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Gao B, Gorgen ARH, Bhatt R, Tano ZE, Morgan KL, Vo K, Zarandi SS, Ali SN, Jiang P, Patel RM, Clayman RV, Landman J. Avoiding "Needless" nephrectomy: What is the role of small renal mass biopsy in 2024? Urol Oncol 2024:S1078-1439(24)00422-8. [PMID: 38643022 DOI: 10.1016/j.urolonc.2024.04.002] [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: 10/24/2023] [Revised: 02/14/2024] [Accepted: 04/01/2024] [Indexed: 04/22/2024]
Abstract
Current guidelines do not mandate routine preoperative renal mass biopsy (RMB) for small renal masses (SRMs), which results in a considerable rate (18%-26%) of needless nephrectomy/partial nephrectomy for benign renal tumors. In light of this ongoing practice, a narrative review was conducted to examine the role of routine RMB for SRM. First, arguments justifying the current non-biopsy approach to SRM are critically reviewed and contested. Second, as a standalone procedure, RMB is critically assessed; RMB was found to have higher sensitivity, specificity, and an equal or lower complication rate when compared with other commonly preoperatively biopsied solid organ tumors (e.g., breast, prostate, lung, pancreas, thyroid, and liver). Based on the foregoing information, we propose a paradigm shift in SRM management, advocating for an updated policy in which partial nephrectomy or nephrectomy for SRM invariably occurs only after a preoperative biopsy confirms that a SRM is indeed malignant.
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Affiliation(s)
- Bruce Gao
- Department of Urology, University of California, Irvine, Orange, CA.
| | | | - Rohit Bhatt
- Department of Urology, University of California, Irvine, Orange, CA
| | - Zachary E Tano
- Department of Urology, University of California, Irvine, Orange, CA
| | - Kalon L Morgan
- Department of Urology, University of California, Irvine, Orange, CA
| | - Kelvin Vo
- Department of Urology, University of California, Irvine, Orange, CA
| | | | - Sohrab N Ali
- Department of Urology, University of California, Irvine, Orange, CA
| | - Pengbo Jiang
- Department of Urology, University of California, Irvine, Orange, CA
| | - Roshan M Patel
- Department of Urology, University of California, Irvine, Orange, CA
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, Orange, CA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, CA
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2
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Lavasani SAM, Rojhani A, Cumpanas AD, Osann K, Morgan KL, Hernandez MC, McCormac A, Piedras P, Vo K, Gorgen ARH, Sharifi SHH, Gao BM, Tano ZE, Patel RM, Landman J, Clayman RV. Surgical Force: Initial Study and Clinical Implications in the Assessment of Ureteral Access Sheath Induced Injury. J Endourol 2024; 38:316-322. [PMID: 38243836 DOI: 10.1089/end.2023.0548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024] Open
Abstract
Purpose: Ureteral access sheaths (UAS) pose the risk of severe ureteral injury. Our prior studies revealed forces ≤6 Newtons (N) prevent ureteral injury. Accordingly, we sought to define the force urologists and residents in training typically use when placing a UAS. Materials and Methods: Among urologists and urology residents attending two annual urological conferences in 2022, 121 individuals were recruited for the study. Participants inserted 12F, 14F, and 16F UAS into a male genitourinary model containing a concealed force sensor; they also provided demographic information. Analysis was completed using t-tests and Chi-square tests to identify group differences when passing a 16F sheath UAS. Participant traits associated with surpassing or remaining below a minimal force threshold were also explored through polychotomous logistic regression. Results: Participant force distributions were as follows: ≤4N (29%), >6N (45%), and >8N (32%). More years of practice were significantly associated with exerting >6N relative to forces between 4N and 6N; results for >8N relative to 4N and 8N were similar. Compared to high-volume ureteroscopists (those performing >20 ureteroscopies/month), physicians performing ≤20 ureteroscopies/month were significantly less likely to exert forces ≤4N (p = 0.017 and p = 0.041). Of those surpassing 6N and 8N, 15% and 18%, respectively, were high-volume ureteroscopists. Conclusions: Despite years of practice or volume of monthly ureteroscopic cases performed, most urologists failed to pass 16F access sheaths within the ideal range of 4N to 6N (74% of participants) or within a predefined safe range of 4N to 8N (61% of participants).
