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Chmielewski M, Meyer MJ. Discussions With End Users to Inform the Vision for a Shared Care Record in Ontario: Qualitative Interview Study. Online J Public Health Inform 2024; 16:e51231. [PMID: 38412006 DOI: 10.2196/51231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/17/2023] [Accepted: 12/22/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Improving the health outcomes of populations of individuals through population health management requires the use of electronic health records that can exchange real-time digital information using an accurate and complete shared care record that is accessible to health care providers, services, and patients. OBJECTIVE The aims of this study were to understand end users' (health care providers) experiences, attitudes, and insights using current electronic health records; their expectations of what is required to establish a shared care record; and how they anticipate adapting to the use of a shared care record in daily practice. This work is the result of a quality improvement initiative deemed not to require ethics approval according to the Western research ethics board checklist. METHODS Clinicians were contacted using voluntary response sampling and interviewed via Zoom (Zoom Video Communications) between June 2022 and July 2022. The participants were from various health care sectors and at various stages of career development. RESULTS Overall, adaptation to the use of a shared care record was viewed positively by health care providers, highlighting the benefits of a centralized, shared, and accessible location for real-time data, promoting patient continuity of care. The main concerns included the privacy, confidentiality, and security of the record along with patients' ability to interpret their own medical information found in a patient portal. The resources requested by end users included multifaceted ongoing training on the use of a shared care record. CONCLUSIONS This study provides practical findings that will help emphasize factors that facilitate clinicians' practical use and process of adaptation to the use of a shared care record.
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Affiliation(s)
- Marta Chmielewski
- Public Health Program, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Matthew J Meyer
- Middlesex London Ontario Health Team, London, ON, Canada
- Office of Health System Transformation, London Health Sciences Centre, London, ON, Canada
- Department of Epidemiology and Biostatistics and Interfaculty Program in Public Health at the Schulich School of Medicine and Dentistry, and the Ivey Business School, Western University, London, ON, Canada
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Goldfield NM, Malapati P, Chafitz T, Saravanapavan Y, Alamgir N, Gander J, Meyer MJ. Sterile surgical supply waste identification using asynchronous analysis: Pediatric surgery QI pilot. Surg Open Sci 2023; 15:32-37. [PMID: 37609369 PMCID: PMC10440549 DOI: 10.1016/j.sopen.2023.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/25/2023] [Accepted: 07/29/2023] [Indexed: 08/24/2023] Open
Abstract
Background The operating room (OR) is a major cost and revenue center for a hospital. One of the few modifiable costs in the OR is single-use, sterile surgical supplies (SUSSS). If SUSSS are opened on the scrub table and not used, then they are wasted. High-fidelity SUSSS usage data is important to strategically implement solutions to reduce waste of SUSSS in the OR. OR waste reduction may decrease health systems' carbon footprints and reduce spending. Methods A convenience sample of general pediatric surgical cases was observed in summer 2021. HIPAA-free images of the surgical scrub table were acquired every 2 s with minimal impact on pediatric OR workflow. These images were asynchronously analyzed to obtain SUSSS usage data for each case. Results Image data from three pediatric surgeons performing 41 pediatric surgeries was reviewed. The median cost of unused SUSSS was $13.10 (IQR = $2.73-$47.97) with a range of $0.07 to $489.08 wasted in a single surgery. The mean number of items wasted was 9.3 ± 6.4. The most frequently wasted items were sutures, syringes, towels, paper rulers, and specimen cups. The most expensive sources of waste were laparoscopic trocars, sutures, insufflation needles, drapes, and guidewires. Conclusions SUSSS that were discarded without being used were successfully identified through the asynchronous analysis of HIPAA-free OR scrub table image data. This may be an opportunity to identify SUSSS waste efficiently without an observer in the OR.
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Affiliation(s)
- Natalie M. Goldfield
- University of Virginia School of Medicine, 1340 Jefferson Park Ave, Charlottesville, VA, USA
| | | | - Tyler Chafitz
- Mount Sinai Health System, 1 Gustave L. Levy Pl, New York, NY, USA
| | | | - Nafisa Alamgir
- Meharry Medical College, 1005 Dr DB Todd Jr Blvd, Nashville, TN, USA
| | - Jeffrey Gander
- University of Virginia School of Medicine, 1340 Jefferson Park Ave, Charlottesville, VA, USA
| | - Matthew J. Meyer
- University of Virginia School of Medicine, 1340 Jefferson Park Ave, Charlottesville, VA, USA
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Bonazzi S, d'Hennezel E, Beckwith REJ, Xu L, Fazal A, Magracheva A, Ramesh R, Cernijenko A, Antonakos B, Bhang HEC, Caro RG, Cobb JS, Ornelas E, Ma X, Wartchow CA, Clifton MC, Forseth RR, Fortnam BH, Lu H, Csibi A, Tullai J, Carbonneau S, Thomsen NM, Larrow J, Chie-Leon B, Hainzl D, Gu Y, Lu D, Meyer MJ, Alexander D, Kinyamu-Akunda J, Sabatos-Peyton CA, Dales NA, Zécri FJ, Jain RK, Shulok J, Wang YK, Briner K, Porter JA, Tallarico JA, Engelman JA, Dranoff G, Bradner JE, Visser M, Solomon JM. Discovery and characterization of a selective IKZF2 glue degrader for cancer immunotherapy. Cell Chem Biol 2023; 30:235-247.e12. [PMID: 36863346 DOI: 10.1016/j.chembiol.2023.02.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 12/15/2022] [Accepted: 02/09/2023] [Indexed: 03/04/2023]
Abstract
Malignant tumors can evade destruction by the immune system by attracting immune-suppressive regulatory T cells (Treg) cells. The IKZF2 (Helios) transcription factor plays a crucial role in maintaining function and stability of Treg cells, and IKZF2 deficiency reduces tumor growth in mice. Here we report the discovery of NVP-DKY709, a selective molecular glue degrader of IKZF2 that spares IKZF1/3. We describe the recruitment-guided medicinal chemistry campaign leading to NVP-DKY709 that redirected the degradation selectivity of cereblon (CRBN) binders from IKZF1 toward IKZF2. Selectivity of NVP-DKY709 for IKZF2 was rationalized by analyzing the DDB1:CRBN:NVP-DKY709:IKZF2(ZF2 or ZF2-3) ternary complex X-ray structures. Exposure to NVP-DKY709 reduced the suppressive activity of human Treg cells and rescued cytokine production in exhausted T-effector cells. In vivo, treatment with NVP-DKY709 delayed tumor growth in mice with a humanized immune system and enhanced immunization responses in cynomolgus monkeys. NVP-DKY709 is being investigated in the clinic as an immune-enhancing agent for cancer immunotherapy.
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Affiliation(s)
- Simone Bonazzi
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA.
| | - Eva d'Hennezel
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA.
| | | | - Lei Xu
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Aleem Fazal
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Anna Magracheva
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Radha Ramesh
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | | | | | - Hyo-Eun C Bhang
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | | | - Jennifer S Cobb
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | | | - Xiaolei Ma
- Novartis Institutes for Biomedical Research, Emeryville, CA, USA
| | | | | | - Ry R Forseth
- Novartis Institutes for Biomedical Research, East Hanover, NJ, USA
| | | | - Hongbo Lu
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Alfredo Csibi
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Jennifer Tullai
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Seth Carbonneau
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Noel M Thomsen
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Jay Larrow
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | | | - Dominik Hainzl
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Yi Gu
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Darlene Lu
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Matthew J Meyer
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Dylan Alexander
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | | | | | - Natalie A Dales
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | | | - Rishi K Jain
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Janine Shulok
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Y Karen Wang
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Karin Briner
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | | | | | | | - Glenn Dranoff
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - James E Bradner
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Michael Visser
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
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Meyer MJ, Jameson SA, Gillig EJ, Aggarwal A, Ratcliffe SJ, Baldwin M, Singh KE, Clouse WD, Blank RS. Clinical implications of preoperative echocardiographic findings on cardiovascular outcomes following vascular surgery: An observational trial. PLoS One 2023; 18:e0280531. [PMID: 36656845 PMCID: PMC9851553 DOI: 10.1371/journal.pone.0280531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/29/2022] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Peripheral artery disease and cardiac disease are often comorbid conditions. Echocardiography is a diagnostic tool that can be performed preoperatively to risk stratify patients by a functional cardiac test. We hypothesized that ventricular dysfunction and valvular lesions were associated with an increased incidence of expanded major adverse cardiac events (Expanded MACE). METHODS AND MATERIALS Retrospective cohort study from 2011 to 2020 including all patients from a major academic center who had vascular surgery and an echocardiographic study within two years of the index procedure. RESULTS 813 patients were included in the study; a majority had a history of smoking (86%), an ASA score of 3 (65%), and were male (68%). Carotid endarterectomy was the most common surgery (24%) and the least common surgery was open abdominal aortic aneurysm repair (5%). We found no significant association between the echocardiographic findings of left ventricular dysfunction, right ventricular dysfunction, or valvular lesions and the postoperative development of Expanded MACE. CONCLUSIONS The preoperative echocardiographic findings of left ventricular dysfunction, right ventricular dysfunction and moderate to severe valvular lesions were not predictive of an increased incidence of postoperative Expanded MACE. We identified a significant association between RV dysfunction and post-operative dialysis that should be interpreted carefully due to the small number of outcomes. The transition from open to endovascular surgery and advances in perioperative management may have led to improved cardiovascular outcomes. TRIAL REGISTRATION Trial Registration: NCT04836702 (clinicaltrials.gov). https://www.google.com/search?client=firefox-b-d&q=NCT04836702.
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Affiliation(s)
- Matthew J. Meyer
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, United States of America
- * E-mail:
| | - Slater A. Jameson
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Edward J. Gillig
- Department of Anesthesiology, Newton Wellesley Hospital, Newton, MA, United States of America
| | - Ankur Aggarwal
- Department of Surgery, Franciscan Physicians Network Vascular Surgeons, Indianapolis, IN, United States of America
| | - Sarah J. Ratcliffe
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Mary Baldwin
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Karen E. Singh
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - W. Darrin Clouse
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Randal S. Blank
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, United States of America
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Molony RD, Funk T, Trabucco G, Corcoran E, Ruddy D, Varadarajan M, Elliot G, Piquet M, Lam J, Meyer MJ, Wang HQ, Kurtulus S, Lu H. CRISPR screening identifies T cell-intrinsic regulators of CD3-bispecific antibody responses. Front Immunol 2022; 13:909979. [PMID: 35990699 PMCID: PMC9388929 DOI: 10.3389/fimmu.2022.909979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
CD3-engaging bispecific antibodies (BsAbs) enable the formation of an immune synapse between T cells and tumor cells, resulting in robust target cell killing not dependent on a preexisting tumor specific T cell receptor. While recent studies have shed light on tumor cell-specific factors that modulate BsAb sensitivity, the T cell-intrinsic determinants of BsAb efficacy and response durability are poorly understood. To better clarify the genes that shape BsAb-induced T cell responses, we conducted targeted analyses and a large-scale unbiased in vitro CRISPR/Cas9-based screen to identify negative regulators of BsAb-induced T cell proliferation. These analyses revealed that CD8+ T cells are dependent on CD4+ T cell-derived signaling factors in order to achieve sustained killing in vitro. Moreover, the mammalian target of rapamycin (mTOR) pathway and several other candidate genes were identified as intrinsic regulators of BsAb-induced T cell proliferation and/or activation, highlighting promising approaches to enhancing the utility of these potent therapeutics.
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Volcko KL, Brakey DJ, McNamara TE, Meyer MJ, McKay NJ, Santollo J, Daniels D. Control of water intake by a pathway from the nucleus of the solitary tract to the paraventricular hypothalamic nucleus. Appetite 2022; 172:105943. [PMID: 35131386 PMCID: PMC9903207 DOI: 10.1016/j.appet.2022.105943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/14/2021] [Accepted: 01/17/2022] [Indexed: 11/19/2022]
Abstract
Several brain areas have been shown to participate in thirst and control of fluid intake. An understanding of how these circuits interact, and their roles in the activation, maintenance, and termination of fluid intake remains incomplete. Central glucagon-like peptide-1 (GLP-1) receptor activation appears to be an important part of the termination of drinking, but the site(s) of action for this suppression has not yet been determined. In an attempt to use GLP-1 responsiveness as a means to screen targets of hindbrain cells that participate in the termination of thirst and the resultant water intake, we injected the GLP-1 receptor agonist exendin-4 (Ex-4) into three brain areas known to express GLP-1 receptors, and measured subsequent water intake. Ex-4 reduced water consumption when injected into the paraventricular hypothalamic nucleus (PVH) and nucleus of the solitary tract (NTS), but not when injected into the nucleus accumbens (NAc). Using the effective response after injection into the PVH as a guide, we examined the connection between the NTS - the site of endogenous central GLP-1 production - and the PVH. Retrograde tracing combined with Fos immunohistochemistry suggested intake-induced activity in PVH-projecting NTS cells. To test the hypothesis that this pathway is important in the termination of drinking, we chemogenetically activated PVH-projecting hindbrain cells. Interestingly, activation of this population of cells increased water intake, calling into question the heterogeneity of the pathway with respect to the control of fluid intake. Taken together, we conclude that the PVH is a site of action for GLP-1 receptor activation in the inhibition of water intake, but suspect that endogenous GLP-1 in NTS-to-PVH projections may be counterbalanced by a parallel pathway that either activates or maintains already activated water intake.
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Affiliation(s)
- K L Volcko
- Department of Psychology, USA; Behavioral Neuroscience Program, USA
| | - D J Brakey
- Department of Psychology, USA; Behavioral Neuroscience Program, USA
| | | | | | - N J McKay
- Department of Psychology, State University of New York Buffalo State College,Buffalo, NY, 14222, USA
| | - J Santollo
- Department of Biology, University of Kentucky, Lexington, KY, 40506, USA
| | - D Daniels
- Department of Psychology, USA; Behavioral Neuroscience Program, USA; Center for Ingestive Behavior Research. University at Buffalo, The State University of New York, Buffalo, NY, 14260, USA.
