Abstract 4909: Molecular analysis of small cell lung cancer provides insights into mechanism of action underlying the novel drug combination of lurbinectedin and TIC10/ONC201

We previously explored the combination of novel imipridone TIC10/ONC201 and small molecule RNA polymerase inhibitor lurbinectedin as a potentially effective treatment regimen for small cell lung cancer (SCLC). Data from cell viability experiments demonstrated synergistic killing of SCLC cells with minimal death of healthy control cells. Analysis of intracellular proteins via Western blot indicated that combinatorial treatment induces the integrated stress response, DNA damage/cell cycle checkpoint responses, and increased apoptosis of tumor cells. We have utilized the Luminex 200 platform to perform analyses of cytokine levels in SCLC cell lines with various genetic alterations before and after ONC201 and lurbinectedin treatment. Our results revealed significant changes in cytokine levels following treatment indicating potential immunomodulatory and angioregulatory effects of ONC201 and lurbinectedin. CCL3, known to recruit and activate granulocytes, was found to be elevated by treatment with lurbinectedin, ONC201 and combination versus control. Angiopoietin 1, which contributes to blood vessel maturation, and angiopoietin 2, which promotes neovascularisation, were elevated by all drug treatments in H1882 SCLC cells. Our ongoing studies are further analysing the importance of specific cytokines in tumor vascularity and in recruitment and killing of SCLC cells by immune cells. Results from these experiments are helping to elucidate the molecular mechanisms underlying SCLC, its immune landscape, and treatment response.

Citation Format: Ashley Sanchez Sevilla Uruchurtu, Nicholas Liguori, Leiqing Zhang, Kelsey Huntington, Lanlan Zhou, Young Lee, Abbas E. Abbas, Christopher G. Azzoli, Wafik S. El-Deiry. Molecular analysis of small cell lung cancer provides insights into mechanism of action underlying the novel drug combination of lurbinectedin and TIC10/ONC201. [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 4909.

Abstract 4457: Post exposure suppression of radiation pneumonitis by TRAIL pathway agonists TLY012 and ONC201

Thoracic therapeutic ionizing radiation is limited by toxicities such as pneumonitis and fibrosis of the lungs. Such limitation restricts therapeutic doses and adversely affects patient quality of life while undergoing and following treatment. ONC201/TIC10 is a small-molecule anti-cancer drug that activates the integrated stress response (ISR) and drives the tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) pathway. Pegylated recombinant long-acting TRAIL (TLY012) has been shown in preclinical models to induce the reversal of fibrosis and currently has orphan drug status for systemic sclerosis and chronic pancreatitis. We show a similar effect of both TLY012 and ONC201 in vivo in protecting from radiation pneumonitis and fibrosis of the lungs. WT and TRAIL-/- C57Bl/6 mice receiving a single 20 Gy thoracic radiation dose with shielding of other organs and treated with 10 mg/kg of TLY012 twice a week showed a significantly reduced alveolar wall thickness and lessened inflammation compared to controls and DR5-/- mice receiving the same treatment upon histological analysis of the lungs conducted 13 days post-irradiation. WT and TRAIL-/- C57Bl/6 mice treated with 100 mg/kg of ONC201 once a week showed similar effect to a lesser extent. Further analysis in C57Bl/6 WT mice bearing orthotopic mammary fat pad e0771 TNBC tumors similarly receiving a single 20 Gy thoracic radiation dose revealed the same pattern of protection from radiation pneumonitis upon TRAIL-pathway agonism through treatment with TLY012 and ONC201 both in combination and alone, while also showing a significant reduction in tumor burden at the experimental endpoint (day 9 post-irradiation) in the combination treated mice. Further, pulse oximetry readings of the hind paw revealed a notable reduction in oxygen saturation in all mice except those treated with TLY012. Cytokinomic profiling of mouse serum upon sacrifice revealed a significant reduction in CCL22/MDC levels in the TLY012 cohort. Additional post-hoc analysis including immunophenotyping, immunostaining, and bulk RNA analysis through Nanostring nCounter technologies is underway. Altogether, these findings suggest a role for TLY012, ONC201, or broader modulation of the TRAIL/DR5 pathway in mitigating adverse effects and outcomes of therapeutic radiation, and may serve as a foundation for safer use of radiation in the clinic.

