Biology subjects

Hoffman, J.

Publications and source records attributed to Hoffman, J..

25 records · Page 2Linked to original sources

bioRxiv2019

Disruption of NOX2-dependent Oxidative Injury with a Targeted Gene-Therapy Approach Prevents Atrial Fibrillation in a Canine Model

Atrial fibrillation is the most common heart rhythm disorder in adults and a major cause of stroke. Unfortunately, current treatments of AF are suboptimal as they are not targeted to the molecular mechanisms underlying AF. In this study, we demonstrated using a novel gene-based strategy in a clinically relevant large animal of AF that oxidative injury is a key mechanism underlying the onset and perpetuation of AF. First, we demonstrated that generation of oxidative injury in atrial myocytes is a frequency-dependent process, with rapid pacing in canine atrial myocytes inducing oxidative injury through induction of NADPH oxidase 2 (NOX2) and generation of mitochondrial reactive oxygen species. We show that oxidative injury likely contributes to electrical remodeling in AF by upregulating a constitutively active form of acetylcholine-dependent K+ current (IKACh) - called IKH - by a mechanism involving frequency-dependent activation of protein kinase C epsilon (PKC{varepsilon}). To understand the mechanism by which oxidative injury promotes the genesis and/or maintenance of AF, we performed targeted injection of NOX2 shRNA in atria of normal dogs followed by rapid atrial pacing. The time to onset of non-sustained AF increased by more than 5-fold in NOX2 shRNA treated dogs. Furthermore, animals treated with NOX2 shRNA did not develop sustained AF for up to 12 weeks. The electrophysiological mechanism underlying AF prevention was prolongation of atrial effective refractory periods, with attenuated activation of PKC{varepsilon}, a likely molecular mechanism underlying this beneficial electrophysiological remodeling. Future optimization of this approach may lead to a novel, mechanism-guided therapy for AF.\n\nOne Sentence SummaryTargeted disruption of NOX2-dependent oxidative injury with a novel gene therapy approach prevents onset as well as perpetuation of atrial fibrillation.

physiology↗

bioRxiv2018

Effect of a Sepsis Prediction Algorithm on Patient Mortality, Length of Stay, and Readmission

ObjectiveTo validate performance of a machine learning algorithm for severe sepsis determination up to 48 hours before onset, and to evaluate the effect of the algorithm on in-hospital mortality, hospital length of stay, and 30-day readmission.\n\nSettingThis cohort study includes a combined retrospective analysis and clinical outcomes evaluation: a dataset containing 510,497 patient encounters from 461 United States health centers for retrospective analysis, and a multiyear, multicenter clinical data set of real-world data containing 75,147 patient encounters from nine hospitals for clinical outcomes evaluation.\n\nParticipantsFor retrospective analysis, 270,438 adult patients with at least one documented measurement of five out of six vital sign measurements were included. For clinical outcomes analysis, 17,758 adult patients who met two or more Systemic Inflammatory Response Syndrome (SIRS) criteria at any point during their stay were included.\n\nResultsAt severe sepsis onset, the MLA demonstrated an AUROC of 0.91 (95% CI 0.90, 0.92), which exceeded those of MEWS (0.71, P<001), SOFA (0.74; P<.001), and SIRS (0.62; P<.001). For severe sepsis prediction 48 hours in advance of onset, the MLA achieved an AUROC of 0.77 (95% CI 0.73, 0.80). For the clinical outcomes study, when using the MLA, hospitals saw an average 39.5% reduction of in-hospital mortality, a 32.3% reduction in hospital length of stay, and a 22.7% reduction in 30-day readmission rate.\n\nConclusionsThe MLA accurately predicts severe sepsis onset up to 48 hours in advance using only readily available vital signs in retrospective validation. Reductions of in-hospital mortality, hospital length of stay, and 30-day readmissions were observed in real-world clinical use of the MLA. Results suggest this system may improve severe sepsis detection and patient outcomes over the use of rules-based sepsis detection systems.\n\nKEY POINTSO_ST_ABSQuestionC_ST_ABSIs a machine learning algorithm capable of accurate severe sepsis prediction, and does its clinical implementation improve patient mortality rates, hospital length of stay, and 30-day readmission rates?\n\nFindingsIn a retrospective analysis that included datasets containing a total of 585,644 patient encounters from 461 hospitals, the machine learning algorithm demonstrated an AUROC of 0.93 at time of severe sepsis onset, which exceeded those of MEWS (0.71), SOFA (0.74), and SIRS (0.62); and an AUROC of 0.77 for severe sepsis prediction 48 hours in advance of onset. In an analysis of real-world data from nine hospitals across 75,147 patient encounters, use of the machine learning algorithm was associated with a 39.5% reduction in in-hospital mortality, a 32.3% reduction in hospital length of stay, and a 22.7% reduction in 30-day readmission rate.\n\nMeaningThe accurate and predictive nature of this algorithm may encourage early recognition of patients trending toward severe sepsis, and therefore improve sepsis related outcomes.\n\nSTRENGTHS AND LIMITATIONS OF THIS STUDYO_LIA retrospective study of machine learning severe sepsis prediction from a dataset with 510,497 patient encounters demonstrates high accuracy up to 48 hours prior to onset.\nC_LIO_LIA multicenter clinical study of real-world data using this machine learning algorithm for severe sepsis alerts achieved reductions of in-hospital mortality, length of stay, and 30-day readmissions.\nC_LIO_LIThe required presence of an ICD-9 code to classify a patient as severely septic in our retrospective analysis potentially limits our ability to accurately classify all patients.\nC_LIO_LIOnly adults in US hospitals were included in this study.\nC_LIO_LIFor the real-world section of the study, we cannot eliminate the possibility that implementation of a sepsis algorithm raised general awareness of sepsis within a hospital, which may lead to higher recognition of septic patients, independent of algorithm performance.\nC_LI

