Optimisation of anti-interleukin-6 therapy: Precision medicine through mathematical modelling

Background

Dysregulated interleukin (IL)-6 production can be characterised by the levels present, the kinetics of its rise and its inappropriate location. Rapid, excessive IL-6 production can exacerbate tissue damage in vital organs. In this situation, therapy with an anti-IL-6 or anti-IL-6 receptor (IL-6R) monoclonal antibody, if inappropriately dosed, may be insufficient to fully block IL-6 signalling and normalise the immune response.

Methods

We analysed inhibition of C-reactive protein (CRP) – a biomarker for IL-6 activity – in patients with COVID-19 or idiopathic multicentric Castleman disease (iMCD) treated with tocilizumab (anti-IL-6R) or siltuximab (anti-IL-6), respectively. We used mathematical modelling to analyse how to optimise anti-IL-6 or anti-IL-6R blockade for the high levels of IL-6 observed in these diseases.

Results

IL-6 signalling was insufficiently inhibited in patients with COVID-19 or iMCD treated with standard doses of anti-IL-6 therapy. Patients whose disease worsened throughout therapy had only partial inhibition of CRP production. Our model demonstrated that, in a scenario representative of iMCD with persistent high IL-6 production not controlled by a single dose of anti-IL-6 therapy, repeated administration more effectively inhibited IL-6 activity. In a situation with rapid, high, dysregulated IL-6 production, such as severe COVID-19 or a cytokine storm, repeated daily administration of an anti-IL-6/anti-IL-6R agent, or alternating daily doses of anti-IL-6 and anti-IL-6R therapies, could neutralise IL-6 activity.

Conclusion

In clinical practice, IL-6 inhibition should be individualised based on pathophysiology to achieve full blockade of CRP production.

Funding

EUSA Pharma funded medical writing assistance and provided access to the phase II clinical data of siltuximab for analysis.

Potentiometric Biosensors Based on Molecular-Imprinted Self-Assembled Monolayer Films for Rapid Detection of Influenza A Virus and SARS-CoV-2 Spike Protein

Rapid, yet accurate and sensitive testing has been shown to be critical in the control of spreading pandemic diseases such as COVID-19. Current methods which are highly sensitive and can differentiate different strains are slow and cannot be conveniently applied at the point of care. Rapid tests, meanwhile, require a high titer and are not sufficiently sensitive to discriminate between strains. Here, we report a rapid and facile potentiometric detection method based on nanoscale, three-dimensional molecular imprints of analytes on a self-assembled monolayer (SAM), which can deliver analyte-specific detection of both whole virions and isolated proteins in microliter amounts of bodily fluids within minutes. The detection substrate with nanoscale inverse surface patterns of analytes formed by a SAM identifies a target analyte by recognizing its surface nano- and molecular structures, which can be monitored by temporal measurement of the change in substrate open-circuit potential. The sensor unambiguously detected and differentiated H1N1 and H3N2 influenza A virions as well as the spike proteins of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Middle-East respiratory syndrome (MERS) coronavirus in human saliva with limits of detection reaching 200 PFU/mL and 100 pg/mL for the viral particles and spike proteins, respectively. The demonstrated speed and specificity of detection, combined with a low required sample volume, high sensitivity, ease of potentiometric measurement, and simple sample collection and preparation, suggest that the technique can be used as a highly effective point-of-care diagnostic platform for a fast, accurate, and specific detection of various viral pathogens and their variants.

Dynamic Immune/Inflammation Precision Medicine: The Good and the Bad Inflammation in Infection and Cancer

