Genome-wide identification, expression, and sequence analysis of CONSTANS-like gene family in cannabis reveals a potential role in plant flowering time regulation

BACKGROUND

Cannabis, an important industrial crop, has a high sensitivity to photoperiods. The flowering time of cannabis is one of its important agronomic traits, and has a significant effect on its yield and quality. The CONSTANS-like (COL) gene plays a key role in the regulation of flowering in this plant. However, the specific roles of the COL gene family in cannabis are still unknown.

RESULTS

In this study, 13 CsCOL genes were identified in the cannabis genome. Phylogenetic analysis implied that the CsCOL proteins were divided into three subgroups, and each subgroup included conserved intron/exon structures and motifs. Chromosome distribution analysis showed that 13 CsCOL genes were unevenly distributed on 7 chromosomes, with chromosome 10 having the most CsCOL members. Collinearity analysis showed that two syntenic gene pairs of CsCOL4 and CsCOL11 were found in both rice and Gossypium raimondii. Of the 13 CsCOL genes, CsCOL6 and CsCOL12 were a pair of tandem duplicated genes, whereas CsCOL8 and CsCOL11 may have resulted from segmental duplication. Furthermore, tissue-specific expression showed that 10 CsCOL genes were preferentially expressed in the leaves, 1 CsCOL in the stem, and 2 CsCOL in the female flower. Most CsCOL exhibited a diurnal oscillation pattern under different light treatment. Additionally, sequence analysis showed that CsCOL3 and CsCOL7 exhibited amino acid differences among the early-flowering and late flowering cultivars.

CONCLUSION

This study provided insight into the potential functions of CsCOL genes, and highlighted their roles in the regulation of flowering time in cannabis. Our results laid a foundation for the further elucidation of the functions of COL genes in cannabis.

Pirtobrutinib in relapsed or refractory B-cell malignancies (BRUIN): a phase 1/2 study

BACKGROUND

Covalent Bruton's tyrosine kinase (BTK) inhibitors are efficacious in multiple B-cell malignancies, but patients discontinue these agents due to resistance and intolerance. We evaluated the safety and efficacy of pirtobrutinib (working name; formerly known as LOXO-305), a highly selective, reversible BTK inhibitor, in these patients.

METHODS

Patients with previously treated B-cell malignancies were enrolled in a first-in-human, multicentre, open-label, phase 1/2 trial of the BTK inhibitor pirtobrutinib. The primary endpoint was the maximum tolerated dose (phase 1) and overall response rate (ORR; phase 2). This trial is registered with ClinicalTrials.gov, NCT03740529.

FINDINGS

323 patients were treated with pirtobrutinib across seven dose levels (25 mg, 50 mg, 100 mg, 150 mg, 200 mg, 250 mg, and 300 mg once per day) with linear dose-proportional exposures. No dose-limiting toxicities were observed and the maximum tolerated dose was not reached. The recommended phase 2 dose was 200 mg daily. Adverse events in at least 10% of 323 patients were fatigue (65 [20%]), diarrhoea (55 [17%]), and contusion (42 [13%]). The most common adverse event of grade 3 or higher was neutropenia (32 [10%]). There was no correlation between pirtobrutinib exposure and the frequency of grade 3 treatment-related adverse events. Grade 3 atrial fibrillation or flutter was not observed, and grade 3 haemorrhage was observed in one patient in the setting of mechanical trauma. Five (1%) patients discontinued treatment due to a treatment-related adverse event. In 121 efficacy evaluable patients with chronic lymphocytic leukaemia (CLL) or small lymphocytic lymphoma (SLL) treated with a previous covalent BTK inhibitor (median previous lines of treatment 4), the ORR with pirtobrutinib was 62% (95% CI 53-71). The ORR was similar in CLL patients with previous covalent BTK inhibitor resistance (53 [67%] of 79), covalent BTK inhibitor intolerance (22 [52%] of 42), BTK C481-mutant (17 [71%] of 24) and BTK wild-type (43 [66%] of 65) disease. In 52 efficacy evaluable patients with mantle cell lymphoma (MCL) previously treated with covalent BTK inhibitors, the ORR was 52% (95% CI 38-66). Of 117 patients with CLL, SLL, or MCL who responded, all but eight remain progression-free to date.

INTERPRETATION

Pirtobrutinib was safe and active in multiple B-cell malignancies, including patients previously treated with covalent BTK inhibitors. Pirtobrutinib might address a growing unmet need for alternative therapies for these patients.

FUNDING

Loxo Oncology.

Risk Factors for Emergency Room and Hospital Care Among Patients With Solid Tumors on Immune Checkpoint Inhibitor Therapy

OBJECTIVES

Immune checkpoint inhibitors (ICIs) are being increasingly used across cancer types. Emergency room (ER) and inpatient (IP) care, common in patients with cancer, remain poorly defined in this specific population, and risk factors for such care are unknown.