Citation Format: Jillian R. Strandberg, Anna Louie, Marina Hahn, Praveen Srinivasan, Andrew George, Arielle De La Cruz, Leiqing Zhang, Liz Hernandez Borrero, Kelsey Huntington, Christopher Azzoli, Abbas E. Abbas, Lanlan Zhou, Seulki Lee, Wafik S. El-Deiry. Post exposure suppression of radiation pneumonitis by TRAIL pathway agonists TLY012 and ONC201. [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 4457.

Abstract 4898: Imipridones and EZH2 inhibitors induce similar changes in cytokines and regulated genes in GBM and DMG while vorinostat potentiates anti-tumor efficacy despite variability in cytokine profiles

TIC10/ONC201 and ONC206 are small molecule imipridones with anti-cancer activity. ONC201, EZH2i and HDACi can modulate tumor microenvironment (TME) and antitumor immunity. We studied the impact of these drugs or their combinations on the TME or tumor immunity by investigating cytokine profiles. We treated U251 GBM and HCT116 CRC cells with vorinostat and found upregulation of CXCL11, CXCL14, INF-γ and TRAIL, and downregulation of prolactin, CXCL9, VEGF and CCL2 in U251. CXCL11 promotes anti-tumor immunity by increasing activated CD8+ T cells in tumors but was associated with metastasis of GBM. CXCL13 induces tertiary lymphoid structures and enhances infiltration of CD8+ T cells in tumors. INF-γ enhances antigen presentation and promotes activation of NK cells. Vorinostat upregulated the secretion of pro-immune cytokines and TRAIL which induces tumor apoptosis. Downregulated cytokines in U251 were prolactin, CXCL9 involved in tumor growth and metastasis, VEGF, and CCL2 involved in immunosuppression in GBM. Cytokines upregulated in HCT116 included IL-8 contributing to CRC progression, and CXCL13, and CXCL11 which correlates with anti-tumor immunity in colon cancer. Downregulated cytokines in HCT116 were soluble TRAIL R2 functioning as a decoy receptor for TRAIL, VEGF, and prolactin. We treated DMG, GBM and HCC cells with imipridones, EHZ2i tazemetostat or HDACi panobinostat alone or combination of imipridones plus tazemetostat or panobinostat or the triple combination of imipridone plus tazemetostat and panobinostat. We observed that cytokines impairing immunity were downregulated and cytokines promoting immunity were upregulated by individual drugs or combinations. Hep3B HCC cells showed the most robust changes among the mentioned tumors with respect to the changes of cytokine profile following the treatments. Imipridone or EZH2i treated cells showed similar cytokine profile changes in tumor cells. Imipridones downregulated EZH1 and EZH2 proteins in tumor cells. We RNA-seq to investigate gene expression profiles following treatment with ONC201 or tazemetostat. In GBM and DMG, ONC201 and tazemetostat shared similar top regulated genes. GO enrichment analysis showed overlap of top regulated pathways between ONC201 and EZH2i treated cells. Shared regulated pathways in U251 included cell cycle arrest, cell adhesion, nervous system development, cell proliferation, negative regulation of proliferation, PERK-mediated unfolded protein response, extracellular matrix organization, regulation of transcription from RNA polymerase II promoter, and cellular response to hypoxia pathways. We conclude that imipridones ONC201, ONC206, and ONC212 which reduce EZH1 and EZH2 proteins share similar cytokine alterations, gene expression targets and actions with EZH2 inhibitors.

Citation Format: Yiqun Zhang, Kelsey Huntington, Wafik S. El-Deiry. Imipridones and EZH2 inhibitors induce similar changes in cytokines and regulated genes in GBM and DMG while vorinostat potentiates anti-tumor efficacy despite variability in cytokine profiles. [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 4898.

