ARTISTRY-7: A phase 3, multicenter study of nemvaleukin alfa in combination with pembrolizumab versus chemotherapy in patients (pts) with platinum-resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer

TPS5609

Background: ARTISTRY-7 will evaluate the novel engineered cytokine nemvaleukin alfa (nemvaleukin, ALKS 4230) in pts with gynecologic cancers. Epithelial ovarian cancer (OC) is the 7th most common cause of cancer mortality in women. OC is an area of high unmet need, as many pts become resistant or refractory to frontline platinum-based chemotherapy. Nemvaleukin was designed to selectively bind to the intermediate-affinity interleukin-2 (IL-2) receptor, preferentially activating and expanding antitumor CD8+ T and NK cells with minimal expansion of Tregs. This selectivity may provide enhanced tumor killing and improved safety/tolerability compared with high-dose IL-2. In clinical studies, nemvaleukin, as monotherapy and in combination with pembrolizumab, has shown evidence of clinical benefit in multiple tumor types, including OC. In ARTISTRY-1, 4 responses were observed in pts with OC, including 2 complete responses, 1 in a pt with platinum-resistant OC and 5 prior lines of therapy, and 2 partial responses. Methods: ARTISTRY-7 is a phase 3, multicenter, open-label randomized study of nemvaleukin and/or pembrolizumab vs chemotherapy. Eligible pts are women (≥18 y) with histologically confirmed epithelial OC (high-grade serous, endometrioid, clear cell), fallopian tube cancer, or primary peritoneal cancer. Pts must have received ≥1 prior line of systemic therapy in the platinum-sensitive setting, ≤5 prior lines in the platinum-resistant setting, and prior bevacizumab, with radiographic progression on most recent therapy. Primary platinum-refractory disease (progression on first-line platinum therapy) or primary platinum resistance (progression < 3 months after completion of first-line platinum therapy) is exclusionary. Pts must have ECOG performance status of 0 or 1, estimated life expectancy of ≥3 months, and adequate hematologic reserve and hepatic and renal function. Approximately 376 pts will be randomized (3:1:1:3) to receive nemvaleukin 6 μg/kg IV on days 1-5 and pembrolizumab 200 mg IV on day 1 of each 21-day cycle, pembrolizumab monotherapy, nemvaleukin monotherapy, or chemotherapy (pegylated liposomal doxorubicin, paclitaxel, topotecan, or gemcitabine) and stratified according to PD-L1 status, histologic subtype (high-grade vs non–high-grade serous), and chemotherapy (paclitaxel vs other). Pts will continue treatment until disease progression or intolerable toxicity (maximum 35 cycles for pembrolizumab; nemvaleukin can be continued). The primary endpoint is investigator-assessed PFS (RECIST v1.1) in the nemvaleukin/pembrolizumab vs chemotherapy group. Secondary/exploratory endpoints include overall survival, other antitumor measures, safety, health-related quality of life, and pharmacokinetic/pharmacodynamic effects. Clinical trial information: NCT05092360.

Nemvaleukin alfa monotherapy and in combination with pembrolizumab in patients (pts) with advanced solid tumors: ARTISTRY-1

2500

Background: Nemvaleukin alfa (nemvaleukin, ALKS 4230) is a novel, engineered cytokine that selectively binds to the intermediate-affinity interleukin-2 (IL-2) receptor (IL-2R) to preferentially activate antitumor CD8+ T cells and natural killer (NK) cells with minimal expansion of immunosuppressive regulatory T cells. It is sterically occluded from binding to the high-affinity IL-2R, leveraging antitumor effects of the IL-2 pathway but mitigating toxicity associated with preferential binding of IL-2 to the high-affinity IL-2R. Methods: ARTISTRY-1 (NCT02799095) is a 3-part, first-in-human, phase 1/2 study of IV nemvaleukin alone and in combination with pembrolizumab in pts with advanced solid tumors. Parts A (dose escalation to 10 µg/kg/day), B (monotherapy in pts with melanoma or renal cell carcinoma [RCC]), and C (combination) included nemvaleukin 3 or 6 µg/kg/day ´ 5 and pembrolizumab every 21 days. Investigator-assessed antitumor activity (confirmed responses as per RECIST v1.1) and safety are reported as of 29 October 2021. Results: In Part A (N = 46), nemvaleukin recommended phase 2 dose was 6 µg/kg/day IV; maximum tolerated dose not reached. One pt had dose-limiting toxicity (grade 4 acute kidney injury) at 10 µg/kg. Pts in Parts B and C were heavily pretreated (1–9 prior lines of therapy, including prior checkpoint inhibitor therapy). Durable antitumor activity was observed for nemvaleukin monotherapy, including in RCC (objective response rate [ORR], 18.2% [4/22]) and in melanoma (ORR, 8.7% [4/46]), with 2 partial responses (1 unconfirmed) in 30 pts with cutaneous melanoma (ORR, 6.7%) and 2 PRs (1 unconfirmed) in 6 pts with mucosal melanoma (ORR, 33.3%). Durable antitumor activity was also observed for combination therapy (ORR, 16.1% [22/137]; disease control rate [DCR], 59.9%), including in platinum-resistant ovarian cancer (PROC; ORR, 28.6% [4/14]; DCR, 71.4%), with 2 complete responses and 2 PRs (1 unconfirmed) in 14 pts. Forty-three pts remain on therapy. The most frequent grade 3/4 treatment-related adverse events in Parts B and C, respectively, were anemia (9%, 10%), neutropenia (34%, 9%), and decreased neutrophil count (12%, 9%). Safety was consistent with previous reports. In pharmacodynamic studies, nemvaleukin monotherapy induced robust expansion of CD8+ T and NK cells, with minimal effect on regulatory T cells. Conclusions: ARTISTRY-1 showed proof of principle for preferential expansion of CD8+ T cells and NK cells by nemvaleukin. Nemvaleukin was generally well tolerated and demonstrated promising efficacy. Durable responses were observed with monotherapy and combination therapy in heavily pretreated pts across a range of tumors, warranting further investigation. The US FDA granted nemvaleukin Fast Track designation for treatment of mucosal melanoma and PROC, and Orphan Drug designation for mucosal melanoma. Clinical trial information: NCT02799095.

ARTISTRY-3: Effect of nemvaleukin alfa with a less frequent IV dosing schedule as monotherapy and in combination with pembrolizumab and impact on the tumor microenvironment (TME) in patients (pts) with advanced solid tumors

TPS2684

Background: Nemvaleukin alfa (nemvaleukin, ALKS 4230) is a novel engineered cytokine that selectively binds the intermediate-affinity interleukin-2 (IL-2) receptor, preferentially activating and expanding antitumor CD8+ T cells and NK effector cells, with minimal effect on regulatory T cells. Nemvaleukin was designed to leverage antitumor effects of the IL-2 pathway while limiting typical IL-2‒associated toxicity. In ARTISTRY-1, the recommended phase 2 dose (RP2D) for nemvaleukin monotherapy of 6 µg/kg IV on days 1 to 5 of a 21-day cycle elicited durable and deep responses in pts with advanced melanoma and renal cell carcinoma (Boni et al. ASCO 2021:abstr 2513). Responses with nemvaleukin plus pembrolizumab were also observed in platinum-resistant ovarian, breast, cervical, gastrointestinal, and genitourinary cancers. ARTISTRY-3 will investigate the effects of nemvaleukin as monotherapy and in combination with pembrolizumab on the TME in pts with advanced solid tumors, and in an additional cohort (Cohort 2), to further assess a less frequent IV dosing schedule for nemvaleukin. Methods: The phase 1/2, open-label ARTISTRY-3 (NCT04592653) study will enroll adults (≥18 years) with select advanced solid tumors, ≥1 accessible lesion for biopsy, ≥1 target lesion (per RECIST v1.1), ECOG PS of 0 or 1, estimated life expectancy of ≥3 months, adequate hematologic reserve, and adequate hepatic and renal function. Primary objectives: to evaluate effects of nemvaleukin monotherapy on the TME (Cohort 1) and to determine RP2D for less frequent dosing schedule (Cohort 2). Additional objectives are to evaluate: efficacy, safety, immunogenicity, and pharmacokinetics of nemvaleukin monotherapy; effects of nemvaleukin plus pembrolizumab on the TME; and correlative biomarkers of nemvaleukin as monotherapy and combination. Following the protocol amendment, additional pts enrolled in Cohort 1 will receive lead-in monotherapy at a dose selected based on results from Cohort 2, and pre- and on-treatment biopsies will be collected for TME assessments. Subsequent cycles will be administered in combination with pembrolizumab, and a biopsy may be collected at cycle 4 or 5. Tumor types eligible for Cohort 2 are selected based on activity observed in the ARTISTRY-1 study. A quantitative system pharmacology model was applied to identify a less frequent schedule for nemvaleukin monotherapy and combination. Cohort 2 will initially assess safety and tolerability of nemvaleukin at 1 dose per 21-day cycle. Two doses per 21-day cycle may be implemented to achieve optimal PK/PD parameters. Bayesian optimal interval design methodology with open enrollment will be applied to facilitate dose escalation decisions. Clinical trial information: NCT04592653.

