Publications by authors named "Whelan C"

Importance: Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive cardiomyopathy that commonly presents with concomitant chronic kidney disease. Chronic kidney dysfunction is associated with worse outcomes, but the prognostic value of changes in kidney function over time has yet to be defined.

Objective: To assess the prognostic importance of a decline in estimated glomerular filtration rate (eGFR) in a large cohort of patients with ATTR-CM.

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  • Cardiac amyloid infiltration significantly impacts survival in systemic light-chain (AL) amyloidosis, with guidelines suggesting early therapy changes for patients not responding well, regardless of cardiac amyloid severity.
  • The study aimed to compare serum biomarkers, echocardiography, and cardiovascular magnetic resonance (CMR) with extracellular volume (ECV) mapping in understanding cardiac amyloid and its prognostic value.
  • Findings revealed that ECV is a strong independent predictor of mortality, showing different relationships between the depth of hematological response and survival based on specific ECV thresholds over 1- and 6-month periods.
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Introduction: Cancer-associated cachexia (CC) is a progressive syndrome characterized by unintentional weight loss, muscle atrophy, fatigue, and poor outcomes that affects most patients with pancreatic ductal adenocarcinoma (PDAC). The ability to identify and classify CC stage along its continuum early in the disease process is challenging but critical for management.

Objectives: The main objective of this study was to determine the prevalence of CC stage overall and by sex and race and ethnicity among treatment-naïve PDAC cases using clinical, nutritional, and functional criteria.

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Parkinson's disease is highly heterogeneous across disease symptoms, clinical manifestations and progression trajectories, hampering the identification of therapeutic targets. Despite knowledge gleaned from genetics analysis, dysregulated proteome mechanisms stemming from genetic aberrations remain underexplored. In this study, we develop a three-phase system-level proteogenomic analytical framework to characterize disease-associated proteins and dysregulated mechanisms.

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  • The study investigates the role of beta-blockers in improving survival for patients with cardiac amyloidosis (CA), highlighting unclear efficacy and concerns about worsening heart failure symptoms.
  • A systematic review and meta-analysis of 13 studies involving 4,215 CA patients concluded that beta-blocker therapy may be associated with reduced mortality, particularly in mixed ATTR-CM and AL-CM cases.
  • However, the study notes significant limitations, such as a lack of information on the staging of CA, which may affect the findings' applicability.
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For many patients, the cancer continuum includes a syndrome known as cancer-associated cachexia (CAC), which encompasses the unintended loss of body weight and muscle mass, and is often associated with fat loss, decreased appetite, lower tolerance and poorer response to treatment, poor quality of life, and reduced survival. Unfortunately, there are no effective therapeutic interventions to completely reverse cancer cachexia and no FDA-approved pharmacologic agents; hence, new approaches are urgently needed. In May of 2022, researchers and clinicians from Moffitt Cancer Center held an inaugural retreat on CAC that aimed to review the state of the science, identify knowledge gaps and research priorities, and foster transdisciplinary collaborative research projects.

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  • This study analyzed the effectiveness and tolerability of SGLT2 inhibitors in patients with transthyretin cardiomyopathy (ATTR-CM), a condition previously excluded from related clinical trials.
  • Out of 2,356 ATTR-CM patients, 260 received SGLT2 inhibitors, and after matching for certain variables, it was found that SGLT2i treatment led to less deterioration in heart failure symptoms and better kidney function over time.
  • The findings suggest that SGLT2i treatment not only had a low discontinuation rate but also significantly reduced the risks of all-cause mortality, cardiovascular mortality, and heart failure hospitalizations in these patients.
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  • Bortezomib is a common first-line treatment for systemic AL amyloidosis, and the study evaluates the effectiveness of a second-line therapy combining daratumumab, bortezomib, and dexamethasone (DVD) in patients previously treated with bortezomib.
  • From a cohort of 116 patients undergoing second-line DVD, a significant percentage (69.8%) achieved a complete response (CR) or very good partial response (VGPR), with better outcomes observed in those who initially responded well to first-line bortezomib.
  • The study also found that patients who received DVD due to inadequate response to first-line treatment had lower event-free survival
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  • - The study investigates cardiovascular autonomic dysfunction in individuals with hereditary transthyretin amyloidosis, revealing that 27% reported symptoms at disease onset, increasing to 78% at the first evaluation (T1) after 4.5 years.
  • - A total of 124 individuals participated, with cardiovascular autonomic failure found in 75% of symptomatic patients and 64% of asymptomatic TTR variant carriers, highlighting a significant underestimate of autonomic issues in early stages.
  • - The findings suggest that autonomic dysfunction can be an early indicator of disease progression, with a faster progression rate observed in individuals reporting autonomic symptoms, emphasizing the need for routine autonomic function testing for better diagnosis and monitoring.
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Pediatric solid tumors are rare malignancies that represent a leading cause of death by disease among children in developed countries. The early age-of-onset of these tumors suggests that germline genetic factors are involved, yet conventional germline testing for short coding variants in established predisposition genes only identifies pathogenic events in 10-15% of patients. Here, we examined the role of germline structural variants (SVs)-an underexplored form of germline variation-in pediatric extracranial solid tumors using germline genome sequencing of 1,766 affected children, their 943 unaffected relatives, and 6,665 adult controls.

