Immunotherapy and the Interventional Oncologist: Challenges and Opportunities-A Society of Interventional Oncology White Paper

Interventional oncology is a subspecialty field of interventional radiology that addresses the diagnosis and treatment of cancer and cancer-related problems by using targeted minimally invasive procedures performed with image guidance. Immuno-oncology is an innovative area of cancer research and practice that seeks to help the patient's own immune system fight cancer. Both interventional oncology and immuno-oncology can potentially play a pivotal role in cancer management plans when used alongside medical, surgical, and radiation oncology in the care of cancer patients.

Heparin-Induced Thrombocytopenia and Thrombosis: Preventing your Thrombolysis Practice from Taking a HITT

Heparin-induced thrombocytopenia and thrombosis (HITT) is an under-recognized cause of deep venous thrombosis treatment failure and of complications during catheter-directed thrombolysis. After a review of HITT pathophysiology, diagnosis, and management, three different cases are presented in this article. Each case highlights subtleties and challenges of HITT diagnosis and management. An example of a practical approach to the diagnosis of HITT is presented.

The law of unintended consequences: current design challenges in inferior vena cava filters

INTRODUCTION

Venous thromboembolic disease (VTD) encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE) is a commonly encountered condition with potentially fatal sequelae. When unable to be adequately anticoagulated, patients require a mechanical means to prevent PE. This review discusses the history of inferior vena cava interruption and the development of inferior vena cava filters (IVCF). Areas covered: Milestone innovations in the mechanical treatment of VTD, their successes and shortcomings are discussed. The unforeseen complications that have occurred with implantation of IVCF have a profound impact on the present utilization of retrievable filters. Particular attention is dedicated to the evidence for safe and effective use of IVCF and the challenges presented to further improvement of these technologies. Expert commentary: While evidence suggests that IVCF are effective in preventing PE, the recent 'de-volution' from permanent to retrievable design has unleashed an epidemic device-related complications. Retrievable filter design is reliant on a 'Goldilocks' premise: make the device stable (so it doesn't migrate), but not too stable (so you can still retrieve it). Efforts must be aimed at optimizing utilization using decision support tools, meticulous follow up after deployment, and conversion from retrievable to permanent devices if the patient requires lifelong mechanical prophylaxis.

Comparison of Color Attractiveness for Agrilus ruficollis (Coleoptera: Buprestidae): Potential for a Simple Trap

The rednecked cane borer, Agrilus ruficollis (F.), is a pest of cultivated and wild blackberries in the midwestern and eastern parts of the United States. Damage from this pest occurs from larvae girdling primocanes and tunneling in the pith, forming galls that can potentially reduce yields. There is only one registered insecticide and no trap available for monitoring. Paints mimicking the spectral reflectance of blackberry leaves and canes of both primocane and floricane were applied to wooden dowels or corrugated plastic mimicking the shape of blackberry canes and leaves. The dowels or corrugated plastic were covered with sticky Tangletrap, and field was evaluated for attractiveness to A. ruficollis for three years, with modifications to trap design each year. Commercially available emerald ash borer, Agrilus planipennis Fairmaire, funnel traps were evaluated for attractiveness to A. ruficollis in 2014. In 2011, the greatest numbers of A. ruficollis adults were captured on prism-shaped, primocane-mimicking traps that reflected light at a peak wavelength between 540-560 nm. In 2012 and 2013, field tests demonstrated that more A. ruficollis adults were captured on green emerald ash borer traps. Testing in 2014 reinforced the previous findings that A. ruficollis was most attracted to the green emerald ash borer traps. In 2013, it was noted that colored traps usually captured significantly more A. ruficollis males than females. This indicated a need to determine if there was a chemical cue used by A. ruficollis adult females to locate and oviposit on only blackberry primocanes and not floricanes.

