Xevinapant combined with pembrolizumab in patients with advanced, pretreated colorectal and pancreatic cancer: results of the phase 1b/2 CATRIPCA trial

PURPOSE

Xevinapant is an orally available inhibitor of apoptosis proteins (IAP) inhibitor. Preclinical data suggest that IAP antagonism may synergize with immune checkpoint blockers (ICB) by modulating the NF-KB pathway in immune cells.

PATIENTS AND METHODS

Adult patients (pts) with non MSI-H advanced/metastatic PDAC or CRC were enrolled in this phase 1b/2 and received pembrolizumab 200mg q3w, IV and ascending doses of oral xevinapant (100, 150 and 200mg daily for 14 days on/7 days off). Dose escalation followed a 3+3 design with a 21-day dose-limiting toxicity (DLT) evaluation period. Following the determination of the recommended phase II dose (RP2D), 14 patients with PDAC and 14 patients with CRC were enrolled in expansion cohorts to assess preliminary efficacy.

RESULTS

Forty-one pts (26 males) with a median age of 64 years were enrolled: 13 in the dose escalation and 28 in the two expansion cohorts. No DLT was observed during dose-escalation. The RP2D was identified as xevinapant 200mg/d + pembrolizumab 200mg q3w. The most common adverse events (AE) were fatigue (37%), gastrointestinal AE (decreased appetite in 37%, nausea in 24%, stomatitis in 12 % and diarrhea and vomiting in 10% each), and cutaneous AE (pruritus, dry skin and rash seen in 20, 15 and 15% of patients respectively). The best overall response according to RECIST1.1 was partial response (PR, confirmed) in one (3%) , stable disease (SD) in four (10%) and progressive disease in 35 (88%).

CONCLUSIONS

Xevinapant combined with pembrolizumab was well tolerated with no unexpected adverse events. However, anti-tumor activity was low.

Epstein-Barr Virus Orchestrates Spatial Reorganization and Immunomodulation within the Classic Hodgkin Lymphoma Tumor Microenvironment

Classic Hodgkin Lymphoma (cHL) is a tumor composed of rare malignant Hodgkin and Reed-Sternberg (HRS) cells nested within a T-cell rich inflammatory immune infiltrate. cHL is associated with Epstein-Barr Virus (EBV) in 25% of cases. The specific contributions of EBV to the pathogenesis of cHL remain largely unknown, in part due to technical barriers in dissecting the tumor microenvironment (TME) in high detail. Herein, we applied multiplexed ion beam imaging (MIBI) spatial pro-teomics on 6 EBV-positive and 14 EBV-negative cHL samples. We identify key TME features that distinguish between EBV-positive and EBV-negative cHL, including the relative predominance of memory CD8 T cells and increased T-cell dysfunction as a function of spatial proximity to HRS cells. Building upon a larger multi-institutional cohort of 22 EBV-positive and 24 EBV-negative cHL samples, we orthogonally validated our findings through a spatial multi-omics approach, coupling whole transcriptome capture with antibody-defined cell types for tu-mor and T-cell populations within the cHL TME. We delineate contrasting transcriptomic immunological signatures between EBV-positive and EBV-negative cases that differently impact HRS cell proliferation, tumor-immune interactions, and mecha-nisms of T-cell dysregulation and dysfunction. Our multi-modal framework enabled a comprehensive dissection of EBV-linked reorganization and immune evasion within the cHL TME, and highlighted the need to elucidate the cellular and molecular fac-tors of virus-associated tumors, with potential for targeted therapeutic strategies.

