Immune biomarker evaluation of sequential tyrosine kinase inhibitor and nivolumab monotherapies in renal cell carcinoma: the phase I TRIBE trial

Background

Predictive biomarkers for immune checkpoint blockade in the second-line treatment of metastatic renal cell carcinoma (mRCC) are lacking.

Materials and methods

Patients with histologically confirmed RCC who started nivolumab after at least 4 months of tyrosine kinase inhibitors (TKIs) were recruited for this study. Serial tissue and blood samples were collected for immune biomarker evaluation. The primary endpoint was to determine the association of specific T-cell subsets with clinical outcomes tested using Wilcoxon rank sum for clinical benefit rate (CBR) and log-rank test for progression-free survival (PFS).

Results

Twenty patients were included in this trial with a median age of 64 years and followed-up for a median of 12 months. The median PFS for patients who received TKI was 13.8 months, while for those subsequently treated with nivolumab following TKI therapy, the median PFS was 2.6 months. CBR of nivolumab was 20% with two partial responses. Functionally active programmed cell death protein 1+ CD4+ T cells were enriched in non-responders (q = 0.003) and associated with worse PFS on nivolumab (P = 0.04). Responders showed a significant reduction in the effector CD4+T-cell (TEF) fraction compared to non-responders at 3 months on nivolumab (0.40 versus 0.80, P = 0.0005). CD127+CD4+ T cells were enriched in patients who developed immune-related adverse effects (q = 0.003). Using in-house validated multiplex immunohistochemistry for six markers, we measured tumour-associated immune cell densities in tissue samples. Responders to nivolumab showed a significantly higher mean of immune cell densities in tissue samples compared to non-responders (346 versus 87 cells/mm2, P = 0.04).

Conclusions

In this small study, analysis of tissue-based and peripheral blood immune cell subsets predicted clinical outcomes of nivolumab. Further studies are warranted with larger populations to validate these observations.

Validation of the emergency surgery score (ESS) in a UK patient population and comparison with NELA scoring: a retrospective multicentre cohort study

INTRODUCTION

Accurate risk scoring in emergency general surgery (EGS) is vital for consent and resource allocation. The emergency surgery score (ESS) has been validated as a reliable preoperative predictor of postoperative outcomes in EGS but has been studied only in the US population. Our primary aim was to perform an external validation study of the ESS in a UK population. Our secondary aim was to compare the accuracy of ESS and National Emergency Laparotomy Audit (NELA) scores.

METHODS

We conducted an observational cohort study of adult patients undergoing emergency laparotomy over three years in two UK centres. ESS was calculated retrospectively. NELA scores and all other variables were obtained from the prospectively collected Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA) database. The primary and secondary outcomes were 30-day mortality and postoperative intensive care unit (ICU) admission, respectively.

RESULTS

A total of 609 patients were included. Median age was 65 years, 52.7% were female, the overall mortality was 9.9% and 23.8% were admitted to ICU. Both ESS and NELA were equally accurate in predicting 30-day mortality (c-statistic=0.78 (95% confidence interval (CI), 0.71-0.85) for ESS and c-statistic=0.83 (95% CI, 0.77-0.88) for NELA, p=0.196) and predicting postoperative ICU admission (c-statistic=0.76 (95% CI, 0.71-0.81) for ESS and 0.80 (95% CI, 0.76-0.85) for NELA, p=0.092).

CONCLUSIONS

In the UK population, ESS and NELA both predict 30-day mortality and ICU admission with no statistically significant difference but with higher c-statistics for NELA score. Both scores have certain advantages, with ESS being validated for a wider range of outcomes.

Reduction in transfer of micro-organisms between patients and staff using short-sleeved gowns and hand/arm hygiene in intensive care during the COVID-19 pandemic: A simulation-based randomised trial

Background

Current personal protective equipment (PPE) practices in UK intensive care units involve "sessional" use of long-sleeved gowns, risking nosocomial infection transmitted via gown sleeves. Data from the first wave of the COVID19 pandemic demonstrated that these changes in infection prevention and control protocols were associated with an increase in healthcare associated bloodstream infections. We therefore explored the use of a protocol using short-sleeved gowns with hand and arm hygiene to reduce this risk.

Methods

ICU staff were trained in wearing short-sleeved gowns and using a specific hand and arm washing technique between patients (experimental protocol). They then underwent simulation training, performing COVID-19 intubation and proning tasks using either experimental protocol or the standard (long-sleeved) control protocol. Fluorescent powder was used to simulate microbial contamination, detected using photographs under ultraviolet light. Teams were randomised to use control or experimental PPE first. During the simulation, staff were questioned on their feelings about personal safety, comfort and patient safety.