METHODS

We retrospectively reviewed charts for patients with solid tumors who received >1 ICI dose at 1 of 2 sites from January 1, 2011 to April 28, 2017. Demographics, medical history, cancer diagnosis/therapy/toxicity details, and outcomes were recorded. Descriptive data detailing ER/IP care at the 2 associated hospitals during ICI therapy (from first dose to 3 mo after last dose) were collected. The Fisher exact test and multivariate regression analysis was used to study differences between patients with versus without ER/IP care during ICI treatment.

RESULTS

Among 345 patients studied, 50% had at least 1 ER visit during ICI treatment and 43% had at least 1 IP admission. Six percent of ER/IP visits eventually required intensive care. A total of 12% of ER/IP visits were associated with suspected or confirmed immune-related adverse events. Predictors of ER care were African-American race (odds ratio [OR]: 3.83, P=0.001), Hispanic ethnicity (OR: 3.12, P=0.007), and coronary artery disease (OR: 2.43, P=0.006). Predictors of IP care were African-American race (OR: 2.38, P=0.024), Hispanic ethnicity (OR: 2.29, P=0.045), chronic kidney disease (OR: 3.89, P=0.006), angiotensin converting enzyme inhibitor/angiotensin receptor blocker medication use (OR: 0.44, P=0.009), and liver metastasis (OR: 2.32, P=0.003).

CONCLUSIONS

Understanding demographic and clinical risk factors for ER/IP care among patients on ICIs can help highlight disparities, prospectively identify high-risk patients, and inform preventive programs aimed at reducing such care.

Salvage nivolumab plus ipilimumab after prior PD-1/PD-L1 inhibitor treatment in metastatic renal cell carcinoma: A meta-analysis

305

Background: Although not officially approved, salvage nivolumab plus ipilimumab (nivo/ipi) treatment after prior PD-1/PD-L1 immune checkpoint inhibition is frequently used in metastatic renal cell carcinoma (mRCC). However, very limited data are available to guide such therapy. Methods: A search in Medline database and conference abstracts published in English before September 1, 2020 yielded 4 studies reporting salvage nivo/ipi outcomes of mRCC patients. We added additional information from 27 mRCC patients who received salvage nivo/ipi at The Ohio State University after prior PD-1 pathway inhibition. Hence, we performed a meta-analysis of five studies to further characterize the safety and efficacy of salvage nivo/ipi treatment. Results: Among 155 patients with measurable treatment response, we found that salvage nivo/ipi had an objective response rate of 19% (95% CI, 0.13-0.25), which was significantly lower than response to prior PD-1/PD-L1 inhibition (odds ratio, 0.35, 95% CI, 0.18-0.67; p < 0.01). Response to prior PD-1/PD-L1 inhibition did not correlate with salvage nivo/ipi response (odds ratio, 1.41, 95% CI, 0.51-3.87; p = 0.51). Additionally, salvage nivo/ipi was associated with 26% (95% CI, 0.19-0.33) grade ≥ 3 adverse events, which was lower than the toxicity in the upfront setting reported in Checkmate-214 trial. Conclusions: It is feasible to have salvage nivo/ipi treatment in mRCC. Salvage nivo/ipi treatment has a lower efficacy and lower toxicity compared with its use in the first-line setting.

HBV induces liver fibrosis via the TGF-β1/miR-21-5p pathway

MicroRNA (miR)-21-5p is a newly discovered factor that mediates TGF-β1 signaling. The present study was designed to investigate the role of TGF-β1/miR-21-5p in hepatitis B virus (HBV)-induced liver fibrosis. HBV-infected sodium taurocholate co-transporting polypeptide (NTCP)-transfected Huh7.5.1 cells were co-cultured with LX2 cells to simulate HBV infection in the present study. A total of 29 patients with chronic HBV infection were enrolled. Cells were transfected with miR-21-5p mimic or inhibitor with or without TGF-β1 stimulation. The demographic, biochemical and virological data from the 29 patients were analyzed and liver tissues were collected. miR-21-5p levels and the mRNA and protein expression of α-smooth muscle actin (SMA), collagen type 1 α 1 (CoL1A1), tissue inhibitor of metalloproteinase (TIMP)-1 and Smad from liver cells or tissues were detected by quantitative PCR analysis and western blotting, respectively. Cell viability was observed, and the liver fibrosis score was evaluated. The association between miR-21-5p and liver fibrosis was evaluated by correlation analysis. HBV infection upregulated TGF-β1/miR-21-5p mRNA expression in NTCP-Huh7.5.1 cells compared with mock infection (P<0.05). TGF-β1 incubation significantly increased miR-21-5p levels, as well as the mRNA and protein expression of α-SMA, CoL1A1 and TIMP-1, and reduced Smad7 expression in LX2 cells compared with the normal group, and these effects were counteracted by miR-21-5p inhibitor (P<0.05). miR-21-5p overexpression also contributed to TGF-β1-induced α-SMA, CoL1A1 and TIMP-1 expression in LX2 cells (P<0.05). Co-culture with HBV-infected NTCP-Huh7.5.1 cells upregulated TGF-β1/miR-21-5p activity and CoL1A1 expression in LX2 cells compared with normal control, which were significantly reduced by miR-21-5p inhibitor (P<0.05). miR-21-5p levels were significantly correlated with the liver fibrosis score (r=0.888; P<0.05). These data demonstrated that HBV induced liver fibrosis via the TGF-β1/miR-21-5p pathway and suggested that miR-21-5p may be an effective anti-fibrosis target.