Normal or “good” inflammation process starts from a local cellular response against injury or any infectious agent, with the activation of neutrophils, macrophages, Langerhans cells, dendritic cells, and innate immune cells. Cytokines and chemokines are produced to amplify the local inflammatory process followed by the migration of immune cells to the regional lymph nodes where adaptive immune response is initiated. Systemic inflammation enhances the biological response to mobilize additional cells from central and peripheral immune/hematopoietic system. Local mechanisms to limit inflammation are initiated and lead to healing. During the normal inflammatory process, there is a balance between the production of inflammatory chemokines/cytokines such as Tumor Necrosis Factor (TNF)-α, interleukin (IL)-6 and IL-1 and the production of compounds that limit inflammation and have an immune suppressive effect, such as IL-10 and Transforming Factor (TGF) β. IL-6 and IL-6/soluble IL-6 Receptor (R) complex stimulate liver cells to produce inflammatory proteins, which represents the systemic inflammation response. The magnitude and the duration of the systemic inflammatory response are linked to the cause, under genetic and epigenetic control. Significant inflammation as seen in septic shock, in severe forms of infections or in certain active cancers, represents the “bad inflammation”, correlated with a poor prognosis. In addition, the persistence of a chronic smoldering inflammation may lead to pathological situations which are observed in the majority of inflammatory, degenerative, dysmetabolic, or dysimmune diseases and cancer. Chronic smoldering inflammation is a cross between different pathological situations possibly linked. In addition, within the tumor microenvironment, inflammatory process results from different cellular mechanisms modulated by metabolic and vascular changes. On the contrary, a limited and balanced inflammation initiates the normal immune response, including the adaptive response which amplifies any immunotherapy, including vaccines. Immune checkpoint inhibitors and chimeric antigen receptor (CAR) T-cells are associated with cytokine release syndrome, a clinical risk leading to the use of anti-cytokine drugs. Nowadays, it is time to monitor the dynamic inflammatory process for a better immune precision medicine in both infections and cancer.

Novel method to produce a layered 3D scaffold for human pluripotent stem cell-derived neuronal cells

BACKGROUND

Three-dimensional (3D) in vitro models have been developed into more in vivo resembling structures. In particular, there is a need for human-based models for neuronal tissue engineering (TE). To produce such a model with organized microenvironment for cells in central nervous system (CNS), a 3D layered scaffold composed of hydrogel and cell guiding fibers has been proposed.

NEW METHOD

Here, we describe a novel method for producing a layered 3D scaffold consisting of electrospun poly (L,D-lactide) fibers embedded into collagen 1 hydrogel to achieve better resemblance of cells' natural microenvironment for human pluripotent stem cell (hPSC)-derived neurons. The scaffold was constructed via a single layer-by-layer process using an electrospinning technique with a unique collector design.

RESULTS

The method enabled the production of layered 3D cell-containing scaffold in a single process. HPSC-derived neurons were found in all layers of the scaffold and exhibited a typical neuronal phenotype. The guiding fiber layers supported the directed cell growth and extension of the neurites inside the scaffold without additional functionalization.

COMPARISON WITH EXISTING METHODS

Previous methods have required several process steps to construct 3D layer-by-layer scaffolds.

CONCLUSIONS

We introduced a method to produce layered 3D scaffolds to mimic the cell guiding cues in CNS by alternating the soft hydrogel matrix and fibrous guidance cues. The produced scaffold successfully enabled the long-term culture of hPSC-derived neuronal cells. This layered 3D scaffold is a useful model for in vitro and in vivo neuronal TE applications.

A chip-based potentiometric sensor for a Zika virus diagnostic using 3D surface molecular imprinting

The latest Zika virus (ZIKV) pandemic caused great international concern from explosively proliferating throughout the Americas. Currently, there is no vaccine to prevent Zika virus infection and available tests rely on antibodies or RNA. Unfortunately, antibody-based detection systems can result in false positive results and RNA-based detection systems are costly, time-consuming, and impractical for testing in remote regions. In this study, a potential point-of-care (POC) diagnostic system was developed using a chip-based potentiometric sensor to detect Zika virus using a 3D molecular imprinting technique. This chip-based potentiometric sensor system was able to detect 10^-1 PFU mL^-1 ZIKV in a buffered solution under 20 minutes without any sample manipulation. This sensor was tested against Dengue virus at clinical viral loads and showed no sign of cross-reactivity. When tested against human saliva samples containing clinical viral loads, this sensor was able to detect 10 PFU mL^-1 ZIKV among the pool of bio-macromolecules. The high sensitivity and high selectivity demonstrated here proved that this lab-on-a-chip diagnostic has the potential to become a POC detection system for rapid and accurate screening of flaviviruses.

ation of the igh ensitiv Label-Free

A highly sensitive electrochemical biosensor with a signal amplification platform of electrodeposited gold nanoparticle (AuNP) has been developed and characterized. The sizes of the synthesized AuNP were found to be critical for the performance of biosensor in which the sizes were dependent on HAuCl₄ and acid concentrations; as well as on scan cycles and scan rates in the gold electro-reduction step. Systematic investigations of the adsorption of proteins with different sizes from aqueous electrolyte solution onto the electrodeposited AuNP surface were performed with a potentiometric method and calibrated by design of experiment (DOE). The resulting amperometric glucose biosensors was demonstrated to have a low detection limit (> 50M) and a wide linear range after optimization with AuNP electrodeposition.

