Innovative treatments for meningiomas

Multi-recurrent high-grade meningiomas remain an unmet medical need in neuro-oncology when iterative surgeries and radiation therapy sessions fail to control tumor growth. Nevertheless, the last 10years have been marked by multiple advances in the comprehension of meningioma tumorigenesis via the discovery of new driver mutations, the identification of activated intracellular signaling pathways, and DNA methylation analyses, providing multiple potential therapeutic targets. Today, Anti-VEGF and mTOR inhibitors are the most used and probably the most active drugs in aggressive meningiomas. Peptide radioactive radiation therapy aims to target SSTR2A receptors, which are strongly expressed in meningiomas, but have an insufficient effect in most aggressive meningiomas, requiring the development of new techniques to increase the dose applied to the tumor. Based on the multiple potential intracellular targets, multiple targeted therapy clinical trials targeting Pi3K-Akt-mTOR and MAP kinase pathways as well as cell cycle and particularly, cyclin D4-6 are ongoing. Recently discovered driver mutations, SMO, Akt, and PI3KCA, offer new targets but are mostly observed in benign meningiomas, limiting their clinical relevance mainly to rare aggressive skull base meningiomas. Therefore, NF2 mutation remains the most frequent mutation and main challenging target in high-grade meningioma. Recently, inhibitors of focal adhesion kinase (FAK), which is involved in tumor cell adhesion, were tested in a phase 2 clinical trial with interesting but insufficient activity. The Hippo pathway was demonstrated to interact with NF2/Merlin and could be a promising target in NF2-mutated meningiomas with ongoing multiple preclinical studies and a phase 1 clinical trial. Recent advances in immune landscape comprehension led to the proposal of the use of immunotherapy in meningiomas. Except in rare cases of MSH2/6 mutation or high tumor mass burden, the activity of PD-1 inhibitors remains limited; however, its combination with various radiation therapy modalities is particularly promising. On the whole, therapeutic management of high-grade meningiomas is still challenging even with multiple promising therapeutic targets and innovations.

Contribution of nuclear medicine to the diagnosis and management of primary brain tumours

Positron emission tomography (PET) is a powerful tool that can help physicians manage primary brain tumours at diagnosis and follow-up. In this context, PET imaging is used with three main types of radiotracers: ¹⁸F-FDG, amino acid radiotracers, and ⁶⁸Ga conjugated to somatostatin receptor ligands (SSTRs). At initial diagnosis, ¹⁸F-FDG helps to characterize primary central nervous system (PCNS) lymphomas and high-grade gliomas, amino acid radiotracers are indicated for gliomas, and SSTR PET ligands are indicated for meningiomas. Such radiotracers provide information on tumour grade or type, assist in directing biopsies and help with treatment planning. During follow-up, in the presence of symptoms and/or MRI modifications, the differential diagnosis between tumour recurrence and post-therapeutic changes, in particular radiation necrosis, may be challenging, and there is strong interest in using PET to evaluate therapeutic toxicity. PET may also contribute to identifying specific complications, such as postradiation therapy encephalopathy, encephalitis associated with PCNS lymphoma, and stroke-like migraine after radiation therapy (SMART) syndrome associated with glioma recurrence and temporal epilepsy, originally illustrated in this review. This review summarizes the main contribution of PET to the diagnosis, management, and follow-up of brain tumours, specifically gliomas, meningiomas, and primary central nervous system lymphomas.

Synthesis and Electron Accepting Properties of Two Di(benz[f]indenone)-Fused Tetraazaanthracene Isomers

We designed and synthesized a novel di(benz[f]indenone)-fused tetraazaanthracene derivative and isolated its two isomers, 1a and 1s, having anti and syn configurations, respectively. Their structure and that of the condensation reaction intermediates, anti-2a and syn-2s, were fully characterized using one- and two-dimensional nuclear magnetic resonance spectroscopy and single-crystal X-ray diffraction. The optical and electronic properties of 1a and 1s were investigated using ultraviolet-visible absorption and fluorescence spectroscopies, cyclic voltammetry, and time-dependent density functional theory calculations. The presence of the carbonyl and ethynyltris(isopropyl)silane groups endows the di(benzoindenone)-fused azaacene derivatives with a strong electron accepting character. With an electron affinity of approximately -3.7 eV, the two isomers represent attractive electron-deficient molecular systems for the generation of n-channel semiconducting materials. Organic field effect transistors of 1a and 1s showed electron transport, and organic solar cells gave a proof of concept of the potential of the two compounds as electron acceptor materials when they are paired with an electron donor polymer.

Access to Fluorenones Using Benzocyclopentynone Surrogate as Partner for the [2 + 2 + 2] Cycloaddition Reaction

A convenient and versatile procedure for the straightforward synthesis of substituted fluorenones as valuable scaffolds is described under rhodium catalysis. The present [2 + 2 + 2] cycloaddition reaction of diynes with 3-acetoxy or-3-alkoxyindenones as surrogates of the highly reactive benzocyclopentynone 2π partner allows the preparation of various fluorenone-type derivatives in good yields and provides an additional and tunable process for the generation of more challenging molecules with application in pharmaceutical, polymer, and material sciences.

Regioselective Metalation and Functionalization of the Pyrazolo[1,5- a]pyridine Scaffold Using Mg- and Zn-TMP Bases

A regioselective functionalization of the pyrazolo[1,5- a]pyridine scaffold using Mg- and Zn-TMP bases (TMP = 2,2,6,6-tetramethylpiperidyl) in the presence or absence of BF₃·OEt₂ is described. Also, various functionalized pyrazolo[1,5- a]pyridines bearing an ester function (and an NHBoc or ethyl group) are magnesiated and functionalized, leading to polysubstituted heterocycles. Additionally, a sulfoxide directed ortho-metalation, followed by the transition-metal-free amination of a pyrazolo[1,5- a]pyridine sulfoxide, using a magnesium amide, is reported.

Fixed Man, Enhanced Man, Transformed Man

In the past, for a patient, any hospitalization would end in one of three ways: recovery, death or disability, also regarded as “little death”. Such was the terrible destiny of a patient. Gradually, chronic diseases have slid into the first two options, thanks to the advent of medical diagnosis. The diagnosis surpassed the symptoms. An example is the definition of diabetes obtained through medical diagnosis: according to international norms, a person suffers from diabetes if his glycaemia is 700 mmol/L (126 mg/dL) or more after 8 hours of fasting.