bioinformatics↗

bioRxiv2018

Identification of new therapeutic targets for osteoarthritis through genome-wide analyses of UK Biobank

Osteoarthritis is the most common musculoskeletal disease and the leading cause of disability globally. Here, we perform the largest genome-wide association study for osteoarthritis to date (77,052 cases and 378,169 controls), analysing 4 phenotypes: knee osteoarthritis, hip osteoarthritis, knee and/or hip osteoarthritis, and any osteoarthritis. We discover 64 signals, 52 of them novel, more than doubling the number of established disease loci. Six signals fine map to a single variant. We identify putative effector genes by integrating eQTL colocalization, fine-mapping, human rare disease, animal model, and osteoarthritis tissue expression data. We find enrichment for genes underlying monogenic forms of bone development diseases, and for the collagen formation and extracellular matrix organisation biological pathways. Ten of the likely effector genes, including TGFB1, FGF18, CTSK and IL11 have therapeutics approved or in clinical trials, with mechanisms of action supportive of evaluation for efficacy in osteoarthritis.

genetics↗

bioRxiv2018

Identification of Novel Common Breast Cancer Risk Variants in Latinas at the 6q25 Locus

Background: Breast cancer is a partially heritable trait and over 180 common genetic variants have been associated with breast cancer in genome wide association studies (GWAS). We have previously performed breast cancer GWAS in Latinas and identified a strongly protective single nucleotide polymorphism (SNP) at 6q25 with the protective minor allele originating from Indigenous American ancestry. Here we report on additional GWAS and replication in Latinas.\n\nMethods: We performed GWAS in 2385 cases and 7342 controls who were either U.S. Latinas or Mexican women. We replicated 2412 cases and 1620 controls of U.S Latina, Mexican, and Colombian women. In addition, we replicated the top novel variants in study of African American and African women and in one study of Chinese women. In each dataset we used logistic regression models to test the association between SNPs and breast cancer risk and corrected for genetic ancestry using either principal components or genetic ancestry inferred from ancestry informative markers using a model based approach.\n\nResults: We identified 3 SNPs (p=1.9x10-8 - 2.8x10-8) at 6q25 locus not in linkage disequilibrium (LD) with variants previously reported at this locus. These SNPs were in high LD with each other, with the top SNP, rs3778609, associated with breast cancer with an odds ratio (OR) and 95% confidence interval (95% CI) of 0.75 (0.68-0.83). In a replication in women of Latin American origin, we also observed a consistent effect (OR: 0.88; 95% CI: 0.78-0.99; p=0.037). Since the minor allele was common in East Asians and African American but not European ancestry populations, we replicated in a meta-analysis of those populations and also observed a consistent effect (OR 0.94; 95% CI: 0.91 - 0.97; p=0.013).\n\nConclusion: The effect size of this variant is relatively large compared to other common variants associated with breast cancer and adds to evidence about the importance of the 6q25 locus for breast cancer susceptibility. Our finding also highlights the utility of performing additional searches for genetic variants for breast cancer in non-European populations.

genetics↗

bioRxiv2018

RAD sequencing and a hybrid Antarctic fur seal genome assembly reveal rapidly decaying linkage disequilibrium, global population structure and evidence for inbreeding