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Meyer MJ, Chafitz T, Wang K, Alamgir N, Malapati P, Gander JW, Ward DT, Gandhi S. Surgeons’ perspectives on operating room waste: Multicenter survey. Surgery 2022; 171:1142-1147. [DOI: 10.1016/j.surg.2021.12.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 11/24/2022]
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Hussey AJ, Sibbald SL, Ferrone M, Hergott A, McKelvie R, Faulds C, Roberts Z, Scarffe AD, Meyer MJ, Vollbrecht S, Licskai C. Confronting complexity and supporting transformation through health systems mapping: a case study. BMC Health Serv Res 2021; 21:1146. [PMID: 34688279 PMCID: PMC8540206 DOI: 10.1186/s12913-021-07168-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Health systems are a complex web of interacting and interconnected parts; introducing an intervention, or the allocation of resources, in one sector can have effects across other sectors and impact the entire system. A prerequisite for effective health system reorganisation or transformation is a broad and common understanding of the current system amongst stakeholders and innovators. Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are common chronic diseases with high health care costs that require an integrated health system to effectively treat. STUDY DESCRIPTION This case study documents the first phase of system transformation at a regional level in Ontario, Canada. In this first phase, visual representations of the health system in its current state were developed using a collaborative co-creation approach, and a focus on COPD and HF. Multiple methods were used including focus groups, open-ended questionnaires, and document review, to develop a series of graphical and visual representations; a health care ecosystem map. RESULTS The ecosystem map identified key sectoral components, inter-component interactions, and care requirements for patients with COPD and HF and inventoried current programs and services available to deliver this care. Main findings identified that independent system-wide navigation for this vulnerable patient group is limited, primary care is central to the accessibility of nearly half of the identified care elements, and resources are not equitably distributed. The health care ecosystem mapping helped to identify care gaps and illustrates the need to resource the primary care provider and the patient with system navigation resources and interdisciplinary team care. CONCLUSION The co-created health care ecosystem map brought a collective understanding of the health care system as it applies to COPD and HF. The map provides a blueprint that can be adapted to other disease states and health systems. Future transformation will build on this foundational work, continuing the robust interdisciplinary co-creation strategies, exploring predictive health system modelling and identifying areas for integration.
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Affiliation(s)
- Anna J Hussey
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
| | - Shannon L Sibbald
- Faculty of Health Sciences, Western University, London, ON, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Madonna Ferrone
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
- Hotel-Dieu Grace Healthcare, Windsor, ON, Canada
| | - Alyson Hergott
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
| | - Robert McKelvie
- St. Joseph's Health Care, London, ON, Canada
- Cardiology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Cathy Faulds
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- St. Joseph's Health Care, London, ON, Canada
| | - Zofe Roberts
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
| | - Andrew D Scarffe
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Matthew J Meyer
- London Health Sciences Centre, London, ON, Canada
- Department of Epidemiology and Biostatistics and Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Ivey Business School, London, ON, Canada
| | | | - Christopher Licskai
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada.
- London Health Sciences Centre, London, ON, Canada.
- Lawson Health Research Institute, London, ON, Canada.
- Respirology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
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Affiliation(s)
- Matthew J Meyer
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia,
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Revilla-León M, Ashby MT, Meyer MJ, Zandinejad A, Umorin M. Self-perception and self-representation preference between 2-dimensional and 3-dimensional facial reconstructions among dentists, dental students, and laypersons. J Prosthet Dent 2021; 127:911-917. [PMID: 33541817 DOI: 10.1016/j.prosdent.2020.11.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 11/27/2022]
Abstract
STATEMENT OF PROBLEM Computer-aided design (CAD) software can merge the intraoral digital scan with patient photographs or 3-dimensional (3D) facial reconstructions for treatment planning purposes. However, whether an individual perceives a 3D facial reconstruction as a better self-representation compared with a 2-dimensional (2D) photograph is unclear. PURPOSE The purpose of this observational study was to compare self-perception ratings and self-representation preference of the 2D and 3D facial reconstructions among laypersons, dental students, and dentists. MATERIAL AND METHODS Three populations participated in the study: laypersons, dental students, and dentists (n=20, N=60). Facial and intraoral features were digitized by using facial and intraoral scanners, and a complete-face smile photograph was obtained. Two simulations were performed for each participant: 2D (2D group) and 3D (3D group) reconstructions. In the 2D group, a maxillary digital veneer waxing from the left to the right second premolars was produced without altering the shape, position, or length of the involved teeth. A software program (Dental Systems; 3Shape A/S) was used to merge the maxillary digital waxing with the full-face smile photograph. One image was obtained for each participant. In the 3D group, a dental software program (Matera 2.4; Exocad GmbH) was used to merge the intraoral and facial scans. Subsequently, 1 video of a 180-degree rotation of each 3D superimposition was obtained. Participants evaluated both superimpositions on a scale from 1 (least esthetically pleasing) to 6 (most esthetically pleasing). Finally, participants were asked which superimposition they preferred for a potential treatment outcome representation. RESULTS All the ratings were esthetically pleasing (median group rating 5 or 6). When analyzed solely for differences across occupation groups, ratings for the 2D representation varied significantly across populations (Kruskal-Wallis chi-squared=13.241, df=2, P=.001), but the ratings for the 3D representation did not exhibit statistically significant differences (Kruskal-Wallis chi-squared=4.3756, df=2, P=.112). Ordinal logistic regression revealed no significant main effects but a significant effect of the population×image-type interaction on the esthetic rating. All participants felt well-represented in both the 2D and 3D representations. Also, 40% of dentists, 55% of dental students, and 50% of laypersons preferred the 3D reconstructions. Sex and occupation in general had no effect on the ratings. However, students tended to give higher ratings to the 3D representations of themselves. CONCLUSIONS There is no evidence based on the current study that 2D and 3D representations were perceived differently, but representation preferences may depend on a person's occupation. When individuals rated 3D visualization higher than 2D visualization, they strongly preferred the 3D visualization for representing the treatment outcome.
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Affiliation(s)
- Marta Revilla-León
- Assistant Professor and Assistant Program Director AEGD, Comprehensive Dentistry Department, College of Dentistry, Texas A&M University, Dallas, Texas; Affiliate Professor, Graduate Prosthodontics, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash; Researcher at Revilla Research Center, Madrid, Spain.
| | - Mark T Ashby
- Undergraduate student of Dentistry, College of Dentistry, Texas A&M University, Dallas, Texas
| | - Matthew J Meyer
- Undergraduate student of Dentistry, College of Dentistry, Texas A&M University, Dallas, Texas
| | - Amirali Zandinejad
- Associate Professor and Program Director AEGD, Comprehensive Dentistry Department, College of Dentistry, Texas A&M University, Dallas, Texas
| | - Mikhail Umorin
- Assistant Professor, Department of Biological Sciences, College of Dentistry, Texas A&M University, Dallas, Texas
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Udelsman BV, Govea N, Cooper Z, Chang DC, Bader A, Meyer MJ. Variation in Patient-Reported Advance Care Preferences in the Preoperative Setting. Anesth Analg 2021; 132:210-216. [PMID: 31923000 DOI: 10.1213/ane.0000000000004617] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND High-quality shared decision-making for patients undergoing elective surgical procedures includes eliciting patient goals and treatment preferences. This is particularly important, should complications occur and life-sustaining therapies be considered. Our objective was to determine the preoperative care preferences of older higher-risk patients undergoing elective procedures and to determine any factors associated with a preference for limitations to life-sustaining treatments. METHODS Cross-sectional survey conducted between May and December 2018. Patients ≥55 years of age presenting for a preprocedural evaluation in a high-risk anesthesia clinic were queried on their desire for life-sustaining treatments (cardiopulmonary resuscitation, mechanical ventilation, dialysis, and artificial nutrition) as well as tolerance for declines in health states (physical disability, cognitive disability, and daily severe pain). RESULTS One hundred patients completed the survey. The median patient age was 68. Most patients were Caucasian (87%) and had an American Society of Anesthesiologists (ASA) score of III (88%). The majority of patients (89%) desired cardiopulmonary resuscitation. However, most patients would not accept mechanical ventilation, dialysis, or artificial nutrition for an indefinite period of time. Similarly, most patients (67%-81%) indicated they would not desire treatments to sustain life in the event of permanent physical disability, cognitive disability, or daily severe pain. CONCLUSIONS Among older, higher-risk patients presenting for elective procedures, most patients chose limitations to life-sustaining treatments. This work highlights the need for an in-depth goals of care discussion and establishment of advance care preferences before a procedure or operative intervention.
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Affiliation(s)
- Brooks V Udelsman
- From the Department of Surgery, Massachusetts General Hospital, Codman Center for Clinical Effectiveness in Surgery, Boston, Massachusetts
| | - Nicolas Govea
- Department of Anesthesiology, NewYork-Presbyterian-Weill Cornell Medical Center, New York, New York
| | - Zara Cooper
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Surgery, Center for Surgery and Public Health, Boston, Massachusetts
| | - David C Chang
- From the Department of Surgery, Massachusetts General Hospital, Codman Center for Clinical Effectiveness in Surgery, Boston, Massachusetts
| | - Angela Bader
- Department of Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Matthew J Meyer
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
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12
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Piedra-Cascón W, Meyer MJ, Methani MM, Revilla-León M. Accuracy (trueness and precision) of a dual-structured light facial scanner and interexaminer reliability. J Prosthet Dent 2020; 124:567-574. [DOI: 10.1016/j.prosdent.2019.10.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/08/2019] [Accepted: 10/08/2019] [Indexed: 11/25/2022]
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13
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Liu C, Lu H, Wang H, Loo A, Zhang X, Yang G, Kowal C, Delach S, Wang Y, Goldoni S, Hastings WD, Wong K, Gao H, Meyer MJ, Moody SE, LaMarche MJ, Engelman JA, Williams JA, Hammerman PS, Abrams TJ, Mohseni M, Caponigro G, Hao HX. Combinations with Allosteric SHP2 Inhibitor TNO155 to Block Receptor Tyrosine Kinase Signaling. Clin Cancer Res 2020; 27:342-354. [PMID: 33046519 DOI: 10.1158/1078-0432.ccr-20-2718] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/27/2020] [Accepted: 10/06/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE SHP2 inhibitors offer an appealing and novel approach to inhibit receptor tyrosine kinase (RTK) signaling, which is the oncogenic driver in many tumors or is frequently feedback activated in response to targeted therapies including RTK inhibitors and MAPK inhibitors. We seek to evaluate the efficacy and synergistic mechanisms of combinations with a novel SHP2 inhibitor, TNO155, to inform their clinical development. EXPERIMENTAL DESIGN The combinations of TNO155 with EGFR inhibitors (EGFRi), BRAFi, KRASG12Ci, CDK4/6i, and anti-programmed cell death-1 (PD-1) antibody were tested in appropriate cancer models in vitro and in vivo, and their effects on downstream signaling were examined. RESULTS In EGFR-mutant lung cancer models, combination benefit of TNO155 and the EGFRi nazartinib was observed, coincident with sustained ERK inhibition. In BRAFV600E colorectal cancer models, TNO155 synergized with BRAF plus MEK inhibitors by blocking ERK feedback activation by different RTKs. In KRASG12C cancer cells, TNO155 effectively blocked the feedback activation of wild-type KRAS or other RAS isoforms induced by KRASG12Ci and greatly enhanced efficacy. In addition, TNO155 and the CDK4/6 inhibitor ribociclib showed combination benefit in a large panel of lung and colorectal cancer patient-derived xenografts, including those with KRAS mutations. Finally, TNO155 effectively inhibited RAS activation by colony-stimulating factor 1 receptor, which is critical for the maturation of immunosuppressive tumor-associated macrophages, and showed combination activity with anti-PD-1 antibody. CONCLUSIONS Our findings suggest TNO155 is an effective agent for blocking both tumor-promoting and immune-suppressive RTK signaling in RTK- and MAPK-driven cancers and their tumor microenvironment. Our data provide the rationale for evaluating these combinations clinically.
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Affiliation(s)
- Chen Liu
- Oncology Disease Area, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Hengyu Lu
- Oncology Disease Area, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Hongyun Wang
- Oncology Disease Area, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Alice Loo
- Oncology Disease Area, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Xiamei Zhang
- Oncology Disease Area, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Guizhi Yang
- Oncology Disease Area, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Colleen Kowal
- Oncology Disease Area, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Scott Delach
- Oncology Disease Area, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Ye Wang
- Oncology Disease Area, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Silvia Goldoni
- Oncology Disease Area, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - William D Hastings
- Exploratory Immuno-Oncology, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Karrie Wong
- Exploratory Immuno-Oncology, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Hui Gao
- Oncology Disease Area, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Matthew J Meyer
- Oncology Disease Area, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Susan E Moody
- Oncology Disease Area, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Matthew J LaMarche
- Global Discovery Chemistry, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Jeffrey A Engelman
- Oncology Disease Area, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Juliet A Williams
- Oncology Disease Area, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Peter S Hammerman
- Oncology Disease Area, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Tinya J Abrams
- Oncology Disease Area, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Morvarid Mohseni
- Oncology Disease Area, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Giordano Caponigro
- Oncology Disease Area, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts.
| | - Huai-Xiang Hao
- Oncology Disease Area, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts.