Communicating through Touch: Macro Fiber Composites for Tactile Stimulation on the Abdomen

Research into sensory substitution systems has expanded, as alternative senses are utilized in real-time to afford object recognition or spatial understanding. Tactile stimulation has long shown promise as a communicatory strategy when applied unobtrusively to the redundant surface areas of the skin. Here, a novel belt, integrating a matrix of macro fiber composites, is purposed to deliver tactile stimuli to the abdomen. The design and development of the belt is presented and a systematic experimental study is conducted to analyze the impact of frequency and duty cycle. The belt is a beta precursor to a soft haptic feedback device that will enable situational awareness and obstacle avoidance through the localization of tactile stimulation relative to a body-centric frame of reference in a local environment.

Design of a molecular imprinting biosensor with multi-scale roughness for detection across a broad spectrum of biomolecules

The molecular imprinting technique has tremendous applications in artificial enzymes, bioseparation, and sensor devices.

Quantitative real-time detection of carcinoembryonic antigen (CEA) from pancreatic cyst fluid using 3-D surface molecular imprinting

In this study, a real time potentiometric biosensor based on the 3D surface molecular imprinting was developed for CEA detection.

Mesoporous silica particle-PLA-PANI hybrid scaffolds for cell-directed intracellular drug delivery and tissue vascularization

Instructive materials are expected to revolutionize stem cell based tissue engineering. As many stem cell cues have adverse effects on normal tissue homeostasis, there is a need to develop bioactive scaffolds which offer locally retained and cell-targeted drug delivery for intracellular release in targeted cell populations. Further, the scaffolds need to support vascularization to promote tissue growth and function. We have developed an electrospun PLA-PANI fiber scaffold, and incorporated mesoporous silica nanoparticles within the scaffold matrix to obtain cell-targeted and localized drug delivery. The isotropy of the scaffold can be tuned to find the optimal morphology for a given application and the scaffold is electroactive to support differentiation of contractile tissues. We demonstrate that there is no premature drug release from particles under physiological conditions over a period of one week and that the drug is released upon internalization of particles by cells within the scaffold. The scaffold is biocompatible, supports muscle stem cell differentiation and cell-seeded scaffolds are vascularized in vivo upon transplantation on the chorioallantoic membrane of chicken embryos. The scaffold is a step towards instructive biomaterials for local control of stem cell differentiation, and tissue formation supported by vascularization and without adverse effects on the homeostasis of adjacent tissues due to diffusion of biological cues.

Development of a biosensor for detection of pleural mesothelioma cancer biomarker using surface imprinting

Hyaluronan-linked protein 1 (HAPLN1) which has been shown to be highly expressed in malignant pleural mesotheliomas (MPM), was detected in serum using an electrochemical surface-imprinting method. First, the detection method was optimized using Bovine serum albumin (BSA) as a model protein to mimic the optimal conditions required to imprint the similar molecular weight protein HAPLN1. BSA was imprinted on the gold electrode with hydroxyl terminated alkane thiols, which formed a self-assembled monolayer (SAM) around BSA. The analyte (BSA) was then washed away and its imprint (empty cavity with shape-memory) was used for detection of BSA in a solution, using electrochemical open-circuit potential method, namely potentiometry. Factors considered to optimize the conditions include incubation time, protein concentration, limit of detection and size of electrode. Matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) was used to confirm selectivity of imprints. With the obtained imprinting control parameters, HAPLN1 was imprinted in duplicate and the detection of spiked HAPLN1 was successfully conducted in serum.

Annexin A2 binds to endosomes following organelle destabilization by particulate wear debris

Endosomal functions are contingent on the integrity of the organelle-limiting membrane, whose disruption induces inflammation and cell death. Here we show that phagocytosis of ultrahigh molecular weight polyethylene particles induces damage to the endosomal-limiting membrane and results in the leakage of cathepsins into the cytosol and NLRP3-inflammasome activation. Annexin A2 recruitment to damaged organelles is shown by two-dimensional DIGE protein profiling, endosomal fractionation, confocal analysis of endogenous and annexin A2-GFP transfected cells, and immunogold labelling. Binding experiments, using fluorescent liposomes, confirms annexin A2 recruitment to endosomes containing phagocytosed polyethylene particles. Finally, an increase in cytosolic cathepsins, NLRP3-inflammasome activation, and IL-1 production is seen in dendritic cells from annexin A2-null mice, following exposure to polyethylene particles. Together, the results indicate a functional role of annexin A2 binding to endosomal membranes following organelle destabilization.