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Affiliation(s)
| | - Allen Rojhani
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Andrei D Cumpanas
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Kathryn Osann
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, Irvine, California, USA
| | - Kalon L Morgan
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Mariah C Hernandez
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Amanda McCormac
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Paul Piedras
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Kelvin Vo
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Antonio R H Gorgen
- Department of Urology, University of California, Irvine, Orange, California, USA
| | | | - Bruce M Gao
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Zachary E Tano
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Roshan M Patel
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, Orange, California, USA
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Tano ZE, Cumpanas AD, Gorgen ARH, Rojhani A, Altamirano-Villarroel J, Landman J. Surgical Artificial Intelligence: Endourology. Urol Clin North Am 2024; 51:77-89. [PMID: 37945104 DOI: 10.1016/j.ucl.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Endourology is ripe with information that includes patient factors, laboratory tests, outcomes, and visual data, which is becoming increasingly complex to assess. Artificial intelligence (AI) has the potential to explore and define these relationships; however, humans might not be involved in the input, analysis, or even determining the methods of analysis. Herein, the authors present the current state of AI in endourology and highlight the need for urologists to share their proposed AI solutions for reproducibility outside of their institutions and prepare themselves to properly critique this new technology.
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Affiliation(s)
- Zachary E Tano
- Department of Urology, University of California, Irvine, 3800 West Chapman Avenue, Suite 7200, Orange, CA 92868, USA.
| | - Andrei D Cumpanas
- Department of Urology, University of California, Irvine, 3800 West Chapman Avenue, Suite 7200, Orange, CA 92868, USA
| | - Antonio R H Gorgen
- Department of Urology, University of California, Irvine, 3800 West Chapman Avenue, Suite 7200, Orange, CA 92868, USA
| | - Allen Rojhani
- Department of Urology, University of California, Irvine, 3800 West Chapman Avenue, Suite 7200, Orange, CA 92868, USA
| | - Jaime Altamirano-Villarroel
- Department of Urology, University of California, Irvine, 3800 West Chapman Avenue, Suite 7200, Orange, CA 92868, USA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, 3800 West Chapman Avenue, Suite 7200, Orange, CA 92868, USA
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Cumpanas AD, Chantaduly C, Morgan KL, Shao W, Gorgen ARH, Tran CM, Wu YX, McCormac A, Tano ZE, Patel RM, Chang P, Landman J, Clayman RV. Efficient and Accurate Computed Tomography-Based Stone Volume Determination: Development of an Automated Artificial Intelligence Algorithm. J Urol 2024; 211:256-265. [PMID: 37889957 DOI: 10.1097/ju.0000000000003766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023]
Abstract
PURPOSE Given the shortcomings of current stone burden characterization (maximum diameter or ellipsoid formulas), we sought to investigate the diagnostic accuracy and precision of a University of California, Irvine-developed artificial intelligence (AI) algorithm for determining stone volume determination. MATERIALS AND METHODS A total of 322 noncontrast CT scans were retrospectively obtained from patients with a diagnosis of urolithiasis. The largest stone in each noncontrast CT scan was designated the "index stone." The 3D volume of the index stone using 3D Slicer technology was determined by a validated reviewer; this was considered the "ground truth" volume. The AI-calculated index stone volume was subsequently compared with ground truth volume as well with the scalene, prolate, and oblate ellipsoid formulas estimated volumes. RESULTS There was a nearly perfect correlation between the AI-determined volume and the ground truth (R=0.98). While the AI algorithm was efficient for determining the stone volume for all sizes, its accuracy improved with larger stone size. Moreover, the AI stone volume produced an excellent 3D pixel overlap with the ground truth (Dice score=0.90). In comparison, the ellipsoid formula-based volumes performed less well (R range: 0.79-0.82) than the AI algorithm; for the ellipsoid formulas, the accuracy decreased as the stone size increased (mean overestimation: 27%-89%). Lastly, for all stone sizes, the maximum linear stone measurement had the poorest correlation with the ground truth (R range: 0.41-0.82). CONCLUSIONS The University of California, Irvine AI algorithm is an accurate, precise, and time-efficient tool for determining stone volume. Expanding the clinical availability of this program could enable urologists to establish better guidelines for both the metabolic and surgical management of their urolithiasis patients.
