors considered and thought process during early clinical development. Critical aspects that can decide the fate of clinical programs, such as origin of the antibody, Ig isotype, FCγR binding, and the dose as well as dosing schedule, are discussed along with the summary of available efficacy and safety data from clinical studies and the challenges in the development of anti-TIGIT antibodies, such as identifying patients who can benefit from therapy and getting payer coverage.
- Published
- 2021
35. Decreased Opioid Consumption and Durable Pain Relief in Patients Treated with 10 kHz SCS: A Retrospective Analysis of Outcomes from Single-Center
- Author
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Anand Rotte, Honghui Feng, and Patrick Doherty
- Subjects
spinal cord stimulation ,business.industry ,Medical record ,Chronic pain ,medicine.disease ,Single Center ,Trunk ,opioid analgesics ,Anesthesiology and Pain Medicine ,Opioid ,Quality of life ,Anesthesia ,Cohort ,medicine ,Morphine ,failed back surgery syndrome ,Journal of Pain Research ,chronic pain ,business ,Original Research ,medicine.drug - Abstract
Honghui Feng,1 Patrick Doherty,1 Anand Rotte2 1Lawrence and Memorial Hospital, Yale New Haven Healthcare, New London, CT, USA; 2Nevro Corp., Redwood City, CA, USACorrespondence: Honghui Feng Email fenghonghui@yahoo.comBackground: Chronic pain is frequently treated with opioid analgesics, but there is limited evidence for efficacy for chronic use of opioids and the drugs pose significant risks to patientsâ physical and mental health. Spinal cord stimulation delivered at a frequency of 10,000 Hertz (10 kHz SCS) is a minimally invasive therapy with demonstrated efficacy and safety in treating chronic pain that has also been associated with decreased opioid use.Objective: To evaluate opioid reduction and pain relief in real-world cohort.Study Design: Retrospective review.Setting: Single center.Patients and Methods: Consecutive patients who were implanted with 10 kHz SCS devices from December 1, 2015, to June 30, 2020 for the treatment of chronic pain in the trunk or lower limbs were included. Changes in opioid use following 10 kHz SCS treatment were extracted from electronic medical records, and patient-reported pain relief, improvement in function and sleep were extracted from manufacturerâs database. Responder rate was defined as the proportion of patients with at least 50% pain relief. Anonymised results from descriptive analysis of the data are reported.Results: At last follow-up (median 21.4 months), mean daily opioid dose fell by 48.4 morphine milligram equivalents (MME), and fewer patients used opioids. Mean pain relief in these patients was 57% ± 4%, and responder rate was 68% at last recorded follow-up. Interestingly, pain relief (66%) and responder rate (86%) were higher in patients with 1 year or more. Finally, 50% of patients reported improved sleep, and 73% reported improvement in function at last recorded follow-up after treatment with 10 kHz SCS.Conclusion: These results support 10 kHz SCS as a safe and effective treatment of chronic pain in real-world patients with secondary benefits to opioid consumption and measures of patientsâ quality of life.Keywords: spinal cord stimulation, chronic pain, opioid analgesics, failed back surgery syndrome
- Published
- 2021
36. PO118 / #291 AMELIORATION OF LOWER LIMB PAIN AND FOOT DROP WITH 10 KHZ SPINAL CORD STIMULATION: SUMMARY OF THREE CASE REPORTS
- Author
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Honghui Feng, Patrick Doherty, Anand Rotte, and Christopher Bovinet
- Subjects
Anesthesiology and Pain Medicine ,Neurology ,Neurology (clinical) ,General Medicine - Published
- 2022
