Certificates of Confidentiality and Mandatory Reporting

This Viewpoint discusses the importance of obtaining federal certificates of confidentiality to free researchers to perform important research into child sexual abuse.

Certificates of confidentiality: privileging research data

With the Supreme Court's decision in Dobbs, reproductive research now joins other sensitive research topics that present legal risks to research participants, underscoring the role of Certificates in protecting them. Yet, stakeholders question whether Certificates will hold up in court. In this article, we describe the essential arguments supporting Congress's regulation of biomedical research and, thus, Certificates, under its authority to regulate interstate commerce. Our analysis should reassure researchers and Institutional review boards who rely on Certificates to protect the confidentiality of research participants' data. We conclude with recommendations for stakeholders based on our analysis.

Get law enforcement out of biospecimen authentication

Use of D NA markers in research that are used in law enforcement risks undermining public trust and participation.

FAMILIAL SEARCHES, THE FOURTH AMENDMENT, AND GENOMIC CONTROL

In recent years, police have increasingly made use of consumer genomic databases to solve a variety of crimes, from long-cold serial killings to assaults. They do so frequently without judicial oversight per the Fourth Amendment's warrant requirement by using consumer genomic platforms, which store hundreds of thousands or millions of user genomic profiles and enable law enforcement to infer the identity of distant genomic relatives who may be criminal suspects. This Essay puts this practice into context given recent legal and technological developments. As for the law, the Supreme Court in United States v. Carpenter has suggested that technologically driven and expansive datasets may be entitled to the full suite of Fourth Amendment protections. As for technology, we describe here the development of a novel technology that allows users to engage in genomic analysis in a secured environment without making such information available to a third party. Taken together, we present a possible technological solution to ensuring Fourth Amendment protections for direct-to-consumer genomic data.

Regulating forensic genetic genealogy

[Figure: see text].

Legal and ethical implications of wastewater monitoring of SARS-CoV-2 for COVID-19 surveillance

Scientists have observed that molecular markers for COVID-19 can be detected in wastewater of infected communities both during an outbreak and, in some cases, before the first case is confirmed. The Centers for Disease Control and Prevention and other government entities are considering whether to add community surveillance through wastewater monitoring to assist in tracking disease prevalence and guiding public health responses to the COVID-19 pandemic. This scientific breakthrough may lead to many useful potential applications for tracking disease, intensifying testing, initiating social distancing or quarantines, and even lifting restrictions once a cessation of infection is detected and confirmed. Yet, new technologies developed in response to a public health crisis may raise difficult legal and ethical questions about how such technologies may impact both the public health and civil liberties of the population. This paper describes recent scientific evidence regarding COVID-19 detection in wastewater, identifying public health benefits that may result from this breakthrough, as well as the limitations of existing data. The paper then assesses the legal and ethical implications of implementing policy based on positive sewage signals. It concludes that the first step to implementing legal and ethical wastewater monitoring is to develop scientific understanding. Even if reliability and efficacy are established, limits on sample and data collection, use, and sharing must also be considered to prevent undermining privacy and autonomy in order to implement these public health strategies consistent with legal and ethical considerations.

Mass surveillance in the age of COVID-19

Epidemiological surveillance programs such as digital contact tracing have been touted as a silver bullet that will free the American public from the strictures of social distancing, enabling a return to school, work, and socializing. This Article assesses whether and under what circumstances the United States ought to embrace such programs. Part I analyzes the constitutionality of programs like digital contact tracing, arguing that the Fourth Amendment's protection against unreasonable searches and seizures may well regulate the use of location data for epidemiological purposes, but that the legislative and executive branches have significant latitude to develop these programs within the broad constraints of the ``special needs'' doctrine elaborated by the courts in parallel circumstances. Part II cautions that the absence of a firm warrant requirement for digital contact tracing should not serve as a green light for unregulated and mass digital location tracking. In light of substantial risks to privacy, policy makers must ask hard questions about efficacy and the comparative advantages of location tracking versus more traditional means of controlling epidemic contagions, take seriously threats to privacy, tailor programs parsimoniously, establish clear metrics for determining success, and set clear plans for decommissioning surveillance programs.

