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  1. Article ; Online: Regulatory B cells in transplantation: roadmaps to clinic.

    Beckett, Joseph / Hester, Joanna / Issa, Fadi / Shankar, Sushma

    Transplant international : official journal of the European Society for Organ Transplantation

    2020  Volume 33, Issue 11, Page(s) 1353–1368

    Abstract: Over the last two decades, an additional and important role for B cells has been established in immune regulation. Preclinical studies demonstrate that regulatory B cells (Breg) can prolong allograft survival in animal models and induce regulatory T ... ...

    Abstract Over the last two decades, an additional and important role for B cells has been established in immune regulation. Preclinical studies demonstrate that regulatory B cells (Breg) can prolong allograft survival in animal models and induce regulatory T cells. Operationally tolerant human kidney transplant recipients demonstrate B-cell-associated gene signatures of immune tolerance, and novel therapeutic agents can induce Bregs in phase I clinical trials in transplantation. Our rapidly expanding appreciation of this novel B-cell subtype has made the road to clinical application a reality. Here, we outline several translational pathways by which Bregs could soon be introduced to the transplant clinic.
    MeSH term(s) Animals ; B-Lymphocytes, Regulatory ; Humans ; Immune Tolerance ; T-Lymphocytes, Regulatory ; Transplantation Tolerance ; Transplantation, Homologous
    Language English
    Publishing date 2020-10-09
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 639435-8
    ISSN 1432-2277 ; 0934-0874
    ISSN (online) 1432-2277
    ISSN 0934-0874
    DOI 10.1111/tri.13706
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    Zs.A 2358: Show issues Location:
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  2. Article ; Online: Towards regulatory cellular therapies in solid organ transplantation.

    Bottomley, Matthew J / Brook, Matthew O / Shankar, Sushma / Hester, Joanna / Issa, Fadi

    Trends in immunology

    2021  Volume 43, Issue 1, Page(s) 8–21

    Abstract: Organ transplantation is a modern medical success story. However, since its inception it has been limited by the need for pharmacological immunosuppression. Regulatory cellular therapies offer an attractive solution to these challenges by controlling ... ...

    Abstract Organ transplantation is a modern medical success story. However, since its inception it has been limited by the need for pharmacological immunosuppression. Regulatory cellular therapies offer an attractive solution to these challenges by controlling transplant alloresponses through multiple parallel suppressive mechanisms. A number of cell types have seen an accelerated development into human trials and are now on the threshold of a long-awaited breakthrough in personalized transplant therapeutics. Here we assess recent developments with a focus on the most likely candidates, some of which have already facilitated successful immunosuppression withdrawal in early clinical trials. We propose that this may constitute a promising approach in clinical transplantation but also evaluate outstanding issues in the field, providing cause for cautious optimism.
    MeSH term(s) Cell- and Tissue-Based Therapy ; Humans ; Immune Tolerance ; Immunosuppression Therapy ; Organ Transplantation ; Transplantation Tolerance
    Language English
    Publishing date 2021-11-26
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 2036831-8
    ISSN 1471-4981 ; 1471-4906
    ISSN (online) 1471-4981
    ISSN 1471-4906
    DOI 10.1016/j.it.2021.11.001
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  3. Article ; Online: International Medical Graduates in Abdominal Transplant Surgery Fellowships in the United States, response to letter by Schlottmann et al.

    Lafranca, Jeffrey Anthony / Shankar, Sushma / Ceulemans, Laurens J / Akhtar, M Zeeshan

    Transplant international : official journal of the European Society for Organ Transplantation

    2018  Volume 31, Issue 5, Page(s) 568–569

    MeSH term(s) Fellowships and Scholarships ; Humans ; Internship and Residency ; Surveys and Questionnaires ; United States
    Language English
    Publishing date 2018
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 639435-8
    ISSN 1432-2277 ; 0934-0874
    ISSN (online) 1432-2277
    ISSN 0934-0874
    DOI 10.1111/tri.13133
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  4. Article: Bilateral Multifocal Renal Angiomyolipoma Associated with Wunderlich's Syndrome in A Tuberous Sclerosis Patient.

