Nano-in-nano enteric protein delivery system: coaxial Eudragit® L100-55 fibers containing poly(N-vinylcaprolactam) nanogels

Oral protein delivery holds significant promise as an effective therapeutic strategy for treating a wide range of diseases. However, effective absorption of proteins faces challenges due to biological barriers such as harsh conditions of the stomach and the low permeability of mucous membranes. To address these challenges, this article presents a novel nano-in-nano platform designed for enteric protein delivery. This platform, obtained by electrospinning, involves a coaxial arrangement comprising poly(N-vinylcaprolactam) nanogels (NGs) enclosed within nanofibers of Eudragit® L100-55 (EU), a pH-responsive polymer. The pH-selective solubility of EU ensures the protection of NGs during their passage through the stomach, where the fibers remain intact at low pH, and releases them in the intestine where EU dissolves. The switchable characteristic of this nano-in-nano platform is confirmed by using NGs loaded with a model protein (ovalbumin), which is selectively released when the intestinal pH is achieved. The versatility of this nano-in-nano delivery platform is demonstrated by the ability to modify the fibers dissolution profile simply by adjusting the concentration of EU used in the electrospinning process. Furthermore, by tuning the properties of NGs, the potential applications of this platform can be further extended, paving the way for diverse therapeutic possibilities.

Resistance to osimertinib in advanced EGFR-mutated NSCLC: a prospective study of molecular genotyping on tissue and liquid biopsies

BACKGROUND

Resistance to osimertinib in advanced EGFR-mutated non-small cell lung cancer (NSCLC) constitutes a significant challenge for clinicians either in terms of molecular diagnosis and subsequent therapeutic implications.

METHODS

This is a prospective single-centre study with the primary objective of characterising resistance mechanisms to osimertinib in advanced EGFR-mutated NSCLC patients treated both in first- and in second-line. Next-Generation Sequencing analysis was conducted on paired tissue biopsies and plasma samples. A concordance analysis between tissue and plasma was performed.

RESULTS

Sixty-five advanced EGFR-mutated NSCLC patients treated with osimertinib in first- (n = 56) or in second-line (n = 9) were included. We managed to perform tissue and liquid biopsies in 65.5% and 89.7% of patients who experienced osimertinib progression, respectively. Acquired resistance mechanisms were identified in 80% of 25 patients with post-progression samples, with MET amplification (n = 8), EGFR C797S (n = 3), and SCLC transformation (n = 2) the most frequently identified. The mean concordance rates between tissue and plasma for the EGFR activating mutation and for the molecular resistance mechanisms were 87.5% and 22.7%, respectively.

CONCLUSIONS

Resistance to osimertinib demonstrated to be highly heterogeneous, with MET amplification the main mechanism. Plasma genotyping is a relevant complementary tool which might integrate tissue analysis for the study of resistance mechanisms.

PD-L1 overexpression induces STAT signaling and promotes the secretion of pro-angiogenic cytokines in non-small cell lung cancer (NSCLC)

BACKGROUND

Monoclonal antibodies (ICI) targeting the immune checkpoint PD-1/PD-L1 alone or in combination with chemotherapy have demonstrated relevant benefits and established new standards of care in first-line treatment for advanced non-oncogene addicted non-small cell lung cancer (NSCLC). However, a relevant percentage of NSCLC patients, even with high PD-L1 expression, did not respond to ICI, highlighting the presence of intracellular resistance mechanisms that could be dependent on high PD-L1 levels. The intracellular signaling induced by PD-L1 in tumor cells and their correlation with angiogenic signaling pathways are not yet fully elucidated.

METHODS

The intrinsic role of PD-L1 was initially checked in two PD-L1 overexpressing NSCLC cells by transcriptome profile and kinase array. The correlation of PD-L1 with VEGF, PECAM-1, and angiogenesis was evaluated in a cohort of advanced NSCLC patients. The secreted cytokines involved in tumor angiogenesis were assessed by Luminex assay and their effect on Huvec migration by a non-contact co-culture system.