Nemvaleukin alfa in patients with advanced renal cell carcinoma: ARTISTRY-1

330

Background: Nemvaleukin alfa (nemvaleukin, ALKS 4230) is a novel engineered cytokine that selectively binds to the intermediate-affinity IL-2 receptor, preferentially activating and expanding antitumor CD8+ T and NK cells, with minimal expansion of Tregs. Nemvaleukin is under investigation for the treatment of advanced solid tumors, including renal cell carcinoma (RCC), in the ARTISTRY-1 trial (NCT02799095). Demonstration of single-agent activity is essential to validate the potential therapeutic benefit of nemvaleukin, both as monotherapy and in combination with a checkpoint inhibitor (CPI), particularly in patients (pts) with limited treatment options, such as CPI-experienced pts with RCC. Methods: Pts with advanced RCC who had previously responded (either objective response or stable disease [SD]) to a CPI alone or as part of a combination were enrolled into an RCC-specific cohort of ARTISTRY-1 Part B. Nemvaleukin 6 µg/kg IV monotherapy was administered daily for 5 days every 14 days in cycle 1 and every 21 days in cycles 2+. Pts with disease progression (PD; after ≥2 cycles) or SD (after ≥4 cycles) could be enrolled into Part C to receive nemvaleukin and pembrolizumab combination therapy. Outcomes presented include antitumor activity (RECIST v1.1), pharmacodynamics, and safety as of August 2021. Results: Twenty-seven pts with RCC received nemvaleukin monotherapy in Part B. Median age was 69 y (range, 39-77); median prior lines of therapy was 2 (range, 1-7). Four of 21 evaluable pts had a best overall response of partial response (1 confirmed, 1 unconfirmed, 2 awaiting confirmation); 11 had SD. Nemvaleukin induced robust expansion of CD8+ T and NK cells with minimal effect on Tregs. The most frequently reported adverse events (AEs), regardless of causality (N = 27), were pyrexia (59.3%), chills (55.6%), nausea (29.6%), and anemia (29.6%). The most frequently reported grade ≥3 nemvaleukin-related AEs are shown in the table. One pt had an AE (nemvaleukin-related bronchospasm) resulting in treatment discontinuation. There were no deaths due to treatment-related AEs. Four pts are continuing monotherapy in Part B (up to 1 y) and 10 have rolled over to Part C (combination therapy). Of the 8 evaluable pts with PD on Part B who subsequently received combination therapy in Part C, 1 had a confirmed partial response and has now been on treatment for almost 1 y and 5 had SD. No additional safety signals were observed. Conclusions: Nemvaleukin was generally well tolerated as monotherapy and in combination with pembrolizumab, and provided evidence of single-agent tumor response and disease control in CPI-experienced pts with advanced RCC. Clinical evaluation of nemvaleukin among pts with advanced RCC is ongoing. Clinical trial information: NCT02799095. [Table: see text]

Nemvaleukin alfa combination therapy for gastrointestinal (GI) cancers: Preclinical evidence and clinical data from the ARTISTRY-1 trial

659

Background: Nemvaleukin alfa (nemvaleukin, ALKS 4230) is a novel engineered cytokine that selectively binds to the intermediate-affinity IL-2 receptor, preferentially activating and expanding antitumor CD8+ T and NK cells, with minimal expansion of regulatory T cells. Inherently active, nemvaleukin neither requires metabolic/proteolytic conversion nor degrades into native IL-2. Preclinical characterization confirmed receptor selectivity and antitumor activity of nemvaleukin alone and with checkpoint inhibitors (CPIs) and informed dose selection for the first-in-human study ARTISTRY-1; other combination regimens are ongoing evaluation. In ARTISTRY-1, responses with nemvaleukin in combination with pembrolizumab were observed in a variety of tumors, including GI. In addition to the clinical outcomes of these patients (pts), we describe preclinical evaluation of nemvaleukin with tyrosine kinase inhibitors (TKIs)—a drug class indicated for some GI cancers. Methods: Pts with GI cancers who had progressed on prior therapy were enrolled into cohorts of mixed tumor types in ARTISTRY-1 (NCT02799095) and received IV nemvaleukin (3 µg/kg) and pembrolizumab (200 mg). Outcomes presented include antitumor activity and safety as of August 2021. Combinations of nemvaleukin with TKIs were evaluated in mouse tumor models, including colorectal adenocarcinoma (MC38). Results: Clinically, 26 pts with GI cancer (colon/colorectal, n = 14; esophageal, n = 5; hepatocellular, n = 3; pancreatic, n = 3; gastric, n = 1) received nemvaleukin + pembrolizumab (median 3 cycles [range: 1-24]). Median age was 55 y (range: 26-82), ECOG performance status was 0 (n = 6) or 1 (n = 20), and median prior lines of therapy was 3 (range: 1-6). Four pts had a partial response, 2 with esophageal, 1 with MSI-H colorectal, and 1 with pancreatic cancer, with target lesion decreases of 37% to 63%. Six pts had stable disease. Two responders remain on treatment (> 36 and > 80 wks for colorectal and esophageal cancer, respectively). Frequent (> 25%) nemvaleukin-related adverse events (AEs) among all pts receiving nemvaleukin combination (n = 156) were chills (58%), pyrexia (53%), nausea (29%), and fatigue (29%). Grade ≥3 nemvaleukin-related AEs (≥8%) were reported in 48%, including anemia (12%), neutrophil count decreased (10%), and neutropenia (8%). In mice, the combination of the mouse ortholog of nemvaleukin with VEGF TKIs showed improved antitumor activity and survival, along with increased immune activation and angiogenesis blockade in the tumor microenvironment compared with any compound alone. Conclusions: Emerging clinical data show responses in GI tumors may be achieved with nemvaleukin/pembrolizumab with manageable safety. Preclinical evidence of antitumor activity of nemvaleukin with CPIs or TKIs warrants further exploration of nemvaleukin in new combinations for pts with GI cancers. Clinical trial information: NCT02799095.

Author Correction: Immunogenomic profiling determines responses to combined PARP and PD-1 inhibition in ovarian cancer

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Immunogenomic profiling determines responses to combined PARP and PD-1 inhibition in ovarian cancer

Combined PARP and immune checkpoint inhibition has yielded encouraging results in ovarian cancer, but predictive biomarkers are lacking. We performed immunogenomic profiling and highly multiplexed single-cell imaging on tumor samples from patients enrolled in a Phase I/II trial of niraparib and pembrolizumab in ovarian cancer (NCT02657889). We identify two determinants of response; mutational signature 3 reflecting defective homologous recombination DNA repair, and positive immune score as a surrogate of interferon-primed exhausted CD8 + T-cells in the tumor microenvironment. Presence of one or both features associates with an improved outcome while concurrent absence yields no responses. Single-cell spatial analysis reveals prominent interactions of exhausted CD8 + T-cells and PD-L1 + macrophages and PD-L1 + tumor cells as mechanistic determinants of response. Furthermore, spatial analysis of two extreme responders shows differential clustering of exhausted CD8 + T-cells with PD-L1 + macrophages in the first, and exhausted CD8 + T-cells with cancer cells harboring genomic PD-L1 and PD-L2 amplification in the second.

