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Yang Y, Kang M, Huang S, Chen CC, Tsai P, Hu L, Yu F, Hajj C, Choi JI, Tome WA, Simone C, Lin H. Impact of respiratory motion on proton pencil beam scanning FLASH radiotherapy: an in silicoand phantom measurement study. Phys Med Biol 2023; 68. [PMID: 36944258 DOI: 10.1088/1361-6560/acc632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/21/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To investigate the effects of respiratory motion on the delivered dose in the context of proton pencil beam scanning (PBS) transmission FLASH-RT by simulation and phantom measurements. 
Approach: An in-house simulation code was employed to perform in silico simulation of 2D dose distributions for clinically relevant proton PBS transmission FLASH-RT treatments. A moving simulation grid was introduced to investigate the impacts of various respiratory motion and treatment delivery parameters on the dynamic PBS dose delivery. A strip-ionization chamber array detector and an IROC motion platform were employed to perform phantom measurements of the 2D dose distribution for treatment fields similar to those used for simulation. 
Main results: Clinically relevant respiratory motion and treatment delivery parameters resulted in degradation of the delivered dose compared to the static delivery as translation and distortion. Simulation showed that the gamma passing rates (2 mm/2% criterion) and target coverage (V100%) could drop below 50% and 80%, respectively, for certain scenarios if no mitigation strategy was used. The gamma passing rates and target coverage could be restored to more than 95% and 98%, respectively, for short beams delivered at the maximal inhalation or exhalation phase. The simulation results were qualitatively confirmed in phantom measurements with the motion platform. 
Significance: Respiratory motion could cause dose quality degradation in a clinically relevant proton PBS transmission FLASH-RT treatment if no mitigation strategy is employed, or if an adequate margin is not given to the target. Besides breath-hold, gated delivery can be an alternative motion management strategy to ensure high consistency of the delivered dose while maintaining minimal dose to the surrounding normal tissues. To the best of our knowledge, this is the first study on motion impacts in the context of proton transmission FLASH radiotherapy.
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Shi C, Lin H, Huang S, Xiong W, Hu L, Choi I, Press R, Hasan S, Simone C, Chhabra A. Comprehensive Evaluation of Carbon-Fiber-Reinforced Polyetheretherketone (CFR-PEEK) Spinal Hardware for Proton and Photon Planning. Technol Cancer Res Treat 2022; 21:15330338221091700. [PMID: 35410544 PMCID: PMC9009152 DOI: 10.1177/15330338221091700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: To evaluate a novel spine implant, carbon-fiber-reinforced polyetheretherketone (CFR-PEEK), for proton and photon treatment planning. Materials and Methods: We compared target coverage and sparing of organs-at-risk (OARs) for a spinal phantom with 4 different spine configurations: (a) normal (no implant); (b) Titanium; (c) CFR-PEEK; and (d) hybrid (CFR-PEEK with Titanium tulip head). The spinal phantom was imaged via computed tomography (CT) scan, and the iterative Metal Artifact Reduction (iMAR) CT set was used for planning. A representative spinal chordoma target and associated OARs were contoured. The prescription dose was 50 Gy to the initial target volume, followed by a 24 Gy boost, for which multi-field optimization (MFO) proton plans were developed with a 3 mm setup and 3.5% range uncertainties. For photon planning, volumetric modulated arc therapy (VMAT) plans were developed for the initial and boost plans. OAR dose constraints were set according to our institutional guidelines. Results: For the 4 spine configurations, the proton plans achieved similar nominal target coverage and OARs sparing. While evaluating coverage and OAR dose under uncertainty scenario analysis for initial clinical target volume (CTV) 50 Gy 95% and 90% coverage, higher means and the narrower band of doses variations were achieved for the normal and CFR-PEEK plans. Similarly, uncertainty analysis of spinal cord Dmax showed tighter distribution for normal and CFR-PEEK plans. Overall plan quality showed no significant difference for photon planning when compared to normal spine versus other inserts. However, for proton planning, there is a larger difference for the normal spine insert scenario versus the Titanium insert scenario. For each insert scenario comparison between photon and proton plans, there was a larger difference for OARs: heart and spinal cord. Conclusion: The CFR-PEEK implant has similar clinical properties to a normal spine for proton planning, allowing us to pass protons through the material and achieve superior target coverage and OAR sparing under nominal and uncertainty conditions.