Abstract 319: Imipridone ONC212 and trametinib combination therapy demonstrates anti-neoplastic effects through immune-mediated mechanisms in pancreatic ductal adenocarcinoma cell lines

Pancreatic ductal adenocarcinoma (PDAC) is characterized by limited therapeutic options and an extremely high mortality-to-incidence ratio. Chemotherapy remains the primary treatment for metastatic disease and results in only modest improvements in median overall survival, typically with significant toxicity. We previously reported a novel treatment approach with the combination of the imipridone ONC212 and the MEK inhibitor trametinib. This combination demonstrated synergy in multiple KRAS-mutated and KRAS wild-type pancreatic cancer cell lines (BxPC3, PANC1, HPAF-II, AsPC-1). Using Western Blot, we assessed markers of autophagy, including Beclin-1 and LC3B, as well as key second messenger pathway activation/suppression with p-AKT/AKT and p-ERK/ERK. The mechanism of this synergy appears to be heterogeneous, working through autophagy inhibition, MAPK/PI3K pathway perturbation, activation of the integrated stress response and increased cell surface expression of death receptor 5. Further investigation has revealed that ONC212 also appears to synergize with various autophagy inhibitors including hydroxychloroquine and chloroquine. We hypothesized that combining trametinib and ONC212 may also induce cell death in-part through immune cell-mediated mechanisms. To explore this, we performed immune cell co-culture experiments using HPAF-II PDAC cells and natural killer (NK-92) cells at a 1:1 effector-to-target cell ratio with or without ONC212, trametinib, or the combination of the two at different concentrations. We assessed the levels of NK cell mediated-tumor cell death 4, 8, and 24-hours after simultaneous treatment and initiation of co-culture using fluorescent microscopy. Compared to trametinib, ONC212 only treated co-culture showed greater NK cell-mediated tumor cell death. At 24-hours, we also observed an increase in NK cell-mediated killing of PDAC cells with dual treatment as compared to single agent alone or vehicle controls. Importantly, this combination did not appear to have any effect on NK or tumor cell viability. Thus, this combination may represent a potential therapeutic modality for PDAC and may hold promise if combined with immunotherapy. Further in vitro experiments will be conducted to evaluate the effect of ONC212, trametinib, and other autophagy inhibitors on the PDAC tumor microenvironment using a T cell co-culture system. Similarly, in vivo murine studies will also be performed to assess the translational potential of this combination.

Citation Format: Alexander G. Raufi, Arielle De La Cruz, Lindsey Carlsen, Kelsey Huntington, Lanlan Zhou, Varun Prabhu, Joshua Allen, Wafik S. El-Deiry. Imipridone ONC212 and trametinib combination therapy demonstrates anti-neoplastic effects through immune-mediated mechanisms in pancreatic ductal adenocarcinoma cell lines [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 319.

Abstract P021: Genomic biomarkers for response to 9-ING-41, a small molecule selective glycogen synthase kinase-3 (GSK-3) inhibitor, in pancreas cancer: Preliminary results