Abstract P3-11-03: Pilot neoadjuvant study of niraparib in HER2-negative, BRCA-mutated resectable breast cancer

Background: Niraparib is a selective poly(ADP-ribose) polymerase 1/2 inhibitor that has demonstrated antitumor activity in advanced triple-negative breast cancer (TNBC) in combination with a programmed cell death 1 inhibitor, with the greatest clinical activity seen in tumors with breast cancer susceptibility gene (BRCA) mutations. Pharmacologically, niraparib has demonstrated a wide volume of distribution and high cell membrane permeability. In breast and ovarian cancer xenograft mouse models, niraparib achieved tumor exposures that were 3.3 times greater than plasma exposure. The objective of this study is to evaluate the antitumor activity of single-agent niraparib in the neoadjuvant treatment of patients with localized, human epidermal growth factor receptor 2 (HER2)-negative, BRCA-mutated breast cancer. The relative concentration of niraparib in tumor versus plasma was also assessed. Methods: Eligible patients were ≥18 years old, with HER2-negative, BRCA-mutated (germline or somatic) resectable breast cancer with a tumor size of ≥1 cm who had not received prior treatment for the current malignancy. Patients received niraparib 200 mg once daily for 2 months. At the end of 2 months, at their treating physician’s discretion, patients proceeded directly to surgery, received additional cycles of niraparib (maximum of 6 months), or received neoadjuvant chemotherapy. The primary endpoint was tumor response rate measured by magnetic resonance imaging (MRI) after 2 months of treatment. Response was defined as a ≥30% reduction in tumor volume from baseline. Secondary endpoints included tumor response rate measured by ultrasound, quantified percent change in tumor volume measured by MRI or ultrasound, pathological complete response, and safety and tolerability. Additionally, niraparib concentrations were measured in tumor and plasma samples using qualified liquid chromatography-tandem mass spectrometry. Results: Twenty-one patients were enrolled. As of June 2019, 18 patients had both an MRI and ultrasound scan at the end of month 2 and were evaluable for response. Ten patients are currently on treatment. The median age of patients was 43 years (range, 21-73). Fourteen patients had a BRCA1 mutation, 6 patients had a BRCA2 mutation, and 1 patient had both. Fifteen patients had TNBC, and 6 patients had hormone receptor-positive disease. All 18 response-evaluable patients had a clinical response after 2 months of treatment by at least one imaging modality; no patient experienced disease progression. Tumor response rate measured by MRI after 2 months of treatment was 89% (n/N = 16/18). Results measured by ultrasound were similar, with a 94% response rate at cycle 2 (n/N = 17/18). The median percent decrease in tumor volume after 2 months of treatment was 88% (range, 26-100%) and 89% (range, 23-100%) as measured by MRI and ultrasound, respectively. In the 5 samples measured thus far, niraparib concentrations in tumor biopsies after 2 months of treatment ranged from approximately 4-131-fold higher than those in corresponding plasma samples. Efficacy and tumor concentration data for all patients will be presented at the meeting. The most common (≥10%) drug-related treatment-emergent adverse events (TEAEs) of any grade were nausea, fatigue, anemia, insomnia, and decreased appetite. The only drug-related grade ≥3 toxicity in ≥10% of patients was anemia (3 patients). Three patients had a dose reduction due to a TEAE; no patient discontinued treatment due to a TEAE. Conclusion: Niraparib was well tolerated and showed promising antitumor activity in the neoadjuvant treatment of patients with localized HER2-negative, BRCA-mutated breast cancer. Niraparib achieved 4-131-fold higher concentrations in tumor than in plasma. Clinical trial information: NCT03329937. Funding: TESARO: A GSK Company (Waltham, MA, USA) sponsored the study.

Citation Format: Hyo Han, Minetta C Liu, Erika Hamilton, Hanna Irie, Cesar A Santa-Maria, James Reeves, Andre Liem, Adrianna Milillo Naraine, Julie Nangia, David Page, Meghan Duncan, Ming Shan, Yongqiang Tang, Julie R Graham, Leif W Ellisen, Steven Isakoff, Laura Spring. Pilot neoadjuvant study of niraparib in HER2-negative, BRCA-mutated resectable breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-11-03.

Single-Arm Phases 1 and 2 Trial of Niraparib in Combination With Pembrolizumab in Patients With Recurrent Platinum-Resistant Ovarian Carcinoma

IMPORTANCE

Patients with recurrent ovarian carcinoma frequently develop resistance to platinum-based chemotherapy, at which time treatment options become limited.

OBJECTIVE

To evaluate the poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitor niraparib combined with pembrolizumab in patients with recurrent ovarian carcinoma.

DESIGN, SETTING, AND PARTICIPANTS

The TOPACIO/KEYNOTE-162 (Niraparib in Combination With Pembrolizumab in Patients With Triple-Negative Breast Cancer or Ovarian Cancer) trial, an open-label, single-arm phases 1 and 2 study enrolled women with advanced or metastatic triple-negative breast cancer (TNBC) or recurrent ovarian carcinoma, irrespective of BRCA mutation status. Median follow-up was 12.4 months (range, 1.2 to ≥23.0 months). Data were collected from April 15, 2016, through September 4, 2018, with September 4, 2018, as a data cutoff, and analyzed from September 4, 2018, through January 30, 2019.

INTERVENTIONS

The recommended phase 2 dose (RP2D) was 200 mg of oral niraparib once daily and 200 mg of intravenous pembrolizumab on day 1 of each 21-day cycle.

MAIN OUTCOMES AND MEASURES

The primary objectives of phase 1 were to evaluate dose-limiting toxic effects and establish the RP2D and dosing schedule. The primary objective of phase 2 was to assess objective response rate (ORR; complete plus partial responses). Results from the phase 1 ovarian carcinoma and TNBC cohorts and phase 2 ovarian carcinoma cohort are reported. Because of the similarity in the phase 1 and 2 ovarian carcinoma populations, the data were pooled to perform an integrated efficacy analysis.

RESULTS

Fourteen patients (9 with ovarian carcinoma and 5 with TNBC) in phase 1 and 53 patients with ovarian carcinoma in phase 2 were enrolled, for a pooled ovarian carcinoma cohort of 62 patients (median age, 60 years [range, 46-83 years]). In the integrated efficacy phases 1 and 2 ovarian carcinoma population (60 of 62 evaluable patients), ORR was 18% (90% CI, 11%-29%), with a disease control rate of 65% (90% CI, 54%-75%), including 3 (5%) with confirmed complete responses, 8 (13%) with confirmed partial responses, 28 (47%) with stable disease, and 20 (33%) with progressive disease. The ORRs were consistent across subgroups based on platinum-based chemotherapy sensitivity, previous bevacizumab treatment, or tumor BRCA or homologous recombination deficiency (HRD) biomarker status. Median duration of response was not reached (range, 4.2 to ≥14.5 months). At data cutoff, 2 patients with a response and 1 patient with stable disease continued to receive treatment.

CONCLUSIONS AND RELEVANCE

Niraparib in combination with pembrolizumab is tolerable, with promising antitumor activity for patients with ovarian carcinoma who have limited treatment options regardless of platinum status, biomarker status, or prior treatment with bevacizumab. Responses in patients without tumor BRCA mutations or non-HRD cancers were higher than expected with either agent as monotherapy.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT02657889.

Open-label Clinical Trial of Niraparib Combined With Pembrolizumab for Treatment of Advanced or Metastatic Triple-Negative Breast Cancer

Importance

Poly(adenosine diphosphate-ribose) polymerase inhibitor and anti-programmed death receptor-1 inhibitor monotherapy have shown limited clinical activity in patients with advanced triple-negative breast cancer (TNBC).