Androgen signaling is a confounding factor for β-catenin-mediated prostate tumorigenesis

Emerging evidence has demonstrated the critical roles for both androgen and Wnt pathways in prostate tumorigenesis. A recent integrative genomic analysis of human prostate cancers has revealed a unique enrichment of androgen and Wnt signaling in early onset prostate cancers, implying their clinical significance in the disease. Additionally, interaction between the androgen receptor (AR) and β-catenin has long been detected in prostate cancer cells. However, the consequence of this interaction in prostate tumorigenesis is still unknown. Because mutations in adenomatous polyposis coli (APC), β-catenin, and other components of the destruction-complex are generally rare in prostate cancers, other mechanisms of aberrant Wnt signaling activation have been speculated. To address these critical questions, we developed Ctnnb1^L(ex3)/+/R26hAR^L/+:PB-Cre4 mice, in which transgenic AR and stabilized β-catenin are co-expressed in prostatic epithelial cells. We observed accelerated tumor development, aggressive tumor invasion, and a decreased survival rate in Ctnnb1^L(ex3)/+/R26hAR^L/+:PB-Cre4 compound mice compared to age-matched Ctnnb1^L(ex3)/+:PB-Cre4 littermate controls, which only have stabilized β-catenin expression in the prostate. Castration of the above transgenic mice resulted in significant tumor regression, implying an essential role of androgen signaling in tumor growth and maintenance. Implantation of the prostatic epithelial cells isolated from the transgenic mice regenerated PIN and prostatic adenocarcinoma lesions. Microarray analyses of transcriptional profiles showed more robust enrichment of known tumor and metastasis promoting genes: Spp1, Egr1, c-Myc, Sp5, and Sp6 genes in samples isolated from Ctnnb1^L(ex3)/+/R26hAR^L/+:PB-Cre4 compound mice than those from Ctnnb1^L(ex3)/+:PB-Cre4 and R26hAR^L/+:PB-Cre4 littermate controls. Together, these data demonstrate a confounding role of androgen signaling in β-catenin initiated oncogenic transformation in prostate tumorigenesis.

Molecular diagnostics of Drosophila suzukii (Diptera: Drosophilidae) Using PCR-RFLP

The invasive spotted wing drosophila, Drosophila suzukii (Matsumura) (Diptera: Drosophilidae), has become a serious pest in the United States. Identification of immature and poorly preserved specimens can be difficult. A molecular diagnostic method for distinguishing D. suzukii from other Drosophila spp. associated with fruit in the United States was developed. A 709-bp region of the mitochondrial DNA cytochrome oxidase I gene was amplified from D. suzukii collections in the United States and compared with sequences of other Drosophila taxa from GenBank. Based on DNA sequence polymorphisms, a polymerase chain reaction-restriction fragment length polymorphism analysis using the restriction enzyme Msp-I was found to differentiate D. suzukii from other Drosophila spp. in the United States. This technique can identify field-collected specimens from various sources and specimens regardless of life stage. This molecular diagnostic method will be useful for monitoring the spread of this economically important invasive insect.

Attractiveness of an aggregation pheromone lure and chicken droppings to adults and larvae of Alphitobius diaperinus (Coleoptera: Tenebrionidae)

The chemical cues by which lesser mealworm, Alphitobius diaperinus (Panzer) (Coleoptera: Tenebrionidae) beetles find each other are still unknown. Laboratory two-choice pitfall bioassays were conducted to evaluate the attractiveness of synthetic aggregation pheromone lure to lesser mealworm adults and larvae. All components of this synthetic aggregation pheromone lure, including: (R)-(+)-limonene, (E)-beta-ocimene, (S)-(+)-linalool, (R)-(+)-daucene, and 2-nonanone were also tested singly. Chicken dropping volatile compounds and fresh chicken droppings (CD) were evaluated singly or in combination with the pheromone lure. In Arkansas, trapping experiments were conducted in different poultry houses with low, moderate, and high lesser mealworm populations to evaluate the attraction of pheromone lure. Laboratory two-choice pitfall bioassay was found to be a useful and convenient tool for evaluating the attractants before testing them in the poultry house. Greater attraction of adults and larvae to a dose of 20-30 microg pheromone lure was identified in laboratory two-choice pitfall bioassays. Adults and larvae were highly attractive to a combination of fresh CD and pheromone lure, whereas, a combination of chicken dropping volatile and pheromone lure was not significantly attractive. The low attraction of limonene and linalool in the laboratory two-choice pitfall bioassays suggest that either they are nonattractive or attractive only at a narrow range of concentrations. Higher numbers of lesser mealworm adults and larvae were found in traps treated with pheromone lure as compared with untreated controls in field experiments. Results indicate a potential for combining the pheromone lure with the attractive CD compounds to enhance trap efficacy.