Background: 9-ING-41, a small molecule specific GSK-3 inhibitor, demonstrated favorable efficacy and safety in a Phase I clinical trial evaluating 9-ING-41 monotherapy and 8 chemotherapy combinations in 236 patients (pts) that has since been expanded to a Phase II multicenter study (NCT03678883). Interim results documented encouraging clinical activity, especially in patients with advanced pancreatic ductal adenocarcinoma (PDAC) and durable responses in melanoma and ATLL. Potential genomic biomarkers for 9-ING-41 response have not yet been evaluated. Methods: Next-generation sequencing (NGS) of tumor samples was obtained, whenever possible, for those receiving 9-ING-41 alone or in combination with chemotherapy across all sites. Genomic sequencing reports were reviewed for somatic alterations deemed potentially actionable or biologically relevant. For those with PDAC, best response was determined using RECIST 1.1 for those who completed at least two cycles of treatment. Chi-square frequency statistics were used to show the observed versus expected rate of pathogenic variants between patients with disease control (complete response [CR], partial response [PR] or stable disease [SD]) and progressive disease (PD). Results: NGS results were available for 135 pts across 11 sites. Most common histologies were PDAC (n=32), colorectal (n=17), and melanoma (n=9). Among pts with PDAC, NGS results were available for 32 pts (23 tumor samples, 9 ctDNA). Four patients received 9-ING-41 monotherapy; 28 received 9-ING-41 combined with gemcitabine/nab-paclitaxel (n=18), gemcitabine (n=7), or irinotecan (n=3). The most frequently mutated genes among PDAC included KRAS (n=22 pts), TP53 (n=21), CDKN2A (n=12), SMAD4 (n=4), CDKN2B (n=4), MTAP (n=3), ATM (n=3), AKT2 (n=2), and ARID1A (n=2). Of these 32 pts, 25 pts were evaluable for response: 2 pts had CR, 2 PR, 9 SD, and 12 PD. Among the pts with CR, one had tumor without pathogenic variants, the other displayed TP53 and KRAS mutations. Pts with PR: one tumor had no pathogenic mutations, the other tumor harbored mutations in ARID1A, TP53, FGF14, and ROS1. Of the nine patients with SD, 8 had KRAS mutations, 5 had CDKN2A loss of function, and 4 inactivating mutations in SMAD4. Eight out of 12 pts with PD had KRAS mutations. There were no significant differences between pts who had disease control and those with PD in the frequency of KRAS (χ2= 0.0189, P=0.89), TP53 (χ 2= 0.0712, P=0.78), or SMAD4 (χ 2= 1.9631, P= 0.1611). Conclusions: 9-ING-41 has shown clinical benefit in patients with PDAC independent of tumor somatic mutational profile. Preliminary analysis does not reveal pathogenic mutations that are associated with clinical benefit. Additional biomarker studies are ongoing.

Citation Format: Brittany A. Borden, Andre De Souza, Devalingam Mahalingam, Steven Powell, Pamela N. Munster, Kelsey Huntington, Andrew Mazar, Ludmila Calvacante, Francis J. Giles, Wafik S. El-Deiry, Howard P. Safran, Benedito A. Carneiro. Genomic biomarkers for response to 9-ING-41, a small molecule selective glycogen synthase kinase-3 (GSK-3) inhibitor, in pancreas cancer: Preliminary results [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2021 Oct 7-10. Philadelphia (PA): AACR; Mol Cancer Ther 2021;20(12 Suppl):Abstract nr P021.

Chitinase 3-like-1 is a therapeutic target that mediates the effects of aging in COVID-19

COVID-19 is caused by SARS-CoV-2 (SC2) and is more prevalent and severe in elderly and patients with comorbid diseases (CM). Because chitinase 3-like-1 (CHI3L1) is induced during aging and CM, the relationships between CHI3L1 and SC2 were investigated. Here, we demonstrate that CHI3L1 is a potent stimulator of the SC2 receptor angiotensin converting enzyme 2 (ACE2) and viral spike protein priming proteases (SPP), that ACE2 and SPP are induced during aging, and that anti-CHI3L1, kasugamycin, and inhibitors of phosphorylation abrogate these ACE2- and SPP-inductive events. Human studies also demonstrate that the levels of circulating CHI3L1 are increased in the elderly and patients with CM, where they correlate with COVID-19 severity. These studies demonstrate that CHI3L1 is a potent stimulator of ACE2 and SPP, that this induction is a major mechanism contributing to the effects of aging during SC2 infection, and that CHI3L1 co-opts the CHI3L1 axis to augment SC2 infection. CHI3L1 plays a critical role in the pathogenesis of and is an attractive therapeutic target in COVID-19.