Objective

To evaluate the clinical activity (primary) and safety (secondary) of combination treatment with niraparib and pembrolizumab in patients with advanced or metastatic TNBC.

Design, Setting, and Participants

This open-label, single-arm, phase 2 study enrolled 55 eligible patients with advanced or metastatic TNBC irrespective of BRCA mutation status or programmed death-ligand 1 (PD-L1) expression at 34 US sites. Data were collected from January 3, 2017, through October 29, 2018, and analyzed from October 29, 2018, through February 27, 2019.

Interventions

Patients were administered 200 mg of oral niraparib once daily in combination with 200 mg of intravenous pembrolizumab on day 1 of each 21-day cycle.

Main Outcomes and Measures

The primary end point was objective response rate (ORR) per the Response Evaluation Criteria in Solid Tumors, version 1.1. Secondary end points were safety, disease control rate (DCR; complete response plus partial response plus stable disease), duration of response (DOR), progression-free survival (PFS), and overall survival.

Results

Within the full study population of 55 women (median age, 54 years [range, 32-90 years]), 5 patients had confirmed complete responses, 5 had confirmed partial responses, 13 had stable disease, and 24 had progressive disease. In the efficacy-evaluable population (n = 47), ORR included 10 patients (21%; 90% CI, 12%-33%) and DCR included 23 (49%; 90% CI, 36%-62%). Median DOR was not reached at the time of the data cutoff, with 7 patients still receiving treatment at the time of analysis. In 15 evaluable patients with tumor BRCA mutations, ORR included 7 patients(47%; 90% CI, 24%-70%), DCR included 12 (80%; 90% CI, 56%-94%), and median PFS was 8.3 months (95% CI, 2.1 months to not estimable). In 27 evaluable patients with BRCA wild-type tumors, ORR included 3 patients (11%; 90% CI, 3%-26%), DCR included 9 (33%; 90% CI, 19%-51%), and median PFS was 2.1 months (95% CI, 1.4-2.5 months). The most common treatment-related adverse events of grade 3 or higher were anemia (10 [18%]), thrombocytopenia (8 [15%]), and fatigue (4 [7%]). Immune-related adverse events were reported in 8 patients (15%) and were grade 3 in 2 patients (4%); no new safety signals were detected.

Conclusions and Relevance

Combination niraparib plus pembrolizumab provides promising antitumor activity in patients with advanced or metastatic TNBC, with numerically higher response rates in those with tumor BRCA mutations. The combination therapy was safe with a tolerable safety profile, warranting further investigation.

Trial Registration

ClinicalTrials.gov identifier: NCT02657889.

Abstract OT3-03-01: Open-label, single-arm study evaluating the antitumor activity and safety of niraparib as neoadjuvant treatment in patients with localized, HER2-negative, BRCA-mutant breast cancer

Background: Neoadjuvant chemotherapy is administered to patients with operable breast cancer to downstage the tumor to allow for less extensive surgery and to provide prognostic information about drug efficacy and risk of disease recurrence. Patients who achieve a pathological complete response (pCR) following neoadjuvant treatment have a more favorable outcome than patients with residual invasive disease. Single-agent poly(ADP-ribose) polymerase (PARP) inhibitors have clinical efficacy in BRCA-mutated breast cancer. Niraparib, a potent and selective PARP1/2 inhibitor, is approved for maintenance treatment of patients with recurrent ovarian cancer and has demonstrated strong antitumor activity in in vivo studies with BRCA1-mutant breast cancer. The objective of this study is to evaluate the antitumor activity of single-agent niraparib in the neoadjuvant treatment of patients with localized, human epidermal growth factor receptor 2 (HER2)-negative, BRCAmut breast cancer.

Trial Design: This is an open-label, single-arm pilot study with a target enrollment of 20 evaluable patients. Eligible patients are those ≥18 years old with histologically-confirmed HER2-negative localized breast cancer and either a BRCA1 or BRCA2 mutation (germline or somatic) and no prior anti-cancer therapies for the current malignancy. Patients will receive 200 mg of oral niraparib once daily for 2 months, after which they may either proceed directly to surgery or receive chemotherapy at the discretion of the physician. The primary endpoint is tumor response rate based on the change in tumor volume as measured by breast MRI after 2 months of treatment with niraparib; a response is defined as ≥30% reduction of tumor volume from baseline. Secondary endpoints include pCR rate, tumor response rate based on the change in tumor volume as measured by breast ultrasound, and safety and tolerability. Data will be summarized in a descriptive nature by frequency distributions (number and percentage of patients) for categorical variables and by the mean, median, and standard deviation for continuous variables. Tumor response rate will be tabulated together with its 95% binomial exact confidence interval.

Funding: TESARO, Inc., Waltham, MA, USA sponsored the study.

Citation Format: Han H, Hamilton E, Irie H, Isakoff S, Jelovac D, Liem A, Liu MC, Milillo A, Nangia J, Page D, Reeves J, Santa-Maria C, Duncan M, Graham JR, Chen J, Dezube BJ, Spring L. Open-label, single-arm study evaluating the antitumor activity and safety of niraparib as neoadjuvant treatment in patients with localized, HER2-negative, BRCA-mutant breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT3-03-01.

Letter to the Editor -- Who benefits from the professionalization of health promotion?

In 2007, Health Promotion Ontario (HPO) began working to advance the "profession" of health promotion (HP) in Canada through development of national competencies for health promoters. Their work was continued by the Pan-Canadian Network for Health Promoter Competencies ("the Network"). Funded by the Public Health Agency of Canada, the Network aimed to address (1) the recommendation made by the Canadian Joint Task Group on Public Health Human Resources for function specific competencies (including "HP Specialists"); and (2) the marginalization health promoters face in practice. The current health promoter competencies were released in November 2015, following a series of literature reviews and practitioner consultations.

MicroRNA-27b targets gremlin 1 to modulate fibrotic responses in pulmonary cells

Fibrosis is a chronic disease characterized by an excessive deposition of scar tissue in the affected organs. A central mediator of this process is transforming growth factor-β (TGF-β), which stimulates the production of extracellular matrix proteins such as collagens. MicroRNAs (miRNAs) have been implicated in both fibrosis as well as in TGF-β signaling, but the extent of their regulation has not been fully defined. A functional screen was conducted using a library of miRNA inhibitors to identify miRNAs that affect TGF-β-induced type I collagen expression, a key event in the development of fibrosis. The inhibition of one miRNA in particular, miR-27b, caused a significant increase in type I collagen expression. We found that miR-27b directly targets Gremlin 1 by binding to its 3'-UTR, reducing its mRNA levels. TGF-β signaling decreased miR-27b expression and caused a corresponding increase in Gremlin 1 levels, suggesting that TGF-β regulates Gremlin 1 expression in part by modulating miR-27b expression. Reducing Gremlin 1 levels by either siRNA-mediated gene silencing or by using the miR-27b mimic inhibited the expression of several genes known to be involved in fibrosis, while increasing Gremlin 1 levels by the addition of either recombinant protein or the miR-27b inhibitor enhanced the expression of these genes. In summary, we have demonstrated that miR-27b targets Gremlin 1, and that this regulation likely represents an important control point in fibrotic pathways.

Serine protease HTRA1 antagonizes transforming growth factor-β signaling by cleaving its receptors and loss of HTRA1 in vivo enhances bone formation

HTRA1 is a member of the High Temperature Requirement (HTRA1) family of serine proteases, which play a role in several biological and pathological processes. In part, HTRA1 regulation occurs by inhibiting the TGF-β signaling pathway, however the mechanism of inhibition has not been fully defined. Previous studies have shown that HTRA1 is expressed in a variety of tissues, including sites of skeletal development. HTRA1 has also been implicated in the process of bone formation, although the precise manner of regulation is still unknown. This study investigated how HTRA1 regulates TGF-β signaling and examined the in vivo effects of the loss of HTRA1. We demonstrated that recombinant HTRA1 was capable of cleaving both type II and type III TGF-β receptors (TβRII and TβRIII) in vitro in a dose-dependent manner, but it did not affect the integrity of TβRI or TGF-β. Overexpression of HTRA1 led to decreased levels of both TβRII and III on the cell surface but had no effect on TβRI. Silencing HTRA1 expression significantly increased TGF-β binding to the cell surface and TGF-β responsiveness within the cell. To examine the role of HTRA1 in vivo, we generated mice with a targeted gene deletion of HTRA1. Embryonic fibroblasts isolated from these mice displayed an increase in TGF-β-induced expression of several genes known to promote bone formation. Importantly, the loss of HTRA1 in the knockout mice resulted in a marked increase in trabecular bone mass. This study has identified a novel regulatory mechanism by which HTRA1 antagonizes TGF-β signaling, and has shown that HTRA1 plays a key role in the regulation of bone formation.

