1
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Shi Y, Reker D, Byrne JD, Kirtane AR, Hess K, Wang Z, Navamajiti N, Young CC, Fralish Z, Zhang Z, Lopes A, Soares V, Wainer J, von Erlach T, Miao L, Langer R, Traverso G. Screening oral drugs for their interactions with the intestinal transportome via porcine tissue explants and machine learning. Nat Biomed Eng 2024; 8:278-290. [PMID: 38378821 DOI: 10.1038/s41551-023-01128-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 10/01/2023] [Indexed: 02/22/2024]
Abstract
In vitro systems that accurately model in vivo conditions in the gastrointestinal tract may aid the development of oral drugs with greater bioavailability. Here we show that the interaction profiles between drugs and intestinal drug transporters can be obtained by modulating transporter expression in intact porcine tissue explants via the ultrasound-mediated delivery of small interfering RNAs and that the interaction profiles can be classified via a random forest model trained on the drug-transporter relationships. For 24 drugs with well-characterized drug-transporter interactions, the model achieved 100% concordance. For 28 clinical drugs and 22 investigational drugs, the model identified 58 unknown drug-transporter interactions, 7 of which (out of 8 tested) corresponded to drug-pharmacokinetic measurements in mice. We also validated the model's predictions for interactions between doxycycline and four drugs (warfarin, tacrolimus, digoxin and levetiracetam) through an ex vivo perfusion assay and the analysis of pharmacologic data from patients. Screening drugs for their interactions with the intestinal transportome via tissue explants and machine learning may help to expedite drug development and the evaluation of drug safety.
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Affiliation(s)
- Yunhua Shi
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel Reker
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - James D Byrne
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - Ameya R Kirtane
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kaitlyn Hess
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Zhuyi Wang
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Natsuda Navamajiti
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Biomedical Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Cameron C Young
- Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Zachary Fralish
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Zilu Zhang
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Aaron Lopes
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Vance Soares
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jacob Wainer
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Thomas von Erlach
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Lei Miao
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Robert Langer
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Giovanni Traverso
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
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2
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Li Y, Lee JS, Kirtane AR, Li M, Coffey CW, Hess K, Lopes A, Collins J, Tamang S, Ishida K, Hayward A, Wainer J, Wentworth AJ, Traverso G. Enzyme-Triggered Intestine-Specific Targeting Adhesive Platform for Universal Oral Drug Delivery. Adv Healthc Mater 2023; 12:e2301033. [PMID: 37314859 PMCID: PMC10653991 DOI: 10.1002/adhm.202301033] [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: 04/01/2023] [Revised: 06/04/2023] [Indexed: 06/15/2023]
Abstract
Patient adherence to chronic therapies can be suboptimal, leading to poor therapeutic outcomes. Dosage forms that enable reduction in dosing frequency stand to improve patient adherence. Variation in gastrointestinal transit time, inter-individual differences in gastrointestinal physiology and differences in physicochemical properties of drugs represent challenges to the development of such systems. To this end, a small intestine-targeted drug delivery system is developed, where prolonged gastrointestinal retention and sustained release are achieved through tissue adhesion of drug pills mediated by an essential intestinal enzyme catalase. Here proof-of-concept pharmacokinetics is demonstrated in the swine model for two drugs, hydrophilic amoxicillin and hydrophobic levodopa. It is anticipated that this system can be applicable for many drugs with a diverse of physicochemical characteristics.
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Affiliation(s)
- Ying Li
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Haidian District, Beijing, 100193, P. R. China
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Jung Seung Lee
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, 16419, South Korea
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon, 16419, South Korea
| | - Ameya R Kirtane
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Mengyuan Li
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Faculty of Applied Science & Engineering, University of Toronto, Toronto, ON, M5S1A4, Canada
| | - Charles William Coffey
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Kaitlyn Hess
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Aaron Lopes
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Joy Collins
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Siddartha Tamang
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Keiko Ishida
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Alison Hayward
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Jacob Wainer
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Adam J Wentworth
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Giovanni Traverso
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
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3
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Lüthge S, Steinbicker A, Schipmann S, Streckert EMS, Hess K, Grauer O, Paulus W, Stummer W, Brokinkel B, Spille DC. P18.01.A The applicability of established clinical and histopathological risk factors for tumor recurrence during long-term perioperative care in meningioma patients. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.328] [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: 11/14/2022] Open
Abstract
Abstract
Background
Risk factors for the prediction of late-onset tumor recurrence in meningioma patients are sparse but needed to estimate duration and control intervals during long-term follow-up in meningioma patients. In this study, we therefore analyzed the value of established risk factors for postoperative meningioma recurrence for the prediction of long-term prognosis in a large, single-center series.
Material and methods
Correlations of established clinical (age, sex, tumor location, extent of resection), radiological (postoperative tumor volume) and histopathological variables (WHO grade, brain invasion) with tumor relapse were analyzed separately after 3, 5, and 10 years following microsurgery for primary diagnosed intracranial meningioma between 1991 and 2021 in uni- and multivariate analyses. The prognostic value was compared to findings in the entire cohort.
Results
Within a median follow-up of 29 months (range: 0-307 months), recurrence was observed in 141 patients (12%) after a median PFS of 36 months. PFS among the entire cohort (n=1218) at 3, 5, 10 and 15 years postoperatively were 90%, 84%, 74% and 70%, respectively. Among all patients included, skull base location (HR: 1.51, 95%CI 1.05-2.16; p=.026), Simpson ≥IV resections (HR: 2.41, 95%CI 1.52-3.84; p<.001), high-grade histology (HR: 3.70, 95%CI 2.50-5.47; p<.001) and male gender (HR: 1.46, 95%CI 1.01-2.11; p=.042) were independent risk factors for recurrence. Skull base location (HR: 1.92, 95%CI 1.17-3.17; p=.010 and HR: 2.02, 95%CI 1.04-3.95; p=.038) and high-grade histology (HR: 1.87, 95%CI 1.04-3.38; p=.038 and HR: 2.29, 95%CI 1.07-4.01; p=.034) but not subtotal resection (HR: 1.53, 95%CI .68-3.45; p=.303 and HR: 1.75, 95%CI .52-5.96; p=.369) remained independently correlated with recurrence after an event-free PFS of at least three (n=485) and five years (n=346), respectively. Similarly, postoperative tumor volume was related with recurrence in the entire cohort (p<.001) but not beyond a follow-up of ≥ three years (p>.05). In 147 patients with a follow-up of ≥ ten years, ten recurrences occurred, and no correlation was found with any of the analyzed variables.
Conclusion
Skull base tumor location and high-grade histology but not the extent of resection should be considered when planning follow-up duration and intervals following ≥5 years after meningioma surgery. Tumor relapses following more than ten years after surgery are very rare, and corresponding predictors are lacking.
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Affiliation(s)
- S Lüthge
- University hospital Münster , Münster , Germany
| | | | - S Schipmann
- University hospital Münster , Münster , Germany
| | | | - K Hess
- University hospital Münster , Münster , Germany
| | - O Grauer
- University hospital Münster , Münster , Germany
| | - W Paulus
- University hospital Münster , Münster , Germany
| | - W Stummer
- University hospital Münster , Münster , Germany
| | - B Brokinkel
- University hospital Münster , Münster , Germany
| | - D C Spille
- University hospital Münster , Münster , Germany
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4
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Kim H, Lee SH, Wentworth A, Babaee S, Wong K, Collins JE, Chu J, Ishida K, Kuosmanen J, Jenkins J, Hess K, Lopes A, Morimoto J, Wan Q, Potdar SV, McNally R, Tov C, Kim NY, Hayward A, Wollin D, Langer R, Traverso G. Biodegradable ring-shaped implantable device for intravesical therapy of bladder disorders. Biomaterials 2022; 288:121703. [PMID: 36030104 PMCID: PMC10485746 DOI: 10.1016/j.biomaterials.2022.121703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/11/2022] [Revised: 07/22/2022] [Accepted: 07/24/2022] [Indexed: 11/26/2022]
Abstract
Intravesical instillation is an efficient drug delivery route for the local treatment of various urological conditions. Nevertheless, intravesical instillation is associated with several challenges, including pain, urological infection, and frequent clinic visits for catheterization; these difficulties support the need for a simple and easy intravesical drug delivery platform. Here, we propose a novel biodegradable intravesical device capable of long-term, local drug delivery without a retrieval procedure. The intravesical device is composed of drug encapsulating biodegradable polycaprolactone (PCL) microcapsules and connected by a bioabsorbable Polydioxanone (PDS) suture with NdFeB magnets in the end. The device is easily inserted into the bladder and forms a 'ring' shape optimized for maximal mechanical stability as informed by finite element analysis. In this study, inserted devices were retained in a swine model for 4 weeks. Using this device, we evaluated the system's capacity for delivery of lidocaine and resiquimod and demonstrated prolonged drug release. Moreover, a cost-effectiveness analysis supports device implementation compared to the standard of care. Our data support that this device can be a versatile drug delivery platform for urologic medications.
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Affiliation(s)
- Hyunjoon Kim
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Seung Ho Lee
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Adam Wentworth
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Sahab Babaee
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Kaitlyn Wong
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Joy E Collins
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Jacqueline Chu
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Keiko Ishida
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Johannes Kuosmanen
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Joshua Jenkins
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Kaitlyn Hess
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Aaron Lopes
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Joshua Morimoto
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Qianqian Wan
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Shaunak V Potdar
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Ronan McNally
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Caitlynn Tov
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Na Yoon Kim
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Alison Hayward
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA; Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Daniel Wollin
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Robert Langer
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Giovanni Traverso
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.
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5
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Anstett T, Smith C, Hess K, Patten L, Pincus S, Lin CT, Ho PM. Dig Deeper: A Case Report of Finding (and Fixing) the Root Cause of Add-On Laboratory Failures. Appl Clin Inform 2022; 13:874-879. [PMID: 35913087 PMCID: PMC9492320 DOI: 10.1055/a-1913-4158] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 07/28/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Venipunctures and the testing they facilitate are clinically necessary, particularly for hospitalized patients. However, excess venipunctures lead to patient harm, decreased patient satisfaction, and waste. OBJECTIVES We sought to identify contributors to excess venipunctures at our institution, focusing on electronic health record (EHR)-related factors. We then implemented and evaluated the impact of an intervention targeting one of the contributing factors. METHODS We employed the quality improvement (QI) methodology to find sources of excess venipunctures, specifically targeting add-on failures. Once an error was identified, we deployed an EHR-based intervention which was evaluated with retrospective pre- and postintervention analysis. RESULTS We identified an error in how the EHR evaluated the ability of laboratories across a health system to perform add-on tests to existing blood specimens. A review of 195,263 add-on orders placed prior to the intervention showed that 165,118 were successful and 30,145 failed, a failure rate of 15.4% (95% confidence interval [CI]: 15.1-15.6). We implemented an EHR-based modification that changed the criteria for add-on testing from a health-system-wide query of laboratory capabilities to one that incorporated only the capabilities of laboratories with feasible access to existing patient samples. In the 6 months following the intervention, a review of 87,333 add-on orders showed that 77,310 were successful, and 10,023 add-on orders failed resulting in a postintervention failure rate of 11.4% (95% CI: 11.1, 11.8) (p < 0.001). CONCLUSION EHR features such as the ability to identify possible add-on tests are designed to reduce venipunctures but may produce unforeseen negative effects on downstream processes, particularly as hospitals merge into health systems using a single EHR. This case report describes the successful identification and correction of one cause of add-on laboratory failures. QI methodology can yield important insights that reveal simple interventions for improvement.