Integrating Molecular Biomarker Inputs Into Development and Use of Clinical Cancer Therapeutics

Biomarkers can contribute to clinical cancer therapeutics at multiple points along the patient’s diagnostic and treatment course. Diagnostic biomarkers can screen or classify patients, while prognostic biomarkers predict their survival. Biomarkers can also predict treatment efficacy or toxicity and are increasingly important in development of novel cancer therapeutics. Strategies for biomarker identification have involved large-scale genomic and proteomic analyses. Pathway-specific biomarkers are already in use to assess the potential efficacy of immunotherapy and targeted cancer therapies. Judicious application of machine learning techniques can identify disease-relevant features from large data sets and improve predictive models. The future of biomarkers likely involves increasing utilization of liquid biopsy and multiple samplings to better understand tumor heterogeneity and identify drug resistance.

Pan-drug and drug-specific mechanisms of 5-FU, irinotecan (CPT-11), oxaliplatin, and cisplatin identified by comparison of transcriptomic and cytokine responses of colorectal cancer cells

Colorectal cancer (CRC) caused over 900,000 deaths worldwide in 2020. A majority of late-stage CRC patients are treated with 5-fluorouracil (5-FU) combined with either irinotecan (CPT-11), oxaliplatin, or both. Despite their widespread use, the mechanisms of efficacy and toxicity of these drugs remain incompletely understood. While previous work has investigated cellular responses to these agents individually, we directly compare the transcriptomic and cytokine profiles of HCT116 wild-type and p53-/- colorectal cancer cells treated with these drugs and report pan-drug, drug-specific, drug class-specific, p53-independent, and p53-dependent signatures. We observed downregulation of histone genes by 5-FU (that significantly correlates with improved survival in CRC patients) and upregulation of FOS and ATF3 by oxaliplatin (which may contribute to peripheral neuropathy). BTG2 was identified as a top gene upregulated by all four drugs, suggesting its critical role in the cellular response to chemotherapy in CRC. Soluble TRAILR2 (death receptor 5; DR5) is a decoy receptor for TRAIL, an apoptosis-inducing cytokine. TRAILR2 was down-regulated by oxaliplatin and 5-FU, was not affected by CPT-11, and was increased by cisplatin. There was an increase in IL-8 by oxaliplatin and increase in ferritin by cisplatin which may contribute to cancer cell survival. Novel drug-specific mechanisms of efficacy or toxicity identified in these signatures may be targeted with combination therapies or development of new targeted therapies. Together, the findings here contribute to our understanding of the molecular bases of efficacy and toxicity of chemotherapeutic agents often used for treatment of GI cancer such as CRC.

Chitinase 3-like-1 is a Therapeutic Target That Mediates the Effects of Aging in COVID-19

COVID-19 is caused by the SARS-CoV-2 (SC2) virus and is more prevalent and severe in the elderly and patients with comorbid diseases (CM). Because chitinase 3-like-1 (CHI3L1) is induced during aging and CM, the relationships between CHI3L1 and SC2 were investigated. Here we demonstrate that CHI3L1 is a potent stimulator of the SC2 receptor ACE2 and viral spike protein priming proteases (SPP), that ACE2 and SPP are induced during aging and that anti-CHI3L1, kasugamycin and inhibitors of phosphorylation, abrogate these ACE2- and SPP- inductive events. Human studies also demonstrated that the levels of circulating CHI3L1 are increased in the elderly and patients with CM where they correlate with COVID-19 severity. These studies demonstrate that CHI3L1 is a potent stimulator of ACE2 and SPP; that this induction is a major mechanism contributing to the effects of aging during SC2 infection and that CHI3L1 coopts the CHI3L1 axis to augment SC2 infection. CHI3L1 plays a critical role in the pathogenesis of and is an attractive therapeutic target in COVID-19.