Results

Sixty-eight staff and 17 proning volunteers were studied. Experimental PPE completely prevented staff contamination during COVID-19 intubation, whereas this occurred in 30/67 staff wearing control PPE (p = .003, McNemar). Proning volunteers were contaminated by staff in 15/17 control sessions and in 1/17 with experimental PPE (p = .023 McNemar). Staff comfort was superior with experimental PPE (p< .001, Wilcoxon). Their personal safety perception was initially higher with control PPE, but changed towards neutrality during sessions (p < .001 start, 0.068 end). Their impressions of patient safety were initially similar (p = .87), but finished strongly in favour of experimental PPE (p < .001).

Conclusions

Short-sleeved gowns with hand and forearm cleansing appear superior to sessional long-sleeved gowns in preventing cross-contamination between staff and patients.

Abstract 6150: AZD0466, a dual BCL-2/XL targeting nanomedicine, is active in small cell lung cancer models

Small cell lung cancer (SCLC) is an aggressive malignancy with critical need for new therapies. While currently treated as a single disease, SCLC is heterogenous, comprised of several transcriptional subtypes. Each of these subtypes has distinct drivers and may warrant unique therapeutic targets. Two potential therapeutic targets for SCLC are the pro-survival proteins BCL-2 and BCL-XL. BCL-2 is overexpressed in ASCL1 (A) and POUF3 (P) subtypes of SCLC. We therefore sought to evaluate efficacy of the dual BCL-2/XL inhibitor AZD0466 in SCLC models and to determine whether transcriptional subtype would predict response. AZD0466 is a novel drug-dendrimer conjugate. The active moiety, AZD4320, is a potent dual inhibitor of BCL-2 and BCL-XL. AZD4320 is covalently conjugated to a 5th-generation PEGylated poly-lysine dendrimer through a hydrolytically labile linker to make AZD0466. AZD0466 has been optimized to deliver efficacy while mitigating potential Cmax-driven on-target toxicities of AZD4320. AZD4320 was active (IC50 ≤0.1 µM) in 9/27 SCLC cell lines. AZD4320 in vitro sensitivity was enriched in cell lines that represented A and P subtypes of SCLC compared to NEUROD1 and YAP1 subtypes. We next profiled AZD0466 in a panel of SCLC patient-derived models: 14 patient-derived xenografts and 10 circulating tumor cell-derived xenografts. AZD0466 monotherapy dosed weekly IV was active in 12/24 SCLC xenografts, driving regressions in 8 models. AZD0466 drove efficacy and cleaved caspase-3 induction in a dose-dependent manner. Similar to in vitro, AZD0466 in vivo efficacy was enriched in subtype-A, driving responses in 10/14 ASCL1 models (7 regression, 3 stable disease). AZD0466 response also correlated strongly with BCL-2 mRNA expression (P&lt;0.0001). AZD0466 outperformed the selective BCL-2 inhibitor venetoclax in 6/10 models. Notably, AZD0466 was active in models resistant to platinum/etoposide chemotherapy, the standard-of-care for SCLC. Together, these data suggest BCL-2/XL inhibition has therapeutic potential in SCLC. AZD0466 is in clinical development. The first-in-human study treated 9 patients with advanced solid tumors (NCT04214093) at doses from 50-200mg, all of which were well-tolerated. The BOR was SD observed in 3 patients (100mg) with 1 patient receiving treatment for 5.5 months. AZD0466 is now under evaluation in patients with hematologic malignancies (NCT04865419 and NCT05205161). AZD0466 has been dosed in 33 patients up to 2400mg. No DLTs have been reported to date. Initial clinical activity has been observed through reduction of bone marrow blasts following AZD0466 treatment. AZD0466 exhibits linear PK, consistent across solid tumor and leukemia patients. The doses tested are in line with preclinical studies in SCLC.

Citation Format: Courtney L. Andersen, Giulia Fabbri, David Jenkins, Zumla Cader, Shringi Sharma, Areya Tabatabai, Srividya Balachander, Jordan Roebuck, Melanie Galvin, Kathryn Simpson, Caroline Dive, Jordi Rodon Ahnert, Jamal Saeh. AZD0466, a dual BCL-2/XL targeting nanomedicine, is active in small cell lung cancer models. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6150.

mSep: investigating physiological and immune-metabolic biomarkers in septic and healthy pregnant women to predict feto-maternal immune health - a prospective observational cohort study protocol

INTRODUCTION

Maternal sepsis remains a leading cause of death in pregnancy. Physiological adaptations to pregnancy obscure early signs of sepsis and can result in delays in recognition and treatment. Identifying biomarkers that can reliably diagnose sepsis will reduce morbidity and mortality and antibiotic overuse. We have previously identified an immune-metabolic biomarker network comprising three pathways with a >99% accuracy for detecting bacterial neonatal sepsis. In this prospective study, we will describe physiological parameters and novel biomarkers in two cohorts-healthy pregnant women and pregnant women with suspected sepsis-with the aim of mapping pathophysiological drivers and evaluating predictive biomarkers for diagnosing maternal sepsis.