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Affiliation(s)
- Tyler Anstett
- Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Chris Smith
- Division of Hospital Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
| | | | - Luke Patten
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Sharon Pincus
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Chen-Tan Lin
- Department of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - P. Michael Ho
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
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6
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Potter A, Pheiffer B, Hess K, Rossi MM, Umar T. Parental Perspectives on Social Health and Family Relationships of Children With Cancer: An Exploratory Study. Am J Occup Ther 2022. [DOI: 10.5014/ajot.2022.76s1-po49] [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: 11/17/2022] Open
Abstract
Abstract
Date Presented 03/31/2022
This study provides an overview of the cancer symptoms measured by the Patient-Reported Outcomes Measure (PROMIS) Parent Proxy-25 and how they affect social health. By addressing factors of depression, fatigue, mobility, and social participation, therapists can provide more effective therapy and ensure quality service delivery to promote occupational participation throughout the cancer care continuum.
Primary Author and Speaker: Ann Potter
Additional Authors and Speakers: Bryna Pheiffer, Kaitlyn Hess, Michael M. Rossi, Taylor Umar
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Affiliation(s)
- Ann Potter
- Moravian University, Bethlehem, Pennsylvania, United States
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7
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Kirtane AR, Karavasili C, Wahane A, Freitas D, Booz K, Le DTH, Hua T, Scala S, Lopes A, Hess K, Collins J, Tamang S, Ishida K, Kuosmanen JLP, Rajesh NU, Phan NV, Li J, Krogmann A, Lennerz JK, Hayward A, Langer R, Traverso G. Development of oil-based gels as versatile drug delivery systems for pediatric applications. Sci Adv 2022; 8:eabm8478. [PMID: 35622910 PMCID: PMC9140966 DOI: 10.1126/sciadv.abm8478] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 04/13/2022] [Indexed: 06/02/2023]
Abstract
Administering medicines to 0- to 5-year-old children in a resource-limited environment requires dosage forms that circumvent swallowing solids, avoid on-field reconstitution, and are thermostable, cheap, versatile, and taste masking. We present a strategy that stands to solve this multifaceted problem. As many drugs lack adequate water solubility, our formulations used oils, whose textures could be modified with gelling agents to form "oleogels." In a clinical study, we showed that the oleogels can be formulated to be as fluid as thickened beverages and as stiff as yogurt puddings. In swine, oleogels could deliver four drugs ranging three orders of magnitude in their water solubilities and two orders of magnitude in their partition coefficients. Oleogels could be stabilized at 40°C for prolonged durations and used without redispersion. Last, we developed a macrofluidic system enabling fixed and metered dosing. We anticipate that this platform could be adopted for pediatric dosing, palliative care, and gastrointestinal disease applications.
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Affiliation(s)
- Ameya R. Kirtane
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Christina Karavasili
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Aniket Wahane
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Dylan Freitas
- Division of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Katelyn Booz
- Sensory Spectrum Inc., New Providence, NJ 07974, USA
| | - Dao Thi Hong Le
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Swiss Federal Institute of Technology (ETH), Zurich 8092, Switzerland
| | - Tiffany Hua
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Stephen Scala
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Stonehill College, North Easton, MA 02357, USA
| | - Aaron Lopes
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Kaitlyn Hess
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Joy Collins
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Siddartha Tamang
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Keiko Ishida
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Johannes L. P. Kuosmanen
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Netra Unni Rajesh
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- University of Toronto, Toronto, ON, Canada
| | - Nhi V. Phan
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Junwei Li
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | | | - Jochen K. Lennerz
- Department of Pathology, Center for Integrated Diagnostics, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Alison Hayward
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Robert Langer
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Giovanni Traverso
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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8
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Lee SH, Wan Q, Wentworth A, Ballinger I, Ishida K, Collins JE, Tamang S, Huang HW, Li C, Hess K, Lopes A, Kirtane AR, Lee JS, Lee S, Chen W, Wong K, Selsing G, Kim H, Buckley ST, Hayward A, Langer R, Traverso G. Implantable system for chronotherapy. Sci Adv 2021; 7:eabj4624. [PMID: 34826238 PMCID: PMC8626078 DOI: 10.1126/sciadv.abj4624] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Diurnal variation in enzymes, hormones, and other biological mediators has long been recognized in mammalian physiology. Developments in pharmacobiology over the past few decades have shown that timing drug delivery can enhance drug efficacy. Here, we report the development of a battery-free, refillable, subcutaneous, and trocar-compatible implantable system that facilitates chronotherapy by enabling tight control over the timing of drug administration in response to external mechanical actuation. The external wearable system is coupled to a mobile app to facilitate control over dosing time. Using this system, we show the efficacy of bromocriptine on glycemic control in a diabetic rat model. We also demonstrate that antihypertensives can be delivered through this device, which could have clinical applications given the recognized diurnal variation of hypertension-related complications. We anticipate that implants capable of chronotherapy will have a substantial impact on our capacity to enhance treatment effectiveness for a broad range of chronic conditions.
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Affiliation(s)
- Seung Ho Lee
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Qianqian Wan
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Adam Wentworth
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Ian Ballinger
- Division of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Keiko Ishida
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Joy E. Collins
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Siddartha Tamang
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Hen-Wei Huang
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Canchen Li
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Kaitlyn Hess
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Aaron Lopes
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Ameya R. Kirtane
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Jung Seung Lee
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University (SKKU), Suwon 16419, Republic of Korea
| | - SeJun Lee
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Wei Chen
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Kaitlyn Wong
- Division of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - George Selsing
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Hyunjoon Kim
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Stephen T. Buckley
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Alison Hayward
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Global Research Technologies, Novo Nordisk A/S, Måløv, Denmark
| | - Robert Langer
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Giovanni Traverso
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Corresponding author. ,
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9
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Erickson TB, Endo N, Duvallet C, Ghaeli N, Hess K, Alm EJ, Matus M, Chai PR. "Waste Not, Want Not" - Leveraging Sewer Systems and Wastewater-Based Epidemiology for Drug Use Trends and Pharmaceutical Monitoring. J Med Toxicol 2021; 17:397-410. [PMID: 34402038 PMCID: PMC8366482 DOI: 10.1007/s13181-021-00853-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/28/2021] [Accepted: 07/09/2021] [Indexed: 12/26/2022] Open
Abstract
During the current global COVID-19 pandemic and opioid epidemic, wastewater-based epidemiology (WBE) has emerged as a powerful tool for monitoring public health trends by analysis of biomarkers including drugs, chemicals, and pathogens. Wastewater surveillance downstream at wastewater treatment plants provides large-scale population and regional-scale aggregation while upstream surveillance monitors locations at the neighborhood level with more precise geographic analysis. WBE can provide insights into dynamic drug consumption trends as well as environmental and toxicological contaminants. Applications of WBE include monitoring policy changes with cannabinoid legalization, tracking emerging illicit drugs, and early warning systems for potent fentanyl analogues along with the resurging wave of stimulants (e.g., methamphetamine, cocaine). Beyond drug consumption, WBE can also be used to monitor pharmaceuticals and their metabolites, including antidepressants and antipsychotics. In this manuscript, we describe the basic tenets and techniques of WBE, review its current application among drugs of abuse, and propose methods to scale and develop both monitoring and early warning systems with respect to measurement of illicit drugs and pharmaceuticals. We propose new frontiers in toxicological research with wastewater surveillance including assessment of medication assisted treatment of opioid use disorder (e.g., buprenorphine, methadone) in the context of other social burdens like COVID-19 disease.
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Affiliation(s)
- Timothy B Erickson
- Department of Emergency Medicine / Division of Toxicology, Brigham & Women's Hospital / Harvard Medical School, 10 Vining St, Boston, MA, 02155, USA.
- Division of Medical Toxicology, Department of Emergency Medicine, Mass General Brigham, Boston, USA.
- Harvard Humanitarian Institute, Cambridge, MA, USA.
| | | | | | | | | | - Eric J Alm
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Cambridge, MA, USA
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, Singapore, Singapore
- Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Peter R Chai
- Department of Emergency Medicine / Division of Toxicology, Brigham & Women's Hospital / Harvard Medical School, 10 Vining St, Boston, MA, 02155, USA
- Division of Medical Toxicology, Department of Emergency Medicine, Mass General Brigham, Boston, USA
- The Fenway Institute, Boston, MA, USA
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology (MIT), Cambridge, MA, USA
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10
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Babaee S, Shi Y, Abbasalizadeh S, Tamang S, Hess K, Collins JE, Ishida K, Lopes A, Williams M, Albaghdadi M, Hayward AM, Traverso G. Kirigami-inspired stents for sustained local delivery of therapeutics. Nat Mater 2021; 20:1085-1092. [PMID: 34127823 DOI: 10.1038/s41563-021-01031-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/29/2021] [Indexed: 06/12/2023]
Abstract
Implantable drug depots have the capacity to locally meet therapeutic requirements by maximizing local drug efficacy and minimizing potential systemic side effects. Tubular organs including the gastrointestinal tract, respiratory tract and vasculature all manifest with endoluminal disease. The anatomic distribution of localized drug delivery for these organs using existing therapeutic modalities is limited. Application of local depots in a circumferential and extended longitudinal fashion could transform our capacity to offer effective treatment across a range of conditions. Here we report the development and application of a kirigami-based stent platform to achieve this. The stents comprise a stretchable snake-skin-inspired kirigami shell integrated with a fluidically driven linear soft actuator. They have the capacity to deposit drug depots circumferentially and longitudinally in the tubular mucosa of the gastrointestinal tract across millimetre to multi-centimetre length scales, as well as in the vasculature and large airways. We characterize the mechanics of kirigami stents for injection, and their capacity to engage tissue in a controlled manner and deposit degradable microparticles loaded with therapeutics by evaluating these systems ex vivo and in vivo in swine. We anticipate such systems could be applied for a range of endoluminal diseases by simplifying dosing regimens while maximizing drug on-target effects through the sustained release of therapeutics and minimizing systemic side effects.