Abstract P6-07-01: Development of a Prosigna® (PAM50)-based classifier for the selection of advanced triple negative breast cancer (TNBC) patients for treatment with enzalutamide

Background: Enzalutamide is an orally administered androgen receptor (AR) inhibitor approved by the FDA for use in men with metastatic castrate-resistant prostate cancer. A recent phase II study of enzalutamide in patients with advanced, AR positive, TNBC (NCT01889238) demonstrated significant improvements in both PFS and OS for patients whose tumors exhibited a gene expression (Gx) profile enriched in AR signaling and luminal biology. A PAM50-based signature was developed from the phase 2 study which used next generation RNA sequencing (NGS) to identify patients likely to respond to enzalutamide. We transitioned the test to the NanoString (NS) nCounter® Analysis System using Prosigna reagents to support clinical validation in a phase 3 trial. Here we describe the development and analytical performance of the NanoString Androgen Gene Expression Profiling Assay-1 (NS-AR-01). Methods: The NS-AR-01 algorithm coefficients were calibrated from the Predict AR algorithm by testing FFPE tumor tissue from patients who were pre-screened but not enrolled in the phase II study with both platforms (NGS and NS). Three unique algorithms were developed and subsequently challenged with an independent sample set with NGS data to provide an unbiased evaluation of the concordance of the platforms. A pre-specified clinical accuracy verification study was performed through prediction of NS-AR-01 scores from the NGS Gx data from the patients included in the phase 2 study efficacy analysis. The final NS-AR-01 algorithm was selected based on performance in the clinical accuracy verification. The final NS-AR-01 algorithm was evaluated in the 118 patients included in the ITT analysis, as well as those treated with 0-1 lines of prior therapy. The analytical performance of the assay was characterized by testing precision from RNA, reproducibility from FFPE tissue, sensitivity to RNA input amounts, and the impact of common interferents. Results: All three algorithm translations met the pre-specified clinical accuracy verification acceptance criteria. The final NS-AR-01 algorithm generated a hazard ratio most similar to that observed from the NGS algorithm. The total standard deviation when testing multiple FFPE sections from the same block was < 1.5% of the score range with an empirical concordance rate of 100% for biomarker status. The range of RNA input specified for Prosigna was successfully verified for NS-AR-01 (125ng–500ng total RNA). The assay was demonstrated to be robust to common interferents including non-tumor tissue. Conclusions: Based on these results, NS-AR-01 is an accurate, precise, and robust assay for the identification of advanced TNBC patients who may respond to treatment with enzalutamide. The assay is well suited to clinical applications, and its ability to identify responders to enzalutamide will be evaluated in future investigational studies.Background: Enzalutamide is an orally administered androgen receptor (AR) inhibitor approved by the FDA for use in men with metastatic castrate-resistant prostate cancer. A recent phase II study of enzalutamide in patients with advanced, AR positive, TNBC (NCT01889238) demonstrated significant improvements in both PFS and OS for patients whose tumors exhibited a gene expression (Gx) profile enriched in AR signaling and luminal biology. A PAM50-based signature was developed from the phase 2 study which used next generation RNA sequencing (NGS) to identify patients likely to respond to enzalutamide. We transitioned the test to the NanoString (NS) nCounter® Analysis System using Prosigna reagents to support clinical validation in a phase 3 trial. Here we describe the development and analytical performance of the NanoString Androgen Gene Expression Profiling Assay-1 (NS-AR-01). Methods: The NS-AR-01 algorithm coefficients were calibrated from the Predict AR algorithm by testing FFPE tumor tissue from patients who were pre-screened but not enrolled in the phase II study with both platforms (NGS and NS). Three unique algorithms were developed and subsequently challenged with an independent sample set with NGS data to provide an unbiased evaluation of the concordance of the platforms. A pre-specified clinical accuracy verification study was performed through prediction of NS-AR-01 scores from the NGS Gx data from the patients included in the phase 2 study efficacy analysis. The final NS-AR-01 algorithm was selected based on performance in the clinical accuracy verification. The final NS-AR-01 algorithm was evaluated in the 118 patients included in the ITT analysis, as well as those treated with 0-1 lines of prior therapy. The analytical performance of the assay was characterized by testing precision from RNA, reproducibility from FFPE tissue, sensitivity to RNA input amounts, and the impact of common interferents. Results: All three algorithm translations met the pre-specified clinical accuracy verification acceptance criteria. The final NS-AR-01 algorithm generated a hazard ratio most similar to that observed from the NGS algorithm. The total standard deviation when testing multiple FFPE sections from the same block was < 1.5% of the score range with an empirical concordance rate of 100% for biomarker status. The range of RNA input specified for Prosigna was successfully verified for NS-AR-01 (125ng–500ng total RNA). The assay was demonstrated to be robust to common interferents including non-tumor tissue. Conclusions: Based on these results, NS-AR-01 is an accurate, precise, and robust assay for the identification of advanced TNBC patients who may respond to treatment with enzalutamide. The assay is well suited to clinical applications, and its ability to identify responders to enzalutamide will be evaluated in future investigational studies.