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14
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Affiliation(s)
- Matthew J Meyer
- From the Department of Anesthesiology, University of Virginia (UVA), UVA Health, Charlottesville, Virginia
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15
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LaMarche MJ, Acker M, Argintaru A, Bauer D, Boisclair J, Chan H, Chen CHT, Chen YN, Chen Z, Deng Z, Dore M, Dunstan D, Fan J, Fekkes P, Firestone B, Fodor M, Garcia-Fortanet J, Fortin PD, Fridrich C, Giraldes J, Glick M, Grunenfelder D, Hao HX, Hentemann M, Ho S, Jouk A, Kang ZB, Karki R, Kato M, Keen N, Koenig R, LaBonte LR, Larrow J, Liu G, Liu S, Majumdar D, Mathieu S, Meyer MJ, Mohseni M, Ntaganda R, Palermo M, Perez L, Pu M, Ramsey T, Reilly J, Sarver P, Sellers WR, Sendzik M, Shultz MD, Slisz J, Slocum K, Smith T, Spence S, Stams T, Straub C, Tamez V, Toure BB, Towler C, Wang P, Wang H, Williams SL, Yang F, Yu B, Zhang JH, Zhu S. Identification of TNO155, an Allosteric SHP2 Inhibitor for the Treatment of Cancer. J Med Chem 2020; 63:13578-13594. [PMID: 32910655 DOI: 10.1021/acs.jmedchem.0c01170] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
SHP2 is a nonreceptor protein tyrosine phosphatase encoded by the PTPN11 gene and is involved in cell growth and differentiation via the MAPK signaling pathway. SHP2 also plays an important role in the programed cell death pathway (PD-1/PD-L1). As an oncoprotein as well as a potential immunomodulator, controlling SHP2 activity is of high therapeutic interest. As part of our comprehensive program targeting SHP2, we identified multiple allosteric binding modes of inhibition and optimized numerous chemical scaffolds in parallel. In this drug annotation report, we detail the identification and optimization of the pyrazine class of allosteric SHP2 inhibitors. Structure and property based drug design enabled the identification of protein-ligand interactions, potent cellular inhibition, control of physicochemical, pharmaceutical and selectivity properties, and potent in vivo antitumor activity. These studies culminated in the discovery of TNO155, (3S,4S)-8-(6-amino-5-((2-amino-3-chloropyridin-4-yl)thio)pyrazin-2-yl)-3-methyl-2-oxa-8-azaspiro[4.5]decan-4-amine (1), a highly potent, selective, orally efficacious, and first-in-class SHP2 inhibitor currently in clinical trials for cancer.
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16
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Lu H, Molony RD, Chen D, Jang S, Wolf B, Ewert S, Flaherty M, Xu F, Isim S, Shim Y, Dornelas C, Balke N, Leber XC, Scharenberg M, Koelln J, Choi E, Ward R, Johnson J, Calzascia T, Isnardi I, Williams JA, Lindenbergh PL, van de Donk NWCJ, Mutis T, Huet H, Lees E, Meyer MJ. Development of Anti-CD32b Antibodies with Enhanced Fc Function for the Treatment of B and Plasma Cell Malignancies. Mol Cancer Ther 2020; 19:2089-2104. [PMID: 32847974 DOI: 10.1158/1535-7163.mct-19-0003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/01/2020] [Accepted: 07/30/2020] [Indexed: 11/16/2022]
Abstract
The sole inhibitory Fcγ receptor CD32b (FcγRIIb) is expressed throughout B and plasma cell development and on their malignant counterparts. CD32b expression on malignant B cells is known to provide a mechanism of resistance to rituximab that can be ameliorated with a CD32b-blocking antibody. CD32b, therefore, represents an attractive tumor antigen for targeting with a monoclonal antibody (mAb). To this end, two anti-CD32b mAbs, NVS32b1 and NVS32b2, were developed. Their complementarity-determining regions (CDR) bind the CD32b Fc binding domain with high specificity and affinity while the Fc region is afucosylated to enhance activation of FcγRIIIa on immune effector cells. The NVS32b mAbs selectively target CD32b+ malignant cells and healthy B cells but not myeloid cells. They mediate potent killing of opsonized CD32b+ cells via antibody-dependent cellular cytotoxicity and phagocytosis (ADCC and ADCP) as well as complement-dependent cytotoxicity (CDC). In addition, NVS32b CDRs block the CD32b Fc-binding domain, thereby minimizing CD32b-mediated resistance to therapeutic mAbs including rituximab, obinutuzumab, and daratumumab. NVS32b mAbs demonstrate robust antitumor activity against CD32b+ xenografts in vivo and immunomodulatory activity including recruitment of macrophages to the tumor and enhancement of dendritic cell maturation in response to immune complexes. Finally, the activity of NVS32b mAbs on CD32b+ primary malignant B and plasma cells was confirmed using samples from patients with B-cell chronic lymphocytic leukemia (CLL) and multiple myeloma. The findings indicate the promising potential of NVS32b mAbs as a single agent or in combination with other mAb therapeutics for patients with CD32b+ malignant cells.
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Affiliation(s)
- Haihui Lu
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts.
| | - Ryan D Molony
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Dongshu Chen
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Sunyoung Jang
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Babette Wolf
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Stefan Ewert
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Meghan Flaherty
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Fangmin Xu
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Sinan Isim
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Yeonju Shim
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | | | - Nicole Balke
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | | | | | - Johanna Koelln
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Eugene Choi
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Rebecca Ward
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Jennifer Johnson
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | | | | | - Juliet A Williams
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Pieter L Lindenbergh
- Department of Hematology, Amsterdam University Medical Centers, VUmc, Amsterdam, the Netherlands
| | - Niels W C J van de Donk
- Department of Hematology, Amsterdam University Medical Centers, VUmc, Amsterdam, the Netherlands
| | - Tuna Mutis
- Department of Hematology, Amsterdam University Medical Centers, VUmc, Amsterdam, the Netherlands
| | - Heather Huet
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Emma Lees
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Matthew J Meyer
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
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17
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Meyer MJ, Carlson JJ, Lin D. Seeing Snakes: An HIV Patient with Visual Hallucinations. Am J Med 2020; 133:687-689. [PMID: 32081653 DOI: 10.1016/j.amjmed.2019.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 09/29/2019] [Accepted: 10/02/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Matthew J Meyer
- Student, School of Medicine, Baylor College of Medicine, Houston, Texas
| | - Jeffrey J Carlson
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Doris Lin
- Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
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Abstract
Background. Returning to work is important for many people following stroke. An estimate of the prevalence of people intending to return to work post-stroke would be helpful in planning services supporting work reintegration. Purpose. This study examined the prevalence of intention to return to work after discharge among stroke rehabilitation inpatients. Methods. We performed secondary analysis of National Rehabilitation Reporting System data for all stroke rehabilitation inpatients across Ontario (2012–2017). Intention to return to work was examined by gender, age, and level of disability. Findings. Among 25,691 stroke rehabilitation inpatients, 4,668 (18.2%) were employed pre-stroke and 2,039 (43.7%) of them intended to return to work. Intention to return to work was somewhat higher among younger and middle-aged stroke survivors and those with mild disability. Implications. Providers and planners should be aware that almost half of previously employed stroke-rehabilitation inpatients may be seeking services to assist with return to work.
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19
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Revilla-León M, Ashby MT, Meyer MJ, Umorin M, Barrington JJ, Zandinejad A. Layperson and Dental Professional Perception When Evaluating Their Own Virtually 2D or 3D Simulated Esthetic Discrepancies. J Prosthodont 2020; 29:466-471. [PMID: 32369876 DOI: 10.1111/jopr.13182] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/20/2020] [Accepted: 04/21/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To analyze the perceptions of laypersons, dental students, and dentists regarding disparities of the maxillary dental midline and the occlusal plane (OP) when analyzing their own 2D or 3D clinical simulation. MATERIAL AND METHODS 20 participants per group volunteered (N = 60). Intraoral and facial scans, and a photograph were obtained from each participant. Two simulation groups were created: 2D and 3D groups, which were subdivided into two subgroups. In the first subgroup, the OP was modified by 1-degree increments without changing the maxillary midline. In the second subgroup, the OP was modified by the same increments, but the maxillary midline was altered to match the OP inclination. Participants were asked to rate the simulations on a 1-to-6 scale and a question survey. Ordinal logistic regression (OR) was used to analyze the ratings. RESULTS Tilt of the OP had the strongest negative effect on the ratings which was further amplified by the dental midline inclination (OR = 0.122). Midline modification alone did not affect the ratings (OR = 0.744). 3D simulations had a stronger positive effect on the ratings compared to 2D simulations. For dental students, the positive rating effect of 3D simulations was similar to dentists. For laypersons, the positive rating effect of 3D simulations compared to the 2D simulations decreased relative to dentists. The survey revealed that 45% of the dentists, 80% of the students, and 50% of the laypersons preferred the 3D simulation. CONCLUSIONS The type of dimensional representation affected the esthetic perception of all participants. 3D simulations obtained higher esthetic ratings for the same esthetic discrepancy than 2D simulations. However, all participants' ratings decreased with increased tilt of the OP and were further decreased with the inclination of the dental midline.
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Affiliation(s)
- Marta Revilla-León
- Advance Education in General Dentistry, Comprehensive Dentistry Department, College of Dentistry, Texas A&M University, Dallas, TX.,Graduate in Prosthodontics, Restorative Dentistry Department, University of Washington, Seattle, WA.,Revilla Research Center, Madrid, Spain
| | - Mark T Ashby
- Advance Education in General Dentistry, Comprehensive Dentistry Department, College of Dentistry, Texas A&M University, Dallas, TX
| | - Matthew J Meyer
- Advance Education in General Dentistry, Comprehensive Dentistry Department, College of Dentistry, Texas A&M University, Dallas, TX
| | - Mikhail Umorin
- Department of Biological Sciences, College of Dentistry, Texas A&M University, Dallas, TX
| | - Jennifer J Barrington
- Department of General Dentistry, College of Dentistry, Texas A&M University, Dallas, TX
| | - Amirali Zandinejad
- Advance Education in General Dentistry, Comprehensive Dentistry Department, College of Dentistry, Texas A&M University, Dallas, TX
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20
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Mathai DS, Meyer MJ, Storch EA, Kosten TR. The relationship between subjective effects induced by a single dose of ketamine and treatment response in patients with major depressive disorder: A systematic review. J Affect Disord 2020; 264:123-129. [PMID: 32056741 DOI: 10.1016/j.jad.2019.12.023] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 12/11/2019] [Accepted: 12/13/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The relationship between ketamine's hallucinogenic- and dissociative-type effects and antidepressant mechanism of action is poorly understood. This paper reviewed the correlation between subjective effects defined by various psychometric scales and observed clinical outcomes in the treatment of patients with Major Depressive Disorder (MDD). METHODS Based on PRISMA guidelines, we reviewed the dissociative and psychotomimetic mental state induced with ketamine during MDD treatment. Our selected studies correlated depression rating with validated scales collected at regular intervals throughout the study period such as the Clinician-Administered Dissociative States Scale (CADSS), Brief Psychiatric Rating Scale (BPRS), and the 5-Dimensional Altered States of Consciousness Rating Scale (5D-ASC). We excluded studies with bipolar depression or with repeated dosing and no single-dose phase. We included 8 of 556 screened reports. RESULTS Two of five CADSS studies found significant negative correlations between increases in CADSS scores and depression scores. One of six BPRS studies demonstrated correlations between BPRS scores and depression scores. The 5D-ASC's one study found no correlation with the MADRS. CONCLUSIONS Ketamine's dissociative and psychotomimetic effects were correlated with depression changes in 37.5% of studies, but most studies did not examine this relationship and future studies should consider this association since it appears important for MDMA and psilocybin therapies.
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Affiliation(s)
- David S Mathai
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, Houston, TX, United States.
| | - Matthew J Meyer
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, Houston, TX, United States
| | - Eric A Storch
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, Houston, TX, United States
| | - Thomas R Kosten
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, Houston, TX, United States; Baylor College of Medicine, Department of Pharmacology, Houston, TX, United States; Baylor College of Medicine, Department of Neuroscience, Houston, TX, United States
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21
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Gosnell SN, Meyer MJ, Jennings C, Ramirez D, Schmidt J, Oldham J, Salas R. Hippocampal Volume in Psychiatric Diagnoses: Should Psychiatry Biomarker Research Account for Comorbidities? Chronic Stress (Thousand Oaks) 2020; 4:2470547020906799. [PMID: 32440605 PMCID: PMC7219869 DOI: 10.1177/2470547020906799] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/24/2020] [Indexed: 12/26/2022]
Abstract
Background Many research papers claim that patients with specific psychiatric disorders
(major depressive disorder, posttraumatic stress disorder, borderline
personality disorder, alcohol use disorder, and others) have smaller
hippocampi, but most of those reports compared patients to healthy controls.
We hypothesized that if psychiatrically matched controls (psychiatric
control, matched for demographics and psychiatric comorbidities) were used,
much of the biomarker literature in psychiatric research would not
replicate. We used hippocampus and amygdala volume only as examples, as
these are very commonly replicated results in psychiatry biomarker research.
We propose that psychiatry biomarker research could benefit from using
psychiatric controls, as the use of healthy controls results in data that
are not disorder-specific. Method Hippocampus/amygdala volumes were compared between major depressive disorder,
sex-/age-/race-matched healthy control, and psychiatric control
(N = 126/group). Similar comparisons were performed for posttraumatic stress
disorder (N = 67), borderline personality disorder (N = 111), and alcohol
use disorder (N = 136). Results Major depressive disorder patients had smaller left
(p = 8.79 × 10−3) and right (p = 3.13 × 10−3)
hippocampal volumes than healthy control. Posttraumatic stress disorder had
smaller left (p = 0.018) and right (p = 8.64 × 10−4) hippocampi
than healthy control. Borderline personality disorder had smaller right
hippocampus (p = 7.90 × 10−3) and amygdala
(p = 1.49 × 10−3) than healthy control. Alcohol use disorder
had smaller right hippocampus (p = 0.034) and amygdala (p = .024) than
healthy control. No differences were found between any of the four
diagnostic groups and psychiatric control. Conclusion When psychiatric controls were used, there was no difference in hippocampal
or amygdalar volume between any of the diagnoses studied and controls. This
strategy (keeping all possible relevant variables matched between
experimental groups) has been used to advance science for hundreds of years,
and we propose should also be used in biomarker psychiatry research.