A GSK-3-mediated transcriptional network maintains repression of immediate early genes in quiescent cells

Glycogen synthase kinase-3 (GSK-3) plays a central role in cell survival and proliferation, in part by the regulation of transcription. Unlike most protein kinases, GSK-3 is active in quiescent cells in the absence of growth factor signaling. In a recent series of studies, we employed a systems-level approach to understanding the transcription network regulated by GSK-3 in a quiescent cell model. We identified a group of immediate early genes that were upregulated in quiescent cells solely by the inhibition of GSK-3 in the absence of growth factor stimulation. Computational analysis of the upstream sequences of these genes identified statistically over-represented binding sites for the transcription factors CREB, NFκB and AP-1, and the roles of these factors in regulating expression of GSK-3 target genes were verified by chromatin immunoprecipitation and RNA interference. In quiescent cells, GSK-3 inhibits CREB, NFκB and AP-1, thereby maintaining repression of their target genes and contributing to maintenance of cell cycle arrest.

The E-box binding factors Max/Mnt, MITF, and USF1 act coordinately with FoxO to regulate expression of proapoptotic and cell cycle control genes by phosphatidylinositol 3-kinase/Akt/glycogen synthase kinase 3 signaling

Phosphatidylinositol (PI) 3-kinase/Akt signaling plays a critical role in cell proliferation and survival, partly by regulation of FoxO transcription factors. Previous work using global expression profiling indicated that inhibition of PI 3-kinase in proliferating cells led to induction of genes that promote cell cycle arrest and apoptosis. The upstream regulatory regions of these genes had binding sites not only for FoxO, but also for Myc/Max transcription factors. In the present study, we have addressed the role of Myc family members and related E-box-binding proteins in the regulation of these genes. Chromatin immunoprecipitations and RNA interference indicated that transcription was repressed by Max-Mnt-Sin3a-histone deacetylase complexes in proliferating cells. Inhibition of PI 3-kinase led to a loss of Max/Mnt binding and transcriptional induction by MITF and USF1, as well as FoxO. Both MITF and USF1 were activated by glycogen synthase kinase (GSK) 3, with GSK3 phosphorylation sites on USF1 identified as the previously described activating site threonine 153 as well as serine 186. siRNA against MITF as well as against FoxO3a protected cells from apoptosis following PI 3-kinase inhibition. These results define a novel E-box-regulated network that functions coordinately with FoxO to regulate transcription of apoptotic and cell cycle regulatory genes downstream of PI 3-kinase/Akt/GSK3 signaling.

AP-1 is a component of the transcriptional network regulated by GSK-3 in quiescent cells

BACKGROUND

The protein kinase GSK-3 is constitutively active in quiescent cells in the absence of growth factor signaling. Previously, we identified a set of genes that required GSK-3 to maintain their repression during quiescence. Computational analysis of the upstream sequences of these genes predicted transcription factor binding sites for CREB, NFκB and AP-1. In our previous work, contributions of CREB and NFκB were examined. In the current study, the AP-1 component of the signaling network in quiescent cells was explored.

METHODOLOGY/PRINCIPAL FINDINGS

Using chromatin immunoprecipitation analysis, two AP-1 family members, c-Jun and JunD, bound to predicted upstream regulatory sequences in 8 of the 12 GSK-3-regulated genes. c-Jun was phosphorylated on threonine 239 by GSK-3 in quiescent cells, consistent with previous studies demonstrating inhibition of c-Jun by GSK-3. Inhibition of GSK-3 attenuated this phosphorylation, resulting in the stabilization of c-Jun. The association of c-Jun with its target sequences was increased by growth factor stimulation as well as by direct GSK-3 inhibition. The physiological role for c-Jun was also confirmed by siRNA inhibition of gene induction.

CONCLUSIONS/SIGNIFICANCE

These results indicate that inhibition of c-Jun by GSK-3 contributes to the repression of growth factor-inducible genes in quiescent cells. Together, AP-1, CREB and NFκB form an integrated transcriptional network that is largely responsible for maintaining repression of target genes downstream of GSK-3 signaling.

Prolyl isomerase Pin1 regulates transcription factor LSF (TFCP2) by facilitating dephosphorylation at two serine-proline motifs

Transcription factor LSF is essential for cell cycle progression, being required for activating expression of the thymidylate synthase (Tyms) gene at the G1/S transition. We previously established that phosphorylation of LSF in early G1 at Ser-291 and Ser-309 inhibits its transcriptional activity and that dephosphorylation later in G1 is required for its reactivation. Here we reveal the role of prolyl cis-trans isomerase Pin1 in activating LSF, by facilitating dephosphorylation at both Ser-291 and Ser-309. We demonstrate that Pin1 binds LSF both in vitro and in vivo. Using coimmunoprecipitation assays, we identify three SP/TP motifs in LSF (at residues Ser-291, Ser-309, and Thr-329) that are required and sufficient for association with Pin1. Co-expression of Pin1 enhances LSF transactivation potential in reporter assays. The Pin1-dependent enhancement of LSF activity requires residue Thr-329 in LSF, requires both the WW and PPiase domains of Pin1, and correlates with hypophosphorylation of LSF at Ser-291 and Ser-309. These findings support a model in which the binding of Pin1 at the Thr-329-Pro-330 motif in LSF permits isomerization by Pin1 of the peptide bonds at the nearby phosphorylated SP motifs (Ser-291 and Ser-309) to the trans configuration, thereby facilitating their dephosphorylation.

GSK-3 represses growth factor-inducible genes by inhibiting NF-kappaB in quiescent cells

GSK-3 is active in the absence of growth factor stimulation and generally acts to induce apoptosis or inhibit cell proliferation. We previously identified a subset of growth factor-inducible genes that can also be induced in quiescent T98G cells solely by inhibition of GSK-3 in the absence of growth factor stimulation. Computational predictions verified by chromatin immunoprecipitation assays identified NF-kappaB binding sites in the upstream regions of 75% of the genes regulated by GSK-3. p50 bound to most of these sites in quiescent cells, and for one-third of the genes, binding of p65 to the predicted sites increased upon inhibition of GSK-3. The functional role of p65 in gene induction following inhibition of GSK-3 was demonstrated by RNA interference experiments. Furthermore, inhibition of GSK-3 in quiescent cells resulted in activation of IkappaB kinase, leading to phosphorylation and degradation of IkappaB alpha and nuclear translocation of p65 and p50. Taken together, these results indicate that the high levels of GSK-3 activity in quiescent cells repress gene expression by negatively regulating NF-kappaB through inhibition of IkappaB kinase. This inhibition of NF-kappaB is consistent with the role of GSK-3 in the induction of apoptosis or cell cycle arrest in cells deprived of growth factors.

A review of the otological aspects of whiplash injury

Approximately 10% of patients who have suffered with whiplash injury will develop otological symptoms such as tinnitus, deafness and vertigo. Some of these are purely subjective symptoms; nevertheless, for the majority there are specific tests that can be undertaken. These tests can quantify the extent and severity of the symptoms as well as provide guidance as to the correct rehabilitation pathway. This article reviews the body of literature relating to the otological aspects of whiplash injury and gives an overview for medical and legal professionals.