Citation Format: Danaher P, Skewis L, Mashadi-Hossein A, Ram N, Gowen-MacDonald J, Harris E, Ferree S, Buckingham W. Development of a Prosigna® (PAM50)-based classifier for the selection of advanced triple negative breast cancer (TNBC) patients for treatment with enzalutamide [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-07-01.

Medicinal chemistry of antiviral/anticancer prodrugs subjected to phosphate conjugation

Certain xenobiotics are given in the "prodrug" form. Either the human body, or one compartment of the body, or the targeted virus itself metabolizes the prodrug into its active form. The bioprecursor form of drugs is used for a wide variety of reasons, namely: to make drug penetration into the target organ (mainly to the brain through the blood-brain-barrier) possible, eliminate unpleasant taste, alter (either increasing or decreasing) the half life of the active component or supply more than one active components to the body.

Eligibility of Cryopreserved Human Embryos for Stem Cell Research in Canada

OBJECTIVE

To determine whether cryopreserved embryos in Canadian in vitro fertilization (IVF) clinics available (in theory) for research use are actually eligible (in practice) for stem cell research in accordance with the Assisted Human Reproduction Act, the Canadian Institutes of Health Research's Human Pluripotent Stem Cell Research: Guidelines for CIHR-Funded Research, and the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans.

METHODS

Copies of current and past patient information sheets and consent forms for embryo cryopreservation, the future disposition of cryopreserved embryos, and the donation of cryopreserved embryos for research were requested from Canadian IVF clinics. Fourteen of 24 clinics (response rate 58%) provided one or more of the requested documents.

RESULTS

A review of the documents currently in use showed that, as of May 2005, all 14 responding clinics require an advance directive for the eventual disposition of cryopreserved embryos. Ten of these 14 clinics allow the donation of cryopreserved embryos for research. Only three of these 10 clinics, however, satisfy in writing the disclosure requirements for embryo research at the time of initial consent for the cryopreservation and future disposition of embryos. Only one clinic specifically identifies the option of embryonic stem cell research.

CONCLUSION

Only three of the responding Canadian IVF clinics provide written details about future donation of cryopreserved embryos for research use and about the need for re-contact in accordance with relevant legislation and guidelines. Two of these three clinics, however, include disposition options that may not be legally available. In the event of death or loss of contact, it will not be possible to get project-specific research consent from the legitimate embryo providers as required by law. These same two clinics also fail to mention embryonic stem cell research as one of the research categories. It follows that we have identified only one Canadian IVF clinic with cryopreserved embryos unequivocally eligible for stem cell research, provided the forms we reviewed were used to obtain consent for the cryopreservation of those embryos.

Cryopreserved Human Embryos in Canada and Their Availability for Research

OBJECTIVE

To determine the number of cryopreserved human embryos at all Canadian in vitro fertilization (IVF) clinics, the number of these embryos that have been donated to research, and the consent processes regarding the disposition of embryos no longer required for reproductive purposes.

METHODS

A questionnaire was mailed to 24 fertility clinics identified as conducting IVF and cryopreservation, inviting completion of the questionnaire by telephone. Thirteen clinics (response rate 54%) completed the survey.