The relevant resting-state brain activity of ecological microexpression recognition test (EMERT)

Zhang, et al. (2017) established the ecological microexpression recognition test (EMERT), but it only used white models’ expressions as microexpressions and backgrounds, and there was no research detecting its relevant brain activity. The current study used white, black and yellow models’ expressions as microexpressions and backgrounds to improve the materials ecological validity of EMERT, and it used eyes-closed and eyes-open resting-state fMRI to detect relevant brain activity of EMERT for the first time. The results showed: (1) Two new recapitulative indexes of EMERT were adopted, such as microexpression M and microexpression SD. The participants could effectively identify almost all the microexpressions, and each microexpression type had a significantly background effect. The EMERT had good retest reliability and calibration validity. (2) ALFFs (Amplitude of Low-Frequency Fluctuations) in both eyes-closed and eyes-open resting-states and ALFFs-difference could predict microexpression M. The relevant brain areas of microexpression M were some frontal lobes, insula, cingulate cortex, hippocampus, parietal lobe, caudate nucleus, thalamus, amygdala, occipital lobe, fusiform, temporal lobe, cerebellum and vermis. (3) ALFFs in both eyes-closed and eyes-open resting-states and ALFFs-difference could predict microexpression SD, and the ALFFs-difference was more predictive. The relevant brain areas of microexpression SD were some frontal lobes, insula, cingulate cortex, cuneus, amygdala, fusiform, occipital lobe, parietal lobe, precuneus, caudate lobe, putamen lobe, thalamus, temporal lobe, cerebellum and vermis. (4) There were many similarities and some differences in the relevant brain areas between microexpression M and SD. All these brain areas can be trained to enhance ecological microexpression recognition ability.

Alterations of DNA damage response genes correlate with response and overall survival in anti-PD-1/PD-L1-treated advanced urothelial cancer

DNA damage response (DDR) gene alterations in cancer are associated with a higher tumor mutational burden (TMB) and may impact clinical outcomes of urothelial cancer (UC). Here, we explore the prognostic role of DDR alterations in advanced UC treated with anti-PD-1/PD-L1 agents. The study included 53 patients who had FoundationOne genomic sequencing and received anti-PD-1/PD-L1 therapy. Fisher exact test and trend test were used to assess differences in objective response rate (ORR). Overall survival (OS) was measured from the time of initial UC diagnosis and Cox proportional hazard regression analysis was performed to calculate hazard ratio (HR) and 95% confidence interval (CI). The cohort had a median age of 66 with 64% receiving platinum-based chemotherapy. DDR alterations (including ATM) were associated with a non-significantly higher ORR to PD-1/PD-L1 blockade (41% vs. 21%, p = 0.136). Patients with DDR alterations (excluding ATM) had non-significantly longer OS, likely due to a small sample size (HR = 0.53, 95% CI 0.20-1.38, p = 0.19). ATM alterations were associated with a non-significantly higher ORR (40% vs. 29%, p = 0.6), but also with significantly shorter OS (HR = 5.7, 95% CI 1.65-19.74, p = 0.006). Patients with ≥ 3 DDR alterations (including ATM) had substantially higher TMB (p = 0.01) and higher ORR (80%) with PD-1/PD-L1 blockade versus 24% ORR in patients with <3 DDR alterations. In summary, DDR alterations were associated with non-significantly higher ORR and longer OS for patients with advanced UC receiving anti-PD-1/PD-L1 agents. ATM alterations were associated with shorter OS.

Increased bleeding risk associated with concurrent vascular endothelial growth factor receptor tyrosine kinase inhibitors and low-molecular-weight heparin

BACKGROUND

Some cancer patients who are diagnosed with thromboembolism may require dual treatment with vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKIs) and factor Xa inhibitors (low-molecular-weight heparin [LMWH] or direct oral anticoagulants [DOACs]). However, to the authors' knowledge, the safety of such combinations has not been well characterized.

METHODS

Patients with advanced cancer who were treated with concurrent VEGFR TKIs and factor Xa inhibitors between 2010 and 2018 at The Ohio State University Comprehensive Cancer Center were included. Charts were reviewed retrospectively for clinically significant bleeding events occurring during concurrent treatment compared with those occurring during factor Xa inhibitor therapy alone, using each patient as their own control. The Fisher exact test was used to compare distribution of bleeding severities. The Cox proportional hazards model was used to compare bleeding risk between groups.

