1
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Kazandjian D, Diamond B, Papadimitriou M, Hill E, Sklavenitis-Pistofidis R, Ziccheddu B, Blaney P, Chojnacka M, Durante M, Maclachlan K, Young R, Usmani S, Davies F, Getz G, Ghobrial I, Korde N, Morgan G, Maura F, Landgren O. Genomic Profiling to Contextualize the Results of Intervention for Smoldering Multiple Myeloma. Clin Cancer Res 2024:743213. [PMID: 38652812 DOI: 10.1158/1078-0432.ccr-24-0210] [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] [Received: 01/19/2024] [Revised: 03/15/2024] [Accepted: 04/19/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Early intervention for High-Risk Smoldering Multiple Myeloma (HR-SMM) achieves deep and prolonged responses. It is unclear if beneficial outcomes are due to treatment of less complex, susceptible disease or inaccuracy in clinical definition of cases entered. EXPERIMENTAL DESIGN Here, we interrogated whole genome and whole exome sequencing for 54 patients across two HR-SMM interventional studies (NCT01572480, NCT02279394). RESULTS We reveal that the genomic landscape of treated HR-SMM is generally simple as compared to Newly Diagnosed (ND)MM counterparts with less inactivation of tumor suppressor genes, RAS pathway mutations, MYC disruption, and APOBEC contribution. The absence of these events parallels that of indolent precursor conditions, possibly explaining overall excellent outcomes. However, some patients harboring genomic complexity fail to sustain response and experience resistant, progressive disease. Overall, clinical risk scores do not effectively discriminate between genomically indolent and aggressive disease. CONCLUSIONS Genomic profiling can contextualize the advantage of early intervention in SMM and guide personalization of therapy.
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Affiliation(s)
| | | | - Marios Papadimitriou
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
| | | | | | | | - Patrick Blaney
- NYU Perlmutter Cancer Center, New York, NY, United States
| | | | | | - Kylee Maclachlan
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ryan Young
- National Cancer Institute, Bethesda, MD, United States
| | - Saad Usmani
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Faith Davies
- New York University Langone Medical Center, New York, NY, United States
| | - Gad Getz
- Broad Institute, Cambridge, MA, United States
| | | | - Neha Korde
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Gareth Morgan
- New York University Langone Medical Center, New York, NY, United States
| | - Francesco Maura
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
| | - Ola Landgren
- Sylvester Comprehensive Cancer Center, Miami, FL, United States
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2
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Maura F, Rajanna AR, Ziccheddu B, Poos AM, Derkach A, Maclachlan K, Durante M, Diamond B, Papadimitriou M, Davies F, Boyle EM, Walker B, Hultcrantz M, Silva A, Hampton O, Teer JK, Siegel EM, Bolli N, Jackson GH, Kaiser M, Pawlyn C, Cook G, Kazandjian D, Stein C, Chesi M, Bergsagel L, Mai EK, Goldschmidt H, Weisel KC, Fenk R, Raab MS, Van Rhee F, Usmani S, Shain KH, Weinhold N, Morgan G, Landgren O. Genomic Classification and Individualized Prognosis in Multiple Myeloma. J Clin Oncol 2024; 42:1229-1240. [PMID: 38194610 DOI: 10.1200/jco.23.01277] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/08/2023] [Accepted: 10/23/2023] [Indexed: 01/11/2024] Open
Abstract
PURPOSE Outcomes for patients with newly diagnosed multiple myeloma (NDMM) are heterogenous, with overall survival (OS) ranging from months to over 10 years. METHODS To decipher and predict the molecular and clinical heterogeneity of NDMM, we assembled a series of 1,933 patients with available clinical, genomic, and therapeutic data. RESULTS Leveraging a comprehensive catalog of genomic drivers, we identified 12 groups, expanding on previous gene expression-based molecular classifications. To build a model predicting individualized risk in NDMM (IRMMa), we integrated clinical, genomic, and treatment variables. To correct for time-dependent variables, including high-dose melphalan followed by autologous stem-cell transplantation (HDM-ASCT), and maintenance therapy, a multi-state model was designed. The IRMMa model accuracy was significantly higher than all comparator prognostic models, with a c-index for OS of 0.726, compared with International Staging System (ISS; 0.61), revised-ISS (0.572), and R2-ISS (0.625). Integral to model accuracy was 20 genomic features, including 1q21 gain/amp, del 1p, TP53 loss, NSD2 translocations, APOBEC mutational signatures, and copy-number signatures (reflecting the complex structural variant chromothripsis). IRMMa accuracy and superiority compared with other prognostic models were validated on 256 patients enrolled in the GMMG-HD6 (ClinicalTrials.gov identifier: NCT02495922) clinical trial. Individualized patient risks were significantly affected across the 12 genomic groups by different treatment strategies (ie, treatment variance), which was used to identify patients for whom HDM-ASCT is particularly effective versus patients for whom the impact is limited. CONCLUSION Integrating clinical, demographic, genomic, and therapeutic data, to our knowledge, we have developed the first individualized risk-prediction model enabling personally tailored therapeutic decisions for patients with NDMM.
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Affiliation(s)
- Francesco Maura
- Myeloma Division, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Arjun Raj Rajanna
- Myeloma Division, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Bachisio Ziccheddu
- Myeloma Division, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Alexandra M Poos
- Heidelberg Myeloma Center, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit (CCU) Molecular Hematology/Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andriy Derkach
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kylee Maclachlan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael Durante
- Myeloma Division, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Benjamin Diamond
- Myeloma Division, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Marios Papadimitriou
- Myeloma Division, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Faith Davies
- Myeloma Research Program, New York University Langone, Perlmutter Cancer Center, New York, NY
| | - Eileen M Boyle
- Myeloma Research Program, New York University Langone, Perlmutter Cancer Center, New York, NY
| | - Brian Walker
- Division of Hematology Oncology, Melvin and Bren Simon Comprehensive Cancer Center, Indiana University, Indianapolis, IN
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ariosto Silva
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | | | - Jamie K Teer
- Department of Biostatistics & Bioinformatics, Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Erin M Siegel
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL
| | - Niccolò Bolli
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Graham H Jackson
- Freeman Hospital, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Martin Kaiser
- The Institute of Cancer Research, London, United Kingdom
| | - Charlotte Pawlyn
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Gordon Cook
- Division of Hematology/Oncology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Dickran Kazandjian
- Myeloma Division, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Caleb Stein
- Division of Hematology/Oncology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Marta Chesi
- Division of Hematology/Oncology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Leif Bergsagel
- Division of Hematology/Oncology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Elias K Mai
- Heidelberg Myeloma Center, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Hartmut Goldschmidt
- Heidelberg Myeloma Center, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Katja C Weisel
- Department of Oncology, Hematology and Blood and Marrow Transplant, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Fenk
- Department of Hematology, Oncology and Clinical Immunology, University-Hospital Duesseldorf, Duesseldorf, Germany
| | - Marc S Raab
- Heidelberg Myeloma Center, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit (CCU) Molecular Hematology/Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Fritz Van Rhee
- Myeloma Institute for Research & Therapy, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Saad Usmani
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kenneth H Shain
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | - Niels Weinhold
- Heidelberg Myeloma Center, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit (CCU) Molecular Hematology/Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gareth Morgan
- Myeloma Research Program, New York University Langone, Perlmutter Cancer Center, New York, NY
| | - Ola Landgren
- Myeloma Division, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
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3
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Purushothaman S, Kostyleva D, Dendooven P, Haettner E, Geissel H, Schuy C, Weber U, Boscolo D, Dickel T, Graeff C, Hornung C, Kazantseva E, Kuzminchuk-Feuerstein N, Mukha I, Pietri S, Roesch H, Tanaka YK, Zhao J, Durante M, Parodi K, Scheidenberger C. Quasi-real-time range monitoring by in-beam PET: a case for 15O. Sci Rep 2023; 13:18788. [PMID: 37914762 PMCID: PMC10620432 DOI: 10.1038/s41598-023-45122-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 10/16/2023] [Indexed: 11/03/2023] Open
Abstract
A fast and reliable range monitoring method is required to take full advantage of the high linear energy transfer provided by therapeutic ion beams like carbon and oxygen while minimizing damage to healthy tissue due to range uncertainties. Quasi-real-time range monitoring using in-beam positron emission tomography (PET) with therapeutic beams of positron-emitters of carbon and oxygen is a promising approach. The number of implanted ions and the time required for an unambiguous range verification are decisive factors for choosing a candidate isotope. An experimental study was performed at the FRS fragment-separator of GSI Helmholtzzentrum für Schwerionenforschung GmbH, Germany, to investigate the evolution of positron annihilation activity profiles during the implantation of [Formula: see text]O and [Formula: see text]O ion beams in a PMMA phantom. The positron activity profile was imaged by a dual-panel version of a Siemens Biograph mCT PET scanner. Results from a similar experiment using ion beams of carbon positron-emitters [Formula: see text]C and [Formula: see text]C performed at the same experimental setup were used for comparison. Owing to their shorter half-lives, the number of implanted ions required for a precise positron annihilation activity peak determination is lower for [Formula: see text]C compared to [Formula: see text]C and likewise for [Formula: see text]O compared to [Formula: see text]O, but their lower production cross-sections make it difficult to produce them at therapeutically relevant intensities. With a similar production cross-section and a 10 times shorter half-life than [Formula: see text]C, [Formula: see text]O provides a faster conclusive positron annihilation activity peak position determination for a lower number of implanted ions compared to [Formula: see text]C. A figure of merit formulation was developed for the quantitative comparison of therapy-relevant positron-emitting beams in the context of quasi-real-time beam monitoring. In conclusion, this study demonstrates that among the positron emitters of carbon and oxygen, [Formula: see text]O is the most feasible candidate for quasi-real-time range monitoring by in-beam PET that can be produced at therapeutically relevant intensities. Additionally, this study demonstrated that the in-flight production and separation method can produce beams of therapeutic quality, in terms of purity, energy, and energy spread.
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Affiliation(s)
- S Purushothaman
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany.
| | - D Kostyleva
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - P Dendooven
- Department of Radiation Oncology, Particle Therapy Research Center (PARTREC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - E Haettner
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - H Geissel
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
- II. Physikalisches Institut, Justus-Liebig-Universität, Gießen, Germany
| | - C Schuy
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - U Weber
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - D Boscolo
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - T Dickel
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
- II. Physikalisches Institut, Justus-Liebig-Universität, Gießen, Germany
| | - C Graeff
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
- Department of Electrical Engineering and Information Technology, Technische Universität Darmstadt, Darmstadt, Germany
| | - C Hornung
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - E Kazantseva
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | | | - I Mukha
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - S Pietri
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - H Roesch
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
- Institute for Nuclear Physics, Technische Universität Darmstadt, Darmstadt, Germany
| | - Y K Tanaka
- RIKEN Cluster for Pioneering Research, RIKEN, Wako, Japan
| | - J Zhao
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
- School of Physics, Beihang University, Beijing, China
| | - M Durante
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany.
- Department of Condensed Matter Physics, Technische Universität Darmstadt, Darmstadt, Germany.
| | - K Parodi
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians Universität München, Munich, Germany
| | - C Scheidenberger
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
- II. Physikalisches Institut, Justus-Liebig-Universität, Gießen, Germany
- Helmholtz Forschungsakademie Hessen für FAIR (HFHF), Campus Gießen, Gießen, Germany
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4
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Lee H, Ahn S, Maity R, Leblay N, Ziccheddu B, Truger M, Chojnacka M, Cirrincione A, Durante M, Tilmont R, Barakat E, Poorebrahim M, Sinha S, McIntyre J, M Y Chan A, Wilson H, Kyman S, Krishnan A, Landgren O, Walter W, Meggendorfer M, Haferlach C, Haferlach T, Einsele H, Kortüm MK, Knop S, Alberge JB, Rosenwald A, Keats JJ, Rasche L, Maura F, Neri P, Bahlis NJ. Mechanisms of antigen escape from BCMA- or GPRC5D-targeted immunotherapies in multiple myeloma. Nat Med 2023; 29:2295-2306. [PMID: 37653344 PMCID: PMC10504087 DOI: 10.1038/s41591-023-02491-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [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: 03/05/2023] [Accepted: 07/05/2023] [Indexed: 09/02/2023]
Abstract
B cell maturation antigen (BCMA) target loss is considered to be a rare event that mediates multiple myeloma (MM) resistance to anti-BCMA chimeric antigen receptor T cell (CAR T) or bispecific T cell engager (TCE) therapies. Emerging data report that downregulation of G-protein-coupled receptor family C group 5 member D (GPRC5D) protein often occurs at relapse after anti-GPRC5D CAR T therapy. To examine the tumor-intrinsic factors that promote MM antigen escape, we performed combined bulk and single-cell whole-genome sequencing and copy number variation analysis of 30 patients treated with anti-BCMA and/or anti-GPRC5D CAR T/TCE therapy. In two cases, MM relapse post-TCE/CAR T therapy was driven by BCMA-negative clones harboring focal biallelic deletions at the TNFRSF17 locus at relapse or by selective expansion of pre-existing subclones with biallelic TNFRSF17 loss. In another five cases of relapse, newly detected, nontruncating, missense mutations or in-frame deletions in the extracellular domain of BCMA negated the efficacies of anti-BCMA TCE therapies, despite detectable surface BCMA protein expression. In the present study, we also report four cases of MM relapse with biallelic mutations of GPRC5D after anti-GPRC5D TCE therapy, including two cases with convergent evolution where multiple subclones lost GPRC5D through somatic events. Immunoselection of BCMA- or GPRC5D-negative or mutant clones is an important tumor-intrinsic driver of relapse post-targeted therapies. Mutational events on BCMA confer distinct sensitivities toward different anti-BCMA therapies, underscoring the importance of considering the tumor antigen landscape for optimal design and selection of targeted immunotherapies in MM.
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Grants
- P30 CA033572 NCI NIH HHS
- P30 CA240139 NCI NIH HHS
- Terry Fox Foundation
- Terry Fox Foundation, and Leukemia Lymphoma Society of Canada
- International Myeloma Society, Myeloma Canada, and Leukemia Lymphoma Society of Canada
- Terry Fox Foundation, International Myeloma Society, Myeloma Canada, and Leukemia Lymphoma Society of Canada
- Judy and Bernard Briskin Center for Multiple Myeloma Research at City of Hope, the MMRF, and the City of Hope Comprehensive Cancer Center NCI Core Grant (P30 CA 033572).