METHODS AND ANALYSIS

Women aged over 18 with an ultrasound-confirmed pregnancy will be recruited to a pilot and two main study cohorts. The pilot will involve blood sample collection from 30 pregnant women undergoing an elective caesarean section. Cohort A will follow 100 healthy pregnant women throughout their pregnancy journey, with collection of blood samples from participants at routine time points in their pregnancy: week 12 'booking', week 28 and during labour. Cohort B will follow 100 pregnant women who present with suspected sepsis in pregnancy or labour and will have at least two blood samples taken during their care pathway. Study blood samples will be collected during routine clinical blood sampling. Detailed medical history and physiological parameters at the time of blood sampling will be recorded, along with the results of routine biochemical tests, including C reactive protein, lactate and white blood cell count. In addition, study blood samples will be processed and analysed for transcriptomic, lipidomic and metabolomic analyses and both qualitative and functional immunophenotyping.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Wales Research Ethics Committee 2 (SPON1752-19, 30 October 2019).

TRIAL REGISTRATION NUMBER

NCT05023954.

Abstract 2360: The role of the neurogenic transcription factor ATOH1 in small cell lung cancer

SCLC is an aggressive neuroendocrine (NE) cancer with a 7% 5-year survival rate. SCLC is treated as a clinically homogenous disease, but evidence of its intra- and inter-tumor heterogeneity is increasing. This is partly attributed to expression of neurogenic transcription factors (TFs) ASCL1 and NEUROD1, which correlate with SCLC pathogenesis and NE status, and are now included in a consensus for SCLC classification1. Our Circulating tumor cell patient Derived eXplant (CDX) models recapitulate disease heterogeneity in terms of neurogenic TF expression; furthermore, we recently identified a previously unrecognized subset within our CDX biobank expressing another neurogenic TF, ATOH12. ATOH1 function has been inferred from mouse embryonic and neonatal developmental mouse models, where Atoh1 governs the formation of cerebellar granule cells, auditory hair cells and Merkel cells. In human settings, ATOH1 reprograms pluripotent stem cells to a neuronal lineage and has context-dependent activity in cancer, being considered an oncogene in medulloblastoma and a tumor suppressor in the intestine3. I am investigating the role of ATOH1 in SCLC, to refine disease classification and explore new therapeutic approaches stratified to SCLC phenotypes. To interrogate the role of ATOH1 in SCLC, we developed an in-house antibody and established stable SCLC CDX and cell lines in which ATOH1 can be inducibly depleted in vitro and in vivo. To understand the transcriptional profile mediated by ATOH1, we performed ChIP-Seq and RNA-Seq in ATOH1-competent and depleted cells and integrated the datasets to infer ATOH1 direct transcriptional targets. In concordance with its role in development, ATOH1 direct transcriptional targets are enriched for processes regulating neurogenesis and inner ear hair cell differentiation. ATOH1 depletion in vitro in CDX17P resulted in elevated expression of Non-NE marker genes and NE to Non-NE phenotype transition, confirmed by gene set enrichment analysis, which implicated a possible role for ATOH1 in regulating neuroendocrine plasticity in SCLC. ATOH1 depletion resulted in a significant increase in apoptosis-independent cell death (p &lt; 0.003), and whilst ATOH1 depletion did not affect cell proliferation in CDX17P, there was decreased S-phase progression in CDX30 and HCC33 cells. Depletion of ATOH1 in CDX17P In vivo did result in slower tumor growth and further studies will investigate the impact of ATOH1 on cell death, proliferation and NE to Non-NE transition in vivo. In summary, we have characterized a rare subset of SCLC expressing ATOH1 and found that ATOH1 is necessary for cell survival in vitro and ablation of ATOH1 slows tumor growth in vivo. Ongoing studies focus on investigating possible therapeutic approaches to modulate ATOH1 expression.

Citation Format: Alessia Catozzi, Mitchell Revill, Jordan Roebuck, Sam Humphrey, Melanie Galvin, Fiona Blackhall, Kathryn Simpson, Alastair Kerr, Kristopher Frese, Caroline Dive. The role of the neurogenic transcription factor ATOH1 in small cell lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2360.

Clinical Case Reports on the acceptability and tolerance of a High-Energy whey peptide-based Pediatric oral nutritional supplement in children aged over 12 months

The nutritional management of the complex needs of children with impaired gastrointestinal function can be challenging, using a high-energy pediatric whey-based peptide formula in clinical practice demonstrates its role in managing symptoms.

