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  1. Article ; Online: Unsupervised machine learning algorithms identify expected haemorrhage relationships but define unexplained coagulation profiles mapping to thrombotic phenotypes in hereditary haemorrhagic telangiectasia.

    Mukhtar, Ghazel / Shovlin, Claire L

    EJHaem

    2023  Volume 4, Issue 3, Page(s) 602–611

    Abstract: Hereditary haemorrhagic telangiectasia (HHT) can result in challenging anaemia and thrombosis phenotypes. Clinical presentations of HHT vary for relatives with identical casual mutations, suggesting other factors may modify severity. To examine ... ...

    Abstract Hereditary haemorrhagic telangiectasia (HHT) can result in challenging anaemia and thrombosis phenotypes. Clinical presentations of HHT vary for relatives with identical casual mutations, suggesting other factors may modify severity. To examine objectively, we developed unsupervised machine learning algorithms to test whether haematological data at presentation could be categorised into sub-groupings and fitted to known biological factors. With ethical approval, we examined 10 complete blood count (CBC) variables, four iron index variables, four coagulation variables and eight iron/coagulation indices combined from 336 genotyped HHT patients (40% male, 60% female, 86.5% not using iron supplementation) at a single centre. T-SNE unsupervised, dimension reduction, machine learning algorithms assigned each high-dimensional datapoint to a location in a two-dimensional plane. k-Means clustering algorithms grouped into profiles, enabling visualisation and inter-profile comparisons of patients' clinical and genetic features. The unsupervised machine learning algorithms using t-SNE and k-Means identified two distinct CBC profiles, two iron profiles, four clotting profiles and three combined profiles. Validating the methodology, profiles for CBC or iron indices fitted expected patterns for haemorrhage. Distinct coagulation profiles displayed no association with age, sex, C-reactive protein, pulmonary arteriovenous malformations (AVMs),
    Language English
    Publishing date 2023-07-03
    Publishing country United States
    Document type Journal Article
    ISSN 2688-6146
    ISSN (online) 2688-6146
    DOI 10.1002/jha2.746
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Iron deficiency responses and integrated compensations in patients according to hereditary hemorrhagic telangiectasia

    Sharma, Lakshya / Almaghlouth, Fatma / Mckernan, Heidi / Springett, James / Tighe, Hannah C / Shovlin, Claire L

    Haematologica

    2024  Volume 109, Issue 3, Page(s) 958–962

    MeSH term(s) Humans ; Telangiectasia, Hereditary Hemorrhagic/genetics ; Smad4 Protein/genetics ; Endoglin ; Activin Receptors, Type II/genetics
    Chemical Substances SMAD4 protein, human ; Smad4 Protein ; ENG protein, human ; Endoglin ; ACVRL1 protein, human (EC 2.7.11.30) ; Activin Receptors, Type II (EC 2.7.11.30)
    Language English
    Publishing date 2024-03-01
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2333-4
    ISSN 1592-8721 ; 0017-6567 ; 0390-6078
    ISSN (online) 1592-8721
    ISSN 0017-6567 ; 0390-6078
    DOI 10.3324/haematol.2022.282038
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Comment on Kilian et al. Comparing Characteristics and Treatment of Brain Vascular Malformations in Children and Adults with HHT.

    Eker, Omer F / Dupuis-Girod, Sophie / Shovlin, Claire L / Boccardi, Edoardo

    Journal of clinical medicine

    2023  Volume 12, Issue 22

    Abstract: We read with interest the recent article by Killian et al. regarding the characteristics and treatment of brain vascular malformations (VMs) in children and adults with hereditary hemorrhagic telangiectasia (HHT) [ ... ]. ...

    Abstract We read with interest the recent article by Killian et al. regarding the characteristics and treatment of brain vascular malformations (VMs) in children and adults with hereditary hemorrhagic telangiectasia (HHT) [...].
    Language English
    Publishing date 2023-11-20
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm12227179
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Implications for COVID-19 triage from the ICNARC report of 2204 COVID-19 cases managed in UK adult intensive care units.