    Shankar, Sushma / Hulikanthimatt, Kiran Shankar / Awatti, Shreeharsha Mallappa / Narayanrao, Suresh Turuvekere

    Journal of clinical and diagnostic research : JCDR

    2015  Volume 9, Issue 8, Page(s) ED01–3

    Abstract: Renal Angiomyolipoma (renal AML) is a benign clonal neoplasm with a incidence of 0.3-3%, occurring as isolated sporadic entity or in association with Tuberous sclerosis (TS) in 80% cases. Multiple, bilateral renal AML are considered diagnostic of ... ...

    Abstract Renal Angiomyolipoma (renal AML) is a benign clonal neoplasm with a incidence of 0.3-3%, occurring as isolated sporadic entity or in association with Tuberous sclerosis (TS) in 80% cases. Multiple, bilateral renal AML are considered diagnostic of Tuberous sclerosis. Wunderlich's syndrome, a urological emergency is a spontaneous nontraumatic bleeding into subcapsular and or peri-renal space and is a life threatening complication of renal AML occurring in 10% cases which has to be timely diagnosed and treated. Here, we present an unusual case of TS with bilateral, multifocal renal AML in a 25-year-old female who presented with Wunderlich's syndrome, which is a rare but life threatening complication that has to be suspected, timely diagnosed and treated. We have discussed the importance of early diagnosis, timely treatment, follow up and education of patient and relatives of the possible complications associated.
    Language English
    Publishing date 2015-08-01
    Publishing country India
    Document type Case Reports
    ZDB-ID 2775283-5
    ISSN 0973-709X ; 2249-782X
    ISSN (online) 0973-709X
    ISSN 2249-782X
    DOI 10.7860/JCDR/2015/13349.6289
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  5. Article ; Online: SARS-CoV-2-Specific T Cell Responses Are Not Associated with Protection against Reinfection in Hemodialysis Patients.

    Shankar, Sushma / Beckett, Joseph / Tipton, Tom / Ogbe, Ane / Kasanyinga, Mwila / Dold, Christina / Lumley, Sheila / Dengu, Fungai / Rompianesi, Gianluca / Elgilani, Faysal / Longet, Stephanie / Deeks, Alexandra / Payne, Rebecca P / Duncan, Christopher J A / Richter, Alex / de Silva, Thushan I / Turtle, Lance / Bull, Katherine / Barnardo, Martin /
    Friend, Peter J / Dunachie, Susanna J / Hester, Joanna / Issa, Fadi / Barnes, Eleanor / Carroll, Miles W / Klenerman, Paul

    Journal of the American Society of Nephrology : JASN

    2022  Volume 33, Issue 5, Page(s) 883–887

    MeSH term(s) COVID-19 ; Humans ; Reinfection ; Renal Dialysis ; SARS-CoV-2 ; T-Lymphocytes
    Language English
    Publishing date 2022-03-31
    Publishing country United States
    Document type Letter ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 1085942-1
    ISSN 1533-3450 ; 1046-6673
    ISSN (online) 1533-3450
    ISSN 1046-6673
    DOI 10.1681/ASN.2021121587
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    Zs.A 3344: Show issues Location:
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  6. Article ; Online: Initiatives in South Africa to enhance the prescribing of generic proton pump inhibitors: findings and implications.

    Truter, Ilse / Shankar, Sushma / Bennie, Marion / Woerkom, Menno van / Godman, Brian

    Journal of comparative effectiveness research

    2015  Volume 4, Issue 2, Page(s) 123–131

    Abstract: Background: There have been multiple reforms in South Africa to conserve resources including policies to enhance generic use, such as compulsory generic substitution and copayments. However, there are concerns with the limited knowledge of their impact.! ...

