Barbara Davis Center

Fort Davis, United States

Barbara Davis Center

Fort Davis, United States
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Tyler K.L.,University of Colorado at Denver | Tyler K.L.,Denver Veterans Affair Medical Center | Grazia T.J.,Barbara Davis Center | Grazia T.J.,University of Colorado at Denver
Clinical Transplantation | Year: 2010

Evidence suggests that West Nile virus (WNV) neuroinvasive disease occurs more frequently in both solid organ and human stem cell transplant recipients. The effect of concomitant anti-B-cell therapy with rituximab, a CD20+ monoclonal antibody, on WNV infection in this population, however, has not been reported. We describe a case of a patient with alpha-1-antitrypsin deficiency who underwent single lung transplantation in 2005 and was maintained on tacrolimus, cytoxan and prednisone. More recently, she had received two courses of rituximab for recurrent A2-A3 grade rejection with concomitant capillaritis and presented six months later with rapid, fulminant WNV meningoencephalitis. Her diagnosis was made by cerebrospinal fluid (CSF) PCR but serum and CSF WNV IgM and IgG remained negative. She received WNV-specific hyperimmune globulin (Omr-Ig-Am®) through a compassionate protocol. She experienced a rapidly progressive and devastating neurological course despite treatment and died three wk after onset of her symptoms. Autopsy revealed extensive meningoencephalomyelitis. © 2009 John Wiley & Sons A/S.

Chase H.P.,Barbara Davis Center | Beck R.W.,Jaeb Center for Health Research | Xing D.,Jaeb Center for Health Research | Tamborlane W.V.,Yale University | And 7 more authors.
Diabetes Technology and Therapeutics | Year: 2010

Background: The use of continuous glucose monitoring (CGM) in the pediatric population is not well characterized. We have evaluated the use of CGM over a 12-month interval in youth with type 1 diabetes (TID) and have provided a description of CGM use. Methods: Eighty subjects 8-17 years old with T1D and baseline hemoglobin A1c (HbA1c) ≥7.0% used CGM as part of a 6-month randomized trial and subsequent 6-month extension study. Outcomes included frequency of CGM use, HbA1c levels, rate of severe hypoglycemia, and a CGM satisfaction scale. Results: Seventy-six (95%) of 80 subjects were using CGM after 6 months (median use=5.5days/week) compared with 67 (84%) after 12 months (median use=4.0days/week). The 17 subjects using CGM ≥6days/week in month 12 had substantially greater improvement from baseline in HbA1c than did the 63 subjects using CGM <6days/week in month 12 (mean change-0.8±0.6% vs. +0.1±0.7%, P<0.001). They also reported greater satisfaction with use of CGM (P=0.001). The incidence of severe hypoglycemic events was low during the 12 months of the study irrespective of the amount of CGM use. Conclusions: In youth with T1D, frequency of use decreases over time. Individuals who use CGM on a near-daily basis can have substantial improvement in glycemic control. © 2010, Mary Ann Liebert, Inc.

Xing D.,Jaeb Center for Health Research | Kollman C.,Jaeb Center for Health Research | Beck R.W.,Jaeb Center for Health Research | Tamborlane W.V.,Yale University | And 6 more authors.
Diabetes Technology and Therapeutics | Year: 2011

Aims and Hypothesis: The optimal duration and frequency of short-term continuous glucose monitoring (CGM) to reflect long-term glycemia have not been determined. The Juvenile Diabetes Research Foundation CGM randomized trials provided a large dataset of longitudinal CGM data for this type of analysis. Methods: The analysis included 185 subjects who had 334 3-month intervals of CGM data meeting specific criteria. For various glucose indices, correlations (r2) were computed for the entire 3-month interval versus selected sampling periods ranging from 3 to 15 days. Other computed agreement measures included median relative absolute difference, values within±10% and±20% of full value, and median absolute difference. Results: As would be expected, the more days of glucose data that were sampled, the higher the correlation with the full 3 months of data. For 3 days of sampling, the r 2 value ranged from 0.32 to 0.47, evaluating mean glucose, percentage of values 71-180mg/dL, percentage of values >180mg/dL, percentage of values ≤70mg/dL, and coefficient of variation; in contrast, for 15 days of sampling, the r2 values ranged from 0.66 to 0.75. The results were similar when the analysis intervals were stratified by age group (8-14, 15-24, and ≥25 years), by baseline hemoglobin A1c level (<7.0% and ≥7.0%), and by CGM device type. Conclusions and Interpretation: Our data suggest that a 12-15-day period of monitoring every 3 months may be needed to optimally assess overall glucose control. Shorter periods of sampling can be useful, but the correlation with 3-month measures of glycemic control is lower. © Copyright 2011, Mary Ann Liebert, Inc. 2011.

James E.A.,Benaroya Research Institute | Mallone R.,French Institute of Health and Medical Research | Schloot N.C.,Heinrich Heine University Düsseldorf | Gagnerault M.C.,French Institute of Health and Medical Research | And 10 more authors.
Diabetes/Metabolism Research and Reviews | Year: 2011

Background: Islet-antigen-specific CD4+ T cells are known to promote auto-immune destruction in T1D. Measuring T-cell number and function provides an important biomarker. In response to this need, we evaluated responses to proinsulin and GAD epitopes in a multicentre study. Methods: A tetramer-based assay was used in five participating centres to measure T-cell reactivities to DR0401-restricted epitopes. Three participating centres concurrently performed ELISPOT or immunoblot assays. Each centre used blind-coded, centrally distributed peptide and tetramer reagents. Results: All participating centres detected responses to auto-antigens and the positive control antigen, and in some cases cloned the corresponding T cells. However, response rates varied among centres. In total, 74% of patients were positive for at least one islet epitope. The most commonly recognized epitope was GAD 270-285. Only a minority of the patients tested by tetramer and ELISPOT were concordant for both assays. Conclusions: This study successfully detected GAD and proinsulin responses using centrally distributed blind-coded reagents. Centres with little previous experience using class II tetramer reagents implemented the assay. The variability in response rates observed for different centres suggests technical difficulties and/or heterogeneity within the local patient populations tested. Dual analysis by tetramer and ELISPOT or immunoblot assays was frequently discordant, suggesting that these assays detect distinct cell populations. Future efforts should investigate shared blood samples to evaluate assay reproducibility and longitudinal samples to identify changes in T-cell phenotype that correlate with changes in disease course. © 2011 John Wiley & Sons, Ltd.

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