RESULTS

Among 86 patients, there were 29 clinically significant bleeding events (including 8 major bleeding events) reported during concurrent treatment and 17 events (including 4 major bleeding events) reported during factor Xa inhibitor therapy alone over a median follow-up of 63 days. Concurrent treatment was associated with significantly higher risks of overall bleeding (hazard ratio, 2.45; 95% confidence interval, 1.28-4.69 [P = .007]) and first-onset bleeding (hazard ratio, 2.23; 95% confidence interval, 1.13-4.42 [P = .02]). Analysis of 6-month bleeding risk and the subgroups of patients treated with concurrent TKIs and LMWH versus LMWH alone demonstrated a similar trend. The sample size was inadequate for comparisons between treatment with concurrent TKIs and DOACs versus DOACs alone.

CONCLUSIONS

Concurrent treatment with VEGFR TKIs and LMWH was found to be associated with a significantly increased risk of bleeding events when compared with LMWH therapy alone.

Association between minimum inhibitory concentration, beta-lactamase genes and mortality for patients treated with piperacillin/tazobactam or meropenem from the MERINO study

INTRODUCTION

This study aims to assess the association of piperacillin/tazobactam and meropenem minimum inhibitory concentration (MIC) and beta-lactam resistance genes with mortality in the MERINO trial.

METHODS

Blood culture isolates from enrolled patients were tested by broth microdilution and whole genome sequencing at a central laboratory. Multivariate logistic regression was performed to account for confounders. Absolute risk increase for 30-day mortality between treatment groups was calculated for the primary analysis (PA) and the microbiologic assessable (MA) populations.

RESULTS

320 isolates from 379 enrolled patients were available with susceptibility to piperacillin/tazobactam 94% and meropenem 100%. The piperacillin/tazobactam non-susceptible breakpoint (MIC > 16 mg/L) best predicted 30-day mortality after accounting for confounders (odds ratio 14.9, 95% CI 2.8 - 87.2). The absolute risk increase for 30-day mortality for patients treated with piperacillin/tazobactam compared with meropenem was 9% (95% CI 3% - 15%) and 8% (95% CI 2% - 15%) for the original PA population and the post-hoc MA populations, which reduced to 5% (95% CI -1% - 10%) after excluding strains with piperacillin/tazobactam MIC values > 16 mg/L. Isolates co-harboring ESBL and OXA-1 genes were associated with elevated piperacillin/tazobactam MICs and the highest risk increase in 30-mortality of 14% (95% CI 2% - 28%).

CONCLUSION

After excluding non-susceptible strains, the 30-day mortality difference was from the MERINO trial was less pronounced for piperacillin/tazobactam. Poor reliability in susceptibility testing performance for piperacillin/tazobactam and the high prevalence of OXA co-harboring ESBLs suggests meropenem remains the preferred choice for definitive treatment of ceftriaxone non-susceptible E. coli and Klebsiella.

The Establishment of Pseudorandom Ecological Microexpression Recognition Test (PREMERT) and Its Relevant Resting-State Brain Activity

The EMERT (ecological microexpression recognition test) by Zhang et al. (2017) used between-subjects Latin square block design for backgrounds; therefore, participants could not get comparable scores. The current study used within-subject pseudorandom design for backgrounds to improve EMERT to PREMERT (pseudorandom EMERT) and used eyes-closed and eyes-open resting-state functional magnetic resonance imaging to detect relevant brain activity of PREMERT for the first time. The results showed (1) two new recapitulative indexes of PREMERT were adopted, such as microexpression M and microexpression SD. Using pseudorandom design, the participants could effectively identify almost all the microexpressions, and each microexpression type had significant background effect. The PREMERT had good split-half reliability, parallel-forms reliability, criterion validity, and ecological validity. Therefore, it could stably and efficiently detect the participants' microexpression recognition abilities. Because of its pseudorandom design, all participants did the same test; their scores could be compared with each other. (2) amplitude of low-frequency fluctuations (ALFF; 0.01-0.1 Hz) in both eyes-closed and eyes-open resting states and ALFF difference could predict microexpression M, and the ALFF difference was less predictive. The relevant resting-state brain areas of microexpression M were some frontal lobes, insula, cingulate cortex, hippocampus, amygdala, fusiform gyrus, parietal lobe, caudate nucleus, precuneus, thalamus, putamen, temporal lobe, and cerebellum. (3) ALFFs in both eyes-closed and eyes-open resting states and ALFF difference could predict microexpression SD, and the ALFF difference was more predictive. The relevant resting-state brain areas of microexpression SD were some frontal lobes, central anterior gyrus, supplementary motor area, insula, hippocampus, amygdala, cuneus, occipital lobe, fusiform gyrus, parietal lobe, caudate nucleus, pallidum, putamen, thalamus, temporal lobe, and cerebellum. (4) There were many similar relevant resting-state brain areas, such as brain areas of expression recognition, microexpressions consciousness and attention, and the change from expression backgrounds to microexpression, and some different relevant resting-state brain areas, such as precuneus, insula, and pallidum, between microexpression M and SD. The ALFF difference was more sensitive to PREMERT fluctuations.