Construction of an active humidity regulation setup for NMR/MRI-Observation and simulation of the controlled evaporation of sessile water droplets

Controlling and improving processes like for example the production of organic semiconductors via printing depends on understanding the interplay of wetting and evaporation of complex fluids. Therefore, examination of the time dependent composition of complex fluid droplets during wetting or evaporation is of interest. The evaporation rate of sessile droplets containing largely water depends on the vapor pressures of the individual components and on the humidity (or partial pressure) of the surrounding gas phase. Hence, for a complete picture of an evaporation process and the comparability of the results of different measurements, it is essential to measure and control the humidity and temperature in the measurement compartment. Accordingly, climate chambers are available in different scales to fit a variety of techniques like contact angle goniometry to obtain results in a controlled atmosphere. We recently reported the application of MRI (Magnetic Resonance Imaging) and spatially resolved NMR (Nuclear Magnetic Resonance) spectroscopy for the examination of the evaporation of sessile droplets on surfaces in 10 mm NMR tubes. These are considered to be closed compartments. Here, we present an apparatus to a) measure and b) control the relative humidity within the sample compartment of the NMR setup by introducing preconditioned gas into the NMR tube. We monitored the evaporation of water droplets using RARE images and compared the volume decay with a) a simple diffusive evaporation model and b) with detailed FEM (finite element numerical model) simulations using COMSOL for validation. We find three evaporation regimes depending on the flow rate as well as on the distance of the gas outlet and the evaporating droplet. In one of the sample configurations tested the evaporation takes place in such a way that it can be described with the help of the simple diffusive model without convection. Thus, the presented approach opens comparative measurements with other methods as well as the observation of droplet evaporation in very dry or very humid environments with and without the influence of convection. Finally, using PRESS spectra, it is shown that the evaporation rate of water from a water/DMSO droplet can be controlled. This shows how the setup presented here can be used to study the evaporation of droplets of more complex mixtures.

Bubble growth analysis during subcooled boiling experiments on-board the international space station: Benchmark image analysis

This work compares four different image processing algorithms for the analysis of image data obtained during the Multiscale Boiling Experiment of ESA, executed on-board the International Space Station. Two separate experimental campaigns have been performed in 2019 and 2020, aiming to investigate boiling phenomena in microgravity, with and without the presence of shear flow and electric field. A heated substrate, at the bottom of the test cell, creates a temperature profile across the liquid bulk above it. A laser beam hits a designated microcavity at the middle of the substrate, to initiate nucleation of a single, isolated bubble. In the presence of shear flow or electric field forces, the bubble slides or detaches respectively, leaving the cavity free for the nucleation and growth of a new bubble. The growth of such a bubble within the prescribed temperature profile is studied for varying experimental conditions (i.e. pressure, heat flux, subcooling temperature) by capturing high speed, black and white video images. The presence of light reflections at random locations around the bubble contour vary with bubble size and population. This, combined with the refraction induced optical distortion of vertical image dimension close to the heater, make the accurate detection of bubbles contour a real challenge. Four research teams, namely the University of Pisa (UNIPI), the Institute of Fluid Mechanics of Toulouse (IMFT), the joint group of Aix Marseille University (AMU) and Kutateladze Institute of Thermophysics (IT), and the joined group of Aristotle University of Thessaloniki (AUTH), Technical University of Darmstadt (TUD) and Foundation of Research and Technology in Crete (FORTH), developed separate specialized algorithms to: a) detect bubble edges and b) use these edges to calculate basic bubble geometrical features, such as contact line diameter, bubble diameter and contact angles. These four different approaches diverge in complexity and concept. In the absence of reference measurements at microgravity conditions, measurements efficiency is evaluated based on the comparison of the estimated bubble geometrical features along with pertinent physical arguments. Results show that the efficiency of each approach varies with the nature of measurement. The studied benchmark dataset is published allowing other research groups to test further their own image processing algorithms.

The protective effect of anterior cruciate ligament reconstruction on articular cartilage: a systematic review of animal studies

OBJECTIVE

It is unclear if anterior cruciate ligament (ACL) reconstruction can prevent the onset of degenerative changes in the knee. Previous studies were inconclusive on this subject. The aim of this study was to systematically review all studies on the effect of ACL reconstruction on articular cartilage in animals.

DESIGN

Pubmed and Embase were searched to identify all original articles concerning the effect of ACL reconstruction on articular cartilage compared with both its positive (ACL transection) and negative (sham and/or non-operated) control in animals. Subsequently a Risk of bias and meta analysis was conducted based on five outcomes (gross macroscopic assessment, medical imaging, histological histochemical grading, histomophometrics and biomechanical characterization) related to articular cartilage.