37. PO143 / #288 EFFECTS OF 10 KHZ SPINAL CORD STIMULATION ON PAIN AND OPIOID CONSUMPTION IN CHRONIC NEUROAXIS AND/OR EXTREMITY PAIN: A RETROSPECTIVE REVIEW
- Author
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Honghui Feng, Patrick Doherty, and Anand Rotte
- Subjects
Anesthesiology and Pain Medicine ,Neurology ,Neurology (clinical) ,General Medicine - Published
- 2022
38. O049 / #289 10 KHZ SPINAL CORD STIMULATION FOR THE TREATMENT OF FAILED NECK SURGERY SYNDROME: ANALYSIS OF DATA FROM TWO MULTICENTER STUDIES
- Author
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Kasra Amirdelfan, Ricardo Vallejo, John Salmon, Ramsin Benyamin, Cong Yu, Thomas Yang, Richard Bundschu, Thomas Yearwood, B Todd Sitzman, Marc Russo, Adele Barnard, Anand Rotte, and Paul Verrills
- Subjects
Anesthesiology and Pain Medicine ,Neurology ,Neurology (clinical) ,General Medicine - Published
- 2022
39. OAB-003: Phase 1 study of CART-ddBCMA, a CAR-T therapy utilizing a novel synthetic binding domain for the treatment of subjects with relapsed and refractory multiple myeloma
- Author
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Matthew Frigault, Jacalyn Rosenblatt, Noopur Raje, Daniella Cook, Mahmoud Gaballa, Estelle Emmanuel-Alejandro, Christine Cornwell, Kamalika Banerjee, Anand Rotte, Christopher Heery, David Avigan, Andrzej Jakubowiak, and Michael Bishop
- Subjects
Cancer Research ,Oncology ,Hematology - Published
- 2022
40. Efficacy and Safety of 10 kHz Spinal Cord Stimulation Using Cervical and Thoracic Leads: A Single-Center Retrospective Experience
- Author
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Anand Rotte, Kerstin Mendryscha, Martin Bettag, Theresa Blaß, Joachim Paulus, and Gernot Surges
- Subjects
medicine.medical_specialty ,Cervical SCS ,integumentary system ,business.industry ,Multiarea SCS ,Pain medicine ,Chronic pain ,Retrospective cohort study ,Spinal cord stimulation ,medicine.disease ,Single Center ,Surgery ,10 kHz SCS ,Anesthesiology and Pain Medicine ,Neuropathic pain ,medicine ,Neurology (clinical) ,Lead Placement ,Adverse effect ,business ,Thoracic SCS ,Original Research - Abstract
Introduction Spinal cord stimulation (SCS) with lower thoracic leads has been studied extensively. However, the evidence base for cervical SCS is less well developed, and reports of multiarea SCS lead placement are uncommon. Therefore, this single-center retrospective study evaluated outcomes from 10-kHz SCS with cervical or combined cervical and thoracic lead placement. Method All patients that underwent a 10-kHz SCS trial with either cervical or combined cervical and thoracic lead placement between 2015 and 2020 were included in our study. We reviewed patient’s charts for demographic information, lead placement, and pain scores up to 48 months after implantation. Results Of the 105 patients that underwent a 10-kHz SCS trial during the review period, 92 (88%) had back/neck or extremity pain that responded to therapy (≥ 50% pain relief from baseline) and received a permanent system. Sixty-two of these patients (67%) were implanted with combined cervical and thoracic leads, while 30 (33%) received cervical-only leads. Pain relief in both regions exceeded 60% at most visits throughout the 48-month study period. Throughout follow-up, the responder rate in both pain areas was consistently ≥ 70%. No unexpected adverse events occurred. Conclusion The 10-kHz SCS provided effective and durable pain relief with either cervical or combined cervical and thoracic leads. The efficacy and safety profile of both applications appears to be comparable to lower thoracic SCS. Our results suggest that 10-kHz SCS is a useful paresthesia-free therapeutic option for chronic neuropathic pain originating in the cervical area, as well as more complex multiarea pain presentations.