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Affiliation(s)
- Sahab Babaee
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yichao Shi
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Saeed Abbasalizadeh
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Siddartha Tamang
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Kaitlyn Hess
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Joy E Collins
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Keiko Ishida
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Aaron Lopes
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Williams
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Mazen Albaghdadi
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alison M Hayward
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Giovanni Traverso
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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11
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Li J, Wang T, Kirtane AR, Shi Y, Jones A, Moussa Z, Lopes A, Collins J, Tamang SM, Hess K, Shakur R, Karandikar P, Lee JS, Huang HW, Hayward A, Traverso G. Gastrointestinal synthetic epithelial linings. Sci Transl Med 2021; 12:12/558/eabc0441. [PMID: 32848090 DOI: 10.1126/scitranslmed.abc0441] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/26/2020] [Indexed: 12/27/2022]
Abstract
Epithelial tissues line the organs of the body, providing an initial protective barrier as well as a surface for nutrient and drug absorption. Here, we identified enzymatic components present in the gastrointestinal epithelium that can serve as selective means for tissue-directed polymerization. We focused on the small intestine, given its role in drug and nutrient absorption and identified catalase as an essential enzyme with the potential to catalyze polymerization and growth of synthetic biomaterial layers. We demonstrated that the polymerization of dopamine by catalase yields strong tissue adhesion. We characterized the mechanism and specificity of the polymerization in segments of the gastrointestinal tracts of pigs and humans ex vivo. Moreover, we demonstrated proof of concept for application of these gastrointestinal synthetic epithelial linings for drug delivery, enzymatic immobilization for digestive supplementation, and nutritional modulation through transient barrier formation in pigs. This catalase-based approach to in situ biomaterial generation may have broad indications for gastrointestinal applications.
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Affiliation(s)
- Junwei Li
- Department of Chemical Engineering and David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Thomas Wang
- Department of Chemical Engineering and David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Ameya R Kirtane
- Department of Chemical Engineering and David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Division of Gastroenterology Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Yunhua Shi
- Department of Chemical Engineering and David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Division of Gastroenterology Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Alexis Jones
- Department of Chemical Engineering and David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Zaina Moussa
- Department of Chemical Engineering and David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Aaron Lopes
- Department of Chemical Engineering and David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Joy Collins
- Department of Chemical Engineering and David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Division of Gastroenterology Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Siddartha M Tamang
- Department of Chemical Engineering and David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Kaitlyn Hess
- Department of Chemical Engineering and David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Rameen Shakur
- Department of Chemical Engineering and David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Paramesh Karandikar
- Department of Chemical Engineering and David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Jung Seung Lee
- Department of Chemical Engineering and David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Hen-Wei Huang
- Department of Chemical Engineering and David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Division of Gastroenterology Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Alison Hayward
- Department of Chemical Engineering and David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Division of Gastroenterology Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.,Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Giovanni Traverso
- Department of Chemical Engineering and David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. .,Division of Gastroenterology Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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12
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Reker D, Rybakova Y, Kirtane AR, Cao R, Yang JW, Navamajiti N, Gardner A, Zhang RM, Esfandiary T, L'Heureux J, von Erlach T, Smekalova EM, Leboeuf D, Hess K, Lopes A, Rogner J, Collins J, Tamang SM, Ishida K, Chamberlain P, Yun D, Lytton-Jean A, Soule CK, Cheah JH, Hayward AM, Langer R, Traverso G. Computationally guided high-throughput design of self-assembling drug nanoparticles. Nat Nanotechnol 2021; 16:725-733. [PMID: 33767382 PMCID: PMC8197729 DOI: 10.1038/s41565-021-00870-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 01/28/2021] [Indexed: 05/22/2023]
Abstract
Nanoformulations of therapeutic drugs are transforming our ability to effectively deliver and treat a myriad of conditions. Often, however, they are complex to produce and exhibit low drug loading, except for nanoparticles formed via co-assembly of drugs and small molecular dyes, which display drug-loading capacities of up to 95%. There is currently no understanding of which of the millions of small-molecule combinations can result in the formation of these nanoparticles. Here we report the integration of machine learning with high-throughput experimentation to enable the rapid and large-scale identification of such nanoformulations. We identified 100 self-assembling drug nanoparticles from 2.1 million pairings, each including one of 788 candidate drugs and one of 2,686 approved excipients. We further characterized two nanoparticles, sorafenib-glycyrrhizin and terbinafine-taurocholic acid both ex vivo and in vivo. We anticipate that our platform can accelerate the development of safer and more efficacious nanoformulations with high drug-loading capacities for a wide range of therapeutics.
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Affiliation(s)
- Daniel Reker
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Yulia Rybakova
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Ameya R Kirtane
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ruonan Cao
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Engineering Science, University of Toronto, Toronto, Ontario, Canada
| | - Jee Won Yang
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Robert Frederick Smith School of Chemical and Biomolecular Engineering, Cornell University, Ithaca, NY, USA
| | - Natsuda Navamajiti
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Biomedical Engineering Program, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Apolonia Gardner
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Rosanna M Zhang
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Tina Esfandiary
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Johanna L'Heureux
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Thomas von Erlach
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Elena M Smekalova
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Kaitlyn Hess
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Aaron Lopes
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jaimie Rogner
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Joy Collins
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Siddartha M Tamang
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Keiko Ishida
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Paul Chamberlain
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - DongSoo Yun
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Abigail Lytton-Jean
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Christian K Soule
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jaime H Cheah
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Alison M Hayward
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert Langer
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Giovanni Traverso
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
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13
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Reker D, Shi Y, Kirtane AR, Hess K, Zhong GJ, Crane E, Lin CH, Langer R, Traverso G. Machine Learning Uncovers Food- and Excipient-Drug Interactions. Cell Rep 2021; 30:3710-3716.e4. [PMID: 32187543 PMCID: PMC7179333 DOI: 10.1016/j.celrep.2020.02.094] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 01/06/2020] [Accepted: 02/26/2020] [Indexed: 12/15/2022] Open
Abstract
Inactive ingredients and generally recognized as safe compounds are regarded by the US Food and Drug Administration (FDA) as benign for human consumption within specified dose ranges, but a growing body of research has revealed that many inactive ingredients might have unknown biological effects at these concentrations and might alter treatment outcomes. To speed up such discoveries, we apply state-of-the-art machine learning to delineate currently unknown biological effects of inactive ingredients—focusing on P-glycoprotein (P-gp) and uridine diphosphate-glucuronosyltransferase-2B7 (UGT2B7), two proteins that impact the pharmacokinetics of approximately 20% of FDA-approved drugs. Our platform identifies vitamin A palmitate and abietic acid as inhibitors of P-gp and UGT2B7, respectively; in silico, in vitro, ex vivo, and in vivo validations support these interactions. Our predictive framework can elucidate biological effects of commonly consumed chemical matter with implications on food-and excipient-drug interactions and functional drug formulation development. Reker et al. use machine learning to identify biological activities of food and drug additives. Validation confirms vitamin A palmitate as an inhibitor of P-glycoprotein transport and abietic acid as an inhibitor of UGT2b7 metabolism. Such associations have important implications as food-or excipient-drug interactions.
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Affiliation(s)
- Daniel Reker
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; MIT-IBM Watson AI Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Yunhua Shi
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Ameya R Kirtane
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Kaitlyn Hess
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Grace J Zhong
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Evan Crane
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Chih-Hsin Lin
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Robert Langer
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; MIT-IBM Watson AI Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Giovanni Traverso
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; MIT-IBM Watson AI Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
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14
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Verma M, Chu JN, Salama JAF, Faiz MT, Eweje F, Gwynne D, Lopes A, Hess K, Soares V, Steiger C, McManus R, Koeppen R, Hua T, Hayward A, Collins J, Tamang SM, Ishida K, Miller JB, Katz S, Slocum AH, Sulkowski MS, Thomas DL, Langer R, Traverso G. Development of a long-acting direct-acting antiviral system for hepatitis C virus treatment in swine. Proc Natl Acad Sci U S A 2020; 117:11987-11994. [PMID: 32424082 PMCID: PMC7275718 DOI: 10.1073/pnas.2004746117] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Chronic hepatitis C virus (HCV) infection is a leading cause of cirrhosis worldwide and kills more Americans than 59 other infections, including HIV and tuberculosis, combined. While direct-acting antiviral (DAA) treatments are effective, limited uptake of therapy, particularly in high-risk groups, remains a substantial barrier to eliminating HCV. We developed a long-acting DAA system (LA-DAAS) capable of prolonged dosing and explored its cost-effectiveness. We designed a retrievable coil-shaped LA-DAAS compatible with nasogastric tube administration and the capacity to encapsulate and release gram levels of drugs while resident in the stomach. We formulated DAAs in drug-polymer pills and studied the release kinetics for 1 mo in vitro and in vivo in a swine model. The LA-DAAS was equipped with ethanol and temperature sensors linked via Bluetooth to a phone application to provide patient engagement. We then performed a cost-effectiveness analysis comparing LA-DAAS to DAA alone in various patient groups, including people who inject drugs. Tunable release kinetics of DAAs was enabled for 1 mo with drug-polymer pills in vitro, and the LA-DAAS safely and successfully provided at least month-long release of sofosbuvir in vivo. Temperature and alcohol sensors could interface with external sources for at least 1 mo. The LA-DAAS was cost-effective compared to DAA therapy alone in all groups considered (base case incremental cost-effectiveness ratio $39,800). We believe that the LA-DAA system can provide a cost-effective and patient-centric method for HCV treatment, including in high-risk populations who are currently undertreated.