ONC201 and imipridones: Anti-cancer compounds with clinical efficacy

ONC201 was originally discovered as TNF-Related Apoptosis Inducing Ligand (TRAIL)-inducing compound TIC10. ONC201 appears to act as a selective antagonist of the G protein coupled receptor (GPCR) dopamine receptor D2 (DRD2), and as an allosteric agonist of mitochondrial protease caseinolytic protease P (ClpP). Downstream of target engagement, ONC201 activates the ATF4/CHOP-mediated integrated stress response leading to TRAIL/Death Receptor 5 (DR5) activation, inhibits oxidative phosphorylation via c-myc, and inactivates Akt/ERK signaling in tumor cells. This typically results in DR5/TRAIL-mediated apoptosis of tumor cells; however, DR5/TRAIL-independent apoptosis, cell cycle arrest, or antiproliferative effects also occur. The effects of ONC201 extend beyond bulk tumor cells to include cancer stem cells, cancer associated fibroblasts and immune cells within the tumor microenvironment that can contribute to its efficacy. ONC201 is orally administered, crosses the intact blood brain barrier, and is under evaluation in clinical trials in patients with advanced solid tumors and hematological malignancies. ONC201 has single agent clinical activity in tumor types that are enriched for DRD2 and/or ClpP expression including specific subtypes of high-grade glioma, endometrial cancer, prostate cancer, mantle cell lymphoma, and adrenal tumors. Synergy with radiation, chemotherapy, targeted therapy and immune-checkpoint agents has been identified in preclinical models and is being evaluated in clinical trials. Structure-activity relationships based on the core pharmacophore of ONC201, termed the imipridone scaffold, revealed novel potent compounds that are being developed. Imipridones represent a novel approach to therapeutically target previously undruggable GPCRs, ClpP, and innate immune pathways in oncology.

MEK inhibitors reduce cellular expression of ACE2, pERK, pRb while stimulating NK-mediated cytotoxicity and attenuating inflammatory cytokines relevant to SARS-CoV-2 infection

COVID-19 affects vulnerable populations including elderly individuals and patients with cancer. Natural Killer (NK) cells and innate-immune TRAIL suppress transformed and virally-infected cells. ACE2, and TMPRSS2 protease promote SARS-CoV-2 infectivity, while inflammatory cytokines IL-6, or G-CSF worsen COVID-19 severity. We show MEK inhibitors (MEKi) VS-6766, trametinib and selumetinib reduce ACE2 expression in human cells. In some human cells, remdesivir increases ACE2-promoter luciferase-reporter expression, ACE2 mRNA and protein, and ACE2 expression is attenuated by MEKi. In serum-deprived and stimulated cells treated with remdesivir and MEKi we observed correlations between pRB, pERK, and ACE2 expression further supporting role of proliferative state and MAPK pathway in ACE2 regulation. We show elevated cytokines in COVID-19-(+) patient plasma (N = 9) versus control (N = 11). TMPRSS2, inflammatory cytokines G-CSF, M-CSF, IL-1α, IL-6 and MCP-1 are suppressed by MEKi alone or with remdesivir. We observed MEKi stimulation of NK-cell killing of target-cells, without suppressing TRAIL-mediated cytotoxicity. Pseudotyped SARS-CoV-2 virus with a lentiviral core and SARS-CoV-2 D614 or G614 SPIKE (S) protein on its envelope infected human bronchial epithelial cells, small airway epithelial cells, or lung cancer cells and MEKi suppressed infectivity of the pseudovirus. We show a drug class-effect with MEKi to stimulate NK cells, inhibit inflammatory cytokines and block host-factors for SARS-CoV-2 infection leading also to suppression of SARS-CoV-2-S pseudovirus infection of human cells. MEKi may attenuate SARS-CoV-2 infection to allow immune responses and antiviral agents to control disease progression.

Natural Killer cell activation, reduced ACE2, TMPRSS2, cytokines G-CSF, M-CSF and SARS-CoV-2-S pseudovirus infectivity by MEK inhibitor treatment of human cells