Abstract 601: Liquid biopsy-based precision medicine for extra-pulmonary neuroendocrine carcinomas

Extra-Pulmonary NeuroEndocrine Carcinomas (EP-NECs) are aggressive tumours (Ki-67&gt;20%, poorly differentiated morphology), with a median overall survival &lt;12 months (ms). In most cases, EP-NECs are metastatic at diagnosis and palliative platinum/etoposide chemotherapy (chemo) is the only active management to offer. Improvements in clinical outcomes of EP-NECs have been hindered by the paucity of knowledge of their biology, and lack of validated biomarkers and preclinical models to inform patient management and therapeutic development. In the phenotypically similar pulmonary counterpart NEC, Small Cell Lung Cancer (SCLC), circulating tumour cells (CTCs) are abundant and prognostic1, and can be used for the generation of patient-relevant mouse models (CTC-Derived eXplants, CDX)2.Using SCLC research as a paradigm, a ‘proof-of-concept' prospective study has been designed to assess feasibility of CTC detection and CDX generation in patients with advanced stage EP-NEC undertaking palliative chemo. Serial CTC counts (pre-chemo, 6 weeks after start of chemo and at disease progression) are performed by using CellSearch (CS) which enumerates EpCAM expressing CTCs. CDX generation is attempted from matched blood samples after RosetteSep CTC-enrichment and engraftment in immunodeficient mice, following the same protocol optimised for SCLC CDX2. As of Nov 2020, pre-chemo CS-CTCs were detected in 11/17 patients (64.7%); mean 18.3, median 2, range 0-166 (per 7.5mL of blood). A CDX model was successfully developed from pre-chemo CTCs from a patient with a metastatic NEC of unknown origin. Histopathological analysis of the CDX tumour confirmed a NEC diagnosis (Ki-67=80%, strong expression of synaptophysin, chromogranin A, CD56) and closely matched the donor patient's biopsy. Notably, the CS-CTC count in a paired blood sample was low at 1/7.5mL of blood. As the CTC count predicts the likelihood of SCLC CDX generation2, this finding suggests that non-EpCAM expressing CTCs are present in the donor patient's bloodstream.In conclusion, the majority of advanced EP-NECs shed epithelial CTCs although at lower levels than SCLC, based on comparison with previous data1. Analysis of CTCs enriched by using a biomarker-independent platform may elucidate the phenotypic composition of CTC pools in EP-NECs. We report here on the feasibility of EP-NEC CDX generation. The model has been successfully passaged, and next steps will include its full phenotypic and molecular characterisation. In vivo drug studies are also underway using the CDX as an avatar to potentially guide future treatment for the donor patient. In addition, CDX-derived cell cultures have been established and hold the potential to serve as ex vivo platforms for functional validation of mechanisms of drug sensitivity/resistance and drug screening.1. Hou et al., J Clin Oncol 2012, 30(5): p. 525-32.2. Simpson et al., Nature Cancer 2020, 1: p. 437-451.

Citation Format: Melissa Frizziero, Elaine Kilgour, Kathryn Simpson, Kristopher Frese, Juan W. Valle, Mairéad G. McNamara, Caroline Dive. Liquid biopsy-based precision medicine for extra-pulmonary neuroendocrine carcinomas [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 601.

Abstract 2436: Heterogeneity of neurogenic transcription factor expression in small cell lung cancer

SCLC is an aggressive neuroendocrine (NE) cancer with a 7% 5-year survival rate. Molecular characterization of this disease has lagged behind other cancer types and standard of care treatment has remained largely unchanged for over three decades. SCLC is treated as a clinically homogenous disease, but evidence of its intra- and inter-tumor heterogeneity is increasing. Part of this heterogeneity is attributed to expression of neurogenic transcription factors (TFs) ASCL1 and NEUROD1, which correlate with SCLC pathogenesis and NE status, and are now included in a consensus for SCLC classification [1]. Our Circulating tumor cell patient Derived eXplant (CDX) models recapitulate disease heterogeneity in terms of neurogenic TF expression; furthermore, we recently identified a previously unrecognized subset within our CDX model panel expressing another neurogenic TF, ATOH1, mostly within NEUROD1 expressing models [2]. I am investigating the roles of the three NE TFs in SCLC CDX, to refine disease classification and explore rationale for new therapeutic approaches stratified to SCLC phenotypes. To do so, we have characterized ASCL1 and NEUROD1 expression in CDX models with multiplex immunofluorescence and flow cytometry. We have begun to interrogate the biology of ASCL1 and NEUROD1 in established SCLC cell lines via CRISPR- and shRNA-mediated genetic depletion of these TFs. Furthermore, we have recently developed antibodies to ATOH1 to support interrogation of its under-researched role in SCLC biology. We have found that CDX models express ASCL1 (30/38), NEUROD1 (3/38) and ATOH1 together with NEUROD1 (4/38) [2]. ASCL1 and NEUROD1 are co-expressed in several CDX but (with the exception of one CDX model) in different cell subpopulations. In contrast with published literature, genetic depletion of ASCL1 and NEUROD1 in established SCLC cell lines did not influence cell proliferation and response to chemotherapy. I have recently generated specific antibodies to ATOH1 and ongoing studies are focused on characterization of ATOH1 expression in CDX models and its impact on the pathogenesis and chemotherapy responses in SCLC. In conclusion, ASCL1 and NEUROD1 are expressed in a mutually exclusive way in CDX models, with the exception of one CDX; manipulation of their expression does not influence cell proliferation or response to chemotherapy in SCLC cell lines. Studies looking at the consequences of genetic depletion of these TFs, including ATOH1, in CDX models are underway.