Comprehensive Genomic Profiling of Upper-tract and Bladder Urothelial Carcinoma

BACKGROUND

Characterization of the different genomic alterations (GAs) in urothelial carcinoma (UC), by site of origin, may identify contrasting therapeutic opportunities and inform distinct putative pathogenetic mechanisms.

OBJECTIVE

To describe the genomic landscape of UC based on the anatomic site of the primary tumor.

DESIGN, SETTING, AND PARTICIPANTS

In total, 479 upper tract UC (UTUC) and 1984 bladder UC (BUC) patients underwent comprehensive genomic profiling (CGP) to evaluate all classes of GAs, tumor mutational burden (TMB), and microsatellite instability (MSI) status. Targetable GAs and signatures were assessed according to the European Society for Medical Oncology Scale for Clinical Actionability of molecular Targets (ESCAT).

INTERVENTION

Hybrid-capture-based CGP.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Descriptive analyses and differences between anatomic subgroups were reported.

RESULTS AND LIMITATIONS

In total, 39% of patients with UC harbored one or more tier 1-2 GAs, suggesting potential benefit from approved or investigational therapies. UTUC cases were enriched in FGFR3 short variant (SV) GA (20% vs 13%) and HRAS SV GA (7.3% vs 3%), the latter attributed specifically to enrichment in renal pelvis UC (9.5%) versus ureteral UC (1.8%, p=0.002). RB1 GAs were more frequent in BUC than in UTUC (21% vs 7.8% p<0.001). Non-FGFR3 kinase fusions were observed in 1% of patients, including BRAF/RAF1 fusions in 0.5%. BRAF mutations/fusions were observed in 2% of cases and were mutually exclusive with FGFR3 GA (p=0.002). There were no differences of TMB high/MSI high for primary tumor and metastatic sites, but UTUC was enriched for MSI high (3.4%) relative to BUC (0.8%, p<0.001).

CONCLUSIONS

Differences in the genomic landscapes of UTUC and BUC were modest; however, patients with UTUC were enriched for FGFR3 and HRAS SV relative to BUC. Further investigation on UC, stratified by the site of origin, is warranted. In addition, these results suggest an opportunity for the routine incorporation of CGP prior to systemic therapy initiation in metastatic UC.

PATIENT SUMMARY

Genomic profiling of advanced urothelial carcinoma can inform several therapeutic opportunities for patients, particularly those with upper tract urothelial carcinoma, an infrequent and generally aggressive tumor entity with nonoverlapping clinical features compared with its bladder counterpart, which is often treated based on the data extrapolated from bladder cancer.

Characterization of the Key Aroma Compounds in Dog Foods by Gas Chromatography-Mass Spectrometry, Acceptance Test, and Preference Test

Gas chromatography-mass spectrometry (GC-MS) coupled with the acceptance test, partial least-squares regression (PLSR) analysis, validation experiment, and preference test was used to identify the key aroma compounds in dog foods (DFs). Six DFs were evaluated by spraying six palatability enhancers onto a basal DF. The differently flavored palatability enhancers were prepared by the Maillard reaction using different protein sources and reaction conditions. The intake ratios of the six DFs were tested by six adult beagle dogs and were classified into high, medium, and low levels. A total of 55 volatile compounds were identified using headspace solid-phase microextraction (HS-SPME) GC-MS. Correlation analysis of the volatile compounds associated with intake ratios using partial least-squares regression (PLSR) found nine significantly positive and three significantly negative compounds that made a significant contribution to the palatability of DFs. Validation tests undertaken by adding three significantly positive compounds, one significantly negative compound, and one nonsignificant compound into the odorless matrix successfully verified the accuracy prediction of the PLSR model. The nine significantly positive compounds were heptanal, nonanal, octanal, (E)-2-hexenal, (E,E)-2,4-decadienal, 2-pentylfuran, 4-methyl-5-thiazoleethanol, 2-furfurylthiol, and (E)-2-decenal. The contributions of nine key aroma compounds were further analyzed by the preference test. (E)-2-decenal, 2-furfurylthiol, and 4-methyl-5-thiazoleethanol showed higher first choice, consumption ratio, and unit contribution rate and were vital to the overall preferred aroma of DFs.