- Paula and Rodger Riney Multiple Myeloma Research Program Fund, the Multiple Myeloma Research Foundation (MMRF), the Perelman Family Foundation, and by a Sylvester Comprehensive Cancer Center NCI Core Grant (P30 CA 240139).
- German Cancer Aid and The Paula and Rodger Riney Foundation.
- Terry Fox Foundation, International Myeloma Society, Myeloma Canada, and Leukemia Lymphoma Society of Canada.
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Affiliation(s)
- Holly Lee
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sungwoo Ahn
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - Ranjan Maity
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - Noemie Leblay
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | | | | | - Remi Tilmont
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - Elie Barakat
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - Mansour Poorebrahim
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sarthak Sinha
- Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - John McIntyre
- Precision Oncology Hub Laboratory, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Angela M Y Chan
- Precision Oncology Hub Laboratory, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Holly Wilson
- Precision Oncology Hub Laboratory, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Shari Kyman
- Translational Genomics Research Institute, Phoenix, AZ, USA
| | | | - Ola Landgren
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | | | | | | | | | - Hermann Einsele
- Department of Internal Medicine 2, University Hospital of Würzburg, Würzburg, Germany
| | - Martin K Kortüm
- Department of Internal Medicine 2, University Hospital of Würzburg, Würzburg, Germany
| | - Stefan Knop
- Department of Internal Medicine 2, University Hospital of Würzburg, Würzburg, Germany
- Department of Internal Medicine 5, Paracelsus Medical School, Nuremberg General Hospital, Nuremberg, Germany
| | | | | | - Jonathan J Keats
- Translational Genomics Research Institute, Phoenix, AZ, USA
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Leo Rasche
- Department of Internal Medicine 2, University Hospital of Würzburg, Würzburg, Germany.
- Mildred Scheel Early Career Center, University Hospital of Würzburg, Würzburg, Germany.
| | | | - Paola Neri
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - Nizar J Bahlis
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada.
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5
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Haettner E, Geissel H, Franczak B, Kostyleva D, Purushothaman S, Tanaka Y, Amjad F, Boscolo D, Dickel T, Graeff C, Hessler C, Hornung C, Kazantseva E, Kuzminchuk N, Morrissey D, Mukha I, Pietri S, Rocco E, Roy P, Roesch H, Schuy C, Schütt P, Weber U, Weick H, Zhao J, Durante M, Parodi K, Scheidenberger C. Production and separation of positron emitters for hadron therapy at FRS-Cave M. Nucl Instrum Methods Phys Res B 2023; 541:114-116. [PMID: 37265512 PMCID: PMC7614599 DOI: 10.1016/j.nimb.2023.04.026] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The FRagment Separator FRS at GSI is a versatile spectrometer and separator for experiments with relativistic in-flight separated short-lived exotic beams. One branch of the FRS is connected to the target hall where the bio-medical cave (Cave M) is located. Recently a joint activity between the experimental groups of the FRS and the biophysics at the GSI and Department of physics at LMU was started to perform biomedical experiments relevant for hadron therapy with positron emitting carbon and oxygen beams. This paper presents the new ion-optical mode and commissioning results of the FRS-Cave M branch where positron emitting 15O-ions were provided to the medical cave for the first time. An overall conversion efficiency of 2.9±0.2×10-4 15O fragments per primary 16O ion accelerated in the synchrotron SIS18 was reached.
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Affiliation(s)
- E. Haettner
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291, Darmstadt, Germany
| | - H. Geissel
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291, Darmstadt, Germany
- II. Physikalisches Institut, Justus-Liebig-Universität, 35392, Gieβen, Germany
| | - B. Franczak
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291, Darmstadt, Germany
| | - D. Kostyleva
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291, Darmstadt, Germany
| | - S. Purushothaman
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291, Darmstadt, Germany
| | - Y.K. Tanaka
- RIKEN Cluster for Pioneering Research, RIKEN, 351-0198, Saitama, Japan
| | - F. Amjad
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291, Darmstadt, Germany
| | - D. Boscolo
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291, Darmstadt, Germany
| | - T. Dickel
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291, Darmstadt, Germany
- II. Physikalisches Institut, Justus-Liebig-Universität, 35392, Gieβen, Germany
| | - C. Graeff
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291, Darmstadt, Germany
| | - C. Hessler
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291, Darmstadt, Germany
| | - C. Hornung
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291, Darmstadt, Germany
| | - E. Kazantseva
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291, Darmstadt, Germany
| | - N. Kuzminchuk
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291, Darmstadt, Germany
| | - D. Morrissey
- Department of Chemistry and NSCL, Michigan State University, 48824, East Lansing, USA
| | - I. Mukha
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291, Darmstadt, Germany
| | - S. Pietri
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291, Darmstadt, Germany
| | - E. Rocco
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291, Darmstadt, Germany
| | - P. Roy
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291, Darmstadt, Germany
| | - H. Roesch
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291, Darmstadt, Germany
| | - C. Schuy
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291, Darmstadt, Germany
| | - P. Schütt
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291, Darmstadt, Germany
| | - U. Weber
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291, Darmstadt, Germany
| | - H. Weick
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291, Darmstadt, Germany
| | - J. Zhao
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291, Darmstadt, Germany
| | - M. Durante
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291, Darmstadt, Germany
- Institut für Physik Kondensierter Materie, Technische Universität Darmstadt, 64289, Darmstadt, Germany
| | - K. Parodi
- Faculty of Physics, Department of Medical Physics, Ludwig-Maximilians-Universität München, 85748, München, Germany
| | - C. Scheidenberger
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291, Darmstadt, Germany
- II. Physikalisches Institut, Justus-Liebig-Universität, 35392, Gieβen, Germany
- Helmholtz Research Academy Hesse for FAIR (HFHF), GSI Helmholtz Center for Heavy Ion Research, Campus Gieβen, 35392, Gieβen, Germany
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6
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Tubin S, Vozenin M, Prezado Y, Durante M, Prise K, Lara P, Greco C, Massaccesi M, Guha C, Wu X, Mohiuddin M, Vestergaard A, Bassler N, Gupta S, Stock M, Timmerman R. Novel unconventional radiotherapy techniques: Current status and future perspectives - Report from the 2nd international radiation oncology online seminar. Clin Transl Radiat Oncol 2023; 40:100605. [PMID: 36910025 PMCID: PMC9996385 DOI: 10.1016/j.ctro.2023.100605] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/25/2023] Open
Abstract
•Improvement of therapeutic ratio by novel unconventional radiotherapy approaches.•Immunomodulation using high-dose spatially fractionated radiotherapy.•Boosting radiation anti-tumor effects by adding an immune-mediated cell killing.
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Affiliation(s)
- S. Tubin
- Medaustron Center for Ion Therapy, Marie-Curie Strasse 5, Wiener Neustadt 2700, Austria
- Corresponding author.
| | - M.C. Vozenin
- Radiation Oncology Laboratory, Radiation Oncology Service, Oncology Department, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Y. Prezado
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay 91400, France
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay 91400, France
| | - M. Durante
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung, Planckstraße 1, Darmstadt 64291, Germany
- Technsiche Universität Darmstadt, Institute for Condensed Matter Physics, Darmstadt, Germany
| | - K.M. Prise
- Patrick G Johnston Centre for Cancer Research Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, United Kingdom
| | - P.C. Lara
- Canarian Comprehensive Cancer Center, San Roque University Hospital & Fernando Pessoa Canarias University, C/Dolores de la Rocha 9, Las Palmas GC 35001, Spain
| | - C. Greco
- Department of Radiation Oncology Champalimaud Foundation, Av. Brasilia, Lisbon 1400-038, Portugal
| | - M. Massaccesi
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - C. Guha
- Montefiore Medical Center Radiation Oncology, 111 E 210th St, New York, NY, United States
| | - X. Wu
- Executive Medical Physics Associates, 19470 NE 22nd Road, Miami, FL 33179, United States
| | - M.M. Mohiuddin
- Northwestern Medicine Cancer Center Warrenville and Northwestern Medicine Proton Center, 4455 Weaver Pkwy, Warrenville, IL 60555, United States
| | - A. Vestergaard
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - N. Bassler
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - S. Gupta
- The Loop Immuno-Oncology Laboratory, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, United States
| | - M. Stock
- Medaustron Center for Ion Therapy, Marie-Curie Strasse 5, Wiener Neustadt 2700, Austria
- Karl Landsteiner University of Health Sciences, Marie-Curie Strasse 5, Wiener Neustadt 2700, Austria
| | - R. Timmerman
- Department of Radiation Oncology, University of Texas, Southwestern Medical Center, Inwood Road Dallas, TX 2280, United States
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7
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Helm A, Totis C, Durante M, Fournier C. Are charged particles a good match for combination with immunotherapy? Current knowledge and perspectives. International Review of Cell and Molecular Biology 2023; 376:1-36. [PMID: 36997266 DOI: 10.1016/bs.ircmb.2023.01.001] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Charged particle radiotherapy, mainly using protons and carbon ions, provides physical characteristics allowing for a volume conformal irradiation and a reduction of the integral dose to normal tissue. Carbon ion therapy additionally features an increased biological effectiveness resulting in peculiar molecular effects. Immunotherapy, mostly performed with immune checkpoint inhibitors, is nowadays considered a pillar in cancer therapy. Based on the advantageous features of charged particle radiotherapy, we review pre-clinical evidence revealing a strong potential of its combination with immunotherapy. We argue that the combination therapy deserves further investigation with the aim of translation in clinics, where a few studies have been set up already.
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Affiliation(s)
- A Helm
- Biophysics Department, GSI, Darmstadt, Germany
| | - C Totis
- Biophysics Department, GSI, Darmstadt, Germany
| | - M Durante
- Biophysics Department, GSI, Darmstadt, Germany.
| | - C Fournier
- Biophysics Department, GSI, Darmstadt, Germany
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8
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Kostyleva D, Purushothaman S, Dendooven P, Haettner E, Geissel H, Ozoemelam I, Schuy C, Weber U, Boscolo D, Dickel T, Drozd V, Graeff C, Franczak B, Hornung C, Horst F, Kazantseva E, Kuzminchuk-Feuerstein N, Mukha I, Nociforo C, Pietri S, Reidel CA, Roesch H, Tanaka YK, Weick H, Zhao J, Durante M, Parodi K, Scheidenberger C. Precision of the PET activity range during irradiation with 10C, 11C, and 12C beams. Phys Med Biol 2022; 68. [PMID: 36533621 DOI: 10.1088/1361-6560/aca5e8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/24/2022] [Indexed: 11/25/2022]
Abstract
Objective. Beams of stable ions have been a well-established tool for radiotherapy for many decades. In the case of ion beam therapy with stable12C ions, the positron emitters10,11C are produced via projectile and target fragmentation, and their decays enable visualization of the beam via positron emission tomography (PET). However, the PET activity peak matches the Bragg peak only roughly and PET counting statistics is low. These issues can be mitigated by using a short-lived positron emitter as a therapeutic beam.Approach.An experiment studying the precision of the measurement of ranges of positron-emitting carbon isotopes by means of PET has been performed at the FRS fragment-separator facility of GSI Helmholtzzentrum für Schwerionenforschung GmbH, Germany. The PET scanner used in the experiment is a dual-panel version of a Siemens Biograph mCT PET scanner.Main results.High-quality in-beam PET images and activity distributions have been measured from the in-flight produced positron emitting isotopes11C and10C implanted into homogeneous PMMA phantoms. Taking advantage of the high statistics obtained in this experiment, we investigated the time evolution of the uncertainty of the range determined by means of PET during the course of irradiation, and show that the uncertainty improves with the inverse square root of the number of PET counts. The uncertainty is thus fully determined by the PET counting statistics. During the delivery of 1.6 × 107ions in 4 spills for a total duration of 19.2 s, the PET activity range uncertainty for10C,11C and12C is 0.04 mm, 0.7 mm and 1.3 mm, respectively. The gain in precision related to the PET counting statistics is thus much larger when going from11C to10C than when going from12C to11C. The much better precision for10C is due to its much shorter half-life, which, contrary to the case of11C, also enables to include the in-spill data in the image formation.Significance. Our results can be used to estimate the contribution from PET counting statistics to the precision of range determination in a particular carbon therapy situation, taking into account the irradiation scenario, the required dose and the PET scanner characteristics.