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Amini A, Verma V, Simone C, Chetty I, Choi JI, Chun S, Donington J, Edelman M, Higgins K, Kestin L, Mohindra P, Movsas B, Rodrigues G, Rosenzweig K, Rybkin I, Shepherd A, Slotman B, Wolf A, Chang J. American Radium Society® (ARS) Appropriate Use Criteria on Radiation Therapy in Oligometastatic or Oligoprogressive Non-Small Cell Lung Cancer (NSCLC). Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.02.582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Berman A, Chao HH, Simone C, Kegelman T, Aggarwal C, Bauml J, Singh A, Levin W, Cengel K, Feigenberg S, Rengan R, Langer C, Ciunci C, Plastaras J. Long-term Outcomes of Proton Beam Re-irradiation for Locoregionally Recurrent Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.02.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hagan M, Kapoor R, Michalski J, Sandler H, Movsas B, Chetty I, Lally B, Rengan R, Robinson C, Rimner A, Simone C, Timmerman R, Zelefsky M, DeMarco J, Hamstra D, Lawton C, Potters L, Valicenti R, Mutic S, Bosch W, Abraham C, Caruthers D, Brame R, Palta JR, Sleeman W, Nalluri J. VA-Radiation Oncology Quality Surveillance Program. Int J Radiat Oncol Biol Phys 2020; 106:639-647. [PMID: 31983560 DOI: 10.1016/j.ijrobp.2019.08.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/08/2019] [Accepted: 08/21/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE We sought to develop a quality surveillance program for approximately 15,000 US veterans treated at the 40 radiation oncology facilities at the Veterans Affairs (VA) hospitals each year. METHODS AND MATERIALS State-of-the-art technologies were used with the goal to improve clinical outcomes while providing the best possible care to veterans. To measure quality of care and service rendered to veterans, the Veterans Health Administration established the VA Radiation Oncology Quality Surveillance program. The program carries forward the American College of Radiology Quality Research in Radiation Oncology project methodology of assessing the wide variation in practice pattern and quality of care in radiation therapy by developing clinical quality measures (QM) used as quality indices. These QM data provide feedback to physicians by identifying areas for improvement in the process of care and identifying the adoption of evidence-based recommendations for radiation therapy. RESULTS Disease-site expert panels organized by the American Society for Radiation Oncology (ASTRO) defined quality measures and established scoring criteria for prostate cancer (intermediate and high risk), non-small cell lung cancer (IIIA/B stage), and small cell lung cancer (limited stage) case presentations. Data elements for 1567 patients from the 40 VA radiation oncology practices were abstracted from the electronic medical records and treatment management and planning systems. Overall, the 1567 assessed cases passed 82.4% of all QM. Pass rates for QM for the 773 lung and 794 prostate cases were 78.0% and 87.2%, respectively. Marked variations, however, were noted in the pass rates for QM when tumor site, clinical pathway, or performing centers were separately examined. CONCLUSIONS The peer-review protected VA-Radiation Oncology Surveillance program based on clinical quality measures allows providers to compare their clinical practice to peers and to make meaningful adjustments in their personal patterns of care unobtrusively.