Effect of alkyl group length on the conductivity in the 2,3,7,8,12,13,17,18-octakis(alkyl-thio)tetraazaporphyrins and redox properties of the metallooctakis(hexyl-thio)tetraazaporphyrins

A series of 2,3,7,8,12,13,17,18-octakis(alkyl-thio)tetraazaporphyrins (H2OATTAP) with different alkyl chain lengths have been synthesized. Cyclic voltammetry and differential pulse voltammetry have been used to investigate the effect of the controlled lengths of the eight peripheral thioether tails on the redox behavior of the molecules. The electrochemical reduction of octakis(hexyl-thio)tetraazaporphyrins, MOHTTAP (where M = Cu , Ni ), was studied in 1,2-dichloroethane at a platinum electrode. The Cu derivative was oxidized in one single-electron-transfer step to yield a π-cation radical and reduced in three single-electron-transfer steps to yield a π-anion radical, dianion and trianion, respectively. For the Ni derivative, electron transfer reactions involving both the central metal atom and the macrocyclic ring were observed. Electron transfer pathways are proposed based upon voltammetric and in situ spectroelectrochemical results.

Stratification of Fullerenes

Dodecylated C60 {(Do)nC60(H)n} and butylated C60 {(Bu)nC60(H)n} were synthesized. Spectroscopic and thermal methods, mass spectrometry, XPD, have been employed to characterize the products. X-ray Powder Diffraction (XPD) results reveal that the facecentered- cubic (fcc) structure of C60 expands to a primitive hexagonal structure upon butylation and to a layered structure upon dodecylation. Butylated C60 diffraction pattern has been indexed as a primitive hexagonal structure with ao = 11.5 angstroms and axial ratio = 1.169. The dodecylated C60 also shows sidechain melting behavior with a transition temperature of around 25°C. The paraffinic crystals are produced by the interdigitation of the sidechains. Butylated C60 does not show any sidechain melting.

Potentiometric monitoring DNA hybridization

The usual procedure to monitor the ion exchange of small ions utilizes a potentiometer with a selective membrane as part of the working electrode. As the next step, we have applied polyaniline electrodes to the monitoring the activity macromolecular ions during DNA hybridization. Single-strand oligonucleotide (ssODN) probes were immobilized using a nucleophilic substitution reaction of the thiolated ssODN molecules with polyaniline. The anionic phosphate groups of the probe molecules also interacted with the cationic-doped polyaniline surface. Three useful findings were observed with the potentiometric experiments. First, the binding of the complimentary target molecules with the immobilized probes revealed a substantial potential change. Further, potential change was observed neither with the non-complimentary targets nor with the samples with a mutation in the sequence. The last two experiments were important for the future evaluation of the impact of medium and potential interfering compounds: anionic groups and hydrogen bonding groups in the non-complimentary samples did not cause any interactions.

Ion concentration of external solution as a characteristic of micro- and nanogel ionic reservoirs

Ion-sensitive hydrogel is regarded as an ionic reservoir, i.e., a system capable of changing the external pH or ionic strength by accumulating or releasing ions. The concept of a hydrogel ionic reservoir was demonstrated for hydrogel particles of three different size ranges: macrogel (1000-6000 microm), microgel (approximately 20-200 microm), and nanogel (approximately 0.2 microm). Ion sensitivity of poly(N-isopropylacrylamide-co-1-vinylimidazole) (PNIPA-VI) microgels with imidazolyl (ionizable) groups was confirmed by the pH dependence of their volume, while nanogels were characterized by dynamic light scattering. On the contrary, the volume of poly(N-isopropylacrylamide) (PNIPA) microgels without ionizable groups was pH independent in the whole range of pH from 10 to 2. Four distinct regions of pH-behavior were observed for PNIPA-VI hydrogel micro- and nanoparticles using potentiometric titration of their suspensions. Time-resolved measurements of ion concentrations in the suspension of hydrogel particles revealed a substantial difference in kinetics of pH equilibration for (i) ion-sensitive hydrogels (PNIPA-VI) vs hydrogels without ionizable groups (PNIPA) and (ii) PNIPA-VI hydrogels of different sizes. On the basis of the experimental observations, a two-step mechanism affecting the kinetics of proton uptake into the hydrogel particles with ionizable groups was proposed: (1) fast binding of ions to the immediate surface of each particle and (2) a slower successive diffusion of bound sites into the next inner layer of polymer network. In accord with the mechanism proposed, a quasi-chemical kinetic model of pH relaxation to equilibrium was developed to fit the experimental data for the time course of proton uptake by macro-, micro-, and nanogels into two exponentials with the characteristic times of tau(1) and tau(2). We believe the same kinetic model will be pertinent to describe phenomenological and molecular mechanisms controlling proton transport in/out bacteria, cells, organelles, drug delivery vehicles, and other natural or artificial multifunctional ionic containers. The approach can be easily extended for the other ions (e.g., Na(+), K(+), and Ca(2+)).