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Affiliation(s)
- D Kostyleva
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - S Purushothaman
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - P Dendooven
- Particle Therapy Research Center (PARTREC), Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - E Haettner
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - H Geissel
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany.,II. Physikalisches Institut, Justus-Liebig-Universität, Gießen, Germany
| | - I Ozoemelam
- Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - C Schuy
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - U Weber
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - D Boscolo
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - T Dickel
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany.,II. Physikalisches Institut, Justus-Liebig-Universität, Gießen, Germany
| | - V Drozd
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany.,Faculty of Science and Engineering, University of Groningen, Groningen, The Netherlands
| | - C Graeff
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - B Franczak
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - C Hornung
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - F Horst
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - E Kazantseva
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | | | - I Mukha
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - C Nociforo
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - S Pietri
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - C A Reidel
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - H Roesch
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany.,Institute for Nuclear Physics, Technische Universität Darmstadt, Darmstadt, Germany
| | - Y K Tanaka
- RIKEN Cluster for Pioneering Research, Wako, Japan
| | - H Weick
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - J Zhao
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany.,School of Physics, Beihang University, Beijing, People's Republic of China
| | - M Durante
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany.,Department of Condensed Matter Physics, Technische Universität Darmstadt, Darmstadt, Germany
| | - K Parodi
- Department of Physics, Ludwig-Maximilians Universität München, Munich, Germany
| | - C Scheidenberger
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany.,II. Physikalisches Institut, Justus-Liebig-Universität, Gießen, Germany.,Helmholtz Forschungsakademie Hessen für FAIR (HFHF), Campus Gießen, Gießen, Germany
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9
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Volz L, Durante M, Graeff C. PO-1494 A-priori beam energy selection for heavy ion arc therapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03458-2] [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: 10/18/2022]
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10
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Steinsberger T, Donetti M, Lis M, Volz L, Wolf M, Durante M, Graeff C. PD-0238 Experimental demonstration of conformal carbon ion therapy for irregularly moving tumors. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02793-1] [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: 10/18/2022]
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11
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Dosanjh M, Cirilli M, Durante M, Facoetti A, Fossati P, Graeff C, Haberer T, Livraga M, Necchi M, Plesko M, Rossi L, Rossi S, Sammut N, Schoetz U, Vretenar M. FLASH in the Clinic Track (Oral Presentations) HITRIPLUS PROJECT: BUILDING A PAN-EUROPEAN HEAVY ION THERAPY RESEARCH COMMUNITY AND PROVIDING RESEARCH FACILITIES ACCESS. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01552-6] [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: 10/19/2022] Open
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12
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Spinelli A, Fiorino C, Schwarz M, Tommasino F, Bellinzona E, Del Vecchio A, Mangili P, Shakarami Z, Deantoni C, Cianchetti M, Attili A, Galli R, Bisio A, Perani L, Simoniello P, Fuss M, Pawelke J, Wong J, Durante M, Scifoni E. FLASH Mechanisms Track (Oral Presentations) ADVANCED DOSIMETRY AND BIOPHYSICAL MODELING FOR PRECLINICAL FLASH RADIOTHERAPY. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01518-6] [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: 10/19/2022] Open
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13
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Weber U, Tinganelli W, Sokol O, Quartieri M, Puspitasari A, Dokic I, Abdollahi A, Durante M, Haberer T, Debus J, Boscolo D, Voss B, Brons S, Moustafa M, Schuy C, Baack L, Horst F, Zink K, Simeonov Y. FLASH Modalities Track (Oral Presentations) ULTRA-HIGH DOSE RATE (FLASH) CARBON ION IRRADIATION: FIRST IN VITRO AND IN VIVO RESULTS. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01510-1] [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: 12/01/2022] Open
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14
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Camazzola G, Boscolo D, Scifoni E, Durante M, Kraemer M, Fuss M. CURRENT STATUS OF THE TRAX-CHEM EXTENSION TO THE HOMOGENEOUS CHEMICAL STAGE. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01640-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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15
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Durante M, Tinganelli W, Weber U. FLASH Modalities Track PROTONS AND CARBON IONS. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01441-7] [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: 11/28/2022] Open
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16
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Sandborn WJ, Ferrante M, Bhandari BR, Berliba E, Hibi T, D'Haens GR, Tuttle JL, Krueger K, Friedrich S, Durante M, Arora V, Naegeli AN, Schmitz J, Feagan BG. Efficacy and Safety of Continued Treatment With Mirikizumab in a Phase 2 Trial of Patients With Ulcerative Colitis. Clin Gastroenterol Hepatol 2022; 20:105-115.e14. [PMID: 32950748 DOI: 10.1016/j.cgh.2020.09.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 07/27/2020] [Accepted: 09/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Mirikizumab is an antibody against the p19 subunit of interleukin 23 that has demonstrated clinical efficacy and was well tolerated following 12 weeks of induction treatment in a phase 2 trial of patients with moderate to severe ulcerative colitis. We present results of the open-label extended induction period in patients who did not initially respond to treatment with mirikizumab. METHODS This study was a continuation of I6T-MC-AMAC, a double-blind trial, performed at 75 sites in 14 countries, in which patients with moderate to severe ulcerative colitis were randomly assigned to 12 weeks induction therapy with 50 mg, 200 mg, or 600 mg mirikizumab or placebo. Patients without a clinical response (a 9-point decrease in Mayo subscore of ≥2 points and ≥35% from baseline and either a decrease of rectal bleeding subscore of ≥1 or a rectal bleeding subscore of 0 or 1) at week 12 were offered the opportunity to participate in an open-label, extended induction study for another 12 weeks, in which they received either 600 mg intravenous mirikizumab (n = 20) or, following a protocol amendment, 1000 mg intravenous mirikizumab (n = 64) every 4 weeks. At week 24, patients with a clinical response continued the extension maintenance period and received 200 mg subcutaneous mirikizumab. Endpoints included clinical remission (Mayo subscores of 0 for rectal bleeding, 0 or 1 with a 1-point decrease from baseline), clinical response, endoscopic remission (Mayo endoscopic subscore of 0), or endoscopic improvement (endoscopic subscore of 0 or 1), at study weeks 24 and 52. Data were analysed for patients who received mirikizumab or placebo during the induction phase of the study. RESULTS Among participants who did not respond to induction mirikizumab, 50.0% of those who received the 12-week extension of 600 mg mirikizumab and 43.8% who received the extension of 1000 mg mirikizumab achieved a clinical response; 15.0% and 9.4% achieved clinical remission, respectively. Endoscopic improvement was achieved by 20.0% of subjects in the 600 mg mirikizumab group and 15.6% subjects in the 1000 mg mirikizumab group. Among initial nonresponders to mirikizumab who had clinical response at study week 24 and continued into maintenance therapy, 65.8% maintained the clinical response, 26.3% achieved clinical remission, and 34.2% had endoscopic improvement at week 52. No new safety concerns were identified. CONCLUSIONS Extended doses of mirikizumab (600 mg and 1000 mg) for an additional 12 weeks produce a clinical response in up to 50% of patients who did not have a clinical response to 12 weeks of induction doses (50 mg, 200 mg, or 600 mg). Most of the responders to the extended doses maintained clinical response for up to 52 weeks. Clinicaltrials.gov no: NCT02589665.
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Affiliation(s)
| | | | | | - Elina Berliba
- Arsenia EM, Chisinau, Moldova (the Republic of), Tokyo, Japan
| | - Toshifumi Hibi
- Kitasato Institute Hospital Center for Advanced IBD Research and Treatment, Minato-ku, Tokyo, Japan
| | - Geert R D'Haens
- Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | | | | | | | - Vipin Arora
- Eli Lilly and Company, Indianapolis, Indiana
| | | | | | - Brian G Feagan
- Western University, Robarts Clinical Trials Inc, London, ON, Canada
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17
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Cella L, Monti S, Xu T, Durante M, Liuzzi R, Mohan R, Liao Z, Palma G. Spatial dose patterns associated to cardiac toxicity and survival in patients treated with photons and protons for lung cancer. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00130-2] [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: 10/19/2022] Open
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18
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Dougan M, Nirula A, Azizad M, Mocherla B, Gottlieb RL, Chen P, Hebert C, Perry R, Boscia J, Heller B, Morris J, Crystal C, Igbinadolor A, Huhn G, Cardona J, Shawa I, Kumar P, Adams AC, Van Naarden J, Custer KL, Durante M, Oakley G, Schade AE, Holzer TR, Ebert PJ, Higgs RE, Kallewaard NL, Sabo J, Patel DR, Dabora MC, Klekotka P, Shen L, Skovronsky DM. Bamlanivimab plus Etesevimab in Mild or Moderate Covid-19. N Engl J Med 2021; 385:1382-1392. [PMID: 34260849 PMCID: PMC8314785 DOI: 10.1056/nejmoa2102685] [Citation(s) in RCA: 446] [Impact Index Per Article: 148.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients with underlying medical conditions are at increased risk for severe coronavirus disease 2019 (Covid-19). Whereas vaccine-derived immunity develops over time, neutralizing monoclonal-antibody treatment provides immediate, passive immunity and may limit disease progression and complications. METHODS In this phase 3 trial, we randomly assigned, in a 1:1 ratio, a cohort of ambulatory patients with mild or moderate Covid-19 who were at high risk for progression to severe disease to receive a single intravenous infusion of either a neutralizing monoclonal-antibody combination agent (2800 mg of bamlanivimab and 2800 mg of etesevimab, administered together) or placebo within 3 days after a laboratory diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The primary outcome was the overall clinical status of the patients, defined as Covid-19-related hospitalization or death from any cause by day 29. RESULTS A total of 1035 patients underwent randomization and received an infusion of bamlanivimab-etesevimab or placebo. The mean (±SD) age of the patients was 53.8±16.8 years, and 52.0% were adolescent girls or women. By day 29, a total of 11 of 518 patients (2.1%) in the bamlanivimab-etesevimab group had a Covid-19-related hospitalization or death from any cause, as compared with 36 of 517 patients (7.0%) in the placebo group (absolute risk difference, -4.8 percentage points; 95% confidence interval [CI], -7.4 to -2.3; relative risk difference, 70%; P<0.001). No deaths occurred in the bamlanivimab-etesevimab group; in the placebo group, 10 deaths occurred, 9 of which were designated by the trial investigators as Covid-19-related. At day 7, a greater reduction from baseline in the log viral load was observed among patients who received bamlanivimab plus etesevimab than among those who received placebo (difference from placebo in the change from baseline, -1.20; 95% CI, -1.46 to -0.94; P<0.001). CONCLUSIONS Among high-risk ambulatory patients, bamlanivimab plus etesevimab led to a lower incidence of Covid-19-related hospitalization and death than did placebo and accelerated the decline in the SARS-CoV-2 viral load. (Funded by Eli Lilly; BLAZE-1 ClinicalTrials.gov number, NCT04427501.).
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Affiliation(s)
- Michael Dougan
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Ajay Nirula
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Masoud Azizad
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Bharat Mocherla
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Robert L Gottlieb
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Peter Chen
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Corey Hebert
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Russell Perry
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Joseph Boscia
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Barry Heller
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Jason Morris
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Chad Crystal
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Awawu Igbinadolor
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Gregory Huhn
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Jose Cardona
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Imad Shawa
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Princy Kumar
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Andrew C Adams
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Jacob Van Naarden
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Kenneth L Custer
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Michael Durante
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Gerard Oakley
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Andrew E Schade
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Timothy R Holzer
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Philip J Ebert
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Richard E Higgs
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Nicole L Kallewaard
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Janelle Sabo
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Dipak R Patel
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Matan C Dabora
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Paul Klekotka
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Lei Shen
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
| | - Daniel M Skovronsky
- From Massachusetts General Hospital and Harvard Medical School, Boston (M. Dougan); Eli Lilly (A.N., A.C.A., J.V.N., K.L.C., M. Durante, G.O., A.E.S., T.R.H., P.J.E., R.E.H., N.L.K., J.S., D.R.P., M.C.D., P. Klekotka, L.S., D.M.S.), and Franciscan Health (I.S.) - both in Indianapolis; Valley Clinical Trials-Northridge, Northridge (M.A.), the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - all in California; the Las Vegas Medical Research Center, Las Vegas (B.M.); Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Gadolin Research, Beaumont (R.P.) - both in Texas; NOLA Research Works, New Orleans (C.H.), and Clinical Trials of Southwest Louisiana, Lake Charles (J.M.) - both in Louisiana; Vitalink Research, Union, SC (J.B.); Eastside Research Associates, Redmond, WA (C.C.); Monroe Biomedical Research, Monroe, NC (A.I.); Cook County Health, Chicago (G.H.); Indago Research and Health Center, Hialeah, FL (J.C.); and Georgetown University, Washington, DC (P. Kumar)
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Colombi S, Rovituso M, Scifoni E, Schuy C, Eichhorn A, Kraemer M, Durante M, La Tessa C. Interaction of therapeutic 12C ions with bone-like targets: physical characterization and dosimetric effect at material interfaces. Phys Med Biol 2021; 66. [PMID: 34438376 DOI: 10.1088/1361-6560/ac215f] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/26/2021] [Indexed: 11/11/2022]
Abstract
Carbon therapy is a promising treatment option for cancer. The physical and biological properties of carbon ions can theoretically allow for the delivery of curative doses to the tumor, while simultaneously limiting risks of toxicity to adjacent healthy structures. The treatment effectiveness can be further improved by decreasing the uncertainties stemming from several sources, including the modeling of tissue heterogeneity. Current treatment plans employ density-based conversion methods to translate patient-specific anatomy into a water system, where dose distribution is calculated. This approach neglects differences in nuclear interactions stemming from the elemental composition of each tissue. In this work, we investigated the interaction of therapeutic carbon ions with bone-like materials. The study concentrated on nuclear interactions and included attenuation curves of 200 and 400 AMeV beams in different types of bones, as well as kinetic energy spectra of all charged fragments produced up to 29 degrees from the beam direction. The comparison between measurements and calculations of the treatment planning system TRiP98 indicated that bone tissue causes less fragmentation of carbon ions than water. Overall, hydrogen and helium particles were found to be the most abundant species, while heavier fragments were mostly detected within 5 degrees from the beam direction. We also investigated how the presence of a soft tissue-bone interface could affect the depth-dose profile. The results revealed a dose spike in the transition region, that extended from the entry channel to the target volume. The findings of this work indicated that the tissue-to-water conversion method based only on density considerations can result in dose inaccuracies. Tissue heterogeneity regions containing bones can potentially produce dose spikes, whose magnitude will depend on the patient anatomy. Dose uncertainties can be decreased by modeling nuclear interactions directly in bones, without applying the tissue-to-water conversion.