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Affiliation(s)
- Andrei D Cumpanas
- Department of Urology, University of California Irvine, Orange, California
| | - Chanon Chantaduly
- Center for Artificial Intelligence in Diagnostic Medicine, University of California Irvine, Irvine, California
| | - Kalon L Morgan
- Department of Urology, University of California Irvine, Orange, California
| | - Wei Shao
- Center for Artificial Intelligence in Diagnostic Medicine, University of California Irvine, Irvine, California
| | - Antonio R H Gorgen
- Department of Urology, University of California Irvine, Orange, California
| | - Candices Minh Tran
- Department of Urology, University of California Irvine, Orange, California
| | - Yi Xi Wu
- Department of Urology, University of California Irvine, Orange, California
| | - Amanda McCormac
- Department of Urology, University of California Irvine, Orange, California
| | - Zachary E Tano
- Department of Urology, University of California Irvine, Orange, California
| | - Roshan M Patel
- Department of Urology, University of California Irvine, Orange, California
| | - Peter Chang
- Center for Artificial Intelligence in Diagnostic Medicine, University of California Irvine, Irvine, California
- Department of Radiological Sciences, University of California Irvine, Orange, California
| | - Jaime Landman
- Department of Urology, University of California Irvine, Orange, California
| | - Ralph V Clayman
- Department of Urology, University of California Irvine, Orange, California
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Piedras P, Cumpanas AD, McCormac A, Lavasani SAM, Gorgen ARH, Rojhani A, Vu MC, Bhatt R, Asplin J, Tano ZE, Landman J, Clayman RV, Patel RM. Alkaline Water: Help or Hype for Uric Acid and Cystine Urolithiasis? J Urol 2024; 211:276-284. [PMID: 38193415 DOI: 10.1097/ju.0000000000003767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/20/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE The consumption of alkaline water, water with an average pH of 8 to 10, has been steadily increasing globally as proponents claim it to be a healthier alternative to regular water. Urinary alkalinization therapy is frequently prescribed in patients with uric acid and cystine urolithiasis, and as such we analyzed commercially available alkaline waters to assess their potential to increase urinary pH. MATERIALS AND METHODS Five commercially available alkaline water brands (Essentia, Smart Water Alkaline, Great Value Hydrate Alkaline Water, Body Armor SportWater, and Perfect Hydration) underwent anion chromatography and direct chemical measurements to determine the mineral contents of each product. The alkaline content of each bottle of water was then compared to that of potassium citrate (the gold standard for urinary alkalinization) as well as to other beverages and supplements used to augment urinary citrate and/or the urine pH. RESULTS The pH levels of the bottled alkaline water ranged from 9.69 to 10.15. Electrolyte content was minimal, and the physiologic alkali content was below 1 mEq/L for all brands of alkaline water. The alkali content of alkaline water is minimal when compared to common stone treatment alternatives such as potassium citrate. In addition, several organic beverages, synthetic beverages, and other supplements contain more alkali content than alkaline water, and can achieve the AUA and European Association of Urology alkali recommendation of 30 to 60 mEq per day with ≤ 3 servings/d. CONCLUSIONS Commercially available alkaline water has negligible alkali content and thus provides no added benefit over tap water for patients with uric acid and cystine urolithiasis.