[1] Rudin et al., Nature Reviews Cancer, 2019 [2] Simpson et al., Nature Reviews Cancer, 2020

Citation Format: Alessia Catozzi, Mitchell Revill, Fiona Blackhall, Kristopher Frese, Kathryn Simpson, Caroline Dive. Heterogeneity of neurogenic transcription factor expression in small cell lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2436.

Abstract 2874: Understanding small cell lung cancer metastasis using circulating tumor cell (CTC)-derived tumor explant (CDX) models

Small cell lung cancer (SCLC) accounts for about 13% of all malignant lung tumors and is characterized by an extremely low survival rate and widespread early dissemination. Over two-thirds of SCLC patients are diagnosed with metastases in multiple organs; typically liver, lymph nodes and brain. The number and site of secondary lesions at diagnosis correlates with unfavorable disease outcome. Studying metastasis in SCLC is extremely challenging, as metastatic tumor samples are rarely obtained from these patients. Our laboratory has developed a patient-faithful biobank of &gt;45 SCLC circulating tumor cell (CTC)-derived explants (CDX) models with which to study SCLC1. We implemented a resection protocol using these models to study the metastatic process in SCLC by interrogating the genetic and phenotypic components of metastatic cells using combinations of tissue pathology and next generation sequencing methods. Upon resection of the subcutaneous tumor, we detect the presence of overt macrometastatic lesions in multiple models, which in most cases retain matched organ tropism to that observed in the patient. Whereas all models so far tested disseminated to the lungs, the ATOH1 subtye2 models CDX17, CDX17P, CDX25 and CDX30P predominantly grew in the liver, and CDX3 and CDX3P (ASCL1 subtype3) preferentially colonized the brain despite having a much slower growth. CDX SCLC cells can be isolated from subcutaneous tumors and orthotopically implanted, recapitulating the same tropism. Finally, CDX cells labelled ex vivo can be re-implanted directly into the bloodstream or into the brain parenchyma giving rise to SCLC secondary tumors, providing us with an excellent tool to monitor and study several steps of the metastatic cascade, including extravasation and brain colonization. We report for the first time, brain tropic mouse models of SCLC. Molecular studies are underway to investigate the underlying genetic determinants and mechanisms underpinning metastatic spread of SCLC via transcriptomic studies of matched subcutaneous and metastatic tissues and CTCs in CDX. In parallel, CDX3P is being used to identify markers of pre-metastatic disease and brain colonization at the single cell level to identify novel therapeutic strategies and biomarkers that may benefit the significant number of SCLC patients who present with brain lesions. 1Hodgkinson et al., Nature Medicine 20, 897-903 (2014) 2Simpson et al., Nature Cancer 1, pages437-451(2020)

Citation Format: Maria Peiris-Pagès, Mitchell Revill, Derrick Morgan, Stewart Brown, Melanie Galvin, Lynsey Priest, Mathew Carter, Sheila K. Singh, Kristopher Frese, Fiona Blackhall, Kathryn Simpson, Caroline Dive. Understanding small cell lung cancer metastasis using circulating tumor cell (CTC)-derived tumor explant (CDX) models [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2874.

New York State Local Health Department Preparedness for and Response to the COVID-19 Pandemic: An In-Progress Review

A mixed-methods approach was taken to describe lessons learned by local health department leaders during the early stages of the COVID-19 pandemic in New York State and to document leaders' assessments of their departments' emergency preparedness capabilities and capacities. Leaders participating in a survey rated the effectiveness of their department's capabilities and capacities in administrative and public health preparedness, epidemiology, and communications on a scale from 1 to 5; those partaking in focus groups answered open-ended questions about the same 4 topics. Subjects rated intragovernmental activities most effective ( = 4.41, SD = 0.83) and reported receiving assistance from other county agencies. They rated level of supplies least effective ( = 3.03, SD = 1.01), describing low supply levels and inequitable distribution of testing materials and personal protective equipment among regions. Local health departments in New York require more state and federal aid to maintain the public health workforce in preparation for future emergencies.

Ribavirin for Hepatitis E Virus Infection After Organ Transplantation: A Large European Retrospective Multicenter Study

BACKGROUND

Ribavirin is currently recommended for treating chronic hepatitis E virus (HEV) infection. This retrospective European multicenter study aimed to assess the sustained virological response (SVR) in a large cohort of solid organ transplant (SOT) recipients with chronic HEV infection treated with ribavirin monotherapy (N = 255), to identify the predictive factors for SVR, and to evaluate the impact of HEV RNA mutations on virological response.