Abstract 3023: Exposure versus efficacy/safety of acalabrutinib and its pharmacologically active metabolite, ACP-5862, for the treatment of chronic lymphocytic leukemia

Background: Acalabrutinib is a selective BTK inhibitor approved for the treatment of Mantle Cell Lymphoma. Relationship between plasma exposures to acalabrutinib and ACP-5862 versus clinical efficacy and safety were evaluated in subjects with B-cell malignancies, following administration of acalabrutinib monotherapy or in combination with obinutuzumab.

Methods: Acalabrutinib and ACP-5862 exposures (AUC24h,ss) were generated using population pharmacokinetic (PK) analysis. To account for the contribution of ACP-5862 to overall activity, an exposure metric (total active AUC24h,ss) accounting for relative BTK potency and protein binding was estimated. Efficacy data from the pivotal Phase 3 study in previously untreated (PU) CLL subjects (n=274), who received acalabrutinib 100 mg twice daily (BID) as monotherapy or in combination, were included. Safety data pooled across 8 studies in PU or relapsed/refractory (R/R) subjects with B-cell malignancies (n=567), who received acalabrutinib 100, 175, 200, and 250 once daily or 100 mg and 200 mg BID as monotherapy or in combination, were included. Efficacy endpoints including best overall response rate (BOR), progression -free survival (PFS) and sum of products of the greatest perpendicular diameters (SPD) of index lesions were evaluated. Safety endpoints including all AEs Grade ≥2 in severity, and Grade ≥2 events of clinical interest such as, anemia, cardiac events, diarrhea, headache, hemorrhage, hepatic events, hypertension, infections, neutropenia, and thrombocytopenia were evaluated. Kaplan-Meier survival and logistic regression analyses were conducted for key efficacy and safety endpoints.

Results: Median acalabrutinib/ACP-5862/total active AUC24h,ss were similar between responders versus non-responders, and across the 4 response categories (i.e. complete response, partial response, stable disease or progressive disease). No correlation between AUC24h,ss and PFS or SPD were noted. With the exception of Grade ≥2 anemia, no significant relationship between AUC24h,ss and safety outcomes was observed. Model-based analyses revealed baseline hemoglobin levels and line of therapy as highly significant predictors of Grade ≥2 anemia (p&lt;0.0001) but not PK exposure (AUC24h,ss; p=0.08), indicating the lack of an exposure-dependent relationship. The results were consistent across acalabrutinib monotherapy or combination with obinutuzumab treatment arms.

Conclusions: No clinically meaningful correlation between PK exposures and selected efficacy and safety outcomes was observed. In pivotal studies, the 100 mg BID acalabrutinib regimen demonstrated an acceptable safety profile and robust efficacy (consistent with ≥95% BTK occupancy over a dosing interval) in PU and R/R CLL. Overall, these data support a fixed 100 mg BID acalabrutinib dose for the treatment of subjects with CLL.

Citation Format: Helena Edlund, Karthick Vishwanathan, Ming Yin, Rakesh Raman, Miné de Kock, Zhongqing He, Huan Liu, Marshall Baek, Nidal Al-Huniti, Joseph Ware, Shringi Sharma. Exposure versus efficacy/safety of acalabrutinib and its pharmacologically active metabolite, ACP-5862, for the treatment of chronic lymphocytic leukemia [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3023.

The predictive value of serum amyloid A and C-reactive protein levels for the severity of coronavirus disease 2019

This study was designed to assess the levels of human serum amyloid A (SAA) and C-reactive protein (CRP) in patients with coronavirus disease 2019 (COVID-19) to determine their prognostic value in predicting the severity of disease. Patients with COVID-19 who presented with acute respiratory distress syndrome (ARDS) shared distinct characteristics. For example, the patients were older, and had higher levels of inflammatory indicators [i.e., levels of CRP, SAA, procalcitonin (PCT), and interleukin-6; CRP-to-PCT ratio; SAA-to-CRP ratio; and neutrophil-to-lymphocyte ratio (NLR)], higher inflammatory cell counts (i.e., white blood cell count and neutrophil count), and lower lymphocyte counts compared with patients without ARDS. Patients without ARDS still exhibited mild illness and had elevated SAA levels but not CRP levels. In patients with elevated SAA and CRP levels, the NLR was statistically associated with disease severity. According to the receiver operating characteristic curve analysis, the combined predictive probability of CRP and SAA levels, along with white blood cell count, showed the highest area under the curve (AUC; 0.878), and was able to distinguish between patients with and without ARDS. The cut-off level for SAA to predict the severity of COVID-19 was 92.900, with a sensitivity of 95.8%, a specificity of 53.7%, and an AUC of 0.712. For patients with elevated levels of SAA but not CRP, a mild condition was predicted. For patients with elevated levels of both SAA and CRP, and a high NLR, a severe infection was predicted, requiring medical attention. Therefore, CRP and SAA levels demonstrate a prognostic value for predicting the severity of COVID-19.