COVID-19 affects vulnerable populations including elderly individuals and patients with cancer. Natural Killer (NK) cells and innate-immune TRAIL suppress transformed and virally-infected cells. ACE2, and TMPRSS2 protease promote SARS-CoV-2 infectivity, while inflammatory cytokines IL-6, or G-CSF worsen COVID-19 severity. We show MEK inhibitors (MEKi) VS-6766, trametinib and selumetinib reduce ACE2 expression in human cells. In some human cells, remdesivir increases ACE2-promoter luciferase-reporter expression, ACE2 mRNA and protein, and ACE2 expression is attenuated by MEKi. In serum-deprived and stimulated cells treated with remdesivir and MEKi we observed correlations between pRB, pERK, and ACE2 expression further supporting role of proliferative state and MAPK pathway in ACE2 regulation. We show elevated cytokines in COVID-19-(+) patient plasma (N=9) versus control (N=11). TMPRSS2, inflammatory cytokines G-CSF, M-CSF, IL-1α, IL-6 and MCP-1 are suppressed by MEKi alone or with remdesivir. We observed MEKi stimulation of NK-cell killing of target-cells, without suppressing TRAIL-mediated cytotoxicity. Pseudotyped SARS-CoV-2 virus with a lentiviral core and SARS-CoV-2 D614 or G614 SPIKE (S) protein on its envelope infected human bronchial epithelial cells, small airway epithelial cells, or lung cancer cells and MEKi suppressed infectivity of the pseudovirus. We show a drug class-effect with MEKi to stimulate NK cells, inhibit inflammatory cytokines and block host-factors for SARS-CoV-2 infection leading also to suppression of SARS-CoV-2-S pseudovirus infection of human cells. MEKi may attenuate SARS-CoV-2 infection to allow immune responses and antiviral agents to control disease progression.

Deficits in memory strategy use related to prefrontal dysfunction during early development: evidence from children with phenylketonuria

The prefrontal cortex has been implicated in the mediation of executive processes that facilitate learning and memory. The authors hypothesized that children with prefrontal dysfunction related to phenylketonuria (PKU) would experience deficits in learning and memory because of impaired strategy use. They evaluated 23 children with PKU and 23 controls by using the California Verbal Learning Test-Children's Version (CVLT-C). General executive abilities were tested using the Stroop Color and Word Test, the Wisconsin Card Sorting Test, and phonemic and category fluency. Children with PKU, especially older children, showed poorer learning across trials and less use of semantic clustering on the CVLT-C but intact retention of previously encoded information. With the exception of phonemic fluency, deficits were not observed in general executive control. Results are discussed within the context of abnormalities in the prefrontal cortex and white matter of the brain.

Increased cardiac and pulmonary endothelin-1 mRNA expression in canine pacing-induced heart failure

The canine model of pacing-induced heart failure (HF) simulates human dilated cardiomyopathy and is characterized by severe hemodynamic perturbations. We have previously demonstrated increased plasma endothelin-1 (ET-1) and left ventricular (LV) tissue peptide levels in this model. However, the gene expression of ET-1 has not been studied. Accordingly, we compared preproET-1 mRNA in the lungs and LV in control normal dogs, dogs with severe HF after 3 weeks of rapid pacing (pHF), and pHF dogs chronically treated with an ETA antagonist, LU135252 (pHF-LU). PreproET-1 mRNA expression was determined by ribonuclease protection assay and quantified by densitometry. In paced dogs, mean pulmonary artery pressure (PA) and LV end-diastolic pressure (LVEDP) increased markedly from 16 +/- 4 and 8 +/- 3 mm Hg, respectively, at baseline to 40 +/- 11 and 34 +/- 7 mm Hg, respectively, at 3 weeks (both p < 0.001). Treatment with LU135252 attenuated the increase in PA and LVEDP by 30% and 19%, respectively (p < 0.05 for both). Compared to controls, preproET-1 mRNA expression in the LV and lungs was markedly increased in pHF. This was not changed in the LV but was reduced in the lungs by treatment with the ETA antagonist. Increased pulmonary and LV expression of preproET-1 suggests that ET-1 plays a role in mediating the pulmonary hypertension and LV dysfunction characteristic of this model.

A prospective study to assess the frequency of familial clustering of congenital bicuspid aortic valve

OBJECTIVES

This study sought to determine the rate of familial occurrence of congenital bicuspid aortic valve (BAV) by using echocardiography to screen family members.

BACKGROUND

Congenital BAV is a common anomaly that carries with it a significant risk of potential long-term cardiac complications. Despite several reports of the familial occurrence of BAV, the condition is not generally considered to be inherited.