RESULTS

From the 19 included studies, 29 independent comparisons could be identified which underwent ACL reconstruction with an average timing of data collection of 23 weeks (range 1-104 weeks). Due to limited data availability meta-analysis could only be conducted for gross macroscopic damage. ACL reconstruction caused significant gross macroscopic damage compared with intact controls (SMD 2.0 [0.88; 3.13]). These findings were supported by individual studies reporting on histomorphometrics, histology and imaging. No significant gross macroscopic damage was found when ACL reconstruction was compared with ACL transection (SMD -0.64 [-1.85; 0.57]).

CONCLUSION

This systematic review with an average follow up of included studies of 23 weeks (range 1-104 weeks) demonstrates that, in animals, ACL reconstruction does not protect articular cartilage from degenerative changes. The consistency of the direction of effect, provides some reassurance that the direction of effect in humans might be the same.

Polypharmacy in psychiatric inpatients: Data from amsp (arzneimittelsicherheit in der psychiatrie), a european pharmacovigilance system

Introduction

Psychotropic polypharmacy is widely used in routine clinical practice although there is still a substantial deficit in established knowledge about combination and augmentation treatments. Polypharmacy is related with a higher risk of adverse drug reactions and incompliance.

Methods

On two reference days per hospital and per year, the following data are recorded for all patients on the wards under AMSP surveillance: all drugs applied on that day with the daily dosage for psychotropic drugs, ICD diagnosis, age, and sex. Data is stored at the study center in Munich. We evaluated data from 2000 (N = 5669) and 2007 (N = 8346).

Results

From 2000 to 2007 inpatient prescriptions including three or more drugs increased significantly from 59.4% to 69.3% (chi2: 144.913; df:1; p < 0.001). Furthermore the percentage of inpatients being prescribed three or more psychotropics increased significantly from 36.5% in 2000 to 47.97% in 2007 (chi2: 180.01; df:1; p < 0.001).

Investigating further, which inpatients, diagnosed according to ICD-10, tend to be treated with more than two psychotropics, we found that this was more common in inpatients, who had an F2., F3. or F9. ICD-10 diagnosis. Especially inpatients with a bipolar disorder (F31.) showed an extremely high rate for psychotropic polypharmacy with three or more psychotropic drugs, with rates of 63,8% in 2000 and 75,2% in 2007.

Conclusion

Polypharmacy is still gaining ground. Our results show that psychotropic agents are commonly used in combination; therefore further studies evaluating assumable positive results of psychotropic combinations are needed.

Experimental Investigation of Micro-Scale Heat Transfer at an Evaporating Moving 3-Phase Contact Line

An experimental study is conducted to investigate the micro-scale heat transfer at an evaporating moving 3-phase contact line. The moving evaporating meniscus is formed by pushing or sucking a liquid column of HFE7100 in a vertical channel of 600 μm width using a syringe pump. The gas atmosphere is pure HFE7100 vapor. This channel is built using two parallel flat plates. A 10 μm thick stainless steel heating foil forms a part of one of the flat plates. Two-dimensional micro-scale temperature field at the back side of the heating foil is observed with a high speed infrared camera with a spatial resolution of 14.8 μm × 14.8 μm and an in-situ calibration procedure is used at each pixel element. A high speed CMOS camera is used to capture the shape of the moving meniscus, the images are post-processed to track the free surface of the meniscus. Local heat fluxes from the heater to the evaporating meniscus are calculated from the measured transient wall temperature distributions using an energy balance for each pixel element. In the vicinity of the 3-phase contact line the heat flux distribution shows a local maximum due to high evaporation rates at this small region. The local maximum heat flux at the 3-phase contact line area is found to be dependent on the input heat flux, the velocity and the direction of the meniscus movement. The results give detailed insight into the specific dynamic micro-scale heat and fluid transport process.