RESULTS

PD-L1 overexpressing cells modulated pathways involved in tumor inflammation and JAK-STAT signaling. In NSCLC patients, PD-L1 expression was correlated with high tumor intra-vasculature. When challenged with PBMC, PD-L1 overexpressing cells produced higher levels of pro-angiogenic factors compared to parental cells, as a consequence of STAT signaling activation. This increased production of cytokines involved in tumor angiogenesis largely stimulated Huvec migration. Finally, the addition of the anti-antiangiogenic agent nintedanib significantly reduced the spread of Huvec cells when exposed to high levels of pro-angiogenic factors.

CONCLUSIONS

In this study, we reported that high PD-L1 modulates STAT signaling in the presence of PBMC and induces pro-angiogenic factor secretion. This could enforce the role of PD-L1 as a crucial regulator of the tumor microenvironment stimulating tumor progression, both as an inhibitor of T-cell activity and as a promoter of tumor angiogenesis.

Film Forming Nanogels for Needle-free Transdermal Vaccination

Transcutaneous immunization (TCI) provides a valuable alternative approach to conventional vaccination because of the high accessibility and the exceptional immunological characteristics of the skin, but its application is limited by the low permeability of the stratum corneum. Although nanogels (NGs) have proven to enhance skin penetration of macromolecules with minimum damage, their use in TCI remains almost unexplored. In this context, this article evaluates the performance of novel film forming NGs (FF-NGs) as TCI. This TCI platform consists of NGs with multilobular morphology that positively combines the properties of crosslinked poly(N-vinylcaprolactam), like thermoresponsiveness and the ability to load and release a cargo, with the film forming capacity of low Tg lobes. FF-NGs and formed films were characterized at different levels. Formed films show to be able to uniformly load an antigenic protein and release it with a profile depending on the temperature and on their FF-NGs content. In-vivo studies have demonstrated that FF-NGs promote the penetration of not only an antigenic protein but also an adjuvant until the immunocompetent area of skin, generating an adjuvant-dependent specific immune response. Finally, this study provides a successful proof of concept that FF-NGs could be a powerful tool for transcutaneous release of complex formulations. This article is protected by copyright. All rights reserved.

YES1 and MYC amplifications as synergistic resistance mechanisms to different generation ALK-TKIs in advanced NSCLC: brief report of clinical and preclinical proofs

Introduction

ALK tyrosine kinase inhibitors (TKIs) are the standard treatment for advanced ALK-positive NSCLC. Nevertheless, drug resistance inevitably occurs. Here, we report a case of a patient with metastatic ALK-positive lung adenocarcinoma with an impressive resistance to sequential treatment with ALK TKIs mediated by YES1 and MYC amplification in a contest of epithelial-to-mesenchymal transition and high progressive chromosomal instability.

Methods

The patient received, after chemotherapy and 7 months of crizotinib, brigatinib and lorlatinib with no clinical benefit to both treatments. A study of resistance mechanisms was performed with whole exome sequencing on different biological samples; primary cell lines were established from pleural effusion after lorlatinib progression.

Results

At whole exome sequencing analysis, YES1 and MYC amplifications were observed both in the pericardial biopsy and the pleural effusion samples collected at brigatinib and lorlatinib progression, respectively. Increasing chromosomal instability from diagnostic biopsy to pleural effusion was also observed. The addition of dasatinib to brigatinib or lorlatinib restored the sensitivity in primary cell lines; data were confirmed also in H3122_ALK-positive model overexpressing both YES1 and MYC.

Conclusions

In conclusion, YES1 and MYC amplifications are candidates to justify a rapid acquired resistance to crizotinib entailing primary brigatinib and lorlatinib resistance. In this context, a combination strategy of ALK TKI with dasatinib could be effective to overcome a rapid resistance.