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Affiliation(s)
- Paul Piedras
- Department of Urology, University of California, Irvine, Orange, California
| | - Andrei D Cumpanas
- Department of Urology, University of California, Irvine, Orange, California
| | - Amanda McCormac
- Department of Urology, University of California, Irvine, Orange, California
| | | | - Antonio R H Gorgen
- Department of Urology, University of California, Irvine, Orange, California
| | - Allen Rojhani
- Department of Urology, University of California, Irvine, Orange, California
| | - Minh-Chau Vu
- Department of Urology, University of California, Irvine, Orange, California
| | - Rohit Bhatt
- Department of Urology, University of California, Irvine, Orange, California
| | - John Asplin
- Litholink Corporation, Labcorp, Ithasca, Illinois
| | - Zachary E Tano
- Department of Urology, University of California, Irvine, Orange, California
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, California
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, Orange, California
| | - Roshan M Patel
- Department of Urology, University of California, Irvine, Orange, California
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6
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Sharifi SHH, Wu YX, Lavasani SAM, Tano ZE, Ali SN, Gao BM, Saadat S, Piedras P, Nourbakhsh M, Jiang P, Patel RM, Landman J, Clayman RV. Electromotive Drug Administration in the Porcine Renal Pelvis: First Report. J Endourol 2024; 38:77-81. [PMID: 37842848 DOI: 10.1089/end.2023.0418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Introduction: Electromotive Drug Administration (EMDA) amplifies drug delivery deep into targeted tissues. We tested, for the first time, the ability of EMDA to deliver methylene blue into the urothelium of the renal pelvis. Materials and Methods: In an anesthetized female pig, both proximal ureters were transected two inches distal to the ureteropelvic junction. An 8F dual lumen catheter and a 5F fenestrated catheter with an indwelling silver wire were inserted into both renal pelvises following which methylene blue (0.1%) was infused at a rate of 5 mL/min for 20 minutes. In one pelvis, a 4 mA positive pulsed electrical current was applied to the silver wire. Results: In contrast to the control pelvis, the EMDA side macroscopically exhibited dense homogeneous staining; microscopy revealed penetration of methylene blue into the urothelium/lamina propria. Conclusion: In the porcine renal pelvis, application of EMDA increased the penetration of a charged molecule into the urothelium/lamina propria.
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Affiliation(s)
| | - Yi Xi Wu
- Department of Urology, University of California, Irvine, Orange, California, USA
| | | | - Zachary E Tano
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Sohrab Naushad Ali
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Bruce M Gao
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Seyedamirvala Saadat
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Paul Piedras
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Mahra Nourbakhsh
- Department of Pathology, University of California, Irvine, Orange, California, USA
| | - Pengbo Jiang
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Roshan M Patel
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, Orange, California, USA
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Tano ZE, Kiesgen S, Chintala NK, Dozier J, Quach HT, Messinger J, Tan KS, Adusumilli PS. Ex vivo pleural effusion cultures to study chimeric antigen receptor T cell cytotoxicity in an immunocompetent environment. Cell Rep Methods 2023; 3:100622. [PMID: 37875122 PMCID: PMC10694486 DOI: 10.1016/j.crmeth.2023.100622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 05/26/2023] [Accepted: 09/29/2023] [Indexed: 10/26/2023]
Abstract
Current in vitro and in vivo assays used to study immunotherapeutic interventions lack human immune components that mimic the tumor microenvironment to investigate drug potency and limitations of efficacy. Herein, we describe an ex vivo pleural effusion culture (ePEC) assay, using malignant pleural-effusion-derived soluble and cellular factors that differentially affected the cytotoxicity of chimeric antigen receptor (CAR) T cells. Following identification of CAR T cell-suppressive factors, blocking of individual factors reveals their contribution to compromising T cell efficacy. ePEC is a human component assay that can be utilized for developing next-generation cell and antibody therapies that counteract immunosuppression.