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Affiliation(s)
- Malvika Verma
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Jacqueline N Chu
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - John A F Salama
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Mohammed T Faiz
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Feyisope Eweje
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115
| | - Declan Gwynne
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Aaron Lopes
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Kaitlyn Hess
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Vance Soares
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Christoph Steiger
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Rebecca McManus
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Ryan Koeppen
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Tiffany Hua
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Alison Hayward
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Joy Collins
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Siddartha M Tamang
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Keiko Ishida
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Jonathan B Miller
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Stephanie Katz
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - Alexander H Slocum
- Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Mark S Sulkowski
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - David L Thomas
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - Robert Langer
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139;
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139
- Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Giovanni Traverso
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139;
- Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115
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15
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Babaee S, Pajovic S, Kirtane AR, Shi J, Caffarel-Salvador E, Hess K, Collins JE, Tamang S, Wahane AV, Hayward AM, Mazdiyasni H, Langer R, Traverso G. Temperature-responsive biometamaterials for gastrointestinal applications. Sci Transl Med 2020; 11:11/488/eaau8581. [PMID: 30996082 PMCID: PMC7797624 DOI: 10.1126/scitranslmed.aau8581] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 12/13/2018] [Accepted: 03/22/2019] [Indexed: 12/12/2022]
Abstract
We hypothesized that ingested warm fluids could act as triggers for biomedical devices. We investigated heat dissipation throughout the upper gastrointestinal (GI) tract by administering warm (55°C) water to pigs and identified two zones in which thermal actuation could be applied: esophageal (actuation through warm water ingestion) and extra-esophageal (protected from ingestion of warm liquids and actuatable by endoscopically administered warm fluids). Inspired by a blooming flower, we developed a capsule-sized esophageal system that deploys using elastomeric elements and then recovers its original shape in response to thermal triggering of shape-memory nitinol springs by ingestion of warm water. Degradable millineedles incorporated into the system could deliver model molecules to the esophagus. For the extra-esophageal compartment, we developed a highly flexible macrostructure (mechanical metamaterial) that deforms into a cylindrical shape to safely pass through the esophagus and deploys into a fenestrated spherical shape in the stomach, capable of residing safely in the gastric cavity for weeks. The macrostructure uses thermoresponsive elements that dissociate when triggered with the endoscopic application of warm (55°C) water, allowing safe passage of the components through the GI tract. Our gastric-resident platform acts as a gram-level long-lasting drug delivery dosage form, releasing small-molecule drugs for 2 weeks. We anticipate that temperature-triggered systems could usher the development of the next generation of stents, drug delivery, and sensing systems housed in the GI tract.
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Affiliation(s)
- Sahab Babaee
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Simo Pajovic
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Ameya R Kirtane
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Jiuyun Shi
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Ester Caffarel-Salvador
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Kaitlyn Hess
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Joy E Collins
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Siddartha Tamang
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Aniket V Wahane
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Alison M Hayward
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Hormoz Mazdiyasni
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Robert Langer
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. .,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Giovanni Traverso
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. .,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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16
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Verma M, Vishwanath K, Eweje F, Roxhed N, Grant T, Castaneda M, Steiger C, Mazdiyasni H, Bensel T, Minahan D, Soares V, Salama JAF, Lopes A, Hess K, Cleveland C, Fulop DJ, Hayward A, Collins J, Tamang SM, Hua T, Ikeanyi C, Zeidman G, Mule E, Boominathan S, Popova E, Miller JB, Bellinger AM, Collins D, Leibowitz D, Batra S, Ahuja S, Bajiya M, Batra S, Sarin R, Agarwal U, Khaparde SD, Gupta NK, Gupta D, Bhatnagar AK, Chopra KK, Sharma N, Khanna A, Chowdhury J, Stoner R, Slocum AH, Cima MJ, Furin J, Langer R, Traverso G. A gastric resident drug delivery system for prolonged gram-level dosing of tuberculosis treatment. Sci Transl Med 2020; 11:11/483/eaau6267. [PMID: 30867322 PMCID: PMC7797620 DOI: 10.1126/scitranslmed.aau6267] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 02/01/2019] [Indexed: 12/12/2022]
Abstract
Multigram drug depot systems for extended drug release could transform our capacity to effectively treat patients across a myriad of diseases. For example, tuberculosis (TB) requires multimonth courses of daily multigram doses for treatment. To address the challenge of prolonged dosing for regimens requiring multigram drug dosing, we developed a gastric resident system delivered through the nasogastric route that was capable of safely encapsulating and releasing grams of antibiotics over a period of weeks. Initial preclinical safety and drug release were demonstrated in a swine model with a panel of TB antibiotics. We anticipate multiple applications in the field of infectious diseases, as well as for other indications where multigram depots could impart meaningful benefits to patients, helping maximize adherence to their medication.
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Affiliation(s)
- Malvika Verma
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Karan Vishwanath
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Feyisope Eweje
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Niclas Roxhed
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Micro and Nanosystems, KTH Royal Institute of Technology, Stockholm 10044, Sweden
| | - Tyler Grant
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Macy Castaneda
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Christoph Steiger
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Hormoz Mazdiyasni
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Taylor Bensel
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Daniel Minahan
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Vance Soares
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - John A F Salama
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Aaron Lopes
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Kaitlyn Hess
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Cody Cleveland
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Daniel J Fulop
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Alison Hayward
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Joy Collins
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Siddartha M Tamang
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Tiffany Hua
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Chinonyelum Ikeanyi
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Gal Zeidman
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Elizabeth Mule
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Sooraj Boominathan
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Ellena Popova
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Biology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Jonathan B Miller
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Andrew M Bellinger
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Cardiovascular Division, Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - David Collins
- Management Sciences for Health, Medford, MA 02155, USA.,Boston University School of Public Health, Boston, MA 02118, USA
| | - Dalia Leibowitz
- Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | | | | | | | | | - Rohit Sarin
- National Institute of Tuberculosis and Respiratory Diseases, New Delhi 110030, India
| | - Upasna Agarwal
- National Institute of Tuberculosis and Respiratory Diseases, New Delhi 110030, India
| | - Sunil D Khaparde
- Former Deputy Director General and Head of Central TB Division, Government of India, New Delhi 110011, India
| | - Neeraj K Gupta
- Department of Respiratory Medicine, Safdarjung Hospital, New Delhi 110029, India
| | - Deepak Gupta
- Division of Pulmonary and Critical Care Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Anuj K Bhatnagar
- Rajan Babu Institute for Pulmonary Medicine and Tuberculosis, New Delhi 110009, India
| | | | - Nandini Sharma
- Department of Community Medicine, Maulana Azad Medical College, New Delhi 110002, India
| | - Ashwani Khanna
- Lok Nayak Hospital Chest Clinic, New Delhi 110002, India
| | | | - Robert Stoner
- Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,MIT Energy Initiative, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Alexander H Slocum
- Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Michael J Cima
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Robert Langer
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. .,Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Giovanni Traverso
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. .,Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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17
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Sen S, Carmagnani Pestana R, Hess K, Viola GM, Subbiah V. Impact of antibiotic use on survival in patients with advanced cancers treated on immune checkpoint inhibitor phase I clinical trials. Ann Oncol 2019; 29:2396-2398. [PMID: 30307530 DOI: 10.1093/annonc/mdy453] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Sen
- Sarah Canon Research Institute at HealthONE, Denver, USA
| | - R Carmagnani Pestana
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - K Hess
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - G M Viola
- Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - V Subbiah
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA.
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18
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Lucci A, Hall C, Hess K, Ravenberg E, Clayborn A, Mittendorf E, Rauch G, Candelaria R, Moulder S, Thompson A. Abstract P3-01-01: Circulating tumor cells (CTCs) after neoadjuvant chemotherapy for triple negative breast cancer (TNBC). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-01-01] [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
Background: ARTEMIS (A Randomized, TNBC Enrolling trial to confirm Molecular profiling Improves Survival) is a randomized trial to determine if precision guided neoadjuvant chemotherapy (NAC) impacts rates of pathologic complete response in the breast and axillary nodes (pCR). We hypothesized that CTCs in peripheral blood after completion of NAC would provide prognostic information beyond pCR alone in TNBC patients.
Methods: Blood was assessed for CTCs after NAC as part of two IRB approved studies, ARTEMIS (2014 – 0185/PA15-1050), and LAB04-0698. CTCs were identified using the Cell Search® System (Menarini Silicon Biosystems). Samples with one or more cells, also having morphologic criteria for malignancy, were deemed CTC positive. Log-rank test and Cox regression analysis were applied to evaluate associations between CTC positive, pCR, and overall survival.
Results: pCR was achieved in 24/68 (35%) patients with TNBC. Twenty four patients (35%) were CTC positive. Three year overall survival was evaluated in 4 groups of patients: pCR and no CTCs (n=20), pCR and CTC positive (n=4), non-pCR and no CTCs (n=24) and non-pCR and CTC positive (n=20). Three year overall survival was higher in the pCR and no CTCs cohort (100%), compared to pCR and CTC positive (50%), non-pCR and no CTCs (83%), non-pCR and CTC positive (19%); log rank p<0.0001. In the non-pCR and CTC positive patient cohorts, the presence of CTCs was associated with significant risk of death at 3 years [hazard ratio of 12.3 (95% CI 3.4-454, p=0.00002)], whereas a favorable, but non-significant trend was noted for pCR [hazard ratio of 0.2 (95% CI 0.0, 1.4, p=0.11)].
Conclusion: The identification of CTCs after NAC has prognostic significance beyond that of pCR, and should be considered in evaluation of patients for clinical trials of adjuvant therapies.
Citation Format: Lucci A, Hall C, Hess K, Ravenberg E, Clayborn A, Mittendorf E, Rauch G, Candelaria R, Moulder S, Thompson A. Circulating tumor cells (CTCs) after neoadjuvant chemotherapy for triple negative breast cancer (TNBC) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-01-01.
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Affiliation(s)
- A Lucci
- University of Texas MD Anderson Cancer Center, Houston, TX; Dana Farber Cancer Institute, Boston, MA
| | - C Hall
- University of Texas MD Anderson Cancer Center, Houston, TX; Dana Farber Cancer Institute, Boston, MA
| | - K Hess
- University of Texas MD Anderson Cancer Center, Houston, TX; Dana Farber Cancer Institute, Boston, MA
| | - E Ravenberg
- University of Texas MD Anderson Cancer Center, Houston, TX; Dana Farber Cancer Institute, Boston, MA
| | - A Clayborn
- University of Texas MD Anderson Cancer Center, Houston, TX; Dana Farber Cancer Institute, Boston, MA
| | - E Mittendorf
- University of Texas MD Anderson Cancer Center, Houston, TX; Dana Farber Cancer Institute, Boston, MA
| | - G Rauch
- University of Texas MD Anderson Cancer Center, Houston, TX; Dana Farber Cancer Institute, Boston, MA
| | - R Candelaria
- University of Texas MD Anderson Cancer Center, Houston, TX; Dana Farber Cancer Institute, Boston, MA
| | - S Moulder
- University of Texas MD Anderson Cancer Center, Houston, TX; Dana Farber Cancer Institute, Boston, MA
| | - A Thompson
- University of Texas MD Anderson Cancer Center, Houston, TX; Dana Farber Cancer Institute, Boston, MA
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19
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Welsh J, Heymach J, Cadena A, Cushman T, Hess K, Shroff G, Tang C, Skoulidis F, Jeter M, Nguyen Q, Chang J, Papadimitrakopoulou V, Gomez D, Sharma P, Allison J, Raju U, Shabaan S, Byers L, Glisson B. Phase I Trial of MK-3475 and Concurrent Radiation for the Elimination of Extensive-Stage Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Welsh J, Heymach J, Cushman T, Hess K, Shroff G, Tang C, Skoulidis F, Jeter M, Nguyen Q, Chang J, Papadimitrakopoulou V, Gomez D, Sharma P, Allison J, Raju U, Shaaban S, Byers L, Glisson B. Phase I Trial of MK-3475 and Concurrent Chemoradiotherapy for Limited-Stage Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Abstract
Coprinopsis cinerea is an environmental fungus which can cause disseminated infections in immunocompromised patients, often leading to death. Here we report the case of a paediatric patient with an invasive wound infection due to C. cinerea, which was successfully treated with surgical debridement and oral posaconazole.