    Shovlin, Claire L / Vizcaychipi, Marcela P

    Emergency medicine journal : EMJ

    2020  Volume 37, Issue 6, Page(s) 332–333

    MeSH term(s) Betacoronavirus ; COVID-19 ; Coronavirus Infections/epidemiology ; Coronavirus Infections/mortality ; Coronavirus Infections/therapy ; Critical Illness ; Humans ; Intensive Care Units/organization & administration ; Intensive Care Units/standards ; Pandemics ; Patient Acuity ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/mortality ; Pneumonia, Viral/therapy ; SARS-CoV-2 ; Triage/organization & administration ; Triage/standards ; United Kingdom/epidemiology
    Keywords covid19
    Language English
    Publishing date 2020-05-04
    Publishing country England
    Document type Letter
    ZDB-ID 2040124-3
    ISSN 1472-0213 ; 1472-0205
    ISSN (online) 1472-0213
    ISSN 1472-0205
    DOI 10.1136/emermed-2020-209791
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Updates on diagnostic criteria for hereditary haemorrhagic telangiectasia in the light of whole genome sequencing of 'gene-negative' individuals recruited to the 100 000 Genomes Project.

    Shovlin, Claire L / Almaghlouth, Fatma I / Alsafi, Ali / Coote, Nicola / Rennie, Catherine / Wallace, Gillian Mf / Govani, Fatima S / Research Consortium, Genomics England

    Journal of medical genetics

    2024  Volume 61, Issue 2, Page(s) 182–185

    MeSH term(s) Humans ; Telangiectasia, Hereditary Hemorrhagic/diagnosis ; Telangiectasia, Hereditary Hemorrhagic/genetics ; Mutation ; Phenotype ; Whole Genome Sequencing
    Language English
    Publishing date 2024-01-19
    Publishing country England
    Document type Journal Article
    ZDB-ID 220881-7
    ISSN 1468-6244 ; 0022-2593
    ISSN (online) 1468-6244
    ISSN 0022-2593
    DOI 10.1136/jmg-2023-109195
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Circulatory contributors to the phenotype in hereditary hemorrhagic telangiectasia.

    Shovlin, Claire L

    Frontiers in genetics

    2015  Volume 6, Page(s) 101

    Abstract: Hereditary hemorrhagic telangiectasia (HHT) is mechanistically and therapeutically challenging, not only because of the molecular and cellular perturbations that generate vascular abnormalities, but also the modifications to circulatory physiology that ... ...

    Abstract Hereditary hemorrhagic telangiectasia (HHT) is mechanistically and therapeutically challenging, not only because of the molecular and cellular perturbations that generate vascular abnormalities, but also the modifications to circulatory physiology that result, and are likely to exacerbate vascular injury. First, most HHT patients have visceral arteriovenous malformations (AVMs). Significant visceral AVMs reduce the systemic vascular resistance: supra-normal cardiac outputs are required to maintain arterial blood pressure, and may result in significant pulmonary venous hypertension. Secondly, bleeding from nasal and gastrointestinal telangiectasia leads to iron losses of such magnitude that in most cases, diet is insufficient to meet the 'hemorrhage adjusted iron requirement.' Resultant iron deficiency restricts erythropoiesis, leading to anemia and further increases in cardiac output. Low iron levels are also associated with venous and arterial thromboses, elevated Factor VIII, and increased platelet aggregation to circulating 5HT (serotonin). Third, recent data highlight that reduced oxygenation of blood due to pulmonary AVMs results in a graded erythrocytotic response to maintain arterial oxygen content, and higher stroke volumes and/or heart rates to maintain oxygen delivery. Finally, HHT-independent factors such as diet, pregnancy, sepsis, and other intercurrent illnesses also influence vascular structures, hemorrhage, and iron handling in HHT patients. These considerations emphasize the complexity of mechanisms that impact on vascular structures in HHT, and also offer opportunities for targeted therapeutic approaches.
    Language English
    Publishing date 2015-04-09
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2606823-0
    ISSN 1664-8021
    ISSN 1664-8021
    DOI 10.3389/fgene.2015.00101
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: Pharmacogenomic Considerations for Anticoagulant Prescription in Patients with Hereditary Haemorrhagic Telangiectasia.

    McCarley, Sarah C / Murphy, Daniel A / Thompson, Jack / Shovlin, Claire L

    Journal of clinical medicine

    2023  Volume 12, Issue 24

    Abstract: Hereditary haemorrhagic telangiectasia (HHT) is a vascular dysplasia that commonly results in bleeding but with frequent indications for therapeutic anticoagulation. Our aims were to advance the understanding of drug-specific intolerance and evaluate if ... ...