METHODS

Data from 255 SOT recipients with chronic HEV infection from 30 European centers were analyzed. Ribavirin was given at the median dose of 600 (range, 29-1200) mg/day (mean, 8.6 ± 3.6 mg/kg/day) for a median duration of 3 (range, 0.25-18) months.

RESULTS

After a first course of ribavirin, the SVR rate was 81.2%. It increased to 89.8% when some patients were offered a second course of ribavirin. An increased lymphocyte count at the initiation of therapy was a predictive factor for SVR, while poor hematological tolerance of ribavirin requiring its dose reduction (28%) and blood transfusion (15.7%) were associated with more relapse after ribavirin cessation. Pretreatment HEV polymerase mutations and de novo mutations under ribavirin did not have a negative impact on HEV clearance. Anemia was the main adverse event.

CONCLUSIONS

This large-scale retrospective study confirms that ribavirin is highly efficient for treating chronic HEV infection in SOT recipients and shows that the predominant HEV RNA polymerase mutations found in this study do not affect the rate of HEV clearance.This large-scale retrospective study that included 255 solid organ transplant recipients confirms that ribavirin is highly efficient for treating chronic hepatitis E virus (HEV) infection and shows that HEV RNA polymerase mutations do not play a role in HEV clearance.

Investigating surface binding effects: antibacterial efficacy of bound 8-hydroxyquinoline against Staphylococcus aureus and Escherichia coli

AIMS

To investigate the binding of the antimicrobial compound 8-hydroxyquinoline (8HQ) to a material interface and to determine whether immobilization affects the antibacterial efficacy.

METHODS AND RESULTS

The 8HQ derivative 5-carboxy-8-hydroxyquinoline (5C8HQ) was attached to silica beads through amide bond coupling at the carboxyl moiety of 5C8HQ. Attachment of 5C8HQ was confirmed using a combination of mass spectrometry, thermogravimetric analysis, colorimetric testing and Soxhlet extraction. Computational modelling results indicated that this substitution did not compromise the active sites on the molecule, whereas other positions on the ring system could potentially inhibit antimicrobial activity. The antibacterial effect of 8HQ and the 5C8HQ-modified silica complex against Escherichia coli 15597 (ATCC^® 25922) and Staphylococcus aureus (ATCC 25923) was evaluated.

CONCLUSIONS

The test results show that the immobilized 8HQ continues to exhibit antibacterial activity, however, quantifying the efficacy compared to free 8HQ bears further investigation. The expected antibacterial mechanism requires that the metal chelation site of 8HQ be retained and available after attachment to a surface. The retention of antibacterial activity after surface bonding represents a novel mechanism of action not previously reported.

SIGNIFICANCE AND IMPACT OF THE STUDY

Recent changes in regulations due to environmental concerns prompted many companies and organizations to explore antimicrobial treatments that are chemically bound to the product. Chemically bonding biocidal compounds to a surface limits environmental release; however, molecular mechanisms that drive antibacterial activity when compounds are immobilized are limited. The results reported here demonstrate that the 8HQ reactive site retains antibacterial efficacy even after covalent attachment to a surface. This approach supersedes other antimicrobial treatments where the active component is gradually released from the material surface in order to elicit antimicrobial effects. This specific antibacterial activity of bound 8HQ represents a novel mechanism of action not previously reported, and a potential conduit to a new class of bound antimicrobial materials.

Re-expression of miR-200s in claudin-low mammary tumor cells alters cell shape and reduces proliferation and invasion potentially through modulating other miRNAs and SUZ12 regulated genes

Background

MicroRNAs are a class of non-coding RNAs that regulate gene expression through binding to mRNAs and preventing their translation. One family of microRNAs known as the miR-200 family is an important regulator of epithelial identity. The miR-200 family consists of five members expressed in two distinct clusters; the miR-200c/141 cluster and the miR-200b/200a/429 cluster. We have found that murine and human mammary tumor cells with claudin-low characteristics are associated with very low levels of all five miR-200s.

Methods

To determine the impact of miR-200s on claudin-low mammary tumor cells, the miR-200c/141 cluster and the miR-200b/200a/429 cluster were stably re-expressed in murine (RJ423) and human (MDA-MB-231) claudin-low mammary tumor cells. Cell proliferation and migration were assessed using BrdU incorporation and transwell migration across Matrigel coated inserts, respectively. miRNA sequencing and RNA sequencing were performed to explore miRNAs and mRNAs regulated by miR-200 re-expression while Enrichr-based pathway analysis was utilized to identify cellular functions modified by miR-200s.

Results

Re-expression of the miR-200s in murine and human claudin-low mammary tumor cells partially restored an epithelial cell morphology and significantly inhibited proliferation and cell invasion in vitro. miRNA sequencing and mRNA sequencing revealed that re-expression of miR-200s altered the expression of other microRNAs and genes regulated by SUZ12 providing insight into the complexity of miR-200 function. SUZ12 is a member of the polycomb repressor complex 2 that suppresses gene expression through methylating histone H3 at lysine 27. Flow cytometry confirmed that re-expression of miR-200s increased histone H3 methylation at lysine 27.