Recent advances in high throughput sequencing have transformed the study of wild organisms by facilitating the generation of high quality genome assemblies and dense genetic marker datasets. These resources have the potential to significantly advance our understanding of diverse phenomena at the level of species, populations and individuals, ranging from patterns of synteny through rates of linkage disequilibrium (LD) decay and population structure to individual inbreeding. Consequently, we used PacBio sequencing to refine an existing Antarctic fur seal (Arctocephalus gazella) genome assembly and genotyped 83 individuals from six populations using restriction site associated DNA (RAD) sequencing. The resulting hybrid genome comprised 6,169 scaffolds with an N50 of 6.21 Mb and provided clear evidence for the conservation of large chromosomal segments between the fur seal and dog (Canis lupus familiaris). Focusing on the most extensively sampled population of South Georgia, we found that LD decayed rapidly, reaching the background level of r2 = 0.09 by around 26 kb, consistent with other vertebrates but at odds with the notion that fur seals experienced a strong historical bottleneck. We also found evidence for population structuring, with four main Antarctic island groups being resolved. Finally, appreciable variance in individual inbreeding could be detected, reflecting the strong polygyny and site fidelity of the species. Overall, our study contributes important resources for future genomic studies of fur seals and other pinnipeds while also providing a clear example of how high throughput sequencing can generate diverse biological insights at multiple levels of organisation.

evolutionary biology↗

bioRxiv2018

Multicenter validation of a sepsis prediction algorithm using only vital sign data in the emergency department, general ward and ICU

ObjectivesWe validate a machine learning-based sepsis prediction algorithm (InSight) for detection and prediction of three sepsis-related gold standards, using only six vital signs. We evaluate robustness to missing data, customization to site-specific data using transfer learning, and generalizability to new settings.\n\nDesignA machine learning algorithm with gradient tree boosting. Features for prediction were created from combinations of only six vital sign measurements and their changes over time.\n\nSettingA mixed-ward retrospective data set from the University of California, San Francisco (UCSF) Medical Center (San Francisco, CA) as the primary source, an intensive care unit data set from the Beth Israel Deaconess Medical Center (Boston, MA) as a transfer learning source, and four additional institutions datasets to evaluate generalizability.\n\nParticipants684,443 total encounters, with 90,353 encounters from June 2011 to March 2016 at UCSF.\n\nInterventionsnone\n\nPrimary and secondary outcome measuresArea under the receiver operating characteristic curve (AUROC) for detection and prediction of sepsis, severe sepsis, and septic shock.\n\nResultsFor detection of sepsis and severe sepsis, InSight achieves an area under the receiver operating characteristic (AUROC) curve of 0.92 (95% CI 0.90 - 0.93) and 0.87 (95% CI 0.86 - 0.88), respectively. Four hours before onset, InSight predicts septic shock with an AUROC of 0.96 (95% CI 0.94 -0.98), and severe sepsis with an AUROC of 0.85 (95% CI 0.79 - 0.91).\n\nConclusionsInSight outperforms existing sepsis scoring systems in identifying and predicting sepsis, severe sepsis, and septic shock. This is the first sepsis screening system to exceed an AUROC of 0.90 using only vital sign inputs. InSight is robust to missing data, can be customized to novel hospital data using a small fraction of site data, and retained strong discrimination across all institutions.\n\nStrengths and limitations of this studyO_LIMachine learning is applied to the detection and prediction of three separate sepsis standards in the emergency department, general ward and intensive care settings.\nC_LIO_LIOnly six commonly measured vital signs are used as input for the algorithm.\nC_LIO_LIThe algorithm is robust to randomly missing data.\nC_LIO_LITransfer learning successfully leverages large dataset information to a target dataset.\nC_LIO_LIRetrospective nature of the study does not predict clinician reaction to information.\nC_LI

bioinformatics↗

bioRxiv2017

Pediatric Severe Sepsis Prediction Using Machine Learning

Early detection of pediatric severe sepsis is necessary in order to administer effective treatment. In this study, we assessed the efficacy of a machine-learning-based prediction algorithm applied to electronic healthcare record (EHR) data for the prediction of severe sepsis onset. The resulting prediction performance was compared with the Pediatric Logistic Organ Dysfunction score (PELOD-2) and pediatric Systemic Inflammatory Response Syndrome score (SIRS) using cross-validation and pairwise t-tests. EHR data were collected from a retrospective set of de-identified pediatric inpatient and emergency encounters drawn from the University of California San Francisco (UCSF) Medical Center, with encounter dates between June 2011 and March 2016. Patients (n = 11,127) were 2-17 years of age and 103 [0.93%] were labeled severely septic. In four-fold cross-validation evaluations, the machine learning algorithm achieved an AUROC of 0.912 for discrimination between severely septic and control pediatric patients at onset and AUROC of 0.727 four hours before onset. Under the same measure, the prediction algorithm also significantly outperformed PELOD-2 (p < 0.05) and SIRS (p < 0.05) in the prediction of severe sepsis four hours before onset. This machine learning algorithm has the potential to deliver high-performance severe sepsis detection and prediction for pediatric inpatients.

bioinformatics↗