[Mortality in past centuries]

"Mortality and life expectancy over a time period of 300 years were studied for a relatively large village population [in Germany]. From synchronous and diachronous comparisons of the data concerning different social classes of this village (subdivided according to their sex and age, social rank, number of children/family and birth rank, registration of orphans, half-orphans, illegitimate children as well as progeny of old parents and children with a high inbreeding degree, and interpretation of causes of death) significant differences in mortality were deduced." (SUMMARY IN ENG)

Factorial structure of the 20-item Toronto Alexithymia Scale: confirmatory factorial analyses in nonclinical and clinical samples

OBJECTIVE

The 20-item Toronto Alexithymia Scale (TAS-20) measures three intercorrelated dimensions of alexithymia: (1) difficulties identifying feelings (DIF), (2) difficulties describing feelings (DDF), and (3) externally oriented thinking (EOT). The aim of the study was to test the three-factor model of the TAS-20 using confirmatory factorial analyses (CFA).

METHOD

769 healthy subjects and 659 patients meeting the DSM-IV criteria for substance use disorders or eating disorders completed the TAS-20. The correlation matrices for each of the samples were analyzed with LISREL 7.16.

RESULTS

In each sample, the three-factor model was found to be replicable.

CONCLUSION

The three TAS-20 subcales can be used to explore the distinct facets of the alexithymia construct.

Evaluation of erythropoietic activity on the basis of the red cell and reticulocyte distribution widths during epoetin beta therapy in patients undergoing cardiac surgery

The changes in the red cell and reticulocyte distribution widths during preoperative treatment with recombinant human erythropoietin (rhEPO) were evaluated in a double-blind, placebo-controlled trial in cardiac surgery patients. The increases in the reticulocyte count, in the hemoglobin and in all distribution widths are the expression of the marked preoperative stimulation of erythropoiesis in the patients treated with rhEPO. Only placebo patients with a hemoglobin < or = 7.5 mmol/l or a transferrin > 4.0 g/l at baseline showed an increase in the red cell distribution width or in the reticulocyte hemoglobin distribution width on oral iron therapy alone. While the reticulocyte count and the distribution widths of red cells in the rhEPO patients decreased postoperatively, only the increases in the distribution widths of reticulocytes after the second postoperative day indicate that stimulation oferythropoiesis had taken place. In patients with a low hemoglobin or a high transferrin the rhEPO therapy should be preceded by iron therapy in order to raise the hemoglobin level and reduce the cost of treatment.

Alexithymia and depression in eating disorders

We compared alexithymia and depression ratings for non-hospitalized women meeting DSM-IV criteria for anorexia nervosa (n=32) and bulimia nervosa (n=32) to ratings for healthy women (n=74). Alexithymia was evaluated by the Toronto Alexithymia Scale (TAS-20) and depression by the Hospital Anxiety and Depression Scale (HAD). TAS and HAD scores were significantly higher in anorexic compared to bulimic patients, although these two scales were significantly and positively correlated (r=0.53, P=0.001). After taking depression into account as a confounding variable, rates of alexithymia did not vary according to the type of eating disorder (anorexia or bulimia).

Increased autologous blood donation in rectal cancer by recombinant human erythropoietin (rhEPO)

A randomised, placebo-controlled trial was conducted to study whether the subcutaneous administration of recombinant human erythropoietin (rhEPO) increases the donated red cell blood volume in patients with rectal cancer. Patients with resectable rectal cancer and a haemoglobin (Hb) level > or = 12.5/ > 12 g/dl (males/females) were scheduled to receive pre-operatively either erythropoietin (200 U/kg body weight daily) (n = 28) or placebo (n = 26) subcutaneously for 11 days. During this period autologous blood was collected. No serious adverse events were attributed to erythropoietin. 20 of 28 patients treated with rhEPO were able to donate > or = 3 units (71%) compared with 11 of 26 control patients (42%). The mean cumulative volume of red cells donated was 29% higher in the patients who received rhEPO (571 versus 444 ml, P = 0.02). The change in the mean reticulocyte value from baseline to the last pre-operative value was significantly higher in the rhEPO group (10.4 to 61.6/1000 versus 11.0 to 20.1/1000, P = 0.0001). The fall in the mean haematocrit from baseline to the last pre-operative value was significantly lower in the rhEPO group (41.4 to 37.6% versus 41.8 to 34.8%, P = 0.0004). rhEPO increases the ability of cancer patients to donate autologous blood during a short pre-operative period and enhances the restoration of haematological values after the donation period.