Conclusions

Re-expression of miR-200s in claudin-low mammary tumor cells alters cell morphology and reduces proliferation and invasion, an effect potentially mediated by SUZ12-regulated genes and other microRNAs.

Quantifying Soft Tissue Artefacts and Imaging Variability in Motion Capture of the Fingers

This study assessed the accuracy of marker-based kinematic analysis of the fingers, considering soft tissue artefacts (STA) and marker imaging uncertainty. We collected CT images of the hand from healthy volunteers with fingers in full extension, mid- and full-flexion, including motion capture markers. Bones and markers were segmented and meshed. The bone meshes for each volunteer's scans were aligned using the proximal phalanx to study the proximal interphalangeal joint (PIP), and using the middle phalanx to study the distal interphalangeal joint (DIP). The angle changes between positions were extracted. The HAWK protocol was used to calculate PIP and DIP joint flexion angles in each position based on the marker centroids. Finally the marker locations were 'corrected' relative to the underlying bones, and the flexion angles recalculated. Static and dynamic marker imaging uncertainty was evaluated using a wand. A strong positive correlation was observed between marker- and CT-based joint angle changes with 0.980 and 0.892 regression slopes for PIP and DIP, respectively, and Root Mean Squared Errors below 4°. Notably for the PIP joint, correlation was worsened by STA correction. The 95% imaging uncertainty interval was < ± 1° for joints, and < ± 0.25 mm for segment lengths. In summary, the HAWK marker set's accuracy was characterised for finger joint flexion angle changes in a small group of healthy individuals and static poses, and was found to benefit from skin movements during flexion.

Dynamics of circulating vascular endothelial growth factor-A predict benefit from antiangiogenic cediranib in metastatic or recurrent cervical cancer patients

AIMS

There is a need for predictive and surrogate response biomarkers to support treatment with antiangiogenic vascular endothelial growth factor (VEGF) inhibitors. We aimed to identify a minimally-invasive biomarker predicting benefit from cediranib pretreatment or early during treatment in patients with recurrent or metastatic cervical cancer.

METHODS

Blood samples were collected before treatment, during treatment and upon disease progression where appropriate from patients enrolled in CIRCCa, a randomised phase II trial of carboplatin and paclitaxel with or without cediranib. Plasma concentrations of VEGF-A, VEGF-receptor 2, Ang1 and Tie2 were measured using multiplex enzyme-linked immunosorbent assay. Pretreatment and temporal changes of the biomarkers were investigated using proportional hazard regression and unsupervised clustering analysis.

RESULTS

Samples (n = 556) from 52 patients were analysed. VEGF-receptor 2 (P = .0006) and Tie2 (P = .04) were downregulated following cediranib, while VEGF-A (P = .0025) was upregulated. High Eastern Cooperative Oncology Group performance status (P = .02, hazard ratio [HR] = 2.15, 95% confidence interval [CI] 1.13-4.09) and low pretreatment Tie2 concentrations (P = .003, HR = 0.57, 95%CI 0.39-0.83) were independent prognostic factors associated with reduced progression-free survival. Two patterns of changes in VEGF-A following cediranib were identified. Patients with elevated VEGF-A in the first 3 treatment cycles, regardless of magnitude, had reduced progression-free survival in the placebo arm but improved survival with the addition of cediranib (P = .019, HR = 0.13, 95% CI 0.02-0.71).

CONCLUSION

Patterns of early elevation in plasma VEGF-A should be studied further as a potential biomarker to predict treatment benefit from cediranib.

Plasma Tie2 is a tumor vascular response biomarker for VEGF inhibitors in metastatic colorectal cancer

Oncological use of anti-angiogenic VEGF inhibitors has been limited by the lack of informative biomarkers. Previously we reported circulating Tie2 as a vascular response biomarker for bevacizumab-treated ovarian cancer patients. Using advanced MRI and circulating biomarkers we have extended these findings in metastatic colorectal cancer (n = 70). Bevacizumab (10 mg/kg) was administered to elicit a biomarker response, followed by FOLFOX6-bevacizumab until disease progression. Bevacizumab induced a correlation between Tie2 and the tumor vascular imaging biomarker, Ktrans (R:-0.21 to 0.47) implying that Tie2 originated from the tumor vasculature. Tie2 trajectories were independently associated with pre-treatment tumor vascular characteristics, tumor response, progression free survival (HR for progression = 3.01, p = 0.00014; median PFS 248 vs. 348 days p = 0.0008) and the modeling of progressive disease (p < 0.0001), suggesting that Tie2 should be monitored clinically to optimize VEGF inhibitor use. A vascular response is defined as a 30% reduction in Tie2; vascular progression as a 40% increase in Tie2 above the nadir. Tie2 is the first, validated, tumor vascular response biomarker for VEGFi.