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Affiliation(s)
- S Colombi
- University of Trento, Via Sommarive 14, I-38123 Trento, Italy.,Trento Institute of Fundamental Physics and Applications (TIFPA), Via Sommarive 14, I-38123 Trento, Italy
| | - M Rovituso
- HollandPTC Proton Therapy Center, Delft, The Netherlands
| | - E Scifoni
- Trento Institute of Fundamental Physics and Applications (TIFPA), Via Sommarive 14, I-38123 Trento, Italy
| | - C Schuy
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstrasse 1, D-64291 Darmstadt, Germany
| | | | - M Kraemer
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstrasse 1, D-64291 Darmstadt, Germany
| | - M Durante
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstrasse 1, D-64291 Darmstadt, Germany.,Technische Universität Darmstadt, Darmstadt, Germany
| | - C La Tessa
- University of Trento, Via Sommarive 14, I-38123 Trento, Italy.,Trento Institute of Fundamental Physics and Applications (TIFPA), Via Sommarive 14, I-38123 Trento, Italy
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20
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Rossi S, Cirilli M, Dosanjh M, Durante M, Facoetti A, Fossati P, Graeff C, Haberer T, Livraga M, Necchi M, Plesko M, Rossi L, Sammut N, Schoetz U, Vretenar M. PO-1529 HITRIplus project: building a pan-European heavy ion therapy research community. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07980-9] [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: 11/15/2022]
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21
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Gottlieb RL, Nirula A, Chen P, Boscia J, Heller B, Morris J, Huhn G, Cardona J, Mocherla B, Stosor V, Shawa I, Kumar P, Adams AC, Van Naarden J, Custer KL, Durante M, Oakley G, Schade AE, Holzer TR, Ebert PJ, Higgs RE, Kallewaard NL, Sabo J, Patel DR, Klekotka P, Shen L, Skovronsky DM. Effect of Bamlanivimab as Monotherapy or in Combination With Etesevimab on Viral Load in Patients With Mild to Moderate COVID-19: A Randomized Clinical Trial. JAMA 2021; 325:632-644. [PMID: 33475701 PMCID: PMC7821080 DOI: 10.1001/jama.2021.0202] [Citation(s) in RCA: 671] [Impact Index Per Article: 223.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Coronavirus disease 2019 (COVID-19) continues to spread rapidly worldwide. Neutralizing antibodies are a potential treatment for COVID-19. OBJECTIVE To determine the effect of bamlanivimab monotherapy and combination therapy with bamlanivimab and etesevimab on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load in mild to moderate COVID-19. DESIGN, SETTING, AND PARTICIPANTS The BLAZE-1 study is a randomized phase 2/3 trial at 49 US centers including ambulatory patients (N = 613) who tested positive for SARS-CoV-2 infection and had 1 or more mild to moderate symptoms. Patients who received bamlanivimab monotherapy or placebo were enrolled first (June 17-August 21, 2020) followed by patients who received bamlanivimab and etesevimab or placebo (August 22-September 3). These are the final analyses and represent findings through October 6, 2020. INTERVENTIONS Patients were randomized to receive a single infusion of bamlanivimab (700 mg [n = 101], 2800 mg [n = 107], or 7000 mg [n = 101]), the combination treatment (2800 mg of bamlanivimab and 2800 mg of etesevimab [n = 112]), or placebo (n = 156). MAIN OUTCOMES AND MEASURES The primary end point was change in SARS-CoV-2 log viral load at day 11 (±4 days). Nine prespecified secondary outcome measures were evaluated with comparisons between each treatment group and placebo, and included 3 other measures of viral load, 5 on symptoms, and 1 measure of clinical outcome (the proportion of patients with a COVID-19-related hospitalization, an emergency department [ED] visit, or death at day 29). RESULTS Among the 577 patients who were randomized and received an infusion (mean age, 44.7 [SD, 15.7] years; 315 [54.6%] women), 533 (92.4%) completed the efficacy evaluation period (day 29). The change in log viral load from baseline at day 11 was -3.72 for 700 mg, -4.08 for 2800 mg, -3.49 for 7000 mg, -4.37 for combination treatment, and -3.80 for placebo. Compared with placebo, the differences in the change in log viral load at day 11 were 0.09 (95% CI, -0.35 to 0.52; P = .69) for 700 mg, -0.27 (95% CI, -0.71 to 0.16; P = .21) for 2800 mg, 0.31 (95% CI, -0.13 to 0.76; P = .16) for 7000 mg, and -0.57 (95% CI, -1.00 to -0.14; P = .01) for combination treatment. Among the secondary outcome measures, differences between each treatment group vs the placebo group were statistically significant for 10 of 84 end points. The proportion of patients with COVID-19-related hospitalizations or ED visits was 5.8% (9 events) for placebo, 1.0% (1 event) for 700 mg, 1.9% (2 events) for 2800 mg, 2.0% (2 events) for 7000 mg, and 0.9% (1 event) for combination treatment. Immediate hypersensitivity reactions were reported in 9 patients (6 bamlanivimab, 2 combination treatment, and 1 placebo). No deaths occurred during the study treatment. CONCLUSIONS AND RELEVANCE Among nonhospitalized patients with mild to moderate COVID-19 illness, treatment with bamlanivimab and etesevimab, compared with placebo, was associated with a statistically significant reduction in SARS-CoV-2 viral load at day 11; no significant difference in viral load reduction was observed for bamlanivimab monotherapy. Further ongoing clinical trials will focus on assessing the clinical benefit of antispike neutralizing antibodies in patients with COVID-19 as a primary end point. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04427501.
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Affiliation(s)
- Robert L. Gottlieb
- Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas, Texas
| | - Ajay Nirula
- Eli Lilly and Company, Indianapolis, Indiana
| | - Peter Chen
- Department of Medicine, Women’s Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Barry Heller
- Long Beach Clinical Trials, Long Beach, California
| | | | | | | | | | - Valentina Stosor
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lei Shen
- Eli Lilly and Company, Indianapolis, Indiana
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22
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Chen P, Nirula A, Heller B, Gottlieb RL, Boscia J, Morris J, Huhn G, Cardona J, Mocherla B, Stosor V, Shawa I, Adams AC, Van Naarden J, Custer KL, Shen L, Durante M, Oakley G, Schade AE, Sabo J, Patel DR, Klekotka P, Skovronsky DM. SARS-CoV-2 Neutralizing Antibody LY-CoV555 in Outpatients with Covid-19. N Engl J Med 2021; 384:229-237. [PMID: 33113295 PMCID: PMC7646625 DOI: 10.1056/nejmoa2029849] [Citation(s) in RCA: 949] [Impact Index Per Article: 316.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (Covid-19), which is most frequently mild yet can be severe and life-threatening. Virus-neutralizing monoclonal antibodies are predicted to reduce viral load, ameliorate symptoms, and prevent hospitalization. METHODS In this ongoing phase 2 trial involving outpatients with recently diagnosed mild or moderate Covid-19, we randomly assigned 452 patients to receive a single intravenous infusion of neutralizing antibody LY-CoV555 in one of three doses (700 mg, 2800 mg, or 7000 mg) or placebo and evaluated the quantitative virologic end points and clinical outcomes. The primary outcome was the change from baseline in the viral load at day 11. The results of a preplanned interim analysis as of September 5, 2020, are reported here. RESULTS At the time of the interim analysis, the observed mean decrease from baseline in the log viral load for the entire population was -3.81, for an elimination of more than 99.97% of viral RNA. For patients who received the 2800-mg dose of LY-CoV555, the difference from placebo in the decrease from baseline was -0.53 (95% confidence interval [CI], -0.98 to -0.08; P = 0.02), for a viral load that was lower by a factor of 3.4. Smaller differences from placebo in the change from baseline were observed among the patients who received the 700-mg dose (-0.20; 95% CI, -0.66 to 0.25; P = 0.38) or the 7000-mg dose (0.09; 95% CI, -0.37 to 0.55; P = 0.70). On days 2 to 6, the patients who received LY-CoV555 had a slightly lower severity of symptoms than those who received placebo. The percentage of patients who had a Covid-19-related hospitalization or visit to an emergency department was 1.6% in the LY-CoV555 group and 6.3% in the placebo group. CONCLUSIONS In this interim analysis of a phase 2 trial, one of three doses of neutralizing antibody LY-CoV555 appeared to accelerate the natural decline in viral load over time, whereas the other doses had not by day 11. (Funded by Eli Lilly; BLAZE-1 ClinicalTrials.gov number, NCT04427501.).
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Affiliation(s)
- Peter Chen
- From the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - both in California; Eli Lilly, Indianapolis (A.N., A.C.A., J.V.N., K.L.C., L.S., M.D., G.O., A.E.S., J.S., D.R.P., P.K., D.M.S.), and Franciscan Health, Greenwood (I.S.) - both in Indiana; Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.); Vitalink Research, Union, SC (J.B.); Imperial Health, Lake Charles, LA (J.M.); Cook County Health (G.H.) and Northwestern University Feinberg School of Medicine (V.S.), Chicago; Indago Research and Health Center, Hialeah, FL (J.C.); and Las Vegas Medical Research Center, Las Vegas (B.M.)
| | - Ajay Nirula
- From the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - both in California; Eli Lilly, Indianapolis (A.N., A.C.A., J.V.N., K.L.C., L.S., M.D., G.O., A.E.S., J.S., D.R.P., P.K., D.M.S.), and Franciscan Health, Greenwood (I.S.) - both in Indiana; Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.); Vitalink Research, Union, SC (J.B.); Imperial Health, Lake Charles, LA (J.M.); Cook County Health (G.H.) and Northwestern University Feinberg School of Medicine (V.S.), Chicago; Indago Research and Health Center, Hialeah, FL (J.C.); and Las Vegas Medical Research Center, Las Vegas (B.M.)
| | - Barry Heller
- From the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - both in California; Eli Lilly, Indianapolis (A.N., A.C.A., J.V.N., K.L.C., L.S., M.D., G.O., A.E.S., J.S., D.R.P., P.K., D.M.S.), and Franciscan Health, Greenwood (I.S.) - both in Indiana; Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.); Vitalink Research, Union, SC (J.B.); Imperial Health, Lake Charles, LA (J.M.); Cook County Health (G.H.) and Northwestern University Feinberg School of Medicine (V.S.), Chicago; Indago Research and Health Center, Hialeah, FL (J.C.); and Las Vegas Medical Research Center, Las Vegas (B.M.)
| | - Robert L Gottlieb
- From the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - both in California; Eli Lilly, Indianapolis (A.N., A.C.A., J.V.N., K.L.C., L.S., M.D., G.O., A.E.S., J.S., D.R.P., P.K., D.M.S.), and Franciscan Health, Greenwood (I.S.) - both in Indiana; Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.); Vitalink Research, Union, SC (J.B.); Imperial Health, Lake Charles, LA (J.M.); Cook County Health (G.H.) and Northwestern University Feinberg School of Medicine (V.S.), Chicago; Indago Research and Health Center, Hialeah, FL (J.C.); and Las Vegas Medical Research Center, Las Vegas (B.M.)
| | - Joseph Boscia
- From the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - both in California; Eli Lilly, Indianapolis (A.N., A.C.A., J.V.N., K.L.C., L.S., M.D., G.O., A.E.S., J.S., D.R.P., P.K., D.M.S.), and Franciscan Health, Greenwood (I.S.) - both in Indiana; Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.); Vitalink Research, Union, SC (J.B.); Imperial Health, Lake Charles, LA (J.M.); Cook County Health (G.H.) and Northwestern University Feinberg School of Medicine (V.S.), Chicago; Indago Research and Health Center, Hialeah, FL (J.C.); and Las Vegas Medical Research Center, Las Vegas (B.M.)
| | - Jason Morris
- From the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - both in California; Eli Lilly, Indianapolis (A.N., A.C.A., J.V.N., K.L.C., L.S., M.D., G.O., A.E.S., J.S., D.R.P., P.K., D.M.S.), and Franciscan Health, Greenwood (I.S.) - both in Indiana; Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.); Vitalink Research, Union, SC (J.B.); Imperial Health, Lake Charles, LA (J.M.); Cook County Health (G.H.) and Northwestern University Feinberg School of Medicine (V.S.), Chicago; Indago Research and Health Center, Hialeah, FL (J.C.); and Las Vegas Medical Research Center, Las Vegas (B.M.)
| | - Gregory Huhn
- From the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - both in California; Eli Lilly, Indianapolis (A.N., A.C.A., J.V.N., K.L.C., L.S., M.D., G.O., A.E.S., J.S., D.R.P., P.K., D.M.S.), and Franciscan Health, Greenwood (I.S.) - both in Indiana; Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.); Vitalink Research, Union, SC (J.B.); Imperial Health, Lake Charles, LA (J.M.); Cook County Health (G.H.) and Northwestern University Feinberg School of Medicine (V.S.), Chicago; Indago Research and Health Center, Hialeah, FL (J.C.); and Las Vegas Medical Research Center, Las Vegas (B.M.)
| | - Jose Cardona
- From the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - both in California; Eli Lilly, Indianapolis (A.N., A.C.A., J.V.N., K.L.C., L.S., M.D., G.O., A.E.S., J.S., D.R.P., P.K., D.M.S.), and Franciscan Health, Greenwood (I.S.) - both in Indiana; Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.); Vitalink Research, Union, SC (J.B.); Imperial Health, Lake Charles, LA (J.M.); Cook County Health (G.H.) and Northwestern University Feinberg School of Medicine (V.S.), Chicago; Indago Research and Health Center, Hialeah, FL (J.C.); and Las Vegas Medical Research Center, Las Vegas (B.M.)
| | - Bharat Mocherla
- From the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - both in California; Eli Lilly, Indianapolis (A.N., A.C.A., J.V.N., K.L.C., L.S., M.D., G.O., A.E.S., J.S., D.R.P., P.K., D.M.S.), and Franciscan Health, Greenwood (I.S.) - both in Indiana; Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.); Vitalink Research, Union, SC (J.B.); Imperial Health, Lake Charles, LA (J.M.); Cook County Health (G.H.) and Northwestern University Feinberg School of Medicine (V.S.), Chicago; Indago Research and Health Center, Hialeah, FL (J.C.); and Las Vegas Medical Research Center, Las Vegas (B.M.)
| | - Valentina Stosor
- From the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - both in California; Eli Lilly, Indianapolis (A.N., A.C.A., J.V.N., K.L.C., L.S., M.D., G.O., A.E.S., J.S., D.R.P., P.K., D.M.S.), and Franciscan Health, Greenwood (I.S.) - both in Indiana; Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.); Vitalink Research, Union, SC (J.B.); Imperial Health, Lake Charles, LA (J.M.); Cook County Health (G.H.) and Northwestern University Feinberg School of Medicine (V.S.), Chicago; Indago Research and Health Center, Hialeah, FL (J.C.); and Las Vegas Medical Research Center, Las Vegas (B.M.)
| | - Imad Shawa
- From the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - both in California; Eli Lilly, Indianapolis (A.N., A.C.A., J.V.N., K.L.C., L.S., M.D., G.O., A.E.S., J.S., D.R.P., P.K., D.M.S.), and Franciscan Health, Greenwood (I.S.) - both in Indiana; Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.); Vitalink Research, Union, SC (J.B.); Imperial Health, Lake Charles, LA (J.M.); Cook County Health (G.H.) and Northwestern University Feinberg School of Medicine (V.S.), Chicago; Indago Research and Health Center, Hialeah, FL (J.C.); and Las Vegas Medical Research Center, Las Vegas (B.M.)