RESULTS

As of August 2003, all 13 clinics cryopreserve embryos not required for intrauterine transfer; in total, 15,615 embryos are currently in storage in these clinics. Nine clinics specifically offer patients the option of donating embryos to research; in total, 299 embryos have been allocated for research, about 2% of all embryos stored by these 13 clinics. All 9 clinics routinely seek consent for research use of embryos, with 7 clinics currently using such embryos for research to improve clinic practices.

CONCLUSION

The results highlight the difficulties of gathering accurate data on assisted human reproduction and related research in a context where there is no legislation governing these practices. Nonetheless, the data suggest there are very few cryopreserved embryos in Canada available for research and that even fewer of these may be potentially eligible for research due to incomplete or inadequate consent processes.

Molecular phylogeny of mangroves. VI. Intraspecific genetic variation in mangrove species Excoecaria agallocha L. (Euphorbiaceae)

Genomic DNA from 84 individuals of Excoecaria agallocha from seven mangrove populations were analysed for random amplified polymorphic DNAs (RAPDs) using 16 random 10-mer primers. Polymorphism within populations varied from 20% to 31%. At the interpopulation level, 111/149 (74%) of RAPDs were polymorphic. Restriction fragment length polymorphism (RFLP) analysis of 21 individuals (3 individuals randomly selected from the 7 populations) using 30 probe-enzyme combinations revealed a high level of interpopulation polymorphism (62.2%) indicating interpopulation genetic divergence. The polymorphic RAPDs and RFLPs were pooled, and clustering was carried out based on mean similarity for individual populations. The dendrogram showed groupings of populations from the West and East Coasts of India into separate clusters, at 60% similarity level. Further, RAPD and RFLP analysis of male and female plants showed approximately the same level of variation in both sexes, and no sex-linked markers were found. These results demonstrate that considerable intrapopulation and interpopulation genetic variations exist in E. agallocha, and that lack of genetic variation is not the reason for the morphological uniformity observed across the range of the species.

A 65-kDa protein mediates the positive role of heme in regulating the transcription of CYP2B1/B2 gene in rat liver

Heme deficiency precipitated by CoCl2 administration to rats leads to a striking decrease in the inducibility of CYP2B1/B2 mRNA levels and its transcription by phenobarbitone (PB), besides decreasing the basal levels. Exogenous hemin administration counteracts the effects of CoCl2 administration. The binding of nuclear proteins to labeled positive cis-acting element (-69 to -98 nucleotides) in the near 5'-upstream region of the gene is inhibited by CoCl2 administration to saline or PB-treated rats, as assessed in gel shift assays. Administration of exogenous hemin to the animal or addition in vitro to the extracts is able to overcome the effects of CoCl2 treatment. The protein mediating this effect has been purified from CoCl2 administered nuclear extracts by heparin-agarose, positive element oligonucleotide affinity, and heme affinity column chromatography. This 65-kDa protein manifests very little binding to the positive element, but in the presence of certain other nuclear proteins, shows a strong heme-responsive binding. The purified protein binds heme. It is also able to stimulate transcription of a minigene construct of the CYP2B1/B2 gene containing -179 nucleotides of the 5'-upstream region and the I exon in a cell-free system, manifesting heme response. It is concluded that the 65-kDa protein mediates the constitutive requirement of heme for the transcription of CYP2B1/B2 gene.

Involvement of synthesis and phosphorylation of nuclear protein factors that bind to the positive cis-acting element in the transcriptional activation of the CYP2B1/B2 gene by phenobarbitone in vivo