- Published
- 2021
41. Opioid‐sparing effects of 10 kHz spinal cord stimulation: a review of clinical evidence
- Author
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Leonardo Kapural, Kasra Amirdelfan, Jeyakumar Subbaroyan, Bradford E. Gliner, Adnan Al-Kaisy, Jean-Pierre Van Buyten, Anand Rotte, and David Caraway
- Subjects
Reviews ,Spinal cord stimulation ,Review ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,0302 clinical medicine ,History and Philosophy of Science ,Quality of life ,030202 anesthesiology ,medicine ,Humans ,Pain Management ,Randomized Controlled Trials as Topic ,Spinal Cord Stimulation ,business.industry ,General Neuroscience ,Chronic pain ,opioids ,Retrospective cohort study ,Biological Sciences ,medicine.disease ,Opioid-Related Disorders ,Trunk ,Analgesics, Opioid ,10 kHz SCS ,Opioid ,Anesthesia ,Opioid sparing ,Intractable pain ,Public Health ,Chronic Pain ,business ,030217 neurology & neurosurgery ,medicine.drug ,Neuroscience - Abstract
Chronic pain is a common condition that affects the physical, emotional, and mental well‐being of patients and can significantly diminish their quality of life. Due to growing concerns about the substantial risks of long‐term opioid use, both governmental agencies and professional societies have recommended prioritizing the use of nonpharmacologic treatments, when suitable, in order to reduce or eliminate the need for opioid use. The use of 10 kHz spinal cord stimulation (10 kHz SCS) is one such nonpharmacologic alternative for the treatment of chronic, intractable pain of the trunk and limbs. This review examines published clinical data regarding the efficacy of 10 kHz SCS for decreasing chronic pain in patients and its potential to reduce or eliminate opioid usage. Multiple prospective and retrospective studies in patients with intractable pain demonstrated that 10 kHz SCS treatment provided ≥50% pain relief in >70% patients after at least 1 year of treatment. Pain relief with 10 kHz SCS therapy ranged from 54% to 87% in the studies. More importantly, the mean daily dose of opioids required by patients in these studies was reduced after 10 kHz SCS treatment, and on average over 60% patients in studies either reduced or eliminated opioids at the last follow‐up., The use of 10 kHz spinal cord stimulation (10 kHz SCS) is a nonpharmacologic alternative for the treatment of chronic, intractable pain of the trunk and limbs. This review examines published clinical data regarding the efficacy of 10 kHz SCS for decreasing chronic pain in patients and its potential to reduce or eliminate opioid usage.
- Published
- 2019
42. A proposed definition of remission from chronic pain, based on retrospective evaluation of 24-month outcomes with spinal cord stimulation
- Author
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David Caraway, Elliot S. Krames, Rose Province-Azalde, Kasra Amirdelfan, Cong Yu, Ricardo Vallejo, Bradford E. Gliner, Anand Rotte, Leonardo Kapural, and B. Todd Sitzman
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Visual analogue scale ,030209 endocrinology & metabolism ,Spinal cord stimulation ,Disease ,030204 cardiovascular system & hematology ,Sensitivity and Specificity ,law.invention ,Disability Evaluation ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,Randomized controlled trial ,law ,medicine ,Humans ,Longitudinal Studies ,Aged ,Pain Measurement ,Retrospective Studies ,Aged, 80 and over ,Spinal Cord Stimulation ,business.industry ,Remission Induction ,Chronic pain ,Reproducibility of Results ,General Medicine ,Middle Aged ,medicine.disease ,Oswestry Disability Index ,Clinical trial ,Lower Extremity ,Patient Satisfaction ,Physical therapy ,Female ,Chronic Pain ,business ,Low Back Pain - Abstract
Objective: In the treatment of chronic diseases, remission is commonly used as a meaningful treatment goal, synonymous with the absence of significant clinical signs and symptoms of a disease, but not representing a cure. The objective of this paper is to propose a definition for remission for use as an outcome to evaluate the long-term efficacy of therapies for chronic pain. Methods: Data from a randomized clinical trial (NCT01609972) testing the efficacy of spinal cord stimulation in low back and leg pain subjects was used to evaluate the association between pain and functional outcomes and identify the cut-off value to predict remission. Available data over 24-month assessment period included visual analog score (VAS), disability (Oswestry Disability Index [ODI]), patient and clinician global impression of change (PGIC and CGIC), and patient satisfaction. Cluster analysis, Pearson's correlation coefficients, sensitivity, and specificity analyses were used to evaluate its utility in predicting higher patient functionality and satisfaction. Results: Though the term remission has been used in the chronic pain field, a consistent definition has not been previously established. Based on the analysis of the clinical data, we propose that a sustained (≥6 months) pain score of ≤3.0 cm out of 10 cm on VAS be defined as remission. Applying this definition to the clinical trial data: subjects in remission at 24 months versus non-remitters were significantly more likely to be in the highest functional category of minimally disabled according to the ODI (31.5 vs. 8.2%, respectively, p = 0.001), and be 'very satisfied' (75.7 vs 22.6%, respectively, p < 0.001). Conclusions: The validity of the proposed definition of remission is supported by the persistence of remission in this study group, and its correspondence with patient satisfaction, and reduced disability. Further evaluation of the definition using clinical data from other long-term studies is needed.