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Affiliation(s)
- Savannah N Gosnell
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Matthew J Meyer
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Danna Ramirez
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | | | - John Oldham
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,The Menninger Clinic, Houston, TX, USA
| | - Ramiro Salas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA.,The Menninger Clinic, Houston, TX, USA.,Center for Translational Research on Inflammatory Diseases, Michael E DeBakey VA Medical Center, Houston, TX, USA
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22
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Revilla-León M, Campbell HE, Meyer MJ, Umorin M, Sones A, Zandinejad A. Esthetic dental perception comparisons between 2D- and 3D-simulated dental discrepancies. J Prosthet Dent 2020; 124:763-773. [PMID: 31982145 DOI: 10.1016/j.prosdent.2019.11.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/05/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
STATEMENT OF PROBLEM Intraoral scanners (IOSs), facial scanners (FSs), and computer-aided design (CAD) software programs have become powerful tools for treatment planning. However, discrepancies in perception regarding 2-dimensional (2D) or 3-dimensional (3D) simulations by dentists, dental students, and laypeople have not been analyzed. PURPOSE The purpose of this observational study was to analyze the perceptions of laypersons, dental students, and dentists regarding disparities of the maxillary dental midline and the occlusal plane when analyzing the dental discrepancies on 2D- and 3D-clinical simulations. MATERIAL AND METHODS A female model was digitized by using an FS, IOS, and a full-face smile photograph. Dental discrepancies were simulated by using a 2D photograph (2D group) and 3D scan (3D group) of the model. In both simulation groups, 2 subgroups were produced. The occlusal plane of the first subgroup was modified in 1-degree increments without changing the dental midline or the position of the maxillary dental incisors. In the second subgroup, the occlusal plane was modified by using the same increments, but the maxillary central incisors and dental midline were altered to match the inclination of the occlusal plane. A total of 300 participants (N=300) were asked to rate the 2D images (N=12) and 3D videos (N=12) on a 1-to-6 scale and answer a questionnaire. Ordinal logistic regression was used to analyze the ratings. RESULTS The ratings decreased with the increased tilt of the occlusal plane, and the layperson group gave consistently higher ratings than the other 2 groups. For dentists, the odds of giving a higher versus lower rating decreased by almost a half for each degree of tilt. However, for students, that effect was diminished by a positive interaction term, and for laypersons, the effect was even less. Students gave similar ratings to dentists, but laypersons gave higher ratings. As the age of the participants increased, however, the ratings also increased. The use of 3D versus 2D images had a positive effect on the ratings, but the effect decreased for the student observers and decreased even further for laypersons. Furthermore, midline alteration led to higher ratings but also resulted in worsening of the odds ratio for the tilt. Seventy percent of the dentists, 57% of the dental students, and 52% of the laypersons preferred 2D simulations to 3D simulations. CONCLUSIONS Dentists, dental students, and laypersons decreased their ratings with increased inclination of the occlusal plane; however, laypersons still graded all the 2D and 3D images as esthetically pleasant, giving consistently higher ratings than the dentists and dental students. Overall, 3D simulations obtained higher ratings than 2D images, but the positive effect decreased for the student observers and decreased even further for laypersons.
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Affiliation(s)
- Marta Revilla-León
- Assistant Professor and Assistant Program Director AEGD, Comprehensive Dentistry Department, College of Dentistry, Texas A&M University, Dallas, Texas; Affiliate Assistant Professor, Graduate Prosthodontics, University of Washington, Seattle, Wash; Researcher, Revilla Research Center, Madrid, Spain.
| | - Hayley E Campbell
- Predoctoral student, College of Dentistry, Texas A&M University, Dallas, Texas
| | - Matthew J Meyer
- Predoctoral student, College of Dentistry, Texas A&M University, Dallas, Texas
| | - Mikhail Umorin
- Assistant Professor, Department of Biological Sciences, College of Dentistry, Texas A&M University, Dallas, Texas
| | - Amerian Sones
- Director, Continuing Education, College of Dentistry, Texas A&M University, Dallas, Texas
| | - Amirali Zandinejad
- Associate Professor and Program Director AEGD, Comprehensive Dentistry Department, College of Dentistry, Texas A&M University, Dallas, Texas
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23
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Revilla-León M, Meyer MJ, Zandinejad A, Özcan M. Additive manufacturing technologies for processing zirconia in dental applications. Int J Comput Dent 2020; 23:27-37. [PMID: 32207459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The objective of this narrative review was to summarize the current status and future perspectives of additive manufacturing (AM) technologies with a particular emphasis on manufacturing zirconia-based materials. AM technologies include vat photopolymerization, material jetting, material extrusion, selective laser sintering (SLS), and selective laser melting (SLM) technologies based on either powder bed fusion (PBF) technologies or direct energy deposition, or sheet lamination based on binder jetting technologies. MATERIALS AND METHODS A comprehensive literature review was performed, specifically evaluating AM technologies assigned for processing zirconia. An electronic database search was performed using keywords and MeSH terms. The search was confined to full-text articles written in English and published in peer-reviewed journals between 1999 and 2018. RESULTS A total of 62 articles were included in this review, of which 56 described the AM processes and 6 reported on AM applications in the field of dentistry. A broad diversity of literature exists regarding AM technologies for ceramic materials, which complicates the establishment of a classification system for the current AM technologies for zirconia. The variations in the composition of zirconia slurries or mixtures across different technologies often made it difficult to identify the proper nature of such information. Mechanical properties of printed zirconia materials utilizing different technologies were investigated through a wide range of tests. Overall, the review indicates that manufacturing zirconia using AM technologies could be achieved without issues, but mechanical properties appear to be poor compared with conventional manufacturing procedures. CONCLUSIONS The results of this review indicate the necessity for further potential improvement in AM technologies for manufacturing zirconia reconstructions along with advances in material composition before zirconia could be considered as a material for standard care.
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Lu H, Chen D, Jang S, Wolf B, Ewert S, Flaherty M, Xu F, Isim S, Shim Y, Dornelas C, Balke N, Leber XC, Scharenberg M, Koelln J, Choi E, Ward R, Johnson J, Calzascia T, Isnardi I, Williams J, Huet H, Lees E, Meyer MJ. Abstract C028: Discovery and characterization of next generation monoclonal antibodies targeting the inhibitory Fc gamma receptor CD32b for the treatment of B and plasma cell malignancies. Mol Cancer Ther 2019. [DOI: 10.1158/1535-7163.targ-19-c028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
CD32b (FcγR2b), the sole inhibitory Fcγ receptor, negatively regulates immune function and is expressed throughout B cell development and on their malignant counterparts with the highest expression found on multiple myeloma. Additionally, CD32b expression on tumor cells is known to sequester IgG Fc thereby providing a mechanism of resistance to therapeutic monoclonal antibodies (mAb) with Fc dependent activity. Taken together, CD32b represents an attractive tumor antigen for targeting with a mAb. To this end, two anti-CD32b mAbs, NVS32b1 and NVS32b2, were developed. The complementarity-determining regions (CDRs) of these antibodies bind the CD32b Fc binding domain with high specificity and affinity while the Fc region is afucosylated enabling enhanced activation of FcγR on immune effector cells. This specificity and optimized potency is highlighted in whole blood assays where NVS32b2 depletes CD32b positive B cells but spares immune subsets with low CD32b expression or expression of the homologous CD32a. The antibodies mediate potent killing of opsonized cells via antibody dependent cell-mediated cytotoxicity, antibody dependent cellular phagocytosis, and complement dependent cytotoxicity. Additionally, NVS32b mAbs’ CDR block the CD32b Fc binding domain, thereby minimizing CD32b mediated resistance to therapeutic mAbs with Fc dependent activity including rituximab, obinutuzumab, and daratumumab. In vivo, NVS32b mAbs demonstrate robust antitumor activity against CD32b positive xenografts and immunomodulatory activity including recruitment of intratumoral macrophages. The NVS32b mAbs’ activity against malignant B and plasma cells featuring a range of CD32b expression demonstrates their therapeutic potential, as a single agent or in combination with therapeutics including mAbs with Fc dependent activity.
Citation Format: Haihui Lu, Dongshu Chen, Sunyoung Jang, Babette Wolf, Stefan Ewert, Meghan Flaherty, Fangmin Xu, Sinan Isim, Yeonjiu Shim, Christina Dornelas, Nicole Balke, Xavier Charles Leber, Meike Scharenberg, Johanna Koelln, Eugene Choi, Rebecca Ward, Jennifer Johnson, Thomas Calzascia, Isabelle Isnardi, Juliet Williams, Heather Huet, Emma Lees, Matthew J Meyer. Discovery and characterization of next generation monoclonal antibodies targeting the inhibitory Fc gamma receptor CD32b for the treatment of B and plasma cell malignancies [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; 2019 Oct 26-30; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2019;18(12 Suppl):Abstract nr C028. doi:10.1158/1535-7163.TARG-19-C028
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Affiliation(s)
- Haihui Lu
- 1Novartis Institutes for Biomedical Research, Cambridge, MA
| | - Dongshu Chen
- 1Novartis Institutes for Biomedical Research, Cambridge, MA
| | - Sunyoung Jang
- 1Novartis Institutes for Biomedical Research, Cambridge, MA
| | - Babette Wolf
- 2Novartis Institutes for Biomedical Research, Basel
| | - Stefan Ewert
- 2Novartis Institutes for Biomedical Research, Basel
| | | | - Fangmin Xu
- 1Novartis Institutes for Biomedical Research, Cambridge, MA
| | - Sinan Isim
- 1Novartis Institutes for Biomedical Research, Cambridge, MA
| | - Yeonjiu Shim
- 1Novartis Institutes for Biomedical Research, Cambridge, MA
| | | | - Nicole Balke
- 2Novartis Institutes for Biomedical Research, Basel
| | | | | | - Johanna Koelln
- 1Novartis Institutes for Biomedical Research, Cambridge, MA
| | | | | | | | | | | | | | | | - Emma Lees
- 7Bristol-Myers Squibb, Cambridge, MA
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Roghanian A, Hu G, Fraser C, Singh M, Foxall RB, Meyer MJ, Lees E, Huet H, Glennie MJ, Beers SA, Lim SH, Ashton-Key M, Thirdborough SM, Cragg MS, Chen J. Cyclophosphamide Enhances Cancer Antibody Immunotherapy in the Resistant Bone Marrow Niche by Modulating Macrophage FcγR Expression. Cancer Immunol Res 2019; 7:1876-1890. [PMID: 31451483 PMCID: PMC7780711 DOI: 10.1158/2326-6066.cir-18-0835] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 05/06/2019] [Accepted: 08/21/2019] [Indexed: 12/14/2022]
Abstract
Therapy-resistant microenvironments represent a major barrier toward effective elimination of disseminated cancer. Many hematologic and solid tumors are resistant to therapeutic antibodies in the bone marrow (BM), but not in the periphery (e.g., spleen). We previously showed that cyclophosphamide (CTX) sensitizes the BM niche to antibody therapeutics. Here, we show that (i) BM resistance was induced not only by the tumor but also by the intrinsic BM microenvironment; (ii) CTX treatment overcame both intrinsic and extrinsic resistance mechanisms by augmenting macrophage activation and phagocytosis, including significant upregulation of activating Fcγ receptors (FcγRIII and FcγRIV) and downregulation of the inhibitory receptor, FcγRIIB; and (iii) CTX synergized with cetuximab (anti-EGFR) and trastuzumab (anti-Her2) in eliminating metastatic breast cancer in the BM of humanized mice. These findings provide insights into the mechanisms by which CTX synergizes with antibody therapeutics in resistant niche-specific organs and its applicability in treating BM-resident tumors.
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Affiliation(s)
- Ali Roghanian
- Koch Institute for Integrative Cancer Research and Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts.
- Antibody and Vaccine Group, Centre for Cancer Immunology, Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Cancer Research UK Centre, University of Southampton, Southampton, United Kindgom
| | - Guangan Hu
- Koch Institute for Integrative Cancer Research and Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Christopher Fraser
- Koch Institute for Integrative Cancer Research and Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Maneesh Singh
- Koch Institute for Integrative Cancer Research and Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Russell B Foxall
- Antibody and Vaccine Group, Centre for Cancer Immunology, Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Cancer Research UK Centre, University of Southampton, Southampton, United Kindgom
| | - Matthew J Meyer
- Novartis Institute for Biomedical Research, Inc., Cambridge, Massachusetts
| | - Emma Lees
- Novartis Institute for Biomedical Research, Inc., Cambridge, Massachusetts
| | - Heather Huet
- Novartis Institute for Biomedical Research, Inc., Cambridge, Massachusetts
| | - Martin J Glennie
- Antibody and Vaccine Group, Centre for Cancer Immunology, Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Cancer Research UK Centre, University of Southampton, Southampton, United Kindgom
| | - Stephen A Beers
- Antibody and Vaccine Group, Centre for Cancer Immunology, Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Cancer Research UK Centre, University of Southampton, Southampton, United Kindgom
| | - Sean H Lim
- Antibody and Vaccine Group, Centre for Cancer Immunology, Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Cancer Research UK Centre, University of Southampton, Southampton, United Kindgom
| | - Margaret Ashton-Key
- Antibody and Vaccine Group, Centre for Cancer Immunology, Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Cancer Research UK Centre, University of Southampton, Southampton, United Kindgom
| | | | - Mark S Cragg
- Antibody and Vaccine Group, Centre for Cancer Immunology, Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Cancer Research UK Centre, University of Southampton, Southampton, United Kindgom
| | - Jianzhu Chen
- Koch Institute for Integrative Cancer Research and Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts.
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Udelsman BV, Govea N, Cooper Z, Chang DC, Bader A, Meyer MJ. Concordance in advance care preferences among high-risk surgical patients and surrogate health care decision makers in the perioperative setting. Surgery 2019; 167:396-403. [PMID: 31668357 DOI: 10.1016/j.surg.2019.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/09/2019] [Accepted: 08/17/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Earlier studies have demonstrated poor concordance between patients' advance care preferences and those endorsed by their surrogate health care decision makers in a medical setting. This study aimed to determine concordance in the perioperative setting among high-risk patients and to identify areas for improvement. METHODS This was a prospective cohort study set in a preoperative clinic for high-risk patients. Patients (>55 y) and their surrogates (dyads) were eligible for participation. Dyads were surveyed on the patient's desire for advance care preferences (cardiopulmonary resuscitation, mechanical ventilation, hemodialysis, artificial nutrition) and tolerance for physical disability, cognitive disability, and chronic pain. Concordance was defined as the surrogate correctly predicting patient preferences. Patients and surrogates were resurveyed for concordance 30 to 60 d after the index procedure. RESULTS A total of 100 dyads (200 subjects) completed the survey. Median patient age was 68 y. Most patients were white (87%) and had an American Society of Anesthesiologists score of III (88%). The majority of dyads (59%) reported prior conversations about advance care preferences. Concordance specifically for cardiopulmonary resuscitation was 84%. In all other domains, <60% of dyads achieved concordance. Prior conversations regarding advance care preferences did not improve concordance in univariable or multivariable analysis. In postoperative surveys, substantial improvement was found in all domains except mechanical ventilation and cardiopulmonary resuscitation. CONCLUSION In all domains except cardiopulmonary resuscitation, concordance was <60% in the preoperative setting and was not improved among dyads who reported prior conversations regarding advance care preferences. Discordance may limit patient autonomy by prolonging undesired interventions or terminating desired interventions prematurely.