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Affiliation(s)
| | - A Brentrup
- Pediatric Neurosurgery, Department of Neurosurgery, Germany
| | - K Hess
- Institute of Neuropathology, University Hospital Muenster, Münster, Germany
| | - K Becker
- Institute of Medical Microbiology, Germany
| | - A H Groll
- Pediatric Hematology and Oncology, University Children's Hospital Muenster, Münster, Germany
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22
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Damodaran S, Symmans F, Helgason T, Mittendorf E, Tripathy D, Hess K, Litton J, Moulder S. A phase II trial of mirvetuximab soravtansine in patients with localized triple-negative breast cancer (TNBC) with tumors predicted insensitive to standard neoadjuvant chemotherapy (NACT) including a lead-in cohort to establish activity in patients with metastatic TNBC. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx365.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Moulder S, Hess K, Rauch M, Astrada B, Litton J, Mittendorf E, Ueno N, Tripathy D, Lim B, Piwnica-Worms H, Thompson A, Symmans WF. Abstract OT2-01-22: NCT02456857: A phase II trial of liposomal doxorubicin, bevacizumab and everolimus (DAE) in patients (pts) with localized triple-negative breast cancer (TNBC) with tumors predicted insensitive to standard neoadjuvant chemotherapy (NACT). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot2-01-22] [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
BACKGROUND: Approximately 50% of TNBC pts treated with standard taxane/anthracycline-based NACT will have chemo-insensitive disease (CID) manifested as extensive residual disease (RCB-II or III) at the time of surgery. 40-80% of these pts will develop recurrence within 3 years of initial diagnosis. Recent advances in molecular profiling have identified subsets of TNBC with distinct, targetable molecular features. We developed a clinical trial to identify and characterize CID (ARTEMIS: A Randomized, TNBC Enrolling trial to confirm Molecular profiling Improves Survival). In the ARTEMIS trial, treatment naïve pts with localized TNBC undergo a pretreatment biopsy and then immediately start their initial phase of anthracycline-based chemotherapy so that the results of the molecular characterization are used in combination with response assessment (clinical exam/diagnostic imaging) to identify CID and inform the second phase of NACT, thus using a 'second hit' strategy in the middle of NACT to overcome drug resistance. The mesenchymal subtypes of TNBC have a high incidence of PI3K pathway activation. Preclinical models demonstrated response to PI3K inhibitors in this subtype. Metaplastic breast cancers make up ∼30% of tumors characterized as 'claudin-low/mesenchymal' by gene signature and are also associated with a high rate of PI3K activating molecular aberrations. A combination regimen of liposomal doxorubicin, bevacizumab and the mTOR inhibitors temsirolimus or everolimus (DAT or DAE) demonstrated response (including durable complete responses) in metastatic metaplastic breast cancer.
PRIMARY OBJECTIVE: Determine the rate of pathologic complete response (pCR/RCB-0) or minimal residual disease (RCB-I) after 4 cycles of DAE for treatment of mesenchymal TNBC deemed to be CID through the ARTEMIS trial
TRIAL DESIGN AND STATISTICAL METHODS: Only pts deemed to have mesenchymal CID on the ARTEMIS trial can enter this non-randomized phase II study. Realizing that pts without response to their initial cycles of chemotherapy have very low chance (5%) of achieving pCR with additional cycles of chemotherapy, it would be clinically meaningful to see pCR in this pt population improved to 20%. Counting pCR (RCB-0) or RCB-I as response, a two-stage Gehan-type design will be employed with 14 pts in the first stage. If at least one pt responds, 23 more pts will be added for a total of 37 pts. This design has a 49% chance of terminating after the first stage if the true response rate is 0.05, 23% chance if the true rate is 0.10, 10% if the true rate is 0.15 and 4% if the true rate is 0.20. If accrual continues to the second stage and a total of 37 pts are enrolled, the 95% confidence interval for a 0.20 response rate will extend from 0.10 to 0.35.
BRIEF ELIGIBILITY CRITERIA: Inclusion: localized TNBC enrolled onto ARTEMIS trial, adequate organ, bone marrow and cardiac parameters Exclusion: metastatic disease, pregnant or lactating pts, medical illness that increases chance of moderate to severe toxicity
CORRELATIVE SCIENCE: Correlate vimentin expression by IHC, mesenchymal signatures and PI3K pathway aberrations with response.
Citation Format: Moulder S, Hess K, Rauch M, Astrada B, Litton J, Mittendorf E, Ueno N, Tripathy D, Lim B, Piwnica-Worms H, Thompson A, Symmans WF. NCT02456857: A phase II trial of liposomal doxorubicin, bevacizumab and everolimus (DAE) in patients (pts) with localized triple-negative breast cancer (TNBC) with tumors predicted insensitive to standard neoadjuvant chemotherapy (NACT) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT2-01-22.
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Affiliation(s)
- S Moulder
- University of Texas, MD Anderson Cancer Center
| | - K Hess
- University of Texas, MD Anderson Cancer Center
| | - M Rauch
- University of Texas, MD Anderson Cancer Center
| | - B Astrada
- University of Texas, MD Anderson Cancer Center
| | - J Litton
- University of Texas, MD Anderson Cancer Center
| | | | - N Ueno
- University of Texas, MD Anderson Cancer Center
| | - D Tripathy
- University of Texas, MD Anderson Cancer Center
| | - B Lim
- University of Texas, MD Anderson Cancer Center
| | | | - A Thompson
- University of Texas, MD Anderson Cancer Center
| | - WF Symmans
- University of Texas, MD Anderson Cancer Center
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Katz JR, Hess K. Über Quellung und Merzerisierung natürlicher Zellulosefasern in Salpetersäure und über philanierte Baumwolle. I. ACTA ACUST UNITED AC 2017. [DOI: 10.1515/zpch-1926-12211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Hess K, Trogus C. Bemerkungen zur Arbeit von W. SCHRAMEK: „Das Röntgenfaserdiagramm als quantitativer Massstab für die Veränderung der Bausteine der Cellulosefaser durch chemische. ACTA ACUST UNITED AC 2017. [DOI: 10.1515/zpch-1933-2131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Trogus C, Tomonari T, Hess K. Beiträge zur Kenntnis der Lösungsvorgänge organischer Substanzen in nichtwässerigen Flüssigkeiten. I. ACTA ACUST UNITED AC 2017. [DOI: 10.1515/zpch-1932-1626] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Tang C, Hess K, Sanders D, Davis S, Kurzrock R, Lee J, Meric Bernstam F, Hong D. Efficient clinical research infrastructure and trial performance: Assessment of a dedicated clinical trials unit within an academic cancer center. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32779-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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George G, Buford A, Hess K, Piha-Paul S, Zinner R, Subbiah V, Iwuanyanwu E, Cleeland C, Meric-Bernstam F, Bernstam E, Hong D. Cancer-related internet use in patients with advanced cancer in a phase I clinical trials clinic. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32782-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sándor PS, Dydak U, Schoenen J, Kollias SS, Hess K, Boesiger P, Agosti RM. MR-Spectroscopic Imaging during Visual Stimulation in Subgroups of Migraine with Aura. Cephalalgia 2016; 25:507-18. [PMID: 15955037 DOI: 10.1111/j.1468-2982.2005.00900.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Migraine pathophysiology possibly involves deficient mitochondrial energy reserve and diminished cortical habituation. Using functional magnetic resonance spectroscopic imaging (fMRSI), we studied cortical lactate changes during prolonged visual stimulation to search for different pathophysiological mechanisms in clinically distinct subgroups of migraine with aura. Eleven healthy volunteers (HV) and 10 migraine patients were investigated interictally: five with visual aura (MA) and five with visual symptoms and at least one of the following: paraesthe-sia, paresis or dysphasia (MAplus). Using MRSI (Philips, 1.5 T) 1H-spectra were repeatedly obtained from a 25 mm-thick slice covering visual and non-visual cortex, with the first and fifth measurements in darkness and the second to fourth with 8-Hz checkerboard stimulation. In MAplus lactate increased only during stimulation, only in visual cortex; in MA resting lactate was high in visual cortex, without further increase during stimulation. This is compatible with an abnormal metabolic strain during stimulation in MAplus, possibly due to dishabituation, and a predominant mitochondrial dysfunction in MA.
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Affiliation(s)
- P S Sándor
- Neurology Department, University Hospital, Zurich, Switzerland
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Affiliation(s)
- P S Sándor
- Headache & Pain Unit, Neurology Department, University Hospital Zurich, Zurich, Switzerland.