Ovavesicula popilliae (Microsporidia: Ovavesiculidae) spore production in naturally infected adult Japanese beetles (Coleoptera: Scarabaeidae)

Ovavesicula popilliae is a microsporidian that infects both Japanese beetle larvae and adults. This is the first study quantifying the number of O. popilliae spores produced by Japanese beetle adults. Mean spore production per adult Japanese beetle was 2.67 × 10(7) (SE ± 4.65 × 10(6)) spores with a range of 1.46 × 10(6)-1.02 × 10(8). The number of spores produced per host is similar to other microsporidian species and may help explain the speed with which this pathogen has spread from introduction sites to surrounding areas.

Survey of pathogens and parasitoids of Popillia japonica (Coleoptera: Scarabaeidae) in northwest Arkansas

The impact of pathogens and parasitoids on the recently established population of Popillia japonica Newman in northwest Arkansas has been unknown. In this study, we quantified the prevalence of natural enemies: Stictospora villani Hays, Ovavesicula popilliae Andreadis and Hanula, Paenibacillus spp. (Dingman), nematodes and parasitic Diptera and Hymenoptera in third instar and adult populations in 2010 and 2011. S. villani was found in 38.4% and 35.5% of larvae in 2010 and 2011, respectively. S. villani was not found in adult beetles. Paenibacillus bacteria were not found in either larvae or adults in either year. In 2010, the microsporidian O. popilliae was not found in larvae but was present in 0.2% of adults. In 2011, 2.6% of larvae were infected with O. popilliae, but the microsporidian was not found in adults. A previously unknown Adelina sp. was found infecting 0.4% of adult beetles in 2010 and 1.3% of larvae in 2011. Nematode infections were found in 1.8% of larvae and 0.1% of adults in 2010 and not found in either life stage in 2011. No parasitic Hymenoptera or Diptera were found in either year. Apparently, pathogens and parasitoids currently provide little control of the Japanese beetle population within northwest Arkansas.

Attractants for the green June beetle (Coleoptera: Scarabaeidae)

The purpose of this study was to develop and evaluate lures for adult green June beetles, Cotinis nitida (L.) (Coleoptera: Scarabaeidae), for future use in a mass trapping program. Volatile organic compounds collected from headspace of green June beetles feeding on fermenting ripe apple (Malus spp.), the natural lure that elicits feeding aggregations, were identified and confirmed by gas chromatography and mass spectrometry. Yellow funnel traps baited with 91% isopropanol or the five component blend were equally effective in eliciting aggregation behavior and often more attractive to green June beetles than the natural lure. In 2008, three trap lines adjacent and parallel to the perimeter of two vineyards, each with 12 Xpando yellow funnel traps baited with either 91% isopropanol or the five component blend, differed in catch of green June beetles across sample dates, and sample date by bait interaction but there were no differences among these two baits. A season total of 324,007 green June beetle were captured by these 36 baited traps. A brief review is included of fermentation volatiles attractive to insects. We conclude with the potential cost to use mass trapping against adult green June beetles.

Ovipositional preferences of the Japanese beetle (Coleoptera: Scarabaeidae) among warm- and cool-season turfgrass species