Phosphatidylinositol 3-kinase signaling in proliferating cells maintains an anti-apoptotic transcriptional program mediated by inhibition of FOXO and non-canonical activation of NFkappaB transcription factors

BACKGROUND

Phosphatidylinositol (PI) 3-kinase is activated by a variety of growth factor receptors and the PI 3-kinase/Akt signaling pathway is a key regulator of cell proliferation and survival. The downstream targets of PI 3-kinase/Akt signaling include direct regulators of cell cycle progression and apoptosis as well as a number of transcription factors. Growth factor stimulation of quiescent cells leads to robust activation of PI 3-kinase, induction of immediate-early genes, and re-entry into the cell cycle. A lower level of PI 3-kinase signaling is also required for the proliferation and survival of cells maintained in the presence of growth factors, but the gene expression program controlled by PI 3-kinase signaling in proliferating cells has not been elucidated.

RESULTS

We used microarray analyses to characterize the changes in gene expression resulting from inhibition of PI 3-kinase in proliferating cells. The genes regulated by inhibition of PI 3-kinase in proliferating cells were distinct from genes induced by growth factor stimulation of quiescent cells and highly enriched in genes that regulate programmed cell death. Computational analyses followed by chromatin immunoprecipitations demonstrated FOXO binding to both previously known and novel sites in promoter regions of approximately one-third of the up-regulated genes, consistent with activation of FOXO1 and FOXO3a in response to inhibition of PI 3-kinase. NFkappaB binding sites were similarly identified in promoter regions of over one-third of the down-regulated genes. RelB was constitutively bound to promoter regions in cells maintained in serum, however binding decreased following PI 3-kinase inhibition, indicating that PI 3-kinase signaling activates NFkappaB via the non-canonical pathway in proliferating cells. Approximately 70% of the genes targeted by FOXO and NFkappaB regulate cell proliferation and apoptosis, including several regulators of apoptosis that were not previously known to be targeted by these transcription factors.

CONCLUSION

PI 3-kinase signaling in proliferating cells regulates a novel transcriptional program that is highly enriched in genes that regulate apoptosis. At least one-third of these genes are regulated either by FOXO transcription factors, which are activated following PI 3-kinase inhibition, or by RelB, which is activated by PI 3-kinase via the non-canonical pathway in proliferating cells.

Assembly and annotation of human chromosome 2q33 sequence containing the CD28, CTLA4, and ICOS gene cluster: analysis by computational, comparative, and microarray approaches

Human chromosome 2q33 is an immunologically important region based on the linkage of numerous autoimmune diseases to the CTLA4 locus. Here, we sequenced and assembled 2q33 bacterial artificial chromosome (BAC) clones, resulting in 381,403 bp of contiguous sequence containing genes encoding a NADH: ubiquinone oxidoreductase, the costimulatory receptors CD28, CTLA4, and ICOS, and a HERV-H type endogenous retrovirus located 366 bp downstream of ICOS in the reverse orientation. Genomic microarray expression analysis using differentially activated T-cell RNA against a subcloned CTLA4/ICOS BAC library revealed upregulation of CTLA4 and ICOS sequences, plus antisense ICOS transcripts generated by the HERV-H, suggesting a potential mechanism for ICOS regulation. We identified four nonlinked, polymorphic, simple repetitive sequence elements in this region, which may be used to delineate genetic effects of ICOS and CTLA4 in disease populations. Comparative genomic analysis of mouse genomic Icos sequences revealed 60% sequence identity in the 5' UTR and regions between exon 2 and the 3' UTR, suggesting the importance of ICOS gene function.

Use of the MMPI-A to detect substance abuse in a juvenile correctional setting

In this study, we examined the ability of the MMPI-A (Butcher et al., 1992) to detect substance abuse problems in a juvenile correctional setting. Specifically, we evaluated the Alcohol/Drug Problem Acknowledgment scale (ACK; Weed, Butcher, & Williams, 1994), the Alcohol/Drug Problem Proneness scale (PRO; Weed et al., 1994), and the MacAndrew Alcoholism Scale-Revised (MAC-R; Butcher et al., 1992) in the prediction of substance abuse. In addition, the incremental validity of ACK in comparison to PRO was evaluated, as was the incremental validity of PRO in comparison to ACK. The sample consisted of 123 boys and girls from ajuvenile correctional facility in Northeastern Ohio. Results indicate that ACK and PRO, but not MAC-R, were related to interviewer ratings of substance abuse. Results point to the superiority of ACK over PRO in substance abuse identification.

Ethnic and gender differences in mental health utilization: the case of Muslim Jordanian and Moroccan Jewish Israeli out-patient psychiatric patients

A sample of 148 (87 Jordanian [61 male, 26 female] and 61 Israeli [26 male, 35 female]) was selected from a psychiatric clinic in Ashdod Israel and Zarka Jordan, using convenience sampling methodology over a 12 month period in late 1997 and early 1998. A revised Hopkins Symptom Checklist: A Self-Report Symptom Inventory (HSCL) was translated into Arabic and Hebrew and distributed to subjects; additional questions explored demographic characteristics, forms of received treatment, patient perceptions of treatment efficacy, patient use of traditional healers, and patient explanation of etiology. Data revealed that there were differences in dimensions between the 2 groups based on nationality and gender. More Jordanians than Israelis expected medications as the main treatment, and unlike Israelis, no Jordanian patients received individual psychotherapy. Israelis expected medications, advice, directions, and instructions from psychiatrists. Both ethnic groups consulted a wide array of traditional healers, although precise types of healers varied according to gender and ethnicity. Israeli subjects gave more diverse explanations of mental health etiologies: physical, family, divorce, economic, unemployment; whereas Jordanians tended to emphasize divine and spiritual sources. Implications for psychiatric practice are discussed.

Gendered utilization differences of mental health services in Jordan

A revised Hopkins Symptom Checklist (HSCL), translated into Arabic, was distributed to a sample of 87 nonpsychotic mental health out-patients in Zarka, Jordan (male = 61, female = 26). Findings revealed no significant gendered differences, but higher responses among women in all dimensions. Regardless of gender, patients also expected and were satisfied with medicinal treatment; explained etiologies as having supernatural origins; and utilized informal community traditional healing and religious healing systems. The supernatural explanations and community healing systems varied by gender. Findings emphasize future treatment and programme development strategies that take into account the biomedical/traditional interface, culturally appropriate treatment modalities, different gendered patient needs, and the potential stigma of professional treatment.

Detection of coached general malingering on the MMPI-2

The current study examined the effects of validity-scale coaching on one's ability to feign general psychopathology. College students were coached on malingering strategies and completed the MMPI-2. Their responses were compared with students asked to malinger psychopathology without validity-scale coaching and with psychiatric inpatients completing the MMPI-2 under standard instructions. In accordance with previous research (e.g., J. R. Graham, D. Watts, & R. E. Timbrook, 1991), uncoached malingerers were adequately discriminated from patients by using the Infrequency (F) scale. However, as suggested by previous research (R. Rogers, R. M. Bagby, & D. Chakraborty, 1993), the F scale was not as effective at classifying coached malingerers. It was found that other validity indicators, such as the Infrequency Psychopathology Scale were more accurate at discriminating between coached malingerers and hospitalized patients.

Detection of coached general malingering on the MMPI-2

The current study examined the effects of validity-scale coaching on one's ability to feign general psychopathology. College students were coached on malingering strategies and completed the MMPI-2. Their responses were compared with students asked to malinger psychopathology without validity-scale coaching and with psychiatric inpatients completing the MMPI-2 under standard instructions. In accordance with previous research (e.g., J. R. Graham, D. Watts, & R. E. Timbrook, 1991), uncoached malingerers were adequately discriminated from patients by using the Infrequency (F) scale. However, as suggested by previous research (R. Rogers, R. M. Bagby, & D. Chakraborty, 1993), the F scale was not as effective at classifying coached malingerers. It was found that other validity indicators, such as the Infrequency Psychopathology Scale were more accurate at discriminating between coached malingerers and hospitalized patients.