METHODS

Thirty consecutive patients with echocardiographically documented congenital BAV were interviewed to construct three-generation family pedigrees. All first-degree relatives were contacted to undergo echocardiography to specifically determine aortic valve morphology.

RESULTS

Of the 210 first-degree relatives, 190 (90.5%) agreed to undergo echocardiography. Four members had technically difficult studies. Of the remaining 186 subjects, 17 (9.1%) were identified as having BAV; 11 (36.7%) of the 30 families had at least one additional member with the condition. The male/female ratio of affected members in the 11 families was 1. In one family, two instances of male-to-male transmission were observed. The distribution of BAV in the majority of multiplex families is compatible with autosomal dominant inheritance with reduced penetrance.

CONCLUSIONS

We demonstrated a high incidence of familial clustering in congenital BAV. We believe that the high rate of occurrence of the condition in immediate relatives justifies echocardiographic screening of first-degree relatives to anticipate and prevent future complications associated with this common cardiac malformation.

Macro-ergonomic risk assessment in nuclear remediation industry

In this study, a macro-ergonomic risk assessment tool was developed based on criteria of scope, simplicity, practicality, usefulness, reliability and job-specificity. A relative stress index 'RSI' was formulated to take into account multiple parameters, such as frequency, duration, repetition, weight, force, travel distance and horizontal distance. This tool was tested in nuclear remediation industry. The results are presented and discussed.

The relationship of swimming exercise to bone mass in men and women

Exercise appears to be capable of exerting a positive effect on bone mass, but how exercise can be used to best advantage in the prevention and therapy of osteopenia is unclear. Weight-bearing activity has been commonly considered to be essential for the beneficial effects of exercise on the skeleton, and, therefore, swimming has been considered valueless in the maintenance of bone mass. To examine this issue we measured radial and vertebral bone mineral density in a group of subjects aged 40 to 85 years who had been swimming regularly for at least 3 years as well as in a similar group of nonexercising control subjects. The swimmers engaged in no other forms of regular exercise, and no subject had other conditions known to affect bone or mineral metabolism. Dietary calcium and protein intakes were similar in the two groups. At both radial (0.84 +/- 0.08 vs 0.81 +/- 0.09 g/cm2) and vertebral (123 +/- 27 vs 108 +/- 31 mg/cm3) sites the male swimmers had significantly greater bone mineral density than did the nonexercisers. In women, however, no relationship of swimming to bone mineral density could be identified. These results suggest that swimming exercise may be beneficial in the prevention or therapy of osteopenia and that its usefulness in this regard should be further investigated.

Forensic gynaecology

To put a patient at ease is always important, but this is especially so when making an examination following a sexual offence. The place of examination is important. The choice can be a police station, a hospital or your own consulting-room. If at all possible, your own consulting-room is best. Always explain exactly what you are doing and for what reason. This is reassuring to the patient. Take the specimens systematically. Number and label them carefully before handing them over to the police officer. Notes taken at the time of your examination can be used when giving evidence in court. Therefore legible notes are invaluable. I have also found it useful to have a photostat of my statement as a witness. The police will provide this on request. Note-taking is particularly important in cases in which there are special difficulties. Examinations following sexual assault involve attending court to give evidence. By no means all the examinations made will lead to court cases. Often the accused cannot be found, sometimes the woman drops the allegation, or the Director of Public Prosecutions does not recommend the case to come for trial. Since the Criminal Justice Act 1967 it has been possible in all criminal proceedings to admit a written statement as evidence just as if it had been given orally. This statement must be signed by the witness, who will be liable to prosecution if he has stated in it anything that he knew to be false or did not believe to be true. A copy is served on the opposing side and if they make no objection it can be used by the defence in evidence. In other words, your presence in court is necessary only if some point needs to be made clear by cross-examination. I should like to see long-term follow up of rape victims. At present there is none that I know of, but at least some immediate reassurance and explanation can be given to the patient, together with treatment and recommendations for further care if necessary.