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Falchook GS, Rady P, Konopinski JC, Busaidy N, Hess K, Hymes S, Nguyen HP, Prieto VG, Bustinza-Linares E, Lin Q, Parkhurst KL, Hong DS, Sherman S, Tyring SK, Kurzrock R. Merkel cell polyomavirus and human papilloma virus in proliferative skin lesions arising in patients treated with BRAF inhibitors. Arch Dermatol Res 2016; 308:357-65. [DOI: 10.1007/s00403-016-1650-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 03/20/2016] [Accepted: 04/14/2016] [Indexed: 01/07/2023]
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Liu X, George GC, Tsimberidou AM, Naing A, Wheler JJ, Kopetz S, Fu S, Piha-Paul SA, Eng C, Falchook GS, Janku F, Garrett C, Karp D, Kurzrock R, Zinner R, Raghav K, Subbiah V, Hess K, Meric-Bernstam F, Hong DS, Overman MJ. Retreatment with anti-EGFR based therapies in metastatic colorectal cancer: impact of intervening time interval and prior anti-EGFR response. BMC Cancer 2015; 15:713. [PMID: 26474549 PMCID: PMC4609167 DOI: 10.1186/s12885-015-1701-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 10/07/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This retrospective study aims to investigate the activity of retreatment with anti-EGFR-based therapies in order to explore the concept of clonal evolution by evaluating the impact of prior activity and intervening time interval. METHODS Eighty-nine KRAS exon 2-wild-type metastatic colorectal patients were retreated on phase I/II clinical trials containing anti-EGFR therapies after progressing on prior cetuximab or panitumumab. Response on prior anti-EGFR therapy was defined retrospectively per physician-records as response or stable disease ≥6 months. Multivariable statistical methods included a multiple logistic regression model for response, and Cox proportional hazards model for progression-free survival. RESULTS Retreatment anti-EGFR agents were cetuximab (n = 76) or cetuximab plus erlotinib (n = 13). The median interval time between prior and retreatment regimens was 4.57 months (range: 0.46-58.7). Patients who responded to the prior cetuximab or panitumumab were more likely to obtain clinical benefit to the retreatment compared to the non-responders in both univariate (p = 0.007) and multivariate analyses (OR: 3.38, 95 % CI: 1.27, 9.31, p = 0.019). The clinical benefit rate on retreatment also showed a marginally significant association with interval time between the two anti-EGFR based therapies (p = 0.053). Median progression-free survival on retreatment was increased in prior responders (4.9 months, 95 % CI: 3.6, 6.2) compared to prior non-responders (2.5 months, 95 % CI, 1.58, 3.42) in univariate (p = 0.064) and multivariate analysis (HR: 0.70, 95 % CI: 0.43-1.15, p = 0.156). CONCLUSION Our data lends support to the concept of clonal evolution, though the clinical impact appears less robust than previously reported. Further work to determine which patients benefit from retreatment post progression is needed.
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Affiliation(s)
- X Liu
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - G C George
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - A M Tsimberidou
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - A Naing
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - J J Wheler
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - S Kopetz
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit # 426, Houston, TX, 77030, USA.
| | - S Fu
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - S A Piha-Paul
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - C Eng
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit # 426, Houston, TX, 77030, USA.
| | - G S Falchook
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - F Janku
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - C Garrett
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit # 426, Houston, TX, 77030, USA.
| | - D Karp
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - R Kurzrock
- Division of Hematology and Oncology, University of California San Diego Moores Cancer Center, San Diego, CA, USA.
| | - R Zinner
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - K Raghav
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit # 426, Houston, TX, 77030, USA.
| | - V Subbiah
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - K Hess
- Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - F Meric-Bernstam
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - D S Hong
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - M J Overman
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit # 426, Houston, TX, 77030, USA.
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Mellmann J, Hess K, Schnaidt U, Stender HS, Lustenberger N. Angiographic results in interstitial, vascular and glomerular kidney diseases. Contrib Nephrol 2015; 16:115-7. [PMID: 467061 DOI: 10.1159/000402884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In earlier stages of parenchymal kidney diseases different changes are to be seen in angiography. No single sign appeared to be pathognomonic for glomerular nephritis, vascular disease or interstitial nephropathy. But the disproportionate frequency of some angiographic features assumed discriminatory value. Morphometry of the renal arteriograms discriminated statistically significant interstitial, vascular and glomerular diseases. The correct angiographical diagnosis was made in 76%.
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Fu S, Hou MM, Naing A, Janku F, Hess K, Zinner R, Subbiah V, Hong D, Wheler J, Piha-Paul S, Tsimberidou A, Karp D, Araujo D, Kee B, Hwu P, Wolff R, Kurzrock R, Meric-Bernstam F. Phase I study of pazopanib and vorinostat: a therapeutic approach for inhibiting mutant p53-mediated angiogenesis and facilitating mutant p53 degradation. Ann Oncol 2015; 26:1012-1018. [PMID: 25669829 DOI: 10.1093/annonc/mdv066] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [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: 12/23/2014] [Accepted: 01/29/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND We carried out a phase I trial of the vascular endothelial growth factor inhibitor pazopanib and the histone deacetylase inhibitor vorinostat to determine the safety and efficacy. Because these agents are known to target factors activated by TP53 mutation and facilitate mutant p53 degradation, a subgroup analysis may be interesting in patients with TP53 mutant malignancies. PATIENTS AND METHODS Patients with advanced solid tumors (n = 78) were enrolled following a 3 + 3 design, with dose expansion for those with responsive tumors. Hotspot TP53 mutations were tested when tumor specimens were available. RESULTS Adverse events of ≥grade 3 included thrombocytopenia, neutropenia, fatigue, hypertension, diarrhea and vomiting. Overall, the treatment produced stable disease for at least 6 months or partial response (SD ≥6 months/PR) in 19% of the patients, median progression-free survival (PFS) of 2.2 months, and median overall survival (OS) of 8.9 months. In patients with detected hotspot TP53 mutant advanced solid tumors (n = 11), the treatment led to a 45% rate of SD ≥6 months/PR (1 PR and 3 SD ≥6 months), median PFS of 3.5 months, and median OS of 12.7 months, compared favorably with the results for patients with undetected hotspot TP53 mutations (n = 25): 16% (1 PR and 3 SD ≥6 months, P = 0.096), 2.0 months (P = 0.042), and 7.4 months (P = 0.1), respectively. CONCLUSION The recommended phase II dosage was oral pazopanib at 600 mg daily plus oral vorinostat at 300 mg daily. The preliminary evidence supports further evaluation of the combination in cancer patients with mutated TP53, especially in those with metastatic sarcoma or metastatic colorectal cancer. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov, NCT01339871.
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Affiliation(s)
- S Fu
- Departments of Investigational Cancer Therapeutics.
| | - M M Hou
- Departments of Investigational Cancer Therapeutics; Division of Hematology-Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - A Naing
- Departments of Investigational Cancer Therapeutics
| | - F Janku
- Departments of Investigational Cancer Therapeutics
| | | | - R Zinner
- Departments of Investigational Cancer Therapeutics
| | - V Subbiah
- Departments of Investigational Cancer Therapeutics
| | - D Hong
- Departments of Investigational Cancer Therapeutics
| | - J Wheler
- Departments of Investigational Cancer Therapeutics
| | - S Piha-Paul
- Departments of Investigational Cancer Therapeutics
| | | | - D Karp
- Departments of Investigational Cancer Therapeutics
| | | | - B Kee
- GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | | | - R Wolff
- GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - R Kurzrock
- University of California San Diego, Moores Cancer Center, La Jolla, USA
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Abstract
Patients with diabetes are at increased risk of cardiovascular morbidity and mortality. While arteriosclerotic lesions have long been recognized as the underlying cause more recent studies suggest that alterations of the blood are also critically involved. Following plaque rupture, adherence of platelets is followed by the formation of a cross-linked fibrin clot. Patients with diabetes exhibit a prothrombotic milieu consisting of hyper reactive platelets, a tight and rigid clot structure which is due to up-regulation of coagulation factors and prolongation of clot lysis. Metabolic alterations as well as inflammatory processes, which are up-regulated in diabetes, are thought to be the main underlying causes. More recently, the complement cascade has emerged as a potential new player in this context with several complement components directly influencing both platelet function and coagulation. This review provides an overview concerning the changes that lead to alterations of platelet function and clot structure in diabetes.
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Affiliation(s)
- K Hess
- Dr. Katharina Hess, Department of Internal Medicine I, University Hospital Pauwelsstr. 30, 52074 Aachen, Germany, Tel. +49/(0)241/803 71 28, Fax +49/(0)241/808 25 45, E-mail:
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Bupathi M, Hajjar J, Hess K, Bean S, Karp D, Meric-Bernstam F, Naing A. 425 Evaluation of drug reactions to anti-neoplastic agents in Phase I clinical trials. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70551-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gonzalez JM, Francis B, Burda S, Hess K, Behera D, Gupta D, Agarwal AN, Verma I, Verma A, Myneedu VP, Niedbala S, Laal S. Development of a POC test for TB based on multiple immunodominant epitopes of M. tuberculosis specific cell-wall proteins. PLoS One 2014; 9:e106279. [PMID: 25247820 PMCID: PMC4172486 DOI: 10.1371/journal.pone.0106279] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 04/08/2014] [Accepted: 07/29/2014] [Indexed: 11/30/2022] Open
Abstract
The need for an accurate, rapid, simple and affordable point-of-care (POC) test for Tuberculosis (TB) that can be implemented in microscopy centers and other peripheral health-care settings in the TB-endemic countries remains unmet. This manuscript describes preliminary results of a new prototype rapid lateral flow TB test based on detection of antibodies to immunodominant epitopes (peptides) derived from carefully selected, highly immunogenic M. tuberculosis cell-wall proteins. Peptide selection was initially based on recognition by antibodies in sera from TB patients but not in PPD-/PPD+/BCG-vaccinated individuals from TB-endemic settings. The peptides were conjugated to BSA; the purified peptide-BSA conjugates striped onto nitrocellulose membrane and adsorbed onto colloidal gold particles to devise the prototype test, and evaluated for reactivity with sera from 3 PPD-, 29 PPD+, 15 PPD-unknown healthy subjects, 10 patients with non-TB lung disease and 124 smear-positive TB patients. The assay parameters were adjusted to determine positive/negative status within 15 minutes via visual or instrumented assessment. There was minimal or no reactivity of sera from non-TB subjects with the striped BSA-peptides demonstrating the lack of anti-peptide antibodies in subjects with latent TB and/or BCG vaccination. Sera from most TB patients demonstrated reactivity with one or more peptides. The sensitivity of antibody detection ranged from 28–85% with the 9 BSA-peptides. Three peptides were further evaluated with sera from 400 subjects, including additional PPD-/PPD+/PPD-unknown healthy contacts, close hospital contacts and household contacts of untreated TB patients, patients with non-TB lung disease, and HIV+TB- patients. Combination of the 3 peptides provided sensitivity and specificity>90%. While the final fully optimized lateral flow POC test for TB is under development, these preliminary results demonstrate that an antibody-detection based rapid POC lateral flow test based on select combinations of immunodominant M. tb-specific epitopes may potentially replace microscopy for TB diagnosis in TB-endemic settings.