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Affiliation(s)
- Zachary E Tano
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Stefan Kiesgen
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Navin K Chintala
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jordan Dozier
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Hue Tu Quach
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - John Messinger
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
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8
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Bhatt R, Vo K, Cumpanas AD, Morgan KL, Shin A, Ali SN, Rojhani A, Peta A, Brevik A, Tano ZE, Jiang P, Patel RM, Clayman RV, Landman J. Evaluation of Renal Function and Stent Durability Following Resonance Stent Placement for Benign Disease. J Endourol 2023; 37:1049-1056. [PMID: 37493542 DOI: 10.1089/end.2022.0822] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
Introduction: The metal-based Resonance stent (RS) has traditionally been placed in patients with malignant ureteral obstruction; as such, the long-term utility of RS among patients with benign ureteral obstruction (BUO) remains underinvestigated. Methods: We retrospectively reviewed our database for patients with BUO who underwent RS placement between 2010 and 2020. The impact of chronic RS placement on renal function was evaluated by estimated serum creatinine-based glomerular filtration rate (eGFR), furosemide renal scan, and CT-based renal parenchymal volume measurement. The number of and reason for RS stent exchanges during the follow-up period, incidence of encrustation, and the average indwell time were recorded. A cost analysis of placing the RS vs a polymeric stent was performed. Results: Among 43 RS patients with BUO, at a mean follow-up of 26 months, there was no change in eGFR (p = 0.99), parenchymal volume (p = 0.44), or split renal function of the stent-bearing side on renal scan (p = 0.48). The mean RS indwell time was 9.7 months. Eleven patients (26%) underwent premature stent replacement (6 cases) or removal (5 cases). Stents in 9 patients (32%) were encrusted, of which 4 (44%) required laser lithotripsy. Overall, 25 patients (58%) and 12 patients (28%) had a mean stent indwell time of ≥6 months and ≥12 months, respectively. Placing an RS resulted in a 52%, 37%, and 5.6% cost reduction compared with a regular polymeric stent placement, where it was exchanged every 6, 4, or 3 months, respectively. Conclusions: RS deployment in the patient with a BUO results in cost-effective maintenance of renal function and of renal parenchymal volume at a mean follow-up of 2 years; however, only 28% of patients fulfilled the 1-year criterion for RS indwell time.
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Affiliation(s)
- Rohit Bhatt
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Kelvin Vo
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Andrei D Cumpanas
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Kalon L Morgan
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Andrew Shin
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Sohrab N Ali
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Allen Rojhani
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Akhil Peta
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Andrew Brevik
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Zachary E Tano
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Pengbo Jiang
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Roshan M Patel
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, California, USA
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Sharifi SHH, Ali SN, Wu YX, Tano ZE, Lavasani SAM, Nourbakhsh M, Jiang P, Patel RM, Landman J, Clayman RV. Electromotive Drug Administration in the Ureter in an In Vivo Animal Model: Initial Report. J Endourol 2023; 37:823-827. [PMID: 37221871 DOI: 10.1089/end.2023.0026] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Introduction: Electromotive drug administration (EMDA) delivers a drug deeply into targeted tissues, such as the bladder. EMDA has never been applied to the ureter. Methods: In four in vivo porcine ureters, a unique EMDA catheter containing a silver conducting wire was advanced for the infusion of methylene blue. In two ureters, a pulsed current was delivered through an EMDA machine, whereas the other two ureters served as a control. After 20 minutes of infusion, the ureters were harvested. Results: In the EMDA ureter, there was diffuse staining of the urothelium; penetration of methylene blue occurred in the lamina propria and muscularis propria. In the control ureter, there was only patchy staining of the urothelium. Conclusion: In this first report of ureteral EMDA, a charged molecule penetrated beyond the urothelium into the lamina propria and muscularis propria of the porcine ureter.