Soluble PD-L1 and Circulating CD8+PD-1+ and NK Cells Enclose a Prognostic and Predictive Immune Effector Score in Immunotherapy Treated NSCLC patients

INTRODUCTION

Upfront criteria to foresee immune checkpoint inhibitors (ICIs) efficacy are far from being identified. Thus, we integrated blood descriptors of pro-inflammatory/immunosuppressive or effective anti-tumor response to non-invasively define predictive immune profiles in ICI-treated advanced non-small cell lung cancer (NSCLC).

METHODS

Peripheral blood (PB) was prospectively collected at baseline from 109 consecutive NSCLC patients undergoing ICIs as first or more line treatment. Soluble PD-L1 (sPD-L1) (immunoassay), CD8+PD-1+ and NK (FACS) cells were assessed and interlaced to generate an Immune effector Score (I_effS). Lung Immune Prognostic Index (LIPI) was computed by LDH levels and derived Neutrophil-to-Lymphocyte Ratio (dNLR). All these parameters were correlated with survival outcome and treatment response.

RESULTS

High sPD-L1 and low CD8+PD-1+ and NK number had negative impact on PFS (P < 0.001), OS (P < 0.01) and ICI-response (P < 0.05). Thus, sPD-L1^high, CD8+PD-1+^low and NK^low were considered as risk factors encompassing I_effS, whose prognostic power outperformed that of individual features and slightly exceeded that of LIPI. Accordingly, the absence of these risk factors portrayed a favorable I_effS characterizing patients with significantly (P < 0.001) prolonged PFS (median NR vs 2.3 months) and OS (median NR vs 4.1) and greater benefit from ICIs (P < 0.01). We then combined each risk parameter composing I_effS and LIPI (LDH^high, dNLR^high), thus defining three distinct prognostic classes. A remarkable impact of I_effS-LIPI integration was documented on survival outcome (PFS, HR = 4.61; 95%CI = 2.32-9.18; P < 0.001; OS, HR=4.03; 95%CI=1.91-8.67; P < 0.001) and ICI-response (AUC=0.90, 95%CI=0.81-0.97, P < 0.001).

CONCLUSION

Composite risk models based on blood parameters featuring the tumor-host interaction might provide accurate prognostic scores able to predict ICI benefit in NSCLC patients.

L718Q mutant EGFR escapes covalent inhibition by stabilizing a non-reactive conformation of the lung cancer drug osimertinib

Impact of L718Q mutation on the inhibitory activity of osimertinib on EGFR revealed by free-energy simulations.

Osimertinib is a third-generation inhibitor approved for the treatment of non-small cell lung cancer. It overcomes resistance to first-generation inhibitors by incorporating an acrylamide group which alkylates Cys797 of EGFR T790M. The mutation of a residue in the P-loop (L718Q) was shown to cause resistance to osimertinib, but the molecular mechanism of this process is unknown. Here, we investigated the inhibitory process for EGFR T790M (susceptible to osimertinib) and EGFR T790M/L718Q (resistant to osimertinib), by modelling the chemical step (i.e., alkylation of Cys797) using QM/MM simulations and the recognition step by MD simulations coupled with free-energy calculations. The calculations indicate that L718Q has a negligible impact on both the activation energy for Cys797 alkylation and the free-energy of binding for the formation of the non-covalent complex. The results show that Gln718 affects the conformational space of the EGFR–osimertinib complex, stabilizing a conformation of acrylamide which prevents reaction with Cys797.

Primary resistance to osimertinib due to SCLC transformation: Issue of T790M determination on liquid re-biopsy

OBJECTIVES

EGFR T790M mutation is the most common mechanism of resistance to first-/second-generation EGFR tyrosine kinase inhibitors (TKIs) in non-small cell lung cancer (NSCLC) and could be overcome by third-generation EGFR-TKIs, such as osimertinib. Liquid biopsy, a non-invasive technique used to test the presence of the resistant mutation, may help avoiding tissue re-biopsy. However, analysing only circulating-free DNA, information about other less frequent and coexisting resistance mechanisms may remain unrevealed.