Liposome-Nanogel Structures for Future Pharmaceutical Applications

Nanoparticles have been extensively studied as drug delivery systems. In this review, we focus on a relatively new type of nanoparticles--lipobeads--a liposome-hydrogel assembly as a novel drug delivery system. An appropriate assemblage of spherical hydrogel particles and liposomes combines the properties of both classes of materials and may find a variety of biomedical applications. The bi-compartmental structure of lipobeads is a natural configuration. Thus, the technology of their preparation can be a key step of designing more stable and effective vaccines. Biocompatibility and stability, ability to deliver a broad range of bioactive molecules, environmental responsiveness of both inner nanogel core and external lipid bilayer, and individual specificity of both compartments make the liposome-nanogel design a versatile drug delivery system relevant for all known drug administration routes and suitable for different diseases with possibility of efficient targeting to different organs. New findings on reversible and irreversible aggregation of lipobeads can lead to novel combined drug delivery systems regarding lipobeads as multipurpose containers. The research on hydrogel-liposome submicrometer structures has just begun and fundamental studies on interactions between hydrogels and liposomes are in demand.

Potentiometric sensor for dipicolinic acid

A potentiometric chemosensor for selective determination of dipicolinic acid (2,6-pyridinedicarboxylic acid, DPA) was developed based on the surface imprinting technique coupled with a nanoscale transducer: an indium tin oxide (ITO)-coated glass plate. The sensor fabrication conditions, optimal recognition condition, as well as selectivity, sensitivity, and stability of the DPA sensor have been investigated. The DPA sensor could recognize DPA from 3,5-pyridinedicarboxylic acid. Potentiometric measurements demonstrated selective detection of DPA in a concentration range of 1.5 x 10(-6) to 0.0194 M. The response time of DPA sensor for 4 x 10(-4) M DPA was 25 s. The potentiometric response of the DPA sensor to DPA is at 90% of its initial magnitude after 550 times measurement. The viability of such a modified ITO electrode in the presence of other inorganic, organic, and biological materials was probed.

Glycoconjugates for the recognition of Bacillus spores

Carbohydrates act as ligands in many biological processes, including the folding and secretion of proteins, cell-cell recognition, adhesion, and sporulation in the Bacillus genus. Fluorescent-labeled disaccharide glycoconjugates have been applied to evaluate binding to bacterial spores assuming that the spore surface is covered with carbohydrates. This study has shown that specific recognition of bacterial spores is based on interactions between disaccharide glycoconjugates acting as ligands and monosaccharide units expressed on the exterior of bacterial spores. Using fluorophore-assisted carbohydrate electrophoresis (FACE), carbohydrates that are expressed on the exterior of the spores were enumerated. The findings have an impact on how to improve ligand selection, essential for sensor development. In addition, the findings provide new information for inhibition of bacterial spores, and in general, demonstrate how carbohydrates function as recognition signals in nature.

Potentiometric Sensing of Chemical Warfare Agents: Surface Imprinted Polymer Integrated with an Indium Tin Oxide Electrode

Rapid and specific recognition of methylphosphonic acid (MPA), the degradation product of nerve agents sarin, soman, VX, etc., was achieved with potentiometric measurements using a chemical sensor fabricated by a surface imprinting technique coupled with a nanoscale transducer, indium tin oxide (ITO). An octadecylsiloxane thin layer was covalently bound to the ITO-coated glass surface in the presence of MPA. After extraction of MPA, potentiometric measurements showed selective detection of MPA. The selectivity of the sensor has been tested on other alkylphosphonic acids, such as ethylphosphonic acid and propylphosphonic acid, as well as tert-butylphosphonic acid. The viability of the sensor in the presence of other chemical analogues, such as organophosphorus pesticides and herbicides, was investigated.

Interaction of modified liposomes with Bacillus spores

The interaction between liposomes modified with a particular peptide sequence and Bacillus subtilis spores was experimentally observed as (1) an increase in the average diameter of spore-related particles, and (2) the formation of dense and structured shells around the spores at higher concentrations of liposomes.