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Affiliation(s)
- Jesus M. Gonzalez
- Department of Chemistry, Lehigh University, Bethlehem, Pennsylvania, United States of America
| | - Bryan Francis
- TB Biosciences, Bethlehem, Pennsylvania, United States of America
| | - Sherri Burda
- Department of Pathology, New York University Langone Medical Center, New York, NewYork, United States of America
| | - Kaitlyn Hess
- Department of Chemistry, Lehigh University, Bethlehem, Pennsylvania, United States of America
| | - Digamber Behera
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dheeraj Gupta
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Indu Verma
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajoy Verma
- National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | | | - Sam Niedbala
- Department of Chemistry, Lehigh University, Bethlehem, Pennsylvania, United States of America
- TB Biosciences, Bethlehem, Pennsylvania, United States of America
| | - Suman Laal
- Department of Pathology, New York University Langone Medical Center, New York, NewYork, United States of America
- Veterans Affairs New York Harbor Healthcare System, New York, New York, United States of America
- * E-mail:
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van West H, Hodgson B, Parent E, Samuel S, Hodgson B, Ferland C, Soroceanu A, Soroceanu A, Protopsaltis T, Protopsaltis T, Radovanovic I, Amritanand R, Shamji M, Haugo K, Malham G, Jarzem P, Rampersaud Y, Tomkins-Lane C, Manson N, Malham G, Rampersaud Y, Malham G, Malham G, King V, Goldstein C, Fisher C, Fehlings M, Fisher C, Wong E, Sardar Z, Christie S, Patel A, Pinkoski C, Ahn H, Drew B, Dvorak M, Pezeshki P, Altaf F, Wilde P, Rampersaud Y, Sparrey C, Tetreault L, Fehlings M, Tetreault L, Rampersaud R, Jack A, Johnstone R, Fernandes A, Urquhart J, Morokoff A, Manson N, Tomkins-Lane C, Phan P, Evaniew N, Shamji M, Manson J, Rampersaud Y, Nault ML, St-Pierre GH, Larouche J, Lewis S, Wilgenbusch C, Lewis S, Rampersaud Y, Johnson R, Cushnie D, Sridharan S, Street J, Gregg C, Missiuna P, Abraham E, Abraham E, Manson N, Huang E, Passmore S, Mac-Thiong JM, Labelle H, Moulin D, Turgeon I, Roy-Beaudry M, Bourassa N, Petit Y, Parent. S, Chabot S, Westover L, Hill D, Moreau M, Hedden D, Lou E, Adeeb. S, Smith M, Bridge C, Hsu B, Gray. R, Group PORSCHES, Saran N, Mac-Thiong JM, Stone L, Ouellet. J, Protopsaltis T, Terran J, Bronsard N, Smith J, Klineberg E, Mundis G, Hostin R, Hart R, Shaffrey C, Bess S, Ames C, Schwab F, Lafage. V, Schwab F, Lafage V, Protopsaltis T, Ames C, Bess S, Smith J, Errico. T, Schwab F, Soroceanu A, Bronsard N, Smith J, Klineberg E, Mundis G, Hostin R, Hart R, Burton D, Ames C, Shaffrey C, Bess S, Errico T, Lafage. V, Terran J, Soroceanu A, Bronsard N, Smith J, Klineberg E, Mundis G, Kim HJ, Hostin R, Hart R, Shaffrey C, Bess S, Ames C, Schwab F, Lafage. V, Urquhart J, Gananapathy V, Siddiqi F, Gurr K, Bailey C, Ravi B, David K, Rampersaud. R, Tu Y, Salter. M, Nichol H, Fourney D, Kelly. M, Parker R, Ellis N, Blecher C, Chow F, Claydon. M, Sardar Z, Alexander D, Oxner W, Plessis SD, Yee A, Wai. E, Lewis S, Davey J, Gandhi R, Mahomed. N, Hu R, Thomas K, Hepler C, Choi K, Rowed K, Haig. A, Lam. K, Parker R, Blecher C, Seex. K, Perruccio A, Gandhi R, Program. UHNA, Ellis N, Parker R, Goss B, Blecher C, Ballok. Z, Parker R, Ellis N, Chan P, Varma. D, Swart A, Winder M, Varga PP, Gokaslan Z, Boriani S, Luzzati A, Rhines L, Fisher C, Chou D, Williams R, Dekutoski M, Quraishi N, Bettegowda C, Kawahara N, Fehlings. M, Versteeg A, Boriani S, Varga PP, Dekutoski M, Luzzati A, Gokaslan Z, Williams R, Reynolds J, Fehlings M, Bettegowda C, Rhines. L, Zamorano J, Nater A, Tetrault L, Varga P, Gokaslan Z, Boriani S, Fisher C, Rhines L, Bettegowda C, Kawahara N, Chou. D, Fehlings M, Kopjar B, Vaccaro A, Arnold P, Schuster J, Finkelstein J, Rhines L, Dekutoski M, Gokaslan Z, France. J, Whyne C, Singh D, Ford. M, Aldebeyan W, Ouellet J, Steffen T, Beckman L, Weber M, Jarzem. P, Kwon B, Ahn H, Bailey C, Fehlings M, Fourney D, Gagnon D, Tsai E, Tsui D, Parent S, Chen J, Dvorak M, Noonan V, Rivers C, Network RHSCIR, Batke J, Lenehan B, Fisher C, Dvorak M, Street. J, Fox R, Nataraj A, Bailey C, Christie S, Duggal N, Fehlings M, Finkelstein J, Fourney D, Hurlbert R, Kwon B, Townson A, Tsai E, Attabib N, Chen J, Dvorak M, Noonan V, Rivers C, Network. RHSCIR, Fehlings M, Paquet J, Ahn H, Attabib N, Bailey C, Christie S, Duggal N, Finkelstein J, Fourney D, Hurlbert R, Johnson M, Kwon B, Parent S, Tsai E, Dvorak M, Noonan V, Rivers C, Shen T, Network. RHSCIR, Fisher C, Kwon B, Drew B, Fehlings M, Paquet J, Ahn H, Attabib N, Bailey C, Christie S, Duggal N, Finkelstein J, Fourney D, Hurlbert R, Johnson M, Mac-Thiong JM, Parent S, Tsai E, Fallah N, Noonan V, Rivers C, Network RHSCIR, Davidson S, McCann C, Akens M, Murphy K, Whyne C, Sherar M, Yee. A, Belanger L, Ronco J, Dea N, Paquette S, Boyd M, Street J, Fisher C, Dvorak M, Kwon B, Gonzalvo A, Fitt G, Liew S, de la Harpe D, Turner P, Rogers M, Bidos A, Fanti C, Young B, Drew B, Puskas. D, Tam H, Manansala S, Nosov V, Delva M, Alshafai N, Kopjar B, Tan G, Arnold P, Fehlings. M, Kopjar B, Arnold P, Ibrahim A, Tetrault. L, Kopjar B, Arnold P, Fehlings. M, Sundararajan K, Eng. S, St-Pierre G, Nataraj A, Urquhart J, Rosas-Arellano P, Tallon C, Gurr K, Siddiqi F, Bailey S, Bailey C, Sundararajan K, Rampersaud. R, Rosa-Arellano P, Tallon C, Bailey S, Gurr K, Bailey. C, Parker R, Milili L, Goss B, Malham. G, Green A, McKeon M, Abraham. E, Lafave L, Parnell J, Rempel J, Moriartey S, Andreas Y, Wilson P, Hepler C, Ray H, Hu. R, Ploumis A, Hess K, Wood. K, Yarascavitch B, Madden K, Ghert M, Drew B, Bhandari M, Kwok D, Tu YS, Salter. M, Hadlow. A, Tso P, Walker K, Lewis S, Davey J, Mahomed N, Coyte. P, Mac-Thiong JM, Roy-Beaudry M, Turgeon I, Labelle H, deGuise J, Parent. S, Jack A, Fox R, Nataraj A, Paquette S, Leroux T, Yee A, Ahn H, Broad R, Fisher C, Hall H, Nataraj A, Hedden D, Christie S, Carey T, Mehta V, Fehlings M, Wadey. V, Dear T, Hashem. M, Fourney D, Goldstein S, Bodrogi A, Lipkus M, Dear T, Keshen S, Veillette C, Gandhi R, Adams D, Briggs N, Davey J, Fehlings M, Lau J, Lewis S, Magtoto R, Marshall K, Massicotte E, Ogilvie-Harris D, Sarro A, Syed K, Mohamed. N, Perera S, Taha A, Urquhart J, Gurr K, Siddiqi F, Bailey C, Thomas K, Cho R, Swamy G, Power C, Henari S, Lenehan. B, McIntosh G, Hall H, Hoffman. C, Karachi A, Pazionis T, AlShaya O, Green A, McKeon M, Manson. N, Green A, McKeon M, Manson. N, Green A, McKeon M, Murray J, Abraham. E, Thomas K, Suttor S, Goyal T, Littlewood J, Bains I, Bouchard J, Hu R, Jacobs B, Cho R, Swamy G, Johnson M, Pelleck V, Amad Y, Ramos E, Glazebrook C. Combined Spine Conference of the Canadian Spine Society New Zealand Orthopaedic Spine Society, Spine Society of Australia: Fairmont Château Lake Louise, Lake, Louise, Alberta, Tuesday, Feb. 25 to Saturday, Mar. 1, 20141.1.01 The use of suspension radiographs to predict LIV tilt.1.1.02 Surgical correction of adolescent idiopathic scoliosis without fusion: an animal model.1.1.03 Are full torso surface topography postural measurements more sensitive to change than back only parameters in adolescents with idiopathic scoliosis and a main thoracic curve?1.2.04 Restoration of thoracic kyphosis in adolescent idiopathic kyphosis: comparative radiographic analysis of round versus rail rods.1.2.05 Scoliosis surgery in spastic quadriplegic cerebral palsy: Is fusion to the pelvis always necessary? A 4–18-year follow-up study.1.2.06 Identification and validation of pain-related biomarkers surrounding spinal surgery in adolescents.1.3.07 Cervical sagittal deformity develops after PJK in adult throacolumbar deformity correction: radiographic analysis using a novel global sagittal angular parameter, the CTPA.1.3.08 Impact of obesity on complications and patient-reported outcomes in adult spinal deformity surgery.1.3.09 The T1 pelvic angle, a novel radiographic measure of sagittal deformity, accounts for both pelvic retroversion and truncal inclination and correlates strongly with HRQOL.1.4.10 Determining cervical sagittal deformity when it is concurrent with thoracolumbar deformity.1.4.11 The influence of sagittal balance and pelvic parameters on the outcome of surgically treated patients with degenerative spondylolisthesis.1.4.12 Predictors of degenerative spondylolisthesis and loading translation in surgical lumbar spinal stenosis patients.2.1.13 Mechanical allodynia following disc herniation requires intraneural macrophage infiltration and can be blocked by systemic selenium delivery or attenuation of BDNF activity.2.1.14 The effect of alanyl-glutamine on epidural fibrosis in a rat laminectomy model.2.1.15 Anterior lumbar interbody fusion using recombinant human bone morphogenetic protein-2: a prospective study of complications.2.2.16 2-year results of a Canadian, multicentre, blinded, pilot study of a novel peptide in promoting lumbar spine fusion.2.2.17 Comparative outcomes and cost-utility following surgical treatment of focal lumbar spinal stenosis compared with osteoarthritis of the hip or knee: long-term change in health-related quality of life.2.2.18 Changes in objectively measured walking performance, function, and pain following surgery for spondylolisthesis and lumbar spinal stenosis.2.3.19 A prospective multicentre observational data-monitored study of minimally invasive fusion to treat degenerative lumbar disorders: complications and outcomes at 1-year follow-up.2.3.20 Assessment and classification of subsidence in lateral interbody fusion using serial computed tomography.2.3.21 Predictors of willingness to undergo spinal and orthopaedic surgery after surgical consultation.2.4.22 Indirect foraminal decompression is independent of facet arthropathy in extreme lateral interbody fusion.2.4.23 Cervical artificial disc replacement with ProDisc-C: clinical and radiographic outcomes with long-term follow-up.2.4.24 Tantalum trabecular metal implants in anterior cervical corpectomy and fusion.3.1.25 Hemangiomas of the spine: results of surgical management and prognostic variables for local recurrence and mortality in a multicentre study.3.1.26 Chondrosarcomas of the spine: prognostic variables for local recurrence and mortality in