Publications (48) View all
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Article: Autologous Umbilical Cord Blood (UCB) Infusion Followed by Oral Docosahexanoic Acid (DHA) and Vitamin D (VitD) Supplementation for C-Peptide Preservation in Children with Type 1 Diabetes (T1D).
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ABSTRACT: We sought to determine if autologous umbilical cord blood (UCB) infusion followed by 1 year of supplementation with vitamin D (Vit D) and docosoahexaenoic acid (DHA) can preserve C-peptide in children with type 1 diabetes (T1D). We conducted an open label, 2:1 randomized study in which 15 T1D subjects with stimulated C-peptide > 0.2 pmol/mL received either (1) autologous UCB infusion, one year of daily oral Vit D (2,000IU) and DHA (38mg/kg), and intensive diabetes management, or (2) intensive diabetes management alone. Primary analyses were performed 1 year following UCB infusion. Treated (n=10) and control (n=5) subjects had median ages of 7.2 and 6.6 years, respectively. No severe adverse events were observed. While the absolute rate of C-peptide decline was slower in treated versus control subjects, intergroup comparisons failed to reach significance (P=0.29). AUC C-peptide declined and insulin use increased in both groups (P=<0.01). VitD levels remained stable in treated subjects but declined in controls (P=0.01). DHA levels rose in treated subjects versus controls (P =0.003). CD4:CD8 ratio remained stable in treated subjects but declined in controls (P=0.03). No changes were seen in regulatory T cell frequency, total CD4 counts, or autoantibody titers. Autologous UCB infusion followed by daily supplementation with Vit D and DHA was safe but failed to preserve C-peptide. Lack of significance may reflect small sample size. Future efforts will require expansion of specific immunoregulatory cell subsets, optimization of combined immunoregulatory and anti-inflammatory agents, and larger study cohorts.Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 04/2013; · 3.15 Impact Factor -
Article: Update on global intervention studies in type 1 diabetes.
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ABSTRACT: Remarkable progress has been made in strategies to arrest pancreatic β-cell destruction in type 1 diabetes. Although knowledge of the disease has increased, a safe therapeutic intervention to reverse or prevent it remains elusive. The interaction of genes, immune system, and environment result in a complex disease process that has delayed hopes for a cure. Several well-designed prevention and intervention studies have aspired to test potentially efficacious and safe therapies. This article updates the principles used to design prevention and intervention trials, reviews clinical trials, addresses controversial issues, and provides a framework for future efforts to interdict this condition.Endocrinology and metabolism clinics of North America 12/2012; 41(4):695-712. · 3.56 Impact Factor -
Article: Response to Comment on: Greenbaum et al. Through the Fog: Recent Clinical Trials to Preserve β-Cell Function in Type 1 Diabetes. Diabetes 2012;61:1323-1330.
Diabetes 12/2012; 61(12):e19. · 8.29 Impact Factor -
Article: Tanner stage 4 breast development in adults: forensic implications.
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ABSTRACT: Forensic testimony in alleged child pornography cases commonly asserts that Tanner stage (TS) 4 breast development, characterized by secondary mounding of the areola that is obliterated in TS 5, is evidence of age <18 years. Clinical experience does not support this notion, but there are no relevant studies. We sought to estimate how frequently TS 4 might be interpreted from nonclinical images by individual forensic experts. Published images of 547 adult women were independently examined by the authors and classified as having TS 4 or TS 5 breast development. There was concordance among all 4 of the examiners for 17 of the images, agreement of 3 of the examiners on another 36 images, of 2 examiners on 39 images, and 53 images were designated TS 4 by only 1 examiner, for a total of 153 (26.5%) images that could have been considered by a single forensic expert to represent TS 4. A substantial number of adults have persistent TS 4 breast development. This observation, and the frequent difficulty distinguishing TS 4 from TS 5, even by adolescent development specialists, especially in nonclinical images, renders testimony based on this distinction invalid. Without clinical relevance for distinguishing these advanced stages of breast development, they should both be considered indicative of full maturation. Testimony based on this inappropriate test of maturity should no longer be allowed.PEDIATRICS 09/2012; 130(4):e978-81. · 4.47 Impact Factor -
Article: Through the fog: recent clinical trials to preserve β-cell function in type 1 diabetes.
Diabetes 06/2012; 61(6):1323-30. · 8.29 Impact Factor