Kinetics of reticulocyte maturity fractions and indices and iron status during therapy with epoetin beta (recombinant human erythropoietin) in cardiac surgery patients

We evaluated the changes in reticulocyte maturity fractions and indices, as measured by flow cytometry, during preoperative treatment with recombinant human erythropoietin (epoetin beta) in cardiac surgery patients. A total of 72 patients was enrolled in this double-blind, randomized, placebo-controlled clinical trial and assigned to the two treatment groups (5 x 500 U/kg bodyweight epoetin beta or placebo intravenously over 14 days preoperatively). Therapy with epoetin beta produced continuous increases in hematocrit/hemoglobin, in the most mature fraction of reticulocytes (LR), and in reticulocyte count. In the first treatment week there were parallel increases in the fraction of most immature reticulocytes (HR) and in the reticulocyte mean cell volume. During the second week of treatment the reticulocyte mean cell hemoglobin content (CHr) decreased, but CHr was independent of all iron parameters, affecting neither the reticulocyte fractions nor the hematocrit/hemoglobin increase. The total preoperative rise in hematocrit correlated with the rises in LR fraction (P = 0.0270) and reticulocyte count (P = 0.0486) during the first week of treatment. Whereas in the epoetin beta patients the preoperative change in HR fraction showed negative correlations with transferrin saturation at baseline (P = 0.0058) and with the preoperative change in iron (P = 0.0113), the preoperative change in the LR fraction correlated positively with transferrin at baseline (P = 0.0115). Postoperatively, the reticulocyte parameters revealed that the onset of increased stimulation of erythropoiesis did not occur in the placebo patients until the second postoperative day, whereas erythropoietic activity in the epoetin beta patients was much higher during the postoperative period as well, as a result of the preoperative stimulation of erythropoiesis. The reticulocyte parameters measured by flow cytometry permitted an objective analysis of erythropoietic activity during treatment with epoetin beta and in all patients postoperatively. Further studies in various types of epoetin beta therapy are needed in order to clarify the value of these reticulocyte parameters for identification of iron deficiency and optimization of epoetin beta treatment regimen.

Dermo-epidermal distribution of ketoconazole in man

The dermo-epidermal distribution of ketoconazole was studied in 50 patients with fungal dermatoses by simultaneously determining drug concentrations in plasma and suction liquid (SL) obtained by dermo-epidermal separation. Fifteen patients were treated with a single 200-mg dose of ketoconazole while the remaining 35 underwent chronic treatment with 200 mg ketoconazole per day. In the single-dose study, ketoconazole SL concentrations determined between 80 and 390 min showed mean peak values of 0.74 +/- 0.53 micrograms/ml at intermediate sampling times of about 180 min. The maximum mean plasma concentration of 2.37 +/- 1.26 micrograms/ml occurred at an intermediate sampling time (141 min) as well. In those patients receiving chronic treatment from 1 to 7 days, the mean plasma and SL concentrations were 1.07 +/- 1.17 micrograms/ml and 0.08 +/- 0.2 micrograms/ml, respectively, while chronic treatment from 15 to 64 days resulted in higher values of 2.22 +/- 1.91 micrograms/ml and 0.56 +/- 0.57 micrograms/ml, respectively. These results suggest that rapid and considerable passive diffusion of ketoconazole could take place during its transfer from the blood to the skin.

[Psychopathologic symptoms in torticollis spasmodicus]

The paper presents the results of detailed diagnosis of 51 patients with torticollis spasmodicus. A discussion of the results would seem to indicate the possibility of there being one group with prior neuroses, one group compulsive in nature, and one group whose diminished performance arises from the condition of the brain. Reliable diagnosis is only possible when both mental and physical parameters have been taken into consideration.