Hot Stars and Cool Clouds: The Photodissociation Region M16

We present high-resolution spectroscopy and images of a photodissociation region (PDR) in M16 obtained during commissioning of the near-infrared spectrometer (NIRSPEC) on the Keck II telescope. PDRs play a significant role in regulating star formation, and M16 offers the opportunity to examine the physical processes of a PDR in detail. We simultaneously observe both the molecular and ionized phases of the PDR and resolve the spatial and kinematic differences between them. The most prominent regions of the PDR are viewed edge-on. Fluorescent emission from nearby stars is the primary excitation source, although collisions also preferentially populate the lowest vibrational levels of H2. Variations in density-sensitive emission-line ratios demonstrate that the molecular cloud is clumpy, with an average density n=3x105 cm-3. We measure the kinetic temperature of the molecular region directly and find that TH2=930 K. The observed density, temperature, and UV flux imply a photoelectric heating efficiency of 4%. In the ionized region, ni=5x103 cm-3 and THii=9500 K. In the brightest regions of the PDR, the recombination line widths include a nonthermal component, which we attribute to viewing geometry.

J-Band Infrared Spectroscopy of a Sample of Brown Dwarfs Using NIRSPEC on Keck II

Near-infrared spectroscopic observations of a sample of very cool, low-mass objects are presented with higher spectral resolution than in any previous studies. Six of the objects are L dwarfs, ranging in spectral class from L2 to L8/9, and the seventh is a methane or T dwarf. These new observations were obtained during commissioning of the near-infrared spectrometer (NIRSPEC), the first high-resolution near-infrared cryogenic spectrograph for the Keck II 10 m telescope on Mauna Kea, Hawaii. Spectra with a resolving power of R approximately 2500 from 1.135 to 1.360 µm (approximately J band) are presented for each source. At this resolution, a rich spectral structure is revealed, much of which is due to blending of unresolved molecular transitions. Strong lines due to neutral potassium (K i) and bands due to iron hydride (FeH) and steam (H2O) change significantly throughout the L sequence. Iron hydride disappears between L5 and L8, the steam bands deepen, and the K i lines gradually become weaker but wider because of pressure broadening. An unidentified feature occurs at 1.22 µm that has a temperature dependence like FeH but has no counterpart in the available FeH opacity data. Because these objects are 3-6 mag brighter in the near-infrared compared with the I band, spectral classification is efficient. One of the objects studied (2MASSW J1523+3014) is the coolest L dwarf discovered so far by the 2 Micron All-Sky Survey (2MASS), but its spectrum is still significantly different from the methane-dominated objects such as Gl 229B or SDSS 1624+0029.

Infrared Spectroscopy of a Massive Obscured Star Cluster in the Antennae Galaxies (NGC 4038/9) with NIRSPEC

We present infrared spectroscopy of the Antennae galaxies (NGC 4038/9) with the near-infrared spectrometer (NIRSPEC) at the W. M. Keck Observatory. We imaged the star clusters in the vicinity of the southern nucleus (NGC 4039) with 0&farcs;39 seeing in the K band using NIRSPEC's slit-viewing camera. The brightest star cluster revealed in the near-IR [MK&parl0;0&parr0; approximately -17.9] is insignificant optically but is coincident with the highest surface brightness peak in the mid-IR (12-18 µm) Infrared Space Observatory image presented by Mirabel et al. We obtained high signal-to-noise ratio 2.03-2.45 µm spectra of the nucleus and the obscured star cluster at R approximately 1900. The cluster is very young ( approximately 4 Myr), massive (M approximately 16x106 M middle dot in circle), and compact (with a density of approximately 115 M middle dot in circle pc-3 within a 32 pc half-light radius), assuming a Salpeter initial mass function (0.1-100 M middle dot in circle). Its hot stars have a radiation field characterized by Teff approximately 39,000 K, and they ionize a compact H ii region with ne approximately 104 cm-3. The stars are deeply embedded in gas and dust (AV approximately 9-10 mag), and their strong far-ultraviolet field powers a clumpy photodissociation region with densities nH greater, similar105 cm-3 on scales of approximately 200 pc, radiating LH21-0S&parl0;1&parr0;=9600 L middle dot in circle.

2 Micron Spectroscopy within 0&farcs;3 of Sagittarius A*

We present moderate- (R approximately 2700) and high-resolution (R approximately 22,400) 2.0-2.4 µm spectroscopy of the central 0.1 arcsec2 of the Galaxy obtained with the facility near-infrared spectrometer (NIRSPEC) for the Keck II telescope. The composite spectra do not have any features attributable to the brightest stars in the central cluster; i.e., after background subtraction, W12CO&parl0;2-0&parr0;<2 Å. This stringent limit leads us to conclude that the majority, if not all, of the stars are hotter than typical red giants. Coupled with previously reported photometry, we conclude that the sources are likely OB main-sequence stars. In addition, the continuum slope in the composite spectrum is bluer than that of a red giant and is similar to that of the nearby hot star IRS 16NW. It is unlikely that they are late-type giants stripped of their outer envelopes because such sources would be much fainter than those observed. Given their inferred youth (tauage<20 Myr), we suggest the possibility that the stars have formed within 0.1 pc of the supermassive black hole. We find a newly identified broad-line component (VFWHM approximately 1000 km s-1) toward the 2.2178 µm [Fe iii] line located within a few arcseconds of Sagittarius A*. A similar component is not seen in the Brgamma emission.

The Rest-Frame Optical Spectrum of MS 1512-cB58

Moderate-resolution, near-IR spectroscopy of MS 1512-cB58 is presented, obtained during commissioning of the near-infrared spectrometer (NIRSPEC) on the Keck II telescope. The strong lensing of this z=2.72 galaxy by the foreground cluster MS 1512+36 makes it the best candidate for detailed study of the rest-frame optical properties of Lyman-break galaxies. In 80 minutes of on-source integration, we have detected Halpha, [N ii] lambdalambda6583, 6548, [O i] lambda6300, He i lambda5876, [O iii] lambdalambda5007, 4959, Hbeta, Hgamma, [O ii] lambda3727, and a strong continuum signal in the range of 1.29-2.46 µm. A redshift of z=2.7290+/-0.0007 is inferred from the emission lines, in contrast to the z=2.7233 calculated from UV observations of interstellar absorption lines. Using the Balmer line ratios, we find an extinction of E(B-V) = 0.27. Using the line strengths, we infer a star formation rate (SFR) of 620+/-18 M middle dot in circle yr-1 (H0=75, q0=0.1, and Lambda=0), which is a factor of 2 higher than that measured from narrowband imaging observations of the galaxy but is a factor of almost 4 lower than the SFR inferred from the UV continuum luminosity. The width of the Balmer lines yields a mass of Mvir=1.2x1010 M middle dot in circle. We find that the oxygen abundance is 13 solar, in good agreement with other estimates of the metallicity. However, we infer a high nitrogen abundance, which may argue for the presence of an older stellar population.

Discovery of an Obscured Broad-Line Region in the High-Redshift Radio Galaxy MRC 2025-218

This Letter presents infrared spectra taken with the newly commissioned near-infrared spectrometer (NIRSPEC) on the Keck II telescope of the high-redshift radio galaxy MRC 2025-218 (z=2.63). These observations represent the deepest infrared spectra of a radio galaxy to date and have allowed for the detection of Hbeta, [O iii] lambdalambda4959, 5007, [O i] lambda6300, Halpha, [N ii] lambdalambda6548, 6583, and [S ii] lambdalambda6716, 6713. The Halpha emission is very broad (FWHM=9300 km s-1) and luminous (2.6x1044 ergs s-1), and it is very comparable to the line widths and strengths of radio-loud quasars at the same redshift. This strongly supports active galactic nucleus unification models linking radio galaxies and quasars, although we discuss some of the outstanding differences. The line [O iii] lambda5007 is extremely strong and has extended emission with large relative velocities toward the nucleus. We also derive that if the extended emission is due to star formation, each knot has a star formation rate comparable to a Lyman-break galaxy at the same redshift.