MATERIALS AND METHODS

All patients reported in this series participated in the ASTRIS trial, a real world treatment study testing the efficacy of osimertinib (80mg os die) in advanced T790M-positive NSCLC progressed to prior EGFR-TKI. Patients were considered eligible to osimertinib if T790M positive on tissue or plasma samples. In our patients, EGFR molecular testing on blood sample was conducted with digital droplet PCR (ddPCR).

RESULTS

We report our experience of five patients treated with osimertinib after T790M detection on liquid biopsy that presented a disease progression at first tumor assessment mediated by SCLC transformation, as evidenced at tissue re-biopsies. All patients showed low ratio T790M/activating mutation in the blood before osimertinib (lower than 0.03). For three patients, EGFR mutational analysis was T790M-negative when re-assessed by using a less sensitive method (therascreen^®) on the same liquid biopsy sample analysed by ddPCR before osimertinib therapy.

CONCLUSION

Although liquid biopsy is a relevant tool to diagnose T790M presence in NSCLC patients resistant to EGFR-TKI, in case of a low ratio T790M/activating mutation, tissue biopsy should be considered to exclude the presence of SCLC transformation and/or other concomitant resistance mechanisms.

Evidence for epigenetic abnormalities of the androgen receptor gene in foreskin from children with hypospadias

CONTEXT

Hypospadias is a malformation of the penis due to an incomplete development of the male urethra, the exact etiology of which in the majority of cases remains unknown.

OBJECTIVE

The objective of the study was to assess whether defects of the androgen receptor (AR) gene (CAG repeats and methylation pattern) and DNA methyltransferases (DNMT) family are present in hypospadic patients.

DESIGN

CAG repeats length, methylation status, and expression of the AR gene were analyzed. The DNMT family was studied at the protein level and the DNMT3A sequenced.

SETTING

The study was performed at a pediatric endocrinology referral clinic.

PATIENTS OR OTHER PARTICIPANTS

Twenty boys with isolated glandular hypospadias and 20 age-matched control children undergoing a surgical procedure for circumcision were studied.

MAIN OUTCOME MEASURE(S)

CAG repeats length and AR methylation pattern in PBLs and foreskin tissue, DNMT expression and sequencing in patients and controls, and in vitro studies in cultured fibroblasts were measured.

RESULTS

AR gene methylation in foreskin tissues from patients with hypospadias was higher than in normal children. AR expression in foreskin tissue of hypospadic patients was lower than in controls, whereas the DNMT3A protein level was significantly higher in patients than controls. In cultured fibroblasts, both dihydrotestosterone and testosterone significantly reduced AR gene methylation and DNMT3A expression in a dose-dependent fashion and increased AR expression.

CONCLUSION

The AR gene in target tissues from patients with hypospadias is more methylated than in control children, resulting in a decreased expression of the AR. The mechanism underlying the modulation of the AR gene expression seems to be mediated by DNMT3A. This epigenetic alteration of the AR gene might be involved in the pathogenesis of hypospadias.

Latex imaging by environmental STEM: application to the study of the surfactant outcome in hybrid alkyd/acrylate systems

Among other uses, latexes are a successful alternative to solvent-borne binders for coatings. Efforts are made to produce hybrid nanostructured latexes containing an acrylic phase and an alkyd phase. However, after the film-forming process, the surfactant used to stabilize these latexes remains in the film, and its location can have a drastic effect on the application properties. Among the processing parameters, the alkyd hydrophobicity can strongly influence this location. This article aims at the imaging of these surfactant molecules in two hybrid latexes with different hydrophobicity level of the alkyd resin. A first part of this paper is dedicated to the understanding of the contrast provided by the surfactant in environmental STEM imaging of latexes. Then, the influence of surfactant-polymer affinity on the surfactant location after film-forming of those hybrid alkyd/acrylate latexes is studied by this technique. It is shown that in the hybrid latex with an alkyd shell (obtained with the most hydrophilic resin), the surfactant molecules tend to remain buried in the alkyd phase. Conversely, in the hybrid latex with an acrylate shell (in the case of the most hydrophobic resin), the surfactant molecules tend to gather into islands like in pure acrylate latex films.