| | - Andrew C Adams
- From the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - both in California; Eli Lilly, Indianapolis (A.N., A.C.A., J.V.N., K.L.C., L.S., M.D., G.O., A.E.S., J.S., D.R.P., P.K., D.M.S.), and Franciscan Health, Greenwood (I.S.) - both in Indiana; Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.); Vitalink Research, Union, SC (J.B.); Imperial Health, Lake Charles, LA (J.M.); Cook County Health (G.H.) and Northwestern University Feinberg School of Medicine (V.S.), Chicago; Indago Research and Health Center, Hialeah, FL (J.C.); and Las Vegas Medical Research Center, Las Vegas (B.M.)
| | - Jacob Van Naarden
- From the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - both in California; Eli Lilly, Indianapolis (A.N., A.C.A., J.V.N., K.L.C., L.S., M.D., G.O., A.E.S., J.S., D.R.P., P.K., D.M.S.), and Franciscan Health, Greenwood (I.S.) - both in Indiana; Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.); Vitalink Research, Union, SC (J.B.); Imperial Health, Lake Charles, LA (J.M.); Cook County Health (G.H.) and Northwestern University Feinberg School of Medicine (V.S.), Chicago; Indago Research and Health Center, Hialeah, FL (J.C.); and Las Vegas Medical Research Center, Las Vegas (B.M.)
| | - Kenneth L Custer
- From the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - both in California; Eli Lilly, Indianapolis (A.N., A.C.A., J.V.N., K.L.C., L.S., M.D., G.O., A.E.S., J.S., D.R.P., P.K., D.M.S.), and Franciscan Health, Greenwood (I.S.) - both in Indiana; Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.); Vitalink Research, Union, SC (J.B.); Imperial Health, Lake Charles, LA (J.M.); Cook County Health (G.H.) and Northwestern University Feinberg School of Medicine (V.S.), Chicago; Indago Research and Health Center, Hialeah, FL (J.C.); and Las Vegas Medical Research Center, Las Vegas (B.M.)
| | - Lei Shen
- From the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - both in California; Eli Lilly, Indianapolis (A.N., A.C.A., J.V.N., K.L.C., L.S., M.D., G.O., A.E.S., J.S., D.R.P., P.K., D.M.S.), and Franciscan Health, Greenwood (I.S.) - both in Indiana; Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.); Vitalink Research, Union, SC (J.B.); Imperial Health, Lake Charles, LA (J.M.); Cook County Health (G.H.) and Northwestern University Feinberg School of Medicine (V.S.), Chicago; Indago Research and Health Center, Hialeah, FL (J.C.); and Las Vegas Medical Research Center, Las Vegas (B.M.)
| | - Michael Durante
- From the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - both in California; Eli Lilly, Indianapolis (A.N., A.C.A., J.V.N., K.L.C., L.S., M.D., G.O., A.E.S., J.S., D.R.P., P.K., D.M.S.), and Franciscan Health, Greenwood (I.S.) - both in Indiana; Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.); Vitalink Research, Union, SC (J.B.); Imperial Health, Lake Charles, LA (J.M.); Cook County Health (G.H.) and Northwestern University Feinberg School of Medicine (V.S.), Chicago; Indago Research and Health Center, Hialeah, FL (J.C.); and Las Vegas Medical Research Center, Las Vegas (B.M.)
| | - Gerard Oakley
- From the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - both in California; Eli Lilly, Indianapolis (A.N., A.C.A., J.V.N., K.L.C., L.S., M.D., G.O., A.E.S., J.S., D.R.P., P.K., D.M.S.), and Franciscan Health, Greenwood (I.S.) - both in Indiana; Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.); Vitalink Research, Union, SC (J.B.); Imperial Health, Lake Charles, LA (J.M.); Cook County Health (G.H.) and Northwestern University Feinberg School of Medicine (V.S.), Chicago; Indago Research and Health Center, Hialeah, FL (J.C.); and Las Vegas Medical Research Center, Las Vegas (B.M.)
| | - Andrew E Schade
- From the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - both in California; Eli Lilly, Indianapolis (A.N., A.C.A., J.V.N., K.L.C., L.S., M.D., G.O., A.E.S., J.S., D.R.P., P.K., D.M.S.), and Franciscan Health, Greenwood (I.S.) - both in Indiana; Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.); Vitalink Research, Union, SC (J.B.); Imperial Health, Lake Charles, LA (J.M.); Cook County Health (G.H.) and Northwestern University Feinberg School of Medicine (V.S.), Chicago; Indago Research and Health Center, Hialeah, FL (J.C.); and Las Vegas Medical Research Center, Las Vegas (B.M.)
| | - Janelle Sabo
- From the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - both in California; Eli Lilly, Indianapolis (A.N., A.C.A., J.V.N., K.L.C., L.S., M.D., G.O., A.E.S., J.S., D.R.P., P.K., D.M.S.), and Franciscan Health, Greenwood (I.S.) - both in Indiana; Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.); Vitalink Research, Union, SC (J.B.); Imperial Health, Lake Charles, LA (J.M.); Cook County Health (G.H.) and Northwestern University Feinberg School of Medicine (V.S.), Chicago; Indago Research and Health Center, Hialeah, FL (J.C.); and Las Vegas Medical Research Center, Las Vegas (B.M.)
| | - Dipak R Patel
- From the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - both in California; Eli Lilly, Indianapolis (A.N., A.C.A., J.V.N., K.L.C., L.S., M.D., G.O., A.E.S., J.S., D.R.P., P.K., D.M.S.), and Franciscan Health, Greenwood (I.S.) - both in Indiana; Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.); Vitalink Research, Union, SC (J.B.); Imperial Health, Lake Charles, LA (J.M.); Cook County Health (G.H.) and Northwestern University Feinberg School of Medicine (V.S.), Chicago; Indago Research and Health Center, Hialeah, FL (J.C.); and Las Vegas Medical Research Center, Las Vegas (B.M.)
| | - Paul Klekotka
- From the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - both in California; Eli Lilly, Indianapolis (A.N., A.C.A., J.V.N., K.L.C., L.S., M.D., G.O., A.E.S., J.S., D.R.P., P.K., D.M.S.), and Franciscan Health, Greenwood (I.S.) - both in Indiana; Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.); Vitalink Research, Union, SC (J.B.); Imperial Health, Lake Charles, LA (J.M.); Cook County Health (G.H.) and Northwestern University Feinberg School of Medicine (V.S.), Chicago; Indago Research and Health Center, Hialeah, FL (J.C.); and Las Vegas Medical Research Center, Las Vegas (B.M.)
| | - Daniel M Skovronsky
- From the Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles (P.C.), and Long Beach Clinical Trials, Long Beach (B.H.) - both in California; Eli Lilly, Indianapolis (A.N., A.C.A., J.V.N., K.L.C., L.S., M.D., G.O., A.E.S., J.S., D.R.P., P.K., D.M.S.), and Franciscan Health, Greenwood (I.S.) - both in Indiana; Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.); Vitalink Research, Union, SC (J.B.); Imperial Health, Lake Charles, LA (J.M.); Cook County Health (G.H.) and Northwestern University Feinberg School of Medicine (V.S.), Chicago; Indago Research and Health Center, Hialeah, FL (J.C.); and Las Vegas Medical Research Center, Las Vegas (B.M.)
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Missiaggia M, Cartechini G, Scifoni E, Rovituso M, Tommasino F, Verroi E, Durante M, La Tessa C. Microdosimetric measurements as a tool to assess potential in-field and out-of-field toxicity regions in proton therapy. Phys Med Biol 2020; 65:245024. [PMID: 32554886 DOI: 10.1088/1361-6560/ab9e56] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Relative biological effectiveness (RBE) variations are thought to be one of the primary causes of unexpected normal-tissue toxicities during tumor treatments with charged particles. Unlike carbon therapy, where treatment planning is optimized on the basis of the RBE-weighted dose, a constant RBE value of 1.1 is currently used in proton therapy. Assuming a uniform value can lead to under- or over-dosage, not just to the tumor but also to surrounding normal tissue. RBE changes have been linked with dose/fraction, the biological endpoint and beam properties. Understanding radiation quality and the associated RBE can improve the prediction of normal-tissue toxicities. In this study, we exploited microdosimetry for characterizing radiation quality in proton therapy in-field, and off-beam at 20 (beam edge), 50 (close out-of-field) and 100 (far out-of-field) mm from the beam center. We measured the lineal energy y spectra in a water phantom irradiated with 152 MeV protons, from which beam quality as well as the physical dose could be obtained. Taking advantage of the linear quadratic model and a modified version of the microdosimetric kinetic model, the microdosimetric data were combined with radiobiological parameters (α and β) of human salivary gland tumor cells for assessing cell survival RBE and RBE-weighted dose. The results indicate that if a dose of 60 Gy is delivered to the peak, the beam edge receives up to 6 Gy while the close and far out-of-field regions receive doses on the order of 10-3 Gy and 10-4 Gy, respectively. The RBE estimate in-beam shows large variations, ranging from 1.0 ± 0.2 at the entrance channel to 2.51 ± 0.15 at the tail. The beam edge follows a similar trend but the RBE calculated at the Bragg peak depth is 2.27 ± 0.17, i.e. twice the RBE in-beam (1.05 ± 0.15). Out-of-field, the estimated RBE is always significantly higher than 1.1 and increases with increasing lateral distance, reaching the overall highest value of 3.4 ± 0.3 at a depth of 206 mm and a lateral distance of 10 mm. The combination of RBE and dose into the biological dose points to the beam edge and the end-of-range in-beam as the areas with the highest risk of potential toxicities.
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Affiliation(s)
- M Missiaggia
- University of Trento, Via Sommarive 14, 38123 Trento, Italy. Trento Institute of Fundamental Physics and Applications (TIFPA), Via Sommarive 14, 38123 Trento, Italy
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Wolf M, Anderle K, Durante M, Graeff C. Robust treatment planning with 4D intensity modulated carbon ion therapy for multiple targets in stage IV non-small cell lung cancer. Phys Med Biol 2020; 65:215012. [PMID: 32610300 DOI: 10.1088/1361-6560/aba1a3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Intensity modulated particle therapy (IMPT) with carbon ions can generate highly conformal treatment plans; however, IMPT is limited in robustness against range and positioning uncertainty. This is particularly true for moving targets, even though all motion states of a 4DCT are considered in 4D-IMPT. Here, we expand 4D-IMPT to include robust non-linear RBE-weighted optimization to explore its potential in improving plan robustness and sparing critical organs. In this study, robust 4D-optimization-based on worst-case optimization on 9 scenarios-was compared to conventional 4D-optimization with PTV margins using 4D dose calculation and robustness analysis for 21 uncertainty scenarios. Slice-by-slice rescanning was used for motion mitigation. Both 4D-optimization strategies were tested on a cohort of 8 multi-lesion lung cancer patients with the goal of prioritizing OAR sparing in a hypofractionated treatment plan. Planning objectives were to keep the OAR volume doses below corresponding limits while simultaneously achieve CTV coverage with D95% ≥ 95 %. For the conventional plans, average D95% was at 98.7% which fulfilled the target objective in 83.2% of scenarios. For the robust plans, average D95% was reduced to 97.6% which still fulfilled the target objective in 80.7% of cases, but led to significantly improved overall OAR sparing: Volume doses were below the limits in 96.2% of cases for the conventional and 99.5% for the robust plans. When considering the particularly critical smaller airways only, fulfillment rates could be increased from 76.2% to 96% for the robust plans. This study has shown that plan robustness of 4D-IMPT could be improved by using robust 4D-optimization, offering greater control over uncertainties in the actual delivered dose. In some cases, this required sacrificing target coverage for the benefit of better OAR sparing.
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Affiliation(s)
- M Wolf
- GSI Helmholtz Center, Darmstadt, Germany
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Palma G, Monti S, Stanzione A, Xu T, Durante M, Mohan R, Liao Z, Cella L. Disentangling Contributions from Heart and Lung Anatomical Substructures to Radiation Induced Toxicities: Characterization of Spatial Properties of Dosimetric Data for Voxel-Based Analyses. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.704] [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: 10/23/2022]
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Cella L, Monti S, Xu T, Liuzzi R, Durante M, Mohan R, Liao Z, Palma G. Pericardial Effusion and Mortality in Patients Treated with Photons and Protons for Locally Advanced Non-small-cell lung Cancer: The Voxel-based Perspective. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2126] [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: 11/30/2022]
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Durante M. SP-0005: Differential biological effects of photon and particle irradiation; experimental highlights and clinical impact. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00031-1] [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: 11/25/2022]
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28
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Palma G, Monti S, Conson M, Xu T, Hahn S, Durante M, Mohan R, Liao Z, Cella L. PH-0285: NTCP models for severe radiation induced dermatitis after thoracic radiation therapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00309-1] [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: 11/29/2022]
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Ramires FA, Durante M, Maiorano G, Migoni D, Rampino P, Fanizzi FP, Perrotta C, Mita G, Grieco F, Bleve G. Industrial scale bio-detoxification of raw olive mill wastewaters by the use of selected microbial yeast and bacterial strains to obtain a new source for fertigation. J Environ Manage 2020; 265:110574. [PMID: 32421563 DOI: 10.1016/j.jenvman.2020.110574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/16/2020] [Accepted: 04/04/2020] [Indexed: 06/11/2023]
Abstract
The Olive Mill Wastewaters (OMWs) are one of the most important agro-industrial wastes of the Mediterranean Countries and the disposal by draining them onto land has been proved to be damaging for soils, plants and groundwater due to their polluting power. The present report describes a new method for bio-detoxification of undiluted fresh OMW based on the driven selection of aerobic yeasts and bacteria. The identified yeast Candida boidinii A5y and the bacterium Paenibacillus albidus R32b strains allowed the treatment of freshly produced raw OMW characterized by very high COD value and phenolic content, when applied as sequential inoculum. The treated OMW showed the absence of antimicrobial effects and a strongly reduction of phytotoxic activity on the germination of several plant seeds. The process was successfully validated on an industrial scale without any pre-treatment, dilution and/or supplementation of the raw waste. Bio-detoxified OMW produced by this sustainable and low-cost process would be suitable for new non-chemical fertigation or soilless applications. The described procedure represents a virtuous example of circular economy efficaciously applied for a depleting agri-food resource.