The synthesis and phosphorylation of protein factor(s) that bind to the positive cis-acting element (-69 to -98 nt) of the CYP2B1/B2 gene have been examined in vivo in the rat. Treatment of rats with cycloheximide, a protein synthetic inhibitor, suppresses basal as well as phenobarbitone-induced levels of CYP2B1/B2 mRNA and its run-on transcription. Under these conditions, complex formation of the nuclear extract with the positive element is also inhibited, as judged by gel shift assays. Treatment of rats with 2-aminopurine, a general protein kinase inhibitor, blocks the phenobarbitone-mediated increase in CYP2B1/B2 mRNA, cell-free transcription of a minigene construct containing the positive element, pP450e179DNA, and binding of nuclear proteins to the positive element. Treatment of rats with okadaic acid, a protein phosphatase inhibitor, mimics the effects of phenobarbitone, but only partially. Thus, both phenobarbitone and okadaic acid individually enhance binding of the nuclear protein(s) to the positive element, cell-free transcription of the minigene construct, and phosphorylation of the approximately 26- and 94-kDa proteins binding to the positive element. But unlike phenobarbitone, okadaic acid is not an inducer of CYP2B1/B2 mRNA or its run-on transcription. Thus, phenobarbitone-responsive positive element interactions constitute only a minimal requirement, and okadaic acid is perhaps not able to bring about the total requirement for activation of CYP2B1/B2 gene transcription that should include interaction between the minimal promoter and further upstream elements. An intriguing feature is the antagonistic effect of okadaic acid on phenobarbitone-mediated effects on CYP21B1/B2 mRNA levels, cell-free and run-on transcription, and nuclear protein binding to the positive element. The reason for this antagonism is not clear. It is concluded that phenobarbitone treatment enhances in vivo the synthesis and phosphorylation of protein factors binding to the positive element and these constitute a minimal requirement for the transcriptional activation of the CYP2B1/B2 gene.

A model for the transcriptional regulation of the CYP2B1/B2 gene in rat liver

The phenobarbitone-responsive minimal promoter has been shown to lie between nt -179 and nt + 1 in the 5' (upstream) region of the CYP2B1/B2 gene in rat liver, on the basis of the drug responsiveness of the sequence linked to human growth hormone gene as reporter and targeted to liver as an asialoglycoprotein-DNA complex in vivo. Competition analyses of the nuclear protein-DNA complexes formed in gel shift assays with the positive (nt -69 to -98) and negative (nt -126 to -160) cis elements (PE and NE, respectively) identified within this region earlier indicate that the same protein may be binding to both the elements. The protein species purified on PE and NE affinity columns appear to be identical based on SDS/PAGE analysis, where it migrates as a protein of 26-28 kDa. Traces of a high molecular weight protein (94-100 kDa) are also seen in the preparation obtained after one round of affinity chromatography. The purified protein stimulates transcription of a minigene construct containing the 179 nt on the 5' side of the CYP2B1/B2 gene linked to the I exon in a cell-free system from liver nuclei. The purified protein can give rise to all the three complexes (I, II, and III) with the PE, just as the crude nuclear extract, under appropriate conditions. Manipulations in vitro indicate that the NE has a significantly higher affinity for the dephosphorylated form than for the phosphorylated form of the protein. The PE binds both forms. Phenobarbitone treatment of the animal leads to a significant increase in the phosphorylation of the 26- to 28-kDa and 94-kDa proteins in nuclear labeling experiments followed by isolation on a PE affinity column. We propose that the protein binding predominantly to the NE in the dephosphorylated state characterizes the basal level of transcription of the CYP2B1/B2 gene. Phenobarbitone treatment leads to phosphorylation of the protein, shifting the equilibrium toward binding to the PE. This can promote interaction with an upstream enhancer through other proteins such as the 94-kDa protein and leads to a significant activation of transcription.

Characterization of a negative cis-acting DNA element regulating the transcription of CYP2B1/B2 gene in rat liver

The region -160 to -127 nt of the upstream of CYP2B1/B2 gene has been found to function as a negative cis-acting element on the basis of DNase-I footprint and gel mobility shift assays as well as cell-free transcriptional assays using Bal-31 mutants. A reciprocal relationship in the interaction of the negative and the recently characterized positive elements with their respective protein factors has been found under repressed and induced conditions of the gene. The negative element also harbors the core glucocorticoid responsive sequence, TGTCCT. It is concluded that the negative element mediates the repressed state of the gene under the uninduced condition and also mediates the repressive effect of dexamethasone, when given along with the inducer phenobarbitone in rats. Dexamethasone is able to antagonize the effects of phenobarbitone at as low a concentration as 100 micrograms/kg body wt in these animals.