Japanese beetles, Popillia japonica Newman (Coleoptera: Scarabaeidae), were evaluated for ovipositional preferences among four turfgrasses common in northwestern Arkansas. Choice assays revealed females preferred to oviposit in tall fescue (Festuca arundinacea Schreb.) and zoysiagrass (Zoysia japonica Steud.), and that they avoided oviposition in common bermudagrass (Cynodon dactylon [L.] Pers.) and hybrid bermudagrass (C. dactylon x C. transvaalensis Pers.). Significantly fewer eggs were oviposited in hybrid bermudagrass in a no-choice assay, suggesting that chemical and/or physical plant characteristics deter oviposition in that grass. The percentage of turfgrass cores with evidence of female activity (presence of female or eggs, or signs of female digging) in choice assays revealed no differences among treatments, yet significantly fewer hybrid bermudagrass cores had eggs. These results suggest that many females did not initially reject hybrid bermudagrass based on aboveground plant characteristics, but rather they left without ovipositing. Therefore, resistance in hybrid bermudagrass is likely expressed below ground. Our results suggest that the use of hybrid bermudagrass as a means of cultural control in an integrated pest management program may discourage Japanese beetle oviposition and subsequent grub infestations in lawns, golf courses, or sports fields.

Transient solution to the bioheat equation and optimization for magnetic fluid hyperthermia treatment

Two finite concentric spherical regions were considered as the tissue model for magnetic fluid hyperthermia treatment. The inner sphere represents the diseased tissue containing magnetic particles that generate heat when an alternating magnetic field is applied. The outer sphere represents the healthy tissue. Blood perfusion effects are included in both the regions. Analytical and numerical solutions of the one-dimensional bioheat transfer equation were obtained with constant and spatially varying heat generation in the inner sphere. The numerical solution was found to be in good agreement with the analytical solution. In an ideal hyperthermia treatment, all the diseased tissues should be selectively heated without affecting any healthy tissue. The present work optimized the magnetic particle concentration in an attempt to achieve the ideal hyperthermia conditions. It was found that, for a fixed amount of magnetic particles, optimizing the magnetic particle distribution in the diseased tissue can significantly enhance the therapeutic temperature levels in the diseased tissue while maintaining the same level of heating in the healthy tissue.

Use of (32)P to study dynamics of the mitochondrial phosphoproteome

Protein phosphorylation is a well-characterized regulatory mechanism in the cytosol, but remains poorly defined in the mitochondrion. In this study, we characterized the use of (32)P-labeling to monitor the turnover of protein phosphorylation in the heart and liver mitochondria matrix. The (32)P labeling technique was compared and contrasted to Phos-tag protein phosphorylation fluorescent stain and 2D isoelectric focusing. Of the 64 proteins identified by MS spectroscopy in the Phos-Tag gels, over 20 proteins were correlated with (32)P labeling. The high sensitivity of (32)P incorporation detected proteins well below the mass spectrometry and even 2D gel protein detection limits. Phosphate-chase experiments revealed both turnover and phosphate associated protein pool size alterations dependent on initial incubation conditions. Extensive weak phosphate/phosphate metabolite interactions were observed using nondisruptive native gels, providing a novel approach to screen for potential allosteric interactions of phosphate metabolites with matrix proteins. We confirmed the phosphate associations in Complexes V and I due to their critical role in oxidative phosphorylation and to validate the 2D methods. These complexes were isolated by immunocapture, after (32)P labeling in the intact mitochondria, and revealed (32)P-incorporation for the alpha, beta, gamma, OSCP, and d subunits in Complex V and the 75, 51, 42, 23, and 13a kDa subunits in Complex I. These results demonstrate that a dynamic and extensive mitochondrial matrix phosphoproteome exists in heart and liver.

Proteomic changes associated with diabetes in the BB-DP rat

These studies were structured with the aim of utilizing emerging technologies in two-dimensional (2D) gel electrophoresis and mass spectrometry to evaluate protein expression changes associated with type 1 diabetes. We reasoned that a broad examination of diabetic tissues at the protein level might open up novel avenues of investigation of the metabolic and signaling pathways that are adversely affected in type 1 diabetes. This study compared the protein expression of the liver, heart, and skeletal muscle of diabetes-prone rats and matched control rats by semiquantitative liquid chromatography-mass spectrometry and differential in-gel 2D gel electrophoresis. Differential expression of 341 proteins in liver, 43 in heart, and 9 (2D gel only) in skeletal muscle was detected. These data were assembled into the relevant metabolic pathways affected primarily in liver. Multiple covalent modifications were also apparent in 2D gel analysis. Several new hypotheses were generated by these data, including mechanisms of net cytosolic protein oxidation, formaldehyde generation by the methionine cycle, and inhibition of carbon substrate oxidation via reduction in citrate synthase and short-chain acyl-CoA dehydrogenase.