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Affiliation(s)
| | - Nicolas Govea
- Department of Anesthesiology, NewYork-Presbyterian-Weill Cornell Medical Center, New York, NY
| | - Zara Cooper
- Department of Surgery, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Boston, MA
| | - David C Chang
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Angela Bader
- Center for Surgery and Public Health, Boston, MA; Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA
| | - Matthew J Meyer
- Department of Anesthesiology, University of Virginia, Charlottesville, VA
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Feng T, Golji J, Li A, Zhang X, Ruddy DA, Rakiec DP, Geyer FC, Gu J, Gao H, Williams JA, Stuart DD, Meyer MJ. Distinct Transcriptional Programming Drive Response to MAPK Inhibition in BRAF V600-Mutant Melanoma Patient-Derived Xenografts. Mol Cancer Ther 2019; 18:2421-2432. [PMID: 31527224 DOI: 10.1158/1535-7163.mct-19-0028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 06/26/2019] [Accepted: 09/10/2019] [Indexed: 11/16/2022]
Abstract
Inhibitors targeting BRAF and its downstream kinase MEK produce robust response in patients with advanced BRAF V600-mutant melanoma. However, the duration and depth of response vary significantly between patients; therefore, predicting response a priori remains a significant challenge. Here, we utilized the Novartis collection of patient-derived xenografts to characterize transcriptional alterations elicited by BRAF and MEK inhibitors in vivo, in an effort to identify mechanisms governing differential response to MAPK inhibition. We show that the expression of an MITF-high, "epithelial-like" transcriptional program is associated with reduced sensitivity and adaptive response to BRAF and MEK inhibitor treatment. On the other hand, xenograft models that express an MAPK-driven "mesenchymal-like" transcriptional program are preferentially sensitive to MAPK inhibition. These gene-expression programs are somewhat similar to the MITF-high and -low phenotypes described in cancer cell lines, but demonstrate an inverse relationship with drug response. This suggests a discrepancy between in vitro and in vivo experimental systems that warrants future investigations. Finally, BRAF V600-mutant melanoma relies on either MAPK or alternative pathways for survival under BRAF and MEK inhibition in vivo, which in turn predicts their response to further pathway suppression using a combination of BRAF, MEK, and ERK inhibitors. Our findings highlight the intertumor heterogeneity in BRAF V600-mutant melanoma, and the need for precision medicine strategies to target this aggressive cancer.
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Affiliation(s)
- Tianshu Feng
- Oncology Drug Discovery, Novartis Institutes for BioMedical Research (NIBR), Cambridge, Massachusetts
| | - Javad Golji
- Oncology Drug Discovery, Novartis Institutes for BioMedical Research (NIBR), Cambridge, Massachusetts
| | - Ailing Li
- Oncology Drug Discovery, Novartis Institutes for BioMedical Research (NIBR), Cambridge, Massachusetts
| | - Xiamei Zhang
- Oncology Drug Discovery, Novartis Institutes for BioMedical Research (NIBR), Cambridge, Massachusetts
| | - David A Ruddy
- Oncology Drug Discovery, Novartis Institutes for BioMedical Research (NIBR), Cambridge, Massachusetts
| | - Daniel P Rakiec
- Oncology Drug Discovery, Novartis Institutes for BioMedical Research (NIBR), Cambridge, Massachusetts
| | - Felipe C Geyer
- Oncology Drug Discovery, Novartis Institutes for BioMedical Research (NIBR), Cambridge, Massachusetts
| | - Jane Gu
- Oncology Drug Discovery, Novartis Institutes for BioMedical Research (NIBR), Cambridge, Massachusetts
| | - Hui Gao
- Oncology Drug Discovery, Novartis Institutes for BioMedical Research (NIBR), Cambridge, Massachusetts
| | - Juliet A Williams
- Oncology Drug Discovery, Novartis Institutes for BioMedical Research (NIBR), Cambridge, Massachusetts
| | - Darrin D Stuart
- Oncology Drug Discovery, Novartis Institutes for BioMedical Research (NIBR), Cambridge, Massachusetts.
| | - Matthew J Meyer
- Oncology Drug Discovery, Novartis Institutes for BioMedical Research (NIBR), Cambridge, Massachusetts.
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Hao HX, Wang H, Liu C, Kovats S, Velazquez R, Lu H, Pant B, Shirley M, Meyer MJ, Pu M, Lim J, Fleming M, Alexander L, Farsidjani A, LaMarche MJ, Moody S, Silver SJ, Caponigro G, Stuart DD, Abrams TJ, Hammerman PS, Williams J, Engelman JA, Goldoni S, Mohseni M. Tumor Intrinsic Efficacy by SHP2 and RTK Inhibitors in KRAS-Mutant Cancers. Mol Cancer Ther 2019; 18:2368-2380. [DOI: 10.1158/1535-7163.mct-19-0170] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/10/2019] [Accepted: 08/16/2019] [Indexed: 11/16/2022]
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Abstract
Anesthesiologists request units of plasma in anticipation of transfusion. The amount of plasma transfused intraoperatively is less than that issued (requested, thawed, and sent). We presented institutional-specific data on plasma usage including anesthesiologist-specific ratios of plasma issued-to-transfused. In month-to-month comparisons from the year before the presentation (June-December 2015) to 7 months after (June-December 2016), plasma issued to the operating room was reduced from 434.9 ± 81 to 327.3 ± 65 units, a change of 107.6 units per month (95% confidence interval [CI], 22-193); plasma discarded by the blood bank was reduced from 109.7 ± 48 units to 69.1 ± 9 units, a change of 40.6 units per month (95% CI, 0.2-81); and plasma transfused went from 188.4 ± 42 units to 160.7 ± 52 units, a nonsignificant change of 27.7 units per month (95% CI, -27 to 83).
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Affiliation(s)
- Matthew J Meyer
- From the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Duong P, Sauvé-Schenk K, Egan MY, Meyer MJ, Morrison T. Operational Definitions and Estimates of Return to Work Poststroke: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2019; 100:1140-1152. [DOI: 10.1016/j.apmr.2018.09.121] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/13/2018] [Accepted: 09/19/2018] [Indexed: 11/29/2022]
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Revilla-León M, Meyer MJ, Barrington JJ, Sones A, Umorin MP, Taleghani M, Zandinejad A. Perception of occlusal plane that is nonparallel to interpupillary and commissural lines but with the maxillary dental midline ideally positioned. J Prosthet Dent 2019; 122:482-490. [PMID: 31003694 DOI: 10.1016/j.prosdent.2019.01.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 11/24/2022]
Abstract
STATEMENT OF PROBLEM How disparities in parallelism between the occlusal plane and the interpupillary (IP) or commissural facial front lines are perceived is unclear. PURPOSE The purpose of this observational study was to examine the perceptions of laypersons, dental students, and dentists regarding disparities of the anterior occlusal plane (AOP) and posterior occlusal plane (POP) with respect to the IP and commissural line (CL) with the maxillary dental midline ideally positioned. MATERIAL AND METHODS A model of a symmetric female face was digitally created with the IP and CL parallel and the facial midline coincident with the maxillary dental midline. Two groups of images were created, one with the POP modified in 1-degree increments, in which both the maxillary dental midline and the position of the maxillary central incisors were not manipulated, and the other with the POP modified in the same increments but with the position of both maxillary central incisors lengthened to follow the inclination of the occlusal plane. Participants (N=312) were asked to rate the images on a 1-to-6 scale. The Kruskal-Wallis medians test and ordinal logistic regression were used to analyze the ratings. RESULTS Group median ratings for different occupations gradually decreased with increased inclination of the occlusal plane. Significant differences were found for inclinations from 2 to 5 degrees. Significant odd ratios were found for age and sex. CONCLUSIONS Dental professionals detected smaller POP disparities. The dentist and dental student groups gave lower ratings in proportion to the amount of POP inclination. Laypersons gave lower ratings only after 3 degrees of POP inclination but still graded all the images as esthetically pleasant. Older people and men tended to give higher ratings to the same image.
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Affiliation(s)
- Marta Revilla-León
- Assistant Professor and Assistant Program Director AEGD, College of Dentistry, Texas A&M University, Dallas, Texas; Affiliate Faculty, Graduate Prosthodontics, University of Washington, Seattle, Wash; Researcher, Revilla Research Center, Madrid, Spain.
| | - Matthew J Meyer
- Predoctoral student, College of Dentistry, Texas A&M University, Dallas, Texas
| | - Jennifer J Barrington
- Clinical Associate Professor and Director Comprehensive Care Program, Department of General Dentistry, College of Dentistry, Texas A&M University, Dallas, Texas
| | - Amerian Sones
- Director, Continuing Education, College of Dentistry, Texas A&M University, Dallas, Texas
| | - Mikhail P Umorin
- Assistant Professor, Department of Biological Sciences, College of Dentistry, Texas A&M University, Dallas, Texas
| | - Mohsen Taleghani
- Chair, Department of General Dentistry, College of Dentistry, Texas A&M University, Dallas, Texas
| | - Amirali Zandinejad
- Associate Professor and Program Director AEGD, College of Dentistry, Texas A&M University, Dallas, Texas
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Revilla-León M, Meyer MJ, Özcan M. Metal additive manufacturing technologies: literature review of current status and prosthodontic applications. Int J Comput Dent 2019; 22:55-67. [PMID: 30848255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To review the current metal-based additive manufacturing (AM) technologies, namely powder bed fusion (PBF) technologies, and their current prosthodontic applications. The PBF technologies reviewed are selective laser sintering (SLS), selective laser melting (SLM), and electron beam melting (EBM). MATERIALS AND METHODS The literature on metal AM technologies was considered, and the AM procedures and their current applications in prosthodontics were collated and described. Published articles about AM metal in dental care were searched (MEDLINE, EMBASE, EBSCO, and Web of Science). All studies related to the description, analysis, and evaluation of prosthodontic applications using metal AM technologies. RESULTS AND CONCLUSIONS AM technologies are reliable for many applications in dentistry, including metal frameworks for removable partial dentures (RPDs), overdentures, tooth- and implant-supported fixed dental prostheses (FDPs), and metal frameworks for splinting implant impression abutments. However, further studies are needed in future to evaluate the accuracy, reproducibility, and clinical outcome throughout function of AM technologies.
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Meyer MJ, Teasell R, Thind A, Koval J, Speechley M. In-Home Rehabilitation Resources and Avoidable Admissions to Inpatient Rehabilitation after Stroke: An Ecological Study. Rehabil Process Outcome 2018. [DOI: 10.1177/1179572718820543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and purpose: In Ontario (Canada’s most populous province), it has been suggested that mildly impaired stroke patients are being admitted to inpatient rehabilitation unnecessarily due to a lack of alternative options in the community. This ecological study aimed to formally test this hypothesis. Methods: Patients admitted to an inpatient rehabilitation bed in Ontario’s most highly functioning patient classification group (Rehabilitation Patient Group 1160) were retrospectively identified as potentially avoidable admissions, and the proportion of such patients was calculated for each Local Health Integration Network every year between 2006/2007 and 2010/2011. Five indicators of community-based rehabilitation availability were used to test the relationships between avoidable admissions and resource indicators. Results: Of the 25 correlations tested, 21 agreed with the hypothesized direction of effect and 4 reached statistical significance. Logistic-linear regressions on combined data from each of the 5 years demonstrated statistically significant associations between all 5 resource indicators and the proportion of potentially avoidable admissions. Conclusions: This study confirms the suggestion of variation in the proportion of mildly impaired patients admitted to inpatient rehabilitation across Ontario’s Local Health Integration Networks. It also adds evidence to support the concern that a lack of community-based rehabilitation is contributing to these potentially avoidable admissions.
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Affiliation(s)
- Matthew J Meyer
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Department of Decision Sciences London Health Sciences Centre, London, ON, Canada
- Aging, Rehabilitation & Geriatric Care Research Centre, Lawson Health Research Institute, London, ON, Canada
| | - Robert Teasell
- Aging, Rehabilitation & Geriatric Care Research Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine & Dentistry, London, ON, Canada
- Department of Physical Medicine and Rehabilitation, St. Joseph’s Healthcare, London, ON, Canada
| | - Amardeep Thind
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Schulich Interfaculty Program in Public Health, Western University, London, ON, Canada
- Department of Family Medicine, Schulich School of Medicine & Dentistry, London, ON, Canada
| | - John Koval
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Schulich Interfaculty Program in Public Health, Western University, London, ON, Canada
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Meyer MJ, Teasell R, Kelloway L, Meyer SB, Willems D, O'Callaghan C. Timely access to inpatient rehabilitation after stroke: a qualitative study of perceived barriers and potential solutions in Ontario, Canada. Disabil Rehabil 2017; 40:3120-3126. [PMID: 28922947 DOI: 10.1080/09638288.2017.1377296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Stroke units have been established as best practice care, in part because they offer timely initiation of rehabilitation. Experts in Ontario, Canada recommend that eligible patients be transferred to inpatient rehabilitation (on average) by day 5 after ischemic stroke and day 7 after a hemorrhagic stroke. This study explores perceived barriers to implementation of these recommendations and potential solutions. METHOD Exploratory focus groups were held with stakeholders from five geographically diverse regions across Ontario between September 2011 and January 2012. Participants were asked to consider the recommendations, list perceived barriers and to collectively discuss potential solutions. Data analysis included coding of transcribed data, sorting material to identify themes and confronting themes with a formalized body of knowledge. RESULTS Barriers identified by participants fell into three categories: patient-centered, clinician-focused and resource or system based, within these, specific challenges included managing patients' medical and emotional readiness for rehabilitation, timely completion of medical tests, staff comfort in discharging patients, dedicated transportation and funding-related concerns. CONCLUSIONS The structure of Ontario's health care system presents challenges to early transfer of stroke patients to inpatient rehabilitation, yet the stakeholders consulted in this study felt that these could be addressed with proper planning, improved coordination and targeted investment. Implications for rehabilitation Stroke units are a well-established best practice in stroke care and timely access to rehabilitation is a key component of their effectiveness. Stroke experts in Ontario, Canada recommend transfer of suitable patients to inpatient rehabilitation on day 5 and day 7, on average, after ischemic and hemorrhagic stroke, respectively. Stakeholders report that meeting these targets may require some adjustments to local processes of care, many of which can be achieved with little to no financial investment.