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Affiliation(s)
- F A Ramires
- CNR - Institute of Sciences of Food Production (ISPA), Unit of Lecce, Via Provincial Lecce-Monteroni, 73100, Lecce, Italy
| | - M Durante
- CNR - Institute of Sciences of Food Production (ISPA), Unit of Lecce, Via Provincial Lecce-Monteroni, 73100, Lecce, Italy
| | - G Maiorano
- CNR - Institute of Sciences of Food Production (ISPA), Unit of Lecce, Via Provincial Lecce-Monteroni, 73100, Lecce, Italy
| | - D Migoni
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA), University of Salento, 73100, Lecce, Italy
| | - P Rampino
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA), University of Salento, 73100, Lecce, Italy
| | - F P Fanizzi
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA), University of Salento, 73100, Lecce, Italy
| | - C Perrotta
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA), University of Salento, 73100, Lecce, Italy
| | - G Mita
- CNR - Institute of Sciences of Food Production (ISPA), Unit of Lecce, Via Provincial Lecce-Monteroni, 73100, Lecce, Italy
| | - F Grieco
- CNR - Institute of Sciences of Food Production (ISPA), Unit of Lecce, Via Provincial Lecce-Monteroni, 73100, Lecce, Italy
| | - G Bleve
- CNR - Institute of Sciences of Food Production (ISPA), Unit of Lecce, Via Provincial Lecce-Monteroni, 73100, Lecce, Italy.
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Durante M, Ferramosca A, Treppiccione L, Di Giacomo M, Zara V, Montefusco A, Piro G, Mita G, Bergamo P, Lenucci MS. Application of response surface methodology (RSM) for the optimization of supercritical CO 2 extraction of oil from patè olive cake: Yield, content of bioactive molecules and biological effects in vivo. Food Chem 2020; 332:127405. [PMID: 32603919 DOI: 10.1016/j.foodchem.2020.127405] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 09/26/2019] [Revised: 04/02/2020] [Accepted: 06/20/2020] [Indexed: 01/03/2023]
Abstract
The two-phase technology for olive oil extraction generates large amounts of patè olive cake (POC), a by-product that is rich in bioactive health-promoting compounds. Here, response surface methodology (RSM) was used to maximize supercritical-CO2 oil extraction from POC, while minimizing operative temperature, pressure and time. Under the optimal parameters (40.2 °C, 43.8 MPa and time 30 min), the oil yield was 14.5 g·100 g-1 dw (~65% of the total oil content of the freeze-dried POC matrix), as predicted by RSM. Compared with freeze-dried POC, the oil contained more phytosterols (13-fold), tocopherols (6-fold) and squalene (8-fold) and was a good source of pentacyclic triterpenes. When the biological effects of POC oil intake (20-40 µL·die-1) were evaluated in the livers of BALB/c mice, no significant influence on redox homeostasis was observed. Notably, a decline in liver triglycerides alongside increased activities of NAD(P)H:Quinone Oxidoreductase 1, Carnitine Palmitoyl-CoA Transferase and mitochondrial respiratory complexes suggested a potential beneficial effect on liver fatty acid oxidation.
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Affiliation(s)
- M Durante
- Institute of Sciences of Food Production (ISPA), CNR, Prov.le Lecce-Monteroni, 73100 Lecce, Italy.
| | - A Ferramosca
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA), University of Salento, Prov.le Lecce-Monteroni, 73100 Lecce, Italy.
| | - L Treppiccione
- Institute of Food Sciences (ISA), CNR, Via Roma 64, 83100 Avellino, Italy
| | - M Di Giacomo
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA), University of Salento, Prov.le Lecce-Monteroni, 73100 Lecce, Italy.
| | - V Zara
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA), University of Salento, Prov.le Lecce-Monteroni, 73100 Lecce, Italy.
| | - A Montefusco
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA), University of Salento, Prov.le Lecce-Monteroni, 73100 Lecce, Italy.
| | - G Piro
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA), University of Salento, Prov.le Lecce-Monteroni, 73100 Lecce, Italy.
| | - G Mita
- Institute of Sciences of Food Production (ISPA), CNR, Prov.le Lecce-Monteroni, 73100 Lecce, Italy.
| | - P Bergamo
- Institute of Food Sciences (ISA), CNR, Via Roma 64, 83100 Avellino, Italy.
| | - M S Lenucci
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA), University of Salento, Prov.le Lecce-Monteroni, 73100 Lecce, Italy.
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Fuss MC, Boscolo D, Durante M, Scifoni E, Krämer M. Systematic quantification of nanoscopic dose enhancement of gold nanoparticles in ion beams. Phys Med Biol 2020; 65:075008. [PMID: 32045892 DOI: 10.1088/1361-6560/ab7504] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
High-Z material nanoparticles are being studied as localized dose enhancers in radiotherapeutic applications. Here, the nano-scale physical dose enhancement of proton, carbon and oxygen ion beam radiation by gold nanoparticles was studied by means of Monte Carlo track structure simulation with the TRAX code. We present 2D distributions and radial profiles of the additional dose and the dose enhancement factor for two geometries which consider an isolated and a water-embedded nanoparticle, respectively. Different nanoparticle sizes (radius of 1.2-22 nm) were found to yield qualitatively different absolute and relative dose enhancement distributions and different maximum dose enhancement factors (up to 20). Whereas the smallest nanoparticles produced the highest local dose enhancement factor close to the metal, larger ones led to lower, more diffuse dose enhancement factors that contributed more at larger distances. Differential absorption effects inside the metal were found to be responsible for those characteristics. For the energy range 15-204 MeVu-1, also a mild trend with ion E/A, regardless of the ion species, was found for embedded nanoparticles. In analogy to the width of the ion track itself, slower ions increased the enhancement at the nanoparticle surface. In contrast, no dependence on linear energy transfer was encountered. For slower ions (3-10 MeVu-1), the enhancement effect began to break down over all distances. Finally, the significance of any indirect physical effect was excluded, giving important hints especially in view of the low probabilities (at realistic concentrations and fluences) of direct ion-NP-hits. The very localized nature of the physical dose enhancement found suggests a strong action upon targets closeby, but no relevant effect at cellular distances. When pondering different possible damage enhancement mechanisms of gold nanoparticles in the context of published in vitro and in vivo experimental results, biological pathways are likely to play the key role.
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Affiliation(s)
- M C Fuss
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Planckstraße 1, 64291 Darmstadt, Germany
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Mattei I, Alexandrov A, Alunni Solestizi L, Ambrosi G, Argiro S, Bartosik N, Battistoni G, Belcari N, Biondi S, Bisogni MG, Bruni G, Camarlinghi N, Carra P, Catanzani E, Ciarrocchi E, Cerello P, Clozza A, Colombi S, De Lellis G, Del Guerra A, De Simoni M, Di Crescenzo A, Donetti M, Dong Y, Durante M, Embriaco A, Emde M, Faccini R, Ferrero V, Ferroni F, Fiandrini E, Finck C, Fiorina E, Fischetti M, Francesconi M, Franchini M, Galli L, Gentile V, Hetzel R, Hild S, Iarocci E, Ionica M, Kanxheri K, Kraan AC, Lante V, Lauria A, La Tessa C, Lopez Torres E, Massimi C, Marafini M, Mengarelli A, Mirabelli R, Montesi MC, Morone MC, Morrocchi M, Muraro S, Narici L, Pastore A, Pastrone N, Patera V, Pennazio F, Placidi P, Pullia M, Ramello L, Ridolfi R, Rosso V, Rovituso M, Sanelli C, Sartorelli G, Sato O, Savazzi S, Scavarda L, Schiavi A, Schuy C, Scifoni E, Sciubba A, Secher A, Selvi M, Servoli L, Silvestre G, Sitta M, Spighi R, Spiriti E, Sportelli G, Stahl A, Tomassini S, Tommasino F, Traini G, Toppi M, Valeri T, Valle SM, Vanstalle M, Villa M, Weber U, Zoccoli A, Sarti A. Measurement of 12C Fragmentation Cross Sections on C, O, and H in the Energy Range of Interest for Particle Therapy Applications. IEEE Trans Radiat Plasma Med Sci 2020. [DOI: 10.1109/trpms.2020.2972197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Koc TA, Durante M, Bunales IA, Wint M, Marshall T. The immediate effects of knee flexion range of motion following manual therapy or self-stretching/active range of motion following a total knee arthroplasty: a case report. J Phys Ther Sci 2020; 31:1002-1005. [PMID: 32038072 PMCID: PMC6893161 DOI: 10.1589/jpts.31.1002] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/19/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purposes of this case study are to: (1) report the immediate effects of
knee flexion range of motion following manual therapy (MT) and self-stretching/AROM
following a total knee arthroplasty (TKA). (2) contribute empirical evidence to the
literature through reports within this case study. [Participant and Methods] For 6 days,
the authors utilized a different MT technique and 1 day of self-stretching and active
range of motion for an 85-year-old male who was 3 days status post right TKA. [Results]
The greatest gains for AROM/PROM for knee flexion were achieved while performing typical
arthrokinematic motion joint mobilizations, for AROM and PROM, resulting in a gain of 10
degrees and 10 degrees, respectfully. [Conclusion] We theorize that performing typical
arthrokinematic motion joint mobilizations stimulates a greater response from the
mechanoreceptors and therefore a greater stimulation response to the central and
peripheral nervous systems. This greater stimulation may explain the greatest immediate
gain in knee flexion range of motion being performed by typical arthrokinematic motion
joint mobilizations. The outcomes of this study demonstrate the start of some empirical
evidence while exploring the immediate effects of knee flexion range of motion following
manual therapy and self-stretching/AROM following a TKA.
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Affiliation(s)
- Thomas A Koc
- Kean University: 1000 Morris Ave, Union, NJ 07083, USA
| | | | | | - Melissa Wint
- Kean University: 1000 Morris Ave, Union, NJ 07083, USA
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Sandborn WJ, Ferrante M, Bhandari BR, Berliba E, Feagan BG, Hibi T, Tuttle JL, Klekotka P, Friedrich S, Durante M, Morgan-Cox M, Laskowski J, Schmitz J, D'Haens GR. Efficacy and Safety of Mirikizumab in a Randomized Phase 2 Study of Patients With Ulcerative Colitis. Gastroenterology 2020; 158:537-549.e10. [PMID: 31493397 DOI: 10.1053/j.gastro.2019.08.043] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 08/02/2019] [Accepted: 08/25/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Interleukin 23 contributes to the pathogenesis of ulcerative colitis (UC). We investigated the effects of mirikizumab, a monoclonal antibody against the p19 subunit of interleukin 23, in a phase 2 study of patients with UC. METHODS We performed a trial of the efficacy and safety of mirikizumab in patients with moderate to severely active UC, enrolling patients from 14 countries from January 2016 through September 2017. Patients were randomly assigned to groups given intravenous placebo (N = 63), mirikizumab 50 mg (N = 63) or 200 mg (N = 62) with exposure-based dosing, or mirikizumab 600 mg with fixed dosing (N = 61) at weeks 0, 4, and 8. Of assigned patients, 63% had prior exposure to a biologic agent. Clinical responders (decrease in 9-point Mayo score, including ≥2 points and ≥35% from baseline with either a decrease of rectal bleeding subscore of ≥1 or a rectal bleeding subscore of 0 or 1) at week 12 who had received mirikizumab were randomly assigned to groups that received maintenance treatment with mirikizumab 200 mg subcutaneously every 4 weeks (N = 47) or every 12 weeks (N = 46). The primary endpoint was clinical remission (Mayo subscores of 0 for rectal bleeding, with 1-point decrease from baseline for stool frequency, and 0 or 1 for endoscopy) at week 12. A multiple testing procedure was used that began with the 600-mg dose group, and any nonsignificant comparison result ended the formal statistical testing procedure. RESULTS At week 12, 15.9% (P = .066), 22.6% (P = .004), and 11.5% (P = .142) of patients in the 50-mg, 200-mg, and 600-mg groups achieved clinical remission, respectively, compared with 4.8% of patients given placebo. The primary endpoint was not significant (comparison to 600 mg, P > .05). Clinical responses occurred in 41.3% (P = .014), 59.7% (P < .001), and 49.2% (P = .001) of patients in the 50-mg, 200-mg, and 600-mg groups, respectively, compared with 20.6% of patients given placebo. At week 52, 46.8% of patients given subcutaneous mirikizumab 200 mg every 4 weeks and 37.0% given subcutaneous mirikizumab 200 mg every 12 weeks were in clinical remission. CONCLUSIONS In a randomized trial of patients with UC, mirikizumab was effective in inducing a clinical response after 12 weeks. Additional studies are required to determine the optimal dose for induction of remission. Mirikizumab showed durable efficacy throughout the maintenance period. Clinicaltrials.gov, Number NCT02589665.