a multicentre study.3.1.27 Risk factors for recurrence of surgically treated spine schwannomas: analysis of 169 patients from a multicentre international database.3.2.28 Survival pattern and the effect of surgery on health related quality of life and functional outcome in patients with metastatic epidural spinal cord compression from lung cancer — the AOSpine North America prospective multicentre study.3.2.29 A biomechanical assessment of kyphoplasty as a stand-alone treatment in a human cadaveric burst fracture model.3.2.30 What is safer in incompetent vertebrae with posterior wall defects, kyphoplasty or vertebroplasty: a study in vertebral analogs.3.3.31 Feasibility of recruiting subjects for acute spinal cord injury (SCI) clinical trials in Canada.3.3.32 Prospective analysis of adverse events in elderly patients with traumatic spinal cord injury.3.3.33 Does traction before surgery influence time to neural decompression in patients with spinal cord injury?3.4.34 Current treatment of individuals with traumatic spinal cord injury: Do we need age-specific guidelines?3.4.35 Current surgical practice for traumatic spinal cord injury in Canada.3.4.36 The importance of “time to surgery” for traumatic spinal cord injured patients: results from an ambispective Canadian cohort of 949 patients.3.5.37 Assessment of a novel coil-shaped radiofrequency probe in the porcine spine.3.5.38 The effect of norepinephrine and dopamine on cerebrospinal fluid pressure after acute spinal cord injury.3.5.39 The learning curve of pedicle screw placement: How many screws are enough?4.1.40 Preliminary report from the Ontario Inter-professional Spine Assessment and Education Clinics (ISAEC).4.1.41 A surrogate model of the spinal cord complex for simulating bony impingement.4.1.42 Clinical and surgical predictors of specific complications following surgery for the treatment of degenerative cervical myelopathy: results from the multicentre, prospective AOSpine international study on 479 patients.4.2.43 Outcomes of surgical management of cervical spondylotic myelopathy: results of the prospective, multicentre, AOSpine international study in 479 patients.4.2.44 A clinical prediction rule for clinical outcomes in patients undergoing surgery for degenerative cervical myelopathy: analysis of an international AOSpine prospective multicentre data set of 757 subjects.4.2.45 The prevalence and impact of low back and leg pain among aging Canadians: a cross-sectional survey.4.3.46 Adjacent segment pathology: Progressive disease course or a product of iatrogenic fusion?4.3.47 Natural history of degenerative lumbar spondylolisthesis in patients with spinal stenosis.4.3.48 Changes in self-reported clinical status and health care utilization during wait time for surgical spine consultation: a prospective observational study.4.3.49 The Canadian surgical wait list for lumbar degenerative spinal stenosis has a detrimental effect on patient outcomes.4.3.50 Segmental lordosis is independent of interbody cage position in XLIF.4.3.51 Elevated patient BMI does not negatively affect self-reported outcomes of thoracolumbar surgery.1.5.52 The Spinal Stenosis Pedometer and Nutrition Lifestyle Intervention (SSPANLI): development and pilot.1.5.53 Study evaluating the variability of surgical strategy planning for patients with adult spinal deformity.1.5.54 Atlantoaxial instability in acute odontoid fractures is associated with nonunion and mortality.1.5.55 Peripheral hypersensitivity to subthreshold stimuli persists after resolution of acute experimental disc-herniation neuropathy.1.5.56 Radiation induced lumbar spinal osteonecrosis: case report and literature review.1.5.57 Comparative outcomes and cost-utility following surgical treatment of focal lumbar spinal stenosis compared with osteoarthritis of the hip or knee: Part 2 — estimated lifetime incremental cost-utility ratios.1.5.58 A predictive model of progression for adolescent idiopathic scoliosis based on 3D spine parameters at first visit.1.5.59 Development of a clinical prediction model for surgical decision making in patients with degenerative lumbar spine disease.2.5.60 Canadian spine surgery fellowship education: evaluating opportunity in developing a nationally based training curriculum.2.5.61 Pedicle subtraction osteotomy for severe proximal thoracic junctional kyphosis.2.5.62 A comparison of spine surgery referrals triaged through a multidisciplinary care pathway versus conventional referrals.2.5.63 Results and complications of posterior-based 3 column osteotomies in patients with previously fused spinal deformities.2.5.64 Orthopaedic Surgical AdVerse Event Severity (Ortho-SAVES) system: identifying opportunities for improved patient safety and resource utilization.2.5.65 Spontaneous spinal extra-axial haematomas — surgical experience in Otago and Southland 2011–2013.2.5.66 Obesity and spinal epidural lipomatosis in cauda equina syndrome.2.5.67 Factors affecting restoration of lumbar lordosis in adult degenerative scoliosis patients treated with lateral trans-psoas interbody fusion.3.6.68 Systematic review of complications in spinal surgery: a comparison of retrospective and prospective study design.3.6.69 Postsurgical rehabilitation patients have similar fear avoidance behaviour levels as those in nonoperative care.3.6.70 Outcomes of surgical treatment of adolescent spondyloptosis: a case series.3.6.71 Surgical success in primary versus revision thoracolumbar spine surgery.3.6.72 The effect of smoking on subjective patient outcomes in thoracolumbar surgery.3.6.73 Modelling patient recovery to predict outcomes following elective thoracolumbar surgery for degenerative pathologies.3.6.74 Outcomes from trans-psoas versus open approaches in the treatment of adult degenerative scoliosis.3.6.75 Lumbar spinal stenosis and presurgical assessment: the impact of walking induced strain on a performance-based outcome measure. Can J Surg 2014. [DOI: 10.1503/cjs.005614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Möllmann J, Liehn EA, Simsekyilmaz S, Hess K, Findeisen H, Lebherz C, Marx N, Lehrke M. GLP-1 (7 – 37) and the GLP-1 metabolite (9 – 37) improve myocardial function and reduce infraction size after LAD ligation. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kahles F, Möllmann J, Bäck C, Liberman A, Hess K, Findeisen HM, Krüger S, Lebherz C, Tacke F, Marx N, Lehrke M. The PDE-4 Inhibitor Roflumilast reduces weight gain, enhances insulin sensitivity and prevents hepatic steatosis in mice by increasing mitochondrogenesis. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Yasuda G, Kinguchi S, Katsumata M, Hirawa N, Shibata K, Van Roeyen CRC, Drescher A, Hess K, Boor P, Martin IV, Zok S, Braun G, Kuppe C, Liehn E, Weiskirchen R, Eriksson U, Gross O, Floege J, Eitner F, Ostendorf T, Mose FH, Jensen JM, Therwani S, Mortensen J, Hansen AB, Bech JN, Pedersen EB, Vink EE, De Boer A, Hoogduin JM, Leiner T, Bots ML, Blankestijn PJ, Silva Sousa H, Branco P, Dores H, Carvalho MS, Goncalves P, Almeida MS, Andrade MJ, Pereira M, Gaspar MA, Mendes M, Barata JD. HYPERTENSION: EXPERIMENTAL. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kahles F, Lehrke M, Marx J, Makowska A, Hess K, Marx N, Findeisen HM. The phosphodiesterase 4 inhibitor roflumilast attenuates neointima formation and vascular smooth muscle cell inflammation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Neergaard-Petersen S, Ajjan R, Hvas AM, Hess K, Larsen SB, Kristensen SD, Grove EL. Platelet aggregation and fibrin clot structure in patients with coronary artery disease and previous myocardial infarction. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Giordano A, Gao H, Cohen EN, Anfossi S, Khoury J, Hess K, Krishnamurthy S, Tin S, Cristofanilli M, Hortobagyi GN, Woodward WA, Lucci A, Reuben JM. Clinical relevance of cancer stem cells in bone marrow of early breast cancer patients. Ann Oncol 2013; 24:2515-2521. [PMID: 23798614 DOI: 10.1093/annonc/mdt223] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [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: 12/17/2022] Open
Abstract
BACKGROUND Cancer stem cells (CSCs) are epithelial tumor cells that express CD44(+)CD24(-/lo). CSCs can be further divided into those that have aldehyde dehydrogenase (ALDH) activity (Aldefluor(+)) and those that do not. We hypothesized that if CSCs are responsible for tumor dissemination, their presence in bone marrow (BM) would be prognostic in early stages of breast cancer (EBC) patients. PATIENTS AND METHODS BM aspirates were collected at the time of surgery from 108 patients with EBC. BM was analyzed for CSCs and ALDH activity by flow cytometry. Overall survival and disease-free survival (DFS) were calculated from the date of diagnosis and analyzed with Kaplan-Meier survival plots. Cox multivariate proportional hazards model was also carried out. RESULTS Patients with CSCs in BM had a hazard ratio (HR) of 8.8 for DFS (P = 0.002); patients with Aldefluor(+) CSCs had a HR of 5.9 (P = 0.052) for DFS. All deceased patients (n = 7) had CSCs in BM. In multivariate analysis, the presence of CSCs in BM was a prognostic factor of DFS (HR = 15.8, P = 0.017). CONCLUSIONS The presence of BM metastasis is correlated with CSCs and these CSCs irrespective of ALDH activity are an independent adverse prognostic factor in EBC patients.
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Affiliation(s)
- A Giordano
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Endocrinology and Molecular and Clinical Oncology, University of Naples Federico II, Naples, Italy
| | - H Gao
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - E N Cohen
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S Anfossi
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J Khoury
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - K Hess
- Departments of Biostatistics
| | - S Krishnamurthy
- Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - S Tin
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M Cristofanilli
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia
| | | | | | - A Lucci
- Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J M Reuben
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA.
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