32P labeling of protein phosphorylation and metabolite association in the mitochondria matrix

Protein phosphorylations, as well as phosphate metabolite binding, are well characterized post-translational mechanisms that regulate enzyme activity in the cytosol, but remain poorly defined in mitochondria. Recently extensive matrix protein phosphorylation sites have been discovered but their functional significance is unclear. Herein we describe methods of using (32)P labeling of intact mitochondria to determine the dynamic pools of protein phosphorylation as well as phosphate metabolite association. This screening approach may be useful in not only characterizing the dynamics of these pools, but also provide insight into which phosphorylation sites have a functional significance. Using the mitochondrial ATP synthetic capacity under appropriate conditions, inorganic (32)P was added to energized mitochondria to generate high specific activity gamma-P(32)-ATP in the matrix. In general, SDS denaturing and gel electrophoresis was used to primarily follow protein phosphorylation, whereas native gel techniques were used to observe weaker metabolite associations since the structure of mitochondrial complexes was minimally affected. The protein phosphorylation and metabolite association within the matrix was found to be extensive using these approaches. (32)P labeling in 2D gels was detected in over 40 proteins, including most of the complexes of the cytochrome chain and proteins associated with intermediary metabolism, biosynthetic pathways, membrane transport, and reactive oxygen species metabolism. (32)P pulse-chase experiments further revealed the overall dynamics of these processes that included phosphorylation site turnover as well as phosphate-protein pool size alterations. The high sensitivity of (32)P resulted in many proteins being intensely labeled, but not identified due to the sensitivity limitations of mass spectrometry. These low concentration proteins may represent signaling proteins within the matrix. These results demonstrate that the mitochondrial matrix phosphoproteome is both extensive and dynamic. The use of this, in situ, labeling approach is extremely valuable in confirming protein phosphorylation sites as well as examining the dynamics of these processes under near physiological conditions.

A discordance in rosiglitazone mediated insulin sensitization and skeletal muscle mitochondrial content/activity in Type 2 diabetes mellitus

Skeletal muscle mitochondrial dysfunction is hypothesized to contribute to the pathophysiology of insulin resistance and Type 2 diabetes. Whether thiazolidinedione therapy enhances skeletal muscle mitochondrial function as a component of its insulin-sensitizing effect is unknown. To test this, we evaluated skeletal muscle mitochondria and exercise capacity in Type 2 diabetic subjects with otherwise normal cardiopulmonary function in response to rosiglitazone therapy. Twenty-three subjects were treated for 12 wk and underwent pre- and posttherapy metabolic stress testing and skeletal muscle biopsies. Rosiglitazone significantly ameliorated fasting glucose, insulin, and free fatty acid levels but did not augment the subjects' maximal oxygen consumption (V̇o2max) or their skeletal muscle mitochondrial copy number. The baseline V̇o2max correlated strongly with muscle mitochondrial copy number ( r = 0.56, P = 0.018, n = 17) and inversely with the duration of diabetes ( r = −0.67, P = 0.004, n = 23). Despite the global lack of effect of rosiglitazone-mediated insulin sensitization on skeletal muscle mitochondria, subjects with the most preserved functional capacity demonstrated some plasticity in their mitochondria biology as evidenced by an upregulation of electron transfer chain proteins and in citrate synthase activity. This study demonstrates that the augmentation of skeletal muscle mitochondrial electron transfer chain content and/or bioenergetics is not a prerequisite for rosiglitazone-mediated improved insulin sensitivity. Moreover, in diabetic subjects, V̇o2max reflects the duration of diabetes and skeletal muscle mitochondrial content. It remains to be determined whether longer-term insulin sensitization therapy with rosiglitazone will augment skeletal muscle mitochondrial bioenergetics in those diabetic subjects with relatively preserved basal aerobic capacity.