Phase II study to evaluate the safety and efficacy of intravenous palonosetron (PAL) in primary malignant glioma (MG) patients receiving standard radiotherapy (RT) and concomitant temozolomide (TMZ)

BACKGROUND

In malignant glioma (MG) patients undergoing radiation therapy (RT) with concomitant temozolomide, chemoradiation-induced nausea and vomiting (cRINV) degrades quality of life (QoL) and reduces treatment adherence, which thereby potentially compromises cancer control.

METHODS

We conducted a 6-week phase II single-arm trial of PAL, a second-generation 5-HT3RA antiemetic, for cRINV prevention in MG patients receiving radiation therapy (RT; 54-60 Gy) and concomitant daily temozolomide (TMZ; 75 mg/m(2)/dX42d). Each week before radiation, patients received single-dose palonosetron (PAL) 0.25 mg IV (total = 6 doses). With safety/tolerability as the primary endpoint, the study was designed to differentiate between toxicity rates of 25 % (unacceptable) and 10 % (acceptable) toxicity rates. Secondary endpoints included the percentage of patients achieving cRINV complete response (CR: no emesis or rescue antiemetic) and QoL. Patients reported adverse effects in Common Toxicity Criteria for Adverse Events diaries; recorded vomiting, nausea, and rescue medication use in diaries (which were used to assess cRINV-CR); and reported QoL 4 days/week using the Modified Functional Living Index-Emesis (M-FLIE) and Osoba nausea and vomiting/retching modules.

RESULTS

We enrolled 38 patients (mean age 59 years, 55 % female, 95 % white, 68 % used oral corticosteroids, 76 % reported low alcohol use). Four patients (10.5 %) experienced unacceptable treatment-related toxicity, defined as any grade 3, 4, or 5 non-hematologic toxicity. M-FLIE and Osoba scores showed no evidence of treatment impact on QoL. Overall, cRINV-CR rates for 6 weeks ranged from 67-79 %.

CONCLUSION

Single-dose weekly PAL is a safe and tolerable antiemetic for cRINV prevention in MG patients receiving standard RT and concomitant TMZ.

Physics considerations for single-isocenter, volumetric modulated arc radiosurgery for treatment of multiple intracranial targets

OBJECTIVE

Our purpose was to address challenges associated with single-isocenter radiosurgery for multiple intracranial targets (SIRMIT) including increased sensitivity to rotational uncertainties (resulting from distance of the targets from isocenter) as well as potential for decreased plan quality from larger multileaf collimator width >4 cm from isocenter.

METHODS AND MATERIALS

We evaluated the effect that a 6 degrees-of-freedom couch correction had on localization uncertainty for SIRMIT using thermoplastic mask immobilization. Required setup margin was determined from rotation of the skull and mask (setup kV cone beam computed tomography relative to planning computed tomography). Intraoperational margin was determined from skull rotation within the mask (difference between pre- and posttreatment cone beam computed tomography). We also investigated 4 isocenter placement strategies: volume centroid, centroid of equally weighted points (1 per target), centroid of points weighted by inverse of volume, and Eclipse's built-in method.

RESULTS

When no 6 degrees-of-freedom couch correction is performed after initial setup, a 0.35-mm margin is required per centimeter of target-isocenter separation to account for 95% of rotational uncertainties at initial setup. This margin is reduced to 0.10 mm/cm of target-isocenter separation to account for intraoperative rotational uncertainties when the initial setup uncertainty is eliminated via image guided 6 degrees-of-freedom couch correction. Analysis of 11 multitarget plans (37 targets) showed that conformity index and gradient index improved with decreasing distance from isocenter, this trend being more pronounced for targets <1 mL. Alternative isocenters aimed at decreasing distance of small targets improved their gradient index, but resulted in poorer dose indices for large targets. Mean distance from isocenter was smallest for the centroid of equally weighted points (4.1 ± 1.6cm vs 4.2-4.5cm).

CONCLUSIONS

Rotational corrections via image guidance are necessary for SIRMIT with a thermoplastic mask for immobilization. There is a clear tradeoff between dosimetric quality of small and large targets that should be considered carefully when placing the isocenter.