    Abstract Hereditary haemorrhagic telangiectasia (HHT) is a vascular dysplasia that commonly results in bleeding but with frequent indications for therapeutic anticoagulation. Our aims were to advance the understanding of drug-specific intolerance and evaluate if there was an indication for pharmacogenomic testing. Genes encoding proteins involved in the absorption, distribution, metabolism, and excretion of warfarin, heparin, and direct oral anticoagulants (DOACs) apixaban, rivaroxaban, edoxaban, and dabigatran were identified and examined. Linkage disequilibrium with HHT genes was excluded, before variants within these genes were examined following whole genome sequencing of general and HHT populations. The 44 genes identified included 5/17 actionable pharmacogenes with guidelines. The 76,156 participants in the Genome Aggregation Database v3.1.2 had 28,446 variants, including 9668 missense substitutions and 1076 predicted loss-of-function (frameshift, nonsense, and consensus splice site) variants, i.e., approximately 1 in 7.9 individuals had a missense substitution, and 1 in 71 had a loss-of-function variant. Focusing on the 17 genes relevant to usually preferred DOACs, similar variant profiles were identified in HHT patients. With HHT patients at particular risk of haemorrhage when undergoing anticoagulant treatment, we explore how pre-emptive pharmacogenomic testing, alongside HHT gene testing, may prove beneficial in reducing the risk of bleeding and conclude that HHT patients are well placed to be at the vanguard of personalised prescribing.
    Language English
    Publishing date 2023-12-15
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm12247710
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Pulmonary arteriovenous malformations may be the only clinical criterion present in genetically confirmed hereditary haemorrhagic telangiectasia.

    Anderson, Emily / Sharma, Lakshya / Alsafi, Ali / Shovlin, Claire L

    Thorax

    2022  Volume 77, Issue 6, Page(s) 628–630

    Abstract: Pulmonary arteriovenous malformations (PAVMs) result in preventable complications demanding specialty care. Underlying hereditary haemorrhagic telangiectasia (HHT) can be identified by genetic testing, if the diagnosis is considered. Retrospectively ... ...

    Abstract Pulmonary arteriovenous malformations (PAVMs) result in preventable complications demanding specialty care. Underlying hereditary haemorrhagic telangiectasia (HHT) can be identified by genetic testing, if the diagnosis is considered. Retrospectively reviewing 152 unrelated adults with genetically confirmed HHT due to
    MeSH term(s) Activin Receptors, Type II/genetics ; Adult ; Arteriovenous Fistula ; Arteriovenous Malformations/complications ; Arteriovenous Malformations/diagnosis ; Arteriovenous Malformations/genetics ; Humans ; Pulmonary Artery/abnormalities ; Pulmonary Veins/abnormalities ; Retrospective Studies ; Telangiectasia, Hereditary Hemorrhagic/diagnosis ; Telangiectasia, Hereditary Hemorrhagic/genetics
    Chemical Substances ACVRL1 protein, human (EC 2.7.11.30) ; Activin Receptors, Type II (EC 2.7.11.30)
    Language English
    Publishing date 2022-02-14
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 204353-1
    ISSN 1468-3296 ; 0040-6376
    ISSN (online) 1468-3296
    ISSN 0040-6376
    DOI 10.1136/thoraxjnl-2021-218332
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article: Iron deficiency, ischaemic strokes, and right-to-left shunts: From pulmonary arteriovenous malformations to patent foramen ovale?

    Shovlin, Claire L

    Intractable & rare diseases research

    2014  Volume 3, Issue 2, Page(s) 60–64

    Abstract: Has the recent identification of iron deficiency as a risk factor for ischaemic stroke in patients with pulmonary arteriovenous malformations (AVMs) unmasked a new paradigm for stroke/infarct pathogenesis? This commentary reviews evidence that spans ... ...