Risk-Factors of Recurrence after Retropubic and Perineal Radical Prostatectomy

The Authors review their own surgical series about retropubic and perineal radical prostatectomy performed in 1993–2002 ys, with particular attention for risk factors of biochemical recurrence of disease.

Coinvolgimento Ureterale Bilaterale Nella Sindrome di Churg-Strauss: Descrizione di un Nuovo Caso

We report a case of Churg-Strauss syndrome, with bilateral ureteral involvement. We describe the endourological approach to the disease and we also discuss the literature about this argument.

[Renal lymphoma: an atypical mass in search of characterization]

We report the case of a B cell, renal non-Hodgkin lymphoma come to our attention due to urologic symptoms. A review of the literature is provided and it is discussed the differential diagnosis with renal cell carcinoma.

Treatment of abacterial pseudomembranous trigonitis with Nd:YAG laser. Personal experience

— Pseudomembranous trigonitis is a syndrome characterized by urgency, frequency, dysuria, bearing down and dyspareunia, with a typical endoscopic appearance and repeatedly negative urine culture examinations. Cystoscopically it appears as a white patch on the mucosal surface, usually well demarcated and often irregular in shape. The lesion may be finely granular in appearance and extend upward toward the ureteral orifices. Histologically it is a squamous not keratinizing metaplasia. Fifty-four female patients were treated with Nd:YAG laser photocoagulation at our Urologic Department from January 1994 to June 1995. Cystoscopic follow-up showed uniform riepithelization, with linear healing, undoubtedly contributing to the relief of symptoms. In our experience, laser treatment gave good and lasting relief of symptoms like no other therapies; so, high patient compliance, easy technique and good results make Nd:YAG laser photocoagulation highly effective in PMT management.

Laser treatment of bladder cancer

— Many authors have reported safety and efficacy of laser treatment, expecially Nd:YAG Laser, for superficial bladder cancer. The many advantages of this treatment include a presumed smaller recurrence rate, also favoured by better laser ability to achieve a limphatic blockage, and an undoubtedly very small treatment-related mortality. This induces laser photocoagulation to be considered a safe procedure, feasible with a mild anaesthesia and under Day Hospital management. On the other hand the main limits of this procedure are the great difficulties in the histological evaluation of tumoral specimens after laser treatment and poor effectiveness on deep bladder wall infiltrating tumours. A critical analysis of literature data follows and our experience in the laser treatment of superficial bladder tumours.

Indici di proliferazione (Ki 67, TLI) ed espressione della p53. Introduzione: Proliferation indices (Ki 67, TLI) and p53 expression. Introduction

Histologic and pathologic findings are the most common and useful prognostic factors in transitional cell cancer of the bladder. Thus, clinicians know their peculiar limits very well. The Authors report the results of a literature review about an oncogenic-derivative protein (p53) and about indices of proliferation Ki 67 and TLI, which are frequently studied in bladder cancer.

Indici di proliferazione (Ki 67, TLI) ed espressione della p53. Esperienza personale: Proliferation indices (Ki 67, TLI) and p53 expression. Personal experience

The Authors report their experience on the study of urothelial bladder cancer by determining the overexpression of p53, DNA-content by flow-cytometry, Ki 67, TLI and cytofluorimetric S-phase in 81 patients. Ki 67, DNA content and p53 overexpression are statistically related with histologic grade, unlike TLI and S-phase. TLI, overexpression of p53 and Ki 67 are statistically related with stage, whereas ploidy and S-phase do not show any relation with stage. The Authors discuss these findings.