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Affiliation(s)
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Elina Berliba
- Nicolae Testemitanu State University of Medicine, Arsenia Exploratory Medicine, Chisinau, Moldova
| | - Brian G Feagan
- Western University, Robarts Clinical Trials Inc, London, Ontario, Canada
| | - Toshifumi Hibi
- Kitasato Institute Hospital Center for Advanced Inflammatory Bowel Disease Research and Treatment, Minato-ku, Tokyo, Japan
| | - Jay L Tuttle
- Eli Lilly and Company, Lilly Biotechnology Center, San Diego, California
| | - Paul Klekotka
- Eli Lilly and Company, Lilly Biotechnology Center, San Diego, California
| | | | | | | | - Janelle Laskowski
- Eli Lilly and Company, Lilly Biotechnology Center, San Diego, California
| | | | - Geert R D'Haens
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Durante M. SP-033: Radioimmunotherapy with high-energy charged particles and checkpoint inhibitors. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(20)30569-7] [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: 10/23/2022]
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Palma G, Taffelli A, Fellin F, D'Avino V, Scartoni D, Tommasino F, Scifoni E, Durante M, Amichetti M, Schwarz M, Amelio D, Cella L. NTCP Models for Permanent Radiation Induced Alopecia in Brain Tumor Patients Treated with Scanned Proton Beams. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.195] [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: 11/25/2022]
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37
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Palma G, Conson M, Xu T, Hahn S, Durante M, Mohan R, Liao Z, Cella L. Severe Radiation Induced Dermatitis after IMRT or Proton Therapy for Thoracic Cancer Patients. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.389] [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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Faiao-Flores F, Emmons M, Durante M, Saha B, Fang B, Koomen J, Chellappan S, Maria-Engler S, Licht J, Harbour W, Smalley K. Abstract 378: HDAC inhibition enhances MEK antagonist therapy in uveal melanoma through combined blockade of YAP, AKT and RTK signaling. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-378] [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
Around 85-90% of all uveal melanomas harbor driver mutations in GNAQ or GNA11 leading to constitutive activation of numerous signaling pathways, including the MAPK pathway. MEK inhibitors have been evaluated clinically for metastatic uveal melanoma, but the responses are short-lived and the mechanisms of adaptation are poorly understood. In the current study, we performed RNA-seq and activity-based protein profiling (ABPP) to define the adaptive response of uveal melanoma cells to MEK inhibition and to design more effective combination therapy strategies. These analyses showed that MEK inhibition caused cytoskeleton remodeling driven by cortactin/Rho-GTPases with an increase in YAP activity, which in turn allowed therapeutic escape. Cortactin knockdown decreased YAP activity in response to MEK inhibition, increased cell death in vitro and was associated with tumor shrinkage in vivo. The proteomic data showed that MEK inhibition increased HDAC activity and an increase in global protein deacetylation. Co-targeting of HDACs and MEK was associated with increased apoptosis, decreased survival in 2D and 3D cell culture assays and suppression of YAP signaling. As YAP was unlikely to be the only escape pathway, we performed kinome and RTK arrays and demonstrated MEK inhibition also increases ROR1/2 and IGF-1R phosphorylation, leading to downstream PI3K/AKT signaling. At a signal transduction level, the combination of a pan-HDAC inhibitor (panobinostat) with a MEK inhibitor (trametinib) blocked all of the adaptive signaling pathways we identified, including RTKs, AKT, YAP and cortactin. In vivo xenograft studies revealed the MEK/HDAC inhibitor combination to outperform either agent alone, leading to long-term decrease of tumor growth and the suppression of adaptive PI3K/AKT, cortactin and YAP signaling. These findings identify HDAC inhibitors as a promising combination partner for MEK inhibitors in advanced uveal melanoma that may lead to improved systemic responses.
Citation Format: Fernanda Faiao-Flores, Michael Emmons, Michael Durante, Biswarup Saha, Bin Fang, John Koomen, Srikumar Chellappan, Silvya Maria-Engler, Jonathan Licht, William Harbour, Keiran Smalley. HDAC inhibition enhances MEK antagonist therapy in uveal melanoma through combined blockade of YAP, AKT and RTK signaling [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 378.
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Affiliation(s)
| | - Michael Emmons
- 1The Moffitt Cancer Center & Research Institute, Tampa, FL
| | | | - Biswarup Saha
- 1The Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Bin Fang
- 1The Moffitt Cancer Center & Research Institute, Tampa, FL
| | - John Koomen
- 1The Moffitt Cancer Center & Research Institute, Tampa, FL
| | | | | | | | | | - Keiran Smalley
- 1The Moffitt Cancer Center & Research Institute, Tampa, FL
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39
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Tommasino F, Rovituso M, Lorentini S, La Tessa C, Petringa G, Cirrone P, Romano F, Scifoni E, Schwarz M, Durante M. STUDY FOR A PASSIVE SCATTERING LINE DEDICATED TO RADIOBIOLOGY EXPERIMENTS AT THE TRENTO PROTON THERAPY CENTER. Radiat Prot Dosimetry 2019; 183:274-279. [PMID: 30535406 DOI: 10.1093/rpd/ncy238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The recent worldwide spread of Proton Therapy centers paves the way to new opportunities for basic and applied research related to the use of accelerated proton beams. Clinical centers make use of proton beam energies up to about 230 MeV. This represents an interesting energy range for a large spectrum of applications, including detector testing, radiation shielding and space research. Additionally, radiobiology research might benefit for a larger availability of proton beams, especially in those centers where a room dedicated to research activities also exists. Here, we describe the initial activities for the setup of a radiobiology irradiation facility at the Trento Proton Therapy Center. Data referring to the characterization of the beam in air are essential to that purpose and will be presented. A basic setup for large field irradiation will be also proposed, which is needed for the majority of in vitro and in vivo radiobiology experiments.
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Affiliation(s)
- F Tommasino
- Department of Physics, University of Trento, Povo, Italy
- Trento Institute for Fundamental Physics and Applications (TIFPA), National Institute for Nuclear Physics (INFN), Povo, Italy
| | - M Rovituso
- Trento Institute for Fundamental Physics and Applications (TIFPA), National Institute for Nuclear Physics (INFN), Povo, Italy
| | - S Lorentini
- Protontherapy Department, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - C La Tessa
- Department of Physics, University of Trento, Povo, Italy
- Trento Institute for Fundamental Physics and Applications (TIFPA), National Institute for Nuclear Physics (INFN), Povo, Italy
| | - G Petringa
- Laboratori Nazionali del Sud, National Institute for Nuclear Physics (INFN), Catania, Italy
| | - P Cirrone
- Laboratori Nazionali del Sud, National Institute for Nuclear Physics (INFN), Catania, Italy
| | - F Romano
- Laboratori Nazionali del Sud, National Institute for Nuclear Physics (INFN), Catania, Italy
- National Physics Laboratory, Acoustic and Ionizing Radiation Division, Middlesex, United Kingdom
| | - E Scifoni
- Trento Institute for Fundamental Physics and Applications (TIFPA), National Institute for Nuclear Physics (INFN), Povo, Italy
| | - M Schwarz
- Trento Institute for Fundamental Physics and Applications (TIFPA), National Institute for Nuclear Physics (INFN), Povo, Italy
- Protontherapy Department, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - M Durante
- Trento Institute for Fundamental Physics and Applications (TIFPA), National Institute for Nuclear Physics (INFN), Povo, Italy
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40
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Walsh L, Schneider U, Fogtman A, Kausch C, McKenna-Lawlor S, Narici L, Ngo-Anh J, Reitz G, Sabatier L, Santin G, Sihver L, Straube U, Weber U, Durante M. Research plans in Europe for radiation health hazard assessment in exploratory space missions. Life Sci Space Res (Amst) 2019; 21:73-82. [PMID: 31101157 DOI: 10.1016/j.lssr.2019.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/09/2019] [Accepted: 04/11/2019] [Indexed: 05/04/2023]
Abstract
The European Space Agency (ESA) is currently expanding its efforts in identifying requirements and promoting research towards optimizing radiation protection of astronauts. Space agencies use common limits for tissue (deterministic) effects on the International Space Station. However, the agencies have in place different career radiation exposure limits (for stochastic effects) for astronauts in low-Earth orbit missions. Moreover, no specific limits for interplanetary missions are issued. Harmonization of risk models and dose limits for exploratory-class missions are now operational priorities, in view of the short-term plans for international exploratory-class human missions. The purpose of this paper is to report on the activity of the ESA Topical Team on space radiation research, whose task was to identify the most pertinent research requirements for improved space radiation protection and to develop a European space radiation risk model, to contribute to the efforts to reach international consensus on dose limits for deep space. The Topical Team recommended ESA to promote the development of a space radiation risk model based on European-specific expertise in: transport codes, radiobiological modelling, risk assessment, and uncertainty analysis. The model should provide cancer and non-cancer radiation risks for crews implementing exploratory missions. ESA should then support the International Commission on Radiological Protection to harmonize international models and dose limits in deep space, and guarantee continuous support in Europe for accelerator-based research configured to improve the models and develop risk mitigation strategies.
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Affiliation(s)
- L Walsh
- Department of Physics, Science Faculty, University of Zürich, Zurich, Switzerland
| | - U Schneider
- Department of Physics, Science Faculty, University of Zürich, Zurich, Switzerland
| | | | - C Kausch
- GSI Helmholtzzentrum für Schwerionenforschung, Biophysics Department, Darmstadt, Germany
| | | | - L Narici
- Department of Physics, University Tor Vergata, and INFN, Roma-2 Section, Rome, Italy
| | - J Ngo-Anh
- ESA-ESTEC, Nordwijk, the Netherlands
| | - G Reitz
- Nuclear Physics Institute, Czech Academy of Sciences, Prague, Czechia; Radiation Biology, Institue for Aerospace Medicine, DLR, Cologne, Germany
| | - L Sabatier
- Fundamental Research Division, D3P, CEA, Paris-Saclay, France
| | - G Santin
- ESA-ESTEC, Nordwijk, the Netherlands
| | - L Sihver
- Atominstitut, Technische Universität Wien, Wien, Austria; MedAustron, Wiener Neustadt, Austria
| | | | - U Weber
- GSI Helmholtzzentrum für Schwerionenforschung, Biophysics Department, Darmstadt, Germany
| | - M Durante
- GSI Helmholtzzentrum für Schwerionenforschung, Biophysics Department, Darmstadt, Germany; Technische Universität Darmstadt, Darmstadt, Germany.
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41
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Garbacz M, Baran J, Battistoni G, Durante M, Gajewski J, Krah N, Krzempek K, Patera V, Pawlik-Niedzwiecka M, Rinaldi I, Sas-Korczynska B, Scifoni E, Skrzypek A, Schiavi A, Tommasino F, Rucinski A. EP-1884 Commissioning and clinical validation of FRED: Monte Carlo on GPU for proton beam therapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32304-7] [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: 10/26/2022]
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42
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Abstract
We report on a novel method for simultaneous biological optimization of treatment plans for hypoxic tumors using multiple ion species. Our previously introduced kill painting approach, where the overall cell killing is optimized on biologically heterogeneous targets, was expanded with the capability of handling different ion beams simultaneously. The current version (MIBO) of the research treatment planning system TRiP98 has now been augmented to handle 3D (voxel-by-voxel) target oxygenation data. We present a case of idealized geometries where this method can identify optimal combinations leading to an improved peak-to-entrance effective dose ratio. This is achieved by the redistribution of particle fluences, when the heavier ions are preferentially forwarded to hypoxic target areas, while the lighter ions deliver the remaining dose to its normoxic regions. Finally, we present an in silico skull base chordoma patient case study with a combination of 4He and 16O beams, demonstrating specific indications for its potential clinical application. In this particular case, the mean dose, received by the brainstem, was reduced by 3%-5% and by 10%-12% as compared to the pure 4He and 16O plans, respectively. The new method allows a full biological optimization of different ion beams, exploiting the capabilities of actively scanned ion beams of modern particle therapy centers. The possible experimental verification of the present approach at ion beam facilities disposing of fast ion switch is presented and discussed.
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Affiliation(s)
- O Sokol
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung GmbH, Planckstraße 1, D-64291 Darmstadt, Germany
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Sokol O, Scifoni E, Hild S, Durante M, Krämer M. 216. Biological treatment planning with multiple ion beams. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.227] [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: 11/29/2022] Open
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44
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Schuemann J, McNamara AL, Warmenhoven JW, Henthorn NT, Kirkby KJ, Merchant MJ, Ingram S, Paganetti H, Held KD, Ramos-Mendez J, Faddegon B, Perl J, Goodhead DT, Plante I, Rabus H, Nettelbeck H, Friedland W, Kundrát P, Ottolenghi A, Baiocco G, Barbieri S, Dingfelder M, Incerti S, Villagrasa C, Bueno M, Bernal MA, Guatelli S, Sakata D, Brown JMC, Francis Z, Kyriakou I, Lampe N, Ballarini F, Carante MP, Davídková M, Štěpán V, Jia X, Cucinotta FA, Schulte R, Stewart RD, Carlson DJ, Galer S, Kuncic Z, Lacombe S, Milligan J, Cho SH, Sawakuchi G, Inaniwa T, Sato T, Li W, Solov'yov AV, Surdutovich E, Durante M, Prise KM, McMahon SJ. A New Standard DNA Damage (SDD) Data Format. Radiat Res 2018; 191:76-92. [PMID: 30407901 DOI: 10.1667/rr15209.1] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Our understanding of radiation-induced cellular damage has greatly improved over the past few decades. Despite this progress, there are still many obstacles to fully understand how radiation interacts with biologically relevant cellular components, such as DNA, to cause observable end points such as cell killing. Damage in DNA is identified as a major route of cell killing. One hurdle when modeling biological effects is the difficulty in directly comparing results generated by members of different research groups. Multiple Monte Carlo codes have been developed to simulate damage induction at the DNA scale, while at the same time various groups have developed models that describe DNA repair processes with varying levels of detail. These repair models are intrinsically linked to the damage model employed in their development, making it difficult to disentangle systematic effects in either part of the modeling chain. These modeling chains typically consist of track-structure Monte Carlo simulations of the physical interactions creating direct damages to DNA, followed by simulations of the production and initial reactions of chemical species causing so-called "indirect" damages. After the induction of DNA damage, DNA repair models combine the simulated damage patterns with biological models to determine the biological consequences of the damage. To date, the effect of the environment, such as molecular oxygen (normoxic vs. hypoxic), has been poorly considered. We propose a new standard DNA damage (SDD) data format to unify the interface between the simulation of damage induction in DNA and the biological modeling of DNA repair processes, and introduce the effect of the environment (molecular oxygen or other compounds) as a flexible parameter. Such a standard greatly facilitates inter-model comparisons, providing an ideal environment to tease out model assumptions and identify persistent, underlying mechanisms. Through inter-model comparisons, this unified standard has the potential to greatly advance our understanding of the underlying mechanisms of radiation-induced DNA damage and the resulting observable biological effects when radiation parameters and/or environmental conditions change.