Will liquid biopsies improve outcomes for patients with small-cell lung cancer?

Small-cell lung cancer (SCLC) is an aggressive tumour that seeds metastases early with dismal outcomes. As expected from a disease that is closely associated with smoking, mutation burden in SCLC is high. Intratumoral and intertumoral heterogeneity is a substantial obstacle to successful treatment and the SCLC genomic landscape reveals few targets that are readily druggable. Chemotherapy elicits responses in most patients with SCLC, but their effects are short lived. Multiple clinical trials have been unsuccessful in showing positive survival outcomes and biomarkers to select patients and monitor responses to novel targeted treatments have been lacking, not least because acquisition of tumour biopsies, especially during relapse after chemotherapy, is a substantial challenge. Liquid biopsies via blood sampling in SCLC, notably circulating tumour cells and circulating free tumour DNA can be readily and repeatedly accessed, and are beginning to yield promising data to inform SCLC biology and patient treatment. Primary cell cultures and preclinical mouse models can also be derived from the relatively plentiful SCLC circulating tumour cells providing a tractable platform for SCLC translational research and drug development.

Signaling pathway screening platforms are an efficient approach to identify therapeutic targets in cancers that lack known driver mutations: a case report for a cancer of unknown primary origin

Precision medicine aims to tailor cancer therapies to target specific tumor-promoting aberrations. For tumors that lack actionable drivers, which occurs frequently in the clinic, extensive molecular characterization and pre-clinical drug efficacy studies will be required. A cell line maintained at low passage and a patient- derived xenograft model (PDX) were generated using a fresh biopsy from a patient with a poorly-differentiated neuroendocrine tumor of unknown primary origin. Next-generation sequencing, high throughput signaling network analysis, and drug efficacy trials were then conducted to identify actionable targets for therapeutic intervention. No actionable mutations were identified after whole exome sequencing of the patient's DNA. However, whole genome sequencing revealed amplification of the 3q and 5p chromosomal arms, that include the PIK3CA and RICTOR genes, respectively. We then conducted pathway analysis, which revealed activation of the AKT pathway. Based on this analysis, efficacy of PIK3CA and AKT inhibitors were evaluated in the tumor biopsy-derived cell culture and PDX, and response to the AKT inhibitor AZD5363 was observed both in vitro and in vivo indicating the patient would benefit from targeted therapies directed against the serine/threonine kinase AKT. In conclusion, our study demonstrates that high throughput signaling pathway analysis will significantly aid in identifying actionable alterations in rare tumors and guide patient stratification into early-phase clinical trials.

Influence of Haemodialysis Membranes on the Release of Granulocyte Elastase

The advantages of multiparameter assessment in the evaluation of the blood compatibility of biomaterials underline the importance of investigating possible relevant parameters. In this respect, a study has been made of granulocyte elastase to establish the influence of haemodialysis membranes on the release of this serine proteinase. Plasma levels of granulocyte elastase were determined as a complex with its natural inhibiter α1-proteinase. This elastase - α1 proteinase (E- α1 Pi)inhibitor complex was measured by a highly sensitive enzyme-linked immunoassay. The membranes evaluated were Cuprophan (15-11, Travenol) and polysulphone (F40, Fresenius). Samples were taken from patients undergoing maintenance haemodialysis, before the start of dialysis, after 15 and 90 minutes and again at the end of dialysis (4 h). This investigation clearly demonstrates the different response of the dialysers, and on correcting for surface area, the end-dialysis level of E-α1 Pi remained significantly greater for the Cuprophan membrane. The results support the view that the release of granulocyte elastase is a relevant parameter for inclusion in membrane compatibility assessment.

Participation of children on the autism spectrum in home, school, and community

BACKGROUND

Children on the autism spectrum participate less frequently, and in a narrower range of activities, than their nonautistic peers, but little is known about exact participation patterns across contexts or how this is perceived by caregivers. This study aimed to document patterns of participation and caregiver views with regard to frequency and intensity of activities.

METHOD

Caregivers of children on the spectrum aged 5 (n = 90) and 9-10 years (n = 128) completed the Participation and Environment Measure for Children and Youth for home, school, and community. Caregivers reported on frequency of child's participation, level of involvement, and caregivers' desire for change in participation patterns.

RESULTS

Item-level analyses revealed similar patterns of participation across home, school, and community for both cohorts with some small age-appropriate differences. Caregivers generally desired increased diversity, frequency, and involvement in activities but a decreased use of electronics (computers, games, TV, and DVDs).

CONCLUSION

The possibility of autism-specific participation patterns could inform future interventions aimed at enhancing social inclusion. This warrants further investigation through multiinformant designs that seek the perspectives of the child and caregivers.