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- 2019
43. A multicenter real‐world review of 10 <scp>kH</scp> z <scp>SCS</scp> outcomes for treatment of chronic trunk and/or limb pain
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Leonardo Kapural, Jeyakumar Subbaroyan, Dawood Sayed, Thomas Stauss, Abdul Ghaaliq Lalkhen, Gernot Surges, William S. Rosenberg, Bradford E. Gliner, Anand Rotte, Deborah R. Edgar, Mohammad Maarouf, Faycal El Majdoub, Richard Bundschu, Martin Bettag, and Nileshkumar Patel
- Subjects
Adult ,Male ,0301 basic medicine ,medicine.medical_specialty ,MEDLINE ,Therapeutics ,03 medical and health sciences ,0302 clinical medicine ,Meta-Analysis as Topic ,Quality of life ,medicine ,Humans ,Pain Management ,Therapy efficacy ,Research Articles ,Pain Measurement ,Retrospective Studies ,Spinal Cord Stimulation ,business.industry ,General Neuroscience ,Torso ,Extremities ,Retrospective cohort study ,Middle Aged ,Trunk ,Treatment Outcome ,030104 developmental biology ,Back Pain ,Meta-analysis ,Concomitant ,Quality of Life ,Physical therapy ,Female ,Observational study ,Neurology (clinical) ,Chronic Pain ,business ,030217 neurology & neurosurgery ,Research Article ,Follow-Up Studies - Abstract
Objectives High‐frequency spinal cord stimulation (HF‐SCS) at 10 kHz has proven to be efficacious in the treatment of chronic back and leg pain in a randomized, controlled, trial (SENZA‐RCT). However, large observational studies have yet to be published. Therefore, we performed a real‐world, multicenter, retrospective, review of therapy efficacy in 1660 patients with chronic trunk and/or limb pain. Methods Data were collected in a real‐world environment and retrospectively sourced from a global database. Included patients were trialed and/or permanently implanted with HF‐SCS at 10 kHz between April 2014 and January 2018. We evaluated responder rates at 3, 6, and 12 months post‐implantation. Response was defined as ≥50% pain relief from baseline. A last visit analysis included responder rate along with overall change in function, sleep, quality of life, and medication intake versus baseline. Results Eighty‐four percent of our HF‐SCS‐treated patients had both chronic back and leg pain. At least 70% of patients reported response to therapy throughout 12 months of follow‐up. This sustained responder rate was corroborated by the last visit value (74.1%). Most patients reported concomitant improvements in function (72.3%), sleep (68.0%), and quality of life (90.3%) at their last visit versus baseline. Thirty‐two percent of patients reported decreased medication intake at their last visit. Interpretation Sustained and effective pain relief was experienced by >70% of our HF‐SCS‐treated patients, consistent with the findings of a previously published randomized, controlled, trial. Our review provides complementary evidence to support the treatment of chronic back and leg pain with this therapy.