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Swaminath A, Vella ET, Ramchandar K, Robinson A, Simone C, Sun A, Ung YC, Yasufuku K, Ellis PM. Surgery after chemoradiotherapy in patients with stage III (N2 or N3, excluding T4) non-small-cell lung cancer: a systematic review. ACTA ACUST UNITED AC 2019; 26:e398-e404. [PMID: 31285684 DOI: 10.3747/co.26.4549] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Chemoradiation with curative intent is considered the standard of care in patients with locally advanced, stage iii non-small-cell lung cancer (nsclc). However, some patients with stage iii (N2 or N3, excluding T4) nsclc might be eligible for surgery. The objective of the present systematic review was to investigate the efficacy of surgery after chemoradiotherapy compared with chemoradiotherapy alone in patients with potentially resectable locally advanced nsclc. Methods A search of the medline, embase, and PubMed databases sought randomized controlled trials (rcts) comparing surgery after chemoradiotherapy with chemoradiotherapy alone in patients with stage iii (N2 or N3, excluding T4) nsclc. Results Three included rcts consistently found no statistically significant difference in overall survival between patients with locally advanced nsclc who received surgery and chemoradiotherapy or chemoradiotherapy alone. Only one rct found that progression-free survival was significantly longer in patients treated with chemoradiation and surgery (hazard ratio: 0.77; 95% confidence interval: 0.62 to 0.96). In a post hoc analysis of the same trial, the overall survival rate was higher in the surgical group than in matched patients in a chemoradiation-only group if a lobectomy was performed (p = 0.002), but not if a pneumonectomy was performed. Furthermore, fewer treatment-related deaths occurred in patients who underwent lobectomy than in those who underwent pneumonectomy. Conclusions For patients with locally advanced nsclc, the benefits of surgery after chemoradiation are uncertain. Surgery after chemoradiation for patients who do not require a pneumonectomy might be an option.
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Niezink A, Jain V, Chouvalova O, Wijsman R, Muijs C, Frick M, Doucette A, Simone C, Chinniah C, Widder J, Langendijk J, Van der Schaaf A, Berman A. PO-0782 External validation of NTCP models for pneumonitis in lung cancer patients receiving proton therapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31202-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rice S, Vyfhuis M, Bentzen S, Grover S, Simone C, Mohindra P. P2.16-09 Patterns of Brain Metastases in Stage I-III Non-Small Cell Lung Cancer: An NCDB Analysis. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vyfhuis M, Bentzen S, Grover S, Simone C, Mohindra P. P1.15-31 Survival and Patterns of Care Comparing Black and White Patients With All Stages of NSCLC: An NCDB Analysis. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Signorile ML, Grossi V, Sanese P, Celestini V, Fasano C, Forte G, Russo L, Simone C. PO-006 The MAPK/c-Myc axis in CRC: new pathogenic mechanisms and therapeutic approaches. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Sanese P, Peserico A, Celestini V, Fasano C, Grossi V, Signorile ML, Caretti G, De Rio A, Simone C. PO-493 Targeting the drug resistance epigenetic driver SMYD3 as a new strategy to potentiate chemotherapeutic effects. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Grossi V, Signorile ML, Forte G, Sanese P, Fasano C, Russo L, Sciglio VD, Simone C. PO-203 A novel member in the β-catenin destruction complex: may MAPK14/P38α foster new therapeutic approaches in colorectal cancer? ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Simone C, Celestini V, Tezil T, Russo L, Fasano C, Sanese P, Forte G, Peserico A, Signorile ML, Grossi V. PO-243 Uncoupling FOXO3A mitochondrial and nuclear functions in cancer cells undergoing metabolic stress and chemotherapy. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Celestini V, Tezil T, Russo L, Fasano C, Sanese P, Forte G, Peserico A, Signorile ML, Grossi V, Simone C. PO-161 The AMPK and MEK/ERK signalling pathways regulate mitochondrial FOXO3A import through phosphorylation of serine 12 and serine 30. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Katz S, Hammer M, Bagley S, Aggarwal C, Bauml J, Nachiappan A, Simone C, Langer C. OA02.01 Comparison of iRECIST to RECIST1.1 for Following Response to Anti-PD1 Therapy in Patients with Non-Small Cell Lung Cancer (NSCLC). J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Verma V, Shostrom V, Simone C. (S008) Purpose: Stereotactic Body Radiotherapy (SBRT) Is the Standard of Care for Nonoperative Early-Stage Non-Small-Cell Lung Cancer (NSCLC) <5cm, But Use for =5cm Cases Is Considerably Less Defined, With Existing Literature Limited to Small, Single-Institution. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Valdes G, Wojtowicz L, Pattison A, Carpenter C, Simone C, Lin A, Solberg T. OC-0253: Machine Learning-Based Enables Data-driven Radiotherapy Treatment Planning Decision Support. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30696-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cengel K, Moon E, Albelda S, Busch T, Simone C. P3.03-027 Growth Factor and Inflammatory Signaling Pathway Interactions Influence Outcomes Following Multimodality Therapy for Mesothelioma. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kang M, Huang S, Solberg T, Mayer R, Thomas A, Teo B, McDonough J, Simone C, Lin L. TH-CD-209-08: Quantification of the Interplay Effect in Proton Pencil Beam Scanning Treatment of Lung. Med Phys 2016. [DOI: 10.1118/1.4958202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Teng C, Ainsley C, Teo B, Burgdorf B, Janssens G, Berman A, Levin W, Xiao Y, Lin L, Simone C, Solberg T. SU-F-J-64: Comparison of Dosimetric Robustness Between Proton Therapy and IMRT Plans Following Tumor Regression for Locally Advanced Non-Small Cell Lung Cancer (NSCLC). Med Phys 2016. [DOI: 10.1118/1.4955972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Teng C, Janssens G, Ainsley C, Teo B, Valdes G, Burgdorf B, Berman A, Levin W, Xiao Y, Lin L, Gabriel P, Simone C, Solberg T. TU-H-CAMPUS-JeP3-04: Factors Predicting a Need for Treatment Replanning with Proton Radiotherapy for Lung Cancer. Med Phys 2016. [DOI: 10.1118/1.4957702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Lin L, Huang S, Kang M, Ainsley C, Simone C, McDonough J, Solberg T. SU-F-T-152: Experimental Validation and Calculation Benchmark for a Commercial Monte Carlo Pencil BeamScanning Proton Therapy Treatment Planning System in Heterogeneous Media. Med Phys 2016. [DOI: 10.1118/1.4956288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Souris K, Glick A, Kang M, Janssens G, Sterpin E, Lin H, McDonough J, Simone C, Solberg T, Ben-Josef E, Lee J, Lin L. SU-F-T-121: Abdominal Compression Effectively Reduces the Interplay Effect and Enables Pencil Beam Scanning Proton Therapy of Liver Tumors. Med Phys 2016. [DOI: 10.1118/1.4956257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Lin L, Huang S, Kang M, Ainsley C, Hiltunen P, Vanderstraeten R, Lindberg J, Siljamaki S, Wareing T, Davis I, Barnett A, McGhee J, Solberg T, McDonough J, Simone C. SU-F-T-153: Experimental Validation and Calculation Benchmark for a Commercial Monte Carlo Pencil Beam Scanning Proton Therapy Treatment Planning System in Water. Med Phys 2016. [DOI: 10.1118/1.4956289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Nizzardo M, Simone C, Rizzo F, Ulzi G, Ramirez A, Rizzuti M, Bordoni A, Bucchia M, Gatti S, Bresolin N, Comi GP, Corti S. Morpholino-mediated SOD1 reduction ameliorates an amyotrophic lateral sclerosis disease phenotype. Sci Rep 2016; 6:21301. [PMID: 26878886 PMCID: PMC4754711 DOI: 10.1038/srep21301] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 01/21/2016] [Indexed: 01/07/2023] Open
Abstract
Neurotoxicity due to the accumulation of mutant proteins is thought to drive pathogenesis in neurodegenerative diseases. Mutations in superoxide dismutase 1 (SOD1) are linked to familial amyotrophic lateral sclerosis (fALS); these mutations result in progressive motor neuron death through one or more acquired toxicities. Interestingly, SOD1 is not only responsible for fALS but may also play a significant role in sporadic ALS; therefore, SOD1 represents a promising therapeutic target. Here, we report slowed disease progression, improved neuromuscular function, and increased survival in an in vivo ALS model following therapeutic delivery of morpholino oligonucleotides (MOs) designed to reduce the synthesis of human SOD1. Neuropathological analysis demonstrated increased motor neuron and axon numbers and a remarkable reduction in astrogliosis and microgliosis. To test this strategy in a human model, we treated human fALS induced pluripotent stem cell (iPSC)-derived motor neurons with MOs; these cells exhibited increased survival and reduced expression of apoptotic markers. Our data demonstrated the efficacy of MO-mediated therapy in mouse and human ALS models, setting the stage for human clinical trials.
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