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Affiliation(s)
| | - Sohrab Naushad Ali
- Department of Urology, University of California, Irvine, California, USA
| | - Yi Xi Wu
- Department of Urology, University of California, Irvine, California, USA
| | - Zachary E Tano
- Department of Urology, University of California, Irvine, California, USA
| | | | - Mahra Nourbakhsh
- Department of Pathology, University of California, Irvine, California, USA
| | - Pengbo Jiang
- Department of Urology, University of California, Irvine, California, USA
| | - Roshan M Patel
- Department of Urology, University of California, Irvine, California, USA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, California, USA
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, California, USA
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10
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Sussman RD, Tano ZE, Nicoll LM, Brucker BM. Magnetic Resonance and Intraoperative Imaging of a Periurethral Leiomyoma. J Minim Invasive Gynecol 2019; 26:1004-1005. [DOI: 10.1016/j.jmig.2019.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/22/2019] [Indexed: 11/24/2022]
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11
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Chen N, Li X, Chintala NK, Tano ZE, Adusumilli PS. Driving CARs on the uneven road of antigen heterogeneity in solid tumors. Curr Opin Immunol 2018; 51:103-110. [PMID: 29554494 DOI: 10.1016/j.coi.2018.03.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 02/03/2018] [Accepted: 03/01/2018] [Indexed: 12/11/2022]
Abstract
Uniform and strong expression of CD19, a cell surface antigen, on cells of B-cell lineage is unique to hematologic malignancies. Tumor-associated antigen (TAA) targets in solid tumors exhibit heterogeneity with regards to intensity and distribution, posing a challenge for chimeric antigen receptor (CAR) T-cell therapy. Novel CAR designs, such as dual TAA-targeted CARs, tandem CARs, and switchable CARs, in conjunction with inhibitory CARs, are being investigated as means to overcome antigen heterogeneity. In addition to heterogeneity in cancer-cell antigen expression, the key determinants for antitumor responses are CAR expression levels and affinity in T cells. Herein, we review CAR T-cell therapy clinical trials for patients with lung or pancreatic cancers, and provide detailed translational strategies to overcome antigen heterogeneity.
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Affiliation(s)
- Nan Chen
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Xiaoyu Li
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Navin K Chintala
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Zachary E Tano
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Abstract
In this article, we review ongoing novel clinical trials currently investigating immunotherapeutic approaches for patients with malignant pleural mesothelioma (MPM). There is a dearth of effective therapeutic options for patients diagnosed with MPM and metastatic cancers of the pleura; these diseases have an estimated annual incidence of 150,000. Modulating the immune microenvironment to promote antitumor immune responses by systemically and regionally delivered therapeutic agents is an active area of investigation. We have conducted a review of the clinical trials database for clinical trials actively recruiting MPM patients. We focused on novel therapeutic agents administered either systemically or intrapleurally to modulate the tumor immune microenvironment. Herein, we have summarized the published results of early phase clinical trials. A total of 43 clinical trials met our inclusion criteria. These trials are investigating immunologic agents (n=20) and antibody directed therapies (n=23). The regional intrapleural delivery technique (6 trials) is used to administer chemotherapy agents (3 of 6 trials) and immunotherapy agents (3 of 6 trials), including chimeric antigen receptor T cells (1 of 6 trials). Current clinical trials modulating the MPM immune microenvironment and the combination of these novel agents with standard of care therapy provide a promising area of investigation for MPM therapy.
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Affiliation(s)
- Zachary E Tano
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Navin K Chintala
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Xiaoyu Li
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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13
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Abstract
Chimeric antigen receptor (CAR) T-cell therapy utilizes genetic engineering to redirect a patient's own T cells to target cancer cells. The remarkable results in hematological malignancies prompted investigating this approach in solid tumors such as pancreatic cancer. The complex tumor microenvironment, stromal hindrance in limiting immune response, and expression of checkpoint blockade on T cells pose hurdles. Herein, we summarize the opportunities, challenges, and state of knowledge in targeting pancreatic cancer with CAR T-cell therapy.
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Affiliation(s)
- Carl J DeSelm
- Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zachary E Tano
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anna M Varghese
- Gastrointestinal Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Prasad S Adusumilli
- Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, New York.,Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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