- Published
- 2019
44. ID:16261 Number Needed to Treat Concept for Pain Relief Outcomes in Patients Treated With SCS
- Author
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Anand Rotte, Ashley Bailey-Classen, Amar Parikh, Nima Adimi, Deborah Edgar, Alice Yan, and David Caraway
- Subjects
Anesthesiology and Pain Medicine ,Neurology ,Neurology (clinical) ,General Medicine - Published
- 2022
45. ID:16191 Pooled Analysis of 10 kHz SCS in Patients With Failed Neck Surgical Syndrome
- Author
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Anand Rotte, Kasra Amirdelfan, John Salmon, Ramsin Benyamin, Cong Yu, Thomas Yang, Richard Bundschu, Thomas Yearwood, Todd Sitzman, Marc Russo, and Paul Verrills
- Subjects
Anesthesiology and Pain Medicine ,Neurology ,Neurology (clinical) ,General Medicine - Published
- 2022
46. ID:16188 Predictors of Response to 10 kHz SCS: Retrospective Review of Data From a Single Center
- Author
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Anand Rotte, Jordan Tate, and Linda Barker
- Subjects
Anesthesiology and Pain Medicine ,Neurology ,Neurology (clinical) ,General Medicine - Published
- 2022
47. ID:16262 Retrospective Case Series of Failed Traditional SCS Patients Rescued With 10 kHz SCS
- Author
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Anand Rotte, Nicholas Park, and Sarah Banducci
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Anesthesiology and Pain Medicine ,Neurology ,Neurology (clinical) ,General Medicine - Published
- 2022
48. ID:16401 Outcomes and Programming Requirements in 10 Khz SCS-Treated Patients: Retrospective Review of Single Center Data
- Author
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Anand Rotte, David Provenzano, and Jozef Leech
- Subjects
Anesthesiology and Pain Medicine ,Neurology ,Neurology (clinical) ,General Medicine - Published
- 2022
49. Phase 1 study of CART-ddBCMA in relapsed or refractory multiple myeloma
- Author
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Matthew J. Frigault, Jacalyn Rosenblatt, Daniella Cook, Ha Na Cho, Gabriel D. Depinho, Emma Logan, Jessica Liegel, Yougeesh Prabhakar, Christine Cornwell, Kamalika Banerjee, Anand Rotte, Christopher Ryan Heery, David Avigan, Andrzej J. Jakubowiak, and Michael Russell Bishop
- Subjects
Cancer Research ,Oncology - Abstract
8003 Background: Chimeric Antigen Receptor (CAR) T cell therapies targeting B-cell maturation antigen (BCMA) have demonstrated benefit in patients (pts) with relapsed and/or refractory Multiple Myeloma (RRMM). CART-ddBCMA is an autologous anti-BCMA CAR T cell therapy that utilizes a novel, synthetic binding domain, called a D-Domain, instead of a typical scFv binder. The objective of this first-in-human trial is to assess the safety and efficacy of CART-ddBCMA. Methods: This is a Phase 1, multi-center, open label, dose escalation trial for pts with RRMM who have received ≥3 prior regimens or are triple-refractory. After apheresis, bridging therapy is allowed during manufacturing. Pts receive fludarabine and cyclophosphamide (30/300 mg/m2/day) days -5 to -3 and CART-ddBCMA infusion on day 0. Dose escalation was performed at 100 (DL1) and 300 (DL2) x 106 (± 20%) CAR+T cells, followed by expansion of DL1. The primary endpoint is incidence of adverse events (AEs), including dose-limiting toxicities (DLTs). Additional endpoints are depth and duration of response (IMWG Criteria), minimal residual disease (MRD, clonoSEQ), progression-free (PFS) and overall survival (OS). Pts with 1- and 3-months follow-up were eligible for safety and efficacy analysis, respectively. Results: As of January 25, 2022, 25 pts received CART-ddBCMA, with median age 66 (range: 44-76), after a median of 5 prior lines of therapy (3-16), including 10 (40%) with extramedullary disease (EMD). Median follow-up was 9.8 (2-23.7) months. Overall, 25 pts (19 DL1; 6 DL2) were evaluable for safety and 24 (18 DL1; 6 DL2) for