An integrative approach combining ion mobility mass spectrometry, X-ray crystallography, and nuclear magnetic resonance spectroscopy to study the conformational dynamics of α1 -antitrypsin upon ligand binding

Native mass spectrometry (MS) methods permit the study of multiple protein species within solution equilibria, whereas ion mobility (IM)-MS can report on conformational behavior of specific states. We used IM-MS to study a conformationally labile protein (α1 -antitrypsin) that undergoes pathological polymerization in the context of point mutations. The folded, native state of the Z-variant remains highly polymerogenic in physiological conditions despite only minor thermodynamic destabilization relative to the wild-type variant. Various data implicate kinetic instability (conformational lability within a native state ensemble) as the basis of Z α1 -antitrypsin polymerogenicity. We show the ability of IM-MS to track such disease-relevant conformational behavior in detail by studying the effects of peptide binding on α1 -antitrypsin conformation and dynamics. IM-MS is, therefore, an ideal platform for the screening of compounds that result in therapeutically beneficial kinetic stabilization of native α1 -antitrypsin. Our findings are confirmed with high-resolution X-ray crystallographic and nuclear magnetic resonance spectroscopic studies of the same event, which together dissect structural changes from dynamic effects caused by peptide binding at a residue-specific level. IM-MS methods, therefore, have great potential for further study of biologically relevant thermodynamic and kinetic instability of proteins and provide rapid and multidimensional characterization of ligand interactions of therapeutic interest.

Strength, power, and speed qualities in English junior elite rugby league players

The aim of this study was to compare strength, power, and speed characteristics of elite junior English rugby league forwards and backs. A squad of males under 20's (n = 24; age 18.70 ± 0.90 years; body mass 86.4 ± 9.93 kg; height 178.47 ± 6.97 cm) players from a Super League team performed a range of assessments, including 10-, 20-, and 40-m sprints; vertical jump; and 1 repetition maximum (1RM) bench press and 1-RM back squat. Independent t-tests revealed no significance between body mass and height (180.13 ± 7.65 cm, 176.83 ± 6.10 cm; p > 0.05) or body mass (90.08 ± 11.72 kg, 82.75 ± 6.28 kg; p > 0.05) for the forwards and backs, respectively. Backs were significantly quicker over the 10-m sprints (1.99 ± 0.60 seconds, 2.06 ± 0.10 seconds; p = 0.011), 20-m sprints (3.26 ± 0.70 seconds, 3.39 ± 0.17 seconds; p = 0.002), and 40-m sprints (5.55 ± 0.13 seconds, 5.80 ± 0.26 seconds; p = 0.0001) compared with the forwards. No significant difference (p > 0.05) was observed for the vertical jump performances between the forwards (50.58 ± 7.06 cm) and the backs (50.60 ± 5.02 cm). In addition, forwards demonstrated a higher 1RM bench press and 1RM back squat (110.00 ± 15.8 kg and 140.21 ± 26.21 kg) compared with the backs (101.67 ± 9.13 kg and 132.71 ± 9.38 kg), although this was not statistically significant (p > 0.05); when expressed relative to body mass the differences between forwards and backs was reduced further for both bench press (1.22 ± 0.10 kg/kg, 1.23 ± 0.08 kg/kg, respectively; p > 0.05) and back squat (1.61 ± 0.13 kg/kg, 1.56 ± 0.20 kg/kg, respectively; p > 0.05). In addition, relative squat strength demonstrated moderate inverse correlations between relative squat strength sprint times (r = -0.45, -0.46, and -0.44; p < 0.01) across 10, 20, and 40 m, respectively. These findings highlight the importance of maximizing squat strength in academy rugby league athletes and highlight that differences in sprint performance between positions may be attributable to the differences in relative strength levels between positions.

Using ¹⁵N-ammonium to characterise and map potassium binding sites in proteins by NMR spectroscopy

A variety of enzymes are activated by the binding of potassium ions. The potassium binding sites of these enzymes are very specific, but ammonium ions can often replace potassium ions in vitro because of their similar ionic radii. In these cases, ammonium can be used as a proxy for potassium to characterise potassium binding sites in enzymes: the (1) H,(15) N spin-pair of enzyme-bound (15) NH4 (+) can be probed by (15) N-edited heteronuclear NMR experiments. Here, we demonstrate the use of NMR spectroscopy to characterise binding of ammonium ions to two different enzymes: human histone deacetylase 8 (HDAC8), which is activated allosterically by potassium, and the bacterial Hsp70 homologue DnaK, for which potassium is an integral part of the active site. Ammonium activates both enzymes in a similar way to potassium, thus supporting this non-invasive approach. Furthermore, we present an approach to map the observed binding site onto the structure of HDAC8. Our method for mapping the binding site is general and does not require chemical shift assignment of the enzyme resonances.