Pediatric tuina for the treatment of fever in children: A protocol for systematic review and meta-analysis

BACKGROUND

Infantile fever is a common symptom of the pediatric diseases, which is often caused by cold, food accumulation, or other pathogenic factors. Pediatric tuina is regarded as an acceptable non-pharmaceutical therapy for children with optimal effects, which has been widely used for infantile fever around China. But there is still a lack of systematic evaluation and research on its safety and effectiveness during the treatment of infantile fever. Thus the protocol is to collect clinical evidence and demonstrate the efficacy and safety of antipyretic manipulation by pediatric tuina.

METHODS

The systematic electronic search will be executed in Cochrane Library (1991-2020.6), EMBASE (1980-2020.6), PubMed (1996-2020.6), WHOICTRP (2004-2020.6), Web of Science (1900-2020.6), CNKI (1994-2020.6), CBM (1994-2020.6), WANFANG (1980-2020.6), and VIP (2000-2020.6) Database. The Review Manager (V.5.3) will be use to assess the risk of bias and data analyses. The methodological quality will be assessed by using the online GRADEpro tool. If the quality of numeric data is favorable, a meta-analysis will be carried out.

RESULTS

A high-quality evidence of pediatric tuina for the treatment of infantile fever.

CONCLUSION

The systematic review will provide a reliable basis for judging whether pediatric tuina is safe and effective in the treatment of pediatric fever.

INPLASY REGISTRATION NUMBER

INPLASY202060032.

Analysis of Flavonoid Compounds by Terahertz Spectroscopy Combined with Chemometrics

Flavonoids are a large class of polyphenols widely distributed in plants in the free form or as glycosides, and they have antioxidation, antibacterial, antitumor growth, and other pharmacological effects. As an important active component of traditional Chinese medicine, they have high medicinal value and development prospects. In this work, the biomolecular properties of 10 common flavonoids, including baicalein, baicalin, apigenin, quercetin, naringenin, hesperetin, daidzein, genistein, puerarin, and gastrodin, are studied by terahertz time-domain spectroscopy (THz-TDS) in the range of 0.2-2.5 THz. The results reveal that these flavonoids have different characteristic absorption peaks in the terahertz band. Moreover, the terahertz absorption characteristics of samples in the temperature range of 78-320 K are studied. The results show that the characteristic absorption peaks gradually increase with the decrease in temperature, and the frequency position of the absorption peak has a slight blue shift. Furthermore, qualitative identification and quantitative analysis of flavonoids are carried out by terahertz spectra combined with chemometrics. Specifically, a series of mixtures of three flavonoids with similar molecular structures under various concentrations are analyzed. The partial least-squares regression (PLSR) model and the artificial neural network (ANN) model are applied to quantitatively analyze the ternary mixture. The results confirm that the ANN model obtains the best predicted value, with the root-mean-square errors in the prediction set (RMSEP) of 1.27% for daidzein. In summary, the biomolecular properties of flavonoids are studied by the THz-TDS technique, and a rapid, effective, and nondestructive method for qualitative identification and quantitative analysis of flavonoids is provided. The results demonstrate that this method has potential application value in the detection of Chinese herbal medicine and has better referential significance for the study of other biomolecules, especially for isomers or similar molecular structures.

Interleukin-6 and severity of COVID-19 patients in Hefei, China

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Twenty-four out of 75 patients developed into severe condition in the course of the infection.

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The prominent laboratory abnormalities of COVID patients were lymphopenia, elevated C-reactive protein (CRP) and lactate dehydrogenase (LDH).

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Elevated interleukin 6 (IL-6) correlated with decrease of LYM%, CD4⁺ and CD8⁺ T cell counts, and increase of CRP, LDH and Procalcitonin (PCT) levels.

Different effects of total flavonoids from Arachniodes exilis on human umbilical cord mesenchymal stem cells in vitro

Traditional Chinese medicines are used in promotion of fractured bone healing and bone diseases. Some studies reported total flavonoids from plant can be used as an auxiliary source of exogenous.Use different methods to identify and verify effects of total flavonoids from Arachniodes exilis (TFAE) on human umbilical cord mesenchymal stem cells (HUCMSCs) in vitro.Concentrations of 1 and 5 μg/mL TFAE significantly increased ALPase activity in HUCMSCs compared to the other concentrations at days 3 and 7 (P < .05). RT-PCR showed that expression levels of osteogenic genes (Col1a1, OPN, Runx2 and Osx) were remarkably enhanced in HUCMSCs following treatment with different concentrations of TFAE for 9 days compared with 0 μg/mL TFAE group (control). The results showed that concentration < 5 μg/mL of TFAE induced osteogenic differentiation in HUCMSCs Alizarin red staining assays revealed that both TFAE and S1191 was significantly decreased (7.80 ± 0.66) compared with the TFAE group (16.00 ± 0.97) (P < .01). ALPase activity on days 3 and 7 was relatively lower in HUCMSCs grown in media supplemented with both S1191 and TFAE than that of in TFAE group only. The results indicated that osteogenic markers (Col1a1, OPN, Runx2 and Osx) were significantly downregulated in the TFAE + S1191 group in comparison to the control group. The expressions of Col1a and OPN in the TFAE + S1191 group decreased significantly (P < .01) by Western blotting.TFAE promotes the odonto/osteogenic differentiation of human UCMSCs via activation of ER.