efficacy analysis. All pts experienced CRS, but only 1 pt (in DL2) had grade (gr) 3 CRS. All other CRS cases were gr ≤2, with no cases of gr ≥3 CRS in DL1. Four pts experienced ICANS (2, gr ≤2; 2, gr 3), with 1 gr 3 case in each of DL1 (5%) and DL2 (17%). Standard management resulted in resolution of CRS/ICANS within 30 days in all cases without sequelae. The ORR = 100%, sCR/CR rate = 67%, and ≥VGPR rate = 88%. Conversion to CR/sCR has occurred with longer follow-up, as late as month 9 in this trial. At time of data-cut 5 pts in DL1 with PR/VGPR have < 9 months follow-up, with 4 (of 4 evaluable) negative at ≥10-5 for MRD. Overall, 17 of 20 (85%) evaluable pts have achieved best MRD response of ≥10-5. In the dose escalation pts (i.e., those with longest follow-up, n = 12), the ORR and CR/sCR rate was 100% and 75%, respectively, despite 58% (7/12) EMD in this group. Of the first 6 pts dosed in DL1, 4 (67%) continue in ongoing sCR beyond 18 months, including 3 with EMD. Median duration of response, PFS and OS were not evaluable at the time of data-cut because 19 of 24 evaluable pts (79%) remain in ongoing response. Conclusions: CART-ddBCMA administration, to date, has demonstrated clinical activity, including 100% ORR with rates of CR/sCR and ≥VGPR of 67% and 88%, respectively. Durable responses beyond 18 months have been observed, including in pts with EMD. Clinical trial information: NCT04155749.
- Published
- 2022
50. Ten kilohertz SCS for Treatment of Chronic Upper Extremity Pain (UEP): Results from Prospective Observational Study
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Abram, Burgher, Peter, Kosek, Steven, Surrett, Steven M, Rosen, Todd, Bromberg, Ashish, Gulve, Anu, Kansal, Paul, Wu, W Porter, McRoberts, Ashish, Udeshi, Michael, Esposito, Bradford E, Gliner, Mona, Maneshi, Anand, Rotte, and Jeyakumar, Subbaroyan
- Subjects
10 kHz SCS ,VAS ,shoulder and upper limb pain ,upper extremity pain ,Original Research - Abstract
Background Chronic upper extremity pain (UEP) has complex etiologies and is often disabling. It has been shown that 10 kHz SCS can provide paresthesia-free and durable pain relief in multiple pain types and improve the quality of life of patients. Objective To gain additional evidence on the safety and effectiveness of 10 kHz SCS for the treatment of chronic UEP. Study Design It was a prospective, multicenter, and observational study. The study was registered on ClinicalTrials.gov prospectively (clinical trial identifier: NCT02703818). Setting Multicenter. Patients, Intervention and Main Outcomes A total of 43 subjects with chronic UEP of ≥5 cm (on a 0–10 cm visual analog scale; VAS) underwent a trial of 10 kHz SCS, and subjects with ≥40% pain relief received a permanent implant. All subjects had upper limb pain at baseline, while some had concomitant shoulder or neck pain. Subject outcomes were assessed for 12 months, and the primary outcome was the responder rate (percentage of subjects experiencing ≥50% pain relief from baseline) at three months. Results Thirty-eight subjects successfully completed the trial (88.3% success rate), 33 received permanent implants (five withdrew consent), and 32 had device activation (per protocol population). There were no paresthesias or uncomfortable changes in stimulation related to changes in posture during the study and there were no neurological deficits. Responder rates at 12 months for upper limb, shoulder, and neck pain in per protocol population (N=32) were 78.1%, 85.2%, and 75.0%, respectively. At 12 months, 84.4% of subjects were satisfied or very satisfied with 10 kHz SCS, and 38.7% either reduced or eliminated opioid usage. Conclusion This study further supports the effectiveness of 10 kHz SCS for chronic UEP treatment and documents the safety profile of the therapy. Clinical Trial Identifier NCT02703818.
- Published
- 2020
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