Ligand-dependent dynamics of the active-site lid in bacterial dimethylarginine dimethylaminohydrolase

The dimethylarginine dimethylaminohydrolase (DDAH) enzyme family has been the subject of substantial investigation as a potential therapeutic target for the regulation of vascular tension. DDAH enzymes catalyze the conversion of asymmetric N(η),N(η)-dimethylarginine (ADMA) to l-citrulline. Here the influence of substrate and product binding on the dynamic flexibility of DDAH from Pseudomonas aeruginosa (PaDDAH) has been assessed. A combination of heteronuclear NMR spectroscopy, static and time-resolved fluorescence measurements, and atomistic molecular dynamics simulations was employed. A monodisperse monomeric variant of the wild-type enzyme binds the reaction product l-citrulline with a low millimolar dissociation constant. A second variant, engineered to be catalytically inactive by substitution of the nucleophilic Cys249 residue with serine, can still convert the substrate ADMA to products very slowly. This PaDDAH variant also binds l-citrulline, but with a low micromolar dissociation constant. NMR and molecular dynamics simulations indicate that the active site "lid", formed by residues Gly17-Asp27, exhibits a high degree of internal motion on the picosecond-to-nanosecond time scale. This suggests that the lid is open in the apo state and allows substrate access to the active site that is otherwise buried. l-Citrulline binding to both protein variants is accompanied by an ordering of the lid. Modification of PaDDAH with a coumarin fluorescence reporter allowed measurement of the kinetic mechanism of the PaDDAH reaction. A combination of NMR and kinetic data shows that the catalytic turnover of the enzyme is not limited by release of the l-citrulline product. The potential to develop the coumarin-PaDDAH adduct as an l-citrulline sensor is discussed.

Stereotactic ablative body radiotherapy (SABR) for effective palliation of metastases: factors affecting local control

We analyzed factors associated with inferior local control following stereotactic ablative body radiotherapy (SABR) for palliation of metastases. We reviewed records of patients receiving SABR for metastases at Duke University from 2006-2010. Biologically effective dose (BED) was calculated using the linear-quadratic model. Toxicity was assessed by CTCAE v4.0. The Kaplan-Meier method was used to estimate overall survival (OS) and local control (LC) within subgroups (primary or salvage SABR). Univariate (UVA) and multivariate (MVA) regression analysis was used. Fifty and 33 patients received primary and salvage SABR, respectively. 105 lesions were treated (52 spine, 27 lung, 7 liver, 11 other); 67 primary SABR and 38 salvage. Median clinical follow-up was 11.1 months and 10.3 months with imaging of the treated lesion. One patient received SABR x3 and died from toxicity. 88% of symptomatic patients improved after SABR. 1-year LC and OS were 83% and 50%, respectively. Primary SABR had higher BED and was associated with improved LC on UVA (HR 3.0, p=0.01) and MVA (p=0.02); treatment site and histology were not. SABR results in effective palliation of metastases regardless of prior treatment. In the absence of prior EBRT, SABR can be delivered with higher BED and may be associated with better outcomes.

Loop interactions and dynamics tune the enzymatic activity of the human histone deacetylase 8

The human histone deacetylase 8 (HDAC8) is a key hydrolase in gene regulation and has been identified as a drug target for the treatment of several cancers. Previously the HDAC8 enzyme has been extensively studied using biochemical techniques, X-ray crystallography, and computational methods. Those investigations have yielded detailed information about the active site and have demonstrated that the substrate entrance surface is highly dynamic. Yet it has remained unclear how the dynamics of the entrance surface tune and influence the catalytic activity of HDAC8. Using long time scale all atom molecular dynamics simulations we have found a mechanism whereby the interactions and dynamics of two loops tune the configuration of functionally important residues of HDAC8 and could therefore influence the activity of the enzyme. We subsequently investigated this hypothesis using a well-established fluorescence activity assay and a noninvasive real-time progression assay, where deacetylation of a p53 based peptide was observed by nuclear magnetic resonance spectroscopy. Our work delivers detailed insight into the dynamic loop network of HDAC8 and provides an explanation for a number of experimental observations.

1H, 15N and 13C backbone resonance assignments of the archetypal serpin α1-antitrypsin

Alpha(1)-antitrypsin is a 45-kDa (394-residue) serine protease inhibitor synthesized by hepatocytes, which is released into the circulatory system and protects the lung from the actions of neutrophil elastase via a conformational transition within a dynamic inhibitory mechanism. Relatively common point mutations subvert this transition, causing polymerisation of α(1)-antitrypsin and deficiency of the circulating protein, predisposing carriers to severe lung and liver disease. We have assigned the backbone resonances of α(1)-antitrypsin using multidimensional heteronuclear NMR spectroscopy. These assignments provide the starting point for a detailed solution state characterization of the structural properties of this highly dynamic protein via NMR methods.