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Affiliation(s)
- Matthew J Meyer
- a Lawson Health Research Institute, Parkwood Institute , London , ON , Canada.,b London Health Sciences Centre , London , ON , Canada.,c Ontario Stroke Network , Toronto , ON , Canada.,d Department of Epidemiology and Biostatistics , Western University , London , ON , Canada
| | - Robert Teasell
- a Lawson Health Research Institute, Parkwood Institute , London , ON , Canada.,e St. Joseph's Health Care, Parkwood Institute , London , ON , Canada.,f Physical Medicine and Rehabilitation , Schulich School of Medicine and Dentistry, University of Western Ontario , London , ON , Canada
| | | | - Samantha B Meyer
- g School of Public Health and Health Systems , University of Waterloo , Waterloo , ON , Canada
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Pu M, Bonte LRL, Spence S, Hsiao K, Liu S, Firestone B, Wang P, Fortin PD, Chen YNP, LaMarche MJ, Meyer MJ. Abstract 1176: Preclinical characterization of the pharmacokinetic-pharmacodynamics-efficacy relationship of novel allosteric SHP2 inhibitors. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-1176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
SHP2 is a non-receptor protein tyrosine phosphatase downstream of receptor tyrosine kinases (RTK). Mutations yielding constitutive activation of SHP2 primarily lead to activation of the MAPK pathway and have been found in multiple tumor types. These observations make SHP2 a potentially promising therapeutic target for the treatment of cancers with RTK dependence. Recently, a novel allosteric mechanism of SHP2 inhibition was identified where the autoinhibited form of SHP2 is stabilized via small molecule binding. Herein we describe efforts to characterize the pharmacokinetic (PK)/pharmacodynamic (PD)/efficacy relationship of orally bioavailable novel allosteric SHP2 inhibitors.
Single dose PK/PD studies were conducted in nude mice engrafted with the EGFR amplified esophageal squamous cell carcinoma cell line, KYSE520. The allosteric SHP2 inhibitor SHP099 achieved time and dose dependent increases in plasma concentrations and concomitant reductions in tumor pERK that could be described by an Emax model. Tumor pERK levels were reduced by 50 to 70% when SHP099 unbound plasma concentrations exceeded the in vitro cellular PD IC50, suggesting that exposure above this threshold was required for pathway inhibition in vivo. A second allosteric SHP2 inhibitor, SHP065, was also profiled in vivo and yielded data consistent with this hypothesis. Two additional allosteric SHP2 inhibitors (SHP156, SHP393) that achieved unbound plasma concentrations approximating their cellular IC50s failed to modulate tumor pERK. The totality of these data support the hypothesis that unbound plasma concentrations in excess of the cellular IC50 is required for allosteric SHP2 inhibitors to inhibit the MAPK pathway in vivo.
We further demonstrated that SHP099 achieves dose dependent inhibition of KYSE520 tumor xenograft growth in nude mice. Integration of the antitumor efficacy data and pERK inhibition data revealed a direct linear relationship between tumor growth inhibition and the fraction of time between dosing intervals in which pERK is inhibited by at least 50%. To test this model, SHP099 PK data from nude rats was applied to the Emax model and the resulting predicted PD responses were applied to the PD/efficacy model to predict SHP099 anti-tumor efficacy in nude rats. Data generated from a SHP099 KYSE520 efficacy study in nude rats demonstrated that the exposure/response model was remarkably robust. Doses of 8 mg/kg qd, 25 mg/kg qd, or 75 mg/kg q2d yielded observed T/C of 70, 14, and 18%, respectively; versus a model predicted T/C of 75, 6, and 6%, respectively. In summary, we describe for the first time successful efforts to characterize the PK/PD/efficacy relationship of novel allosteric SHP2 inhibitors. These exposure/response models served as a basis for further allosteric SHP2 inhibitor drug discovery efforts and begin to inform rational approaches to dose and schedule selection in clinic.
Citation Format: Minying Pu, Laura R. La Bonte, Stan Spence, Kathy Hsiao, Shumei Liu, Brant Firestone, Ping Wang, Pascal D. Fortin, Ying-Nan P. Chen, Matthew J. LaMarche, Matthew J. Meyer. Preclinical characterization of the pharmacokinetic-pharmacodynamics-efficacy relationship of novel allosteric SHP2 inhibitors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1176. doi:10.1158/1538-7445.AM2017-1176
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Affiliation(s)
- Minying Pu
- Novartis Insts. for BioMedical Research, Cambridge, MA
| | | | - Stan Spence
- Novartis Insts. for BioMedical Research, Cambridge, MA
| | - Kathy Hsiao
- Novartis Insts. for BioMedical Research, Cambridge, MA
| | - Shumei Liu
- Novartis Insts. for BioMedical Research, Cambridge, MA
| | | | - Ping Wang
- Novartis Insts. for BioMedical Research, Cambridge, MA
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Acker MG, Chen YNP, LaMarche MJ, Chan HM, Fekkes P, Garcia-Fortanet J, LaRochelle JR, Antonakos B, Chen CHT, Chen Z, Cooke VG, Dobson JR, Deng Z, Feng F, Firestone B, Fodor M, Fridrich C, Gao H, Hao HX, Jacob J, Ho S, Hsiao K, Kang ZB, Karki R, Kato M, Larrow J, Bonte LRL, Liu G, Liu S, Majumdar D, Meyer MJ, Palermo M, Pu M, Price E, Shakya S, Shultz MD, Venkatesan K, Wang P, Warmuth M, Williams S, Yang G, Yuan J, Zhang JH, Zhu P, Blacklow SC, Ramsey T, Keen NJ, Sellers WR, Stams T, Fortin PD. Abstract 2084: Conformational activation and allosteric inhibition of SHP2 in RTK-driven cancers. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-2084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The non-receptor protein tyrosine phosphatase (PTP) SHP2 is an important component of RTK signaling in response to growth factor stimulus and sits just upstream of the RAS-MAPK signaling cascade. The first oncogenic phosphatase to be identified, SHP2 is dysregulated in multiple human diseases including the developmental disorders Noonan and Leopard syndromes, as well as leukemia, lung cancer and neuroblastoma where aberrant activity of SHP2 leads to uncontrolled MAPK signaling. Cancer-associated activating mutations in SHP2 impart an “auto-on” state of the enzyme, boosting basal activity by shifting the equilibrium away from the auto-inhibited state. Reduction of SHP2 activity through genetic knockdown suppresses tumor growth, validating SHP2 as a target for cancer therapy. SHP099, a recently reported potent and selective allosteric inhibitor of SHP2, stabilizes the auto-inhibited form of SHP2 through interactions with the N-terminal SH2 and C-terminal PTP domains of the protein. SHP099 suppresses MAPK signaling in RTK amplified cancers resulting in suppressed proliferation in vitro and inhibition of tumor growth in mouse tumor xenograft models. Together, these data demonstrate the therapeutic potential of SHP2 inhibition in the treatment of cancer and other RAS/MAPK-linked diseases.
Citation Format: Michael G. Acker, Ying-Nan P. Chen, Matthew J. LaMarche, Ho Man Chan, Peter Fekkes, Jorge Garcia-Fortanet, Jonathan R. LaRochelle, Brandon Antonakos, Christine Hiu-Tung Chen, Zhuoliang Chen, Vesselina G. Cooke, Jason R. Dobson, Zhan Deng, Fei Feng, Brant Firestone, Michelle Fodor, Cary Fridrich, Hui Gao, Huai-Xiang Hao, Jaison Jacob, Samuel Ho, Kathy Hsiao, Zhao B. Kang, Rajesh Karki, Mitsunori Kato, Jay Larrow, Laura R. La Bonte, Gang Liu, Shumei Liu, Dyuti Majumdar, Matthew J. Meyer, Mark Palermo, Minying Pu, Edmund Price, Subarna Shakya, Michael D. Shultz, Kavitha Venkatesan, Ping Wang, Markus Warmuth, Sarah Williams, Guizhi Yang, Jing Yuan, Ji-Hu Zhang, Ping Zhu, Stephen C. Blacklow, Timothy Ramsey, Nicholas J. Keen, William R. Sellers, Travis Stams, Pascal D. Fortin. Conformational activation and allosteric inhibition of SHP2 in RTK-driven cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2084. doi:10.1158/1538-7445.AM2017-2084
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Affiliation(s)
| | | | | | - Ho Man Chan
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | - Peter Fekkes
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | | | | | | | | | - Zhuoliang Chen
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | | | | | - Zhan Deng
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | - Fei Feng
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | | | - Michelle Fodor
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | - Cary Fridrich
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | - Hui Gao
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | - Huai-Xiang Hao
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | - Jaison Jacob
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | - Samuel Ho
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | - Kathy Hsiao
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | - Zhao B. Kang
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | - Rajesh Karki
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | - Mitsunori Kato
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | - Jay Larrow
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | | | - Gang Liu
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | - Shumei Liu
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | - Dyuti Majumdar
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | | | - Mark Palermo
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | - Minying Pu
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | - Edmund Price
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | - Subarna Shakya
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | | | | | - Ping Wang
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | - Markus Warmuth
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | - Sarah Williams
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | - Guizhi Yang
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | - Jing Yuan
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | - Ji-Hu Zhang
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | - Ping Zhu
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | | | - Timothy Ramsey
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
| | | | | | - Travis Stams
- 1Novartis Institutes for BioMedical Research, Cambridge, MA
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Bialucha CU, Collins SD, Li X, Saxena P, Zhang X, Dürr C, Lafont B, Prieur P, Shim Y, Mosher R, Lee D, Ostrom L, Hu T, Bilic S, Rajlic IL, Capka V, Jiang W, Wagner JP, Elliott G, Veloso A, Piel JC, Flaherty MM, Mansfield KG, Meseck EK, Rubic-Schneider T, London AS, Tschantz WR, Kurz M, Nguyen D, Bourret A, Meyer MJ, Faris JE, Janatpour MJ, Chan VW, Yoder NC, Catcott KC, McShea MA, Sun X, Gao H, Williams J, Hofmann F, Engelman JA, Ettenberg SA, Sellers WR, Lees E. Discovery and Optimization of HKT288, a Cadherin-6-Targeting ADC for the Treatment of Ovarian and Renal Cancers. Cancer Discov 2017; 7:1030-1045. [PMID: 28526733 DOI: 10.1158/2159-8290.cd-16-1414] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/11/2017] [Accepted: 05/10/2017] [Indexed: 11/16/2022]
Abstract
Despite an improving therapeutic landscape, significant challenges remain in treating the majority of patients with advanced ovarian or renal cancer. We identified the cell-cell adhesion molecule cadherin-6 (CDH6) as a lineage gene having significant differential expression in ovarian and kidney cancers. HKT288 is an optimized CDH6-targeting DM4-based antibody-drug conjugate (ADC) developed for the treatment of these diseases. Our study provides mechanistic evidence supporting the importance of linker choice for optimal antitumor activity and highlights CDH6 as an antigen for biotherapeutic development. To more robustly predict patient benefit of targeting CDH6, we incorporate a population-based patient-derived xenograft (PDX) clinical trial (PCT) to capture the heterogeneity of response across an unselected cohort of 30 models-a novel preclinical approach in ADC development. HKT288 induces durable tumor regressions of ovarian and renal cancer models in vivo, including 40% of models on the PCT, and features a preclinical safety profile supportive of progression toward clinical evaluation.Significance: We identify CDH6 as a target for biotherapeutics development and demonstrate how an integrated pharmacology strategy that incorporates mechanistic pharmacodynamics and toxicology studies provides a rich dataset for optimizing the therapeutic format. We highlight how a population-based PDX clinical trial and retrospective biomarker analysis can provide correlates of activity and response to guide initial patient selection for first-in-human trials of HKT288. Cancer Discov; 7(9); 1030-45. ©2017 AACR.This article is highlighted in the In This Issue feature, p. 920.