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Affiliation(s)
- J Schuemann
- a Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - A L McNamara
- a Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - J W Warmenhoven
- b Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - N T Henthorn
- b Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - K J Kirkby
- b Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - M J Merchant
- b Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - S Ingram
- b Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - H Paganetti
- a Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - K D Held
- a Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - J Ramos-Mendez
- c Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - B Faddegon
- c Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - J Perl
- d SLAC National Accelerator Laboratory, Menlo Park, California
| | - D T Goodhead
- e Medical Research Council, Harwell, United Kingdom
| | | | - H Rabus
- g Physikalisch-Technische Bundesanstalt (PTB), Braunschweig, Germany.,h Task Group 6.2 "Computational Micro- and Nanodosimetry", European Radiation Dosimetry Group e.V., Neuherberg, Germany
| | - H Nettelbeck
- g Physikalisch-Technische Bundesanstalt (PTB), Braunschweig, Germany.,h Task Group 6.2 "Computational Micro- and Nanodosimetry", European Radiation Dosimetry Group e.V., Neuherberg, Germany
| | - W Friedland
- h Task Group 6.2 "Computational Micro- and Nanodosimetry", European Radiation Dosimetry Group e.V., Neuherberg, Germany.,i Institute of Radiation Protection, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - P Kundrát
- i Institute of Radiation Protection, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - A Ottolenghi
- j Physics Department, University of Pavia, Pavia, Italy
| | - G Baiocco
- h Task Group 6.2 "Computational Micro- and Nanodosimetry", European Radiation Dosimetry Group e.V., Neuherberg, Germany.,j Physics Department, University of Pavia, Pavia, Italy
| | - S Barbieri
- h Task Group 6.2 "Computational Micro- and Nanodosimetry", European Radiation Dosimetry Group e.V., Neuherberg, Germany.,j Physics Department, University of Pavia, Pavia, Italy
| | - M Dingfelder
- k Department of Physics, East Carolina University, Greenville, North Carolina
| | - S Incerti
- l CNRS, IN2P3, CENBG, UMR 5797, F-33170 Gradignan, France.,m University of Bordeaux, CENBG, UMR 5797, F-33170 Gradignan, France
| | - C Villagrasa
- h Task Group 6.2 "Computational Micro- and Nanodosimetry", European Radiation Dosimetry Group e.V., Neuherberg, Germany.,n Institut de Radioprotection et Sûreté Nucléaire, F-92262 Fontenay aux Roses Cedex, France
| | - M Bueno
- n Institut de Radioprotection et Sûreté Nucléaire, F-92262 Fontenay aux Roses Cedex, France
| | - M A Bernal
- o Applied Physics Department, Gleb Wataghin Institute of Physics, State University of Campinas, Campinas, SP, Brazil
| | - S Guatelli
- p Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - D Sakata
- p Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - J M C Brown
- q Department of Radiation Science and Technology, Delft University of Technology, Delft, The Netherlands
| | - Z Francis
- r Department of Physics, Faculty of Science, Saint Joseph University, Beirut, Lebanon
| | - I Kyriakou
- s Medical Physics Laboratory, University of Ioannina Medical School, Ioannina, Greece
| | - N Lampe
- l CNRS, IN2P3, CENBG, UMR 5797, F-33170 Gradignan, France
| | - F Ballarini
- j Physics Department, University of Pavia, Pavia, Italy.,t Italian National Institute of Nuclear Physics, Section of Pavia, I-27100 Pavia, Italy
| | - M P Carante
- j Physics Department, University of Pavia, Pavia, Italy.,t Italian National Institute of Nuclear Physics, Section of Pavia, I-27100 Pavia, Italy
| | - M Davídková
- u Department of Radiation Dosimetry, Nuclear Physics Institute of the CAS, Řež, Czech Republic
| | - V Štěpán
- u Department of Radiation Dosimetry, Nuclear Physics Institute of the CAS, Řež, Czech Republic
| | - X Jia
- v Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - F A Cucinotta
- w Health Physics and Diagnostic Sciences, University of Nevada Las Vegas, Las Vegas, Nevada
| | - R Schulte
- x Division of Biomedical Engineering Sciences, School of Medicine, Loma Linda University, Loma Linda, California
| | - R D Stewart
- y Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - D J Carlson
- z Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - S Galer
- aa Medical Radiation Science Group, National Physical Laboratory, Teddington, United Kingdom
| | - Z Kuncic
- bb School of Physics, University of Sydney, Sydney, NSW, Australia
| | - S Lacombe
- cc Institut des Sciences Moléculaires d'Orsay (UMR 8214) University Paris-Sud, CNRS, University Paris-Saclay, 91405 Orsay Cedex, France
| | | | - S H Cho
- ee Department of Radiation Physics and Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - G Sawakuchi
- ee Department of Radiation Physics and Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - T Inaniwa
- ff Department of Accelerator and Medical Physics, National Institute of Radiological Sciences, Chiba, Japan
| | - T Sato
- gg Japan Atomic Energy Agency, Nuclear Science and Engineering Center, Tokai 319-1196, Japan
| | - W Li
- i Institute of Radiation Protection, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.,hh Task Group 7.7 "Internal Micro- and Nanodosimetry", European Radiation Dosimetry Group e.V., Neuherberg, Germany
| | - A V Solov'yov
- ii MBN Research Center, 60438 Frankfurt am Main, Germany
| | - E Surdutovich
- jj Department of Physics, Oakland University, Rochester, Michigan
| | - M Durante
- kk GSI Helmholtzzentrum für Schwerionenforschung, Biophysics Department, Darmstadt, Germany
| | - K M Prise
- ll Centre for Cancer Research and Cell Biology, Queens University Belfast, Belfast, United Kingdom
| | - S J McMahon
- ll Centre for Cancer Research and Cell Biology, Queens University Belfast, Belfast, United Kingdom
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Mohamad O, Yamada S, Durante M. Clinical Indications for Carbon Ion Radiotherapy. Clin Oncol (R Coll Radiol) 2018; 30:317-329. [DOI: 10.1016/j.clon.2018.01.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 11/20/2017] [Indexed: 12/16/2022]
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Boscolo D, Krämer M, Durante M, Fuss M, Scifoni E. TRAX-CHEM: A pre-chemical and chemical stage extension of the particle track structure code TRAX in water targets. Chem Phys Lett 2018. [DOI: 10.1016/j.cplett.2018.02.051] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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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Kreuzer M, Auvinen A, Cardis E, Durante M, Harms-Ringdahl M, Jourdain JR, Madas BG, Ottolenghi A, Pazzaglia S, Prise KM, Quintens R, Sabatier L, Bouffler S. Multidisciplinary European Low Dose Initiative (MELODI): strategic research agenda for low dose radiation risk research. Radiat Environ Biophys 2018; 57:5-15. [PMID: 29247291 PMCID: PMC5816101 DOI: 10.1007/s00411-017-0726-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/10/2017] [Indexed: 05/05/2023]
Abstract
MELODI (Multidisciplinary European Low Dose Initiative) is a European radiation protection research platform with focus on research on health risks after exposure to low-dose ionising radiation. It was founded in 2010 and currently includes 44 members from 18 countries. A major activity of MELODI is the continuous development of a long-term European Strategic Research Agenda (SRA) on low-dose risk for radiation protection. The SRA is intended to identify priorities for national and European radiation protection research programs as a basis for the preparation of competitive calls at the European level. Among those key priorities is the improvement of health risk estimates for exposures close to the dose limits for workers and to reference levels for the population in emergency situations. Another activity of MELODI is to ensure the availability of European key infrastructures for research activities, and the long-term maintenance of competences in radiation research via an integrated European approach for training and education. The MELODI SRA identifies three key research topics in low dose or low dose-rate radiation risk research: (1) dose and dose rate dependence of cancer risk, (2) radiation-induced non-cancer effects and (3) individual radiation sensitivity. The research required to improve the evidence base for each of the three key topics relates to three research lines: (1) research to improve understanding of the mechanisms contributing to radiogenic diseases, (2) epidemiological research to improve health risk evaluation of radiation exposure and (3) research to address the effects and risks associated with internal exposures, differing radiation qualities and inhomogeneous exposures. The full SRA and associated documents can be downloaded from the MELODI website ( http://www.melodi-online.eu/sra.html ).
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Affiliation(s)
- M Kreuzer
- Department of Radiation Protection and Health, Federal Office for Radiation Protection, BfS, Neuherberg, Germany.
| | - A Auvinen
- University of Tampere, Tampere, Finland
- STUK, Helsinki, Finland
| | - E Cardis
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - M Durante
- Institute for Fundamental Physics and Applications, TIFPA, Trento, Italy
| | - M Harms-Ringdahl
- Centre for Radiation Protection Research, Stockholm University, Stockholm, Sweden
| | - J R Jourdain
- Institute for Radiological Protection and Nuclear Safety, IRSN, Fontenay-aux-roses, France
| | - B G Madas
- Environmental Physics Department, MTA Centre for Energy Research, Budapest, Hungary
| | - A Ottolenghi
- Physics Department, University of Pavia, Pavia, Italy
| | - S Pazzaglia
- Italian National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA), Rome, Italy
| | - K M Prise
- Queens University Belfast, Belfast, UK
| | - R Quintens
- Belgian Nuclear Research Centre, SCK-CEN, Mol, Belgium
| | - L Sabatier
- French Atomic Energy Commission, CEA, Paris, France
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Sokol O, Scifoni E, Tinganelli W, Kraft-Weyrather W, Wiedemann J, Maier A, Boscolo D, Friedrich T, Brons S, Durante M, Krämer M. Oxygen beams for therapy: advanced biological treatment planning and experimental verification. Phys Med Biol 2017; 62:7798-7813. [PMID: 28841579 DOI: 10.1088/1361-6560/aa88a0] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Nowadays there is a rising interest towards exploiting new therapeutical beams beyond carbon ions and protons. In particular, [Formula: see text]O ions are being widely discussed due to their increased LET distribution. In this contribution, we report on the first experimental verification of biologically optimized treatment plans, accounting for different biological effects, generated with the TRiP98 planning system with [Formula: see text]O beams, performed at HIT and GSI. This implies the measurements of 3D profiles of absorbed dose as well as several biological measurements. The latter includes the measurements of relative biological effectiveness along the range of linear energy transfer values from ≈20 up to ≈750 keV μ [Formula: see text], oxygen enhancement ratio values and the verification of the kill-painting approach, to overcome hypoxia, with a phantom imitating an unevenly oxygenated target. With the present implementation, our treatment planning system is able to perform a comparative analysis of different ions, according to any given condition of the target. For the particular cases of low target oxygenation, [Formula: see text]O ions demonstrate a higher peak-to-entrance dose ratio for the same cell killing in the target region compared to [Formula: see text]C ions. Based on this phenomenon, we performed a short computational analysis to reveal the potential range of treatment plans, where [Formula: see text]O can benefit over lighter modalities. It emerges that for more hypoxic target regions (partial oxygen pressure of ≈0.15% or lower) and relatively low doses (≈4 Gy or lower) the choice of [Formula: see text]O over [Formula: see text]C or [Formula: see text]He may be justified.
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Affiliation(s)
- O Sokol
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung GmbH, Planckstr. 1, D-64291 Darmstadt, Germany
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Gerardi C, Albano C, Calabriso N, Carluccio MA, Durante M, Mita G, Renna M, Serio F, Blando F. Techno-functional properties of tomato puree fortified with anthocyanin pigments. Food Chem 2017; 240:1184-1192. [PMID: 28946241 DOI: 10.1016/j.foodchem.2017.08.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 04/28/2017] [Revised: 08/11/2017] [Accepted: 08/17/2017] [Indexed: 12/14/2022]
Abstract
This study investigates the effects of tomato puree fortification with several anthocyanin-rich food colorants on bioactive compound content (phenolics, isoprenoids), antioxidant capacity, in vitro biological activities and consumer acceptance. Tomato puree (tp) was added with different anthocyanin extracts from black carrot (Anthocarrot), grape fruit skins (Enocolor), elderberry fruits (Elderberry) or mahaleb cherry fruits (Mahaleb), thus obtaining a 'functional tomato puree' (ftp). The consumer acceptance (colour, flavor, taste, visual appearance) was at high level, except for Mahaleb-added ftp. Compared to the control (tp), the addition of colouring extracts increased significantly the total phenolic content, before pasteurization, in addition to the expected anthocyanin content. However, after pasteurization, mostly Anthocarrot-ftp preserved an increased phenolic (+53%) content, as well as a higher antioxidant capacity (50%), more than the other added-extracts. Consistently, against tp, Anthocarrot-ftp exhibited an increased anti-inflammatory capacity as showed by the reduced expression of vascular cell adhesion molecule (VCAM)-1 in human cultured endothelial cells, under inflammatory conditions.
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Affiliation(s)
- C Gerardi
- Institute of Sciences of Food Production, CNR, Lecce Unit, Lecce, Italy
| | - C Albano
- Institute of Sciences of Food Production, CNR, Milan Unit, Milan, Italy
| | - N Calabriso
- Institute of Clinical Physiology, CNR, Lecce Unit, Lecce, Italy
| | - M A Carluccio
- Institute of Clinical Physiology, CNR, Lecce Unit, Lecce, Italy
| | - M Durante
- Institute of Sciences of Food Production, CNR, Lecce Unit, Lecce, Italy
| | - G Mita
- Institute of Sciences of Food Production, CNR, Lecce Unit, Lecce, Italy
| | - M Renna
- Department of Agricultural and Environmental Science, University of Bari 'Aldo Moro', Bari, Italy; Institute of Sciences of Food Production, CNR, Bari, Italy
| | - F Serio
- Institute of Sciences of Food Production, CNR, Bari, Italy
| | - F Blando
- Institute of Sciences of Food Production, CNR, Lecce Unit, Lecce, Italy.
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Alfonsi L, Ambroglini F, Ambrosi G, Ammendola R, Assante D, Badoni D, Belyaev V, Burger W, Cafagna A, Cipollone P, Consolini G, Conti L, Contin A, Angelis E, Donato C, Franceschi G, Santis A, Santis C, Diego P, Durante M, Fornaro C, Guandalini C, Laurenti G, Laurenza M, Lazzizzera I, Lolli M, Manea C, Marcelli L, Marcucci F, Masciantonio G, Osteria G, Palma F, Palmonari F, Panico B, Patrizii L, Picozza P, Pozzato M, Rashevskaya I, Ricci M, Rovituso M, Scotti V, Sotgiu A, Sparvoli R, Spataro B, Spogli L, Tommasino F, Ubertini P, Vannaroni G, Xuhui S, Zoffoli S. The HEPD particle detector and the EFD electric field detector for the CSES satellite. Radiat Phys Chem Oxf Engl 1993 2017. [DOI: 10.1016/j.radphyschem.2016.12.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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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