    Abstract Background: There have been multiple reforms in South Africa to conserve resources including policies to enhance generic use, such as compulsory generic substitution and copayments. However, there are concerns with the limited knowledge of their impact.
    Objective: The objective was to determine utilization and expenditure of different proton pump inhibitors (PPIs).
    Methodology: A retrospective drug utilization study was conducted on a prescription database of a medical aid administrator in 2010.
    Results: The limited prescribing of single-sourced PPIs accounted for 21.5% of total prescriptions. The limited use of originators omeprazole and lansoprazole accounted for 1.8 and 1.4% of total prescriptions for the molecule, respectively. Generic prices accounted for 36-68% of the originator in 2010. Patients received on average 2.91 PPI prescriptions during the year.
    Conclusion: Policies to enhance prescribing of generics appear working. Opportunities exist to further lower generic prices given low prices in some European countries.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Drugs, Generic/economics ; Drugs, Generic/supply & distribution ; Female ; Humans ; Infant ; Infant, Newborn ; Lansoprazole/economics ; Lansoprazole/supply & distribution ; Male ; Middle Aged ; Omeprazole/economics ; Omeprazole/supply & distribution ; Practice Patterns, Physicians'/economics ; Practice Patterns, Physicians'/statistics & numerical data ; Private Sector/statistics & numerical data ; Proton Pump Inhibitors/economics ; Proton Pump Inhibitors/supply & distribution ; Retrospective Studies ; South Africa ; Young Adult
    Chemical Substances Drugs, Generic ; Proton Pump Inhibitors ; Lansoprazole (0K5C5T2QPG) ; Omeprazole (KG60484QX9)
    Language English
    Publishing date 2015-03
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 2042-6313
    ISSN (online) 2042-6313
    DOI 10.2217/cer.14.70
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  7. Article ; Online: Prescribing efficiency of proton pump inhibitors in China: influence and future directions.

    Zeng, Wenjie / Finlayson, Alexander E / Shankar, Sushma / de Bruyn, Winnie / Godman, Brian

    BMC health services research

    2015  Volume 15, Page(s) 11

    Abstract: Background: Pharmaceutical expenditure is currently rising by 16% per annum in China, greater in recent years. Initiatives to moderate growth include drug pricing regulations, essential medicine lists and encouraging generic prescribing. These are ... ...

    Abstract Background: Pharmaceutical expenditure is currently rising by 16% per annum in China, greater in recent years. Initiatives to moderate growth include drug pricing regulations, essential medicine lists and encouraging generic prescribing. These are principally concentrated in hospitals, which currently account for over 80% of total pharmaceutical expenditure. However, no monitoring of prescribing and perverse incentives encouraging physicians and hospitals to profit from drug procurement encourages irrational prescribing. This includes greater utilisation of originators versus generics as well as injectables when cheaper oral equivalents are available. The objective of the paper is to assess changes in proton pump inhibitor (PPI) utilisation and expenditure in China as more generics become available including injectables.
    Methods: Observational retrospective study of PPI utilisation and procured expenditure between 2004 and 2013 in the largest teaching hospital in Chongqing District as representative of China.
    Results: Appreciable increase in PPI utilisation during the study period rising 10.4 fold, with utilisation of generics rising faster than originators. Oral generics reached 84% of total oral preparations in 2013 (defined daily dose basis), with generic injectables 93% of total injectables by 2013. Injectables accounted for 42% of total PPI utilisations in 2008 and 2009 before falling to below 30%. Procured prices for oral preparations reduced over time (-34%). Generic oral omeprazole in 2010 was 87% below 2004 originator prices, mirroring reductions seen in Western Europe. Injectable prices also decreased over time (-19%). However, injectables typically 4.3 to 6.8 fold more expensive than equivalent orals - highest for injectable lansoprazole at 13.4 to 18.0 fold. High utilisation of more expensive oral PPIs as well as injectables meant that PPI expenditure increased 10.1 fold during the study period. Lower use of injectables, and only oral generic omeprazole, would result in accumulated savings of CNY249.65 million, reducing total accumulated expenditure by 84%.
    Conclusions: Encouraging to see high utilisation of generic PPIs and low prices for oral generics. However, considerable opportunities to enhance prescribing efficiency through greater use of oral generic omeprazole.
    MeSH term(s) Administration, Oral ; China ; Drug Costs ; Drug Utilization ; Drugs, Generic/economics ; Drugs, Generic/therapeutic use ; Forecasting ; Gastroesophageal Reflux/drug therapy ; Gastroesophageal Reflux/economics ; Health Expenditures ; Humans ; Injections, Intravenous ; Omeprazole/therapeutic use ; Practice Patterns, Physicians'/economics ; Practice Patterns, Physicians'/trends ; Proton Pump Inhibitors/economics ; Proton Pump Inhibitors/therapeutic use ; Retrospective Studies
    Chemical Substances Drugs, Generic ; Proton Pump Inhibitors ; Omeprazole (KG60484QX9)
    Language English
    Publishing date 2015-01-22
    Publishing country England
    Document type Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
    ISSN 1472-6963
    ISSN (online) 1472-6963
    DOI 10.1186/s12913-014-0638-6
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  8. Article ; Online: Examination of serum miRNA levels in kidney transplant recipients with acute rejection.