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Affiliation(s)
- Carl U Bialucha
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts.
| | - Scott D Collins
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Xiao Li
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Parmita Saxena
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Xiamei Zhang
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Clemens Dürr
- Novartis Institutes for Biomedical Research, Novartis Campus, Basel, Switzerland
| | - Bruno Lafont
- Novartis Institutes for Biomedical Research, Novartis Campus, Basel, Switzerland
| | - Pierric Prieur
- Novartis Institutes for Biomedical Research, Novartis Campus, Basel, Switzerland
| | - Yeonju Shim
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Rebecca Mosher
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - David Lee
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Lance Ostrom
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Tiancen Hu
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Sanela Bilic
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | | | - Vladimir Capka
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Wei Jiang
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Joel P Wagner
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - GiNell Elliott
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Artur Veloso
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Jessica C Piel
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Meghan M Flaherty
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Keith G Mansfield
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Emily K Meseck
- Novartis Institutes for Biomedical Research, East Hanover, New Jersey
| | - Tina Rubic-Schneider
- Novartis Institutes for Biomedical Research, Campus Klybeckstrasse, Basel, Switzerland
| | | | | | - Markus Kurz
- Novartis Pharma AG, Novartis Campus, Basel, Switzerland
| | - Duc Nguyen
- Novartis Pharma, Cambridge, Massachusetts
| | - Aaron Bourret
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Matthew J Meyer
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Jason E Faris
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Mary J Janatpour
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Vivien W Chan
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | | | | | | | | | - Hui Gao
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Juliet Williams
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Francesco Hofmann
- Novartis Institutes for Biomedical Research, Campus Klybeckstrasse, Basel, Switzerland
| | | | - Seth A Ettenberg
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - William R Sellers
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Emma Lees
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
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Schaller SJ, Anstey M, Blobner M, Edrich T, Grabitz SD, Gradwohl-Matis I, Heim M, Houle T, Kurth T, Latronico N, Lee J, Meyer MJ, Peponis T, Talmor D, Velmahos GC, Waak K, Walz JM, Zafonte R, Eikermann M. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet 2016; 388:1377-1388. [PMID: 27707496 DOI: 10.1016/s0140-6736(16)31637-3] [Citation(s) in RCA: 405] [Impact Index Per Article: 50.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/13/2016] [Accepted: 07/19/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Immobilisation predicts adverse outcomes in patients in the surgical intensive care unit (SICU). Attempts to mobilise critically ill patients early after surgery are frequently restricted, but we tested whether early mobilisation leads to improved mobility, decreased SICU length of stay, and increased functional independence of patients at hospital discharge. METHODS We did a multicentre, international, parallel-group, assessor-blinded, randomised controlled trial in SICUs of five university hospitals in Austria (n=1), Germany (n=1), and the USA (n=3). Eligible patients (aged 18 years or older, who had been mechanically ventilated for <48 h, and were expected to require mechanical ventilation for ≥24 h) were randomly assigned (1:1) by use of a stratified block randomisation via restricted web platform to standard of care (control) or early, goal-directed mobilisation using an inter-professional approach of closed-loop communication and the SICU optimal mobilisation score (SOMS) algorithm (intervention), which describes patients' mobilisation capacity on a numerical rating scale ranging from 0 (no mobilisation) to 4 (ambulation). We had three main outcomes hierarchically tested in a prespecified order: the mean SOMS level patients achieved during their SICU stay (primary outcome), and patient's length of stay on SICU and the mini-modified functional independence measure score (mmFIM) at hospital discharge (both secondary outcomes). This trial is registered with ClinicalTrials.gov (NCT01363102). FINDINGS Between July 1, 2011, and Nov 4, 2015, we randomly assigned 200 patients to receive standard treatment (control; n=96) or intervention (n=104). Intention-to-treat analysis showed that the intervention improved the mobilisation level (mean achieved SOMS 2·2 [SD 1·0] in intervention group vs 1·5 [0·8] in control group, p<0·0001), decreased SICU length of stay (mean 7 days [SD 5-12] in intervention group vs 10 days [6-15] in control group, p=0·0054), and improved functional mobility at hospital discharge (mmFIM score 8 [4-8] in intervention group vs 5 [2-8] in control group, p=0·0002). More adverse events were reported in the intervention group (25 cases [2·8%]) than in the control group (ten cases [0·8%]); no serious adverse events were observed. Before hospital discharge 25 patients died (17 [16%] in the intervention group, eight [8%] in the control group). 3 months after hospital discharge 36 patients died (21 [22%] in the intervention group, 15 [17%] in the control group). INTERPRETATION Early, goal-directed mobilisation improved patient mobilisation throughout SICU admission, shortened patient length of stay in the SICU, and improved patients' functional mobility at hospital discharge. FUNDING Jeffrey and Judy Buzen.
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Affiliation(s)
- Stefan J Schaller
- Klinik für Anaesthesiologie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Matthew Anstey
- Department of Intensive Care, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Manfred Blobner
- Klinik für Anaesthesiologie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Thomas Edrich
- Department of Anesthesiology and Critical Care, Klinikum Landkreis Erding, Erding, Germany; Universitätsklinik für Anästhesiologie, perioperative Medizin und allgemeine Intensivmedizin, Universitätsklinikum Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Stephanie D Grabitz
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ilse Gradwohl-Matis
- Universitätsklinik für Anästhesiologie, perioperative Medizin und allgemeine Intensivmedizin, Universitätsklinikum Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Markus Heim
- Klinik für Anaesthesiologie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Timothy Houle
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tobias Kurth
- Institute of Public Health, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Nicola Latronico
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, University of Brescia, Brescia, Italy
| | - Jarone Lee
- Department of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew J Meyer
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Thomas Peponis
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Daniel Talmor
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - George C Velmahos
- Department of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Karen Waak
- Department of Physical Therapy, Massachusetts General Hospital, Boston, MA, USA
| | - J Matthias Walz
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham, MA, USA; Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Matthias Eikermann
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Universität Duisburg-Essen, Klinik für Anaesthesiologie und Intensivmedizin, Essen, Germany.
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Affiliation(s)
- Matthew J Meyer
- From the *Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts; †Department of Anesthesiology, Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota; ‡Department of Anesthesiology and Perioperative Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
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Bialucha CU, Collins SD, Shim Y, Zhang X, Velazquez R, Kowal C, Bullock C, Cai H, Rivera SM, Goldovitz JM, Kurth E, Loo AT, Yang G, Green J, Ostrom L, Meyer MJ, Mosher R, Gao H, Williams J, Lees E. Abstract 872: In vivo activity of a novel CDH6 targeting antibody-drug conjugate, including population-scale ovarian PDX clinical trial. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The Cadherin-6 (CDH6) gene was found to be frequently overexpressed in ovarian and renal cancers, while featuring a lineage-restricted normal tissue expression pattern. We hypothesized that based on the combined observation of frequent overexpression of CDH6 in cancer and a restricted normal tissue expression, CDH6 might be an ideal tumor antigen for targeting using an antibody-drug conjugate (ADC) approach. CHD6-ADC is a fully-human anti-CDH6 IgG1, linked via sulfo-SPDB to the tubulin-binding maytansinoid payload DM4. CDH6-ADC was evaluated across multiple linker-payload combinations with the sulfo-SPDB-DM4 format being selected based on a superior combined profile pertaining to activity, selectivity and tolerability.
To gain a broader understanding of CDH6-ADC activity in vivo we profiled the lead candidate against a panel of 31 unselected patient derived ovarian xenograft (PDX) models in a 1×1×1 PDX clinical trial, similar to that described in Gao et al., 2015. In this unbiased high throughput in vivo screen, CDH6-ADC demonstrated robust antitumor activity, with an overall response rate of 39%. Responses were generally durable beyond 150 days and were achieved at doses yielding exposures anticipated to be achievable in humans and observed in PDX models featuring a range of CDH6 expression level and degree of tumor heterogeneity. Retrospective analysis of individual PDX responses and molecular profiling data demonstrate that sensitivity to CDH6-ADC is highly correlated to CDH6 transcript and protein levels. These findings suggest an ability to prospectively identify patients most likely to benefit from this novel targeted therapy. Furthermore, CDH6-ADC demonstrated robust tumor regressions in a representative PDX xenograft model that was refractory to carboplatin/paclitaxel standard of care therapy. These data suggest that CDH6-ADC may benefit both treatment naïve patients and patients that have progressed on prior therapy containing tubulin-targeting anti-mitotics. Extending beyond ovarian cancer, we found CDH6 to be frequently overexpressed in renal cancer. CDH6-ADC was active against RCC PDX models featuring patient relevant levels of CDH6 expression. Data described herein suggest that this novel ADC may be an effective treatment for patients with CDH6 expressing tumors, including ovarian and renal cancer - both indications with a high unmet medical need.
Citation Format: Carl U. Bialucha, Scott D. Collins, Yeonju Shim, Xiamei Zhang, Roberto Velazquez, Colleen Kowal, Caroline Bullock, Hongbo Cai, Stacy M. Rivera, Julie M. Goldovitz, Esther Kurth, Alice T. Loo, Guizhi Yang, John Green, Lance Ostrom, Matthew J. Meyer, Rebecca Mosher, Hui Gao, Juliet Williams, Emma Lees. In vivo activity of a novel CDH6 targeting antibody-drug conjugate, including population-scale ovarian PDX clinical trial. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 872.
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Affiliation(s)
| | | | - Yeonju Shim
- Novartis Institutes for Biomedical Research, Cambridge, MA
| | - Xiamei Zhang
- Novartis Institutes for Biomedical Research, Cambridge, MA
| | | | - Colleen Kowal
- Novartis Institutes for Biomedical Research, Cambridge, MA
| | | | - Hongbo Cai
- Novartis Institutes for Biomedical Research, Cambridge, MA
| | | | | | - Esther Kurth
- Novartis Institutes for Biomedical Research, Cambridge, MA
| | - Alice T. Loo
- Novartis Institutes for Biomedical Research, Cambridge, MA
| | - Guizhi Yang
- Novartis Institutes for Biomedical Research, Cambridge, MA
| | - John Green
- Novartis Institutes for Biomedical Research, Cambridge, MA
| | - Lance Ostrom
- Novartis Institutes for Biomedical Research, Cambridge, MA
| | | | - Rebecca Mosher
- Novartis Institutes for Biomedical Research, Cambridge, MA
| | - Hui Gao
- Novartis Institutes for Biomedical Research, Cambridge, MA
| | | | - Emma Lees
- Novartis Institutes for Biomedical Research, Cambridge, MA
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Garcia Fortanet J, Chen CHT, Chen YNP, Chen Z, Deng Z, Firestone B, Fekkes P, Fodor M, Fortin PD, Fridrich C, Grunenfelder D, Ho S, Kang ZB, Karki R, Kato M, Keen N, LaBonte LR, Larrow J, Lenoir F, Liu G, Liu S, Lombardo F, Majumdar D, Meyer MJ, Palermo M, Perez L, Pu M, Ramsey T, Sellers WR, Shultz MD, Stams T, Towler C, Wang P, Williams SL, Zhang JH, LaMarche MJ. Allosteric Inhibition of SHP2: Identification of a Potent, Selective, and Orally Efficacious Phosphatase Inhibitor. J Med Chem 2016; 59:7773-82. [DOI: 10.1021/acs.jmedchem.6b00680] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Jorge Garcia Fortanet
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Christine Hiu-Tung Chen
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Ying-Nan P. Chen
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Zhouliang Chen
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Zhan Deng
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Brant Firestone
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Peter Fekkes
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Michelle Fodor
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Pascal D. Fortin
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Cary Fridrich
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Denise Grunenfelder
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Samuel Ho
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Zhao B. Kang
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Rajesh Karki
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Mitsunori Kato
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Nick Keen
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Laura R. LaBonte
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Jay Larrow
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Francois Lenoir
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Gang Liu
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Shumei Liu
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Franco Lombardo
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Dyuti Majumdar
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Matthew J. Meyer
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Mark Palermo
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Lawrence Perez
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Minying Pu
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Timothy Ramsey
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - William R. Sellers
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Michael D. Shultz
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Travis Stams
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Christopher Towler
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Ping Wang
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Sarah L. Williams
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Ji-Hu Zhang
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Matthew J. LaMarche
- Global Discovery Chemistry, ‡Oncology Disease
Area, §Center
for Proteomic Chemistry, ∥Metabolism and Pharmacokinetics, Novartis Institutes
for Biomedical Research, and ⊥Chemical and Pharmaceutical Profiling, Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
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Chen YNP, LaMarche MJ, Chan HM, Fekkes P, Garcia-Fortanet J, Acker MG, Antonakos B, Chen CHT, Chen Z, Cooke VG, Dobson JR, Deng Z, Fei F, Firestone B, Fodor M, Fridrich C, Gao H, Grunenfelder D, Hao HX, Jacob J, Ho S, Hsiao K, Kang ZB, Karki R, Kato M, Larrow J, La Bonte LR, Lenoir F, Liu G, Liu S, Majumdar D, Meyer MJ, Palermo M, Perez L, Pu M, Price E, Quinn C, Shakya S, Shultz MD, Slisz J, Venkatesan K, Wang P, Warmuth M, Williams S, Yang G, Yuan J, Zhang JH, Zhu P, Ramsey T, Keen NJ, Sellers WR, Stams T, Fortin PD. Allosteric inhibition of SHP2 phosphatase inhibits cancers driven by receptor tyrosine kinases. Nature 2016; 535:148-52. [DOI: 10.1038/nature18621] [Citation(s) in RCA: 493] [Impact Index Per Article: 61.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 05/26/2016] [Indexed: 01/20/2023]
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Lantermann AB, Chen D, McCutcheon K, Hoffman G, Frias E, Ruddy D, Rakiec D, Korn J, McAllister G, Stegmeier F, Meyer MJ, Sharma SV. Inhibition of Casein Kinase 1 Alpha Prevents Acquired Drug Resistance to Erlotinib in EGFR-Mutant Non-Small Cell Lung Cancer. Cancer Res 2015; 75:4937-48. [PMID: 26490646 DOI: 10.1158/0008-5472.can-15-1113] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/07/2015] [Indexed: 11/16/2022]
Abstract
Patients with lung tumors harboring activating mutations in the EGF receptor (EGFR) show good initial treatment responses to the EGFR tyrosine kinase inhibitors (TKI) erlotinib or gefitinib. However, acquired resistance invariably develops. Applying a focused shRNA screening approach to identify genes whose knockdown can prevent and/or overcome acquired resistance to erlotinib in several EGFR-mutant non-small cell lung cancer (NSCLC) cell lines, we identified casein kinase 1 α (CSNK1A1, CK1α). We found that CK1α suppression inhibits the NF-κB prosurvival signaling pathway. Furthermore, downregulation of NF-κB signaling by approaches independent of CK1α knockdown can also attenuate acquired erlotinib resistance, supporting a role for activated NF-κB signaling in conferring acquired drug resistance. Importantly, CK1α suppression prevented erlotinib resistance in an HCC827 xenograft model in vivo. Our findings suggest that patients with EGFR-mutant NSCLC might benefit from a combination of EGFR TKIs and CK1α inhibition to prevent acquired drug resistance and to prolong disease-free survival.