Does milk have a cataractogenic effect? Weighing of clinical evidence

We undertook a prospective study to test Simoons' hypothesis that in certain susceptible races milk exerts a cataractogenic effect. Overall milk intake in low lactase deficiency areas did not correlate with cataract occurrence. Subgrouping of cataract patients revealed that greater milk intake did show positive correlation with cortical cataracts. Cortical cataracts were also markedly more common in females. Analysis of data from three different regions showed greater milk intake in cortical cataract patients only. Our data indicate the importance of specifying cataract type in cataract studies and highlight the problem this approach brings forth. We noted no different trends in subjects from northwest and southeast India, although the number of subjects from the southeast was considerably less. Patients with early cortical cataracts may be advised to restrict milk intake.

The effects of propranolol HCl in hippocampal-lesioned rats

Experiments were conducted to determine the effects of propranolol administration in rats lesioned in the hippocampal area. Chronic oral administration of propranolol to intact rats produced a significant decrease in mean systolic blood pressure. No significant changes in blood pressure were produced with propranolol treatment in rats lesioned in the septal or anterior hypothalamic areas, whereas, in rats lesioned in the hippocampal area, a significant elevation of blood pressure was observed. These findings confirm previous results that suggest that the hypotensive effects observed with chronic propranolol administration are mediated via the hippocampus.

Cardiovascular effects of 5-hydroxypropranolol (ORF 12592) in dogs

ORF 12592, the 5-hydroxy analog of propranolol, produced reductions in mean arterial pressure, heart rate, cardiac contractility and hind limb perfusion pressure in the anesthetized normotensive dog. Blood pressure and heart rate were also lowered in the carotid-sinus denervated dog. ORF 12592 blocked heart rate and blood pressure responses induced by isoproterenol. Similar results were observed with propranolol administration except for a transient decrease in blood pressure in the mormotensive dog. These results indicate that ORF 12592 possesses antihypertensive and beta-blocking properties in the anesthetized dog.

Centrally induced hypotensive effects of beta-adrenergic blocking drugs

The mechanism of the antihypertensive effects of propranolol, pindolol and sotalol were investigated using chloralose-anesthetized cats and dogs. When administered i.v. into a carotid or vertebral artery, propranolol was readily taken up by several brain areas. Highest drug concentrations were detected in the hypothalamus and its projection areas and low concentrations in the cerebral cortex and peripheral tissues. Discrete drug administration at several brain sites decreased efferent sympathetic but increased efferent parasympathetic nerve activity. These neural changes were associated with reductions in both blood pressure and heart rate. Hippocampal propranolol administration induced the greatest neural and cardiovascular changes. Significant concurrent reductions in blood pressure, heart rate and cardiac contractile force occurred following propranolol (500 mug) administration into the hippocampus and pindolol (80 mug) administration into the septum. Sotalo injections at various brain sites failed to influence the cardiovascular system. The centrally induced cardiovascular and neural changes induced by both propranolol and pindolol were prevented by pretreatment with hexamethonium. These results suggest that the hypotensive effects of both propranolol and pindolol may be related to a reduction in the level of central autonomic control resulting in decreased levels of blood pressure, heart rate and cardiac contractile force.

Comparative antihypertensive effects and tissue distribution of beta adrenergic blocking drugs

The precise mechanism of the antihypertensive action of beta adrenergic blocking drugs is not known. Both peripheral and central sites of action have been proposed. The comparative antihypertensive actions and tissue distribution of propranolol, pindolol and sotalol were investigated in both normotensive Sprague-Dawley and spontaneously hypertensive rats. From recordings of concurrent changes in blood pressure and heart rate it was observed that oral or subcutaneous administrations of both propranolol and pindolol, but not sotalol, consistently reduced blood pressure and heart rate. Tissue distribution of all three agents was determined after 14 days of treatment. Propranolol and a metabolite were concentrated in the hippocampus whereas pindolol was concentrated in the septum. Significant central concentrations of sotalol were not demonstrable. All three agents produced persistent peripheral beta adrenergic blockade. It is concluded that beta adrenergic blockade may not be the important mechanism of the antihypertensive action of beta adrenergic blocking drugs. A modification of central autonomic control mechanisms is proposed as a possible mechanism of action.