Association of goserelin and flutamide in the treatment of advanced prostatic carcinoma

From January 1987 to June 1990, 40 previously untreated patients, 60–85 years old (mean 76.7 years) with C and D stage (according to AUS) prostatic adenocarcinoma, were administered analogous LH-RH goserelin and the non-steroid antiandrogen flutamide. The patients were followed until June 1992. 9 patients died from the disease. The treatment was well tolerated in 68% of the cases (27 patients); in the other 13 patients, the administration of flutamide caused secondary effects (gastro-intestinal intolerance, alterations of hepatic function). The administration of goserelin did not cause any secondary effect. The local response (assessed by transrectal echography) was good and in 31 cases consisted of a regression of the initial area from 25 to 50%. The performance status improved in 16 patients. 12 patients had a remission of pain. In all the patients, from the third month of treatment, the testosteronemia remained under 0.8 ng/ml; the prostatic alkaline phosphatase and the prostatic specific antigen presented a good correlation with the clinical evolution of the disease.

Day Hospital and resources utilization: A DRG-analysis of the relationship between costs and benefits

We present the results of our analysis on the operative efficiency of the Day Hospital since it opened on 27/04/92 in the Division of Urology of ULSS 4 Parma. This study has been performed by comparing both median stays in hospital for the numerically more representative surgical operations (prostatectomy, TURP, TURV) and by using the DRG system. The DRG specific cost for every hospitalization has also been calculated. Both systems show an increase in the number of treated cases and a decrease in the average hospitalization. This positive trend has been confirmed by the analysis of the costs.

[Small-cell carcinoma of the bladder: description of a case and review of the literature]

Small-cell carcinoma (also known as oat-cell carcinoma) is a rare tumor that previously concerns the lung; small-cell carcinoma of the bladder is extremely rare (0.5% of all bladder malignancies). The Authors report here the case of a 78th years old man. Fourteen months before our observation he was submitted to a partial cystectomy for a small-cell carcinoma of the bladder cupola. There was no evidence of extra-vesical location at that moment and the patient was not submitted to any adjuvant therapy. At the moment of our observation the disease was very advanced and the patient died in a few time. The Authors discuss about the therapy of bladder small-cell carcinoma in the few cases described by the literature and about the survival of those patients. A radical surgical treatment in association with an adjuvant chemo- or radiotherapy appears as a better way to treat these patients. On account of this case the Authors agree with this choice and conclude that only a combined treatment can allow a better survival.

Trattamento con laser Nd-Yag della schistosomiasi vescicale

We present the case of a young man from Ghana, who complained of dysuria and gross haematuria: he had bladder schistosomiasis. We associated Nd-Yag-laser photocoagulation of residual polipoid lesions with standard pharmacotherapy to obtain a linear cicatrization, without spreading infectious pathological material and with better riepithelialization, to reduce belated obstructive complications, common in this disease. A larger casuistry and longer follow-up are necessary to define the efficacy of this technique.

Epidemiological study of urinary tract stones in a Northern Italian city

An epidemiological study about stone disease was carried out by mailing a postal questionnaire to 6000 persons; it concerned a sample of the population of the USL n. 5 (Fidenza - PR). This population sample was divided into two groups: those who live on the hills and those who live on the plain. No differences of any kind were found between the two groups. It came out that the incidence of stone disease in the general population is 8%. There was a relationship between stone disease and hypertension and other renal diseases. Stone-formers showed no alimentary difference from non-stone formers. Stone-formers drank more still mineral water than non-stone formers, but only 37% of them drank at least 2 litres a day.

Mass screening for prostatic carcinoma and therapeutic options

In western countries, prostatic carcinoma is the most frequent neoplasia in the male sex after pulmonary neoplasia. Its early diagnosis is very important. The authors report the results of a screening for prostatic carcinoma effected in some municipalities of the district of Parma (Italy); 28 prostatic carcinomas were diagnosed (1.2% of the examined patients). Twelve patients were submitted to radical nerve-sparing prostatectomy according to Walsh. In all of them, PSA values decreased to values < 1 ngr/ml, confirming the radicality of the operation and few complications occurred. The conclusion of the authors is that nowadays timely radical prostatectomy is the only “definitive” treatment of prostatic carcinoma, allowing a better quality of life, however long it is.