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Affiliation(s)
- Alexandra B Lantermann
- Oncology Drug Discovery, Novartis Institutes for Biomedical Research, Cambridge, Massachusetts.
| | - Dongshu Chen
- Oncology Drug Discovery, Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Kaitlin McCutcheon
- Oncology Drug Discovery, Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Greg Hoffman
- Oncology Drug Discovery, Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Elizabeth Frias
- Oncology Drug Discovery, Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - David Ruddy
- Oncology Drug Discovery, Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Daniel Rakiec
- Oncology Drug Discovery, Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Joshua Korn
- Oncology Drug Discovery, Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Gregory McAllister
- Oncology Drug Discovery, Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Frank Stegmeier
- Oncology Drug Discovery, Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Matthew J Meyer
- Oncology Drug Discovery, Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Sreenath V Sharma
- Oncology Drug Discovery, Novartis Institutes for Biomedical Research, Cambridge, Massachusetts.
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Teasell R, Meyer MJ, McClure A, Pan C, Murie-Fernandez M, Foley N, Salter K. Stroke Rehabilitation: An International Perspective. Top Stroke Rehabil 2015; 16:44-56. [DOI: 10.1310/tsr1601-44] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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45
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Meyer MJ, Jenkins D, Batt D, Mosher R, Isaacs R, Hu T, Capka V, Zhang X, Chen D, Tang L, Daley M, Nowakowski P, Shim Y, Jiang W, Ettenberg S, Lees E. Abstract 1680: In vitro and in vivo activity of a highly potent and novel FGFR2/FGFR4 dual targeting antibody-drug conjugate. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-1680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The fibroblast growth receptors 2 and 4 (FGFR2, FGFR4) are overexpressed in a broad spectrum of malignancies. In a subset of breast, gastric, and esophageal cancers, increased FGFR2 expression is driven by FGFR2 copy number (CN) gain, which renders these tumors dependent on FGFR2 pathway activation and is associated with poor prognosis. FGFR4 expression is increased in response to both FGFR4 CN gain, as seen in embryonal rhabdomyosarcoma, or by the PAX3-FOXO1 fusion gene product which transcriptionally activates FGFR4, as seen in alveolar rhabdomyosarcoma. Additionally, other mechanisms drive increased FGFR2 expression, e.g. in subsets of lung and breast cancer, and increased FGFR4 expression, e.g. in subsets of hepatocellular, breast, and pancreatic cancer. This elevated expression in malignancies combined with the observation that FGFR2 and FGFR4 are efficiently internalized upon antibody binding make both receptors attractive targets for antibody-drug conjugate (ADC) therapy. To this end, a drug discovery campaign was initiated and a novel, highly potent FGFR2, FGFR4 dual targeting ADC was discovered. This ADC consists of a fully human antibody (discovered in collaboration with MorphoSys) conjugated to the potent maytansine-derived microtubule-disruptor, DM1, via an SMCC non-cleavable thioether linkage (linker payload technology licensed from ImmunoGen, Inc.). In vitro, the ADC is active against FGFR2 and FGFR4 positive cells in viability assays and is efficiently processed yielding the principle catabolite Lys-SMCC-DM1. In vivo, the ADC is highly efficacious against a variety of disease relevant xenograft models including FGFR2 amplified breast and gastric models and a PAX3-FOXO1 translocation positive alveolar rhabdomyosarcoma model. Additionally, the ADC is potent against a subset of primary tumor derived breast and lung xenograft models that lack FGFR2 CN gain or the PAX3-FOX01 translocation. Consistent with the molecule's mode of action, anti-tumor activity is preceded by G2/M cell cycle arrest and apoptosis. Taken together these data suggest that this novel, dual targeting ADC may be an effective treatment for patients with FGFR2 or FGFR4 positive tumors including, but not limited to those with FGFR2 CN gain or the PAX3-FOXO1 fusion gene.
Citation Format: Matthew J. Meyer, David Jenkins, David Batt, Rebecca Mosher, Randi Isaacs, Tiancen Hu, Vladimir Capka, Xiamei Zhang, Dongshu Chen, Lujia Tang, Mike Daley, Patrycja Nowakowski, Yeonju Shim, Wei Jiang, Seth Ettenberg, Emma Lees. In vitro and in vivo activity of a highly potent and novel FGFR2/FGFR4 dual targeting antibody-drug conjugate. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1680. doi:10.1158/1538-7445.AM2015-1680
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Affiliation(s)
| | - David Jenkins
- 2Novartis Institutes for Biomedical Research; Currently at MedImmune, Gaithersburg, MD
| | - David Batt
- 1Novartis Institutes for Biomedical Research, Cambridge, MA
| | - Rebecca Mosher
- 1Novartis Institutes for Biomedical Research, Cambridge, MA
| | - Randi Isaacs
- 3Novartis Institutes for Biomedical Research, East Hanover, NJ
| | - Tiancen Hu
- 1Novartis Institutes for Biomedical Research, Cambridge, MA
| | - Vladimir Capka
- 1Novartis Institutes for Biomedical Research, Cambridge, MA
| | - Xiamei Zhang
- 1Novartis Institutes for Biomedical Research, Cambridge, MA
| | - Dongshu Chen
- 1Novartis Institutes for Biomedical Research, Cambridge, MA
| | - Lujia Tang
- 1Novartis Institutes for Biomedical Research, Cambridge, MA
| | - Mike Daley
- 1Novartis Institutes for Biomedical Research, Cambridge, MA
| | | | - Yeonju Shim
- 1Novartis Institutes for Biomedical Research, Cambridge, MA
| | - Wei Jiang
- 4Novartis Institutes for Biomedical Research; Currently at Merck Pharmaceuticals, Rahway, NJ
| | - Seth Ettenberg
- 5Novartis Institutes for Biomedical Research; Currently at Unum Therapeutics, Cambridge, MA
| | - Emma Lees
- 1Novartis Institutes for Biomedical Research, Cambridge, MA
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Meyer MJ, Pereira S, McClure A, Teasell R, Thind A, Koval J, Richardson M, Speechley M. A systematic review of studies reporting multivariable models to predict functional outcomes after post-stroke inpatient rehabilitation. Disabil Rehabil 2014; 37:1316-23. [DOI: 10.3109/09638288.2014.963706] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Matthew J. Meyer
- Graduate Program in Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada,
- Ontario Stroke Network, Toronto, Ontario, Canada,
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada,
| | - Shelialah Pereira
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada,
| | - Andrew McClure
- Heart and Stroke Foundation of Canada, Toronto, Ontario, Canada,
| | - Robert Teasell
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada,
- Department of Physical Medicine and Rehabilitation, St Joseph's Health Care, London, Ontario, Canada,
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, London, Ontario, Canada,
| | - Amardeep Thind
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada, and
- Centre for Studies in Family Medicine, Western University, London Ontario, Canada
| | - John Koval
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada, and
| | - Marina Richardson
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada,
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada, and
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Meyer MJ, Stanislaus AB, Lee J, Waak K, Ryan C, Saxena R, Ball S, Schmidt U, Poon T, Piva S, Walz M, Talmor DS, Blobner M, Latronico N, Eikermann M. Surgical Intensive Care Unit Optimal Mobilisation Score (SOMS) trial: a protocol for an international, multicentre, randomised controlled trial focused on goal-directed early mobilisation of surgical ICU patients. BMJ Open 2013; 3:e003262. [PMID: 23959756 PMCID: PMC3753523 DOI: 10.1136/bmjopen-2013-003262] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Immobilisation in the intensive care unit (ICU) leads to muscle weakness and is associated with increased costs and long-term functional disability. Previous studies showed early mobilisation of medical ICU patients improves clinical outcomes. The Surgical ICU Optimal Mobilisation Score (SOMS) trial aims to test whether a budget-neutral intervention to facilitate goal-directed early mobilisation in the surgical ICU improves participant mobilisation and associated clinical outcomes. METHODS AND ANALYSIS The SOMS trial is an international, multicentre, randomised clinical study being conducted in the USA and Europe. We are targeting 200 patients. The primary outcome is average daily SOMS level and key secondary outcomes are ICU length of stay until discharge readiness and 'mini' modified Functional Independence Measure (mmFIM) at hospital discharge. Additional secondary outcomes include quality of life assessed at 3 months after hospital discharge and global muscle strength at ICU discharge. Exploratory outcomes will include: ventilator-free days, ICU and hospital length of stay and 3-month mortality. We will explore genetic influences on the effectiveness of early mobilisation and centre-specific effects of early mobilisation on outcomes. ETHICS AND DISSEMINATION Following Institutional Review Board (IRB) approval in three institutions, we started study recruitment and plan to expand to additional centres in Germany and Italy. Safety monitoring will be the domain of the Data and Safety Monitoring Board (DSMB). The SOMS trial will also explore the feasibility of a transcontinental study on early mobilisation in the surgical ICU. RESULTS The results of this study, along with those of ancillary studies, will be made available in the form of manuscripts and presentations at national and international meetings. REGISTRATION This study has been registered at clinicaltrials.gov (NCT01363102).
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Affiliation(s)
- Matthew J Meyer
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Anne B Stanislaus
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jarone Lee
- Department of Surgery, Trauma, Emergency Surgery, Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Karen Waak
- Department of Physical and Occupational Therapy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Cheryl Ryan
- Department of Clinical Nursing Services, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Richa Saxena
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Stephanie Ball
- Department of Clinical Nursing Services, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ulrich Schmidt
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Trudy Poon
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Simone Piva
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University of Brescia at Spedali Civili, Brescia, Italy
| | - Matthias Walz
- UMass Memorial Medical Center and UMass Medical School, Worcester, Massachusetts, USA
| | - Daniel S Talmor
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Manfred Blobner
- Klinik für Anaesthesiologie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Nicola Latronico
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University of Brescia at Spedali Civili, Brescia, Italy
| | - Matthias Eikermann
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Universitaet Duisburg-Essen, Germany
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48
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Levine AR, Meyer MJ, Bittner EA, Berg S, Kalman R, Stanislaus AB, Ryan C, Ball SA, Eikermann M. Oral midodrine treatment accelerates the liberation of intensive care unit patients from intravenous vasopressor infusions. J Crit Care 2013; 28:756-62. [PMID: 23845791 DOI: 10.1016/j.jcrc.2013.05.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/25/2013] [Accepted: 05/31/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE Persistent low-level hypotension represents a barrier to discharging patients from the intensive care unit (ICU). Midodrine may be an effective adjunct to wean intravenous (IV) vasopressors and permit ICU discharge. We tested the hypothesis that midodrine, given to patients on IV vasopressors who otherwise met ICU discharge criteria, increased the magnitude of change in IV vasopressor rate. MATERIALS AND METHODS This was a prospective, observational study in 20 adult surgical ICU patients who met ICU discharge criteria except for an IV vasopressor requirement. We compared the change in phenylephrine equivalent rates during the day before midodrine to the change in phenylephrine equivalent rates after midodrine initiation and analyzed changes in total body fluid balance, heart rate, mean arterial pressure, and white blood cell count during this period. RESULTS Patients received 41.0±33.4 μg/min of phenylephrine equivalents and the change in IV vasopressor rate (slope) decreased significantly from -0.62 μg/min per hour of phenylephrine equivalents before midodrine to -2.20 μg/min per hour following the initiation of midodrine treatment (P=.012). Change in total body fluid balance, heart rate, mean arterial pressure, and white blood cell count did not correlate with change in IV vasopressor rate. CONCLUSION Midodrine treatment was associated with an increase in the magnitude of decline of the IV vasopressor rate. Oral midodrine may facilitate liberation of surgical ICU patients from an IV vasopressor infusion, and this may affect discharge readiness of patients from the ICU.
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Meyer MJ, O’Callaghan C, Kelloway L, Hall R, Li S, Fang J, Bayley M, Reeves M, Teasell R. Abstract 7: The Impact of Post-Stroke Rehabilitation on 2-year Healthcare Costs in Ontario, Canada: Can Rehabilitation Save Us Money? Stroke 2013. [DOI: 10.1161/str.44.suppl_1.a7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
A substantial evidence base supports the positive benefits of post-stroke rehabilitation. The objective of this study was to evaluate the impact of inpatient rehabilitation on 2-year healthcare costs in Ontario, Canada.
Methods:
Acute patient data was drawn from the 2004 and 2008 Ontario Stroke Audits for 3439 patients with ischemic stroke discharged alive from an acute care hospital. Patients were assigned a propensity score using 15 demographic and clinical variables. Patients admitted to inpatient rehabilitation (Rehab) were then matched one-to-one with a patient not admitted to inpatient rehabilitation (No-Rehab) using propensity score and modified Rankin Scale (mRS) score. The cohort was stratified by mRS into three groups (mRS 0-2,3,4-5) and comparisons were drawn between Rehab and No-Rehab patients for 2-year mortality and government-billed healthcare costs (hospital, home care, and drug benefit costs).
Results:
No difference in mortality was noted between Rehab and No-Rehab patients with discharge mRS scores of 0-2 (p=0.39), but Rehab patients cost an average of $33,056 more over the 2 years (p<0.001) and $63 more per day survived (p<0.0001). Among patients with mRS 3, Rehab patients were significantly more likely to survive to 2 years (p<0.001), and cost an average of $22,394 more up to 2 years (p<0.001) and $5 more per day survived (p<0.0001). Rehab patients with mRS scores of 4-5 were significantly more likely to survive to 2-years (p=0.01), but cost an average of $6,607 less (p=0.24) and $29 less per day survived (p=0.07).
Conclusions:
Findings suggest that disability level plays an important role in the cost-effectiveness of inpatient rehabilitation. Among patients with milder disability, inpatient rehabilitation is significantly more costly with no demonstrated benefit in 2-year mortality. However among patients with moderate to severe disability, inpatient rehabilitation significantly reduces mortality rates and may actually reduce overall healthcare spending up to 2-years post stroke.
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Affiliation(s)
| | | | | | - Ruth Hall
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Shudong Li
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Jiming Fang
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Mark Bayley
- Toronto Rehabilitation Institute, Toronto, Canada
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