    Betts, Gareth / Shankar, Sushma / Sherston, Sam / Friend, Peter / Wood, Kathryn J

    Transplantation

    2014  Volume 97, Issue 4, Page(s) e28–30

    MeSH term(s) Biomarkers/blood ; Biopsy ; Gene Expression Regulation ; Glomerular Filtration Rate ; Graft Rejection/blood ; Humans ; Immunosuppressive Agents/therapeutic use ; Kidney Transplantation/adverse effects ; MicroRNAs/blood ; Time Factors
    Chemical Substances Biomarkers ; Immunosuppressive Agents ; MIRN10 microRNA, human ; MIRN223 microRNA, human ; MicroRNAs
    Language English
    Publishing date 2014-02-27
    Publishing country United States
    Document type Letter
    ZDB-ID 208424-7
    ISSN 1534-6080 ; 0041-1337
    ISSN (online) 1534-6080
    ISSN 0041-1337
    DOI 10.1097/01.TP.0000441098.68212.de
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    Zs.A 488: Show issues Location:
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    Zs.MO 509: Show issues

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  9. Article: Minimally invasive surgical technique in total knee arthroplasty: a learning curve.

    Kashyap, Shankar N / Van Ommeren, Jan Willem / Shankar, Sushma

    Surgical innovation

    2009  Volume 16, Issue 1, Page(s) 55–62

    Abstract: Clinical experience of learning a new technique of minimally surgery for total knee arthroplasty is presented. Close monitoring of the technique, pitfalls, learning tips, and tricks are discussed. A "learning phase" is identified as approximately 10 ... ...

    Abstract Clinical experience of learning a new technique of minimally surgery for total knee arthroplasty is presented. Close monitoring of the technique, pitfalls, learning tips, and tricks are discussed. A "learning phase" is identified as approximately 10 months or 21 knee replacements using minimally invasive technique. It took 50 operations before the surgical time equaled the open technique. There was no incidence of increased complications during the learning phase. Functional results such as stair climbing, walking distance, and walking with aids was significantly better after minimally invasive technique than after standard technique.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee/methods ; Clinical Competence ; Female ; Humans ; Male ; Middle Aged ; Osteoarthritis, Knee/surgery ; Recovery of Function
    Language English
    Publishing date 2009-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2182571-3
    ISSN 1553-3514 ; 1553-3506
    ISSN (online) 1553-3514
    ISSN 1553-3506
    DOI 10.1177/1553350609331396
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  10. Article ; Online: Neutralising antibodies after COVID-19 vaccination in UK haemodialysis patients.

    Carr, Edward J / Wu, Mary / Harvey, Ruth / Wall, Emma C / Kelly, Gavin / Hussain, Saira / Howell, Michael / Kassiotis, George / Swanton, Charles / Gandhi, Sonia / Bauer, David Lv / Billany, Roseanne E / Graham-Brown, Matthew Pm / Beckett, Joseph / Bull, Katherine / Shankar, Sushma / Henderson, Scott / Motallebzadeh, Reza / Salama, Alan D /
    Harper, Lorraine / Mark, Patrick B / McAdoo, Stephen / Willicombe, Michelle / Beale, Rupert

    Lancet (London, England)

    2021  Volume 398, Issue 10305, Page(s) 1038–1041

    MeSH term(s) Antibodies, Neutralizing ; Antibodies, Viral ; COVID-19 ; COVID-19 Vaccines ; Humans ; Renal Dialysis ; SARS-CoV-2 ; United Kingdom ; Vaccination
    Chemical Substances Antibodies, Neutralizing ; Antibodies, Viral ; COVID-19 Vaccines
    Language English
    Publishing date 2021-08-13
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 3306-6
    ISSN 1474-547X ; 0023-7507 ; 0140-6736
    ISSN (online) 1474-547X
    ISSN 0023-7507 ; 0140-6736
    DOI 10.1016/S0140-6736(21)01854-7
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