Development of an Infrequency-Psychopathology scale for the MMPI-A: the Fp-A Scale

This article describes the development and initial validation of the Infrequency-Psychopathology scale, Fp-A, for the MMPI-A (Butcher et al., 1992). The scale parallels the Infrequency-Psychopathology scale, F(p), that has been developed for the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). Results demonstrated that the 40-item Fp-A scale is superior to the F scale at discriminating between faking-bad and accurate reports of psychopathology, although the improvement over F was modest, particularly when compared to the improvement found for the F(p) scale. The difference seemed to reflect the superiority of the MMPI-A F scale to the MMPI-2 F scale. Even so, the findings suggest that the identification of overreporting on the MMPI-A could potentially be enhanced by using Fp-A as an adjunct to the F scale.

Culturally sensitive social work practice with Arab clients in mental health settings

Several culturally specific practical considerations should inform social work interventions with ethnic Arab peoples in Arab countries or in Western nations. These include taking into account gender relations, individuals' places in their families and communities, patterns of mental health services use, and, for practice in Western nations, the client's level of acculturation. Such aspects provide the basis for specific guidelines in working with ethnic Arab mental health clients. These include an emphasis on short-term, directive treatment; communication patterns that are passive and informal; patients' understanding of external loci of control and their use of ethnospecific idioms of distress; and, where appropriate, the integration of modern and traditional healing systems.

Effects of nutrient intake and number of oestrous cycles on in vitro development of preimplantation pig embryos

The effects of nutrient intake and insemination of gilts at first versus third oestrus on the in vitro development of preimplantation pig embryos were investigated. Standard swine management involves ad libitum feeding of gilts at first oestrus and restricted feeding of gilts at third oestrus. According to previous research, gilts inseminated at first oestrus demonstrate greater embryonic mortality than gilts inseminated at third oestrus, and it is possible that differences in nutrient intake between gilts inseminated at first versus third oestrus affect the viability of eggs or embryos. In the present study, experimental gilts were assigned to three treatments: animals designated 1A were inseminated at first oestrus and fed ad libitum; animals designated 3R were inseminated at third oestrus and were fed a restricted diet; and 3A animals were inseminated at third oestrus and fed ad libitum. Embryos collected from each treatment group were cultured in vitro, and data were evaluated according to cell stage at collection. Comparison of treatments 1A and 3R supported the contention of increased embryo mortality in gilts inseminated at first oestrus under normal management conditions. When cultures were initiated at the one- to two-cell or two- to four-cell stages, the percentage of 1A embryos developing to the morula stage (50.9%, 68.0%) was significantly lower than that of 3R embryos (88.9%, 90.9%; P < 0.05). Comparison of treatments 1A and 3A addressed effects due to the number of oestrous cycles. Significantly more two- to four-cell embryos from gilts inseminated at third oestrus and fed ad libitum reached the morula and expanded blastocyst stages of development (87.0%, 41.3%) compared with embryos from gilts inseminated at first oestrus and fed ad libitum (68.0%, 20.3%; P < 0.05). Finally, the effects of ad libitum feeding were determined by comparing treatments 3A and 3R. These data were inconclusive, as both positive and negative effects were observed. More one- to two-cell embryos from treatment 3R developed to the morula stage (88.9%) compared with 3A embryos collected at the same stage (64.7%), whereas a greater number of 3A embryos in the two- to four-cell category reached the expanded blastocyst stage (41.3%) than 3R embryos (21.2%; P < 0.05). These results support the hypothesis of lower in vitro developmental capacity for embryos collected from gilts inseminated at first oestrus. Furthermore, the findings indicate that differences in embryo viability between gilts inseminated at first versus third oestrus are related to the number of oestrous cycles and possibly to differential nutrition.

Gender and biomedical/traditional mental health utilization among the Bedouin-Arabs of the Negev

Twenty Bedouin-Arab non-psychotic subjects in Israel (10 male, 10 female) utilized biomedical and traditional healing mental health care systems. Common patterns of utilization were observed: first to family/friends, then to a general practitioner, next to a traditional healer, and finally to a psychiatrist. Men were more familiar with the biomedical system, and women with the traditional. Women, more than men, made group utilization decisions; men, more than women, saw traditional healers outsider their home communities. Gender differences were found in symptomatology and in patient construction of etiology. The biomedical system successfully addressed physical symptoms. The traditional system struck a stronger therapeutic alliance, tended to diagnose more comprehensibly, and was perceived by many patients as being more clinically beneficial. Biomedical practitioners can learn from traditional healers how to read a client's ecological map, incorporate the family/community in treatment, and communicate in the patient's cultural idiom. In their search for models of traditional/biomedical system integration, scholars should turn to patients themselves, who are currently living such integration.

Social work intervention with Bedouin-Arab children in the context of blood vengeance

Blood vengeance is a culturally specific phenomenon that can place Bedouin-Arab children at high risk of neglect. This case study examines the psychological and social implications of vengeance on children, the children's coping strategies, and the role of social work. The social work function includes nonauthoritarianism, strategies for forming a positive helping alliance, and various forms of culturally sensitive assessment and intervention. The study therefore yields insight into bridging the emic-etic gap in conceptualizing and responding to child neglect in a non-Western society.

Long-term stability of MMPI-A scales

Adolescents (24 boys, 37 girls) from public school settings were given the MMPI-A on 2 occasions with approximately 1 year between testing sessions. Long-term stability of validity, clinical, content, supplementary, and the new Psychopathology Five scales are examined and correlation coefficients are presented. The reliabilities of the MMPI-A scales are consistent with previously reported data. In addition, improvements made during development of the MMPI-A may have led generally to modest increases in stability of the clinical scales for adolescents. Given the importance of both short-term and long-term test-retest data in the evaluation of the validity of an assessment instrument, this study represents an important step in evaluating the validity of the MMPI-A for assessment of personality.

MADD, a novel death domain protein that interacts with the type 1 tumor necrosis factor receptor and activates mitogen-activated protein kinase

The death domain of the type 1 tumor necrosis factor receptor (TNFR1) mediates interactions with several proteins involved in signaling the downstream effects of TNF. We have used the yeast interaction trap to isolate a protein, MADD, that associates with the death domain of TNFR1 through its own C-terminal death domain. MADD interacts with TNFR1 residues that are critical for signal generation and coimmunoprecipitates with TNFR1, implicating MADD as a component of the TNFR1 signaling complex. Importantly, we have found that overexpression of MADD activates the mitogen-activated protein (MAP) kinase extracellular signal-regulated kinase (ERK), and expression of the MADD death domain stimulates both the ERK and c-JUN N-terminal kinase MAP kinases and induces the phosphorylation of cytosolic phospholipase A2. These data indicate that MADD links TNFR1 with MAP kinase activation and arachidonic acid release and provide further insight into the mechanisms by which TNF exerts its pleiotropic effects.

The healing significance of the Negev's Bedouin Dervish

Among the Bedouins of the Negev desert, Israel, there are Dervish healers specializing in what are now called psychiatric disorders. Five Dervish (three male, two female) were interviewed and observed with reference to concepts of etiology, symptom classification, diagnosis, stages of treatment, and aftercare. The conclusion examines reasons why Bedouins might want to seek treatment from a Dervish, rather than a modern health care practitioner.

Detecting Fake-Bad MMPI-A Profiles

This study examined the extent to which the validity scales of the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A; Butcher et al., 1992) could identify adolescents who were faking-bad. This study also examined the extent to which the validity scales could differentiate between nonclinical adolescents instructed to fake-bad and both clinical and nonclinical adolescents who received standard instructions. Participants were 58 male and 80 female high school students and 58 male and 80 female adolescents from clinical settings. Results indicated that the mean profiles resembled those previously reported for adults on the MMPI (Graham, 1987) and MMPI-2 (Graham, Watts, & Timbrook, 1991) and for adolescents on the original MMPI (Archer, Gordon, & Kirchner, 1987). Accurate identification of students who were faking-bad was achieved. It was possible to differentiate between the clinical adolescents and nonclinical adolescents who were faking, and it was possible to differentiate between nonclinical adolescents who were faking and nonclinical adolescents with standard instructions; however, different cutoff scores were needed for these two discriminations. Optimal cutoff scores were presented.