The indirect binding of triose-phosphate isomerase to myofibrils to form a glycolytic enzyme mini-complex

Binding of triose-phosphate isomerase (D-glyceraldehyde-3-phosphate ketol-isomerase, EC 5.3.1.1) to muscle myofibrils depends upon the concurrent binding of either fructose-bisphosphate aldolase (EC 4.1.2.13), glyceraldehyde-3-phosphate dehydrogenase (EC 1.2.1.12) or both of these enzymes together. Thus triose-phosphate isomerase does not bind directly to myofibrils but to glycolytic enzymes already bound to the myofibril. This was established using 125I-labelled enzymes, which are required to provide the necessary sensitivity for the measurement of the complex multiphasic adsorption isotherms. In the presence of aldolase, the most stable stoichiometric relationship is two aldolase bound per triose-phosphate isomerase. The results show that not all sites of aldolase or glyceraldehyde-3-phosphate dehydrogenase binding are available for triose-phosphate isomerase binding. Nevertheless, the results suggest the formation under particular circumstances of a minicomplex spanning the catalysis of fructose 1,6-bisphosphate to 3-phosphoglycerate. Such a complex could provide the physical basis of metabolic channeling in which metabolic intermediates are not released from the complex.

Metabolic dependence of glycolytic enzyme binding in rat and sheep heart

Perfused rat hearts show a markedly increased binding of phosphofructokinase and fructose-bisphosphate aldolase as a consequence of ischaemia, but little change in binding of pyruvate kinase, lactate dehydrogenase or glyceraldehyde-3-phosphate dehydrogenase. After 10 min ischaemia over one quarter of the phosphofructokinase and three quarters of the aldolase are bound. The effect of anoxia is less well marked in its influence on binding with only aldolase showing a significant increase in binding. These results suggest that one factor involved in the increased binding during ischaemia is the fall in pH of the heart. Binding studies with isolated myofibrils confirm that the affinity and stoichiometry of aldolase binding are considerably increased as the pH is lowered over a range comparable to that which occurs in ischaemic heart. The low level of binding of glyceraldehyde-3-phosphate dehydrogenase in perfused rat hearts correlates with the relatively low affinity of this enzyme for binding to rat or rabbit cardiac myofibrils. There are species differences in the enzyme binding response to ischaemia. Sheep hearts show rapid and large increases in the binding of glyceraldehyde-3-phosphate dehydrogenase in addition to changes in aldolase and phosphofructokinase binding. The greater binding of glyceraldehyde-3-phosphate dehydrogenase reflects the greater affinity of sheep cardiac myofibrils. It is suggested that the altered metabolic demands of ischaemia are satisfied by changes in glycolytic enzyme organisation as the enzymes shift from the soluble to the particulate phase of cardiac muscle.

Morphology of horizontal cells in the frog retina

Two types of horizontal cells, H1 and H2, were classified using the Golgi technique on flat mounts of the retina of the frog. Cell type H1 possesses rather short, thick dendrites; the diameter of its dendritic field ranges from 40-90 micrometers. H2-cell displays long and thin dendrites; the diameter of its dendritic field is 70-160 micrometers. H1-cells possess an axon running horizontally within the outer plexiform layer. The axon terminals are slight swellings emitting fine processes that end in the outer plexiform layer. H2-cells do not have a discernible axon.

[Myxoma of the mitral valve in a child. Apropos of an operated case]

The case of an 8 year old child with a symtomless murmur of mitral incompetence is reported. Echocardiography showed the presence of an intracardiac tumour, a mass of dense echos between the two mitral leaflets being recorded; multiscan examination suggested insertion on the anterior mitral leaflet. The tumour and its pedicle were resected, causing some loss of valvular tissue, which required repair with a strip of pericardium. This would appear to be the first reported case of mitral valve myxoma in children. Left atrial myxoma, the commonest cardiac tumour, is rarely observed before 15 years of age; insertion on the mitral valve itself is rare at any age. The site of insertion is determined by quite separate echocardiographic criteria compared to left atrial myxoma. This is important as surgery may sacrifice the mitral valve, and mitral valve replacement may be needed; valvuloplasty should be attempted in this age group, despite the risk of tumour recurrence, which is porbably greater with this unusual location.