Risk factors for emergency room and hospital care for patients with advanced solid tumors on immune checkpoint inhibitor therapy

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Background: Immune checkpoint inhibitors (ICIs) are increasingly utilized across cancer types. Risk factors for emergency room (ER) and inpatient (IP) care in this patient (pt) population remain poorly defined. Methods: We retrospectively reviewed charts for pts with (w/) advanced solid tumors who received more than 1 ICI dose at Mount Sinai from 1/1/11 – 4/28/17. Demographics, medical history, cancer diagnosis and therapy (tx) details, and outcomes were recorded. Descriptive data detailing ER/IP care during ICI tx (from first dose to 3 months after last dose) were collected. Fisher’s exact test and multivariable regression analyses were used to study differences between pts w/ versus w/out ER/IP care during ICI tx. Significance level was set at 0.05 for all tests. Results: 345 patients met the inclusion criteria for this study. Mean age was 64 years. Common tumor types were non-small cell lung cancer (n = 87), melanoma (n = 78), hepatocellular carcinoma (n = 53), and urothelial carcinoma (n = 38). 83% of patients had metastatic disease. Median duration of ICI tx was 2 months. During ICI tx, 50% received ER care and 43% received IP care, resulting in 369 total episodes of ER and/or IP care. 12% of episodes were attributed to ICI toxicity; 6% required intensive care. Median time to ER/IP care was 111 days. Median IP length of stay was 2 days. Several factors were found to be significant predictors of risk for ER or IP care on multivariable analysis (Table). African-American race and Hispanic ethnicity were each predictive of increased risk for both ER and IP care. Conclusions: ER/IP care is common among pts w/ advanced solid tumors on ICI tx. Understanding demographic and clinical risk factors can help prospectively identify higher-risk pts to inform preventive programs aimed at reducing such care. [Table: see text]

Analysis of bleeding risk with concurrent treatment of VEGFR tyrosine kinase inhibitors (TKIs) and factor Xa inhibitors

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Background: Tyrosine kinase inhibitors (TKIs) of vascular endothelial growth factor receptor (VEGFR) may interfere with the coagulation system making patients susceptible to both hemorrhage and thromboembolism. Some cancer patients require dual treatment with VEGFR TKIs and factor Xa inhibitors. However, the safety of such combination treatment (e.g. bleeding risk) has not been well characterized in the literature. Methods: This retrospective study identified metastatic cancer patients who received VEGFR TKIs (pazopanib, sunitinib, sorafenib, axitinib, regorafenib, vandetanib, lenvatinib, cabozantinib, tivozanib) and Xa inhibitors (low-molecular weight heparin [LMWH] or direct oral anticoagulants [DOACs]- rivaroxaban or apixaban) from 2001 to 2018 at the Ohio State University. We assessed bleeding risks of dual therapy vs factor Xa inhibitors alone, using the same patients as self-controls. We defined bleeding based on criteria from the International Society on Thrombosis and Haemostasis. Fisher’s exact test was used to compare distribution of bleeding severities and the Cox model was used to analyze bleeding risk. Results: A total of 86 patients were included for analysis, with a median age of 56 (range, 34-88). The patient population was predominantly of male gender (69.7%), Caucasian race (89.3%) and renal cell cancer type (48.9%). As some patients had been on both LMWH and DOAC at different time periods, we found that 81 patients received concurrent TKI and LMWH; 19 patients had concurrent TKI and DOAC. Overall, 25 patients developed 29 clinically significant bleeding events (including 8 major bleeding) during concurrent treatment, and 15 patients developed 17 clinically significant bleeding events (4 major bleeding) during factor Xa inhibitor alone over a median follow up of 63 days. We found a statistically higher bleeding risk with concurrent treatment (HR = 2.23, 95% CI, 1.13–4.42, p = 0.02) compared with Xa inhibitor alone. In a stratified analysis, concurrent VEGFR TKI plus LMWH or DOAC both showed a strong trend for elevated bleeding risk. Although there were increased bleeding events with concurrent treatment, there was no significant difference in the proportion of major bleeding (27.6% vs 23.5%, p = 0.76). Median time to first bleeding event was 56 days for concurrent therapy and 72 days for Xa inhibitor alone. Conclusions: Concurrent treatment of VEGFR TKI and factor Xa inhibitors is associated with significantly increased bleeding risk when compared with factor Xa inhibitors alone in metastatic cancer patients.