    Abstract Has the recent identification of iron deficiency as a risk factor for ischaemic stroke in patients with pulmonary arteriovenous malformations (AVMs) unmasked a new paradigm for stroke/infarct pathogenesis? This commentary reviews evidence that spans associations between iron deficiency and ischaemic strokes, iron deficiency enhancement of platelet aggregation in response to serotonin/5HT, settings in which plasma 5HT is elevated, and clinical trial confirmation that 5HT receptor antagonists prevent ischaemic stroke. The critical leap which directs attention away from atherothrombotic events at the neurovascular wall is that ischaemic strokes due to pulmonary AVMs are attributable to compromised pulmonary capillary bed filtration of venous blood. Right-to-left shunting is continuous through pulmonary AVMs, but also occurs intermittently in approximately 30% of the general population with intracardiac shunts such as patent foramen ovale (PFO). The testable hypothesis presented is that paradoxical embolism of venous platelet-based aggregates may constitute part of the causal chain between iron deficiency and ischaemic stroke, not only in the rare disease state of pulmonary AVMs, but also in major subgroups of the general population.
    Language English
    Publishing date 2014-09-29
    Publishing country Japan
    Document type Journal Article
    ZDB-ID 2672570-8
    ISSN 2186-361X ; 2186-3644
    ISSN (online) 2186-361X
    ISSN 2186-3644
    DOI 10.5582/irdr.2014.01008
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Pulmonary arteriovenous malformations.

    Shovlin, Claire L

    American journal of respiratory and critical care medicine

    2014  Volume 190, Issue 11, Page(s) 1217–1228

    Abstract: Within the past decade, pulmonary arteriovenous malformations (PAVMs) have evolved from rare curiosities to not uncommon clinical states, with the latest estimates suggesting a prevalence of ~1 in 2,600. PAVMs provide anatomic right-to-left shunts, ... ...

    Abstract Within the past decade, pulmonary arteriovenous malformations (PAVMs) have evolved from rare curiosities to not uncommon clinical states, with the latest estimates suggesting a prevalence of ~1 in 2,600. PAVMs provide anatomic right-to-left shunts, allowing systemic venous blood to bypass gas exchange and pulmonary capillary bed processing. Hypoxemia and enhanced ventilatory demands result, although both are usually asymptomatic. Paradoxical emboli lead to strokes and cerebral abscesses, and these commonly occur in individuals with previously undiagnosed PAVMs. PAVM hemorrhage is rare but is the main cause of maternal death in pregnancy. PAVM occlusion by embolization is the standard of care to reduce these risks. However, recent data demonstrate that currently recommended management protocols can result in levels of radiation exposure that would be classified as harmful. Recent publications also provide a better appreciation of the hematologic and cardiovascular demands required to maintain arterial oxygen content and oxygen consumption in hypoxemic patients, identify patient subgroups at higher risk of complications, and emphasize the proportion of radiologically visible PAVMs too small to treat by embolization. This review, therefore, outlines medical states that exacerbate the consequences of PAVMs. Chief among these is iron deficiency, which is commonly present due to concurrent hereditary hemorrhagic telangiectasia: iron deficiency impairs hypoxemia compensations by restricting erythropoiesis and increases the risk of ischemic strokes. Management of periodontal disease, dental interventions, pulmonary hypertension, and pregnancy also requires specific consideration in the setting of PAVMs. The review concludes by discussing to what extent previously recommended protocols may benefit from modification or revision.
    MeSH term(s) Anemia, Iron-Deficiency/complications ; Arteriovenous Malformations/complications ; Arteriovenous Malformations/diagnosis ; Arteriovenous Malformations/epidemiology ; Arteriovenous Malformations/therapy ; Brain Abscess/etiology ; Brain Abscess/prevention & control ; Diagnostic Imaging/methods ; Disease Progression ; Embolization, Therapeutic/methods ; Female ; Hemorrhage/complications ; Hemorrhage/etiology ; Hemorrhage/prevention & control ; Humans ; Hypoxia/complications ; Hypoxia/etiology ; Hypoxia/prevention & control ; Maternal Death/etiology ; Maternal Death/prevention & control ; Pregnancy ; Prevalence ; Pulmonary Artery/abnormalities ; Pulmonary Veins/abnormalities ; Standard of Care/trends ; Stroke/etiology ; Stroke/prevention & control
    Language English
    Publishing date 2014-09-26
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 1180953-x
    ISSN 1535-4970 ; 0003-0805 ; 1073-449X
    ISSN (online) 1535-4970
    ISSN 0003-0805 ; 1073-449X
    DOI 10.1164/rccm.201407-1254CI
    Database MEDical Literature Analysis and Retrieval System OnLINE

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