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  • * It analyzed data from 2,141 ATTR-CA patients, revealing that those who walked less than 350 meters on the 6MWT had a significantly higher mortality risk, with mortality rates increasing as walking distance decreased.
  • * The findings suggest that monitoring changes in 6MWT performance can enhance risk assessment and disease progression understanding, offering valuable insights beyond conventional measures like N-terminal pro-B-type natriuretic peptide levels.
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  • Transthyretin cardiac amyloidosis (ATTR-CA) is a serious heart condition that can progress at different rates among patients, making it hard to track disease advancement.
  • This study analyzed the significance of rising levels of NT-proBNP and increased need for diuretics as predictors of worsening heart function over one year in a large sample of ATTR-CA patients.
  • Results showed that increases in NT-proBNP and diuretic use were both strongly linked to increased mortality risk, highlighting the importance of these markers for monitoring patients' health outcomes.
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Objectives: Temporal lobe epilepsy (TLE) is commonly associated with mesiotemporal pathology and widespread alterations of grey and white matter structures. Evidence supports a progressive condition although the temporal evolution of TLE is poorly defined. This ENIGMA-Epilepsy study utilized multimodal magnetic resonance imaging (MRI) data to investigate structural alterations in TLE patients across the adult lifespan.

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Primary low milk supply (PLMS) prevents mothers from producing sufficient milk to breastfeed exclusively. However, limited evidence exists regarding women's experiences of breastfeeding with PLMS. This article aims to investigate the emotional experiences of mothers breastfeeding with PLMS in the first 3 months postpartum.

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  • Cardiopulmonary exercise testing (CPET) is important for evaluating heart failure but lacks data specifically for patients with transthyretin (ATTR) amyloidosis.
  • The study aimed to characterize the functional capabilities of ATTR amyloidosis patients using CPET and explore how these relate to the severity of cardiac amyloid deposits and patient prognosis.
  • Results indicated that functional impairment was common, particularly in patients with ATTR-CM and ATTR-mixed phenotypes, highlighting issues like decreased oxygen consumption and inefficiencies in exercise performance across the different disease types.
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Acidosis is an important immunosuppressive mechanism that leads to tumor growth. Therefore, we investigated the neutralization of tumor acidity to improve immunotherapy response. L-DOS47, a new targeted urease immunoconjugate designed to neutralize tumor acidity, has been well tolerated in phase I/IIa trials.

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  • Transthyretin cardiac amyloidosis (ATTR-CA) is a serious heart condition, and this study aimed to understand the relationship between various blood biomarkers and patient prognosis.
  • Researchers examined 2,566 patients with ATTR-CA, finding high rates of anemia, urea, hyperbilirubinemia, and elevated troponin levels, which increased with disease severity.
  • The study concluded that several biomarkers, especially anemia and elevated troponin levels, are independently linked to higher mortality rates in patients, with variations based on genetic factors and heart function.
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  • Cardiac involvement is crucial in systemic amyloidosis outcomes, with this study investigating how myocardial ischaemia affects cellular damage using advanced imaging and tissue analysis.
  • The study involved 93 patients with cardiac amyloidosis and 97 controls, revealing that those with amyloidosis had significantly lower myocardial blood flow during stress tests compared to other groups.
  • Histopathological analysis showed vascular abnormalities and reduced capillary density in cardiac tissue from amyloid patients, highlighting a complex relationship between amyloid infiltration and ischaemia.
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  • Amyloidogenic serum free light chains (sFLCs) contribute to the worsening of AL amyloidosis, and a new testing method called FLC-MS shows improved sensitivity for detecting disease remnants.
  • In a study involving 487 patients, FLC-MS identified that 16.6% and 20.7% were negative for sFLCs at 6 and 12 months post-treatment, respectively, highlighting its ability to correlate with better survival rates and organ response.
  • The findings indicate that FLC-MS negativity is a strong predictor of positive outcomes in patients, suggesting it may become the new standard for assessing treatment responses in AL amyloidosis.
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Background And Objectives: Amyloid-related imaging abnormalities (ARIA) were the most common adverse events reported in the phase 3 ENGAGE and EMERGE trials of aducanumab, an anti-amyloid monoclonal antibody. ε4 carrier status has been shown to increase risk of ARIA in prior trials of aducanumab and other anti-amyloid therapies; however, the remainder of the human genome has not been evaluated for ARIA risk factors. Therefore, we sought to determine in a hypothesis-free manner whether genetic variants beyond influence risk of ARIA in aducanumab-treated patients.

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  • Transthyretin cardiac amyloidosis (ATTR-CA) often occurs alongside chronic kidney disease, with albuminuria being common and linked to worse health outcomes; however, its exact impact on ATTR-CA is not fully understood.
  • In a study of 1,181 ATTR-CA patients, nearly 48% had albuminuria, which was associated with more severe heart issues marked by elevated cardiac biomarkers and poorer heart function compared to those with normal protein levels in urine.
  • Both microalbuminuria and macroalbuminuria independently predicted higher mortality rates, with significant risks evident even in patients without other complicating conditions like hypertension or diabetes; an increase in urinary albumin levels over 12 months also indicated increased
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